As Kathy Ronan opens the door, she is hit by a blast of noise. Her patient
is screaming, lashing out and taunting her with death threats.
Without hesitation, Ronan turns and leaves the room. "I'm not afraid,"
says Ronan. Out of thousands of patient visits, she has only felt threatened
on two or three occasions.
"And in all of the occasions the person was grossly psychotic. The screaming
and yelling had nothing to do with me -- it was a chemical imbalance," she
says matter-of-factly. "Of course, I didn't need a sixth sense then to
know I was in danger."
More nerve-wracking than dealing with an occasional patient in a psychotic
state is testifying in court. "It's a challenge because so many people
are affected by your decisions," says Ronan. But again, she isn't intimidated
by the rigors of cross-examination.
"I've found that I deal with stress by making sure that I do a damn
good job," she says. "You've got to be prepared and back up your opinions.
It would be more stressful for someone who went in there unprepared and had
to fly by the seat of their pants."
Above all, a forensic psychologist has to be prepared. Most of the cases
they are called to testify at are complicated or have contradictory evidence
that needs to be straightened out.
"If someone robs a bank, has three accomplices and has planned it for a
month, then you can be pretty sure that this crime didn't have to do
with the person having a mental illness," says James Hooper. He works with
Ronan at a forensic psychology and psychiatry hospital in Alabama.
If someone walks into a store, asks everyone to stand on their heads and
doesn't take any money, the crime most likely has to do with a mental
illness. "If the person did this bizarre thing, and then takes the money out
of the cash, well, that's where it gets difficult to do an evaluation,"
he says. And that's just the kind of case where a forensic psychologist
would be needed to give an expert opinion.
"It's fascinating to dig into the mind of someone who's committed
a crime," says Ronan. "That's what makes this work so interesting."
Granted, the work is always interesting, but it's not always pleasant.
Ronan says she has learned to cut off her personal emotions from what she
sees at work. "You couldn't do it unless you managed to put your personal
emotions aside," she says.
It's necessary to work with the gruesome, but also the hopelessness
that is often present when you deal with the mentally unstable. "It's
true that in here, for some people, there isn't a lot of hope," says
Ronan. "And for some, the likelihood of recovery will be impeded by their
mental illness."
However, cutting off emotions doesn't mean cutting off empathy or
care. The hospital houses many people who are found unfit to stand trial because
of their present mental illness. "We help stabilize them for the trial," says
Hooper. "Many of them we help and don't see again."
The hospital also treats people who are deemed to be criminally insane.
"Some of these illnesses are very treatable with medication," says Hooper.
"However, there are some who just don't respond to treatment and they
will stay here for a long, long time.
"It's extremely rare to be found not guilty by reason of insanity,"
says Hooper. Only five percent of defendants even attempt to say they are
insane, and only one-tenth of those are found to be insane, he says.
The criminally insane who slip through the cracks end up in prison, and
are in need of help. Many prisons have a psychologist on staff who can help
these people. Often, a healthy person's mental state can weaken. "After
serving a 10-year prison sentence...mental illness can occur," says Hooper.
"And somebody has to take care of these people."
Stuart Clayman, a forensic psychologist in Boston, takes care of people
in a different fashion. He examines the victim of an accident or crime, rather
than examining the accused. "I examine people who may have crashed in a car
and weren't wearing their seat-belt, for example," he says.
He looks for evidence of a head injury, but he's most concerned with
examining the emotional toll the accident has taken on the victim. "They may
be out of work for a while during the period of disability -- not able to
pick up their kids anymore or get along with their husband or wife after a
trauma," says Clayman.
Lawyers hire Clayman to examine the emotional toll that a car accident
or a crime has had on a person, and they hire Clayman to find out the truth
behind the victim's claims.
Clayman uses different exams and adult IQ tests to help him determine how
a person has been affected. One test, called the Minnesota Multi-Phasic Personality
Inventory, consists of 567 true and false questions.
Once Clayman has determined how a particular crime or accident has affected
the victim, he writes a report for the lawyer, and then is often called in
to court to testify about his statements.
Clayman sees people who are depressed or disoriented because of what has
happened to them. "I see people when everything in their life at the moment
seems to be going wrong for them," he says. But it's not his job at the
time to help the people. As a forensic examiner, he must remain objective.
Which is one of the reasons he chooses to devote part of his practice to
psychotherapy treatment. Above all, psychologists must be empathetic -- once
someone has been found mentally ill, the diagnosis may be complete, but they
will still require help and care.