Testimony
At all times, court is a serious and sensitive business. First, it is an important institution and an arm of government with the other two being the Executive and the Legislature. Secondly, there must be respect for the court, failure to which one would be declared to be in contempt of court with serious ramifications. Further, the nature of this appearance places me in a unique position as the matter of the guilt or innocence of an accused person is being canvassed. Although it is entirely upon the judge whether or not the defendant will face trial, my report and what I have to say in court will go a long way in determining whether or not he is condemned to stand trial or set free, or even committed to the asylum. His future is in my hands, so is justice for the persons he may have offended, harmed or hurt.
Lastly, there is the important obligation to the amorphous client involved in this matter being the Justice department as well as the accused person who is being assessed with further consideration to the individual that the accused person has allegedly offended. Primarily, a psychiatrist is bound by humanity and professional ethics to an obligation to the patient with any other considerations like the patient’s love-ones or the society around the patient being secondary. In the instant case, the obligation above all is to the body that referred the defendant to the institution, being the court to whom I am to report. In the instance situation however, the welfare of the patient becomes secondary, even inconsequential as the patient is now a defendant and the only obligation is to establish whether or not he qualifies to face trial.
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To prepare for court, I first warned myself of the two important issues outlined about; the weight and possible implications of a court appearance and the amorphous professional obligation. After appreciating that, I went through all the documents regarding this case, from the bundle of documents that came with the defendant, to the raw data collected during the 30 days of stay at the institution. I also perused the report, both to familiarize myself with it and also ensure that it was in order. The courtroom etiquette followed included, addressing the court always as ‘Your Honor’. Addressing all my answers, comments, and statements to the bench and not to the individual asking the questions, speaking only when spoken to and limit my answers specifically to the questions asked.
The probable cross examination questions would include: ‘What is the level of accuracy of the tests you undertook’. Since there are a lot of criticisms against the psychological profession with regard to the accuracy of diagnosis, I would prepare a careful response to this question including studying on the issue of how the multiplicity of the tests so conducted with congruent results solidifies the findings and the conclusion. Another probable cross examination question would be “are you aware of the implications of your testimony today to this case”. This is an unfair question but an anticipated one since the report is injurious to the prosecution. My response will be that I am aware of my obligation as a professional to the court and it is the court that will make a finding regarding the case. In this way, I will not be pushed to usurp the courts authority.
Evaluations
The evaluation regiment used to evaluate the defendant was based on two main premises; the legal premises based on what the department of justice (DOJ) has set as the parameters for testing defendants for qualification to stand trial. This must however, be guided by the operational rules set by the American Psychology profession (APA) to assist their members in achieving that duty as set out by the DOJ. The testing regimen followed was, therefore. carefully designed to give the DOJ exactly what it needed but precisely under the precepts and mode of operation set by the APA rules or practice and code of ethics.
According to the DOJ, the defendant should have the ability to understand what it means to be in court and be able to respect the court and its processes. Further, the defendant should be able to understand the charges as set and read out and the implications thereof and also be able to enter a plea, being an indication of either guilt or innocence. The defendant should also be able to follow the proceedings of the court and understand them. Finally, with regard to defense, the defendant should be able to give proper instructions to the advocate on record as well as prepare strategies for defense as and when the prosecution builds their case. Therefore, it is mandatory for the defendant to have a minimum of an average IQ, the cognitive abilities to understand, appreciate, and translate the happenings in court and finally the ability to reason things out and express them to the advocate.
The evaluations used in the case study are the current mental status and behavioral observations. These involved both passive evaluation of the defendant and formal evaluation through questioning. This was a general assessment of the state of the defendant to create the parameters for further evaluation. The second evaluation was the intellectual and cognitive functioning set to test the intelligence capacity of the defendant and the ability to understand the environment. It was conducted through the 14 subtests of the Wechsler Adult Intelligence Scale—Third Edition (WAIS—III) . This is an IQ test developed by David "Wex" Wechsler, a leading American psychologist, designed to test both the intelligence and the cognitive abilities of the patient.
The results of the WAIS—III are them compared with those of the seven tests referred to as the Verbal Comprehension Index (VCI) which is a purely verbal assessment of the intelligence quotient meant to verify or contradict the initial test as aforesaid. Further, the Perceptual Organization Index (POI) which not only tests the intelligence quotient but also the intelligence application by the defendant. The POI number is normally not an independent test but a derivative of the conjunction between several selected outcomes from the WAIS—III tests as aforesaid.
Further, there was the Working Memory Index (WMI) which was meant to test the capacity of the brain that is active, euphemistically like the computer’s RAM, by testing the ability to listen, understand, and respond. Finally there was the Processing Speed Index (PSI), which is supplemental to the WMI and tests the speed at which the comprehension, processing, and response to information would be undertaken.
These tests were carefully designed to check and counter check all the issues indicated above so as to satisfy the expectations of the DOJ but in a manner that confirms with the APA rules. One of the important APA rules involves the consultation of a fellow member of the APA on complex matter, those involving sensitive issues and those whose outcomes could be ambiguous. This instant automatically qualifies as one that requires such consultation, therefore, this evaluation. I would consult with any practitioner who had handled the defendant before to avoid over-contrast of results, an issue that can be troublesome during cross examination. In the event that one cannot be reached, I would have an APA member, preferably senior to myself peruse the material available as well as my report and critique it.
Diversity
Psychiatric tests are not scientific in nature but are based on procedures that bring together a collection of research based preconditions based on trends and sets of responses. This creates a myriad of permutations that can be varied by various aspects such as race, gender, nationality and language, and culture. Most of the tests outlined above check the conduct, reactions and responses of the patient against preset parameters based of data and research conducted on patients whose situations in life, ailments suffered or environments are congruent with those of the patient being tested. It is, therefore, incumbent upon the professional undertaking the testing to calibrate the machines being used accordingly so as to suit the diverse elements of each patient, and also consider these issues when evaluating the findings of the tests.
If the defendant had been from a different country and culture, the first consideration would be the defendant’s understanding of the English language and to what extent that understanding would affect the reactions in the non-verbal tests and the answers in the verbal tests. It is noteworthy that some cultures make some people bolder while others make them more timid, some make individuals too sensitive while others make them indifferent. This would also be considered in the tests under these circumstances.
If the defendant was from a different gender, the tests involving IQ would have generally remained the same but the reactionary and emotional tests would have been recalibrated to allow for the lower emotional question of a female gender or the higher emotional quotient of a male gender. Finally, had the defendant been of a different religious background, the mode of tests and interaction would have been checked. This would ensure that issues that were intolerant to the religion of the individual and that would create a different impression to the individual were removed from the tests where possible and if not, the results would be tempered with that understanding during interpretation. For example, if pigs were mentioned to an Islamic or Jewish patient or beef to a Hindu patient, the result would be different from when mentioned to a Christian patient.
Ethics
The professional ethics for psychiatrist are outlined in the American Psychological Association (APA) code of Ethics. In the instant case, the most important element of the code is (APA) code of Ethics Standard 4 that regards the absolute secrecy and privilege for any and all information given by a patient to a defendant. In this instance however , the information so given will not only be shared with several people in a court of law but also be used to develop a report that will be surrendered in court with no assurance as to how many other non-psychology professionals will handle it.
(APA) code of Ethics Standard 4.02 however, provides that in instances such as this where information shared cannot be privileged, the patient should be informed at initial professional contact. Following APA code of Ethics 4.02 (b), the information so given was not absolutely privileged and where possible, consent for the same should be given by the patient, in this case the defendant. Even when it is unclear whether or not the patient is in apposition to comprehend this ethical issue or breach of confidentiality, it is so critical that the practitioner has to conscientiously explain the position and options to the patient and carefully record the patient’s response to the same and the patient’s apparent mental qualification to make that response.
Reflection
Testifying in court is one of the obligations expected of a professional practicing psychology. Among the new lessons learnt through the undertaking of this project are the rigors of court appearances and the etiquette involved. Another major lesson learnt is the professional dilemma that comes about when the duty of a psychiatrist is not professionally based on the patient as is always supposed to be the case since in the instant case, this obligation is to the ends of justice. A defendant who is accused of grievous crimes can escape punishment because of the professional mistakes made by a psychiatrist, the other extreme being occasioning an incompetent person to stand trial through wrong diagnosis. This amplified my opinion on the importance of the psychiatric profession.
