At PsychLaw.net we consider a 1929 study examined the opinions of 12 interviewers who interviewed 2000 homeless men, attempting to ascertain the reasons for their homelessness.[1] Co‑workers described one of the interviewers as an ardent socialist. By an almost three to one margin, the “socialist” interviewer concluded the homelessness of the men he interviewed reflected economic conditions beyond their control (lay‑offs, plant closings, etc.). Another interviewer was described as a strong prohibitionist. Again by an almost three to one margin, the “prohibitionist” interviewer attributed homelessness to alcohol abuse. While relying on their clinical judgments, these interviewers demonstrated a remarkable facility for finding evidence consistent with their preconceived expectations.
Despite 70 years elapsing since this landmark study, the problems associated with clinical judgment continue to persist. Curiously enough, professional identity is unrelated to the accuracy of clinical judgment. The judgments of psychiatrists, psychologists, and other mental health professionals are all equally unreliable because they commit the same kinds of errors. To belabor the obvious, the patients they see in treatment exhibit problems more often than effective adjustment. This skewed exposure to maladjustment results in mental health professionals developing an exaggerated sensitivity to psycho-pathology.
In a 1968 study, for example, psychologists and psychiatrists listened to the tape‑recorded interview of a patient who, in fact, was not psychotic.[2] Before listening to the audiotape, a well‑respected clinician ‑ cooperating as a confederate with the experimenter ‑ told some of the psychologists and psychiatrists that the patient was “a very interesting man because he looked neurotic but actually was quite psychotic.” The other group of psychologists and psychiatrists did not encounter this misinformation. When asked to diagnose this patient 60% of the psychiatrists, and 28% of the psychologists, in the “misinformed group” labeled him as psychotic. None of the psychologists or psychiatrists in the “not misinformed group” regarded the patient as this disturbed. The expectations of the misinformed group led them to look for serious pathology of psychotic proportions; and, they found what they looked for.
At PsychLaw.net we look to a 1980 study that further demonstrated the powerful effects of interviewer expectations.[3] In this study, psychiatric residents reviewed written descriptions of people described as: (1) interested undergraduate students taking a psychology course, or (2) undergraduate students recently evaluated for psychiatric hospitalization. Except for these labels ‑ interested student vs. candidate for hospitalization ‑ the written descriptions of these people were exactly the same. Nevertheless, the residents reviewing the cases labeled “candidates for hospitalization” found significantly more evidence of psycho-pathology than the other group.
The researchers explained that the characterization, “candidate for hospitalization,” influenced the thinking of the residents more than any other information they reviewed. As a result, they interpreted the remaining information about these individuals to conform with what they considered most informative. When people engage in these processes of selective information processing, they remember more clearly what seems consistent with their expectations more.[4] They respond to information inconsistent with their expectations by: (1) discounting it as a mere accident or anomaly, (2) reinterpreting it so it becomes expectation consistent, and/or (3) simply forgetting or overlooking the inconsistency.
At PsychLaw.net we know that when an expert’s pre-conceived notions result in overlooking important data, courts typically rely on a rule 703 analysis. A recent example found the federal court excluding an expert’s entire examination because the facts and data upon which the expert relied were:
“….critically inaccurate or incomplete, as determined by what other experts would or would not be willing to base opinions upon.” Christophersen v. Allied-Signal Corp., 939 F.2d 1106 (5th Cir. 1991), cert. denied, 112 S. Ct.1280 (1992).
In another recent example, a Michigan court noted an expert’s failure to reasonably consider contrary evidence. The expert’s analysis was also inconsistent with the driver’s testimony. When questioned about these inconsistencies, the only response of the expert was to disparage the witness’s powers of observation, demonstrating that pre-conceived notions die hard.[5]
Commentators Bonnie and Slobogin note:
“Many clinicians are not sensitive to the limitations of their own disciplines; if they are not researchers, they focus on what they think they know rather than what they do not know. More important, many clinicians are entirely untrained in, and insensitive to, the purposes and limitations of the legal process.”[6]
At PsychLaw.net we believe that preconceived expectations keep mental health professionals from seeing what’s before them.
Footnotes
[1]. Rice, S.A. (1929). Interviewer bias as a contagion. American Journal of Sociology, 35, 421-423.
[2]. Temerlin, M.K. (1968). Suggestion effects in psychiatric diagnosis. Journal of Nervous and Mental Disease, 147, 349-353,
[3]. Sattin, D.B. (1980). Possible sources of error in the evaluation of psycho-pathology. Journal of Clinical Psychology, 36, 99-105.
[4]. Rothbart, M., Evans, M. & Fulero, S. (1979). Recall for confirming events: Memory processes and the maintenance of social stereotypes. Journal of Personality and Social Psychology, 15, 343-355.
[5]. Green v. Jerome-Duncan Ford, Inc., 491 N.W.2d 243 (Mich. Ct. App., 1992); Also, in O’Conner v. Commonwealth Edison Co.,807 F. Supp. 1376 (C.D. 111. 1992), aff1d, 13 F.3d 1090 (7th Cir. 1994), federal district court judge Michael Milim dealt with proffered testimony from an ophthalmologist, who proposed to testify that by merely examining the plaintiff, he discovered that the plaintiff’s cataracts were a result of his exposure to radiation at the defendant’s nuclear power plant. The basis the expert’s opinion was that the type of radiation to which the plaintiff was exposed could cause cataracts, and that he had observed five patients in the past who had the same type of cataracts as the plaintiff, all of which had been radiation-induced. Judge Milim noted that the expert had committed the logical fallacy known as the “Converse Accident” (hasty generalization). Judge Mihm wrote that this occurs, when a person erroneously creates a general rule from observing too few cases. The judge noted that the expert had ignored the scientific literature that showed that the plaintiff’s cataracts could have come from other sources. Judge Mihm therefore excluded the testimony. For other examples of courts excluding causation testimony when the expert did not discount other possible causes, see Smith v. Ortho Pharmaceutical Corp., 770 F. Supp. 1561, 1581 (N.D. Ga. 1991); DeLuca v. Merrell Dow Pharmaceuticals, 791 F. Supp. 1042, 1058-59, aff1d, 6 F.3d 778 (3d Cir. 1993), cert. denied, 114 S. Ct. 691 (1994); Paoli, 706 F. Supp. at 376; In re “Agent Orange” Prod. Liab. Litig., 611 F. Supp. 1223, 1251, 1253 (E.D.N.Y. 1985), aff ‘d, 818 F.2d 187 (2d Cir. 1987), cert. denied sub nom. Lombardi v. Dow Chem. Co., 487 U.S. 1234 (1988).
[6]. Bonnie, R & Slobogin, C. (1980). The role of Mental Health Professionals in the Criminal Process: The Case for Informed Speculation. 66 Virginia Law Review 427, p 457