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A delusion is a false belief that arises without reality-oriented external stimulation and that is maintained unshakably in the face of reason.18 When delusional ideation becomes associated with body feelings, somatic delusions are experienced. Bleuler originally emphasized the importance of such symptoms in schizophrenia as follows: “Characteristic of the schizophrenic hallucinations is the preference for the auditory sphere and the sphere of body sensations. Frequent are delusions and illusions which are related to different body organs.”4 The importance of physical symptoms in schizophrenia has been emphasized by modern psychiatrists such as Chapman13,14 and Adamson and Varsomis.2 Although somatic delusions occur most commonly in schizophrenia, they can also be observed in all psychotic states, including those of organic origin. This paper employs a newly developed projective technique to investigate the psychopathology underlying certain types of somatic delusions involving sexual organs.
The procedure employs a series of 20 inkblots that are highly structured in depicting aspects of the body. The projective responses to these provide a new source of information concerning body awareness. The inkblots represent an external series of objects upon which the delusional patient is able to project disturbed body feelings. The psychological test is reviewed in the Eighth Handbook of Mental Measurements.10 There is evidence suggesting that it is a reliable and valid measure1,5-9 of body awareness.
Certain case histories will be reviewed to illustrate how a content analysis approach3 with this projective technique may be employed as a clinical aide in the evaluation of somatic delusions. The first history involves a 65-year-old farmer who suffered from a psychotic depression and somatic delusions. (Psychotic depression is frequently associated with hypochondriasis and a tendency in the Rorschach to project anatomical responses.17) He believed that he had venereal disease