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Rorschach and the brain

Rorschach and the brain. Helge Malmgren 22th IRS congress, Paris, 19 July 2017. Four different approaches. Finding/using Rorschach profiles for diagnosing the general ”organicity” of clinical cases. Example: Piotrowski’s 10 signs

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Rorschach and the brain

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  1. Rorschach and the brain Helge Malmgren 22th IRS congress, Paris, 19 July 2017

  2. Four different approaches • Finding/using Rorschach profiles for diagnosing the general ”organicity” of clinical cases. Example: Piotrowski’s 10 signs • Finding/using Rorschach profiles for diagnosing specific organic mental syndromes or disorders. Example: Amnestic Syndrome/Korsakoff • Using the Rorschach to elucidate the nature of specific organic mental syndromes or disorders. Example: Amnestic Syndrome/Korsakoff • (Elucidating the processes behind Rorschach responses using brain imaging, neurophysiology or other ”objective” methods. Example: M and mirror neurons. Not today!)

  3. Are there any ”organic” mental disorders? • In 1992, Spitzer et al suggested abandoning the concept of organic mental disorders since it suggests a false dichotomy between those mental disorders that have a biological basis and those that have not. • DSM-IV (1994) followed this suggestion • Spitzer’s idea was in my view a big philosophical mistake, and it has had deleterious consequences for research and clinical practice • Organic mental disorders are those where the causative biological process cannot also be described in psychological terms (as it can, for example, in grief reactions). • Recognizing mental symtoms as organic rather than psychogenic may be very important for treatment and prognosis. • If there is time: Mild neurocognitive disorder (DSM-V), or astheno-emotional disorder (AED, Lindqvist & Malmgren 1993), is a case in point. It is not purely cognitive! • It is best known as a consequence of traumatic brain injury (TBI) but occurs in a multitude of conditions such as brain tumour, endocrine disturbances, infections etc. • It is not seldom the first sign of that condition, and then its organic nature must not be missed. But it is too often taken to be psychogenic. • Rorschach could be very helpful for diagnosis in these cases, as well as in monitoring the course of AED.

  4. AED – the by far commonest organic mental disorder

  5. ”Organic signs” • Example: Piotrowski’s 10 signs • Undoubted but limited validity (see e.g. Goldfried et al 1971) • The first and second sign are among the most useful, but cannot be used in the CS or R-PAS due to different administrative procedures • Suggestions (not only relevant to Piotrowski’s signs, but to today’s topic in general): - Start measuring response and reaction times - Collect responses in two rounds, the first using only Rorschach’s/ Bohm’s prompting procedure - Use more of Bohm’s ”special Rorschach phenomena”, e.g. colour shock (cf. Malmgren 1999) But who is this Bohm?

  6. The unknown classical tradition • Bohm’s Lehrbuch was the standard European textbook for many years • The 4th edition (1972) has been reprinted 4 times, last time in 2004 • Exner, in The Rorschach Systems (1969), does not describe Bohm’s system – only the American ones • In the 4th ed of Exner’s CS (2003), only the first edition of Bohm (1957, English transl. 1961) is mentioned. • The same holds for The Inkblots by Damien Hirst (2017). • Research and practice using Bohm’s method has been dwindling since the 1970’s, but there are still a few enthusiasts left (cf B. Sindelar, and see Eichenberg et al 2017). • Obvious suggestion: Translate the 4th edition of Bohm into English!

  7. A few references • Bohm, E. (1972). Lehrbuch der Rorschach-Psychodiagnostik. (4 ed.). Bern: Huber. – Later editions including the 8th (2004) are essentially reprints of the 4th. • Caputo, J. S. (1989). Rorschach Studies of Neuropsychological Groups of the Past, Present, and Future: A Historical Review of the Literature from 1867 to the Present, with a Delphi Forecast Into the 21st Century (Doctoral dissertation, Central Michigan University). • DSM-IV. Diagnostic and statistical manual of mental disorders, 4th Ed. (1994). Washington: American Psychiatric Association. • Eichenberg, C., Schott, M., Decker, O., Sindelar, B. Attachment Style and Internet Addiction: An Online Survey. J Med Internet Res 2017;19(5):e170 • Exner, J. (2003). The Rorschach: A comprehensive system. (4 ed.). (Vol. 1). New York: Wiley. • Goldfried, M., Stricker, G., & Weiner, I. (Eds.). (1971). Rorschach handbook of clinical and research applications, Ch. 11 (306–44): Organic signs. Englewood Cliffs, NJ: Prentice-Hall. • Lindqvist, G., & Malmgren, H. (1993). Organic mental disorders as hypothetical pathogenetic processes. Acta Psychiatrica Scandinavica, 88 (Suppl. 373), 5-17 • Malmgren H. (1999), Colour shock - does it exist, and does it depend on colour? Oral presentation at the 16th IRA Congress, Amsterdam, July 19-24, 1999. • Malmgren, H. (2000), Rorschach's Idea of a ’Movement’ Response in the Light of Recent Philosophy and Psychology of Perception. Rorschachiana, 24, 1-27. • Piotrowski, Z. (1937), The Rorschach inkblot method in organic disturbances of the central nervous system. Journal of Nervous and Mental Disease, 86, 525-537. • Searls, D. (2017), The Inkblots. Hermann Rorschach, his iconic text, and the power of seeing. Crown Publishers, New York. • Spitzer, R., First, M., Williams, J.et al. (1992). Now is the time to retire the term “Organic Mental Disorders”. American Journal of Psychiatry, 149, 240-4.

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