In Depp v. Heard, forensic psychiatry took the stand. Let’s correct the record

Like millions of people around the world, we’ve found ourselves drawn to the Depp v. Heard trial. As forensic psychiatrists, we’ve had a professional interest as well as a pop culture interest, since members of our profession were in the spotlight in court.

In this unfortunate and complex clash between divorced actors, Johnny Depp sued Amber Heard for $50 million for defamation due to her 2018 Washington Post essay that implied Depp had perpetrated partner violence. Heard counter-sued Depp for $100 million for defamation, stemming from statements made by his attorney in 2020 that the abuse was a hoax. On Wednesday, the jury found that Depp had been defamed by the op-ed, and also that Heard had been defamed by Depp’s lawyer, and awarded large damages to each.

This live-streamed case has blurred lines between entertainment and the courtroom. It has also drawn attention to forensic psychiatry.

We often find it bizarre to see fictional forensic psychiatrists testify in court in movies or on television shows. Hannibal Lecter, one of the greatest villains of all time in film, is also a fictional forensic psychiatrist. A rare positive example is B.D. Wong’s portrayal of an New York Police Department forensic psychiatrist in “Law & Order: SVU.”

Seeing real-life psychiatrists in an internationally televised Virginia courtroom is even more curious, further blurring the lines between Hollywood and law. Memes were plentiful on the internet, comparing one of the psychiatrists to Doc Brown from the “Back to the Future” franchise, as well as other fictional characters.

Forensic psychiatry, which applies mental health knowledge to legal questions that could include evaluation of a possible crime or wrongdoing, is a subspecialty of psychiatry that interfaces with the law. A board-certified forensic psychiatrist is a physician who has completed medical school, a residency in general psychiatry followed by a fellowship in forensic psychiatry, and passed certification examinations.

Because most cases do not go to trial, forensic psychiatrists are often consultants who perform comprehensive psychiatric evaluations to help with a legal question relevant to psychiatry. In real life, forensic psychiatrists work with defendants with mental illness in forensic psychiatric hospitals (where they may be sent by the court if they are found insane or incompetent), assess other defendants and plaintiffs for court cases, and work in jails or prisons.

Forensic psychiatry plays an important role in consideration of insanity pleas, or whether someone is mentally fit to stand trial. It also plays a role in answering questions in contested wills or guardianship cases. Defamation cases are less common.

Forensic psychiatrists are commonly depicted in pop culture as evil, crazy, confused, dippy, activists, or hired guns — and rarely reputable. These depictions propagate a distorted view of what forensic psychiatrists do and this trial risks validating that skewed view.

In the final week of the Depp-Heard trial, two psychiatrists testified. We were surprised that neither one was a board-certified forensic psychiatrist nor had specific expertise in intimate partner violence. The psychiatrist retained by Heard’s team had proffered opinions about Depp’s mental health without the benefit of a clinical interview, raising two ethical questions: Was the American Psychiatric Association’s (APA) Goldwater Rule violated? And were the American Academy of Psychiatry and the Law (AAPL)’s practice guidelines for the forensic assessment followed?

More people have asked us about these two items in the last few days than during the entirety of our careers. The rebuttal psychiatrist retained by the Depp team explained his own understanding of the Goldwater rule and AAPL’s Practice Guidelines.

The Goldwater Rule is not generally a rule for the courtroom but for interactions with the media or the public at large. It states that psychiatrists should not give professional opinions about public figures whom they have not examined, and have not been granted authorization to share an opinion. This came about after a quite uncomfortable situation for organized psychiatry. In 1964, Fact magazine polled 12,000 psychiatrists about whether presidential candidate Barry Goldwater was fit to become president. More than 1,000 said he was not, and Fact published a special issue which highlighted this. Goldwater sued the magazine. The APA’s Principles of Medical Ethics eventually included the rule.

The Goldwater Rule had been little known outside of our field until it was raised during Donald Trump’s presidency, and then again during the Depp-Heard trial.

Just like other Americans, psychiatrists come from all sorts of political backgrounds, and one can easily envision a situation in which one psychiatrist gives an opinion about one political candidate, and another psychiatrist says the same about the opposition. The Goldwater Rule is the reason that when a psychiatrist is speaking to the media and is asked about the mental health of a public figure they haven’t evaluated, they ethically should not be giving a professional opinion.

Psychiatric opinions about an individual should not be given without appropriate effort to personally examine that individual. Nor should they be given lightly, inside or outside of a courtroom.

One paragraph of the lengthy AAPL practice guidelines says that if no interview had been conducted in a forensic assessment, that limitation should be discussed in both the report and the testimony, and the reasons why an interview was not completed should be indicated.

In this case, the court did not order Depp to comply with a psychiatric examination. The crux of his team’s argument was that the psychiatrist providing testimony on behalf of Heard did not outline the limitations of his opinion, which was made without a psychiatric examination of Depp.

Another tenet of forensic psychiatry that was not clearly presented in this trial is the concept of objectivity. According to AAPL ethics guidelines, forensic psychiatrists must strive for objectivity, no matter who is retaining them. Forensic psychiatrists are not supposed to be fact finders. Instead, their role is to aid and educate the court about the psychiatric question or questions involved. Failing to acknowledge biases compromises the integrity of the individual psychiatrists and the entire field. Over-reaching outside of areas of expertise, when it occurs, is cause for concern. Absolute opinions are rare in psychiatry and, in complicated cases such Depp v. Heard, can signal bias.

Forensic psychiatrists serve a small role in the outcome of a case. Jurors are tasked with understanding a multitude of information, as they needed to do in Depp v. Heard, and most of the time, the role of the forensic psychiatrist is narrow. Good or bad expert witnesses do not win or lose cases. However, experts who do not follow the guidelines of the field can threaten its reputation. Regardless, as exemplified by this highly publicized trial, the juxtaposition of the media with forensic psychiatry can easily distort the public perception of our field.

Susan Hatters Friedman is a psychiatrist and professor of forensic psychiatry at Case Western Reserve University. Renee Sorrentino is a psychiatrist and assistant professor of psychiatry at Harvard Medical School. Karen B. Rosenbaum is a psychiatrist and clinical assistant professor of psychiatry at New York University, Langone Medical Center.