As an expert witness, I often testify at trials and hearings. Part of my testimony often includes reports of scientifically-based, objective psychological tests I have administered. An objective psychological test is scored with no input from the evaluator, rendering the skill level or potential bias of the evaluator irrelevant. Such tests can offer significant diagnostic information, as well as information regarding how the test-taker approached the test. Did the test-taker attempt to appear more mentally ill than he or she actually is? Did the test taker attempt to minimize mental health problems and try to appear more mentally healthy than he or she really is? In administering such measures, the examiner hopes to obtain a valid test result that describes the test-takers current level of psychological functioning.
Sometimes, I have the opportunity to listen to the testimony from the opposing expert, and I have noticed a disturbing and misleading trend in some mental health expert testimony. Experts who failed to administer scientifically-based, objective psychological tests will list “the Mental Status Examination,” or MSE, as if it is somehow equivalent to scientifically-based, objective psychological testing. I consider this an attempt to “snow” the court by making something appear to be a valid scientific test when it is not. Neither judges, juries nor most attorneys know what a MSE is. From its name—Mental Status Examination—it sounds like some sort of procedure that derives some special information beyond the clinical interview. In fact, it is not. The MSE is merely a summary of various findings that occurred during the clinical interview. It is unscientific and is merely a summation of what the examiner learned by asking questions and observing the person being interviewed. The MSE is a useful summary of an individual’s mental functioning, but it is in no way equivalent to objective testing.
What is included in the MSE? Here is a list of topics that are generally summarized in a mental health report under the heading, Mental Status Examination:
- Orientation: Does the examinee know who they are; where they are; the time and date; the season; the purpose of the interview; and who the interviewer is?
- Judgement: Does the examinee suffer from any impairment of judgment?
- Cognition: Is there a thinking impairment, such as dementia or psychosis?
- Auditory hallucinations and delusions: Does the examinee hear voices or subscribe to imaginary beliefs as if they are real?
- Appearance: Is the examinee well groomed, properly attired and with good hygiene? Features such as beards, hairstyle and tattoos may be described.
- Manner: Is the examinee cooperative, hostile, talkative, withdrawn, robotic?
- Affect: Does the examinee show the normal range of emotion? Is the examinee euphoric or severely depressed? Does the examinee appear to have no emotional reactions whatsoever? Is the examinee laughing or crying?
- Sensorium: Does the examinee have the normal abilities to see and hear?
- Physical disabilities: Are any disabilities present? Is the examinee using a wheelchair or a walker? Does the examinee display tremulousness in the voice or extremities?
- Psychomotor pace: Is the examinee talking fast? Does the examinee display pressured speech such that he or she can barely talk fast enough to express his or her thoughts? Does the examinee display psychomotor retardation, moving in a slowed down fashion?
The Mental Status Examination includes a great deal of very useful information about the examinee. However, all of this information derives from the observational skills and clinical judgement of the examiner. Attorneys and Judges need to recognize that the Mental Status Examination is not any different from the rest of the clinical interview. It is unscientific and is based on clinical training and wisdom. The MSE is both useful and important, but it should never be presented to the court as a substitute for objective and scientific psychological testing.