So, a man walks into a doctor’s office and he says, “Doctor, help me! I’m depressed and want to kill myself.” What is the first thing the doctor is supposed to say? “Tell me about it? How do you feel about that?” No, you are supposed to ask, “Do you have a plan?” If he has a plan, you have to call the police. This has become universal truth among mental health professionals because it is the law.
Some of the more enterprising of us would give that man a Beck Depression Scale. Considering the Beck in light of the best made plans of mice, men, and psychologists, this guy is just as likely to answer all the questions in such a way as to produce a low score, meaning that he is a happy guy and has lots to look forward to in life, even though he may not really be. Why might a test score not be consistent with his complaints upon interview? Because the Beck has high face validity, meaning that almost anyone would know what the questions are getting at because no effort has been taken to conceal the purposes of the test items.
Why would a person not want to answer questions honestly? Maybe because the man is concerned about leaving a paper trail so that someone can use the results against him. Maybe because he came to see a therapist as to a priest and expects both confidentiality and sanctity to be displayed in his treatment, but will present the better side of his nature, however insincere, if he thinks his answers may be viewed by others outside his therapist’s office. He might also adulterate his responses to the Beck because he was raised to believe that you should not complain because people don’t really want to know about your problems. (“How are you today?” “Fi-i-ine.” Insert smile here.)
I should add at this point that the reason most mental health professionals administer the Beck in clinical practice is to cover their bum. That way, if the man does something stupid, like attempt suicide after you discharge him from your care, you have a piece of paper that will say to any licensing board or court of law that he was not depressed at the time he left your care. See, the test proves it! This, incidentally, is frequently what happens in psychotherapy. A patient will lie to a therapist or reveal less than the truth with the idea that he only wants therapy to find a solution to a very restricted area of stress.
Take as another example, the patient who sees a mental health practitioner for depression for years, takes a variety of pills from a psychiatrist and/or does behavioral or insight oriented therapy with a psychologist or counselor, but never reveals that he was severely abused sexually and physically because it is both too embarrassing and too painful to discuss even with the treating doc.
“So, what is testing supposed to do?” you or someone might sneeringly ask who has had his or her deepest, darkest secrets revealed by some yokel writing a blog in the middle of nowhere with a Doctor of Philosophy degree from some Podunk town in Indiana.
Testing is supposed to reveal things about you, in this case about your personality, which cannot be revealed in any other way. It is meant to be a way to shed light on a set of psychiatric symptoms, to provide additional information about your clinical picture. It is not meant to be the picture itself. For this reason, the Beck is not expected to replace the way you report your own symptoms in therapy, but to provide some basis to view progress in treatment. It is no better than a snapshot of someone who is smiling for the camera. The subject knows that a picture is being taken and smiles accordingly, even if he has a plan to commit suicide afterward. If the patient reports severe depression, but the test says that person is happy, you have something meaningful to work with because it gives you the opportunity to explore the reason for the discrepancy, an exploration that can be very meaningful. It should not work as a defense in court, if a patient discharged from the hospital with a normal Beck score, walks onto the freeway during rush hour and is returned to the hospital in a mangled state or else deceased. However, there are always exceptions. A court may see the results of this test as proof that the patient became suicidal after, not at the point of discharge.
Regardless of what we know about psychological tests and the Beck in particular, psychiatrists frequently want to use the Beck in this way. Anytime there is a question of self-harm upon discharge, the question most frequently asked by MDs is, “Did you give him the Beck?”
