Schizophrenia Daily News Blog

Inkblots spot mental illness?

A recent article in the April issue of Scientific American challenges the validity of the Rorschach inkblot test, a classical psychological assessment tool, as a definitive way to diagnose mental illness. I was personally greatly surprised (and a little unnerved) to learn that a test which involves identifying pictures seen in inkblots is apparently a valid measure for what is normal and abnormal in the incredibly complex human brain.

The test itself sounds like a cross between Freudian psychoanalysis and old-fashioned phrenology. Subjects are asked to identify pictures or create stories from ambiguous inkblot photographs - drawing on their own emotions, memories, and thought processes to do so. Some psychologists assert that a trained professional can evaluate a person's responses, and thus determine personality traits, repressed impulses, and overall mental state.

It makes some kind of sense that someone's impulsive responses to ambiguous images might say something about their inner though processes - much like free-association can bring sub-concscious thoughts and feelings to the fore. However, to use something as subjective as this test appears to be in situations as serious as mental illness diagnosis is perhaps a little much. The Scientific American article points out that the Rorschach test (along with the similar TAT assessment) has both a low scoring validity and low reliability.

Scoring validity errors often come from the subjective assessments of the professionals who administer the test. Although there is a Comprehensive System (developed in the 1970s) detailing rules on how responses should be scored and interpreted, two independed assesors are still unlikely to agree on what the same "psychological profile" (as determined from the inkblot test responses), means.

Research has also indicated that the test is not adequate to identify most psychiatric conditions. Interestingly, the article noted schizophrenia as an exception to this rule - apparently (no sources were cited in the article), the inkblot test can be a valid measure of disordered thought, one of the symptoms of schizophrenia.

However, the article also points out that even if the information gathered from these assessment tools is accurate, it rarely adds much to the information collected from generally more reliable diagnostic tools - for example, one-on-one interviews with a patient.

Although the author notes that some mental health professionals disagree with the critiques of the Rorschach and other similar tests, the article concludes thusly:

"We find it troubling that psychologists commonly administer projective instruments in situations for which their value has not been well established by multiple studies; too many people can suffer if erroneous diagnostic judgments influence therapy plans, custody rulings or criminal court decisions. Based on our findings, we strongly urge psychologists to curtail their use of most projective techniques and, when they do select such instruments, to limit themselves to scoring and interpreting the small number of variables that have been proved trustworthy."

I am inclined to agree, and hope that the new diagnostic tools currently in development (blood tests and brain scans, to name just two) will prove to be more reliable measures with better standardization. Too many people suffer for too long with incorrect diagnoses and treatments, and all research shows that effective, early intervention is anyone's best hope for recovery.

Two views on using the Rorschach test for diagnosing schizophrenia:

The Rorschach Test in Clinical Diagnosis: A Critical Review. J Clin Psychol. 2000 Mar;56(3):395-430; discussion 431-4

Let's Call the Whole Thing Off - A Response to Dawes 2001. Psychol Assess. 2003 Dec;15(4):582-5. (This abstract examines how critiques of Rorschach and similar assessments may be biased, and suggests value for them as assessment tools).

Original Source: "What's Wrong With This Picture?" Scientific American Mind, April 2005