Wednesday, February 17, 2010

Forensic psychiatrist: Courts fostering "POLITICAL DIAGNOSIS"

After sex offenders, who will be next?

More leading experts are starting to notice and voice alarm over the pretextual use of psychiatric diagnoses in SVP civil commitment cases. In an editorial this week, a prominent forensic psychiatrist quotes the late Michael Crichton, calling it "bad science 'tricked out' for public policy ends."

Writing in the Psychiatric Times, James Knoll, psychiatry professor at SUNY-Syracuse and director of a forensic fellowship program, critiques both the questionable diagnoses and the shaky risk assessment techniques being used to civilly commit Sexually Violent Predators:
A variety of instruments have been developed (PCL-R, Static-99, Phallometry, Minnesota Sex Offender Screening Tool, etc.); however, these tests are often challenged in courts as not meeting legal standards for expert evidence and testimony. So while the research database has grown, the question remains: is it reliable enough to be proffered as expert testimony? Experts in the field continue to have serious reservations, and express caution about the (mis)use of these instruments for expert testimony.
Turning to the questionable diagnoses being used in SVP cases, Knoll puts the onus squarely on the U.S. Supreme Court for creating a tautological and "politico-legal" definition of "mental disorder or abnormality" for use in these civil commitment proceedings:
[T]he courts may use our diagnoses when they choose to, and they may ignore them and/or devise their own if it suits public policy…. Since it is forensic mental health professionals who are tasked with SVP evaluations, they have attempted to give this term meaning within the confines of their science. Have these attempts reached a consensus? It would appear that they have not. There continues to be substantial disagreement….

When psychiatric science becomes co-opted by a political agenda, an unhealthy alliance may be created. It is science that will always be the host organism, to be taken over by political viruses…. [P]sychiatry may come to resemble a new organism entirely -- one that serves the ends of the criminal justice system.
If we want to know where all this is headed if someone doesn't slam on the brakes, Knoll points us across the Atlantic to the United Kingdom, where offenders are indefinitely committed on the basis of a nebulous "Dangerous and Severe Personality Disorder" (DSPD):
Given the similarities between our SVP laws and the UK’s DSPD laws, is it too outrageous to speculate that a psychopathy (or DSPD-equivalent) commitment law might be on the U.S. horizon? Remember, the driving force behind such initiatives is usually only one highly publicized, egregious case away.
Related resource:

For an empirical study on the scientific problems with determining future violence under the UK's "Dangerous and Severe Personality Disorder" law, see: Ullrich, S., Yang, M., & Coid, J. (2009), "Dangerous and severe personality disorder: An investigation of the construct," International Journal of Law & Psychiatry (in press). The ultimate conclusions are strikingly similar to the issues posed by Knoll.

The study found a high rate of false positives -- that is, people categorized as DSPD and at high risk of serious reoffending when they actually did not reoffend when tracked in the community: 26 DSPD offenders would need to be civilly committed to prevent one major violent act.

When tracking sex crimes, which are of particular public concern, the researchers found that most new sex offenses were committed by offenders who were NOT categorized as DSPD, undermining the UK Home Office and Department of Health assumption that offenders at the highest risk for future sex offending would be categorized as DSPD.

After critiquing the accuracy of actuarial techniques, the article concludes:
"Bearing in mind the inaccuracy of DSPD criteria in identifying high risk individuals ... the construction of medico-legal terms, as in the case of DSPD, appears highly questionable.... [M]any determinants of violence are circumstantial and situational, and will invariably change over time, rather than related to some inherent characteristics of the perpetrator.... [F]ar more research is necessary ... before attempting to integrate a psychiatric condition into a legal system."
Heed these warnings, folks. The way things are headed in the U.S. criminal justice system, I expect to hear expansion of civil commitment to other groups -- violent offenders, juveniles, and others -- being proposed any minute now.

9 comments:

  1. "It is science that will always be the host organism, to be taken over by political viruses…."

    Exactly. Yet at the end of the day the discipline has only itself to blame. The real problem is that practitioners wont engage in hand to hand combat in the trenches. We know who these reprobate practitioners are. Is anyone willing to file a complaint with the state licensing body? Would anyone stand by them when they do. Will journals refuse to publish their so called research? The answer in both cases is "no" and that's the problem. The psychology community doesn't have to just stand by and wring their hands; they can kick ass. Publishing articles is hand wringing.

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  2. Anonymous:

    While I share some of your sentiments and frustration, I find it ironic, dear reader, that you did not sign your name.

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  3. Sadly, largely it's more the nature of politics than that of the mind. Political grasping will never be content with the tools that they are given, and seeks to expand to fill vacuums of power. It seems to be as much human nature and insanity as that which they claim to seek to prevent.

    One of the questions I must ask is how many very real harms may be accomplished whilst purporting to legislate against feared harms?

    How much harm to society, and to the rule of law is necessary to prevent a perceived potential of harm?

    Is any of it ethical or justifiable?

    Where the government has no duty to protect, might the utilization of such powers have other purposes? I have noted in the past numerous instances where such protections are sidestepped, for all the 'best reasons'... with the same outcomes.

    It cannot end with the offenders. Even this total idiot can see that any such group with a separate burden of law will expand to the point where it affects all.

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  4. Here is an excerpt from an article I wrote a few years ago regarding earlier instances of the abuse of science for political ends:

    Soviet psychiatry created and then abused the diagnosis of sluggishly progressing schizophrenia (вялотекущая шизофрения) – a special form of the illness that supposedly affects only the person's social behavior, with no trace of other traits: "most frequently, ideas about a struggle for truth and justice are formed by personalities with a paranoid structure," according to the Moscow Serbsky Institute professors. Some of them had high rank in the MVD (the Ministry of Internal Affairs), such as the infamous Danil Luntz, who was characterized by Viktor Nekipelov1 as "no better than the criminal doctors who performed inhuman experiments on the prisoners in Nazi concentration camps" .

    Psychiatrists described a “sufferer” of sluggishly progressing schizophrenia as a person appearing quite normal most of the time but who would break out with a severe case of "inflexibility of convictions," or "nervous exhaustion brought on by his or her search for justice," or "a tendency to litigation" or "reformist delusions." The treatment involved intravenous injections of psychotropic drugs that were so painfully administered patients became unconscious.

    “Criminal lunacy” became part of the Criminal Code in 1961 and described a person who was unable to “realize his actions or to control them.” Such actions included, “dissemination of patently false statements defaming Soviet political and social system,” “abuse of a national emblem or flag” or “active participation in group acts that break public peace.”

    Russian historian and archivist Anatoli Prokopenko said, “By certifying people who were undesirable for the State as insane, it was possible to isolate them in psychiatric hospitals without court actions or public, internal or international upset.”

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  5. A recent decision from the 7th Circuit on the issues with antisocial personality disorder and paraphilia NOS noted in the editorial:

    http://www.ca7.uscourts.gov/tmp/VC0U2D39.pdf

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  6. I often wonder if male sex offenders would opt for surgical removal of the testicles if it meant early release. Would this deter sex crimes and save money in the process?

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  7. It is good that a professor of psychiatry is questioning the validity of these proposed diagnoses. But why stop at the pre-textual items? All the diagnoses in DSM are bogus. The problem behaviors, of course, are real, but these behaviors are not caused by the putative mental illnesses/disorders. These so-called diagnoses were invented by psychiatric committees to consolidate turf and to legitimize the pushing of drugs as a solution to life’s problems.

    Philip Hickey, PhD
    http://behaviorismandmentalhealth.com/

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  8. You might find this article interesting, it talks about the DSPD program possibly being shut down http://www.channel4.com/news/articles/uk/dangerous+offenders+scheme+to+be+axed/3542837

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  9. Thanks for letting me know about this important article. I'll try to get to a follow-up blog post letting readers know.

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