October 31, 2011

Happy Halloween!

For the past four years on this date, I have posted a column on Halloween and the sex offender bogeyman. I'm going to skip it this year, but you can check out my previous offerings by clicking on these links:
View from my walking path of San Francisco Bay and Golden Gate Bridge
By the way, there is an actual crime spike on Halloween; it's just not of a sexual variety. You may also be interested in an article at The Psychologist on "The Lure of Horror."

Collating these Halloween posts reminds me that I’ve been blogging for almost five years now. It's hard for me to believe this will be my 735th post! My increasingly large and diverse international subscriber base makes quitting unthinkable. But occasionally blogging must take a back seat to other things, including my forensic work, academic writing, non-professional activities, and even simply enjoying our glorious October weather (so much nicer than the record-breaking snow storm that just struck the East Coast!).

I did manage to find time to view and review three indie films, a diversion from the increasingly mindless Hollywood fare that is so hard to stomach. You can click on any of these links to read the full review. In order from most to least recommended, they are:
  • Salt of This Sea (a Palestinian film I highly recommend)
  • Incendies (a critically acclaimed film about the Lebanese conflict, which is worth seeing if you are into horror)
  • Ballast (a film set in the Mississippi Delta that doesn’t live up to the hype)
When I don't get around to blogging, I often still find time to tweet forensic news, a much shorter and simpler task. Click on any of the below links to go to some of the interesting news articles I've tweeted about in the past couple of weeks (you can view my tweets in real-time at any time, on the upper-right side of my blog site):
In closing, whatever you are up to today, I wish you a very happy Halloween. No tricks, just treats.

October 30, 2011

Study: Psychopathy score fails to predict sexual recidivism

Many forensic psychologists believe that psychopathy is a risk factor for sex offender recidivism. Not surprisingly, when forensic psychologists assign a sex offender a high score on a psychopathy test, it increases the risk of extreme legal sanctions such as civil commitment.

But a new study out of Texas found zero correlation between sexual recidivism and psychopathy, as measured by the widely used Psychopathy Checklist (PCL-R). If anything, sex offenders who were arrested for a new sexually violent offense tended to have lower scores on the PCL-R than those who were not rearrested!

Regular blog readers should be familiar with these researchers by now: Dan Murrie, Marcus Boccaccini and crew are the same scholars who informed us of the partisan allegiance phenomenon, in which evaluators working for the government tend to assign far higher PCL-R scores than do those working for the defense.

In their most recent study, they examined PCL-R scores from about 400 sex offenders in Texas who were released from prison and then tracked for anywhere from about two to seven years. They examined not just the total scores on the PCL-R, but also scores on the instrument's two factors, as well as four so-called facet scores. Not one of these seven PCL-R variables was a statistically significant predictor of whether a man would be arrested for a new sex crime.

“Overall, these predictive validity findings were striking because the PCL-R apparently failed to predict the type of outcome (i.e., sexually violent reoffense) for which it was administered in this context,” the authors noted.

Further, in cases in which the PCL-R was administered by more than one evaluator, the study found poor agreement between the two, even though both were working for the government. Consistent with prior research, interrater agreement was higher on Factor 2, which measures antisocial behavior and an impulsive lifestyle, than on Factor 1, which measures the vaguely operationalized personality and emotional dynamics thought to underlie psychopathy.

In an interesting twist, the researchers tried to determine whether some evaluators were more accurate than others at predicting recidivism through PCL-R scores. They identified four highly prolific evaluators; together, these three psychologists and one medical doctor had provided almost two-thirds of the PCL-R scores in the study. Although the PCL-R scores of three of these four evaluators were more likely than other evaluators' scores to correlate with a new arrest for a non-sexual crime, even these evaluators could not produce PCL-R scores that predicted sexual offense recidivism.

Despite the PCL-R’s lack of predictive validity, sex offenders with higher PCL-R scores were more likely than others to be recommended for civil commitment, indicating that the unreliable rating was far from harmless in forensic practice.

The study is: 

Murrie, D. C., Boccaccini, M. T., Caperton, J. and Rufino, K. Field Validity of the Psychopathy Checklist–Revised in Sex Offender Risk Assessment. Psychological Assessment. Click HERE to request a copy from the first author, at the Institute of Law, Psychiatry, and Public Policy.

Of related interest:

October 27, 2011

DSM-5 petition takes off like wildfire

I just checked back on the status of the petition by psychologists about the DSM-5 that I blogged about Sunday, and found that it's gaining momentum fast: 1,160 signatures as of this moment, and there will be a dozen more in the few minutes it takes me to upload this post!

The blaze of interest is especially remarkable because the petition was launched without any publicity at all, and has gained traction solely through word of mouth.

If you haven’t checked it out yet, I urge you to do so, and pass it along to others.

According to Allen Frances, chair of the DSM-IV task force and an outspoken critic of the current DSM-5 process, the American Psychiatric Association leadership is aware of the petition, but plans no formal response. Writing yesterday at the Psychiatric Times, he said:
They hope to ride out the storm of opposition mounting on all sides and dismiss it as the work of professional rivals or antipsychiatry malcontents. Characteristically, DSM-5 offers no rebuttal based on evidence. Instead, it stubbornly soldiers on in its promotion of radical diagnostic changes that are risky, untested, unsupported by a strong science base, and vigorously opposed by the field.

The really unexplainable paradox is the APA's systematic promotion of greater diagnostic inflation at a time when we are already so obviously plagued by diagnostic inflation, fad diagnoses, and false epidemics. Unless it comes to its senses, DSM-5 will promote greater drug use exactly when we have a public health problem caused by the inappropriately loose prescription of antipsychotics, antidepressants, antianxiety agents, pain medicines, and stimulants. The paradox is that, contrary to conspiracy theorists, the DSM-5 experts are not making their risky suggestions because of financial conflict of interest or the desire to line drug company pockets. They have the best of intentions, but are terminally naïve about how their suggestions will be misused....
Frances has another good commentary on the petition and its ramifications at his Psychology Today blog dedicated to the mounting crisis, DSM5 in Distress:
DSM 5 has lived in a world that seems to be hermetically sealed. Despite the obvious impossibility of many of its proposals, it shows no ability to self correct or learn from outside advice. The current drafts have changed almost not at all from their deeply flawed originals. The DSM 5 field trials ask the wrong questions and will make no contribution to the endgame.

But the DSM 5 deafness may finally be cured by a users' revolt. The APA budget depends heavily on the huge publishing profits that accrue from its DSM sales. APA has ignored the scientific, clinical, and public health reasons it should omit the most dangerous suggestions- but I suspect APA will be more sensitive to the looming risk of a boycott by users.
Again, I encourage you to join the movement now, by clicking on the link below and by spreading the word.

October 20, 2011

More on test administration issues in Twilight Rapist case

Alan Cohen, the attorney in the Billy Joe Harris case that I blogged about last week, wrote to clarify the unusual test administration procedures of psychiatrist Colin Ross, who testified for the defense. Because his letter (which he posted at my Psychology Today blog, Witness) is of general interest to forensic psychology, I re-post it here, along with my response:

Mr. Cohen wrote:
I found your article of interest and hope this will create a forum for further discussion on DID and its use in the courtroom setting.

The issue of my administering the examination to my client took on a sinister spin from the way it was interpreted by Dr. [Robert] Barden when in fact it was nothing more then my hand-carrying it to the jail and passing the sealed envelope into the hand of a deputy who then gave it to my client. The transaction took less then a minute. I remained in an attorney booth with my client who spent four hours answering the self-administered questions. When he completed the exam he placed the results in an envelope and sealed it. He then handed the envelope to a deputy who then gave it to me. That transaction took less then a minute.

I personally carried the test to the jail so that the contents would not be examined by either the sheriffs department or the prosecutors office since Mr. Harris was under extremely tight surveillance and the results of the test would/could form the basis of our defense. I could not jeopardize the results of the exam being compromised by falling into the "wrong hands."

* * * * *

Mr. Cohen,

Thanks for writing to clarify the circumstances of the test administration. I have seen other cases in which psychologists have had third parties administer psychological tests, or have even given prisoners tests to fill out in their spare time and return at their leisure. While the intermediary who delivers the test is not doing anything sinister, from the standpoint of professional ethics and practice there are several problems with such practices.

First and foremost, if a test is standardized -- that is, if it has norms to which an individual is being compared -- then such procedures violate the standardized administration and may invalidate the results.

Second, such procedures violate test security.

Third, they prevent the expert from ensuring the adequacy of testing conditions, or of observing the individual as he performs the tasks; observation by skilled examiners can be an important component of one's ultimate opinions. Relatedly, sitting with the test-taker allows the examiner to assess for adequate comprehension, and answer any questions that may come up.

When Dr. Barden testified that it was unethical for the attorney to administer the tests, he was likely referring to the Ethics Code for psychologists, as well as the Standards for Educational and Psychological Testing ("The Standards") promulgated by the American Educational Research Association, the American Psychological Association and the National Council on Measurement in Education.

As noted in the introduction to the Standards, which apply to everyone who administers, scores and interprets psychological or educational tests, regardless of whether they are a psychologist:
The improper use of tests can cause considerable harm to test takers and other parties affected by test-based decisions. The intent of the Standards is to promote the sound and ethical use of tests and to provide a basis for evaluating the quality of testing practices. 
Collectively, the Ethics Code and the Standards require that:
  • Test administrators receive proper training (Ethics Code 9.07; Standards 12.8)
  • Tests not be administered by unqualified persons (Ethics Code 9.07; Standards 12.8)
  • Examinees receive proper informed consent (Ethics Code 9.03; Standards 12.10)
  • Test data be kept confidential and secure (Ethics Code 9.04; Standards 12.11)
  • Assessment techniques be protected from disclosure to the extent permitted by law (Ethics Code 9.11; Standards 12.11) 
Again, I appreciate your taking the time to write.

NOTE: After I posted this exchange, the testifying psychiatrist, Colin A. Ross, posted a comment at my Psychology Today blog. He provided more information about the screening tests for dissociation and why they were administered as they were. He also offered his opinion on the validity of Dissociative Identity Disorder. His comment can be viewed HERE. Please feel free to join in the discussion, either here or (preferably) at my Witness blog, where the conversation began.

October 13, 2011

Multiple personality excluded in Texas insanity case

A serial rapist’s attempt to claim insanity based on multiple personality disorder fell flat, as a judge ordered the expert's trial testimony stricken from the record as junk science.
Billy Joe Harris
Psychiatrist Colin Ross testified that Billy Joe Harris, the so-called "Twilight Rapist" who targeted elderly women, suffered from multiple personality disorder -- now known as dissociative identity disorder (DID) -- brought on by childhood abuse.

Ross, who runs the Colin A. Ross Institute that provides trainings on psychological trauma and dissociative identity disorder, testified that the condition’s presence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association establishes it as a "real and valid disorder."

Ross testified that he gave the defendant three tests for DID. However, in a most unusual procedure, rather than personally administering the tests, he gave them to the defense attorney to administer. Thus, he has no way of knowing for sure who filled in the tests, or under what circumstances. 

Ross testified that the defendant's scores on a screening test, the Dissociative Experiences Scale, were so high that he questioned the test's validity. He also conceded that the defendant was "clearly telling stories that are not true" about other aspects of his life, for example falsely claiming to have served in Iraq when he was actually in Saudi Arabia. However, Ross testified that after getting a chance to talk personally with one of Harris's alters, "Bobby," he was convinced of Harris's claim of multiple personalities.

"I don't think he's faking the dissociative identity disorder," he testified. "I could be wrong."

The real culprit, David the Dog
The defendant, a former prison employee, also took the witness stand, "weaving tales of bestiality, aliens, transvestites and combat heroism," in the words of news reporter Sonny Long. Harris testified that he had three other personalities inside him, including a black Great Dane named David who committed the rapes.

A dramatic moment came during cross-examination, when prosecutor Bobby Bell asked to speak to the defendant's alter, also named Bobby. As Long described the scene:
Harris lowered his head momentarily, raised it back up, rolled his neck and declared in a deep voice to be "Bobby."
Several jurors stifled laughter during the subsequent give-and-take between Harris and Bell, according to Long's account in the Victoria Advocate.

But perhaps even more damaging to Harris's credibility was an audiotape played for the jury in which he talks to his girlfriend about having put on "a good show" in court one day. Earlier that day, he had fallen to the floor and twitched and shook until he was restrained. The girlfriend warned Harris that the telephone call was being recorded, to which Harris replied, "I know it."

Forensic psychologist Walter Quijano also testified for the defense. (If the name sounds familiar, he has been in the spotlight for using race as a risk factor in death penalty cases, as I recently blogged about.) He testified that when multiple personality popped up as an issue, he stepped back because that is not an area of expertise for him. However, he did testify that it is unusual for someone to begin a rape career so late in life. Harris is 54.

Mere presence in DSM doesn’t establish validity

After the defense rested, the prosecution called as a rebuttal witness a Minnesota psychologist and attorney who has made a crusade out of pushing so-called "junk science" out of the courts.

Robert Christopher Barden testified that dissociative identity disorder (aka multiple personality disorder) is a controversial condition looked upon with skepticism by the scientific mainstream. He cited several articles rejecting the condition as a viable diagnosis, despite its presence in the DSM.

"Because something is in the DSM doesn't mean it's reliable or should be allowed in a court of law," he testified, according to an article in the Victoria Advocate. "One of the ways to get junk science out of the legal system is you rely on the relevant scientific community. If something is controversial it means it's not generally acceptable."
Barden said the number of mental health professionals who tout dissociative identity disorder as viable are few and far between.
"There are a few pockets of people left who are doing this," he said. "The scientists I know condemn it to be the worst kind of junk science and dangerous to the public. Controversial and experimental theories should not be allowed to contaminate the legal system."
Concerning the tests given to Harris, Barden said, "There's no magic to these tests. It looks scientific. It looks professional, but when you get down into it, it's junk. It's unusual for a psychiatrist to interpret a psychological test and it's highly unethical for Mr. Cohen [the defense attorney] to give the tests."

After Barden’s testimony that the condition is not generally accepted by the scientific community, despite the fact that it is listed in the DSM, District Judge Skipper Koetter ordered Dr. Ross’s testimony on dissociative identity disorder stricken from the record.

Justice, Texas-style

In the end, the defendant’s overdramatization and courtroom theatrics likely did him in. During the trial, he trembled and twitched and sat in the courtroom with paper stuffed in his ears, which his attorney said was “to keep the voices from speaking to him."

The jury took only 10 minutes to convict Harris, and another 10 minutes later in the month to sentence him to life in prison.

After the verdict, Barden said in a press release that the outcome demonstrates “the power of science-law teams in protecting the legal system from junk science testimony."

Barden has been involved in hundreds of lawsuits, criminal prosecutions and licensure actions across the United States over the past two decades, targeting not only multiple personality disorder but also quack therapists in the repressed memory and rebirthing therapy movements.

Judge Koetter's ruling is not the last word, of course, as it is just one trial judge's opinion. Appellate courts in other states have ruled differently. For example, in the 1999 case of State v. Greene (139 Wn. 2d 64), the Washington Supreme Court held that dissociative identity disorder was a generally accepted diagnosis because it was listed in the DSM-IV, and therefore met the Frye test for admissibility. But the Court went on to say that the applicability of this diagnosis to the issue of criminal responsibility was problematic and that testimony about DID was not "helpful" to the jury. (The Trowbridge Foundation has more information on this case HERE.)

The battle lines over dissociative identity disorder have heated up in the dozen years since that ruling, so who knows how an appellate court might rule today.

For those interested in learning more about the controversy, I recommend the chapter "Dissociative Identity Disorder: Multiple Personalities, Multiple Controversies" by Scott Lilienfeld and Steven Jay Lynn, in their book, Science and Pseudoscience in Clinical Psychology.

October 10, 2011

California deals big blow to bogus paraphilia diagnoses

Government evaluators in California have been instructed to be more cautious in invoking ad hoc psychiatric diagnoses such as "paraphilia not otherwise specified-nonconsent" to justify the civil commitment of sex offenders.

In a report in today's Psychiatric Times, Allen Frances calls the move by California's Department of Mental Health a "giant step forward in ending the Paraphilia NOS fad."

The new marching orders are likely to have national repercussions. California has a large cadre of sexually violent predator evaluators, many of whom moonlight in other states and in federal court as well.

As Frances reports, evaluators were summoned to a training workshop at which "they were explicitly instructed to adhere closely to the intent of DSM-IV and to desist from making idiosyncratic paraphilia diagnoses. The training made clear that a diagnosis of 'Paraphilia NOS nonconsent' would require affirmative supportive evidence that the rapist is sexually aroused specifically by raping rather than all the many very much more common situations in which rape is simply criminal."

Increasingly, government evaluators had been using so-called "NOS" diagnoses to justify civil commitment of men whose sex offenses were not driven by any recognized mental disorder. Because rape is a crime rather than a mental illness, it is not included as a diagnosis in any psychiatric manual. Similarly, evaluators have taken to labeling men who sexually assaulted post-pubertal minors but did not meet the diagnostic criteria for pedophilia with the ad hoc label of "paraphilia not otherwise specified-hebephilia."

Frances expressed optimism that California's policy change signals the beginning of the end for “paraphilia NOS” in court:
The misdiagnosis of rape as a mental disorder has been a forensic disaster,  allowing the widespread misuse of involuntary psychiatric hospitalization.... [T]he California DMH has only limited control over its errant state SVP evaluators, who by contract are entitled to exercise their individual 'clinical judgment' however mistaken and baseless it may be. 'Paraphilia NOS' will likely linger longer than it should. But the tide has clearly turned in California and California is likely to be a bellweather state; its return to proper diagnostic practice undoubtedly will spread across the country.
Blog readers may also be interested in Frances's commentary on a proposed change in the diagnostic criteria for Posttraumatic Stress Disorder (PTSD) in the upcoming DSM-5. The change could open the door for increased forensic misuse of this controversial diagnosis. Frances's report is HERE.

October 5, 2011

Combating the pull to overpredict violence

Like the moon's effect on tides, the pull to overpredict violence exerts a powerful influence, even on seasoned forensic evaluators who know its strength.

When directly informed that an event has a low base rate of occurrence -- for example, that a homicide offender has only a 1 in 100 likelihood of being arrested for another homicide -- both laypeople and professionals will markedly overpredict violence.

In an article in the Journal of the American Academy of Psychiatry and Law, eminent forensic psychologist Stanley Brodsky and postdoctoral fellow Sarah L. Miller analyze why this is so.

For one thing, the risk of underpredicting violence has more potential to negatively impact the evaluator. Bad publicity, public outrage, even civil litigation. Not to mention the harm committed by a high-risk individual who reoffends. 

Far safer to "err on the side of public safety," goes clinical lore. A claim of dangerousness is well nigh impossible to disprove. And especially in the context of civil commitment of sex offenders, the issue is not framed as punishment but, rather, as "an acceptable restriction of individual rights in the interest of public safety and rehabilitation." It's not as if these guys are sympathetic characters, with a constituency of supporters looking out for their rights.

Certain psychological mechanisms also contribute to bias in the direction of overpredicting risk. These include confirmation bias, or seeking information to support a preconceived conclusion, and illusory correlation, in which the evaluator assumes two things are related just because they co-occurred.

The purpose of Brodsky and Miller's well-argued review is to make evaluators more aware of the natural overprediction tendency, and to provide a checklist that evaluators can use to assess and correct their potential biases.

It's a great idea, although I am a bit skeptical that such a simple approach will make much of an impact in the adversarial arena.

The full article is available for free download HERE.

October 1, 2011

Russell Banks' new novel explores sex offender banishment

The Kid is all alone in the world, hiding in the shadows under the freeway, part of an ever-growing mass of exiles electronically shackled to a society that despises and shuns them.

But who are these modern-day lepers? And why are there so many of them? What if sex offending is a symptom of a malfunctioning society, and these men are just the canaries in the coal mine, carrying the burden of society' shame? What if the Internet is the snake in the Garden of Eden, and pornography is the forbidden fruit?

In Lost Memory of Skin, best-selling novelist Russell Banks explores the deeper ironies of a culture that condemns pedophiles even while turning its children into dehumanized sexual commodities. But on a deeper level, the novel is about the profound loneliness and alienation of the digital age, the inability of people to get beyond false facades to truly trust and connect with each other.

My review continues HERE.

(As always, if you appreciate the book review, please click "yes" at the Amazon site, to boost the placement of my Amazon reviews.)