Sunday, August 30, 2009

Outing the Rorschach Inkblots (2)

A few weeks ago I wrote about the controversy surrounding the publication in Wikipedia of the ten Rorschach inkblots accompanied by the most common responses. (See the original post here.) Now two psychologists have filed complaints with the Saskatchewan Medical Society against Dr. James Heilman, the emergency room physician who posted the images.

Here's the gist of the complaints (see here for more details):
One of them, Andrea Kowaz of the College of Psychologists of British Columbia, complained that by including the inkblots on Wikipedia, Dr. Heilman was violating the test’s secrecy and that if he were a psychologist his behavior would be “viewed as serious misconduct.”

The other letter, from Laurene J. Wilson, a psychologist at Royal University Hospital in Saskatoon, echoed the concern about the test’s security but added that Dr. Heilman “shows disrespect to his professional colleagues in psychology and disparages them in the eyes of the public.”

Dr. Wilson said she had read interviews with Dr. Heilman in which he “refers to psychologists as undertaking practices akin to a magic show with smoke and mirrors.”
I side with Dr. Heilman.

Dr. Kowar accuses Dr. Heilman of "violating the test's secrecy." But the test is just a series of inkblots and an interpretive system. Secrecy is a commitment psychologists make about the test and an aspiration they hold for it. The commitment is a piece of professional self-regulation and isn't binding on others. And a visit to Amazon will show that the secrecy cat is long since out of the bag. All the major texts on Rorschach interpretation are readily available. The idea that the images and the theories about how to interpret responses are secret is a naive fantasy, and the claim that a professional society's code of ethics applies to people outside of the profession is muddled thinking.

Dr. Wilson raises a more vexing question - what do professionals owe to each other in terms of public respect or disrespect? Putting aside the fact that psychology and medicine are different professions, professional etiquette has long demanded that physicians speak of each other respectfully in public. At best this expectation avoids undermining patient respect for doctors who deserve to be respected. At worst it protects colleagues from justified criticism and prevents action to protect patients from harm.

I don't agree that competent psychologists are conducting "practices akin to a magic show with smoke and mirrors" any more than I see emergency room doctors as butchers, even though some psychologists are presumably smoke and mirror charlatans and some ER doctors are probably dangerous butchers. If Dr. Heilman spoke this way and I were part of the Saskatchewan Medical Society I would point out that public trust is crucial for the health professions. He should be free to make reasoned and evidence-based critiques of medical (including psychological) practices, but name calling is demeaning to him as well as to those the names are aimed at. Respectful debate can improve practice and will enhance public trust that the health professions are doing their best to get things right. Name calling does nothing for quality and makes professionals look like children squabbling in a sandbox.

This, however, does not rise to the level of being an ethical violation. I'll be surprised if the Saskatchewan Medical Society concludes otherwise. The Society usually responds within 60 days, so stay tuned!


Unknown said...

Hey Jim

Few comments on the Rorschach. First of all my exact quote was "the Rorschach is a bit of smoke and mirrors". I was in no way refering to all of psychology. A very similar comments is found in psychologies own literature. James Wood a PhD psychologist from Texas writes in 2003 that "some sectors of psychology regard the test as an unfortunate vestige from the discipline's past, only one step removed from tea leaves and crystal balls."

He also called for a moratorium on this tests use until evidence is generated to show that it is 1) safe 2) effective


Jim Sabin said...

Hi Jim

Great to hear from you. What a ride you've had over posting the Rorschach images! Has the medical society addressed the complaint the psychologists brought against you yet?

I understood that "smoke and mirrors" was being applied to the Rorschach and not to all of psychology. But in my view Dr. Wood's comment is off base. In psychotherapy we know from research that the quality of the therapist matters. "Psychotherapy" isn't a single entity - it's delivered by clinicians in whose hands it is variably effective. I'd bet dollars to donuts that the same is true for the Rorschach. Over the years I dealt with some terrific psychologists, and with them the test was a lot more than "tea leaves and crystal balls," but I'm sure there are Rorschach interpreters whose work is worse than tea leaves, since in our society the psychologists ares taken more seriously than Gypsies!