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Day of Discovery examines tests, probate law  by Heather Woolwine Public Relations The following is the final article in a series of three about the MUSC Institute of Psychiatry’s Day of Discovery: Forensic Psychiatry.   The topic of this year’s Day of Discovery for the Institute of Psychiatry was forensic psychiatry. On May 12, MUSC and other legal and health care professionals gathered to discuss a variety of issues related to forensic psychiatry, from personality disorders and controversies that surround them to catching a person faking mental illness.   I. Richard Gershon, Charleston School of Law dean and professor, presented information on the relationship of probate law and forensic psychiatry, specifically on the topic of mental capacity as it relates to estate planning and powers of attorney.   South Carolina law states that only a person, or testator, of sound mind and not a minor, may execute a will. Mental capacity is an issue with estate planning, medical care, and a variety of other circumstances involving individual wishes. Definitions of mental capacity exist to protect the testator, his or her family, and to give effect to the testator’s true desires in several circumstances. It assures the rational dispositions that benefit society and protects those who are mentally incompetent from exploitation.   To demonstrate mental capacity, the testator must know the nature and extent of one’s property, the persons who are the natural objects of one’s bounty (meaning that they have knowledge and understanding of those people who would naturally benefit from their estate), the disposition of one’s property, and how these elements combine to form an orderly plan of disposition. Minimum mental capacity, or competence, can be determined if someone is judicially declared incompetent but has testamentary capacity.   If someone believes that a testator executed a will or changed a will without competency, then it is the burden of that individual to contest the will and prove incapacity by demonstrating the failure of one of the components of mental capacity.   Gershon discussed several cases involving issues of mental capacity of testators, like insane delusions, undue influence and fraud. Insane delusions are beliefs that testators adhere to against all evidence and reason to the contrary, like a man refusing to leave his wife any part of the estate because he’s sure she cheated on him, despite the lack of evidence to support his claim. A person with an insane delusion can not make a will with respect to that heir, but the burden of proof lies with the contestant to show something more than the testator was operating under an incorrect belief. Only the part of the will affecting the delusion is invalid.   Undue influence describes a situation where the testator’s desires are overcome by someone else’s desires and was forced to do what he or she would otherwise not do on their own free will. An example here is a 1963 case in Texas when grandchildren sued the deceased’s lawyer son who was involved in disinheriting them. Lastly, fraud might occur when someone prevents the testator from executing a new will in favor another so that person can hang on to what is already in the will for him or her. An example of this might be a testator wanting to make a new will leaving the estate to charity while some family members prevent her from doing so because they would lose what’s coming to them.     To conclude his presentation, Gershon discussed a case involving a woman with diminished mental capacity because of Alzheimer’s disease and how her third cousins attempted to change her will and power of attorney after the onset of Alzheimer’s to benefit themselves. The court and several appellate courts upheld the ruling that her diminished capacity rendered the changing of her will and power of attorney from a long-time family friend as illegal. Use of psychological tests in forensic evaluations L. Randolph Waid, Ph.D., MUSC departments of Psychiatry and Neurology, opened his presentation with the case of John T., the boyfriend of a graduate school colleague. After he completed the Minnesota Multiphasic Personality Inventory as a favor to his girlfriend, his test yielded results discrepant from impressions generated through interpersonal contact, interview, and intimate contact. The test results proved to be a more valid understanding of John T. so the moral to Waid’s story was somewhat tongue and cheek: Don’t become intimate with an individual until you have them complete psychological testing.   To further illustrate that psychological testing and assessments are good indicators of what is really going on with an individual, Waid told the story of another patient who  claimed that after a work-related fall, he suffered post-traumatic stress related head aches and cervical pain. An MRI, CT scan, EEG, and lumbar puncture were all normal and initial neuropsychological testing revealed issues that hindered him from meeting the demands of intellectual and neurocognitive testing.   Symptom validity testing was not suggestive of conscious malingering. During his reevaluation the following year, after multiple forgery arrests, the patient still had highly disruptive headaches and performed in the lowest percentile on all tests. Psychiatric treatment was recommended. After two years of psychiatric treatment, the patient still presented with a severe, debilitating headache at every appointment with the psychiatrist so he was referred to a neurologist.   At the request of the neurologist, more testing was performed, including the Stroop Test, Judgment of Line Orientation Test, symptom validity tests, and a Test of Memory Malingering with two learning trials and one retention trial. The trials demonstrated a high possibility of malingering, or faking mental illness. At the conclusion of treatment, the neurologist’s report said that the behaviors and test performance were inconsistent with any known neurological dysfunction and indicated the patient’s potential to pick the incorrect response while knowing the correct response. Waid’s moral here: Sometimes, if not often, psychological tests confirm clinical hypotheses.   Next, Waid explained psychological assessment, or the process of answering questions in which psychological tests are often used as one method of collecting data.    The advantages associated with this type of testing are its objectivity, quantifiable terms, psychological tests can represent the best and sometimes only feasible way of collecting certain data, and they are economical and efficient. By definition, psychological tests represent a method of obtaining sample behavior under controlled conditions through the use of standardized and objective instruments. The tests themselves are evaluated based on their ability to define the construct being measured, how standardized they are, their reliability (consistency and accuracy), and their validity (of content, criterion, and construct).   He discussed further the criteria for the use of testing in forensic psychological assessments and common cases that testing is used in like child custody evaluations, personal injury assessment, malingering evaluations, violence risk assessments, and substance abuse assessments. He concluded his presentation with an example detailing a personal injury assessment and evaluation for post traumatic stress disorder.     Friday, June 17, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.