Try to minimize unconscious bias in forensic evaluations.
The academy's ethical guidelines require psychiatrists to strive to be objective when doing their work, but "objectivity is not quite that simple," said Dr. Goldyne, who is a fellow in the psychiatry and the law program at the University of California, San Francisco. "The task of conducting a psychiatric evaluation requires us to make decision after decision. Most cases allow plenty of wiggle room for bias to sneak in during evaluations."
If an expert is conscious of a bias, "the person can reflect on whether it affects objectivity," Dr. Goldyne continued. "But all of us have things about which we're not conscious. It's sort of sneaky because it can profoundly affect decision making, but we're not on the lookout for it. We see reports all the time where information is discounted, and we don't know why," he said. "It can be very hard ... when these things are sneaking in."
There are several potential sources of bias, Dr. Goldyne said. For example, if the expert unconsciously experiences an affinity for a retaining attorney who resembles a sibling, the expert may be motivated to opine in favor of the attorney's client.
An expert who unconsciously experiences guilt feelings that motivate him or her to protect "underdogs," may, without realizing it, discount information unfavorable to a plaintiff in a personal injury lawsuit. And an expert who wants to be hired again by an attorney could be unconsciously motivated to please the attorney, Dr. Goldyne noted. Without realizing the desire to please, the expert opines in favor of the attorney's client.
If a retaining attorney's aggressive style provokes an expert's anger, this could unconsciously motivate the expert to defy the attorney. Without realizing why, the expert subtly discounts data favoring the attorney's case.
An expert who trained in a forensic hospital may strongly associate violence with psychosis, even though the expert is well aware of literature showing there generally is a low correlation between the two, Dr. Goldyne said. In this type of bias, the association of violence with psychosis unconsciously causes the expert to overestimate violence risk in psychotic individuals being evaluated.
In another type of bias, the expert's knowledge base may be an issue. An expert unfamiliar with the literature that shows women frequently fail to report unwanted sexual advances at work may misinterpret a plaintiff's delay in reporting sexual harassment to mean that the plaintiff was not distressed by the harassment.
Psychiatrists need to ask themselves questions that will help identify their unconscious biases, Dr. Goldyne said:
* Am I thinking about this case more or less than is typical?
* Have I failed to follow up on discrepancies or details?
* Have I had difficulty with parties associated with the case?
* Does this case resonate with my sociopolitical beliefs?
* Do I have emotions or motivations about an issue or person related to this case?
* Is my training and experience adequate for this case?
* Does my reasoning involve unchecked assumptions?
Although examining unconscious bias can help experts improve how they handle these cases, "it's not the easiest regimen to follow," Dr. Goldyne admitted. It requires experts to resist becoming defensive and to risk confronting painful motivations. However, making these biases conscious "allows an expert to recognize and counteract the threats that these biases pose to objectivity," he said.
BY JOYCE FRIEDEN
Associate Editor, Practice Trends
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|Title Annotation:||Forensic Psychiatry|
|Publication:||Clinical Psychiatry News|
|Date:||Dec 1, 2005|
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