Featured Article | Law and Human Behavior | 2023, Vol. 47, No. 1, 292-306
Adapting Assessment Processes to Consider Cultural Mistrust in Forensic Practices: An Example With the MMPI Instruments
Janelle N. Dixon; Department of Psychology, Patton State Hospital, Patton, California, United States
Tonneka M. Caddell; Department of Psychology, Patton State Hospital, Patton, California, United States
Apryl A. Alexander; Department of Public Health Sciences, University of North Carolina at Charlotte
Danielle Burchett; Department of Psychology, California State University, Monterey Bay
Jaime L. Anderson; Department of Psychology and Philosophy, Sam Houston State University
Ryan J. Marek; Department of Primary Care and Clinical Medicine, Sam Houston State University
David M. Glassmire; Department of Psychology, Patton State Hospital, Patton, California, United States
Objective: Our first goal in this study was to identify cultural mistrust critical items (CMCIs) on two versions of the Minnesota Multiphasic Personality Inventory (MMPI)—the MMPI–Second Edition–Restructured Form (MMPI-2-RF) and MMPI–Third Edition (MMPI-3)—that might be endorsed by people of color because of cultural mistrust rather than clinical paranoia. Our second goal was to determine whether CMCIs and items on the MMPI-2-RF/MMPI-3 Ideas of Persecution scale (Restructured Clinical Scale 6 [RC6]) were endorsed at different rates across cultural groups in a nonclinical college sample and a forensic inpatient sample. Hypotheses: Our primary hypothesis was that expert raters would reliably identify a subset of MMPI-2-RF and MMPI-3 items as reflective of cultural mistrust. Black college students would endorse the highest level of CMCIs, followed by Latina/o students, and then White students. We hypothesized that the same pattern of findings would occur in forensic inpatients but that the differences would be attenuated because of the high base rate of psychiatric symptomatology and the nature of the forensic assessment setting. Method: Three Black female and three Black male psychologists rated the degree to which each item on the MMPI-2-RF and MMPI-3 reflected cultural mistrust. Black (n = 90), Latina/o (n = 83), and White (n = 100) college students were compared on CMCIs and on MMPI-2-RF/MMPI-3 RC6 item endorsement. The same comparisons were made among Black (n = 221), Latina/o (n = 142), and White (n = 483) forensic inpatients who completed the MMPI-2-RF. Results: Black college students endorsed the highest levels of cultural mistrust, followed by Latina/o students, and then White students, resulting in small-to-medium effect sizes (Hedges’s gs = 0.14–0.52). Although we observed some item-level differences in forensic patients, the overall pattern of item endorsement did not significantly differ in this group. Conclusions: There are multiple reasons for the reporting of clinical paranoia and cultural mistrust in forensic assessment.
Cultural mistrust, racial identity, people of color, clinical paranoia, MMPI
Summary of Research
“Psychologists have the ethical responsibility to practice with ‘beneficence and nonmaleficence,’ that is, ‘to do no harm’ (American Psychological Association, 2017, p. 3). However, this can be challenging for those who specialize in forensic psychology and face job duties that pose conflicts with professional, ethical, and even moral principles. Such conflict poses the question, How are we consciously or unconsciously contributing to systemic racism as forensic evaluators and treatment providers? To gain better insight on this matter, we must examine the forensic assessment process…Forensic evaluations often employ multiscale instruments of personality and psychopathology to answer psycholegal questions and provide diagnostic impressions and recommendations…Multiscale measures of psychopathology used in forensic evaluations may inaccurately label POC [people of color], and particularly Black Americans, as having clinical paranoia when, in fact, their endorsement of certain items may be driven by an accurate self-appraisal of their lived experiences (i.e., cultural mistrust)…” (p. 295).
“To date, no empirical studies have specifically examined items from the MMPI [Minnesota Multiphasic Personality Inventory] instruments as potential markers of cultural mistrust. In the present study, we sought to identify items reflective of cultural mistrust using an expert rater methodology in which Black psychologists…were asked to rate every item from the MMPI-2-RF [Minnesota Multiphasic Personality Inventory – Second Edition – Restructured Form] and MMPI-3 [Minnesota Multiphasic Personality Inventory – Third Edition] item pools to determine whether these items might be endorsed because of cultural mistrust rather than clinical paranoia…We hypothesized that Black psychologists would reliably rate some items on MMPI instruments as markers of cultural mistrust. We also hypothesized that there would be significant differences in the endorsement rates of MMPI-2-RF items related to cultural mistrust across cultural groups in a forensic inpatient sample but that these differences would be smaller than those found in a nonclinical and nonforensic sample of college studies…Because our methodology identified items that are most likely to be salient for Black individuals, we hypothesized that any observed effects would be more pronounced for Black individuals that for Latino/a individuals across samples. Further, because cultural mistrust may be influenced by multiple factors, such as age, generational cohort, and gender, we conducted exploratory analyses to determine whether there were differences in the endorsement of cultural mistrust across gender and age groups” (p. 295).
“Participants in the initial undergraduate sample were 337 students at a moderate-size university in the southwestern United States…Participants in the initial forensic sample were 1,277 inpatients at a maximum-security forensic hospital in the western United States…First, using an expert rating methodology, we found that both Black female and Black male psychologists reliably rated 10 items from the combined MMPI-2-RF/MMPI-3 as reflective of cultural mistrust…The content of these items covered a range of themes such as being the object of criticism from others, being the object of malicious actions from others, being unjustly punished, being in trouble with the law, and not having confidence in law enforcement…After identifying items that might be reflective of cultural mistrust, we conducted two studies using different samples to investigate the total number of endorsed CMCIs [cultural mistrust critical items] and the individual item endorsement rates of CMCIs…” (p. 296-301).
“As hypothesized, Black college students endorsed significantly more CMCIRFs than White students. Although Black students endorsed more CMCIRFS than Latina/o students, the difference was nonsignificant, and the effect size was small for this comparison. We also found that Black college students endorsed significantly more items on the MMPI-2-RF RC6 [Restructured Clinical Scale 6] scale than White students, but Black students’ and Latina/o students’ MMPI-2-RF RC6 scores did not differ significantly…Regardless of which version of the MMPI was used, the difference between Black and Latina/o students’ RC6 item endorsements reflected a small effect size, and the difference between Black and White students’ RC6 item endorsements reflected a medium effect size. Notably, there were two CMCIRFS and three CMCI3S that demonstrated significant omnibus differences across cultural groups in the college sample…The content of these items included feelings of being unjustly punished, not having confidence in law enforcement, and feeling that people are against the examinee for no reason. Items regarding lack of confidence in law enforcement and feeling that people are against the examinee for no reason were both endorsed at significantly higher rates among Black college students in comparison with the other cultural groups” (p. 301-302).
“In the second study, with forensic inpatients, CMCIRF scores did not differ significantly across groups. In contrast, on the MMPI-2-RF RC6 scale, Black forensic inpatients scored significantly higher than White forensic inpatients, but the effect size was small. Although we hypothesized that any observed differences across cultural groups in the college sample would be attenuated among forensic inpatients, we did not expect that the differences across groups on the CMCIRF endorsement would be nonsignificant among forensic patients…Although the total number CMCIRFS endorsed did not differ across cultural groups in the forensic inpatient sample, endorsement rates for two CMCIRFS showed significant…differences across cultural groups in this sample. The content of these items included having been in trouble with the law and feeling that people say insulting and vulgar things about the examinee…” (p. 302).
Translating Research into Practice
“On the basis of the current findings and the lack of available measures to distinguish between cultural mistrust and clinical paranoia, we offer some recommendations for clinical practice when conducting evaluations in forensic settings. First, when interpreting the MMPI-2-RF or MMPI-3 in particular, the evaluator should determine whether any CMCIs were endorsed by the examinee…particularly when RC6 is elevated. Next, the evaluator should clarify with the examinee why such items were endorsed to aid in distinguishing between cultural mistrust and clinical paranoia. It is important for the evaluator to ask open-ended questions…The evaluator should also incorporate standard questions into the clinical interview to initially screen for cultural mistrust. As an example, the evaluator could ask, ‘Has there ever been a time in which the police have mistreated you without reason? If so, please describe the encounter.’ Further, the evaluator should include questions in the clinical interview relevant to the examinee’s home environment…to understand the racial status of the examinee’s community” (p. 303).
“If the evaluator suspects or is uncertain whether the examinee may have a high level of cultural mistrust, we offer sample questions that can be modified as needed as part of the evaluation process…The questions provided were adapted from the Revised Cultural Mistrust Inventory created by Terrell and Terrell (1981). Sample questions include the following: ‘Do you believe that White Americans are usually air to all people regardless of race? If not, why?’…We note that the level of rapport, as well as the stimulus value of the evaluator, should be considered when using questions to assess cultural mistrust in a forensic evaluation context because of the power differential between the evaluator and the examinee…Given the direct nature of the questions that aid in assessing cultural mistrust, the examinee may interpret them as confrontational when the examiner is from a different cultural background. Therefore, the questions may require modification depending on the level of rapport that is developed between the evaluator and the examinee…” (p. 303-304).
Other Interesting Tidbits for Researchers and Clinicians
“Lazarus and Folkman (1984) developed the transactional model of stress and coping, which suggests that the interaction between a person and his or her environment can cause psychological stress…This model was modified by researchers who incorporated racial and cultural factors and the appraisal of race-related stressors (Harrell, 2000; Outlaw, 1993)…Racial trauma and related race-based traumatic stress can potentially influence how POC interact with the world and perceive others. One area in which altered perceptions on the basis of racial discrimination can be seen is cultural mistrust…a distinction is made between cultural paranoia – an adaptive coping mechanism – and clinical paranoia – a symptom of mental illness. The term cultural paranoia was later changed to cultural mistrust to accentuate that it is an adaptive skill rather than psychopathology (Whaley, 2001)…we operationally defined cultural mistrust as an attitudinal stance, or cultural coping response, characterized by reality-based expressions of lack of trust, suspiciousness, and heightened sense of self-consciousness…” (p. 294). “The current findings also highlight the fact that it is important to be cognizant of an individual’s multiple and intersecting identities when conducting forensic assessments, particularly when assessing for cultural mistrust. The fact that the Black female and Black male psychologist raters occasionally selected different items as potential indicators of cultural mistrust highlights the diversity and identity factors other than ethnicity impact how individuals view and experience the same phenomenon…Individuals involved in the legal system are more likely to come from marginalized groups, such as communities of color and low-income backgrounds, and the intersectionality of their diversity variables could increase cultural mistrust” (p. 303).