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Use and Misuse of Psychological Testing in the Evaluation of Black Patients
Benjamin Roy, M.DPresident, Black Psychiatrists of America Inc.
September 16, 2021
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MHTTC Network
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MHTTC Purpose
The MHTTC Network vision is to unify science, education and service to transform lives through evidence-based and promising treatment and recovery practices in a recovery-oriented system of care.
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Central East MHTTC GoalsFunded by SAMHSA to:• Accelerate the adoption and implementation of
mental health related evidence-based practices• Heighten the awareness, knowledge, and skills of
the behavioral health workforce • Foster alliances among culturally diverse
practitioners, researchers, policy makers, family members, and consumers
• Ensure the availability and delivery of publicly available, free of charge, training and technical assistance
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Central East Region 3
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DISCLAIMERThis webinar was prepared for the Central East Mental Health Technology Transfer Center under a cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this presentation, except that taken directly from copyrighted sources, is in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. Do not reproduce or distribute this presentation for a fee without specific, written authorization from the Central East Mental Health Technology Transfer Center. This webinar is posted on the Central East Mental Health Technology website.
At the time of this presentation, Miriam Delphin-Rittmon served as Assistant Secretary for Mental Health and Substance Use and Administrator of SAMHSA. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by SAMHSA/HHS, or the U.S. Government.
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Evaluation Information
As part of receiving funding through SAMHSA to provide this training, the Central East MHTTC is required to submit data related to the quality of this event. At the end of today’s presentation, please take a moment to complete a brief survey about today’s training.
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Use and Misuse of Psychological Testingin the Evaluation of Black Patients
Benjamin Roy, MDPresident, Black Psychiatrists of America
Health Equity Webinar SeriesA collaboration of the CE-MHTTC and the Black Psychiatrists of America
September 16, 2021
Moderator:Annelle B. Primm, MD, MPH
Black Psychiatrists of America, Council of Elders
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COVID-19: Unprecedented Disaster
• Catastrophic impact on Black and other marginalized communities: disparate levels of death and economic fallout superimposed on layers of pre-existing inequities
• Rise in anxiety, depression, and substance use, and exacerbation of pre-existing mental disorders in adults and children in the Black community
• Evaluation of psychiatric conditions may include psychological testing which does not occur in a vacuum
• Consider historical, social, and political contexts
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Today’s Program
• Special thanks to the CE-MHTTC for its support of this fiscal year’s session of the Black Psychiatrists of America Health Equity Webinar Series
• Focus is regional on Delaware, Maryland, Pennsylvania, Virginia, Washington, DC, and West Virginia yet the information has national relevance
• Today’s webinar features Benjamin Roy, MD, President of the Black Psychiatrists of America
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Use and Misuse of Psychological Testing in the Evaluation of Black Patients
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Social Value of Psychological Tests
Clinical diagnosis and treatment Disability determination Justice system: Incarceration Sentencing Probation and Parole Employment Fitness C-Suite
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Physiognomy
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Portrait of a Man Suffering from Delusions of Military Command Theodore Gericault, 1822
Étienne-Jean Georget, the chief physician of the Salpêtrière
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Patients at Surrey County Lunatic AsylumHenry Welch Diamond 1855
On the Application of Photography to the Physiognomy and Mental Phenomena of Insanity, The Photographic Journal, July, 1856
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National Science and Media Museum.
Royal Photographic Society Collection
Wikimedia Commons
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Eugenics Foundation of Psychological Testing
Enlightenment: free will, people choose or make poor decisions that lead to crime
Charles Darwin On the Origin of Species, 1859 The Descent of Man, 1871
Social Darwinism: behavior is innate, inborn, irremediable Francis Galton Coined the word Eugenics
Heriditary Genius, 1869
The History of Twins, 1875
adoption studies for nature vs. nurture
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Cesare LombrosoCriminal Man, 1876
transl. Mary Gibson and Nicole Hahn Raftner, Duke Univeristy Press, 2006
“. . . criminals closely resemble not the insane but savages. All travelers know among the Negroes and savages of America, sensitivity to pain is so limited that the former laugh as they mutilate their hands to escape work, [Dysesthesia ethiopica] while the latter sing their tribe’s praises while being burned alive.”
“Race shapes criminal organizations. Both Bedouins and Gypsies can be considered races of organized criminals. The same seems to apply to Negroes in the United States . . .”
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Francis GaltonComposite portraits made by combining those of many different persons into a single figure. Nature 1878; 18:97-100.
”Composite portraits showing "features common among men convicted of crimes of violence," by Francis Galton, c. 1885, University College London, GP 158/2M
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The facial features of biracial Khoi/Boer
were the criminal type
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North Miami Police Target PracticeMedley Firearms Training Center, Medley, Florida
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Francis Galton and Linear Regression
Historians claim Francis Galton devised “regression to the mean” in 1875 studying generations of peas.
Francis Galton. Regression toward mediocrity in heredity stature. Journal of the Anthropological Institute 1885; 15:246-263.
Francis Galton. Galton, F. (1894), Natural Inheritance (5th ed.), New York: Macmillan and Company, New York: Macmillan and Company, 1894
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Francis Galton, Letter February 23, 1851Karl Pearson. The Life, Letters, and Labours of Francis Galton. Cambridge University Press, 1914
“I am sure that you will be curious to learn whether the Hottentot Ladies are really endowed with that shape which European milliners so vainly attempt to imitate. They are so, it is a fact, Darwin. I have seen figures that would drive the females of our native land desperate … I sat at a distance with my sextant, and as the ladies turned themselves about, as women always do, to be admired, I survej'ed them in every way and subsequently measured the distance of the spot where they stood—worked out and tabulated the results at my leisure.”
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SteatopygiaWelcome Collection, 1930
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Saartjie Baartman 1789-1815“The Hottnetot Venus”
Muséum d'histoire naturelle d’Angers, France
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Sextant
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Karl PearsonNational Life from the Standpoint of Science.
An Address Delivered at Newcastle, November 19, 1900Adam and Charles Black, London, 1901, pp. 19-21
“If you bring the white man into contact with the black, you too often suspend the very process of natural selection which the evolution of a higher type depends. . . . They naturally sink into the position of master and servant, if not admittedly or covertly into that of slave-owner and slave. . . Thus it comes about that when the struggle for existence between races is suspended, the solution of great problems may be unnaturally postponed . . . Such problems in suspense, it appears to me, are to be found in the negro population of the Southern States of America, in the large admixture of Indian blood in some of the South American races, but above all, in the Kaffir factor in South Africa.”
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PSYCHOMETRICS
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$500 million a year industry Meyer-Briggs administered to 2.5 million
people each year, collecting $20 million National Research Council meta-study
reports personality tests (particularly Meyer-Briggs) have no validity
Popular because of belief in their utility
Personality Testing
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Problem of Measurement in Psychology
Psychological variables, e.g., emotions, do not have a physical presence so are not directly observable, i.e. are “latent”
Can latent variables be measured or not? Yes (Edward Lee Thorndike)
▪ Introduction to the Theory of Mental and Social Measurements, 1904
▪ The Measurement of Intelligence, 1927 No (Norman Robert Campbell)▪ Physics: The Elements, 1920
Ferguson Committee 1932 of the British s Association for the Advancement of Science
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Scales of MeasurementS S Stevens. On the theory of scales of measurement. Science 1946; 103(2684):677-680.
Nominal Variables are categories assigned a name or label
Ordinal Variables are noncalculable, named, and in a specific order. Likert scale
Interval Named, ordered, but numerical with proportionate
intervals Ratio Named, ordered, proportionate intervals, and zero point
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Nominal Scale
Definition:
Variables are categories assigned a name or label Numbers are tags and have no quantitative meaning Responses can be counted Data: Open-ended questions Multiple choice questions Statistical Analysis: Sums Percentages
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Ordinal Rating Scales
Data: Relative rank Interval does not have a Real value Measure of non-numeric traits Add-on to nominal data Ordinal data has a median Statistical analysis Mann-Whitney U Test: difference between 2 groups Kruskal–Wallis H test: more than 2 groups
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Conjoint Measurement Theory
“axiomatization for the comparison of the effects of (or response to) pairs formed from two specified kinds of “quantities”” Luce DR and Tukey JW. Simultaneous conjoint measurement. A
new type of fundamental measurement. Journal of Mathematical Psychology 1964; 1:1-27.
Debreu, G. (1960). "Topological methods in cardinal utility theory". In Arrow, K.J.; Karlin, S.; Suppes, P. (eds.). Mathematical Methods in the Social Sciences. Stanford University Press. pp. 16–26
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Example: Hamilton Depression Rating Scale (17-Item)
A single item about depressed mood: 1 - Depressed Mood (sadness, hopeless, helpless,
worthless)▪ 0 Absent.▪ 1 These feelings states only indicated on questioning.▪ 2 These feeling states spontaneously reported verbally.▪ 3 Communicates feeling states non-verbally, i.e., through
facial expression, posture, voice, and tendency to weep. ▪ 4 Patient report VIRTUALLY ONLY these feeling states in
his spontaneous verbal and nonverbal communication.
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Example: Hamilton Depression Rating Scale (17-Item)
“Depressed Mood” constitutes four “feeling states,” i.e., sadness, helplessness, hopelessness, and worthlessness but is ranked by a single integer value 0-4. No weighted value although only hopelessness correlates with suicide
There is no unit of measure. A score of 2 is not twice the depression of 1, etc. So there is no norm.
One cannot perform arithmetic operations, e.g., you cannot add or multiply scores, meaning the scale does not function in a mathematical space (normed vector space, etc.) - no proof
Non-verbal communication is nonspecific (motor not psychic): Hypomimia facial expression in Parkinson’s disease or drug-induced
parkinsonism is described as flat or depressed affect. Tearfulness in pseudobulbar palsy secondary to subcortical lacunar
infarcts may not have associated sadness, etc. 36
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Associated Press, 7/9/15: Rep. Carl Anderson embraces Rev. Jesse Jackson to celebrate approval of bill to remove
the Confederate flag from capitol grounds in Columbia, S.C. Pittsburgh Tribune Review
37Image courtesy of the Pittsburgh Tribune Review
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Muhammad Ali and wife LonniePhoto credit: Kwaku Alston for AARP 2014
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Attention Deficit Hyperactivity Disorder
There are 50 million school age children in the United States.
The prevalence of ADHD ranges from 3-18%; 6 million (12% of 50 m) have been treated with medications
The gold standard for ADHD testing is the ConnersRating Scale, a subjective scale for parents and teachers. Purported sensitivity is 0.94 (false positives is 0.06) and specificity is 0.92 (false negatives is 0.08)
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There are two kinds of errors made by medical tests: false negatives (the test misses someone who has
the disease) false positives (the test mistakenly identifies a
healthy person as diseased). These are aspects of a test’s sensitivity and
specificity, respectively. These are not the same and each has important consequences for determining a child’s risk for ADHD
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Percent of Youth 4-17 Ever Diagnosed with Attention-Deficit/Hyperactivity Disorder by State: National Survey of Children's Health 2011
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Serotonin, Aggression, and Parental Psychopathology inChildren With Attention-Deficit Hyperactivity Disorder
Halperin JM et al. J. Am. Acad. Child Ado/esc. Psychiatry, 1997, 36(10):1391-1398.
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Evolution of Personality Tests
Woodworth Psychoneurotic Inventory (Robert Woodworth) WWI to identify soldiers at risk for shell shock (PTSD) Single scale: emotional instability Hospitalized psychiatric patients
Bernreuter Personality Inventory (Robert Bernreuter, 1930)
Multiscale: neurotic tendency, self-sufficiency, introversion-extraversion, sociabilty, confidence and dominance-submission
Thematic Apperception Test (Henry Murray and Christiana Morgan, 1935) Projective test has the patient weave a story in response to 32 pictures Inspiration Carl Jung, Personality Types 1921
Minnesota Multiphasic Personality Inventory (MMPI) All white, Protestant, Scandinavians (“Minnesota Normals”)
Atheoretical, patient interviews
Starke Hathaway and Charnley McKinley, 1943
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Sixteen Personality Factor Questionnaire Raymond Cattell Five Factor Model Openness to Experience, Conscientiousness,
Extraversion, Agreeableness, and Neuroticism (OCEAN)
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Carl Jung and the Negro “infection”Civilization in Transition. The Collected Works of C.G. Jung: The First Complete English Edition of the Works of C.G. Jung.
Princeton University Press, 2014, pp. 4350-4351
“Another thing that struck me was the great influence of the Negro, a psychological influence naturally, not due to the mixing of the blood. The emotional way an American expresses himself, especially the way he laughs . . . The peculiar walk with loose joints, or the swinging of the hips . . . American music draws its main inspiration from the Negro, and so does the dance . . . other abnormalities are strongly influenced by the Negro . . . Everything seems to be street.
This infection by the primitive, of course, can be observed in other countries . . . the white man is a diminishing minority and must protect himself from the Negro by observing the most rigorous social forms, otherwise he risks “going black.” If he succumbs to the primitive influence he is lost.
It is natural that in the dreams of my American patients the Negro should play no small role as an the expression of the inferior side of their personality. “
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The Myers-Briggs Type IndicatorMerve Emre. The Personality Brokers. The Strange History of Myers-Briggs and the Birth of Personality Testing. Doubleday, New York 2018
Carl Jung’s Psychological Types, 1921 is the basis of the Myers-Briggs Type Indicator (MBTI)
Katharine Cook Briggs (mother) and Isabel Briggs Myers (daughter), amateurs, created the test in 1943
Katharine Cook Briggs worshipped Jung as a “god” Isabel Briggs Myers authored a novel about whites who
after learning they had black blood committed suicide Pseudoscience Stein R and Swan AB. Evaluating the validity of Myers-Briggs Type Indicator theory. A teaching
tool and window into intuitive psychology. Social and Personality Psychology Compass 2019; 13(2):e12434
Boyle GJ. Myers-Briggs Type Indicator (MBTI): Some psychometric limitations. Australian Psychologist 1995; 30(1):71-74
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Kenneth B Clark and Mamie Katherine Phipps Clark
Kenneth B Clark and Mamie K Clark. The development of consciousness of self and the emergence of racial identification in Negro preschool children. Journal of Social Psychology, Society for the Psychological Study of Social Issues Bulletin 1939; 10:591-599.
Briggs v. Elliott 1952 Harry Briggs and 19 other parents brought suit against segregation and
R.W. Elliott, the president of the school board for Clarendon County, South Carolina
“discrimination, prejudice and segregation have definitely detrimental effects on the personality development of the Negro child. The essence of this detrimental effect is a confusion in the child's concept of his own self-esteem—basic feelings of inferiority, conflict, confusion in the self-image, resentment, hostility towards himself, hostility towards whites . . . [or] a desire to resolve his basic conflict by sometimes escaping or withdrawing ”
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Peter Neubauer and Alexander NeubauerNature’s Thumbprint: The New Genetics of Personality
Addison-Wesley/Addison Wesley Longman, Boston, 1990
Identical siblings, wards of Louise Wise adoption services, by policy were placed in separate families on recommendations by Dr. Viola Bernard with Columbia University
Dr. Peter Neubauer of Jewish Board of Guardians’ Child Development Center and NYU exploited the policy and placed siblings in families of disparate socioeconomic status to research nature vs. nurture and whether mental illness was genetic
Investigators tracked their development with personality and other psychometric tests. The source of funding is not known.
The research papers are sealed at Yale until 2065 Documentary films:
The Twinning Reaction. USA: Fire Horse Pictures 2017.
Three Identical Strangers. USA: CNN films, Raw TV 2018.
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Genetic Tests of Personality
‘Karmagenes’ Personality DNA test Employs a proprietary algorithm psychological
assessment based on the five-factor model (The Big Five) that links 14 behaviors to single nucleotide polymorphisms in DNA
Easy DNA Genomelink - (The Big Five) Circle DNA - (The Big Five) Others
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Property in “Personality”
23andMe has patented information elicited from its customers’ DNA but its customers have no property rights in these patents US 8,187,811 B2: Polymorphisms Associated with Parkinson’s
Disease There is the prospect then that companies compiling
DNA and psychological data may patent “personality” or mental health disorders or even intelligence characteristics
Police agencies have used DNA relatives’ information from commercial sites to track felons
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Forensic Psychological TestingEl-Shenawy OE. Traditional Psychological Tests Usage in Forensic Assessment. J Forensic Leg Investig Sci2017; 3: 020.
Forensic Assessment Instruments: Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
Wechsler Adult Intelligence Scale (WAIS)
Personality Assessment Inventory
Evaluation of Competence to Stand Trial-Revised (ECST-R)
MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA)
Juveniles’ Adjudicative Competence Interview (JACI) Forensically Relevant Instruments: Structured Assessment of Violence Risk in Youth
Historical Clinical Risk Management 20 (HCR-20)
Hare Psychopathy Checklist - Revised (PCL-R) Clinical Assessment Instruments:
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Educational Testing
Special Issue: Testing and Assessing African Americans: Past, Present, and Future Problems and Promises. The Journal of Negro Education 2012; 81(3)
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Artificial Intelligence and Psychological Testing
ELIZA: a chatbot created in 1966 simulated a psychotherapist
Capabilities superior to human therapists Infrared imaging to recognize temperature changes
Facial recognition
Optical sensing interprets facial expression and eye blinking
Vocal analysis of speech characteristics
Olfaction (smell) analysis
Fuzzy logic Augmented Virtual Reality Therapy (cell phones, iPads) Virtual Life Coaching, e.g., Second Life
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Artificial Intelligence in Psychology
Watson Health Mental Health Diagnostic Expert System RP-VITA Detection and Computational Analysis of
Psychological Signals (DCAPS) - DARPA (Defense Advanced Research Projects Agency)
Computer Science and Artificial Intelligence Laboratory at MIT
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Checklist
What are the credentials of the test developers?
Is the test published in a peer-reviewed journal? Has the test been validated and normed for the
subject’s age, race, and gender? Check publications for and against the test. Is the person administering the test certified? Does the test serve the needs of the subject? Does the test serve a social agenda?
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Questions
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Appreciation
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Contact Us
a program managed by
Central East MHTTC websiteOscar Morgan, Project Director
Danya Institute websiteEmail
240-645-1145