Thursday, August 3, 2017

The Inkblots Hermann Rorschach, His Iconic Test, and the Power of Seeing



Damion Searls’ new biography of Hermann Rorschach is excellent.  His description of the test and how Rorschach crafted it is both intriguing and, from the perspective of a clinician and teacher like me, both spot on and helps me experience the test in a new way.  After talking about Rorschach himself, Searls talks about the development of the test and the place that it has played in our collective psyche – but also how it has been in favor and fallen out of favor - all the while being a useful clinical instrument.

I am reading this book on vacation and, about a third of the way through the book, I took the reluctant family with me to visit two people who have been very dear to me – and one of whom was a mentor when I was a trainee at the Menninger clinic which, at the time, was a very psychoanalytic place.  My mentor, Fred Shectman, the former director of outpatient assessment, was curious about the book and asked if it had been written by a clinician.  I noted that the author was not a clinician – but, at least to that point in the book, I didn’t think that was relevant.  Searls seemed to be doing a very good job describing both Rorschach and his test.  This book is well written and would be a good read for the neophyte – but I would caution that neophyte that Searls makes the same mistake he accuses the users of the test (rightfully) of making (and that I think Fred intuited) – he does not remain balanced.  After the biographical section, when he is describing how the test develops after Rorschach’s premature death, Searls chooses psychoanalysis as the bad guy in this drama, even though he also praises the insights derived from it.  I think Fred anticipated something – not for the first time in my experience.  It takes a clinician to understand the complexity of the test and its application – the opportunities and the perils associated with it.  But I have gotten ahead of myself.

Searls contextualizes Rorschach in a way that I have not previously been able to do.  Biographical details have been sketchy.  I knew that he died early – shortly after publishing his test – so he was not able to direct its development and use.  I knew that he died of appendicitis, but did not know that his wife, a Russian physician, minimized the symptoms and despite his being doubled over in pain, did not call for help until it was too late.  She, apparently, was a piece of work and, when Rorschach’s sister’s appendix burst at his funeral, she accused the sister of trying to upstage her brother’s death.  In fact, Rorschach’s relationship with his wife was tempestuous and difficult.  More importantly, though, I did not know that Rorschach was taken with the Russian people as a whole, and with their art in particular, nor did I know that he was a very early feminist and, as a student of Bleuler – about whom I learned a great deal and came to admire in this book  – and Jung, he was exposed to the best psychiatric teaching of his day.  I did know that he was an artist and that the inkblots were not inkblots, but works of art – something that we did not know until about twenty years ago or so because he stated in his book, which took forever to publish, that they were blots and by the time it made sense to articulate what they really were, he was dead.

What Searls is able to clarify is that the blots are skillfully crafted.  He does not state that Rorschach originally wanted to use 16 blots and because of the expense of printing so many, they were cut to ten.  Whether that is true or not, the ten blots are carefully constructed and arranged.  The first blot is in black and white and like all of the blots, has more structure – meaning more shape to it – than the blot that Rorschach modelled it after – and originally used, but found lacking.  It has more structure – it looks like something – but more precisely it looks like many things – and nothing in particular.

The second card also looks like something – actually many things – but it, unlike the first card, is not just black and white, but has some red in it, too.  Searls does a nice job of describing the roles of black and white and red in our color vocabulary – and pointing out that, after black and white, red is the next color to enter our vocabularies.  He does this using anthropological data, but I am struck by the developmental aspects of the Rorschach.  You see, Rorschach, the son of an artist and an accomplished artist himself, was working both intuitively and interpretively.  He was developing a test of perception without a theory of perception – or at least not a stated one.  But he did some things that indicated that he had a latent theory.

All of the blots, in their basic structure, include depictions of movement – people are bowing – birds are flying.  This was an important aspect of our perceptual worlds that Rorschach wanted to evaluate – how much motion does each of us see?  But he also wanted to evaluate how much color we used in reporting what we see – he intuited and then demonstrated that if we focused more on movement we were more likely to be what he called introversive in our style – Searls pointed out that he wanted to have an adjectival use of the word rather than using Jung’s noun – to describe people’s functioning rather than to categorize them.  Similarly, if we were weighted towards producing more responses based on the colored aspects of the blots we would be seen as being extratensive in our style.  To capture this difference, the blots need to be balanced in what they pull for – he could, as an introversive himself, have crafted even more movement into the blots and neglected color.  But he was seeking balance.

Now, why does color equal emotional processing – a critical component of the extratensive style, while movement is related to thoughtful, but also less social means of functioning?  The rather lame position that I have taken traditionally is that the essential task is a cognitive one – the examiner asks, “What might this be?” and the appropriate response is one that is based on formal qualities of the blot (including noticing tension states that get perceived as motion).  From this perspective, color is a distraction - and emotions can be a distraction from various tasks that require pure cognition.  But color can bring a painting to life, and emotions can lead us to creative solutions, especially to interpersonal problems.  Searls' description of the artistic zeitgeist that Rorschach was working in supports a more theory based understanding – though I draw this theory from a psychoanalytic clinician and researcher, Daniel Stern.  The idea that Searls all but articulates is that we are built (Stern provides evidence of this in newborns) to translate experiences across our sensory modes.  This cross modal integration, essential to our functioning, allows us to depict feelings with – of all things – colors, though also with verbalizations and with kinesthetic experiences.  The appreciation of the tension state in an object requires a certain kind of projection that Searls points out Rorschach called, in the tradition of the philosopher Robert Vischer Einfűhlung literally feeling-in, which was translated with a new word in English, empathy.

Another possible connection between theory and the blots that Rorschach created has to do with symmetry.  Rorschach was insistent that the symmetry in the blots be vertical – so that the left side is the same as the right side of the blot, not horizontal or diagonal.  He also insisted that the symmetry be present (other inkblotters have experimented with asymmetrical blots, but without much success).   Stern noted that developmentalists have long seen a preference on the part of newborns for vertically symmetrical arrangements of material.  Stern posits that this is due to our being “programmed” to gaze at our mother’s face while nursing and to begin to “read” that face.  We are built to appreciate faces and face-like works of art – they tap into something that is deeply part of our essentially social selves.  This was not something that Rorschach could consciously articulate – but it was something that he intuited – that a vertical symmetry – and a symmetrical blot – would elicit more useful responses for interpreting things about the person looking at it.

Another thing that Rorschach did that Searls did not call so much attention to is that he intentionally mislead the person he was evaluating; he put colors on things that didn’t belong with them and appendages that shouldn’t have been there (pink bears and men with breasts and penises).  He was working to develop a test that would identify those of us who were struggling with minds that were not working well.  He was trying to find what would tell us about the misfunctioning that we were experiencing.  I think that, while we are born prepared to cross modally integrate, we also learn how and when to over-ride that.  Part of what we see on the Rorschachs of those who are most disturbed among us is more “primitive” functioning – part of what we lose when we lose executive function is that we lose abilities to override “instinctive” functioning – and the Rorschach reveals the subtle (and sometimes not so subtle) ways that we are vulnerable to this. 

To go back to that first card: most people see a bat.  I, like Rorschach, don’t really see it, but most people do.  Then a funny thing happens; the next most frequently seen thing is seen about a third as often, and the next most frequently, about a third as often as the second and so one – until we get to individual things – and there are a great many of those things.  This is something like the English language and many other naturally occurring things, where “the” is the most common word and it is three times more frequently used than “to” and so on until we get to a whole bunch of words, like catecholamine, that are infrequently used.   Rorschach intuited an instrument that functions in this organic way – it allows for both assessing how someone is like others – do they see the bat? – and how they are themselves – isn’t it interesting that they see something I have never heard of before but that can be seen in the blot – isn’t it telling something important about this individual?

After telling Rorschach’s personal history, Searls then tells about how the Rorschach has been used – and misused – and how it became all the rage and has recently fallen out of favor.  The arc of this story is partially familiar and I have lived some of it.  What was novel and intriguing was Searls descriptions of ways that it was used in high profile evaluations – like of the war criminals at the Nuremberg trials.  This is a fascinating read – and the conflict between the two evaluators is well told and leads to painting with a very broad brush the war between the academics and the practitioners about the use of the Rorschach in the 1990s.  But Searls paints this as a war between the empiricists and the psychoanalytic interpreters – as if the interpreters didn’t give a damn about the empirical basis of the test and just practiced wild interpretation. 

Searls holds up Steven Finn’s work on Collaborative Assessment as a hallmark of how to rectify and bring together the two factions.  I greatly admire Finn’s work and I am a big fan of what he has done.  But I learned collaborative evaluation long before Finn started writing.  Collaborative assessment was practiced at Menninger in the context of giving psychoanalytically informed, empirically supported test evaluations.  Searls obliquely referenced Rappaport and Schafer, painting them with the brush of being tainted psychoanalytic thinkers – and this really rubbed me the wrong way.  I think that the best clinicians have always tried to collaboratively work with their patients.  There are many clinicians of every brand name who have failed to do this.  They are likely to tell their patients what is wrong with them rather than ask them.  If they are psychoanalytically oriented, they are likely to provide an explanation of an unconscious mechanism that is mysterious and never supported as a means towards exercising power over a situation rather than helping the patient increase their own power in that situation.  This is the fault of the psychoanalyst, not of psychoanalysis, just as when a cognitive behaviorist does a similar thing by explaining the power of the situation without empowering the person to affect it – it is not the fault of cognitive behaviorism that the person feels disempowered but of the practitioner.

Searls seems to understand the dilemmas faced by practitioners who are forced by the legal system to answer yes or no questions with an instrument that provides adjectives and ranges – not with categorical definitions.  Should a person who tends to freak out under less pressure than most be entrusted with the care of a child who puts pressure on a caregiver?  Should the caregiver, if it is the child’s parent, have custody of the child denied because of this?  That is a judgment call – and one that should use lots of information – including from the Rorschach – but neither the Rorschach nor any other instrument should make that decision – indeed, I don’t think that is a clinical decision, but one that a judge should make.

Ironically, Searls gets that the efforts, first of Exner – which were helpful in important ways and misguided in ways that Searls articulates – and more recently the R-PAS system which supersedes Exner’s Comprehensive system for coding and interpreting the Rorschach, to improve the instrument has led to narrowing it – making it more reliable – we are less likely to make an egregious error – but has also limited its ability to articulate what is unique and delightful about this particular person.  The irony is that our ability to articulate the unique aspects of a person, to put forth hypotheses about that, requires a theory of human functioning – and the psychodynamic theory of human functioning is the broadest and best articulated one that we have.  Tony Brams and Mary Jo Peebles’ book, Psychological Testing that Matters puts the Menninger system of testing, which includes psychoanalytic interpretation of the Rorschach, alongside using the Comprehensive and R-PAS systems, as a means for clinicians to use psychoanalytic thinking in ways that are responsible and useful.

I have taken Searls to task about his dismissal of psychoanalytic thinking as a viable way to understand humans.  I obviously strongly disagree with him, reluctant as I may be about my own psychoanalytic identity.  Part of my reluctance is the realization that I have an unconscious – something that foils me at least as often as it helps – or at least I am aware of the ways that it interferes with my functioning on a relatively regular basis.  I don’t think that Searls criticism of the psychoanalytic perspective is going to make mine or anyone else’s unconscious go away, so I’m not worried about the long term well-being of the psychoanalytic perspective.  It is frustrating, however, that a person as sensitive as Searls is to the human condition – and as aware as he is of how the particular person should be connected with and enjoyed – doesn’t realize that a psychoanalytic approach is the best means of opening that up.

The Rorschach itself provides an excellent example of this.  The best measure of dependency on the Rorschach turns out to be a highly psychoanalytic theory based code called the Oral Dependency code.  To use this code, every time a person taking the test mentions something that is orally related, like eating or cigarettes, you need to note it.  This makes some minimal sense to the members of the Rorschach group that do the stats, but the thing they find most frustrating is that the code is less predictive of dependency when you eliminate the really obscure and tangentially orally related items - such as silverware being included in what is seen.  It turns out that a purely content based code is a very good predictor of central personality feature.

Another layer of my frustration is that my own program has recently changed the requirements of our incoming students so that they don't have to take the Rorschach class.  I am, in the referenced posting, upset about this, particularly because one of the stated reasons for that is that psychoanalytic approaches to people and other means of getting to know them deeply were not seen as something that it is important to teach our students.  Searls would, I am sure, be my ally - though he would fight as a humanist - in the importance of connecting with individual people.  I don't think that he gets that psychoanalysis, at least as I understand it, is a humanistic enterprise.  

In a conversation with another friend on this trip I was pointed in a very different direction.  He remembered a conversation with Gabriel Marcia Marquez about his fiftieth anniversary.  When asked what the secret to a long marriage was, Marquez, in my friend’s memory responded that the secret was to realize each day that you are married to someone that you know less about than you knew the day before.  We are infinitely complex, and when we get boxed in, whether by a diagnostic label or by the prejudices that are learned from secondary sources – as I think Searls has been – something truly remarkable is lost.  Don’t let his prejudice get in the way of reading this fascinating book.  You will learn more about philosophy, psychology, the currents of the twentieth century and how they flowed together than you will think possible.  Just don’t take Searls moment of imbalance as an indication of the value of the entire work.

I have previously posted on teaching the Rorschach here.  To access a narrative description of other posts on this site, link here For a subject based index, link here. 
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