THE VALUE OF THE RORSCHACH TEST IN DIFFERENTIAL DIAGNOSES

Abstract

The diagnosis of typical or advanced cases of the various psychiatric syndromes is made without difficulty by competent psychiatrists. One’s diagnostic acumen is often put to a severe test, however, in the differentiation of early and incipient cases of mental illness. Probably the 3 more common disorders which give the most difficulty in this respect are certain of the psychoneuroses, psychopathic personalities, and the schizophrenias. Often the diagnosis is made principally on anamnestic data and less on the signs and symptoms which may be observable in the patient. Difficulties in the determination of early schizophrenia have been recognized by Polatin and Hoch( I) and of psychopathic states by Karpman(2). The initial symptoms of these 3 disorders indicate varying degrees of social maladjustment and illogical behavior which are often interpreted and explained by the psychiatrist as pointing to one of these syndromes. Often in staff discussions there may be a division of opinion and consequent difficulty in arriving at a definite decision in determining what the treatment should be. After a lapse of time, varying from weeks to months or even years, the symptoms and findings become more clear-cut and the patient can finally be accurately labeled but, in the meantime, treatment may have been unscientific. In this type of case the Rorschach test can play the decisive role in the determination of the personality type and diagnosis. Rorschach diagnostics are not by rule of thumb but often when there has been a marked diversity of opinion among psychiatrists the findings according to this test are more definite and clear-cut and point without doubt to one diagnosis rather than several. Personality types probably do not change. The neurotic, the psychopath, and the schizophrenic have a more or less characteristic way of thinking and deciding problems. The