March 2006 Note - This article was originally written in late 1998. The content stands the test of time, and the documents from Mike Tyson's assessment can still teach us much about how different mental health professionals approach the assessment process.
You probably heard that the Nevada Athletic Commission ordered Mike Tyson to undergo an evaluation to determine whether he was mentally fit to return to boxing. This is apparently unprecedented. Some have commented about the irony in this - psychologists and psychiatrists and neurologists are being asked to determine if Mike Tyson is sane enough to compete in a sport which involved inflicting temporary brain damage on your opponent.
Mike Tyson made it clear that he did not want this report to be released to the public. The doctors who performed the assessment stated the same opinion. A report of this type is usually made a part of the medical record, and it is kept extremely confidential. The Nevada Supreme Court ruled that the reports should be released, so Tyson signed a waiver to make them public.
The report describes some interesting aspects of Tyson's personality. It also illustrates nicely some of the finer distinctions among doctoral level mental health professionals. Here are the major players, with links to their vitas (résumés) and their reports.
Ronald Schouten, M.D., J.D. is both a psychiatrist and a lawyer. He wrote the independent medical evaluation which synthesized the information from all of the experts. His expertise in both law and psychiatry was helpful in an assessment which was written for a quasi-legal body. He also ordered labwork to look at Tyson's general health, to screen for drugs of abuse, and to look at the level of sertraline (an antidepressant) in his blood.
Jeremy Schmahmann, M.D. is a neurologist. Neurologists are medical doctors who study the brain. Dr. Schmahmann's report is written in the form of a letter to Dr. Schouten. This is a common format for reports from a specialist who has been asked to consult on a case. By reading this report you will get a good idea of what is often included in a neurologist's examination. A history is taken with the emphasis being on possible past head injuries or neurological symptoms. Reflexes are tested and the subject is asked to perform various simple tasks. A mental status exam is administered to determine if aware of his surroundings. An EEG (electroencephalogram ) and an MRI (magnetic resonance image) were both performed to look at the structure and functioning of his brain. The EEG looks at the electrical activity in the brain, while the MRI looks at the structure of the brain. Both were normal. Dr. Schmahmann commented favorably on Tyson's demeanor, stating that he "demonstrated an ability to be both gentle and generous." He found Tyson to be neurologically intact.
David Medoff, Ph.D. is a clinical psychologist who was asked to administer psychological tests to Tyson. He administered a standard battery of tests which psychologists often use. The Bender-Gestalt is a very brief screening test which looks at visual-motor skills. It is sometimes used as a very rough screening test for brain damage. The Rorschach Inkblot Test is the famous projective test where a person is shown a series of inkblots and asked what they see in them. Their responses are compared with responses of a large sample of others to get a picture of their cognitive and emotional life. One of the things that the Rorschach does best is to examine whether a psychotic process (such as schizophrenia or bipolar disorder) is present. The MMPI-2 is a standardized psychological test consisting of almost 600 true-false questions. Most people find it to be a chore to take, and Tyson appeared to be giving random responses at one point. A second administration of this test appeared valid. Psychologists combine data from tests such as these with information from an interview to paint a picture of a person's personality. Dr. Medoff had mostly positive things to say about Tyson. Some mild depression was reported to be present, but not a full-blown "major depression."