July 10, 2010

Normality endangered: "Psychiatric fads and overdiagnosis"

That's the title of this week's Psychiatric Times commentary by Dr. Allen Frances, chair of the DSM-IV Task Force and psychiatry professor emeritus at Duke University. The column begins:
Fads in psychiatric diagnosis come and go and have been with us as long as there has been psychiatry…. In recent years the pace has picked up and false "epidemics" have come in bunches involving an ever-increasing proportion of the population. We are now in the midst of at least 3 such epidemics -- of autism, attention deficit, and childhood bipolar disorder. And unless it comes to its senses, DSM5 threatens to provoke several more (hypersexuality, binge eating, mixed anxiety depression, minor neurocognitive, and others).

Fads punctuate what has become a basic background of overdiagnosis. Normality is an endangered species. The NIMH estimates that, in any given year, 25 percent of the population (that’s almost 60 million people) has a diagnosable mental disorder. A prospective study found that, by age thirty-two, 50 percent of the general population had qualified for an anxiety disorder, 40 percent for depression, and 30 percent for alcohol abuse or dependence. Imagine what the rates will be like by the time these people hit fifty, or sixty-five, or eighty. In this brave new world of psychiatric overdiagnosis, will anyone get through life without a mental disorder?
While focusing on the alarming spread of psychiatric diagnoses among children, as he has in the past Dr. Frances touches on the forensic implications of diagnostic freneticism:
Mental disorder labels can provide cover for societal problems. Criminal behavior has been medicalized (eg, rape as a psychiatric disorder) because prison sentences are too short and such labeling allows for indefinite psychiatric commitment.
Frances concludes:
The DSM-5 bias to thrust open the diagnostic floodgates is supported only by flimsy evidence that does not come close to warranting its great risks of harmful unintended consequences. It is too bad that there is no advocacy group for normality that could effectively push back against all the forces aligned to expand the reach of mental disorders.
The full essay is HERE.

July 9, 2010

Correctional ethics: New guidelines; licensing complaints

New correctional psychology standards published

As most of you know, the largest mental health institutions in the Land of the Free are not hospitals, but penal institutions: Riker's Island in New York, Cook County Jail in Chicago, and the Los Angeles County Jail. The USA incarcerates the largest proportion of its population of any country on the planet, and at least 15 percent of those 2 million or more people have serious mental illnesses. Unfortunately, many correctional systems lack resources to meet the constitutionally mandated needs of mentally ill individuals in their custody.

For you folks in correctional psychology, Criminal Justice and Behavior has just published a special issue containing the newly revised standards for psychologists working in jails, prisons, and other correctional facilities and agencies. This is only the second revision of the standards since their initial publication by the International Association for Forensic and Correctional Psychology (IACFP) in 1980. They are the result of more than a year's effort by a revision committee chaired by Richard Althouse, Ph.D., president of the IACFP.

Guantanamo psychologists face ethics charges

The timing of these new guidelines is serendipitous. Earlier this week, the San Francisco-based Center for Justice and Accountability and Harvard Law School's International Human Rights Clinic filed state licensing board complaints against two former Guantanamo psychologists. The aim of the complaints, filed in New York and Ohio, is to force investigations into the psychologists’ roles in the torture of prisoners.

The Ohio complaint alleges that Larry C. James, now dean of Wright State University's School of Professional Psychology, headed a special unit called the Behavioral Science Consultation Team, known as "Biscuit," that advised the military on how to break down prisoners and participated in the controversial interrogations at Guantánamo. The New York complaint is against psychologist John Leso, Dr. James's predecessor on the special team.

APA revises ethics standards

In the wake of the Guantanamo abuses, the American Psychological Association has revised its Ethics Standards to clarify that compliance with the law is no excuse for unethical behavior.

Specifically, language has been added to Standards 1.02 and 1.03 ("Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority" and "Conflicts Between Ethics and Organizational Demands") stating that the standards may "under no circumstances … be used to justify or defend violating human rights." In addition, a clause allowing psychologists to behave unethically in order to "adhere to the requirements of the law, regulations, or other governing legal authority" has been struck out.

Related resources:
  • The new correctional standards are available HERE for free for a limited time.
  • Mother Jones and Democracy Now have in-depth coverage of the Guantanamo complaints, with links to additional background materials.
  • The Ohio complaint against psychologist Larry James is HERE. Local coverage of that case, in the Dayton Daily News, is HERE.

July 8, 2010

Video: Criminalization of mentally ill

I just stumbled across an outstanding educational video on the mentally ill in U.S. prisons. Focusing on Texas prisons, it touches on the problems of isolation, decreased funding, and telecare. Brought to you by Al Jazeera.

July 7, 2010

Fools competent to represent themselves at trial

Buffoonery doesn’t qualify under Edwards, appellates rule

Two hucksters were not incompetent to represent themselves despite engaging in "nonsensical antics" during their month-long jury trial, the Ninth U.S. Circuit Court of Appeals ruled this week.

Defendants Kurt F. Johnson and Dale Scott Heineman were convicted of conspiracy and 34 counts of mail fraud stemming from a debt-elimination program in which they took more than $3 million from as many as 3,500 homeowners throughout 35 states. The basic premise of their so-called "Dorean Process" was that homeowners should stop paying on their mortgages because banks were being unfair, and take out new loans on which the defendants earned sizeable commissions.

During their trial, the defendants filed "meaningless and nonsensical documents" and advanced "an absurd legal theory wrapped up in Uniform Commercial Code gibberish," the appellate court stated. They insisted on wearing jail attire in front of the jury, and one of their "recurring themes in their colloquies with the court was their peculiar theory that they were 'sentient human beings' " distinct from the capitalized titles by which they were referred to in court documents.

A forensic evaluator, James R. Missett, M.D., Ph.D., had evaluated them before trial and testified at a pretrial hearing that neither had a diagnosable mental disorder. Further, the defendants adamantly insisted on representing themselves, even after the trial judge repeatedly warned them about the dangers and "practically begged them to accept counsel."

The appeal was brought under Indiana v. Edwards, which was decided by the U.S. Supreme Court in 2008, after their trial concluded. That opinion set out a higher standard for self representation than for competency to stand trial when represented by an attorney. Interestingly, however, the trial court had carefully probed and made a record of the defendants' competency to represent themselves, even before Edswards established a higher standard.

Said the Ninth Circuit:
"The record clearly shows that the defendants are fools, but that is not the same as being incompetent.... The behavior of the defendants during the trial in this case, while occasionally wacky, was not disruptive or defiant…. [T]hey did not exhibit a blatant disregard for courtroom rules or protocol and did not make it impossible for the court to administer fair proceedings. In fact, they made opening statements, closing arguments, cross-examined witnesses, argued jury instructions, and testified on their own behalf…. They were examined by a psychiatrist and found to be fine. In the absence of any mental illness or uncontrollable behavior, they had the right to present their unorthodox defenses and argue their theories to the bitter end."
Additional background: Defendant Kurt Johnson’s gibberish-laden blog, The Dorean Group, gives a flavor of the defendants' anti-government, religious rhetoric. Attorney Rachel Dollar's Mortgage Fraud blog cites some examples of the pair's wild legal motions. And fraud prevention consultant Chuck Gallagher discusses some of the interesting ethical issues involved in homeowners' willingness to rely upon the defendants' assertions. My 2008 analysis of Indiana v. Edwards is HERE.

Hat tip: Kathleen

July 6, 2010

Mitchell to plead insane

No surprise, but Brian David Mitchell has filed official notice that he plans to go for an insanity defense. Mitchell, as you all know, is awaiting trial in the 2002 kidnapping of Elizabeth Smart in Salt Lake City. The defense notice states an intent to rely upon unspecified "expert testimony as to mental disease or defect." I'm not holding my breath that the trial will start as scheduled on November 1, but when and if it does it is bound to be quite interesting.

I highly recommend that all forensic practitioners read U.S. District Judge Dale Kimball's lengthy ruling on Mitchell's competency to stand trial, issued four months ago. At 149 pages, it's the most comprehensive competency decision I have seen. In describing Mitchell as a cunning malingerer, the decision has plenty of implications for the insanity trial as well.

Utah abolished the insanity defense some years back. The state now uses the restrictive standard of Guilty But Mentally Ill, under which evidence of mental disorder can be introduced only for the restricted purpose of disproving mens rea, or the mental state that must be present in order to be convicted of certain special-intent offenses. (A handy chart showing the insanity standards of each U.S. state is HERE.) However, since the federal government is prosecuting Mitchell, he should still be able to rely upon the defense.

POSTSCRIPT: Subsequent news coverage on the government's response to the insanity filing is HERE.

July 1, 2010

Eyewitness ID: Landmark report urges overhaul

New Jersey case may change legal landscape, reduce wrongful convictions

Mistaken eyewitness identifications are the leading cause of wrongful convictions, playing a role in three out of four DNA exoneration cases to date, according to the Innocence Project. Now, a cutting-edge report commissioned by the Supreme Court of New Jersey recommends major changes to bring the courts into alignment with the current state of the science on eyewitness testimony.

Geoffrey Gaulkin, a retired judge, spent close to a year reviewing three decades of research and taking testimony from experts in a hearing that legal observers describe as unprecedented. His conclusion: About a third of witnesses who pick out a suspect choose the wrong person, and the courts are not keeping up with science to prevent such wrongful identifications in court. Expert witnesses at the evidentiary hearing included John Monahan, law professor at the University of Virginia, Gary Wells of Iowa State University, and Steven Penrod of the John Jay College of Criminal Justice.

The state high court request for a comprehensive probe stemmed from the case of Larry Henderson, who was convicted of manslaughter in 2004 based on a photographic identification procedure.

In his report, Gaulkin recommends far-reaching procedural safeguards, including procedures to assess the reliability of witnesses' identification of suspects. He also proposes that prosecutors, rather than defendants, should bear the burden of proof regarding the reliability of eyewitness testimony, and that juries and judges should be fully informed about the science of eyewitness identification and its fallibility.

Observers say the Special Master's findings of science and law represent a sea change that may eventually serve as a blueprint for other jurisdictions to revamp both their witness identification protocols and their rules on the use of eyewitness evidence in court.

Further resources:
Hat tip: Jane