Tuesday, August 4, 2009

Outing the Rorschach Inkblots

There's been a free-for-all at Wikipedia over the publication of Herman Rorschach's famous inkblots.

When the article initially reproduced one of the ten images controversy began to bubble, with psychologists describing the action as an irresponsible threat to the integrity of the test itself. At this point Dr. James Heilman, an emergency room physician at Moose Jaw Union Hospital in Saskatchewan posted all ten, along with the most common interpretations printed underneath each.

I spent several hours today reading the fascinating and often vitriolic exchange on the Wikipedia talk page. It's a tectonic encounter between two cultures - the let-it-all-hang-out openness of the web banging against a concept of professionalism as a self-regulating societal resource. So far they're largely talking at each other, but the argument they're having could provide the basis for an excellent ethics class.

Sometimes the Wiki folks get hot under the collar ("only fascists withhold data") but the basic thrust and strongest argument echoes John Milton's Aeropagitica:
I cannot praise a fugitive and cloistered virtue, unexercised and unbreathed, that never sallies out and sees her adversary, but slinks out of the race where that immortal garland is to be run for, not without dust and heat.
The Wiki perspective is that people have the right to know about as important a cultural phenomenon as the Rorschach test and to think about it for themselves.

The psychologists in the discussion are on strongest ground when they argue that (a) publishing the Rorschach images accompanied by (b) the commonest responses could (c) undermine the validity and usefulness of a test that (d) contributes to psychiatric treatment, court proceedings, and other socially important activities.

The discussion contains a lot of back and forth about the validity of the test itself. Some of the Wiki folks argue, in effect, "the test is worthless, so what's the problem with publishing the images and interpretations?" The psychologists respond by citing research studies they see as showing the value of the Rorschach test. But this pi - - - ng contest isn't the important part of the debate.

I'm not an expert on psychological testing, but in my practice I had enough occasion to see the results of testing of my patients to believe that in skillful hands the Rorschach has a real contribution to make. And I understand the psychologists' concern that the Wikipedia article can lead to gaming of the test by people who want to appear sicker than they are to avoid legal prosecution or healthier than they are to get out of a hospital and, at worst, commit suicide.

But even if the psychologists are right, and the publication of the images along with modal responses weakens the test, we're in a radically different world than when Herman Rorschach published "Psychodiagnostik" in 1921. There's simply no way of keeping knowledge about how the test is interpreted secret from the public. As one of the Wiki folks said - "the horse is not only out of the barn - it is in the freaking next country..." I don't think that's a bad thing - certainly not for society, and even for psychological testing itself.

Hypnosis started as an authoritarian stage technique ("you are in my power...!"), but by the time I first studied it in the early 1970s it had evolved into a highly collaborative "permissive" format, in which therapist and patient designed the approach together. (See here for a discussion of the ethics of hypnosis.) If the publication of the inkblots has any of the impact the psychologists fear I expect that they will develop new ways of giving and interpreting the test, as by talking with the person being tested about what they know about the test and encouraging them to put aside what they've read and heard to use the inkblots for a constructive purpose.

It may be easier to game the test than in the past, but Wikipedia didn't create this risk. If I were coming to court and knew I would be examined by a prosecution psychologist it wouldn't take me long to thumb through the Yellow Pages for psychologists to help me case the tests I'd be confronted with. Psychological testing will have to evolve on the basis of more collaboration and openness than has been true in the past, just as hypnosis had to evolve from an authoritarian to a permissive format.

With the publication of the Rorschach materials, psychologists are experiencing what other health professionals have already encountered - the "empowered" patient, and a skeptical public. Adapting to these changes isn't easy for professionals, but I think doing so is respectful of our patients and ultimately makes us more effective in our mission. But even if I'm wrong about this, as the Wiki participant said, the horse is in the freaking next country, so we don't have much choice!

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