Rorschach tested

The red-and-black splashes on the card are bustling with images: bad-tempered crows, a butterfly in a belly and even a couple of blood-stained kidneys -- if it isn’t a pair of monkeys contemplating their rears.

You, however, would see other things, for this card and nine others in the world-famous Rorschach test have strange powers and are said to reveal much about a person’s mind when a skillful seer interprets them.

The cards have another uncanny power: to really, really tick people off.

The Rorschach inkblot test was named after its inventor, Hermann Rorschach, a young Swiss psychiatrist with smoldering Brad Pitt looks. More than 80 years later, the test remains one of the most popular personality tests in clinical psychology, still used in helping assess the mental health of patients, the sanity of defendants in murder trials and the suitability of parents in child-custody disputes.

But a chorus of critics has emerged in recent years, saying that much of the test is mumbo jumbo, better relegated to a medical museum along with radioactive tonics and bloodletting fleams. They say that the test has potential to do harm by misdirecting therapy or by influencing decisions in high-stakes situations such as custody disputes.

“If psychologists used tea leaves instead of the Rorschach, we’d probably be better off, because then, at least, no one else would take the results seriously,” says James Wood, associate professor of psychology at the University of Texas at El Paso.

Wood and two other psychologists, Howard Garb and Scott Lilienfeld, say the test often labels perfectly normal people as sick and maladjusted. The cause: huge interpretive leaps that are made in connecting what someone sees in swirls of ink and the inner workings of the psyche.

They cite, for instance, one 2000 study in which 100 ordinary Fresno schoolchildren took the Rorschach test and were found as a group to be “grossly misperceiving and misinterpreting their surroundings” with a “distortion of reality and faulty reasoning” that approaches “psychosis.”

The trio has waged a protracted assault on the test, ruffling feathers and spawning an unseemly Internet flame war and a head-spinning number of Rorschach “special issues” in psychology journals debating the meaning of all those bats, bears, mirrors and marmosets that patients spot in a blot. They fired off another volley this March: “What’s Wrong With the Rorschach?” a book they co-authored with Wood’s wife, psychologist Teresa Nezworski.

“We have upset people incredibly,” says Garb, a psychologist with the Pittsburgh Veterans Affairs Health Care System and the University of Pittsburgh. “It isn’t nice to be upsetting your colleagues. But I want to see clients receive good care. And that means we can’t just keep doing something because ‘It’s what we’ve always been doing.’ ”

Rorschach defenders are fighting back fiercely. They counter that critics are unfairly scapegoating the test with a tenacity that borders on the fanatical. They say the test, which homes in on people’s differing reactions to ambiguous images, is far more solid than detractors claim, and that time after time, Wood, Garb and Lilienfeld have failed to acknowledge the evidence in support of it.

“There’s been some pretty extreme criticisms floated about in the past few years, a sort of, ‘The Rorschach world is crumbling’ message,” says Greg Meyer, associate professor of psychology at the University of Alaska Anchorage, and a champion of the test. “The evidence just doesn’t warrant it.”

Controversy isn’t new for the Rorschach test. Wave after wave of psychologists has attacked the test over the decades, but it always came back swinging, imbued with a Rasputin-like resistance to bullets and barbs.

The test’s biggest challenge came in the 1960s, when multiple methods were being used to interpret the blots and the two most eminent Rorschach practitioners had long refused to speak to each other. It took years of toil by a young psychologist, John Exner, to standardize the test and whisk it from the jaws of death.

Today, many psychologists simply dismiss the test. But in the world of psychological assessment, it remains one of the most frequently used personality tests in the field, trailing somewhere behind the front-running Minnesota Multiphasic Personality Inventory (or MMPI) and the so-called Wechsler IQ test. In a 1995 survey of clinical psychologists, 82% reported using the Rorschach “occasionally,” and 43% said they did so “frequently” or “always.”

In some ways, the test has changed little since Hermann Rorschach devised it in the far-off 1920s. The same 10 inkblots are used, printed in only one place in the world. The publisher, Hans Huber of Switzerland, still uses old-fashioned machinery to faithfully render the splashes, splotches and swirls.

Now, as in the past, when a subject takes the Rorschach test, the psychologist presents each inkblot, asking the standardized question: “What might this be?” The person being tested responds: a bat, a butterfly, a brace of armadillos.

The psychologist probes deeper. Where in the blot does the client sees those two armadillos, their snouts, their plated backs? Does texture or color in the ink contribute to the viewer’s perceptions? Everything is carefully noted and classified.

Finally comes interpretation -- and this part of the test was totally overhauled by Exner to render it more hard-nosed and scientific. Today, mastering the test requires long hours of training and practice. Exner’s definitive guide to Rorschach analysis is 1,560 pages long, and even the Rorschach-for-dummies-style primers are hard slogs, brimming with lettered codes (such as “C” for use of color, “M” for seeing movements) and fearsome algorithms to be number-crunched, such as “eb=(Sum of FM+m/Sum C’T,V,Y.)”

Each client’s results must be compared to so-called “norms” based on hundreds of Rorschach tests of patients and regular people.

Only after all this is done can the psychologist derive a client’s “Egocentricity Index,” “Depression Index,” “Aspirational Ratio” and more.

Rorschach practitioners stress that there are no “right” or “wrong” responses. It is the pattern of responses, not individual items, that matter. Seeing one mangled corpse in a blot signifies little. Seeing several in a row might be a tip-off.

The notion that responses to an inkblot might reveal facets of personality seems reasonable enough on the surface. Just as people react differently to life’s events, so might they be expected to build different stories and pictures out of ambiguous swirls of ink.

Even critics agree the test homes in on some things well, such as the delusions that come with schizophrenia.

“If you show someone one of the blots -- a well-known one that looks like a bat or a butterfly -- and he looks at that and sees a giraffe, it is not a good sign because that card does not look like a giraffe,” says Lilienfeld, associate professor of psychology at Emory University in Atlanta.

But the test is meant to reveal far more than major psychosis.

According to Exner’s system, for instance, seeing a greater than average number of reflections in the Rorschach blots (say, one flamingo preening in a mirror instead of two distinct flamingos) means you’re self-centered and narcissistic. Greater than average use of white spaces to conjure up a picture means you’re stubborn. Paying attention to color in the blots means you’re emotional, while seeing a lot of human-like movements suggests you’re reflective.

Rorschach experts say the test reliably identifies levels of self-control, stress management and potential for aggression.

Wood, Garb and Lilienfeld say there is scant evidence the Rorschach does these things. Worse, they say, it may falsely “pathologize” people, as it did with the Fresno schoolchildren, and as it also seemed to do to 123 non-patient adults described in a 1999 research paper. The subjects, most of them donors at a California blood bank, agreed to take the Rorschach test. One in 6 scored in the pathological range for schizophrenia and nearly 1 in 3 saw a mirror or reflection in a blot, indicating narcissism, though this, even in California, is meant to happen only rarely.

Wood, Garb and Lilienfeld have reviewed 32 other studies of supposedly ordinary people and reported that people, again, were over-pathologized by the Rorschach.

“It’s scary to think that would happen in a clinical context,” says Garb, who has called for a moratorium on use of the test in legal and many clinical settings. “It’s even scarier to think that it could happen in ... say, a custody battle.”

The Rorschach does still crop up in the criminal courts and in civil cases, such as ones for worker’s compensation and child custody. And sometimes it can play a pivotal role. Garb points to a case of a Midwestern psychologist who in 2000 was denied reinstatement of his license because of a Rorschach test. The therapist had been suspended from clinical practice for one year because of a drinking problem. After treatment, he was declared fit for duty by a psychiatrist and appeared psycho- logically normal on the less controversial MMPI test, but flunked the Rorschach.

In a report, the psychologist administering the test reported that the man’s responses to the inkblots revealed, among other things, that he was depressed, had an inflated self-image, was “internally stressed,” “over-complex in his cognitions,” was “markedly emotionally and psychologically needy” and displayed “a limitation in his own capacity to maintain control in situations that do not provide some sort of boundaries, structure, and organization.”

Reinstatement was denied. “The Rorschach was totally pivotal in this,” said the therapist’s lawyer, George W. Schmedlen, of Cleveland. The therapist was eventually reinstated, but only after a year of legal wrangling. “It was absolutely horrible for him,” Schmedlen said.

In another case, 39-year-old Mike Davis, a Trenton, N.J., policeman, was assigned first to desk work in 1998 and eventually dismissed from the police department in 2000 after complaining about irregularities in the radio room and being sent for several rounds of psychological testing.

Davis appeared normal on a battery of other assessment tests and had favorable reports from his new supervisors and a licensed psychotherapist he was seeing.

But the psychologist whose center administered the tests focused on results of two Rorschach tests. Davis’ Rorschach responses, he wrote, indicated “a strong tendency towards unrealistic, paranoid thinking that can become delusional due to his low ego strength and lack of reality testing under stress.” He recommended that Davis not be returned to active duty and concluded that he was unlikely to improve in the near future.

In March of this year, a New Jersey judge criticized many aspects of the case against Davis, including the Rorschach interpretations, and ruled that Davis should be reinstated as a police officer with full back pay and benefits.

Exner himself agrees that the test he has worked on for so long is not perfect.

“Some of the criticisms have certainly been warranted. There are a lot of variables in the test and some of them are soft,” he says.

For instance, he said, the Rorschach measure of depression does not correlate well with clinical measures of depression. But Exner and others who support the Rorschach test say that the attacks go far beyond what is justified.

“It appears that no amount of reporting of the relevant evidence seems to be convincing enough to a small group of people who find the Rorschach lacking in some qualities that they think it should have,” says Irving Weiner, professor of psychiatry and behavioral medicine at the University of South Florida and president of the International Rorschach Society.

For example, they say, measures such as the one linking reflections to narcissism are very solid. Also, dozens of studies involving hundreds of subjects have shown that the Rorschach test is very similarly scored by different psychologists, even though Wood, Garb and Lilienfeld charge there is great variability. Studies also find scant evidence that the test has a cultural bias, a charge also made by the critics.

As for the case of the Fresno schoolchildren and blood donors who ended up appearing so sick, Meyer, the University of Alaska professor, has evidence that concluded the Rorschach tests were inexpertly conducted. He suspects the testers failed to put their subjects at ease and properly explore how features such as texture and shading contributed to the images people saw.

It is also not the fault of the Rorschach if it is sometimes improperly administered or unduly weighted, defenders say. In Davis’ case, he was given one Rorschach test after a night shift and after hours of other psychological tests. In his other Rorschach test, he simply gave too few responses to the blots for the test to be valid.

Even if the test has problems in administration and scoring, some psychologists say that dumping it would be wrong. The Rorschach test is harder to fake than a paper-and-pencil test, such as the MMPI, and can also reveal aspects of someone’s personality that the MMPI cannot, they say. It is also useful for drawing out children.

Last fall, hundreds of Rorschach enthusiasts from Asia, Africa, Europe and the Americas converged on Rome for a meeting of the International Rorschach Society. They showed no sign that walls of their intricate city were under attack, but were hard at work bringing their test into the next century, presenting new ways to use it in therapy and even some brain scans obtained from people taking Rorschach tests.

There was much talk, too, of the ongoing effort to collect a brand-new set of “norms” from people around the world, for the first time in decades.

But surveys suggest use of the test is on the downswing, especially in legal settings. University clinical psychology departments are de-emphasizing the test -- eliminating Rorschach classes or making them optional. The current health care climate is not helping the Rorschach either: a test that can take hours to administer and score is not the first choice for a cost-conscious HMO.

Even Exner, who rescued the Rorschach test from oblivion decades ago and has worked on refining it ever since, cannot predict where the test is headed -- whether it will still be around to celebrate its centennial in 2021, or if it will be fondly toasted in absentia as a whimsical, 20th century curiosity. After years of exposure to hard slog and strife, he sounds a mite weary of the topic.

“I honestly don’t know,” he says. “I’m too old, almost, to care anymore.”

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The interpretations

The 10 blots in the Rorschach test are not made public. Here is a similar blot and a few simple ways in which inkblots are interpreted, based on how the viewer sees the image:

* Finding “reflections” of people or objects: narcissism.

* Relying on color to build up images: greater emotionality.

* Seeing humanlike movement in the blots: intelligence, creativity.

* Focusing on unusual details in the blot instead of the whole:

obsessiveness.

* Creating images out of the white background instead of the blot itself: stubborness, oppositionality, anger.

* Involving the entire inkblot in a picture: tendency to look at the big picture.

Sources: James Wood (University of Texas at El Paso); Times staff research