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The Inkblot test, a beautiful mess

a popular book with poetry, inspired by the Blotto game

I was first exposed to the test as a teenager when I was administered the inkblot test by a psychologist. I remember little of the experience other than enjoying it and feeling engaged, it was so open ended and felt creative. The examiner later told my mom that I was imaginative and that made me feel good, otherwise, I learned little of the results.

Years later the test emerged in my life once again. I had helped a psychologist friend move to a new home and he asked me what he might do to return the favor. For no good reason the Rorschach popped to mind and my friend agreed to teach me some of its principles. This led to a deep dive over the next couple of years including attending a conference and getting some training in the Exner scoring system by Exner himself. The whole experience was enriching; not only did I learn the technique of administering and interpreting the Rorschach but a window was also opened into the world of psychological testing, dimensional diagnosis vs categorical diagnosis, and an increased awareness of the subtlety of psychological functioning much of which transcends diagnosis.

For those not familiar with the Rorschach, let me take a moment to present some its attributes. The test consists of ten cards offered in turn to the subject. An inkblot can be pictured as a splash of ink applied to a piece of paper that is then folded so that upon completion the resulting image is symmetrical about the fold. The standardized blots that are used with the Rorschach have a number of attributes such as form, shading, and color. Some of these 'determinants' are obvious and frequently responded to by subjects others are quite subtle.

The subject who is presented the cards is given broad scope to respond. Prompts from the examiner are non-directive such as, 'what might this be?,' with occasional gentle requests for clarification, 'can you tell me a bit more?' Most subjects experience the test as interesting and even fun. The latter is attested to by the fact that prior to inkblots being conceived of for their psychological potential, there was a popular 19th century game called Blotto. In this game people created their own ink-blots and then amused themselves by passing them around in gatherings to compare responses to what others were seeing- the cover of a popular little book from those times is pictured at the head of this post.

Rorschach saw in these projective games the potential to elicit attributes of personality. He standardized some blots and developed a simple scoring system to categorize people's responses, the aim being to systematize things to the point where different examiners hearing the responses of a subject would score them in a consistent way. Over ensuing decades more elaborate and consistent scoring systems were developed. The most elaborate and widely excepted modern system growing out of earlier work was developed in recent decades by the psychologist, Exner.

The qualities of personality that are revealed through a Rorschach are rich. Whether the test is administered or not, a clinician who is simply aware of these dimensions of psychological functioning will be a more sensitive listener. Let me elaborate. The Rorschach provides information on the richness versus poverty of a subject's inner world; a perspective is offered regarding interpersonal relations and whether such relations tend to be cooperative and enriching or bitter and tense. The test exposes the degree of creativity in a subject. It also speaks to the outlook of a person, is the subject optimistic or is his life shaded with darkness. Through the test one can predict the degree of emotional intensity of a person, and whether these emotions are channeled in a constructive way or are they are a source of possible destructive dyscontrol. The clinician can forecast elements of mood that correlate with depression and even suicidal risk, as well as determine if there are possible elements of psychosis and distortion of reality.

I write about the Rorschach with a bitter sweet feeling of nostalgia, as well as a degree of optimism. I miss the era when the test popular. It was a time in which psychologists and psychiatrist were enthralled by the complexity and mystery of personality. The Rorschach is not offered that much these days as a part of personality assessment. These days there is a presumption of exactness, we tend to think we know more than we do, some of the mystery is gone. The word, 'metric,' is often heard in relation to psychological tests. Most of modern testing being offered on computer screens, inexpensively scored by the very same machines.

In contrast, the Rorschach is beautifully messy. It offers conjectures rather than precision, the latter being a source of debate and criticism. Critics challenge whether the test is consistent in its read of individuals and is validly predictive of their behavior. Added to this, the test is time consuming and hence expensive leading to its disfavor in our modern era of industrialize and depersonalize medicine.

Yet in the context of psychotherapy, the conjectures the test offers increase the sensitivity of the listening therapist. While some of the conjectures the test offers may fall by the wayside, those that stick often offer the clinician a nuanced early understanding of a patient's psyche.

My nostalgia is accompanied by optimism. It seems to me that we are reaching an era where psychiatry is being encouraged to re-embrace humanism; new medication interventions including Ketamine therapy, with psychedelics on the horizon, invite a sophisticated melding of drugs and the psyche.

We humans are beautifully messy, as therapist must respect this and is more like finger painting then calligraphy. The Rorschach comes from an era in which this was taken for granted. The test may re-emerge as we assume a broader humanistic perspective.

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