Hermann Rorschach, a Swiss psychiatrist with an artistic flair, died suddenly in 1922. He was only 37. A year earlier, he had presented the test that would be named for him, after discovering that the 10 inkblots he had created enabled him to distinguish between healthy patients and schizophrenics. The mysterious stains subsequently entered the popular culture, becoming the images most closely associated with psychology.
Partisans of the test maintain that it’s an “X-ray of the personality,” that it reveals the architecture of the psyche. Devout believers attribute to the test an almost magical ability to help professionals detect mental illnesses, evaluate personality traits, predict patterns of behavior and uncover repressed traumas.
“People who do a Rorschach are stunned by the quality of the results,” says Ami Bronsky, a clinical psychologist who maintains a private practice. “If you want to know who the person who’s sitting across from you is, put your money on the Rorschach. Guaranteed.”
But this is far from being the consensus view. Critics of the Rorschach Performance Assessment System, as the test is called in professional circles, maintain that its validity is dubious, because it is ultimately dependent on the subjective judgment of the person administering it. The detractors add that the test tends to point up disorders that don’t necessarily exist in reality, and as such it is scientifically worthless. Many universities across the world no longer include it in their psychology curricula, but in Israel, the Rorshach continues to enjoy the status of a protected flower, and its mastery remains a mandatory, central element in the accreditation of clinical psychologists. A recent study conducted by the psychology department of the Hebrew University of Jerusalem found that this is not the case in any other country in the West – not even in Switzerland, birthplace of the inkblots.
Local use of the test goes far beyond academic settings. In custody battles over children, for example, the Rorschach is a tool for examining the parents’ psychological qualifications. Candidates for adopting a child are also asked by welfare officials to take the test. Courts have recourse to demand that it be used to diagnose criminal tendencies or a potential for violence among prison inmates, and it also helps determine whether certain people are fit to stand trial. Additionally, the Rorschach is sometimes conducted when a person’s eligibility to receive a mental disability allowance is being decided; security and intelligence bodies make use of it to assess staff and potential employees; and some private companies ask candidates for sensitive positions to take it.
An attempt was recently made by the Hebrew University to challenge the dominance of the Rorschach. As of this year, the psychology department announced, students in its clinical track will no longer be required to administer and analyze Rorschach tests as part of their diagnostic training. The head of the clinical psychology track, Iftah Yovel, was taken aback by the intensity of the reaction to that move: “It really raised a ruckus, we didn’t expect the system to kick back like that,” says Dr. Yovel.
A century after coming into the world, the 10 cards bearing blotchy, ambiguous images continue to stir powerful emotions, and the debate over their usefulness is far from abating.
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By means of the subject’s responses to stimuli, the Rorschach test examines a range of functional traits, including cognitive parameters (reality testing, conceptual and thought disorders), offering indications of the subject’s self-perception and interpersonal relations, of the ability to express emotion and of the existence of resources for problem-solving and coping with pressure. Administration of the test is a two-stage process: response and clarification. In the response stage, the inkblot cards are shown in succession and the subject is asked to describe what they look like to him or her. The aspiration is to get two to four answers for each card, in order to reinforce the validity of what the test measures. A situation of rejection of a card – that is, where the subject refuses to give a response – is undesirable. In general, however, if the subject gives too few responses, the cards can be presented again in order to encourage additional responses.
The clarification stage is intended to elicit additional information from the subject about the elements in the cards that generated the responses (location on the card, content, motion). Afterward, the subject’s verbal responses are recorded in a chart: That is the scoring part of the test, from which the bulk of the analysis derives.
“If I had to choose one tool to describe personality, it would be the Rorschach,” says Prof. Yona Teichman, former head of the clinical psychology program at the Interdisciplinary Center, Herzliya. “Through it I will receive the most diversified, credible and interesting description,” the professor adds.
High praise also comes from Ety Berant, director of the treatment clinic in the IDC’s School of Psychology and a Rorschach expert of world repute. She notes, for example, that one patient was saved by the test twice: from being classified as possessing low intelligence and from having his mental distress ignored.
“He was a person from a very impoverished background and from a milieu that demands a very high degree of conformity, who arrived at the examination with depression and anxiety,” Prof. Berant relates. “In the Wechsler test (which measures intelligence) he got a result of borderline intelligence, and because of the tendency to comply socially, the questionnaires he filled out showed that everything was ostensibly fine [but did not reflect his actual situation]. He was then given a Rorschach and his replies indicated high intelligence and an impressive ability for inner observation. That allowed us to provide a more accurate response to his distress.”
The test, Berant adds, can also reveal whether children have suffered abuse, although their responses must be weighed cautiously: “Most children will not provide responses that come from the realm of sexual content, and in any event we would not immediately classify it as indicating an act of abuse. Possibly they come from a tough background, or they were exposed to inappropriate images. Sometimes the descriptions [of the inkblots] will be aggressive – two people tearing each other to shreds, someone whose head is about to snap. Here too we need to take into account that the source might be exposure to violent content.”
“The Rorschach is an excellent X-ray for trauma,” Bronsky notes, and illustrates: “I had a case of a woman whose boyfriend was arrested aggressively at a demonstration, in her presence. The incident fomented an extreme mental crisis for her. On the face of it, the experience and the intensity of the crisis were incongruent. Through the Rorschach it turned out that in her childhood, the woman had been beaten in a shocking way. The demonstration generated a flashback to that experience.”
Bronsky also uses the test when he works with private companies. “It’s an area that’s under the radar,” he says. “Employers, mostly tech companies, send me candidates for sensitive positions or for positions that involve a lot of money. The diagnosis will focus on questions of mental stability and reliability, and will give an indication of the candidate’s decency, their ability to keep a secret, the sum total of their qualifications. There will always be a bottom line [after various psychological tests are conducted]: to hire or not to hire.”
Dr. Giora Zakin, a clinical psychologist who frequently administers the test, receives many requests from the defense establishment, particularly its more classified units. “The Rorschach shows me how people function according to their inner resources, when they lack external frameworks by which to navigate,” he explains. “It’s the only test that examines how a person organizes himself or herself when facing unclear circumstances.”
Not all requests by the Israel Defense Forces for Rorschach tests relate to classification. “I had a soldier who alleged that his commanding officer was treating his complaints of abuse insensitively, along the lines of ‘What are you whining about?’” Zakin recalls. “It looked like an easy case, but the diagnosis showed that the soldier was in a psychotic slide and a deep crisis. As a result, we were able to pull him out and treat him immediately.”
Zakin also offers a reverse example. “There was a guy in the career army from the intelligence community, whom the army psychiatrists wanted to discharge in the wake of a psychotic crisis. I tested him and the result showed that he had actually returned to his former self and was no longer psychotic.”
According to Avi Saroff, a clinical psychologist who has studied and worked with the Rorschach and receives requests from security bodies to assess people with it, “there are indices that examine a person’s resources for coping with pressure. For example, people who tend to see movement in the inkblots have a high correlation for developing abilities to cope with stress. But it’s not only a matter of a statistical correlation, it’s theoretically and psychologically significant that a person sees motion on a cardboard card.”
Saroff mentions two indices addressed by the test that are considered reliable. “The suicide index is considered to possess strong validity, as does the dependency index. Both touch on areas that are not necessarily mediated outwardly by the individual. The Rorschach uncovers unreported needs, the scale of one’s dangerousness toward oneself, and the hazard one poses to the surroundings. A prison inmate who is scheduled for a furlough will obviously report that he doesn’t intend to cause trouble. But if I give him a Rorschach and his risk index comes out high, the question arises of whether to let him out.”
Criminals, especially those who are particularly cruel, are often tested by means of Rorschach blots, especially if they plead insanity. “There was a case of someone who murdered two Palestinians and planted explosive devices against left-wingers,” Zakin relates. “The psychiatrists who testified on his behalf maintained that he was schizophrenic, but the test we did showed that he wasn’t. In the end, the argument that he was unfit to stand trial was not accepted.”
Berant, too, had occasion to test a murderer: “I did it once and that was it. I felt uncomfortable about putting myself into the shoes of someone who had committed murder. The defense wanted to know whether he could distinguish between good and bad. The diagnosis did not indicate disorders in reality-testing or thought disorders. There were indications of a lack of empathy for others and of one-dimensional thinking: ‘all or nothing.’”
What does the Rorschach of a sociopath look like?
The Rorschach says more about the tester than the subject. I’m not against administering it in a broader series of tests, but in Israel it’s been made sacrosanct.Dr. Janna Assa
Berant: “I don’t want to spoil the show, but in the case of someone with an antisocial personality disorder, we would expect to see a person with high intelligence and a lack of empathy, who is very much occupied with his self-esteem and who always has to be right and in control of the situation. How will this find expression in his responses to the Rorschach? Perhaps in indirect aggressiveness, through very strong representations – rifles, missiles. Sociopaths possess elements that abut on narcissism. They are people who will bend your arm to get you to see the world as they do.”
“We won’t see deep, multifaceted representations among psychopaths,” Saroff notes. “Their emotional world tends to be meager, flat and diminished, without any connection to intelligence. We will expect to see less texture in their responses, less motion, difficulties in discerning nuance.” He recalls the test Nazi war criminal Adolf Eichmann underwent ahead of his 1961 trial. “What was perceived in him was not sadistic murderousness but superficiality, rigidity and lack of empathy.”
The Rorschach was also used in the Nuremberg trials in an attempt to examine whether a specific disorder could be attributed to the Nazi criminals. Diagnoses were made by various professionals, who arrived at different conclusions. Some of them did not identify substantial anomalies in the personality profiles of the accused, whereas others said that their responses indicated that they were “depressed psychopaths.” The findings of the latter were always controversial: It was claimed that they reflected primarily the investigators’ personal frame of mind.
Ted Bundy’s liver
Ted Bundy, the serial killer active in America during the 1970s, also underwent a Rorschach test after he was caught. In fact, of all the tests he was subjected to, the Rorschach was the only one that showed his abnormal attitude toward women. On one card, Bundy discerned two women looking at each other and he dwelt on a description of their breasts – a routine, acceptable response. But afterward he remarked that the figures were asexual, as they had “no additional sexual identity.” That response was interpreted as evidence of an ambivalent approach toward women, which could manifest in avoidance or hostility. The test showed also that Bundy had difficulty forging social ties, despite his highly developed verbal ability.
According to Saroff, Bundy identified the image of a leader in one of inkblots, and also of his own liver. “That’s a sign of a very serious disorder, which Freud described as ‘contamination,’ a simultaneous mixing of stimuli,” he says.
Zakin notes that this is “very characteristic of psychopathic individuals. They see things that we cannot see even if we try very hard, or they see two different things in the same response. The systemic disruption in terms of perception and thought leads them to make odd connections. For example, if the bear [he sees] is brown and the bird is brown, apparently the bear is a bird. Of something that is situated in the center they will say that it’s a heart, only because of its centrality.” As a rule, he adds, “the worse the situation, the better the Rorschach. It’s a less useful tool for describing people’s proper functioning.”
New establishment vs. old
Criticism of the Rorschach today comes mainly from psychologists who specialize in cognitive behavioral therapy, or CBT. These practitioners prefer short-term therapy and aim to create a change in the patient’s perception of reality and to instill new patterns of behavior. Dr. Yovel is part of a group of Israeli psychologists who advocate this method and who, upon their return to Israel after attending prestigious academic institutions abroad, have assumed key positions in the country’s universities.
The influence they and their views have acquired in the psychological establishment is a source of constant friction, however, with those professionals identified with the “old establishment.” The latter consist for the most part of therapists who employ the psychodynamic approach, which emphasizes a rooting out of an individual’s inner conflicts, the psyche’s deep structure and the reciprocal relations between the unconscious and the conscious. Yovel’s critique of what he calls a “stagnant and conservative system” cannot be divorced from his professional affinity for CBT.
Projective assessments – that is, personality tests based on stimuli that are open to interpretation – are a major source of dispute between the two groups. “The Rorschach became the red rag of the CBT people,” Zakin observes. “It’s a distilled expression of the tension between the dynamic approach, which maintains that what one sees outwardly is a product of an interaction between impulses, needs and emotions, and the CBT approach, which places what’s visible in the center.”
Early on in her career, Janna Assa, a neuropsychologist and a rehabilitative psychologist in the pediatric rehabilitation department at Sheba Medical Center, Tel Hashomer, and a lecturer in the Academic College of Tel Aviv-Yafo, conducted a large number of projective tests, including the Rorschach – but remained skeptical.
“I never felt it was worth it,” Dr. Assa says. “My feeling is that the Rorschach says more about the tester than the subject, because of the scoring method, which contains a dominant subjective element. I am not against administering the Rorschach test within a broader series of tests, but in Israel it’s been made sacrosanct.”
In her view, “to enable effective intervention, it’s necessary to look at the patient through a totality of cognitive, social and medical factors. Let’s say the patient suffered a head injury. If we test him solely by means of the Rorschach, we might discern in him bizarre impulses and pathological symptoms, even though his anomalous responses derive from processing faulty information, which stems from his injury. Even if his distress stems from the fact that since then he’s been unemployed and dependent on his parents, that’s something that needs to be taken into account.”
Assa admits that “it’s to the credit of the Rorschach people that they are working hard in an effort to update and adjust the method.” However, she believes that they have difficulty providing answers not only in extreme situations, such as physical injury, but even when different cultural norms are involved: “In Israel there are large groups of ultra-Orthodox, Arabs, people of Ethiopian origin and others from the former Soviet Union. There are differences even in the sheer willingness of a person who grew up in a Haredi environment or immigrated from Ethiopia to reveal their inner world. If there were designated adjustments [made in the test] for different population groups, perhaps its results would be more valid.”
Zakin does not rule out that approach: “The norms are international, and most of them were derived from a Western environment. It’s true that there is a lack of distinctive norms that have been adjusted to the Arab world, Africa or even the Haredi community.”
For his part, Bronsky maintains that the Rorschach is actually quite flexible. “It’s self-evident that if the person sitting opposite you is mentally disabled or organically deficient, you will not be able to make use of these tests. But a proficient psychologist with a proper education will know what Rorschachs of trauma victims, of depressed people or of those on the autistic spectrum look like.”
He also rejects the argument that projective tests ignore the concept of the holistic individual: “We will never do a Rorschach on a patient before conducting a comprehensive interview with him. I need to know whether the person across from me underwent a traumatic event of some kind, or is going through a rough patch, which doesn’t necessarily represent the primary foundation of his personality. A Rorschach is not a blood test.”
Prof. Berant argues that cultural adjustments are just a matter of time “We’re working on it – there will be norms.” In her view, some of the necessary changes are meanwhile being implanted through a sort of natural evolution: “There are popular answers, blots for which a third of the population gives the same answer, like the famous bat or the bears. But in Scandinavia the bears are usually described as trolls, and in Japan, where most of us will see a butterfly, they will see witches.”
So the witches will not be classified as dark content?
Berant: “Exactly. If someone offers an answer of ‘a dybbuk [a possessive spirit] is talking to me,’ that might be an indication of a thought disorder. But if he comes from a culture which engages with the dybbuk phenomenon and it’s an accepted phenomenon, I will not treat it as a disorder. There are things that are considered normative in a certain culture and in another culture are considered pathological.”
If I had to choose one tool to describe personality, it would be the Rorschach. Through it I receive the most credible and interesting description.Prof. Yona Teichman
Berant notes that Rorschach criteria, which are subject to universal standards, are updated frequently. “Until the late 1980s the conception was that a person who is capable of experiencing attachment will necessarily see texture in at least one of the cards – in other words, offer an answer that is related to touch. However, a study I conducted showed that only a third of a sample of people in Israel who had done a Rorschach describe texture. Studies from other countries also don’t support that conception, and the criterion was in fact dropped.”
Does the identification of dark content in these inky blotches indicate a gloomy personality or the existence of some sort of disorder? This begs the question of the weight assigned to each of the test’s components.
“One mustn’t take one answer, even three answers, and sever them from the whole,” Prof. Teichman emphasizes. “Possibly there are indicators of a dark side alongside other indicators that balance them out, and then the personality is far more diversified and interesting. And overall, the content is the less important dimension of the Rorschach. The structural components are those whose combination creates a composite personality portrait” – i.e., taking into account all elements collectively is more important than focusing on one specific response.
“Even the Rorschach’s fiercest critics admit that it’s precise in identifying people with faulty reality testing who think in an unconventional way,” Zakin says. “For example, someone who discerns in the inkblot impossible things, like two skeletons ripping an infant apart. In a case like that it’s not the dark content that’s the essence, but the very fact that a person sees things that are unseen by anyone else in an ambiguous stain.”
Says Dan Freed, a clinical psychologist and neuropsychologist who heads a closed ward at Merkaz Merhavim, a therapeutic center in Binyamina, south of Haifa: “Even if you saw a body [in the inkblot], it makes a difference what body it is. Is it dismembered? Is it a person who was murdered? Someone who died of old age? If the subject is preoccupied with morbid images, it’s likely that all his tests will be loaded with such content. But for that I don’t need the Rorschach, a clinical interview is enough. The Rorschach paints me a picture of what’s not seen. The analysis of the content it contains is marginal.”
Berant: “It’s interesting to see how a person starts the test and how he finishes it. For example, where a subject saw a delightful flower the first time, the second time he may see a bloodstain. What does that say? Perhaps it’s an attempt to prettify something painful, perhaps it reflects a dimension of worry about things related to the body, perhaps it’s a trauma.”
Is the Rorschach test biased in favor of people gifted in their linguistic abilities and a developed conceptual ability? Teichman explains that it does not measure intelligence. “Of course, if I show someone 10 cards and he sees a bat in all of them, he might be characterized by some sort of rigidity in his thinking and have difficulty freeing himself from patterns, but that is not a derivative of intelligence.”
In Berant’s view, however, the test does in fact provide a fairly solid indication of a person’s intelligence. “Not directly like the Wechsler test,” she explains, “but when people give complex, deep, multidimensional answers, all those indices are correlated with high intelligence.”
It follows that simplistic answers are liable to arouse concern. “In the Rorschach there’s a different picture between the chronic situation and the fraught situation,” Berant says. “With a person having a first psychotic attack, we will probably see a turbulent picture characteristic of thought disorders. On the other hand, with a chronic schizophrenic, we will probably not find thought disorders, but a paucity of content.”
There are also subjects in which the meagerness is built in, and not necessarily connected to a personality disorder.
Berant: “Clearly, but it’s not just a matter of the Rorschach. For example, it’s sometimes difficult to get adolescents to cooperate. Sometimes also prison inmates, who are afraid of what might be inferred about them. Or people in whose family there’s a history of schizophrenia and who are reluctant to do a Rorschach test, for fear of what it might indicate about them. In a case of that kind, it must be said that the test does not reflect the person.”
The underlying assumption of the Rorschach test is that the subject approaches it like a blank slate. But that is not always the case, says Zakin: “There is a phenomenon of transferring information in closed [WhatsApp] groups dealing with parental capabilities. People there, especially men, operate in an organized and crystallized way, on the assumption that there are ‘correct’ answers.”
Berant adds that there are even private companies that offer courses on how to “succeed” in the test, “like the preparation for the [university entrance] psychometric examination.” However, they are of limited use, she adds: “We can usually discover if someone prepared. For example, when he describes only wonderful things, like two people making a sculpture. That’s what’s known as too good to be true.”
Truth and science
During the past 50 years, the Rorschach test has undergone two stages of improvement, aimed at deflecting criticism and consolidating its scientific status. In 1974, Dr. John Exner’s scoring system was adopted. Each of a subject’s responses is given points, according to parameters such as his description of the location of a shape in the inkblot, its clarity or movement and so on. A group of American analysts and statisticians continued Exner’s path and developed an even more rigorous scoring method, which deleted indices deemed not to be solidly valid. This system, which is the standard today in most Western countries, was introduced in Israel in 2014.
Not all advocates of the test welcome the change. “Instead of offering an answer for the psyche, an answer was offered to the criticism, and along the way many of the virtues of the old methods of analysis were forgone,” says Bronsky, who continues to integrate elements of the previous method in the tests he administers. “In order to prove to dismissive scientists that we are doing things properly, we went to the opposite extreme, where there’s no interest in the truth but in what can be defended scientifically.”
By contrast, Berant says that comparative studies of the methods found that the use of the newer one does not result in a loss of valuable information. An experienced Rorschach administrator, she says, will know how to make intelligent use of the information that arises from the test, even if it can’t be quantified. “For example, if the subject sees a crown of gold in a black-and-white card. That’s a finding that usually characterizes people who are coming out of a depression. But it’s so rare – a frequency of one in 600 – that it’s impossible to study it properly. So, although you can’t generalize an inference from it, it’s interesting to know about it.”
Still, the present refined incarnation of the Rorschach does not persuade critics of its necessity. “The question is not only whether the Rorschach is valid, but also whether it has added validity that’s worth the investment,” Yovel says. “In my eyes, the answer is that it’s certainly not. If I administer a depression questionnaire to you, which takes you two minutes to fill out and takes me half a minute to score, there’s no point in my investing as much as five hours in a Rorschach in order to determine whether you’re depressive.”
He adds that he’s doubtful that the test truly provides the equivalent of an X-ray of the psyche. “But even if it does, the question is whether it’s needed at all. When you come to me for therapy, I don’t need that X-ray.”
“The Rorschach purports to tell us things about a person that he doesn’t know about himself, but a person is not only his unconscious,” Prof. Assa observes. “It’s not always necessary to begin with the assumption that people aren’t aware or are denying something. Sometimes, when you ask someone how he feels on a scale of one to 10, he’ll simply tell you.”
In response to that point, Berant says, “I don’t argue with the usefulness of a self-report, but what happens when the person doesn’t report? There are certain subjects about which we are conflicted, certainly in the case of people with low self-revelation who won’t answer questionnaires sincerely. The Rorschach test bypasses that and shows how a person conducts himself. That’s its uniqueness.”