Review of the textbook, Coping with Psychiatric and Psychological Testimony, Fourth Edition, Jay Ziskin Ph.D., LLB. and David Faust, Ph.D. Law and Psychology Press, 1988.

by James O'Brien, M.D.

Psychiatry's scientific and methodological advancements over the past century have unfortunately been exceeded by its faddishness and lapses into shamanistic cultism. Psychobabble, victimology, recovered memories, orgone therapy, orthopsychiatry, and the Diagnostic and Statistical Manual are examples of faith substituting for science, while claiming the mantle of scientific credibility.

Credible psychiatric criticism is good for the discipline of psychiatry and will prevent the field from descending into the realm of romanticism, voodoo, and witchcraft. I use the term credible to distinguish critical objective assessment from criticism based upon personal vendettas or political agendas. Examples of the latter would be Scientology's organized attack on psychiatry as revenge for dismissing L. Ron Hubbard as a quack, or the rantings of gadfly of serial womanizer Jeffrey Masson, whose basic thesis is that since he never helped a patient, the rest of us can't either.

Ziskin and Faust's reference book "Coping with Psychiatric and Psychological Testimony" represents credible psychiatric and especially forensic psychiatric criticism at its best. Some of you have no doubt heard of the famous-in-psych-legal circles (or infamous, depending on your point of view) "Ziskin" book for lawyers on how to discredit psychiatric testimony. For a number of years I had searched for this book, and I recently obtained a copy of the three volume fourth edition with supplements. The ultimate testament to the power of the work is that forensic psychiatrists now complain of being "Ziskined" on the witness stand.

The first edition of this book was printed in 1970 and is summed up in the first sentence: "It is the aim of this book to demonstrate that despite the ever increasing utilization of psychiatric and psychological evidence in the legal process such evidence frequently does not meet reasonable criteria of admissibility and should not be admitted in a court of law, and if admitted, should be given little or no weight."

This is the kind of book that should not be read by first year psychiatry residents, or touchy feely Stuart Smalley (the Saturday Night Live character always in some kind of recovery) types with fragile self esteems. Ziskin has few kind things to say about the nature of psychiatric evidence, especially in the courtroom. In a culture of the twinkie defense, the abuse excuse used in the Menendez trials, and years of fraudulent post-termination stress claims, it is difficult to argue with Ziskin and Faust's thesis. Ziskin and Faust go straight for the jugular of the Diagnostic and Statistical Manual of Psychiatry and the sophism of psychiatric testimony. They point out that most psychiatric diagnoses are not based upon hard empirical data, but the result of consensus and politics.

Ziskin devotes a whole chapter on the 1973 Rosenhan study, in which normal volunteers were psychiatrically hospitalized on the basis of psychotic symptoms, but remained in the hospital with the same diagnosis long after the volunteers persistently denied those symptoms. This showed how psychiatrists tend to get locked into a certain impression and stay with it despite lack of evidence.

Ziskin extensively reviews psychological testing, and discusses the methodological problems in using clinical instruments in forensic settings. He has few kind things to say about computerized MMPI narratives. He heartily endorses the use of the MMPI to detect clinical malingering, citing a broad body of evidence supporting the value of the MMPI validity scales based upon actuarial and statistical fact rather than theoretical value. Ziskin recognizes malingering at a much lower threshold than most psychologists and particularly the disciples of MMPI authors McKinley and Hathaway who use the caveat of F-K>11 as indicative of malingering. He convincingly argues for a cutoff point on the F-K index of +5-- "for forensic purposes the probability that only 6.5% of genuine profiles would be considered malingered at that cutoff point, while 83% would correctly indicate malingering according to Gough's data...for example, if there is an F-K of +10, testimony can show that according to Gough's research, there are less than three chances in 100 of error in viewing the MMPI as malingered." The implications of this data for forensic work is staggering.

The authors deconstruct psychiatry from the bottom up and have show mercy on psychiatry's unwillingness to test its theories empirically. There are chapters on how to challenge an expert's clinical judgment, expreience, education. Volume III includes guidelines to cross-examination of mental health experts on the witness stand and in depostion with case illustrations. This is must reading for an attorneys who deal with forensic psychiatric issues and any psychiatrist or psychologist who testifies in court as well.

If the book has any weakness, it is not in its impeccable analysis of the data, but may be in its premise that the modern jury (and, in many cases, judge) can be swayed by reason. I have serious doubts about the capacity of many people to think critically and in certain situations an attack on expert testimony may backfire, since psychobabble is ultimately a religion and not a science. Juries comprised of Ricki Lake addicts and judges influenced by the culture of victimology may see such scrutiny and criticism as cruel, and ultimately blasphemous.

This 3-Volume reference is a must for every forensic psychiatrist or psychologist and should be a part of any law library. Anyone defending himself in an emotional injury case should demand that his attorney read it cover to cover. A newer edition is forthcoming and will include discussions of the newer Daubert standard for expert testimony and other developments.

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