When the Diagnosis Isn't the Problem

Sometimes the condition everyone is focused on turns out to have very little to do with the question the court is trying to answer.

I've often found myself sitting across from someone during a forensic evaluation, listening as they tell me their story.

They explain what happened. They tell me about a diagnosis they've lived with for years, a condition they're being treated for, or medications they take. Sometimes they'll pull out a medication list, show me photos of all their bottles on their phone, or even bring the bottles themselves. There's almost a sense of, See? Look at all of this. This is what I'm dealing with.

They may show me records documenting the diagnosis and tell me how long they've been living with it. What it's been like for them. For their family. Sometimes they already know that this condition is one of the reasons their attorney wanted them evaluated in the first place.

And then, as I'm listening, I notice a shift in my body and I begin to realize something: their diagnosis may be real, but it seems to have very little to do with the question I'm actually there to answer.

When the Story and the Question Don't Line Up

In forensic work, having a diagnosis and having a psychological condition that is relevant to the legal question are two very different things.

Someone may genuinely have the thing everyone is focused on. They may have legitimately struggled with it for years. It may affect important parts of their life in very real ways. And that's not nothing.

But none of that necessarily means it affected their ability to make a particular decision, understand something, choose a course of action, or do whatever else I'm being asked to evaluate.

Sometimes I see that fairly early in an interview. Other times, it takes a while.

Either way, that's when things get interesting ...

I Still Have to Keep Listening

Once I start thinking that the presumed explanation may not actually explain what's going on, I can't just decide I've figured it out and say "we're done."

I still have to listen. I have to keep asking questions, gather the relevant information, review the records, consider other explanations, and stay open to the possibility that my initial impression could be wrong.

That's part of remaining objective.

Because I can become just as attached to my own new theory as someone else may have become attached to the theory that brought the person to me in the first place.

So even when I'm sitting there thinking, I don't think this diagnosis has anything to do with what I'm being asked to evaluate, that's not yet a conclusion. It's something I still need to explore.

Sometimes the Evaluation Goes Somewhere Nobody Expected

Eventually, the evidence may lead somewhere very different from where everyone thought it would.

The person being evaluated may believe that a particular diagnosis explains their difficulty. Their attorney or the referring party may have been working from the same assumption. There may even be records and years of treatment supporting the fact that the diagnosis itself is legitimate.

But that's not the same as showing that the diagnosis is connected to the issue I'm being asked to evaluate.

And sometimes, it simply isn't.

That doesn't mean the diagnosis is wrong. It doesn't mean the person hasn't struggled. It means that when I look at the specific psychological question in front of me, the evidence doesn't support the connection everyone expected it to support.

Then I'm the One Who Has to Say It

Now, this is one of the parts of forensic work that I don't think gets talked about very much.

At some point, I'm the one who has to break this to the person who referred the case to me.

And I'm a human being. I understand that an attorney or another professional may have come into the evaluation with certain expectations. Sometimes an entire strategy has been built around a particular theory about what's going on with this person. I know that my findings can complicate things rather than make them easier.

So yes, it can be tough to be the person who has to say, That's not what I'm seeing. Or more importantly, That's not what the psychological evidence supports.

There's a real human side to having those conversations. I don't particularly enjoy disappointing the people I'm working with, who have entrusted a process to me, and I understand what's at stake for them and for the person being evaluated.

Ultimately, my job isn't to support the theory that brought the case to me. It's to answer the psychological question as objectively as I can, even when the answer isn't the one anyone expected.

Sometimes the diagnosis matters enormously.

Sometimes something entirely different is going on.

And sometimes, the diagnosis everyone expected to explain the problem simply doesn't.