Sunday, March 13, 2011

SVP morass: Will psychologists "just say no"?

 Dr. Franklin,
          My understanding is that psychiatrists and the American Medical Association made a conscious, ethical decision to not get involved in the SVP [Sexually Violent Predator] morass. I am not sure why psychologists dove in. Smelling blood in the water, cash in bank accounts or trying to show up the "real doctors" has led to our participation in one of the largest, most expensive frauds put over on society, with the field of psychology becoming the laughingstock of real researchers. We are now participating in a system that systematically violates the Constitutional rights of individuals and uses the shoddiest of data to rationalize our position. Has there been any thought to a movement by psychologists or the APA to "just say no"?
-- Eugene Braaksma, Licensed Psychologist



What a timely question. Privately, many mainstream forensic psychologists agree with your assessment, and some have even gone public with their concerns. Most recently, two psychologists in the San Francisco Bay Area have gone so far as to echo your call for a professional boycott. But for several reasons, I think the major impetus for change will come not from within, but from larger systemic forces outside psychology.

Photo © Karen Franklin 2011
Calling for a boycott are forensic psychologists Paul Good and Jules Burstein. Writing in the American Journal of Forensic Psychology, they liken preemptive detention laws to a "modern-day witchhunt":
Psychologists testifying for the state in SVP civil commitment trials are using contrived mental disorders and the scientific veneer of actuarial formulae…. [The ‘predator’ paradigm] gives the public a false sense of security by concentrating vast sums of money on incarcerating a small group of sexually violent offenders, in place of a more useful public health approach to the problem of sexual violence. The consequences of this misguided effort include emphasizing incarceration over treatment, draining scarce resources from a multi-pronged approach to preventing sex crimes, demonizing sex offenders, and promoting the "slippery slope" of preventive detention…. Psychologists should put the public interest ahead of their guild interest and expose this mistake in social policy. One dramatic step would be to resign from state SVP panels.
"Full Employment for Psychologists Act"*

But, as this semi-facetious title by Charles Patrick Ewing suggests, two decades into these laws the sheer number of embedded psychologists makes a boycott impractical. These psychologists will not boycott a system that is making them "boatloads" of money, as one testified – up to a cool $1.5 million a year. As Ewing lays bare in Justice Perverted, the opportunity has proved irresistible for psychologists, many with little scientific sophistication or prior expertise in forensic psychology or sex offending:
In the short run the payoff, especially for some individual practitioners, has been great, but in the long run, the damage done to their professions and the people who would be served by them may prove to be much greater…. It is difficult to picture … psychologists who now earn their living developing checklists that purport to predict sex offender recidivism, doing evaluations and testifying in sex offender civil commitment trials, and/or training others who do so, encouraging state legislatures to put them out of work.

Photo © Karen Franklin 2011
Most of these psychologists are well intended. They believe they are doing righteous work to protect the public from dangerous predators. If they thought otherwise, cognitive dissonance would force them to quit the lucrative panels, as a minority of their colleagues have done. Their structural position of embeddedness creates blinders. When one is walking among the trees, one cannot see the forest. And there is an element of group-think. Surrounded by like-minded professionals, they mistake these colleagues' concordance for a consensus in the broader profession.

More alarmingly, as psychiatrists Michael First and Allen Frances point out in the current issue of the Journal of the American Academy of Psychiatry and Law, these practitioners are being systematically mistrained as to proper diagnostic and risk assessment practices. Just last week, I heard about a government evaluator (annual earnings from SVP evaluations: $500,000) who testified in support of civilly detaining a rapist based upon a previously unknown mental disorder called "paraphilia not otherwise specified – attracted to power and control."

You can't make this stuff up. 

Even if psychology had the unified will to step into this minefield, I doubt that our field has the political clout to impact the industry in any significant way. Embedded psychologists are mere functionaries, interchangeable cogs in a machine, scoring checklists and regurgitating memorized formulas. Unless and until legislatures and courts recognize that these laws are not doing much (if anything) to reduce sexual violence or keep the public safe, the growing chorus of critical scholars in the fields of psychology, criminology and law will remain as tiny voices crying out in the wilderness.

Will the courts step up?

In a critical overview just published online in Psychiatry, Psychology and Law, a leading forensic scholar in Australia says the courts shoulder some of the responsibility for failing in their role as gatekeepers. If the courts were more rigorous, fatally flawed approaches to risk assessment would not predominate in sex offender cases, argues Ian Coyle of Bond University in Queensland.

At a minimum, Coyle suggests, the playing field should be leveled. In Australia, as elsewhere around the world, the government has vastly superior resources for expert witnesses than does the defense:
The theoretical equality of all before the law is thus subverted in practice by inequality of means.

Another barrier to justice is the complexity of the statistics and measurement theory invoked in these cases. Lacking advanced scientific training, it is hard for the average judge or attorney to make sense of the competing claims and accurately determine which are valid and which are not.

Making matters worse, even when individual judges educate themselves so that they can detect and reject pseudoscience, for example by rejecting the fictional diagnosis of "hebephilia" as a basis for civil commitment, higher courts often overturn their decisions. The disappointing truth is, judges are mere functionaries, too.

The coming crash

Photo © Karen Franklin 2011
In the end, I predict the system will ultimately crumble not due to principled opposition but by virtue of its own excesses. In the United States, as many states teeter on the edge of bankruptcy, it is hard to justify spending $1 billion per year or more to civilly detain a tiny handful of sex offenders at the expense of public schools, higher education, and even prisons.

It is a tricky business, because legislators and judges do not want to incur public wrath by appearing "soft" on sex offenders. Still, as citizens feel the effects of massive cutbacks in public services, I expect they will become less tolerant of government waste across the board.

The backlash is already starting. For example, last week in Minnesota a legislative auditor released a report slamming the sex offender civil commitment program as costly and ineffective:
Hundreds of sex offenders confined in state treatment facilities receive inadequate therapy from under-qualified staff at excessive cost, according to [the] report…. At the same time, many other offenders present such low risk to the public that they could safely be released to community group homes, saving taxpayers millions of dollars. And in what they describe as a public safety paradox, auditors found that some sex offenders are held indefinitely, even though they pose less risk than dangerous felons in state prisons who are being released back to the streets. Auditors called on state officials to replace this "all or nothing'' system and develop a plan for low-cost alternatives, while spending more on treatment of the most dangerous offenders.
California is following suit, with an audit of its SVP program due out in June. Psychologists may be especially interested in one particular task of the audit, to examine "the qualifications of staff or contractors who conduct the evaluations and determine if they are consistent with professional standards and laws and regulations."

Bottom line, the bough will come crashing down when the massive costs finally become too much for governments to bear, and when citizens figure out that SVP laws -- while symbolically appealing -- are a wasteful and ineffective approach to reducing sexual violence.

How will our misguided colleagues pay their mortgages and fund their children's college educations then? Hopefully they're putting some of those millions in the bank for a rainy day.

*from Justice Perverted 

3 comments:

  1. I've been getting to know some people in online minor attracted communities and perusing their message boards, and the effects of the current pseudoscientific crap that psychologists spew forth are painfully clear. This past fall, a woman (very sympathetic towards them) wanted to do her dissertation on this group of people, with the hope of making accurate information about them available (rather than relying entirely on correctional and/or clinical populations), and about half of the people attacked her simply because she was a psychologist (the other half defended her). In talking to people, knowledgable MAPs know that so much of what the sex-offender industry puts out is based on wildly false assumptions and suppression of data that doesn't fit their agenda. I find among them an utter contempt for all psychologists because of the moral crusaders who are incapable of the self-doubt necessary for good science.

    Recently, as I've been reading through some stuff in ATSA's journal, I found articles that call a clinical sample of pedophiles a "community sample" which is completely contrary to the whole idea behind using community samples. I found another article on online "pedophile" communities that seemed to attempt an ethnographic study without actually talking to the people being studied. At one point, they were saying how on these forums, "pedophiles" get advice on how to use the internet to meet children, clearly reinforcing a pernicious stereotype of "the pedophile." And the quote they used to show this? And the quote that they used was clearly advice to an adult wanting to use the internet to meet other adults in real life.

    In each case, I emailed the authors about the matter, and the editor of the journal. Never got a response.

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  2. I agree, of course, that SVP laws are unconstitutional, and I hope they will eventually disappear because they are too expensive.

    But I also think we should be aware that psychiatrists like First and Frances, whom you mention in favor of your position, are in fact greatly responsible for the current deplorable situation.

    Case in point: recently, Frances made clear that he is in favor of EXPANDING civil commitment to mental disorders beyond the paraphilias: "other mental disorders may properly justify commitment in SVP proceedings. The possible list includes schizophrenia, substance dependence, mental retardation, dementia, bipolar disorder, delusional disorder, and antisocial personality" (from http://www.psychologytoday.com/blog/dsm5-in-distress/201103/surprise-i-support-some-svp-commitment).

    Frances and First also make two fundamental mistakes in their latest piece in the Journal of the American Academy of Psychiatry and Law that you mention. So although this piece apparently supports your view, I think it in fact undermines it. Their two mistakes are:

    1) A historical mistake: they complain that the "hebephilia" diagnosis "arose, not out of psychiatry, but rather to meet a perceived need in the correctional system. This solution represents a misuse of the diagnostic system and of psychiatry." They are unaware that all the paraphilias were invented in the nineteenth century because of legal issues. The paraphilias, in other words, are originally forensic categories, not clinical ones. So if Frances and First have a problem with "hebephilia" because of its origin in the courtroom, then they should have a problem with all the other paraphilias. But they don't, and this is why their support for the existence of the current paraphilias is also, logically, a support for "hebephilia."

    2) A philosophical mistake: they claim that hebephilia is not a disorder because sexual attraction to pubescent youngsters is common. Obviously, that's a very problematic way to define disorder. Cavities are very common, but aren't they pathological? Homosexuality is not very common, so should it be pathological? In order to make a convincing argument, Frances and First need to have a solid definition of mental disorder. But other writings by these psychiatrists, especially Frances, make clear that this is not at all their priority. It's no wonder that they can't come up with anything better than "this is not a disorder because it is common." To base an argument against "hebephilia" on such shaky grounds cannot possibly convince anyone who does not already agree.

    In my opinion, the extreme weakness of Frances and First's argument ends up bringing support to the idea that "hebephilia" is valid. What is needed is a radical critique of the category of paraphilia as a whole -- something that Frances and First have no intention of doing.

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  3. @Patrick, I have a suspicion that First and Frances (or at least one of them) know at some level that their arguments against hebephilia render problematic their support for including pedophilia in the DSM. As far as I can tell, they give two (extremely weak) arguments for keeping it in. 1) Psychiatrists have historically regarded it as a mental disorder, and 2) I mean wanting to have sex with children!?! That's just messed up! (i.e. the endorsement of DSM-III's standard of "bizarre")

    Obviously (1) is a problem. They historically thought homosexuality was a disorder--this only changed because gay liberation forced them to rethink the issues and got the powers that be to get to know homosexuals as people. The fact is that those attracted to children are poorly politically organized and so incredibly stigmatized that even the ones who abide by the law (quite possibly the majority) are too afraid to come out. Sociologically and historically, these are important, but they can hardly be regarded as very substantive scientifically or ethically.

    As for "bizarre", bizarre according to who? I don't find anyone "hot" and I find hotness itself (the phenomenon of looking at someone and finding them "hot") to be utterly bizarre, so much so that I still feel a need to use scare quotes in talking about the subject. I mean, it's just weird! Now, I have a definite sense that I'm in the minority on this one, and suspect that a lot more people would consider me "bizarre" than they would most of the rest of humanity. As such, I'm forced to acknowledge that this is simply my own prejudice rather than anything objectively bizarre about hotness.

    I think that First and Frances are absolutely right in making being "bizarre" at the core of paraphilias. I've seen attempts to define the concept without this but they either make no sense (Blanchar's recent attempt) or are forced into self-contradiction right and left (Blanchard's recent attempt; also Federoff has proposed one that does this).

    Here's my own definition of paraphilia: "Asy sexual interest that's like totally messed up or something. And dude's that cross-dress, 'cause that's like totally messed up too." I doubt that you'll find a better definition out there. But admitting this fundamentally undermines the whole concept.

    I think that First and Frances likely feel, deep down, that pedophilia is just messed up, and they know that arguing for it's removal from the DSM (or even saying that they support this) would instantly put them at the center of a firestorm that they want no part of.

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