This test 'makes everyone look sick'

How did the creation of an artistic Swiss psychiatrist come to decide people's fates? Karen Gold explores the discredited but enduring Rorschach inkblot test

An X-ray of the mind. The idea is so seductive. Imagine having a simple, non-intrusive test to probe our personality. For more than half a century, advocates of the Rorschach test have claimed to have just this with their ten inkblots onto which we unwittingly project our deepest desires. And for almost as long, appalled sceptics have rebutted their claims. So how has the Rorschach managed to defy death for so long?

At least 1 million psychiatric patients, prisoners and ordinary people take Rorschach tests every year in the US alone. It is the US's second most popular psychological test. It is used in hospitals, courts and prisons to determine who is psychologically fit for parenting, who is incorrigibly criminal, who deserves to get parole.

Such testing is on a scale and for purposes never dreamt of by Hermann Rorschach, an obscure Swiss psychiatrist with artistic leanings. Working in a small insane asylum in 1918, he began to ask his patients what pictures they saw in a series of coloured inkblots he had painted himself.

If a patient saw lots of movement in the blots, that showed introversion and creativity, Rorschach believed. If they were struck by colour, that meant instability. Little of both indicated low intelligence and depression. Rorschach published these ideas in a book, Psychodiagnostics , in 1921 and died of peritonitis, aged 37, the following year.

His system, like many equally obscure others of the time, might have been expected to die with him - not least because it was built on straw, according to a host of evidence-hungry psychologists over the past 80 years, including the authors of a new book called What's Wrong with the Rorschach?

Rorschach used none of science's standard building blocks. He based his interpretations on a small sample, two-thirds of whom were schizophrenic, epileptic or retarded. He used no norms to standardise his findings. His interviews and interpretations were subjective. There was no "blind" testing to confirm or refute his verdicts on patients he already knew well.

He constructed no standardised scales of measurement, and his work was not objectively replicated.

Still, his ideas spread like a forest fire. Psychodiagnostics was not translated into English until the late 1930s, but by word of mouth it travelled through Europe into the US via émigré psychologists fleeing Nazi Germany for the safety of New York. Many of them were Freudians or were committed to "projective psychology" systems based on the belief that patients project their inner thoughts and drives in an external form, whether dreams or inkblots. One of the most hubristic was Bruno Klopfer, who left Berlin in 1933, became an anthropology research assistant at Columbia University, and set up a Rorschach study group to systematise the test's scoring and interpretation.

Klopfer was both enthusiast and salesman, says James Wood, associate professor of psychology at the University of Texas at El Paso and lead author of What's Wrong with the Rorschach? Klopfer attracted a devoted following, set up a newsletter, then an institute. He delved ever deeper into inkblot interpretation, implying as he did so that only the most rarefied minds could determine whether a patient's image of a rock smashing into a house implied movement.

It was Klopfer who promoted the Rorschach as a psychological X-ray, penetrating the mind without the patient feeling a thing, Wood says. "I believe that without Klopfer, the Rorschach would have disappeared," he says.

But Klopfer also caught the moment. From the mid-1930s to the mid-1940s, US psychology experienced an extraordinary expansion, partly prompted by the arrival of the European émigrés but even more by the enthusiasm of the US military, which, Wood says, drafted researchers used to working with rats in university labs into clinical work with traumatised GIs.

These unpractised psychologists needed tools to do the job. And in an atmosphere where medicine had only recently shed its snake oil for hard science and intelligence assessment had solidified into well-proven scales, clinical psychology needed to prove that it had snappy answers, too.

Enter the Rorschach. One test, ten inkblots and, apparently, systematic results. The blots could be projected on a screen and the test taken by hundreds of army recruits simultaneously. There was even a multiple-choice version. It could be used to determine occupational suitability, psychiatric illness and emotional state; it could even define an entire personality.

The trouble was, the test did not work. Even by 1949, several of the crucial flaws in the Rorschach were evident to researchers who tested its claims. Separate studies by the universities of Pittsburgh, Texas and Southern California showed that the Rorschach failed to identify ability - for example, it could not predict which air force pilots would successfully complete pilot training. It also failed to distinguish between pilots and psychiatric patients when their tests were anonymised. And its supposedly most skilled interpreters produced completely contradictory analyses of the same patients' tests.

The real trouble with the Rorschach, Wood says, is that "it makes everybody look sick". Even if one psychologist does not find egocentricity or depression in the patient - and estimates suggest that at least three-quarters of people who take the Rorschach appear unstable - another one will.

Outside the US, these studies had varying impact. In Europe, where the Rorschach was associated predominantly with psychoanalysis, they meant little: the test was only a prompt for patient-therapist communication. In Britain, apart from Sir Cyril Burt with his inexhaustible affinity for dodgy data, there were few Rorschach enthusiasts. Hans Eysenck dismissed the test. Arthur Jensen called the Rorschach "worthless", adding: "The rate of scientific progress in clinical psychology might well be measured by the speed and thoroughness with which it gets rid of the Rorschach."

That was in 1965. Apparently impervious to academic scorn, the generation of clinicians who had adopted the Rorschach carried on using it. And in 1969 they found a saviour. John Exner, a clinical psychology trainer at universities in Indiana, Ohio and New York, published The Rorschach Systems , a proposal for integrating all the various test interpretations drawn up in the past 40 years.

Over the next 20 years, Exner created the Rorschach Comprehensive System, a massive set of volumes detailing norms, indexes and measures for everything from schizophrenia and obsession perception to impulsiveness and paranoia.

It was an extraordinary undertaking, and it was recognised as such by the American Psychological Association, which in 1997 gave him an award for distinguished professional contribution to psychology.

That same year, Wood and two other academic psychologists published an article in Psychological Assessment attacking Exner's comprehensive system.

They questioned Exner's norms, the reliability of his indexes and his research base. Other articles showed that Exner and his colleagues admitted that the system's norms were based on a smaller sample than initially claimed, and that most of the research on which it was based was unpublished and had been carried out within Exner's own Rorschach workshop.

Since then, Wood says, some empirically oriented psychologists have contacted him to say that they had always been worried about the Rorschach; academics have said they could not understand why he was fussed about a test discredited half a century ago. But the Rorschach empire of courses, tests and fees has continued to thrive. (The British Psychological Society believes it is rarely used today in the UK, but the University of East London has run and validated several Rorschach training workshops in the past five years.)

Every day, Wood estimates, in courts and hospitals throughout the US, people lose their liberty or their children because of a psychological diagnosis from the Rorschach. "It would be funny if it wasn't so sad," Wood says. His interest in the Rorschach arose from such a case: a woman who claimed that her ex-husband had abused her child lost custody because of a damaging Rorschach analysis. The abuse was later proven. That set Wood and his fellow authors on a hunt to explain the Rorschach's longevity.

Klopfer's efforts and the mushrooming of psychology both played a role, he says. But there were other reasons: money, the cultish atmosphere that grew up around Rorschach interpreters, self-deception and hindsight bias, poor scientific understanding of norms and bias, the fact that without the Rorschach clinical psychology would have had no scientific clothing.

The book does not quite call on clinical psychology to bury the Rorschach outright. One author, Howard Garb, says there should be a moratorium on Rorschach use until research has proved or disproved its effectiveness. The others, all of whom were until recently Rorschach operators, say they want the profession to discuss the science and then decide. They believe, they imply, that the clinical psychology profession will eventually grasp that "if the history of science teaches us anything, it is that common sense and intuition can be undependable barometers of the truth".

What's Wrong with the Rorschach? , by James M. Wood, M. Teresa Nezworski, Scott O. Lilienfeld and Howard N. Garb, will be published by Josey-Bass/John Wiley on April 11 (£18.95).