Thursday, November 06, 2008

The Snake Trail Test

Psychiatrists have a way of assessing judgment during the mental status examination. Typically they'll ask a question like, "If you found an envelope lying on the sidewalk and it was addressed and stamped, what would you do with it?" The typical answer, the one that will get you a 'good' rating on the judgment line, is: "I'd mail it." Duh. There are other possible responses, some of them more interesting or creative than others, but that's the response you get most of the time.

I had a chance to come up with a new "judging judgment" type question this week. I call it the Snake Trail Test. Here's how I came up with it:

As coincidence would have it, one of the best local climbing spots near here also happens to be a repository for copperhead snakes. Since I've taken up climbing I've now seen more copperheads in the wild than I've ever seen in any zoo. Whenever I see a snake, I warn any hikers I happen to see in the area. Many hikers are parents with small children. It's been interesting to see the wide variety of responses.

One parent immediately grabbed the kid and said, "No no honey, don't go down that way. We'll go on this trail instead." Another parent still went down the trail, but cautioned the kids and made sure they stayed on the far side of the path, away from where the snake was spotted. The most interesting reaction came yesterday, from a young tattooed woman hiking with four kids under the age of ten. After I gave her the warning she shrugged, pointed back over her shoulder at the trail she had just come down, and said, "Yeah there's another one back there." Not a word to the kids and they all scrambled on without a care.

The psychiatrist within me thought: "Checkmark for 'poor' judgment." Then I thought again: "Maybe she's an herpetologist. Maybe she comes from a charismatic poisonous snake-handling cult. Maybe she's been hiking here for 20 years, has seen lots of snakes and never had a bad outcome." There were a lot of reasons why someone might not be freaked out by the idea of a poisonous snake in the trail.

My new Snake Trail Test has got me thinking about how we interpret judgment.

Judgment is formed through learning, experience, culture and a multitude of other personal idiosyncratic factors that a psychiatrist might or might not be aware of. The best way to sort out 'normal' and 'impaired' judgment is to ask followup questions. "Why would you do that?" is a good one. "Why not do this?" is another good followup question.

I didn't have a chance to ask the tattooed lady more questions, but I bet if I did she might have given me a good education about snakes.
Note from Dinah: Here's a post from Edwin Leap about what Not to bring to the ER with you, and it includes the snake that bit you.