This question stems from someone in my family right now. Sometimes, courts will order psychological evaluations - I bring this up to note that the psych eval, in such a case, is involuntary.
The individual will seek out a mental health professional, get a report/recommended treatment, and report back to the court. What stops, say, a bi-polar individual or a high-functioning borderline personality disorder person from “gaming” the evaluation? Knowing that a negative result could have negative effects on the status quo of their life, it seems that the individual has a strong vested interest in giving the evaluator every answer they need to hear so no actions are taken. This seems like an especially high risk among people who usually tend to dishonesty/generating confusion anyway.
To give this a GQ question: what methods does a mental health professional use to evaluate persons who are actively trying to avoid an accurate evaluation? How could they find out a personality disorder/mood disorder based only on interviews, exams, etc.? What happens in these evaluations?
There are two fundamental situations I can think of in which a court has a material interest in a psych eval of a person of interest:
•the person of interest, or the attorney representing that person, is alleging that the person lacks capacity and hence cannot be held legally liable for their actions; or
• the person of interest is the subject of allegations made by someone else that they are impaired and that therefore some intervention (guardianship, involuntary psychiatric detention, forced psychiatric treatment etc) should be ordered
In the second situation I don’t think there’s any reasonable consideration for the possibility that the person of interest can game the system. (If you can do that, you must not be all that impaired, yes?)*
Confining ourselves to the first situation, there is indeed a suspicion that the person of interest will attempt to represent themselves as impaired in ways they are not in order to escape responsibility for their crimes. I think it is common in some venues for more than one psych expert to take the stand, one as a witness for one side and one as the witness for the opposing side.
Keep in mind that the act of doing an evaluation of this sort is not an empirically driven fact-rooted excursion; at best it’s an art that relies on experience and the consideration of a lot of intangibles, at worst it’s a guesstimate strongly influenced by cultural and personal values of the person doing the assessment.
ETA: there may be some UNreasonable consideration; judges do some damn frustrating things
My understanding is that the tests can compensate for some degree of deception. The example I heard was that suppose schizophrenics claim to have a better sense of smell than other people. As far as a test for schizophrenia, it doesn’t matter whether schizophrenics really have a better sense of smell, mistakenly believe that they have a better sense of smell, or knowingly lie about having a better sense of smell. It’s the correlation of the claim with schizophrenia that matters not the accuracy of the claim itself.
That said, these just cover the first level of deception. A mentally ill person who’s aware of the answers that a psychologist is looking for can then use that knowledge for deceit. A schizophrenic who knows that schizophrenics claim to have a better sense of smell can lie and tell his psychologist that his sense of smell is average.
I can think of another: the DA might be interested in administering a test for psychopathic mentation (I am sure there are lots of those ready to be used). Perhaps there are such tests which claim to be able to focus narrowly, such as on tendencies toward kleptomania, or tendencies toward homicidal aggression.
I am not sure a defendant can be compelled to take such a test, maybe one of our legal eagles can shed some light on that issue.
IANAD and I don’t intend to present myself as even remotely qualified as one. This is all anecdotal.
The concept you’re looking for is “validation.” Most of my experience is limited to folks presenting claims of cognitive impairment associated with alleged brain injuries. The evaluations are rather lengthy and very detailed. The patient’s results are compared to known control subjects and then further evaluated through the lens of the psychologist’s professional experience. Different sorts of maladies will manifest in different ways, and unusual or inconsistent results tend to stand out. Now this sort of examination is, admittedly, different from one focusing on a psychiatric disorder but there is at least one common element that I’ve seen. The tests are lengthy and complex by design. If your responses are genuine, then one would expect consistent, predictable results. If you’re faking it, then you are more likely to respond consistently inappropriately.
For example, if you’re really wanting a “fruitcake” diagnosis you might be inclined to respond with extra nutty answers while drooling all over yourself and chewing your doctor’s toenails. Over the top responses will start to ping the doc’s BS meter and the test may be determined to be “invalid.” On the other hand, if you really ARE a fruitcake you’re more than likely going to respond predictably according to the demons afflicting your brainorgan. I personally witnessed this when my son was being interviewed by a shrink who suspected bipolar disorder–it was terrifying and fascinating to watch as doc used simple conversation and body language to push various of the kid’s buttons to elicit responses that a ‘normal’ kid would have just ignored or been confused by.
Also: the test subject is never really certain when the test has started, when it’s ended, and what parts of the evaluation are relevant as opposed to just filler.
I know a guy who decided to escape the draft via a mentally unfit designation (not in the US). He did not just walk in drooling all over the place. He decided on what his condition was going to be and read up a lot on that condition and all the symptoms. Aced it.
[Weird thing was that he managed to minimize actually lying by saying a lot of true statements that could easily be misinterpreted as resulting from his ostensible condition. I remember in particular that he never rode public transportation and that his “wife didn’t let him shop for groceries”, but there were others.]
When the movie “One Flew Over the Cuckoo’s Nest” came out, there was a lot of news about mental hospital conditions. I recall an article by one reporter who got himself committed to a mental hospital. he found the easiest people to fool were the doctors, who spent maybe an hour or two a week with him (budget constraint?). The attendants suspected something was up, and most of the inmates told him “what the hell are you doing here? You don’t belong in here.”
But again, who cares? The prosecutors know what they are looking for, their people have interacted with the suspect for a decent amount of time, they pick a doctor who will tell them what they want to hear and they tell him what they’ve seen so far to get the doctor looking for deceptive behaviour. Unless they have been totally oblivious, there won’t be any great surprise in what the doctor says. Ditto for the defence.
A guy who was relatively coherent when first arrested, for example, will have trouble pulling off the raving loonie defence. It takes years of previous history to pull off a “too stupid” defence. Schizophrenic has its own evidence trail.
Just to give you some context, the actual real-life scenarios I am thinking of are:
[ul]
[li]an evaluation ordered as part of a divorce/custody proceeding[/li][li]in another case, an evaluation ordered as part of a criminal plea where the defendant agreed to undergo a psychiatric evaluation (and he agreed to comply with the recommended treatment)[/li][li]a very old “family story” of a distant relative (who I can verify is mentally screwed up in some very significant ways) gaming a court-ordered evaluation and getting an “all-clear” when she really wasn’t. On this last one, I am aware of the HUGE signal-to-noise ratio of old family stories, so take that as you will.[/li][/ul]
The first two of these are what made me think of this question. They are scenarios that are kind of the opposite of something like the opposite of Vincent Gigante (the “Oddfather”), who acted crazy to try to get out of trouble…more like scenarios where it is useful to put on a good front for the evaluation and get a (possibly misleading) clear report
This is part of what I was thinking of…like how does the evaluator look for signs of an illness in spite of a patient feigning OK-ness. What sort of tactics/methods/so on. Does anyone know any more examples?
I suppose this would be one of the methods, counting on the inability of people to sustain a deception over a long period of time.
What really made me think of this was particularly the first item above under the bullet points (the second individual is still pending as far as I know and the evaluation hasn’t happened yet)
In the first situation (the divorce proceeding), the psychologist did an evaluation, and then, due to the vigilance of the other party, was provided some additional documentation that the subject was unaware of. In a later deposition of the psychologist, he remarked that, if it were not for the additional documents, he would have had an inaccurate psych evaluation due to the deceit of the person being evaluated. That kind of blew my mind, thinking it wouldn’t be that easy.
How does anyone tell if someone’s lying? A good psychiatrist* is a person of above average emotional intelligence who’s had his social skills refined by book learning. However, psychiatry is an art, not a science, nor are psychiatrists mind readers. They can be wrong about people, just like anyone else, as in this famous example.
*Never mind what a bad one is
Something else that can affect evaluations is timing.
Last time I was with my grandmother she was just fine. Exactly one week before, we spent three hours together and had the same conversation five times because she kept forgetting it. My aunt is diagnosed with PTSD and depression, but right now she’s in a manic phase - and, since she’s on top of the world and there is nothing wrong with her nor has ever been, she’s not seeing her doctors. Any of them, neither the psychiatrist nor the oncologist nor the internist.
One Flew Over the Cuckoo’s Nest, the novel, came out in 1962 and caused a lot of news and controversy about conditions and treatment in mental hospitals ever since.
The movie came out in 1975, and brought the controversy to even much greater public attention.
Do you have a cite about the reporter who got himself committed to a mental hospital? You might be thinking of the Rosenhan Experiment, published in 1973, before the Cuckoo’s Nest movie came out. coffeecat linked to the Wiki page a few posts above. Here is a link to a copy of Rosenhan’s actual report, On Being Sane in Insane Places.
This involved more than just one person. Rosenhan, a psychologist at Stanford, recruited a dozen or so people to go to several hospitals, complain they were “hearing voices”, and get themselves committed. Then, their instructions were to immediately drop all pretenses of having any mental problems and just act normal, and see how long it would take for doctors to recognize that there was nothing wrong with them. Result: Then never did, and Rosenhan even had to intervene in a few cases to get them out. (ETA: They also noted that other real patients realized there was nothing wrong with them, and made comments like md2000 mentions above.)
They noted that the doctors and staff tended to interpret every action of every patient, even perfectly normal actions, as the acts of insane persons. One subject was seen taking notes, and the nurse wrote in his chart “Patient exhibits writing behavior” or something like that. At one hospital, the bored patients tended to gather around the cafeteria around lunchtime. A psychiatrist, leading a class of students through, pointed them out and declared that they exhibited “oral-acquisitive behavior”.
Some of the standardized tests have many questions, validated by large statistical studies of other subjects’ answers to those questions. The MMPI (Minnesota Multiphasic Personality Inventory) is a major and widely used example of such a test. It has 400-some true/false questions, a great many of which seem totally off-the-wall. There are lots of items like “I like to read sports magazines” or “Strange smells come to me at times”. Mostly, none of the questions directly point to psychological problems (maybe some do). Instead, they are questions that, statistically, many people with various particular psychological problems answered in a particular way. This sounds like you could get false readings on any one question, but with that many questions, you can get a statistically valid read on the patient’s psychological condition on many different measures.
(ETA: I don’t know if schizophrenics actually are more sensitive to smells, as someone mentioned above. But it’s apparently a known fact that they often say they are. That’s the sort of thing that a lot of MMPI questions catch.)
There are also many consistency checks in the test – questions that nearly all people would be expected to answer in a particular way, and duplicate or near-duplicate questions scattered throughout. This gives a measure of how truthful the patient is being. There may also be a lot of filler questions.
So the test is considered to have high validity and is not easily gamed.
ETA: What I would be skeptical of, would be those psychological tests that have only a small number of questions, like maybe just five or ten questions. I think I’ve seen examples of tests like that posted on Wikipedia. (One might also wonder about the validity of tests after they questions have been posted publicly on-line too.)
I think everyone understands that these days, it’s a lot harder to get involuntarily committed to a psychiatric hospital that it used to be, and the criteria for doing so are a lot tighter in many (most?) states.
I believe that Cuckoo’s Nest and the Rosenhan experiment, and the controversy they caused, were very significant factors in changing the public perception of mental hospitals and involuntary commitment, and in bringing about the changes in the laws regarding that.