History of Medicine: June 2017

THE RORSCHACH TEST

Anybody remember the Rorschach test? It was all the rage in the fifties but has since dwindled in the public eye. Its origins are reviewed in a recent biography of its inventor, Hermann Rorschach.

Rorschach was born in 1884 in Zurich, and grew up in the nearby town of Schaffhausen where his father was an art teacher. His father died as he finished high school (gymnasium) leaving him short of money but he managed to afford medical school at the

Hermann Rorschach (from Wikipedia)

University of Zurich. Connected to the Zurich medical school was a large psychiatric hospital, the Burghölzli, whose director, Eugen Bleuler, was already known for his commitment to mentally ill patients, probably related to the fact that his own sister had catatonic schizophrenia. Bleuler invented the name schizophrenia to replace Emil Kräpelin’s dementia praecox (premature dementia. Joining him in 1900 was a young assistant, Carl Jung.

Rorschach did not work at the Burghölzli but Bleuler was one of his professors, influencing him to take up psychiatry. In Zurich Rorschach met numerous Russian women (unable to study medicine in Russia), learned Russian himself, and fell in love with a student named Olga, six years his senior. He completed his medical studies in Berlin in 1909. An attempt to practice in Russia failed and he took a job as psychiatrist in a mental hospital in Münsterlingen, near Lake Constance, where he and Olga were married.

Psychiatric clinic, Münsterlingen (photo by Dominic Venezia, on Wikipedia)

He engaged intimately with his patients, introduced art therapy, and arranged entertainments, slide shows, and dances for the patients. He and a nearby friend and schoolteacher, Konrad Gehring began to experiment with inkblots. While Gehring showed them to schoolchildren Rorschach showed them to his patients. The results encouraged him to explore further.

Inkblots were not new. Probably the first to use them was Justinus Kerner, a German romantic poet and doctor (and the first to describe botulism and document the poison’s interruption of motor nerve transmission) who printed them as an accompaniment to his poems. Playing with inkblots soon became a child’s game. The psychologist Alfred Binet (of the Stanford-Binet test) used them as a measure of the level of imagination in a child. Some say that the whole idea of conjuring up realities from abstract designs originated with Leonardo da Vinci, who had written, “By looking attentively at old and smeared walls, or stones and veined marble of various colors, you may fancy that you see in them several compositions, landscapes, battles, figures in quick motion, strange countenances,….”.[i]

Rorschach card II (Wikipedia)

At the same time psychoanalytic theories of Freud and Jung were coming into vogue, and Jung and Franz Riklin, both working for Bleuler at the Burghölzli, had introduced word association tests.

Rorschach’s work was interrupted when he took a job in a private psychiatric clinic near Moscow. Psychoanalysis was already popular in Russia; the first journal of psychoanalysis in the world was published in Russia. The technique meshed with the Russian proclivity for introspection and probing one’s “inner world”. Coincidentally, Russian “futurism” was exploding. New ideas on poetry, color perception and its relation to music, abstract forms (Kandinsky and Malevich are examples), and other themes permeated artistic and psychology circles. Rorschach, educated in art by his father, took it in.

His next stop was a mental hospital in Herisau, in northeast Switzerland, where he returned to making blots. He used brushes and ink to create many, probably hundreds, of images, working to achieve something halfway between recognizable and unrecognizable shapes, introducing color, and opting for horizontal symmetry (rather than vertical). To allay patient anxiety the blots could be presented as a game or a test. He tried many samples on patients and eventually narrowed the selection to ten “blots” that became the standard. They helped him distinguish between certain diagnoses and provided insights into psychological types, such as introverted or extroverted, as advanced by Carl Jung. He separated patients’ answers into three categories: Form, Movement, and Color. Did an answer reflect a predominant focus on shape or form, was color important, or was something seen that moved or implied movement? His preliminary results were published in 1921 in a book entitled Psychodiagnostics.

Rorschach card IV (Wikipedia)

But Rorschach’s research came to a tragic end. He contracted appendicitis and, because of delay in calling a doctor and the lack of a surgeon in the small town of Herisau, he died of peritonitis in April 1922 at the age of 37.

The inkblots lived on, however. They were taken up in various countries, but reached greatest renown in America. Promoters of the blots ranged from objective researchers who sorted answers into measurable categories to help define personality types to those who used them as a psychoanalytic tool to probe the unconscious. Anthropologists administered them to remote tribes, the more remote the better. They were given (unofficially) to the top criminals awaiting trial in Nuremberg, by both the Army psychiatrist and the “morale officer” (who had written a book on Rorschach tests). None were “insane” and the overall results were not outside the range found in the general population. The military experimented with using them in recruits to weed out those unfit for combat (this was dropped). Eventually controlled trials were undertaken to evaluate their accuracy, shedding doubt on their value in diagnosis. Positive findings in one study were often absent in another. Problems were that the test giver could influence the results and that classifying the individualized responses to images was subjective.

The Rorschach test, using the original ten images, is still in use, though with diminished frequency. Controversy on its usefulness remains. Results are admissible as evidence in court and the test is reimbursed by insurance companies.