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Source: The NY Times MagazineThe Rorschach Test
By DIRK OLIN
Last month, a quartet of academics published ''What's Wrong With the Rorschach?'' -- attacking a test administered to more than a million people worldwide each year. According to recent surveys by the American Psychological Association, 82 percent of its members ''occasionally'' and 43 percent ''frequently'' use the test, in which subjects speculate about five colored and five black-and-white inkblots. Test-givers in turn interpret the answers to diagnose mental illness, predict violent behavior and reveal suppressed trauma. Their conclusions are applied to everything from child-custody disputes to parole reviews. According to James M. Wood, an associate professor of psychology at the University of Texas at El Paso and one author of the book, tarot cards would work almost as well.
Wood and his colleagues level basic criticisms against the inkblot test's foundations. They say it lacks accurate norms to serve as benchmarks for comparing healthy and sick patients. Reliability is also at issue, because many scores are determined by test-givers' subjective interpretations. And last, they contend that virtually none of the scores are scientifically valid, because they neither measure what they claim nor can be consistently correlated with other tests or diagnoses. The Rorschachers simply harbor a ''romantic'' devotion to the test's efficacy, Wood says, one based on ''an uncritical, even gullible, acceptance of ridiculous claims that the Rorschach is like a medical test, a sort of brain scan.''
In the few years since the critics first began making their arguments, a sometimes visceral academic firefight has broken out. Rorschachers have hired a lobbyist, and one of the test's historic champions has been joined by younger acolytes in churning out hotly disputed studies in its defense. Irving B. Weiner, a clinical professor of psychiatry and behavioral medicine at the University of South Florida (and formerly the part-time paid ''advocacy coordinator'' for test defenders) replies that Wood & Company are being irresponsibly provocative: ''A small handful of people are saying negative things, as opposed to a large international group of practitioners getting good results from it. The test had its critics 50 years ago, too, and there was less systematic and empirical support before its renaissance in the 70's. But the criticism has spurred even more research supporting it in the last few years.'' Maybe not enough to save Cary Stayner, the murderer of three tourists near Yosemite National Park. To bolster his plea of not guilty by reason of insanity, Stayner's defense team late last year called an eminent psychologist to testify that Stayner's responses to the Rorschach test that she had given him had yielded the highest score possible on the test's ''psychotic index.'' But in the end, Stayner was adjudged sane and sentenced to die.
HISTORY
The Swiss psychologist Hermann Rorschach got the idea for his test from a popular European parlor game, Klexographie, and developed it into the 10-card sequence in 1921. (Rorschach was so adept at the game as a child that he earned the German nickname Klecks, or ''Blot.'') The exam's rise both abroad and in the United States mirrored the rapid ascent of psychoanalysis. But during the 1950's and 60's, the test increasingly came under fire for its lack of standardized administration and scoring.
John E. Exner Jr., then a professor of psychology at Long Island University, saved Rorschach devotees from sharing the fate of phrenologists or leech-wielding barbers. Exner, who now trains hundreds of clinicians a year at his North Carolina-based Rorschach Workshops, created the so-called Comprehensive System, a matrix of test-giving techniques and response categories that soon returned inkblots to their legendary status. ''It was a significant rehabilitation,'' says Robert P. Archer, a professor of psychiatry at Eastern Virginia Medical School and the editor of Assessment, a leading psychiatry journal. ''Exner's work provided a very important scientific foundation for Rorschach interpretation.''
But Archer, who says he occupies a ''middle ground'' in the Rorschach fracas, says that the work of Wood and his colleagues has for the first time called into question the adequacy and independence of the research Exner used to support his system. ''The supporters have tended to become fixed in a pattern of providing rather blanket defenses of the test instrument,'' he says.
THE BIGGER PICTURE
Scott O. Lilienfeld, one of Wood's co-authors and an associate professor of psychology at Emory University, says that the test suffers from the same subjectivity that afflicts other so-called projective exams, which parse patients' reactions to pictures or their completions of unfinished sentences. And Lilienfeld points out that the rift reflects a basic change within the profession at large. ''It's emblematic of the widening scientist-practitioner gap in clinical psychology,'' he notes. ''No psychological technique better illustrates the yawning gulf'' between data and clinical practice.
Of the Rorschach categories that are commonly used by psychologists today, Wood explains, only two (perceptual distortion and thought disorder) have shown a consistent relationship to psychological disturbance. To this Weiner counters that the test is in some ways the victim of its best conductors' therapeutic usage: ''The test can give you objective data, like a blood work. But we all know that some physicians, for whatever reason, are skillful diagnosticians beyond the tests, in seeing the way the patient looks or moves. The Rorschach is a stimulus that generates a lot of information. You may generate hypotheses that aren't in the hard data yet, but that doesn't mean this is the same thing as reading tea leaves.''
Yet however talented some such psychologists might be, they're ultimately interpreting the tea-leaf reading of their patients. The more artistic among them might draft insightful psychological portraits, but they're more like Impressionist painters than digital photographers. And, after all, how many great masters can there be?
TESTING BIAS
From 'What's Wrong With the Rorschach?' (Jossey-Bass, 2003), by James M. Wood, M. Teresa Nezworski, Scott O. Lilienfeld and Howard N. Garb
Some psychologists believe that the Rorschach is completely worthless. Others, like us, believe that it's somewhat useful for a few purposes but is vastly overrated. . . . Conspiring to enhance the Rorschach's image are several mental illusions or ''tricks of the mind'' that can deceive unwary clinicians into believing that the test is much more powerful than it really is. . . . First, ''confirmation bias'' can mislead a clinician who attempts to evaluate the validity of a test through personal observation. If one begins with such a bias, evidence to support it can nearly always be found. . . . Second is the phenomenon known as ''illusory correlation,'' whereby clinicians come to believe that they've repeatedly seen a strong relationship between a test score and personality traits, even though no such relationship exists. . . . Third is what we term the ''overpathologizing illusion.'' . . . Clinicians may erroneously come to believe that such a test provides more profound insights than tests that do not overpathologize, because it tends to uncover pathlogy that better-normed tests do not.
FOR FURTHER INTERPRETATION
• ''Psychodiagnostics'' (Grune & Stratton, 1942), by Hermann Rorschach.
• ''The Rorschach: Basic Foundations and Principles of Interpretation'' (John Wiley & Sons, 2002), by John E. Exner Jr.
• http://www.rorschach.com.
• The Hermann Rorschach Archives and Museum, Berne, Switzerland.
• ''Flowers for Algernon'' (Harcourt, 1995), by Daniel Keyes. The learning-impaired hero in this 1960's sci-fi novel recounts a Rorschach test in an opening scene.
Dirk Olin is national editor at The American Lawyer.
I've always been a bit sceptical of a diagnostic tool that was so subjective in its interpretation.
