Wednesday, July 15, 2009

The myth of the chemical cure - It only gets you stoned

A commentary publish on the BBC website It looks like the drugs merely get you stoned or something, and cost way too much as well.

Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance.

Medication is a mainstay of mental health therapy

But in this week's Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states".

If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it.

It's not just doctors that think this way, either.

Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin.

The trouble is there is little justification for this view of psychiatric drugs.

Altered states

First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.

Second, it is often said the fact that drug treatment "works" proves there's an underlying biological deficiency.

Psychoactive drugs make people feel different

But there is another explanation for how psychiatric drugs affect people with emotional problems.

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis.

Psychoactive drugs make people feel different; they put people into an altered mental and physical state.

They affect everyone, regardless of whether they have a mental disorder or not.

Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce.

Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis.

Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation.

Drugs labelled as "anti-depressants" come from many different chemical classes and produce a variety of effects.

Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

'Informed choice'

Views about psychiatric drugs changed over the course of the 1950s and 1960s.

They gradually came to be seen as being specific treatments for specific diseases, or "magic bullets", and their psychoactive effects were forgotten.

However, this transformation was not based on any compelling evidence.

In my view it remains more plausible that they "work" by producing drug-induced states which suppress or mask emotional problems.

If we gave people a clearer picture drug treatment might not always be so appealing

This doesn't mean psychiatric drugs can't be useful, sometimes.

But, people need to be aware of what they do and the sorts of effects they produce.

At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.

That sounds good. If your brain is not functioning properly, and a drug can make it work better, then it makes sense to take the pill.

If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.

If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could.

On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.

People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems.

To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce.

How to Interpret Your Rorschach Ink Blots

I occasionally poke around the news site Reddit, and came across this discussion related to the Rorschach Ink Blots. It seems only fair to post some of the interpretation summaries so that Redditors can see how they did.

From a legal standpoint, the Rorschach test images have been in the public domain for many years in most countries, particularly those with a copyright term of up to 70 years post mortem auctoris. They have been in the public domain in Hermann Rorschach's native Switzerland since 1992 (70 years after the author's death, or 50 years after the cut-off date of 1942), according to Swiss copyright law. They are also in the public domain under United States copyright law where all works published before 1923 are considered to be in the public domain. This means that the Rorschach images may be used by anyone for any purpose. William Poundstone was, perhaps, first to make them public in his 1983 book Big Secrets, where he also described the method of administering the test

I imagine that these days a lot of people will see imagery from many of the games they have played, movies they have seen, local TV shows, popular songs, etc. The standard imagery seems to be based on psychoanalysis and original conjectures of the 1920s. It would probably be dangerous to try to derive universals, when so many variations exist between cultures and subcultures, etc in each region of planet earth.

For example, a Yankee team uniform has different meaning in New York City vs in Boston. (The two cities are known for a long standing sports rivalry)

Thus we come to this SPECIAL NOTE OF IMPORTANCE: There are different responses seen as normal depending on culture!!! Something interpreted as normal in one culture (Europe, etc) can be seen as a sign of schizophrenia in another culture (North America). Military people have different responses compared to nonmilitary. Different political parties have different responses.

For these and other reasons, I believe that the tests are NOT valid. What is given below is a combination from various sources. I regard inkblots to be no better than fortune-telling.

Origins of the Test

As a child, Hermann Rorschach was a big fan of a popular game called Klecksography, so much so that his nickname was "Kleck" (meaning "inkblot"). The idea of the game was to collect inkblot cards that could be bought from local shops and make associations and stories from the inkblots.

Rorschach went on to study psychiatry and while training, in 1918, he noticed that patients diagnosed with schizophrenia made radically different associations to the Klecksography inkblots than did normal people. He therefore developed the Rorschach test as a diagnostic tool for schizophrenia.

In 1896, a similar game was described in the United States by Ruth McEnery Stuart and Albert Bigelow Paine in a book titled Gobolinks, or Shadow-Pictures for Young and Old. The book explained how to make inkblot monsters ("gobolinks") and use them as prompts for writing imaginative verse.

The term Klecksography originates with the doctor and poet Justinus Kerner (1786-1862). Kerner also dealt with the interpretation of the images. After the color blobs were interpreted, he drew conclusions about the nature of the person. The interpretations were made using poetic rhymes.

As an artistic device and technique, the nature of the resulting images are affected to some degree by selective application and choice of the paint volume. Among the artists who experimented with Klecksography is J. Beuys.

Notes on the scientific value of the test

Rorschach never intended the inkblots to be used as a general personality test, but developed them as a tool for the diagnosis of schizophrenia. It was not until 1939 that the test was used as a projective test of personality, a use of which Rorschach had always been skeptical. Controversy about the reliability and validity of the Rorschach has been present since its conception. Today, many - probably most - psychologists think the Rorschach is nonsense.

A survey conducted on the members of The American Psychological Association Division-12, and The Indian Association of Clinical Psychologists showed concern from respondents about the limitations of the test (Wade et al 1978; Sharma, Ojha and Vagrecha, 1975; Dubey, 1982). Zubin (1965) has charged seven major failures as follows:
  1. Failure to provide an objective system, free of arbitrary conventions, and showing high interscorer agreement.
  2. Lack of satisfactory internal consistency, or test-retest reliability.
  3. Failure to provide cogent evidence for clinical validity.
  4. Failure of the individual Rorschach scoring categories to relate to diagnosis.
  5. Lack of prognostic, or predictive validity with respect to the outcome of treatment, or later behavior.
  6. Individual differences between groups of normal subjects.
  7. Failure to find any significant relationships between Rorschach scores and intelligence, or creative ability.
Many professionals now feel that the Rorschach is outdated, inaccurate, and meaningless. For example:
"Nobody agrees how to score Rorschach responses objectively. There is nothing to show what any particular response means to the person who gives it. And, there is nothing to show what it means if a number of people give the same response. The ink blots are scientifically useless." (Bartol, 1983).

"The only thing the inkblots do reveal is the secret world of the examiner who interprets them. These doctors are probably saying more about themselves than about the subjects." (Anastasi, 1982).
What these comments seem to indicate is that the Rorschach is potentially unreliable, easily misinterpreted, and essentially not a valid means of determining what it claims to detect. For more information on the use and potential unreliability of the Rorschach test read "Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples" by Ralph Underwager and Hollida Wakefield.

Notes for if you take the test

Every Rorschach image has at least one obvious representation of sexual anatomy. You're not expected to mention them all. In some interpretation schemes, mentioning more than four sex images in the ten plates is diagnostic of schizophrenia. Most Rorschach workers believe the sex images should play a part in the interpretation of responses even when not mentioned.

The trouble is, subjects who took Psychology 101 often assume they should detail every possible sex response, so allowances must be made. People have since also come up with various methods and systems to try to objectively score the tests, but a lot of it is still the basis of you think it should mean this, and they think it should mean something else. It is like dream interpretation or fortune telling.

Your best bet when taking the test is probably to stick to "seeing" healthy, friendly images. Avoid dark or violent answers ("I see a monster eating a baby's brain!"). Butterflies, people holding hands, leaves, mountains, etc are all generally considered to be "safe" responses (although nothing is guaranteed when taking the Rorschach). If you can show how a particular shape really does resemble something, go ahead and say so. If you come up with a novel or particularly interesting answer you may get "points" for your creativity. The fact is, however, that in the end it's mostly up to the examiner as to how your responses are interpreted.

Further notes and advice on taking the test from this source
Just as secret as the blots themselves are the ground rules for administering the test. There are a few things that you, as a subject, are supposed to know and a lot of things you aren't supposed to know. If you ask about something you're not supposed to know, the psychologist will give you a pat answer as prescribed in Rorschach literature. For example, if you ask if it is okay to turn the card upside down, the psychologist will respond that you may do as you like; it's up to you. The psychologist won't say that many of the cards are easier to interpret when turned; that most people do turn the cards; that he or she will make a notation with a little arrowhead every time you do turn a card; and that you lose points in the initiative department if you don't turn the cards.

You'll be handed the cards one by one in the fixed order devised by Rorschach (there are numbers on the backs of the cards for the psychologist's benefit). The first card, for instance, looks like a fox's head or a jack-o-lantern. The cards are thick, rectangular cardboard, 6 5/8 inches by 9 1/5 inches. Half of the blots are black ink on a white background. Two others are black and red ink on white, and the last three blots are multicolored. The psychologist will always put each card in your hands "right" side up.

You aren't supposed to know it, but the psychologist will write down everything you say. This includes any seemingly irrelevant questions you may have. To keep you from getting wise, the psychologist always arranges to sit to your side and a little behind you, so that you can't look at the card and the psychologist at the same time. Most subjects realize the psychologist is taking notes, of course, but they don't realize that the notes are a special shorthand record of everything said. Some psychologists use hidden tape recorders.

The psychologist will also time how long it takes you to respond, using a "tickless" watch. The psychologist will not ask you to hurry up or slow down and will not make any reference to time, but response times (in seconds) are one of the things he or she is writing in the notes.

Don't hold the card at an unusual angle. Watch how you phrase things. Say "This looks like ..." or "This could be ..." never "This is..." After all, you're supposed to realize that it is just a blot of ink on a card. By the same token, don't be too literal and say things as, "This is a blotch of black ink." Don't groan, get emotional, or make irrelevant comments. Don't put your hands on the cards to block out parts. The psychologist will watch for all of the foregoing as signs of brain damage.

If there are no right answers for the test, there are some general guidelines as to what is a normal response. You can probably see images in the inkblots proper and in the white spaces they enclose. Stick to the former. Don't be afraid of being obvious. There are several responses that almost everyone gives; mentioning these shows the psychologist you're a regular guy.

It is okay to be original if you can justify what you see in the shape, shading, or color of the blot. If you see an abalone and can point out why it looks like one, then say so. Justifiable original responses are usually judged to be indicative of creativity or intelligence.

You don't want non sequiturs, images that don't fit the blot in the judgment of the psychologist. These may be interpreted as signs of psychosis. *(Comment: Again the cultural variation is important. If your are a big fan of Star Wars or Batman or Anime, you might upset some shrinks if all of your interpretations are filled with references to these cultural icons!)*

You're expected to see more than one thing on all or most of the cards. Not being able to see anything on a card suggests neurosis. Usually the more things you can see, the better, as long as they fit the form and color of the blot. Of course, you can see things in the whole blot or in parts of it, and images may overlap. *(Comment: Note more intelligent people tend to score higher on many pathology scales, since many scales do not correct for high response rate! if a subject gives twice as many responses overall, it is more likely that some of these will seem "pathological")*

Since time is a factor, it is important to come up with good answers fast. (It looks particularly bad if you take a long time and give a dumb, inappropriate answer.)

Information on Interpretations

The information on Interpretations is compiled from data seen at
  2. and
  3. Rorschach Test.htm
Pics are from Wikipedia, and are in the public domain in both Switzerland (their country of origin) and the USA.

Note that these pictures are pretty small, you can click on them to embiggen (i.e., see larger).

The Wikipedia article on the test now forwards the line that there is no specific correct answer to the test, and generally fudges any interpretation.

But see the general notes below, followed by the set of pictures.

I Repeat: SPECIAL NOTE OF IMPORTANCE: There are different responses seen as normal depending on culture!!! Something interpreted as normal in one culture (Europe, etc) can be seen as a sign of schizophrenia in another culture (North America)

French subjects often identify a chameleon in card VIII, which is normally classed as an "unusual" response, as opposed to other animals like cats and dogs; in Scandinavia, "Christmas elves" (nisser) is a popular response for card II, and "musical instrument" on card VI is popular for Japanese people, and different languages will exhibit semantic differences in naming the same object (the figure of card IV is often called a troll by Scandinavians and an ogre by French people).

Many "popular" responses (those given by at least one third of the North American sample used) seem to be universally popular, as shown by samples in Europe, Japan and South America, while specifically card IX's "human" response, the crab or spider in card X and one of either the butterfly or the bat in card I appear to be characteristic of North America.

Some critics argue that the testing psychologist must also project onto the patterns. A possible example sometimes attributed to the psychologist's subjective judgement is that responses are coded (among many other things), for "Form Quality": in essence, whether the subject's response fits with how the blot actually looks. Superficially this might be considered a subjective judgment, depending on how the examiner has internalized the categories involved. One example is that the response "bra" was considered a "sex" response by male psychologists, but a "clothing" response by females psychologists. Scoring systems have be developed to get around this, but in my personal opinion they sound like reading astrology charts, elaborately complex constructions on a foundation of sand.

For these and other reasons, I believe that the tests are NOT valid. What is given below is a combination from various sources. I regard it no better than fortune-telling.

The Rorschach Ink Blots

The cards are numbered 1 through 10, and that is the order in which they're always given to you by the psychologist. The originals are thick, rectangular cardboard, 6 5/8 inches by 9 1/5 inches. This will make a difference on what you see, vs the smaller images on a computer screen.

Plate I

Possible Sexual Imagery: Breasts, primarily the rounded areas at the top of the image.

Good/Common Answers: "Bat, butterfly, female figure (in the centre), moth"

You may be a little paranoid if you see: "Mask, animal face, jack o lantern"

Bad Answer: "Anything insulting about the female figure (it is an indicator of your own body image)"

The first blot is easy. How fast you answer is taken as an indication of how well you cope with new situations. The best reaction is to give one of the most common responses immediately.

A bad response is any that says something untoward about the central female figure. "She" is often judged to be a projection of your own self-image. Avoid the obvious comment that the figure has two breasts but no head.

If you don't give more than one answer for Plate I, many psychologists will drop a hint -- tell you to look closer.

Plate II

Possible Sexual Imagery: Male sex organ at top center or, in some cases, a vagina (at the center near the bottom).

You should see this image as: "Two human-like forms (females or clowns) If you don't it is an indicator that you have trouble relating to people."

Other Good/Common Answers: "Butterfly, cave entrance"

It is important to see this blot as two human figures usually females or clowns.

If you don't, it's seen as a sign that you have trouble relating to people. You may give other responses as well, such as cave entrance (the triangular white space between the two figures) and butterfly (the red "vagina," bottom center).

Should you mention the penis and vagina? Not necessarily. You may not say that the lower red area looks like a vagina, but psychologists assume that what you do say will show how you feel about women. Nix on "crab"; stick with "butterfly."

Plate III

Possible Sexual Imagery: Male sex organs and female breasts, right about where you would expect to find them.

This is the blot that allegedly can determine sexual preference.

A heterosexual response would be: "Seeing two male figures"

A homosexual response would be: "Seeing two androgynous (remember "Pat" from SNL?) or female figures."

Most people see the two human figures. Both figures have prominent "breasts" and an equally prominent "penis." If you don't volunteer the gender of the figures, you'll be asked to specify it.

This blot has been the subject of much debate, so it's best to take your answer's meaning with a grain of salt. Does it work? Not really

The splotches of red ink are usually perceived separately. Common responses are "bow-tie" or "ribbon" (inner red area) and a stomach and esophagus (outer red areas).

Plate IV

Plate IV is the "father card." At first glance it is a difficult blot to see as a single image. The two lower corners are often described as shoes or boots. This card may also be seen as viewing a person from below or a male figure with an enormous sex organ.

The "boots" are fairly conspicuous; between them is the apparent head of a dog or Chinese dragon. Many subjects see the blot as an animal skin. After a few seconds, though, most can see it as a standing figure seen from below.

The boots become the feet, enlarged because of the unusual perspective. The arms and head, at the top, are smaller. Common descriptions are bear, gorilla, or man in a heavy coat. Rorschach theorists equate your description of the figure with your perception of your father or male authority figures.

Possible Sexual Imagery: A pair of male sex organs, typically seen at the top of the image. Some subjects may instead visualize a vagina in the upper center of the blot.

Good/Common Answers: "A standing figure (man, bear, gorilla)"

A Bad Answer Would Be: "To describe the figure as menacing in any way, i.e. a monster, or attacking gorilla, as this blot indentifies with your perception of your father, or authority figures."

Plate V

Possible Sexual Imagery: A pair of male sex organs at the very top of the inkblot.

Good/Common "Answers: Bat, Butterfly"

Bad Answers: "Seeing the butterfly antennae as scissors or any cutting device is an indicator of a castration complex. Schizophrenics occasionally see moving people in this image. Seeing crocodile heads on the ends of the bat's wings indicates hostility."

Rorschach himself thought this was the easiest blot to interpret. It is a bat or a butterfly, period. You don't want to mention anything else.

Many psychologists take particular note of the number of responses given to this plate. If you mention more images here than in either Plate IV or VI, it is suggestive of schizophrenia.

Plate VI

Possible Sexual Imagery: The head of the male sex organ (the portion at the top of the card) or alternately, a female sex organ (middle and bottom part of the card).

Common Answers: "animal hide, boat, submarine, mushroom cloud, men with long noses and goatees. Apparently this blot reveals subconscious attitudes about sexuality."

Occasionally described as a foreshortened view of a person with their arms outstretched.

Basically, the secret of this plate is to turn it. A good response is to say it looks like an animal hide (about the only reasonable response when held right side up), then turn it on its side and say it looks like a boat or surfaced submarine with reflection, and then turn it upside down and say it looks like a mushroom cloud, a pair of theater masks, or caricatures of men with long noses and goatees.

Plate VII

Possible Sexual Imagery: The female sex organs (seen at the bottom of the card where the figures join.

Good/Common Answers: "Two Girls, or Women"

Bad Answers: "Insulting descriptions of the two figures i.e. gossips, girls fighting, witches.

This card has a rough "V" shape sometimes described as faces pointing towards one another, "bunny ears", or similar visualizations.

This blot is supposed to reveal how you really feel about your mother. Virtually everyone sees two girls or women. Deprecating descriptions of the figures~ "witches," "gossips," "girls fighting," "spinsters" indicate poor maternal relations. Seeing the blot as thunderclouds instead of female figures suggests anxiety to some psychologists; seeing it as a walnut kernel may mean a vulvar fixation.

There is an entirely different side to this blot, but you're not supposed to see it. The white space between the girls or women can be interpreted as an oil lamp or similar object. It is claimed that only schizophrenics usually see the lamp.

Plate VIII

A very colorful card with blue, orange, pink, and gray ink. A roughly diamond-shaped image with lots of places to see things

Possible Sexual Imagery: Female sex organs, usually seen at the bottom of the card.

Good/Common Answers: "Four legged animals such as lions, pigs, bears, etc. on the sides. Other common responses are tree, butterfly, rib cage, christmas tree."

Bad/Answers: "Not seeing the four legged animals can indicate that you are mentally defective"

It is important that you see the four-legged animals- lions, pigs, bears, etc. -on the sides of the blot. They're one of the most common responses on the test, and you're assumed to be a mental defective if you don't see them. Other good responses are tree (gray triangle at top), butterfly (pink and orange area at bottom), and rib cage or anatomy chart (skeletal pattern in center between blue rectangles and gray triangles). The entire configuration can be seen as a heraldic design (good answer) or a Christmas tree with ornaments (reaching).

Children tend to like this blot and say a lot about it-the bright colors and animal shapes make it more interesting than your basic penis/vagina number (II, IV, or VI).

Plate IX

Another colorful card, this time with orange, pink, and green inks. This one is tough to visualize anything specific in; most test subjects struggle to find something to "see" in it.

Possible Sexual Imagery: Female sex organs, usually seen at the bottom of the card.

Good/Common Answers: "Fire, smoke, explosion, map, anatomy, flower."

Bad Answers: "Mushroom cloud on the centre line at top can indicate paranoia. Monsters or men fighting can indicate poor social development."

If you're going to throw up your hands (figuratively!!!) and plead a mental block, this is the place to do it. The colors clash, apparently by Rorschach's design.

If you turn the card ninety degrees, you can make out a man's head in the pink areas at bottom. (The man is identified as Mark Twain, Santa Claus, or Teddy Roosevelt.)

As with Plate V, the psychologist may be counting the number of responses you give to this blot for comparison with the preceding and succeeding blots. You want to give fewer responses to this blot.

Plate X

This is the last Rorschach card and certainly the most colorful, consisting of blue, gray, pink, green, orange and yellow inks. It's a very complex mish-mash of shapes with lots of "activity" and plenty of places to "see" things.

Possible Sexual Imagery: Male sex organs at the top center of the card.

Good/Common Answers: "Sea life, or a view through a microscope. Also common: spiders, crabs, caterpillars, rabbit's head"

Bad Answers: "Two faces at top centre blowing bubbles, or smoking pipes can indicate an oral fixation"

The unspoken purpose of this last blot is to test your organizational ability. Plate X is full of colorful odds and ends easy to identify---blue spiders, gray crabs, paired orange maple seeds, green caterpillars, a light-green rabbit's head, yellow and orange fried eggs--and you're expected to list them.

But the psychologist will also be looking for a comprehensive answer, something that shows you grok the whole Gestalt. There are two good holistic answers: sea life and a view through a microscope.

Some subjects see two reddish faces at top center, separated by the orange maple key. If you describe them as blowing bubbles or smoking pipes, it may be interpreted as evidence of an oral fixation. Seeing the gray "testes" and "penis" as two animals eating a stick or tree indicates castration anxiety.

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

As seen on We have not quoted the entire paper, but only the introductory section with a few of the smaller examples.

The original post has many fine examples, plenty of detailed references, and is oriented to situations where parents are separated. Unfortunately, given other news reports of recent years, this paper is still quite relevant

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

Ralph Underwager and Hollida Wakefield

American Journal of Forensic Psychology, Volume 11, Issue 1

Psychological tests are often used inappropriately and are misinterpreted and overinterpreted in the forensic setting. This harms the person being evaluated and interferes with the cause of justice. It also does a disservice to the reputation of psychologists and the science of psychology. Actual examples of misuse of particular techniques and tests and misinterpretation illustrate what has been done in forensic settings.

A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual — a decision which can markedly affect the person's life.

If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.

In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.

In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations.


Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1) notes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The Tenth Mental Measurements Yearbook (2), in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.

Here are some of the examples as given:

Example 2
A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.

When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.

Example 5
A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).

The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.

Example 20
A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations.

We can just imagine the horror that happens when this gets involved with separation and divorce proceedings.

Tuesday, July 14, 2009

Attorneys begin closing arguments in William Ayres trial

As reported in the San Mateo County Times

Closing arguments are expected to conclude today in the trial of Dr. William Ayres, the once-prominent child psychiatrist accused of lewdly touching half a dozen boys under the guise of medical necessity.

Prosecutor Melissa McKowan and defense attorney Doron Weinberg began their closing statements Monday in San Mateo County Superior Court. Ayres, 77, faces nine counts of lewd and lascivious conduct with a minor younger than 14. The charges are based on the accusations of six former patients who argue that they were molested by Ayres between the ages 9 and 13.

McKowan said Monday that a 10th charge had been dropped during the course of the trial that stemmed from the accusations of a man referred to in court as Eric B., who testified that Ayres masturbated him during a physical exam when he was 13. He originally was going to testify that a second incident had occurred, McKowan said.

She told the jury Monday that Ayres performed physical and genital exams exclusively on male patients because he is a pedophile — a psychiatrist who desired to undress, touch and see the bodies of young boys. She referred to the exams he conducted as "sloppy, drop your pants and sit on the table" procedures.

"If genital exams are necessary in the diagnosis of adolescent children with psychological or mental health issues, why would you only conduct those exams on boys?" she asked the jury.

McKowan urged the jury to consider why Ayres kept poor notes of the exams and the unusual conditions under which he gave them. She also pointed out that no witness ever testified for the defense that Ayres taught the importance of physical exams at UC San Francisco, something he told the court last week that he had done.

Judge Beth Freeman issued jury instruction before closing arguments. She told the jury that four former patients who accused Ayres of molesting them but whose charges fall outside the state's statute of limitations can be considered in deciding if Ayres has a disposition to commit sexual offenses, or if their testimony can show that Ayres had a plan to lewdly touch the in-statute accusers.

Weinberg told the jury that there is simply no evidence Ayres committed a crime. He said the case rests entirely on memory, asking jurors to recall the testimony of memory expert Dr. Elizabeth Loftus.

"This case is about memory and memory alone," Weinberg argued. "There is no physical evidence."