Deposition of a defense psychiatrist: doctor do you have a crystal ball

Photo:  At the arbitration before State Farm's special video connect program (not skype) failed to work.

Photo:  At the arbitration before State Farm's special video connect program (not skype) failed to work.

Ms. A is insured by State Farm with UIM. They do not want to pay the claim.  They hire this psychiatrist to do a records review. To help them challenge the injury claim.   Dr. P never meets or interviews Ms. A.   But being the God-like creature that he is, will testify that Ms. A somaticizes her injuries and has "secondary gain."   What this means in real people language - is that she is making the injuries up.   My job is to show that he is the one making things up.

In order to get the full flavor you have to picture:  a) The court reporter and I are in my office; b) the doctor is on the phone from California; c) the defense lawyer is on the phone in his office; d) as I begin to lose my temper am - waving arms in air, rolling eyes around head, throwing head down on arms on table, and being major drama queen.  You get the drift.  This is the nice part about doing a deposition when no one else can see you.

A teeny bit of background.  Ms. A is in her mid 20s when this happens while she is getting her PhD. She now is doing post doctoral work.  She brings a claim for medical bills and personal injuries.  She is not making a wage loss claim.

I am asking for his opinions.  And the fight begins:
25   Anything else?
1   A    Well, I think I -- I believe she's using her symptoms
2        for secondary gain, that is, to get benefits that she
3        would not otherwise receive.
4   Q    So, this -- let me get this straight.  She hasn't seen a
5        doctor for psychological issues since two thousand --
6        for almost four years.  She functions at a very high
7        level, she is in a successful relationship, and she is
8        making up her symptoms so she can get money from her
9        uninsured motorist insurance company?
10   A    No, that's not correct, and that's not what I said.  I
11        said --
12   Q    Well, it sure sounded like it.
13   A    Allow me to finish, please.  I said that she has
14        secondary gain motivation.  I didn't say that -- you
15        know, any of what you said.
16   Q    Well, secondary gain from this litigation means she's
17        trying to get money by making up or magnifying her
18        symptoms.
19   A    No, you have a misunderstanding of secondary gain.
20   Q    Well, you tell me then what your understanding of it is.
21   A    Well, what it means is that she is attempting to use her
22        symptoms -- and as far as I can tell it's unconscious --
23        to get benefits that she would otherwise not receive.
24        If I had evidence that she was consciously, you know,
25        using her symptoms to gain benefits that she would not
1        otherwise receive, that would be malingering.  I'm not
2        saying she's malingering, I'm saying she has secondary
3        gain motivations.  That's different.
4   Q    So your opinion is that she's not a malingerer?
5   A    I did not say that.  I said I did not have evidence that
6        she is malingering.  I don't know whether she is or is
7        not malingering.
8   Q    Am I correct that there is no evidence that she's
9        malingering?
10   A    I never said that.  She could be.
11   Q    Doctor, that's not what I said.  I said you have found
12        no evidence that she's a malingerer?
13   A    No, that's not correct.
14   Q    What evidence have you found that she's malingering?
15   A    I've found that she's reporting more physical symptoms
16        than can be objectively accounted for based on the
17        nature of the accident she's experienced.
18   Q    Are you telling us on a more probable than not basis
19        that she is a malingerer or not?
20   A    I said, I am not -- I do not have -- I do not conclude
21        at this point that she is malingering.  However, is it
22        possible she's malingering?  Yes, it's possible.
23   Q    I don't care about possibilities.  We only care about
24        more probable than not.  You know that.
25   A    At this moment I do not think it's probable she's
1        malingering.  That opinion could change if additional
2        material were provided.
3   Q    But you do believe she has secondary gain?
4   A    Oh, yes, of course.
5   Q    And what is the benefit that she's trying to get?
6   A    Well, money, for one.  She's trying to get money, she's
7        getting concern, care, support from others -- for
8        instance -- let me just find this.  She was -- she
9        was -- she was going to have -- somebody else was going
10        to present a paper for her, and I -- that -- you know,
11        so that she wouldn't have to present it because of her
12        physical symptoms.  Now, it turned out that that didn't
13        actually happen.  She herself did, in fact, go ahead and
14        present the paper.
15             And also, her supervisor at the University of
16        Washington, he was -- I think it's a he, I'm not sure
17        about that, but whoever her supervisor was, was going to
18        also -- I have to find that.  I have it here
19        someplace -- was going to help her out in some way.  So
20        those are examples of secondary gain right there.
21   Q    Secondary gain because somebody that's as prideful as
22        her and as accomplished as her needs to have help?  I
23        find your insinuations to be shockingly rude.
24   A    No, you're misinterpreting what I'm saying.  I'm saying
25        on a psychological basis, this lady -- okay, look.  This
1        lady has unmet dependency needs.  Her parents were
2        divorced when she was four.  She was raised by her
3        paternal grandparents until ten.  She then -- her father
4        then got custody of her, which is extraordinarily
5        unusual in California, which I believe that happened.
6        And then her mother then got custody of her the
7        following year, okay?  This lady has unmet dependency
8        needs.  She is using these symptoms that she has to try
9        to get these unmet dependency needs met for secondary
10        gain purposes.
11   Q    I find your opinions outrageous.  You have not even met
12        her.
13   A    I have records that --
14   Q    I mean, honestly --
15                     MR. CROWELL:  Objection, argumentative.
16   Q    (By Ms. Koehler)  I am absolutely appalled.
17                     MR. CROWELL:  Is that a question, Counsel?
18   Q    (By Ms. Koehler)  Oprah Winfrey was abused as a child
19        and she's one of the most powerful women in the world.
20        How can you try to insinuate that she's got secondary
21        gain issues because of her abandonment and family of
22        origin issues?  I mean, that is an extraordinary leap of
23        faith.
24   A    If she has unmet dependency needs, and if those are
25        there, which I believe they are -- and I can show you
1        some other evidence for that.  But if she does, and I
2        believe that she does, then, she is in a position to
3        attempt to get those unmet dependency needs met, and one
4        of the ways -- and this is unconscious.  I'm not saying
5        this lady is doing this consciously, deliberately.
6        Don't get me wrong.  She's functioning at a very high
7        level.  She's doing very well.  But psychologically I
8        believe what I'm saying is going on, and that accounts
9        for some -- some of the -- some of the behavior that we
10        see.
11   Q    Doctor, do you have a crystal ball on the other end of
12        that phone?
13   A    What are you talking about?
14   Q    How can you make this kind of declaration when you've
15        never examined her, when you've said that you're -- that
16        testing should have been performed that wasn't
17        performed, and that there's information that you think
18        is missing?  How can you jump to these conclusions when
19        you don't have any basis to make them?
20   A    You're wrong.  I have my knowledge, training, and
21        experience.  I know what happens in these kind of
22        situations.  I know what happens when parents are -- you
23        know, when a person -- parents are divorced when they're
24        four years old.  I know what that does.  There's all
25        kinds of research that indicates what happens.
1   Q    Well, I'm really offended now --
2   A    Judith Wallerstein wrote a whole book about this kind of
3        thing in Marin County here.  I mean, she's a
4        psychoanalyst.  I mean, this is well known.  This is
5        hardly something that's not known.
6   Q    Well, I have a daughter who was four years old when her
7        parents were divorced and she doesn't appear to have
8        unmet dependency issues.  She's functioning quite highly
9        and very well.
10   A    Look.  Miss A is functioning highly as well.  But
11        we're talking accounting for certain kinds of behavior
12        and symptoms.  And just because somebody was, you know,
13        parents were divorced when they were four, that doesn't
14        necessarily mean that that will be the result.  But in
15        this case, when I put everything together that is
16        present, and you know, using my knowledge, training and
17        experience, I think it's a reasonable conclusion.  I
18        think it's more likely than not.
19   Q    Well, I think that you should be ashamed.

There should really  be an exclamation mark after the word ashamed!

But perhaps the most amazing part comes at the end of cross examination the next week.  Today in fact.  During the UIM Arbitration proceeding.    After testifying again to the above crapola, I ask the doctor for any evidence he has that Ms. A somaticized before the car crash.  And here is what he says.  No lie.  Am not kidding.

She had headaches which is evidence of somatization.  She also had dysmenorrhea which again is evidence of somatization.  I actually look it up on the internet to make sure I have this right.  Yep.  I do.

So you are saying, doctor that headaches and pain with menstruation are evidence of somatization.


So a woman who has headaches and pain with menstruation is likely somatizing the events.


Since women are the only ones who have pain with menstruation, I suppose the statistics show that women have a much higher incidence of somatization than men.


Pinch my leg to make sure have not time travelled back to the 1930s.  Yes, ladies and gentleman, this is the kind of defense expert your good neighbor will hire to testify against you, if you are hurt in a crash and bring an underinsured motorist claim.