(From Thomas J. Deters, Ph.D)

Reason for referral

	MORE OF THE EVALUATION
	Cover letter Overview Overview (cont.) Neurologic component Psychological testing Neuropsychological evaluation

At the request of Dr. Ronald Schouten, I have undertaken a comprehensive neuropsychological evaluation of Mr. Michael Tyson. This evaluation was requested to assist in the evaluation of Mr. Tyson's fitness for duty as a professional boxer. This evaluation was part of a team evaluation. The team members and their roles in this evaluation are outlined in the summary report prepared by Dr. Schouten. The specific referral questions that were outlined by the Nevada State Athletic Commission are also addressed in this summary report.

Since Mr. Tyson was interviewed by various members of our evaluation team, I did not conduct a comprehensive diagnostic interview. I briefly interviewed him on each of the days that I saw him, and I relied on interview data that was acquired through interviews conducted by other team members. I also relied on the evaluation results of our entire team in arriving at my conclusions.

Procedures

The Commission requested Comprehensive Neuropsychological Testing. There are different, but widely accepted approaches to conducting this type of evaluation, including the use of the Halstead-Reitan Battery which was requested by the Commission. I did not use the Halstead-Reitan Battery as it is not as widely used in this part of the country, where many or most psychologists are trained to use a flexible approach to neuropsychological assessments. It is my opinion that this provides at least an equivalent or a more comprehensive evaluation than would be represented by the Halstead-Reitan Battery. The following is a list of the tests used in this evaluation and is typical of the flexible approach.

Neurobehavioral Interview (Multiple brief interviews)
Temporal Orientation Test

Wechsler Adult Intelligence Scale-Revised
Trail Making Tests A and B
California Verbal Learning Test
Rey-Osterrieth Complex Figure Test (Copy and Delayed Recall)
Wechsler Memory Scale-Revised (selected subtests)
Boston Diagnostic Aphasic Examination (reading comprehension subtest)
Visual Naming Test
Controlled Oral Word Association Test
Token Test
Speech Articulation Rating Scale
Writing Praxis Rating Scale
Wide Range Achievement Test-3 (Reading Subtest)
Draw a Clock Test
Test of Directed Attention
Judgment of Line Orientation Test
Alternating Visual Patterns Test
Wisconsin Card Sorting Test
Booklet Category Test
Stroop Neuropsychological Screening Test
Finger Tapping Test
Grooved Pegboard Test
Beck Depression Inventory
Profile of Mood States

Background

(From my interview and interviews conducted by other evaluation team members)

Mr. Tyson is a 32-year-old, right-handed, black male. He indicated that he is currently is good health. With the exception of a history of multiple traumas to the head, he denied any significant medical history.

Mr. Tyson reported a history of head traumas dating back to early childhood. He indicated that he was in many street fights, and was hit with bars, bricks, and other objects. He estimated that he lost consciousness on approximately five occasions. He was never taken to the hospital as his family was unable to afford it. He was vague about the details of these incidents, indicating that he had a poor recollection of them. He would get home by various means, and recover at home. He also sustained a trauma to the head in a motor-vehicle accident with an estimated 20-minute loss of consciousness. He indicated that he has sustained many blows to his head during his boxing career, but that he never lost consciousness.

Mr. Tyson indicated that he completed the 10th grade. He dropped out of Catskill High School in the 11th grade. He indicated that he received special education services, but that this was due to his behavior problems, and not due to academic difficulties. He attempted the GED on one occasion but failed it. While he denied receiving special educational services for academic difficulties, he indicated that he has a history of difficulties with reading, spelling, and math.

As you know, Mr. Tyson was seen by Dr. Jeremy Schmahmann on 9/25/98 for a neurological evaluation. The elementary neurological evaluation was normal, with the exception of vision in the left eye being 20/25 uncorrected. On the mental status examination he found minor executive control system problems. Magnetic resonance imaging of the brain and electroencephalogram were both normal. He denied a significant alcohol or other drug history. Dr. Schmahmann recommended that Mr. Tyson engage in ongoing counseling.

Mr. Tyson seemed to be extremely candid in his discussion of his history, and gave no indication of efforts to impress me with discussions of part or current virtuous behavior. When I asked him about the incident with Mr. Holyfield, he fully acknowledged that his behavior was grossly inappropriate. He indicated that this behavior was a manifestation of self-protective behaviors that he learned on the streets of New York. He expressed remorse for his behavior, but also indicated that it was in response to the head-butts of Mr. Holyfield and the failure of the referee to intervene. This did not appear to be a rationalization of his behavior, and he indicated that he would have never behaved in this manner had he known the penalty that he would have to pay. He indicated that if he were in a similar situation in a future fight, he would persist in notifying the referee of the perceived fouls of his opponent.

Medications

None at the present time, but he has been treated with Zoloft and Lithium in recent years.

Behavioral observations

As indicated above, I saw Mr. Tyson on three separate dates. On the first occasion (9/23/98), I met him with Dr. Schouten. This was his first morning in Boston, and immediately after Dr. Schouten had conducted a brief interview with him. His demeanor was initially friendly, and in fact he was quite insistent that I refer to him as "Mike" as opposed to "Mr. Tyson." He appeared anxious, and while not appearing angry with me or Dr. Schouten, he indicated that he was angry and apprehensive about having to undergo our evaluation. During our efforts to introduce him to the evaluation and to put him at ease about it, I inquired about his reading ability. He indicated that he was not very good at reading, and that he preferred not to take any tests that required reading. I did not push the issue. However, soon after this his demeanor seemed to change. He became much less engaged in the interview, and at one point he expressed deep feelings of anger directed at me and the evaluation process. He quickly assured me that he had no intention to act on these feelings. We were able to continue our introduction and interview. He seemed to be well-engaged in the interview, but clearly felt affronted when Dr. Schouten indicated that he had to see another patient. I indicated that I wanted to see him at that time to conduct the interview, but he refused to see me.

Due to scheduling conflicts, I was not able to Mr. Tyson again until 9/26/98. In the interim, Dr. Schouten discussed with him the fact that he would be seeing me again. It is my understanding that he agreed with little or no hesitation. He acknowledged to Dr. Schouten his acute sensitivity to difficulties that he has had with academic tests, and realized that he overreacted during our first encounter.

At our second and third meeting, Mr. Tyson presented a friendly, cooperative demeanor. His manner suggested that he was not enthusiastic about the evaluation process, but he did not express any overt resistance to it. During a brief interview, he talked openly and candidly about his history and current circumstances. He exhibited a thoughtful and emphatic dimension of his personality, with expressions of concern about oppressed social groups. He exhibited a good sense of humor and a genuine concern about the well-being of others. He expressed warm and loving feeling toward his children, while admitting to some difficulties in his marriage. He indicated that his wife is embarrassed about his behavior, and that he is regretful that she has had to be exposed to his public humiliation.

Mr. Tyson agreed to participate in all aspects of the evaluation process. He appeared somewhat restless, with indications of difficulties with sustained attention. He seemed to be making a good effort, but seemed to have difficulty remaining focused. He put his face down in his arms on the table on numerous occasions, but continued his participation in the evaluation. I asked him if he was tired, and he acknowledged that he was not sleeping well as a result of numerous stressors in his life. Since he seemed to remain well-engaged in the evaluation, I did not discourage this behavior. Additionally, it was my impression that this behavior may have been a compensatory technique to help him in focusing his attention. While sustaining attention on the examination seemed difficult for him, he did not request frequent breaks and he did not display any overt resistance to the process. He frequently responded with a polite "yes, sir" when asked to complete another task.

On a number of occasions when experiencing difficulties on a task he seemed to give up prematurely. In general, his failure to persist on some tasks appeared to be a manifestation of feelings of frustration and some embarrassment about his difficulties on the task. For example, it was clear that he refused to write a sentence that I dictated to him due to embarrassment about spelling deficiencies. He reluctantly agreed to write another less complex sentence. On a number of occasions he gave up on timed tasks before expiration of the time limit. I encouraged him to continue, and in most cases he made some further effort. On some measures, due to what appeared to be difficulties with attention and executive control, he did not follow the standard procedures for completion of the task. For example, on a visual memory task he was instructed to study a design for 10 seconds and then draw it when it was taken away. On one of the items, he started drawing the item before the design was removed. His failure to follow the standard procedure seemed primarily due to difficulties with attention and anxiety, as contrasted with an intentional effort to circumvent the rules.

On a number of occasions when he was succeeding on a task he referred to the testing as "fun" and seemed to enjoy the challenge of the evaluation process. In general, he remained well-engaged throughout the evaluation and persisted to the end of the tasks. Overall, this appears to be a valid assessment of his current functioning.

Summary of results/impressions

Mr. Tyson was seen for a comprehensive neuropsychological evaluation and for limited assessment of his emotional state. This evaluation was part of a team evaluation, and the findings of other team members were made available to me. I relied on information that was obtained by other team members, as well as my own findings. I personally administered, scored and interpreted all of the tests listed in an earlier section of this report. I did not take a complete medical or psychiatric history as this was being conducted by other team members. I briefly interviewed Mr. Tyson on each of the occasions that I saw him. I had the opportunity to evaluate him on three separate days. My conclusions reflect a synthesis of my personal observations and results from the testing that I conducted, in addition to information obtained from the evaluations of other team members.

There are a number of limitations that need to be kept in mind when reviewing these results. Given significant time constraints placed on the completion of the evaluation, we did not have access to many of Mr. Tyson's records. As a result, we had to rely on his self-report regarding matters such as his medical history and his educational history. School and prison records which document learning or behavioral problems would have been very useful.

In my interpretation of the results I have attempted to keep in mind moderator variables including age, gender, educational level, occupation, and race. I have attempted to use the most appropriate standardization samples available, many of which were adjusted for some of these variables, but some do not include these adjustments.

Results on neuropsychological testing was highly variable, with scores ranging from the superior range to the impaired range. However, functioning on most measures was in the average-to-borderline range. General intellectual functioning was in the average range. His greatest relative strength was on a measure of verbal fluency. Other relative strengths (high average to low average range) were in the areas of: temporal orientation, remote memory/fund of knowledge, functional expressive and receptive language, expressive vocabulary, receptive language, verbal concept formation and verbal social reasoning, reading recognition and reading comprehension, fundamental visuoperceptual and visuoconstructional abilities, non-verbal reasoning and problem solving on select measures, and visual memory.

Relative weaknesses were found in the areas of: attention/mental tracking; short-term memory/working memory; verbal learning and memory; executive functions on select measures, and bilateral motor speed/coordinations. My observation of his performance also revealed mild difficulties with impulsivity and executive control.

Functioning on neuropsychological measures was likely decreased due to emotional factors including depression, frustration, anger and other emotional factors which are outlined in the psychological test report. Additionally, he experienced significant stress related to the outcome of this evaluation. While he reported and appeared to be fatigued at times, there were indications on some personality scales that he had a high level of energy, and there were no clear observable indications of psychomotor slowing.

Given the complex interplay of cognitive and emotional factors, it is difficult to determine the degree to which his reduced performance on some neuropsychological measures is a manifestation of a neurobehavioral syndrome and to what degree it is a reflection of his emotional state. This is conflicting data with regard to this matter. However, it is my impression that neuropsychological test results reflect mild to possibly moderate neurobehavioral compromise. There is evidence of a developmental learning disability. I did not examine this in depth due to his acute sensitivity regarding his difficulties with reading and spelling, and because this was not the focus of the referral question. He may have residual Attention Deficit/Hyperactivity Disorder, but I would need more detailed developmental history from individuals who were familiar with his childhood behavior to make this diagnosis. He reported experiencing numerous serious traumas to the head during his childhood with a loss of consciousness on approximately 4-5 occasions. He was also involved in a motor-vehicle accident in which he struck his head and lost consciousness for approximately 20 minutes. He also experienced many traumas to the head during his boxing career, but with no reported loss of consciousness. While I do not have detailed history of these events, they appear to be the major factors which contribute to his current neuropsychological status.

Mr. Tyson exhibits a constellation of neurobehavioral deficits that appear to be largely consistent with the findings on a neurological examination. My findings seem to be somewhat more pronounced, which is likely a manifestation of the fact that I conducted more detailed mental status testing. While specific neurobehavioral deficits are outlined above, the key issue related to this referral question appears to be findings which are consistent across the neurological and neuropsychological evaluations which demonstrate executive control deficits. Individuals with this neurobehavioral profile often have difficulties with impulse control, inhibition of behavior, judgment, and rapid decision-making. These findings also need to be considered in the context of an apparent history of depression and significant mood fluctuations, which may serve to mediate the expression of these behaviors. If his mood can be adequately managed, he will likely have better control over the neurobehavioral deficits. With deteriorations in his mood, he is likely to be more susceptible to acting on impulse and showing poor judgment.

The above findings are a concern to me. However there are other positive findings that need to be considered in the determination of Mr. Tyson's fitness to return to boxing. While he exhibited difficulties on some measures of executive control, he performed normally on others. Functioning was normal on some measures of social reasoning, abstract concept formation, planning, and problem solving.

I did not observe any behavioral control problems during the three days that I had contact with Mr. Tyson. While he expressed anger on the first day of our meeting, he gave no indication of acting on this, and was very affable during the remainder of his stay. I also had a few opportunities to observe his behavior outside of the hospital. He was playful and generous when approached by strangers on the street. On the final day of his evaluation he indicated that he wished he could stay in Boston as he was comfortable with the members of our team, and he enjoyed the people of Boston.

While Mr. Tyson initially presented me with an confrontative demeanor, this seems to be largely a manifestation of low self-esteem related to a history of academic difficulties. He appears to have a developmental learning disability in at least one or more areas. While his intellectual functioning is average or above average in some domains, he is very aware of and sensitive to relative difficulties with reading and spelling. It is my impression that he was likely very aware of this at an early age, and that he developed and maintained an image of being intellectually inferior since that time. While this is somewhat speculative, it is not unusual for young males with learning problems to act out in an aggressive manner, which may at least in part explain early aggressive behavior and numerous fights. The degree to which his emotional state regresses to an earlier developmental stage around learning issues is very remarkable. As mentioned in an earlier section of the report, on my initial meeting with Mr. Tyson he immediately became very angry and refused to meet with me after I inquired about his reading ability. However, when he was engaged in the evaluation and realized that I wasn't criticizing or judging his ability, he became much more relaxed, and actually seemed to be challenged by and to enjoy aspects of the evaluation.

Another strength exhibited by Mr. Tyson was his acute awareness of his current and past emotional state. He indicated on a number of occasions that he believes that he has been depressed his entire life. He apparently had a very tumultuous childhood, raised in a poor neighborhood by his mother who died of cancer at age 14. He apparently had very limited contact with his father. Mr. Cus D'Amato and Ms. Camille Ewald took him in at age 12, which apparently was a stable, supporting, and trusting relationship. Mr. D'Amato has since died, and Ms. Ewald is in her 90s. He is fond of her, and at one point indicated that he would like to be living with her away from the many stressors in his life. It is my understanding that he speaks to her often and that he continues to provide financial support. He candidly stated that there is currently nobody in his life that he trusts, and he seems to realize the adverse implications of this for his emotional functioning. We discussed the possibility of his participation in psychotherapy to address this issue and related matters. He indicated that he would be willing to do so. While he will initially have difficulty trusting a therapist, it is my opinion that he has the capacity for a trusting relationship with the right individual.

With regard to his boxing career, while he has unquestionably been successful as a boxer, he was humble about that success, and minimized his abilities. While he would like to return to boxing, and has a need (to) earn a living, he was strikingly unassuming about his boxing career. He repeatedly expressed a desire to return to boxing as it is the only way that he can support his children.

Mr. Tyson spontaneously discussed his religious beliefs on a number of occasions. He doesn't consider himself particularly religious, and gave no indication of trying to pass this off as a panacea for his troubles. However, it was evident that this has become a stabilizing force in his life.

Conclusions

Mr. Tyson exhibited neurobehavioral and emotional difficulties, as well as many strengths. He seems to be very resilient in light of a history of many obstacles. He exhibited intelligence that seemed to be beyond what is reflected in some of his test scores. He seems to have a clear recognition that his behavior in the Holyfield fight was completely inappropriate and he expressed remorse for his behavior. While his behavior in the Holyfield fight was deplorable, it is my understanding that he has not exhibited similar behaviors in the past, and that he has a boxing record of few fouls.

I am unable to predict whether or not Mr. Tyson will lose control of his behavior in a future boxing match. He exhibits neurobehavioral and emotional deficits that make him susceptible to this, but are by no means predictive of it. It is my opinion that if he is able to better understand his emotional life, he will be in much better position to control impulses and behaviors that my be a manifestation of neurobehavioral deficits. To this end, I strongly recommend that Mr. Tyson be seen for weekly, if not more frequent psychotherapy sessions. This should be a therapist that he chooses, and he should have the opportunity to try a number of therapists until he finds the best match for him. He expressed fondness for Dr. Goldberg, a psychiatrist that he has seen in the past, so he may want to return to him.

It is my understanding that the Commission does not have the authority to stipulate ongoing psychotherapy as a condition for Mr. Tyson's return to boxing. However, I recommend that this treatment be strongly encouraged to the degree that it is possible. It is my opinion that his participation in this treatment will be a pivotal factor in influencing and guiding his future behavior. It will also serve as an ongoing measure of his motivation to examine his behavior and to take responsibility for it. Furthermore, the Commission could be assured that if he was experiencing emotional deterioration, he would have a familiar and trusted individual to confide in and provide necessary support.

It is my opinion that Mr. Tyson's past behavior needs to be viewed in the context of his neuropsychological status, as well as in the context of the sport of boxing. As in many contact sports, overtly aggressive behaviors with go beyond the rules of the game, while not be condoned, are not uncommon during the heat of battle. While there need to be strict controls of these behaviors, Mr. Tyson's behavior, while beyond the norm, was by no means isolated in the world of contact sports.

Mr. Tyson seems to have a clear understanding that he will have no future chance of returning to boxing if he commits the same, or a similar foul. If he is given the opportunity to return to boxing, his behavior will possibly be the most scrutinized behavior in the history of professional sports. I believe that he realizes this, that he has the ability to have an unambiguous understandings of the sanctions should he commit a similar foul, and that he is highly motivated to be fully compliant with all the rules and regulations.

I recommend that Mr. Tyson be seen in one year for a repeat neuropsychological evaluation to make sure that his current cognitive difficulties do not represent a progressive deterioration of functioning. Furthermore, repeat testing may reveal an improvement in his functioning on neuropsychological measures if there is an improvement in his emotional state.

Thank you for referring Mr. Tyson for my evaluation.

Thomas J. Deters, Ph.D
Licensed Psychologist
Commonwealth of Massachusetts #3637
Diplomate in Clinical Neuropsychology
American Board of Professional Psychology