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PATIENTS WHO MAKE FALSE ALLEGATIONS
The Role of the Forensic Psychiatrist
Richard C. W. Hall, M.D.
Courtesy Clinical Professor of Psychiatry
University of Florida, Gainesville
Ryan C. W. Hall
Second-year Medical Student
Georgetown University School of Medicine
As forensic psychiatrists, we are often asked to see and evaluate
individuals to determine if the nature of the allegations that they
are making against others, particularly health care providers and
persons in authority, are valid and accurate. The more heinous the
allegation, the more serious the subsequent investigation is likely
to be. Allegations based on sexual misconduct, physical violence,
or child abuse carry a particularly charged quality. The sensational
nature of these charges is often unsettling and touches on underlying
emotional issues in both the examiner and the accused.1, 2
Professional review boards and medical ethics and review committees
are often polarized and respond to personally-held biases and beliefs.
The concepts of "where there's smoke, there's fire" and
there has to be "at least a grain of truth" in every allegation
are often evoked to further justify elaborate and extensive investigations,
which can place the accused in the unfortunate and impossible position
of trying to disprove a negative. As Chairman of a state Ethics
Committee, we have reviewed many allegations that are patently preposterous.
There is rarely difficulty in dealing with complaints of abductions
by aliens or physicians employed by the KGB. Conversely, investigative,
feminist, and religious passions are regularly raised by any hint
that a healthcare provider has been sexually, interpersonally, or
socially inappropriate with a patient. Charges of child abuse, incest
and sexual misconduct by police are other allegations that psychiatrists
are frequently called upon to evaluate. Several authors have reviewed
specific types of false complaints.3-8
In 1994, Kimberly Mays (who had been switched at birth) accused
the man who had raised her of sexual abuse. She made the allegation
after meeting her biological parents. The local and national press
was filled for months with reports that this troubled young woman
had subsequently disowned her biological family, then that she abruptly
moved in with them, telling authorities that she had been abused
since age seven by the man who had raised her. Later, she reported
she made the whole story up and that her charges against her father
were false.9 This case may well represent a troubled
young woman's attempt to establish boundaries and to seek attention
through the public media.
In an interesting letter written to Robert Wallace's Talking
With Teens column, a teenager wrote "Dear Dr. Wallace:
I need your advice -- and make it fast. My best friend hates her
stepfather. About a month ago, she told me she was going to tell
the police that he molested her sexually even though it wasn't true.
Well, last week she did just that and has caused a big stink. Her
stepfather had to hire a lawyer to defend himself even though he
was 100% innocent. He was also tossed out of their house by my friend's
mom. The main reason she hates her stepfather is that he made her
break up with her 19-year-old boyfriend. My friend is 14. The only
people who know that this man is innocent is my friend, her boyfriend,
who also hates him, and me. So that means I am the only one who
can save him. What should I do? I really don't want to lose my best
friend, and if I speak the truth, I know that she will never talk
to me again." Dr. Wallace advised the teen to talk to her parents
and let them know that her best friend was lying and that the stepfather
never molested her. He suggested that her parents then talk to the
mother and contact the police.10 This case illustrates
revenge as a motive for making a false allegation.
The Ramona case 11,12 deals with the "cottage
industry" of false sexual complaints, as does the McMartin
Preschool case. It illustrates the risks therapists face when taking
controversial adversarial positions, which grant credibility to
unsubstantiated allegations in the guise of "therapy."
Holly Ramona, a young woman in psychotherapy, exhibited what her
therapist felt were telltale symptoms of sexual abuse. She reportedly
dreamed of a snake crawling up her vagina, refused gynecological
examinations, and feared men with "pointy canine teeth"
-- the kind of teeth that reminded her of her father, who she had
accused of sexually abusing her. She reported an aversion to whole
bananas, melted cheese and mayonnaise -- items, it was claimed,
that reflected her trauma over having to perform oral sex on her
father. When the case went to court, a Napa, California jury felt
that the culprit was not the father, but rather two therapists who
helped Holly "remember" this alleged abuse.
The patient's father, Gary Ramona, a respected industrialist,
charged that therapists had planted ideas of abuse in Holly's already-unstable
mind and in the process ruined his life. The case became a landmark
and "struck a blow against the increasingly controversial techniques
of recovered-memory therapy." Courtroom testimony illustrated
an unusual pattern of events that led to the allegations against
Mr. Ramona. Holly had suffered from bulimia and her counselor advised
the mother that 80% of all bulimic cases are caused by childhood
sexual abuse, an unfounded and untrue statement. Holly began having
"flashbacks" after being in therapy for several months.
She was then given sodium amytal to help her remember specific details
of sexual molestation. Holly accused her father of raping her and
when Holly's mother found out about this, she served the father
with divorce papers. The rumors of abuse resulted in serious damage
to Mr. Ramona's reputation. The jury awarded Mr. Ramona $500,000
in damages. The jury foreman commented, "We felt that there
was nothing done [by the therapists] that was malicious. It was
more a case of negligence."
Several years ago, our office had occasion to see a young woman,
at the request of her father, who was emotionally distraught because
her high school teacher had "fingered her." In talking
with the young girl, she broke into tears and reported that her
current situation had gotten totally out of hand. She had failed
one of her high school courses and when confronted by her father
over her poor grades she told him that she had failed because the
teacher had it in for her because he attempted to "finger"
her and she refused. The father became enraged, called his boyhood
friend, the Sheriff, and had his daughter file charges of sexual
assault. The teacher was arrested. The local newspaper prominently
featured the story. We subsequently learned that even the teacher's
wife was unsure that he did not actually commit this act. Although
he vehemently denied any inappropriate contact with the young woman,
it was a matter of his word vs. hers as there was no physical evidence.
In interviewing the child, she reported that her father's anger
at her failed grade took her by surprise and "that was the
first thing that came to my mind." After making the allegation,
she felt trapped and was unable to withdraw it. We called both the
Sheriff and the father, with the girl's knowledge and permission,
and charges were subsequently dropped, but the teacher's standing
and career in the community were adversely affected. He and his
wife ultimately sold their home and moved to another state. This
young woman made a protective false allegation to protect herself.
On another occasion, we talked with a young borderline woman,
who reported that she had made allegations to her county medical
society that her psychiatrist had been sexually inappropriate with
her. She reported that she was angry at him, that he had not given
her the attention that she wanted, and that she made up the charges
to get even. Although she candidly reported that he had never touched
her, she said that she "was sure that he wanted to." Her
physician was subjected to a lengthy series of hearings, but the
accuser left the state prior to the conclusion of any formalized
complaint. The charges were dropped when she refused to further
pursue them or attend a hearing to tell her story. The doctor had
clearly been made to "pay the price" for not meeting her
narcissistic and borderline needs for attention and recognition.
Meadow13 reports on 14 children from seven families
where false allegations of sexual abuse were made by an emotionally
disturbed mother. Twelve of the 14 children were alleged to have
incurred sexual abuse, one both sexual and physical abuse, and one
physical abuse alone. Thirteen of these children had incurred or
were currently victims of factitious abuse that had been invented
by the mother. The one child with no factitious illness abuse has
a sibling that had incurred definite factitious illness abuse. These
were all cases of Munchausen syndrome by proxy. The ages of the
children ranged from three to nine. The mother was the source of
the false allegations and was the person who encouraged or taught
six of the children to substantiate the allegations of abuse.
All these cases emphasize the need for psychiatrists evaluating
such charges to keep an open mind and to realize that false allegations
do occur and are, in fact, common. Myers14 notes that
45% of allegations of sexual abuse in the U.S. are totally unsubstantiated.
Forensic psychiatrists and psychiatric clinicians in general need
to remain vigilant to the fact that, although allegations may be
genuine in many cases, in an almost equal number of cases, if Myers'
data can be believed, they are not. This is particularly true when
they emerge in the context of an angry doctor/patient relationship,
an ugly divorce, an angry child custody case, or a situation where
a patient with a significant personality disorder is confronting
a legal authority.
False allegations of abuse occur in a variety of contexts; the
most frequent being 1) disputed and ugly divorce cases; 2) in custody
disputes involving children; 3) by angry borderline patients; 4)
by patients with Munchausen's syndrome by proxy; 5) by psychopaths
against authority figures; 6) by inadequate patients with strong
needs for recognition and attention; 7) by patients with personality
disorders; 8) by substance abusers, particularly alcoholics; 9)
by patients with paranoid psychoses; 10) by patients with paranoid
personality; 11) by patient with "multiple personalities"15;
12) by passive patients urged to file complaints by their therapists
to meet the unspoken needs of the therapist.
Knight16 notes that "the fact is that a significant
proportion of allegations of rape and indecent assault reported
to the police are found to be untrue. This is often hotly denied
by women's groups, but is an indisputable fact, proven by many subsequent
admissions by girls that no such attack took place." "However,
against this is the equally true fact that only a minority of real
sexual assaults are reported to authorities."
When evaluating these allegations, the forensic psychiatrist must
remain impartial, be aware of their own gender biases, and resist
pressure by other members of the team who may have their own agendas
to avenge some social wrongdoing or who identify too strongly with
the accuser. They should respond methodically and cautiously. In
the absence of positive forensic proof, the allegations must be
looked at carefully and impartially. Conclusions should be reached
only after carefully reviewing all objective facts and after a detailed
history and examination. The accused should be given the benefit
of doubt as it is almost impossible to disprove a negative.
False accusations are most likely to occur in the context noted
above. Where clear-cut revenge is a motive, where patients are psychotic
or delusional, or where the allegations occur at a time when the
accuser is intoxicated with alcohol or drugs, particular caution
should be exercised. If there is a history of repetitive allegations
made against many figures in the past, the index of suspicion should
go up. One must also consider the timing of allegations, particularly
date rape, where a female sees a boy regularly, dates for several
months, gives consent for intercourse, and then later makes accusations
of rape or sexual misbehavior when the relationship ends. The investigator
must always be cautious of a patient's desire for revenge or mischief.
The use of regressive technique, inferences about early sexual
trauma from dreams or symptoms, such as gastrointestinal complaints,
and the use of nonstandardized "psychiatric tests," such
as figure drawing, to support allegations should be discouraged.
The amount of harm that can be done by failure to obtain a full
and complete history is evidenced by the following case.
A university professor was accused of attempting to impose sexual
activity on a coed with threats that should she fail to satisfy
him sexually, she would receive a failing mark in his class. The
coed also alleged that he had fondled her and called her repetitively
at her home. Her charges were initially quite creditable and were
taken seriously by the university. The professor was placed on administrative
leave. The young woman gave elaborate details. Toward the end of
her evaluation, she reported that she was distressed that one cannot
trust teachers as they "always do this sort of thing."
When questioned as to whether this had ever occurred before, she
reported that she had been sexually accosted by both the principal
of her high school and a band director. In addition, several years
earlier she had made charges that she had been raped by a sailor
on leave. The probability that this same young woman would be the
victim of four sexual assaults within such a short period of time
led to a careful inquiry of the previous cases. Her allegations
had caused considerable harm to all of the individuals so accused
and we subsequently learned from her parents that they were aware
that the allegations that she had made against the high school principal
and the band director were unfounded and that the parents also suspected
consequently that her initial complaint of having been raped by
a sailor was an attention-seeking device. When this information
was made available to the university, the charges against the professor
were dropped.
In another case, a police officer was accused of attempting to
drag an intoxicated woman into the woods to have sex with her. On
careful inquiry, she reported a similar situation had occurred in
a remote state under similar circumstances when she had been stopped
by a highway patrolman for driving while intoxicated and speeding.
The fact that there had been two allegations made under almost identical
circumstances when she had been apprehended and was being charged
with DUI raised questions as to the credibility of her statements.
The forensic psychiatrist, thus, has a responsibility to protect
both the accused and the accuser. He/she should obtain a careful,
detailed review of the allegation and the accuser's mental state
and circumstances. The allegation should be examined with cautious
skepticism and an unwillingness to jump to absolute conclusions
in the absence of specific credible evidence.
- Orlando Sentinel, July 14, 1993; March 1, 1994; September 27,
1994; November 6, 1994; December 16, 1994; March, 21, 1996; April,
1996; April 4, 1997.
- Florida Today, April 6, 1995.
- Adshead, Gwen: Psychological Trauma and its Influence on Genuine
and False Complailnts of Sexual Assault. Med. Sci. Law; Apr. 1996;
36(2)95-99.
- Williamson, Tom: Police Investigations - separating the false
and genuine. Med. Sci. Law; Apr. 1996; 36(2)135-140.
- Kanin, Eugene: False Rape Allegations. Arch Sex Behav; 1994;
23(1)81-92.
- Jamieson, MA; Walker, M; Daicar, A; et al: False Allegations
of Pregnancy Resulting From Incestuous Rape and Physician Misconduct:
Proof Positive. J Pediat Adolesc Gynecol; 1998; 11:181-184.
- Mantell, D: Clarifying Erroneous Child Sexual Abuse Allegations.
Amer J Orthopsychiat. Oct. 1998:58(4)618-621.
- Schreier, Herbert: Repeated False Allegations of Sexual Abuse
Presenting to Sheriffs: When Is It Munchausen By Proxy? Child
Abuse & Neglect; 1996; 20(10)985-991.
- Orlando Sentinel, 6B and C6, October 20, 1994.
- Orlando Sentinel, October 11, 1992.
- Willwerth, James: Dubious Memories, Time, May 23, 1994, pg.
51.
- Grinfeld, MJ and Duffy, JF: Jury Awards Father $500,000 in
Recovered Memories Trial. Psychiatric Times, June 1994.
- Meadow, R: False allegations of abuse and Munchausen syndrome
by proxy. Arch Dis Child 1993; 68:444-447.
- Myers, JEB: Allegations of child sexual abuse in custody and
visitation litigation: recommendations for improved fact finding
and child protection. J Fam Law; 1989-90; 28:1-41.
- Lewis, DO; Bard, JS: Multiple Personality and Forensic Issues.
Psychiatric Clinics of North America; Sept. 1991; 14(13):741-756.
- Knight, B: Simpson's Forensic Medicine, 11th edition. Oxford
University Press, New York, NY; 1991; p134.
EVALUATION OF PATIENTS' ALLEGATIONS
Factors To Be Considered
- Is accuser creditable?
- Is story consistent and believable?
- Is there a motive for revenge or mischief?
- Have other allegations been made previously? Does a pattern
of allegations exist?
- Has the patient been counseled in their charges by some professional
who has vested interest?
- Is there any physical evidence of misdeed?
- What is the reputation of the accused?
- How does the accused respond to the charges?
- Are there issues of custody, property settlement, divorce,
or suit involved?
- Is there a history of personality disorder - antisocial, narcissistic,
borderline - in either party?
- Is there a history of alcohol or substance abuse in either
party?
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