The Rorschach test is a unique method of studying the psyche, which has found its application in various fields. In psychiatric clinics and forensic practice, it was used to analyze the personality of a criminal; in medicine, it was once used to study organic brain damage, such as dementia, epilepsy and schizophrenia, and when hiring, it is sometimes still given to job candidates. Why the test is not actively used now, how it works and whether it is possible to make a diagnosis with its help – on the birthday of the test’s author, Hermann Rorschach, Gazeta.Ru learned from psychologists and psychiatrists.
What is the Rorschach test
The Rorschach test is a psychodiagnostic test using ink blots, developed by Swiss psychiatrist Hermann Rorschach in 1921. It is part of a group of projective tests in which a person is offered certain conditions – situations, images, started sentences, and so on. The subject must interpret these conditions in accordance with his perception or suggest associations that arise in his head. Based on this interpretation, or, as it is called, “projection,” the doctor draws conclusions about his mental state and personality.
“The patient must interpret ten ink blots, symmetrical about the vertical axis. Half of them are colored, and the other half are dark. The subjects, as Rorschach believed, transferred their inner feelings and thoughts onto these inkblots.”
– Doctor of Medical Sciences, psychiatrist, psychotherapist of the NCC №2 of the Federal State Budgetary Institution “Russian Scientific Center for Chemistry” told Gazeta.Ru. acad. B.V. Petrovsky” Rafael Mirzabekyan.
One of the key features of projective tests is that their purpose remains unknown to the subject. There are no right or wrong answers in these tests – any person’s reactions and his vision of the proposed situation will be significant indicators. Mirzabekyan noted that Rorschach’s professional activity took place during the period of popularity of Freud’s psychoanalysis, which affected the test itself.
“If you draw parallels between psychoanalysis and the tests developed by Rorschach, you can find a certain connection. Freud, with the help of psychoanalysis, identified hidden motives, and the creators of the tests sought to make this method more objective with the help of blots, to find relationships between psychopathologies and what a person sees in these blots. Rorschach suggested that when a person sees these symmetrical spots, his imagination draws a hidden image. He projects his feelings and thoughts onto them, therefore, by what a person sees, one can diagnose various states of a person’s inner world,” Mirzabekyan explained.
What was it used for?
This test was used to diagnose organic brain damage: dementia, epilepsy, schizophrenia. When interpreting the test subject’s answers, initially, according to the author’s plan, a system of five parameters was used, Doctor of Psychological Sciences, Professor, Director of the Institute of Clinical Psychology and Social Work at Pirogov University Vera Nikishina told Gazeta.Ru.
“These are parameters of localization, parameters of determinants, parameters of form, content and originality. A table was compiled and the specialist made a conclusion based on the analysis of these five parameters. This technique at the beginning and middle of the 20th century was a fairly active tool used in the work of psychiatrists, including in Russia. It was used when working with organic lesions, in diagnosing organic brain lesions, in neurodegenerative disorders, as well as in diagnosing personality in schizophrenia,” Nikishina said.
According to experts, Rorschach formulated a number of theoretical positions based on the test. So, if the subject perceives the spot as a single whole, this indicates his ability to think systematically. If the interviewee pays attention to the small details of the drawing, this indicates his attentiveness and thoroughness. If a mentally healthy person identifies a white background from an image, this indicates his persistence and tendency to argue.
“There is another example: if the patient catches movement in the spots, then this may be a sign of unrealistic fantasies, which may be associated with psychopathology. Rorschach did associate the meaning of some of his patients' responses with certain conditions.
So, if they saw, for example, skeletons or skulls, then this indicated a depressed state of the patient. If they saw eyes in these images, then he diagnosed them with paranoia,”
— said Mirzabekyan.
Rorschach himself reported some characteristic test results for diseases such as depression and schizophrenia. In the first case, subjects do not notice the colors and dynamics of the drawings, do not see human figures, and usually start with small details. Mentally healthy people do the opposite. In schizophrenia, subjects refuse most of the cards, see movement well, and practically do not see animals.
Does the test work?
However, as Marina Kinkulkina, head of the department of psychiatry and narcology at Sechenov University of the Ministry of Health of Russia, director of the Korsakov Clinic of Psychiatry at the Clinical Center for Health Sciences at Sechenov University of the Ministry of Health of Russia, said, it cannot be said that a certain perception of images is a sign of a specific diagnosis.
“The Rorschach test is a projective psychological test that is used to assess personality and emotional functioning. The method allows you to understand the patient’s mood, his fears and anxieties. The Rorschach test, like any other test, cannot serve as a basis for making a diagnosis; it can be an auxiliary method in the arsenal of an experienced clinician,” explained Kinkulkina.
According to Mirzabekyan, today we can say that the relationships described above really exist, but only in a certain percentage of cases.
“For example, I have a patient who is very sensitive to external noise and cannot sleep because he hears a person crying from upstairs. He has a certain hypersensitivity and if he is asked to take a Rorschach test, there is a certain probability that in the images of the inkblots he will see ears or noises that cause him discomfort.
If the patient sees eyes in the blot, this does not mean that he is paranoid, but such a response can give us a hint that the person has a certain fixation on some sensations,”
– said Mirzabekyan.
Clinical psychologist, senior lecturer at the Department of Child and Adolescent Clinical Psychology at the Moscow Institute of Psychoanalysis, Yuri Barmenkov, noted in a conversation with Gazeta.Ru that the Rorschach test has its pros and cons.
“The advantage of this method is a comprehensive assessment of all areas of the human psyche. Unlike self-reports, the Rorschach test allows you to record the results of mental activity observed live under controlled conditions. Such data allows us to form a more complete picture about a person,” the specialist noted.
The disadvantages, according to the psychologist, traditionally include the difficulty of mastering the testing methodology and interpreting the results. Not every specialist can use the Rorschach test correctly.
“The disadvantage of the test is the high demands placed on the specialist conducting it. Psychodiagnostic skills, knowledge of the features of a specific conduction and assessment system, and clinical experience play an important role for the correct interpretation of results. In skillful hands, the Rorschach test can be used to diagnose a wide range of mental pathologies from schizophrenia spectrum disorders and affective pathologies to neurotic disorders. The test is included in the “gold standard” for personality diagnostics. But no disease is diagnosed based on the results of one technique,” said Barmenkov.
So is it possible to use the blot method?
At the end of the last century, they even wanted to introduce a moratorium on the test due to its bias. Today, according to Mirzabekyan, it is almost never used for the same reason. The fact is that two different specialists, assessing the same patient responses, will come to completely different conclusions.
“The Rorschach test is biased and therefore not popular in psychiatry. In psychiatry, clinical conversation and observation are given first place; they are more objective.
In rare cases, psychologists use it to interpret dreams or the patient’s condition, but this does not negate his subjectivity. But it is impossible to make an objective diagnosis using this test; the result largely depends on the interpretation of the specialist himself: two psychiatrists will give a different diagnosis to one patient,” said Mirzabekyan.
Vera Nikishina expressed the same point of view: the use and interpretation of test results is characterized by a high level of subjectivity.
“It is impossible to ensure the reliability of the diagnostic conclusions obtained using this technique. This is the main reason why we, specialists, have limited use of this tool. Now interest in this instrument has increased significantly, precisely because it contains philosophical characteristics of both the procedure and the content of the test itself. It is very similar in its everyday, emotional appeal to metaphorical cards. The mystery and attractiveness of the very content of the tool, in my opinion, triggered a renaissance of attention to it and the activity of its use, but outside of healthcare,” said the specialist.
According to Barmenkov, the test is still actively used in the United States: “According to some data, every third specialist involved in psychodiagnostics in the United States uses the Rorschach test. There is a lot of research aimed at creating more effective assessment and interpretation models. In our country it is also used in clinical and scientific work. Although, of course, there are fewer people who know this technique than in English-speaking countries.”
Kinkulkina also noted that the Rorschach test is still used in practice today in Russia.
“The Rorschach test is sometimes used. If you go online, you can find clinics that offer to take the Rorschach test. Therefore, to say that it is not used at all is incorrect. Nowadays the Rorschach test is used infrequently due to its subjectivity and lack of reliability. The interpretation of the test results largely depends on the doctor; its validity has not been proven in scientific studies,” the doctor noted.
It is not recommended to use it to make a diagnosis for several reasons.
“Firstly, its validity (that is, the accuracy and reliability of the results) has not been proven. Secondly, it is known that the results greatly depend on the personality of the person conducting the testing. These factors limit the use of the test,” the doctor concluded.
