October 31, 2012

Forensic psychiatrists reject hebephilia - yet again!

Will American Psychiatric Association heed professional consensus?

Twenty years ago, Humbert Humbert went to prison for a series of sexual assaults on his 12-year-old stepdaughter, whom he famously nicknamed "Lolita." Now, as his lengthy prison term draws to a close, Wisconsin is petitioning to have the 60-year-old literature professor indefinitely detained as a Sexually Violent Predator.

The venue for last week's trial of Vladimir Nabokov's fictional protagonist was the annual convention of the American Association of Psychiatry and Law (AAPL) in Montreal. The central question, decided by audience vote, was whether the controversial diagnosis "hebephilia" qualified as a legitimate mental disorder justifying Mr. Humbert's indefinite civil detention.

The rousing theatrical performance featured an all-star cast of attorneys and psychologists, presided over by Toronto Judge Maureen D. Forestell. New Jersey Assistant Attorney General Mark Singer served as prosecutor. His expert witness was prominent psychiatrist Richard Krueger, a member of the paraphilias subworkgroup that has proposed adding "hebephilia" to the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A hebephilic qualifier would extend pedophilia to men with sexual preferences for children who have entered puberty, such as the fictional Lolita.

Defending Mr. Humbert was preeminent Wisconsin attorney Robert LeBell. His expert was Washington psychologist Richard Wollert, who has published peer-reviewed articles on SVP-related topics and testifies for the defense in civil commitment proceedings. Appearing as the court's expert was prominent Canadian psychiatrist John Bradford, an advisor on paraphilia (or sexual deviance) to the DSM-IV, past president of the AAPL and clinical director of the Sexual Behaviors Clinic in Ottawa.

After a spirited and sometimes heated trial, the 131-member audience was given electronic clickers and voted overwhelmingly -- 82 percent -- against including hebephilia as a diagnosis in the DSM-5, due out in mid-2013. A majority also voted against even including the controversial diagnosis in a DSM-5 appendix as a condition meriting further study.

Third time's the charm?

This marks at least the third time in two years that respected professional bodies have voted against the idea of hebephilia as a new mental disorder. At a 2010 vote in Oslo, Norway, members of the International Association for the Treatment of Sexual Offenders (IATSO) were near-unanimously opposed to the newly proposed sexual paraphilia. U.S. forensic psychiatrists followed suit a month later at the 2010 AAPL conference, overwhelmingly voting against hebephilia as well as two other proposed paraphilias, "paraphilic coercive disorder" (aka rape) and hypersexuality, both since scrapped.

Earlier this year, more than 100 professionals, including prominent forensic psychologists and psychiatrists in the U.S. and internationally, sent an open letter to the DSM-5 revisers, urging them to nix hebephilia. Since then, at least two peer-reviewed articles have been published deconstructing its legitimacy, one in the respected Journal of Nervous and Mental Diseases ("Hebephilia and the Construction of a Fictitious Diagnosis" by forensic psychologists Paul Good and the late Jules Burstein) and the other a broad review ("Hebephilia as mental disorder?") by scholars Bruce Rind and Richard Yuill in the Archives of Sexual Behavior.

Rind and Yuill said they undertook their extensive review of the historical and cross-cultural evidence after hebephilia proponent Raymond Blanchard (a member of the DSM-5 paraphilias subworkgroup) and his colleagues at Toronto's Centre for Addiction and Mental Health brushed aside numerous published criticisms of the proposed disorder (see Table 1). Building on their earlier research, Rind and Yuill argue that hebephilia -- generally defined as sexual attraction to young pubescents in the age range of 11 to 14 -- is a biologically normal trait found to varying degrees in both human males and our closest mammalian relatives, such as higher apes. They blast hebephilia as a bold example of naked moral values masquerading as science:

"Blanchard et al. … did not invoke comparative evidence…. They did not invoke any evidence…. They declared it a disorder by fiat, bypassing scientific analysis in favor of a pre-given conclusion supportable only because it is, for the current time and place, culturally resonant. Had their pronouncement been the opposite (i.e., hebephilia is functional), their article would never have been accepted in a peer-reviewed journal without massive evidential backing. Strongly resonant opinion can facilely pass through without the kind of scrutiny demanded of non-resonant views."

Why hebephilia still clings to life, despite so much opposition and so little scientific support, is beyond me. It's like an unwanted house guest who just refuses to take the hint and pack his suitcase.

The evidence at trial 

In attacking the government's diagnosis of his client, defense attorney LeBell focused on the dearth of empirical studies on the condition, other than by researchers at a single Toronto clinic, and the likelihood of "false positive" diagnoses in legal cases.

The wording of the proposed new diagnosis has been changed again and again over the past couple of years. In its current iteration, pedophiles are defined as those who have "an equal or greater sexual arousal from prepubescent or early pubescent children than from physically mature persons, as manifested by fantasies, urges, or behaviors." (The requirements that the fantasies or urges be "recurrent" or "intense" have been removed, broadening the potential pool of sufferers.) Hebephiles are now defined as those with sexual attractions to "pubescent children" in Stages 2 to 3 of Tanner's pubertal stages (e.g., early development of pubic hair and breasts).

Defense expert Wollert testified that the problem of "false positives" -- people incorrectly identified as having a condition -- was extraordinarily high even in the controlled setting of the research laboratory. This problem would be much more acute in the forensic trenches where the hebephilia diagnosis is being deployed, he testified.

One insurmountable problem would be reliably identifying a sexual abuse victim's Tanner stage of pubertal development. Complicating this issue, testified the court's expert, John Bradford, Tanner Stages are highly variable. Because they reflect hormonal developments rather than specific ages, one could not assume a specific Tanner stage based on the age of a victim. About two years ago, alarming research indicated that girls are entering puberty far earlier than in previous generations; this month, a large study by the American Academy of Pediatrics identified a similar trend in boys.

Wisconsin psychiatrist Lynn Maskel, who organized and moderated the mock trial, labeled hebephilia a "weed diagnosis in the botanical garden of DSM."

"The question is not if sex with pubescent year old girls illegal, or if it is immoral," she told the audience of forensic psychiatrists. "The question to the psychiatric field is: Is it a disorder? And if it is, does this translate, for the expert witness, into a requisite mental disorder found in the specific SVP statute?"

Meanwhile, back in the real courtroom trenches …

In my seminal review, published in 2010 in Behavioral Sciences and the Law, I traced hebephilia's sudden emergence and rapid spread in legal discourse to the advent of Sexually Violent Predator laws, which require that the individual being considered for civil detention have a mental disorder that makes him qualitatively different from the garden-variety offender.

Since that article's publication, the introduction of hebephilia in U.S. courts has continued unabated, despite the lack of an official imprimatur by the American Psychiatric Association. In a string of SVP cases brought under the Adam Walsh Act, federal judges in North Carolina have ruled that the faux diagnosis is not a legitimate basis for civil detention.

However, other courts have been less circumspect. For example, just yesterday, in a narrow, 4-3 opinion, New York's high court upheld the civil commitment of a repeat sex offender named "Shannon S." based on the purported conditions of "paraphilia NOS" and "hebephilia." Mr. S. had engaged in a series of forcible rapes of adolescent girls, ages 13 through 16.

As the dissenters conceded, Shannon S. was a "very bad actor" and "the community may well be safer if he is kept behind bars."

"But, they added, "to put him there on the fiction that he has some sort of mental condition other than a tendency to commit the crimes for which he was convicted (and has served his time) is and should be constitutionally unacceptable."

Judge Robert Smith, writing for the minority, labeled as "absurd" the premise that attraction to adolescent girls is abnormal, as the government's two experts testified: "What is abnormal about appellant, and others who commit statutory rape by having sex with girls below the age of consent, is not that they find the girls attractive, but that they are willing to exploit them for their sexual pleasure -- in other words, they commit statutory rape."

Smith labeled hebephilia and the similarly disputed diagnosis of "paraphilia not otherwise specified" (rape) as "junk science devised for the purpose of locking up dangerous criminals." While such a practice might seem appealing from a public safety viewpoint, it creates "dangers of abuse," he eloquently warned:

"Many sex offenders are, or could reasonably be found to be, dangerous, and in common parlance they all have mental abnormalities: Mentally normal people do not commit sex crimes. Thus, unless 'mental abnormality' is defined with scientific rigor, such statutes could become a license to lock up indefinitely, without invoking the cumbersome procedures of the criminal law, every sex offender a judge or jury thinks likely to offend again.

"Some will intuitively respond: Not a bad idea. But it is a very bad idea, because not even a concern for public safety should be allowed to trump certain fundamental rules. Among them are that criminals can be confined only for crimes they have committed, after their guilt is proved beyond a reasonable doubt in a procedure in which they receive the many protections that our Constitution gives to those accused of crime, and that even when convicted they can be incarcerated for no more than the term of the maximum sentence provided by law. If the present sentences for sex offenders are too short, the Legislature should make them longer, but it should not, and constitutionally cannot, simply substitute civil for criminal proceedings as a means of keeping dangerous criminals off the streets."

As Judge Smith seems to recognize, it's a slippery slope. Bogus psychiatric diagnoses for sex offenders now, political dissidents (or others) tomorrow. That's the way they rolled in the former Soviet Union, after all.

Pretextual court rulings aside, the paraphilias subworkgroup has had more than two years to produce evidence for the reliability and validity of hebephilia, and it has not done so.

It is clear to most observers that hebephilia is not accepted by the relevant professional community. What remains unclear is whether the Board of Trustees of the American Psychiatric Association will get the message in time to prevent yet another in a veritable maelstrom of public-relations disasters and historical mistakes.

* * * * *

Additional resources: My resource page on hebephilia is HERE.

Of related interest: DSM-5  field trials discredit the American Psychiatric Association, by Allen Frances, Huffington Post, 10/31/2012

Happy Halloween!

October 27, 2012

Another one bites the dust: Hollow SVP prosecution no match for jurors' common sense

15 minutes.

After a five-week trial, that's how long it took a jury in a rural Northern California county to decide that an openly gay man who had served two years in prison for a forcible oral copulation of an acquaintance back in 2003 did not merit civil commitment as a sexually violent predator.

The prosecution's case featured a lone government psychologist whose opinion rested on a hollow combination of homophobia, bogus psychiatric diagnoses and trumped-up risk estimates. The psychologist cited archaic (and discredited) Freudian theory to claim that the ex-offender's crime at age 23 was evidence of an "oral incorporation" fixation caused by a domineering mother and an absent biological father. As a legal basis for civil commitment, he cited the bogus disorder of "paraphilia not otherwise specified-nonconsent,” and he used the Static-99R actuarial tool to present a highly inflated estimate of risk.

Testifying for the defense were four psychologists, including two retained by the defense, a government evaluator who had changed her mind (or "flipped," in the current parlance) and the man's treating psychologist at Coalinga State Hospital, who testified in no uncertain terms that "Mr. Smith," as I will call him, is neither mentally disordered nor likely to reoffend.

The defense team had barely left the courthouse when the court clerk summoned them back, saying the jury had reached a verdict. Their astonishingly fast decision hints that the jurors agreed that this case was an egregious example of overzealous prosecution and a waste of their valuable time.

Prior to being screened for possible civil commitment, Mr. Smith had been on parole in the community for 14 months without getting into any trouble whatsoever. Indeed, he was busy doing good works. His sexually violent predator screening stemmed from an entirely accidental parole violation connected with his charity work for a local gay rights organization. He had a special parole condition forbidding any contact with children. When a fellow member of the executive board brought his child to an awards ceremony, Mr. Smith was exposed to "incidental contact as one might have while shopping at a market," in the words of the parole hearing officer. Unfortunately for Mr. Smith, this was just one month after California voters enacted Jessica's Law, which allows for civil commitment of sex offenders who have only one qualifying victim rather than the previous minimum of two.

The prosecutor's strategy, as is typical in weak cases, was to hurl as many prejudicial, pseudoscientific labels as possible in Mr. Smith's direction, and hope a few might stick and scare jurors into voting for civil commitment: Psychopath, antisocial, homosexual, paraphilic, high risk, etc.

While licensed as a psychologist, the government's expert had not done what clinical psychologists are trained to do: Psychological testing, individualized case formulation, etc. Rather, as he boldly admitted on the witness stand, he relied on an assistant to cull through Mr. Smith's hospital records and pull out negative behavioral reports for him to review. Wow! Can you spell B-I-A-S?

In my testimony, which stretched over the course of three days, I stressed that Mr. Smith was neither sexually deviant nor likely to reoffend. His risk of sexual reoffense, I testified, was no greater than that of any other garden-variety sex offender. (The base rate of sexual recidivism among convicted sex offenders in California -- similar to the rest of the United States -- hovers around 6 percent or less.) I explained how growing up gay in a homophobic family and community causes sexual identity confusion that can lead to sexual acting out and other delinquent behavior in adolescence and early adulthood, and how Mr. Smith had changed as he matured and accepted his sexuality. I further debunked the accuracy of the Static-99R "actuarial" risk estimates assigned in this case, and the pretextually applied diagnoses of "paraphilia not otherwise specified-nonconsent" (which I've blogged about repeatedly) and antisocial personality disorder, a red herring that was invoked despite Mr. Smith's exceptionally good conduct in the community and while in prison.

Stacking the deck

The prosecutor tried to stack the deck by striking from the jury all gay people or those who admitted having relatives or close friends who are gay; he also challenged those with advanced educational degrees. I guess he thought it would be easier to pull the wool over the eyes of an uneducated jury. It just goes to show that times have changed: Even in a rural county, antigay discrimination is no longer considered acceptable, and jurors don't need PhD's to recognize bias and pseudoscience when they hear it.  

The verdict was likely a bitter-sweet moment for Mr. Smith, who had spent more than four years incarcerated at Coalinga awaiting trial. Luckily, he has close friends to stay with while getting on his feet.

This is my third SVP case in a row that evaporated when finally exposed to the light of day. Like Mr. Smith's case, one of the other two also featured prominent antigay bias; the other targeted an immigrant. In neither case were the men either pedophiles or rapists.

I suppose I should feel pleased to see such gross miscarriages of justice thwarted. Instead, I find myself horrified by the unfettered power wielded by rogue psychologists, assigned to a case by luck of the draw. Whereas many government evaluators reserve "positive" findings for the rare sex offenders who are truly deviant and at high risk to reoffend, others are just hacks who are raking in obscene amounts of public funds while making little effort to truly understand these men, their motivations, their circumstances, or their pathways to desistance.

Especially frightening is the unconscious bias that creeps into SVP prosecutions. The constructs of "mental disorder" and "risk for reoffense" are malleable, lending themselves to use as pretextual weapons of prejudice wielded against gay men, racial minorities (especially African American men) and immigrants.

Clearly, people shouldn't get away with sexual misconduct. But none of these men had. All had pleaded guilty and served their time, only to be ambushed at the end of their prison terms with misguided efforts to indefinitely detain them based on purported future risk.

As it turned out, each case was about as solid as a house of cards. It didn't take gale-force winds like Hurricane Sandy's to flatten them.

Evaluators flipping like pancakes

The "flipping" of government evaluators illustrated this weak foundation. In two of the three cases, after reading the more thorough and individualized reports of the defense-retained experts, government psychologists abruptly changed their minds and decided that their previously proffered diagnoses of "paraphilia not otherwise-nonconsent" were invalid.

On the one hand, I applaud the openness and ethical backbone such a change of heart signals. But these "flips" also demonstrate the whimsical, nonscientific nature of the commitment process. The longer I work in these trenches, the more I realize that the random assignment of evaluators and attorneys (on both sides) exerts as much influence on the outcome as does the true level of future risk to the community that an ex-offender poses.

Indeed, the real reason Mr. Smith -- clearly not a sexual predator to anyone with a whit of commons sense -- was taken to trial, at a total cost to the citizenry of hundreds of thousands of dollars, was not because of his high risk, but because of a rigid prosecutor who was blind to the writing on the wall.

In contrast, the government dismissed the other two cases (one in the Midwest and one in the South) on the eve of trial. One case involved a gay man who had a brief sexual interlude with a teenage male relative; the other involved an immigrant who had gone on two dates with an underage teen girl he met on an online dating site (his misconduct never went beyond petting). Both had served substantial prison terms. But, again, garden-variety sex offenders, not the depraved, sex-crazed monsters likely envisioned by jurors when they are told they will be deciding a "sexually violent predator" case.

Bottom line: Should a random clinical psychologist, earning hundreds of thousands of dollars a year churning out boilerplate pseudoscientific garbage, be allowed to decide the fates of others?

At least in this one case, 12 discerning and conscientious jurors answered that question with a resounding "NO."

ON OTHER,TOTALLY UNRELATED NOTES: If you're looking for an intelligent movie in theaters now (always a challenging search), ARGO earns a qualified thumbs-up from me; my review is HERE. (If you find the review helpful, please click on "yes" at the bottom.) I've also just finished reading a thoroughly researched and well-written cultural biography of John Brown, Midnight Rising, that positions his raid on Harper's Ferry as a seminal moment in the lead-up to the Civil War. Tony Horwitz previously wrote Conservatives in the Attic, which -- as the descendant of Southerners -- I found spot-on.

October 18, 2012

Static-99R risk estimates wildly unstable, developers admit

The developers of the widely used Static-99R risk assessment tool for sex offenders have conceded that the instrument is not accurate in providing numerical estimates of risk for sexual recidivism for any specific offender.

The startling admission was published in the current issue of Criminal Justice and Behavior.

Examining the data from the 23 separate groups (totaling 8,106 offenders) that cumulatively make up the instrument’s aggregate norms, the researchers found alarmingly large variability in risk estimates depending on the underlying sample. The problem was especially acute for offenders with higher risk scores. A few examples:
  • At a low Static-99R score of "2," an offender’s predicted sexual recidivism rate after 10 years ranged from a low of 3 percent to a high of 20 percent, depending on the sample.
  • A score of "5" led to a recidivism estimate after five years of 10 percent in a large, representative sample of Swedish sex offenders, but a 250 percent higher risk, of 25 percent, in one U.S. sample. The absolute differences for more extreme scores were even larger.
  • Conversely, the Static-99R score that would predict a 15 percent likelihood of recidivism after five years ranged from a low-risk score of "2" to a high-risk score of "8," an enormous difference (greater than two standard deviations).
The study’s authors -- Karl Hanson, Leslie Helmus, David Thornton, Andrew Harris and Kelly Babchishin -- concede that such large variability in risk estimates "could lead to meaningfully different conclusions concerning an offender’s likelihood of recidivism."

Overall risk lower than previously found

Despite the wide variations in rates of offending, the absolute recidivism rate for the typical sex offender in the combined samples was low overall. The rate of recidivism among typical sex offenders after five years was only 7 percent or less (with a range of 4 to 12 percent), lower than had been reported in a previous meta-analysis. The 10-year risk ranged from 6 to 22 percent for the typical offender.

The research team speculates that the risk inflation in earlier analyses may have been an artifact of characteristics of the underlying samples, with data from higher-risk offenders more likely to be preserved and available for study. We know that a sister instrument, the MnSOST-R, produced inflated estimates of risk due to oversampling of high-risk offenders.

Will risk inflation continue?

MC Escher, "Hand with Reflecting Sphere"
The Static-99R has a very modest ability to discriminate recidivists from non-recidivists. Its so-called "Area Under the Curve" statistic of around .70 means that, if you were to randomly select one known recidivist and one non-recidivist from a group of offenders, there is about a 70 percent probability that someone who will reoffend will have a higher score than someone who won’t.

Such information about a test’s relative accuracy may be helpful when one is choosing which method to employ in doing a risk assessment. But there are a number of problems with relying on it when reporting one's assessment of a specific individual.

First of all, even that level of reliability may be illusory. A study that is currently in progress is finding poor inter-rater agreement on scores in routine practice, especially at the higher risk levels.

Second, with base rates of recidivism hovering around 6 to 7 percent, even under optimal conditions it is very difficult to accurately predict who will reoffend. For every person correctly flagged as a recidivist based on a high Static-99R score, at least three non-recidivists will be falsely flagged, according to research by Jay Singh and others, as well as published error-rate calculations by forensic psychologists Gregory DeClue and Terence Campbell.

Finally, and perhaps most importantly, telling a judge or jury how an offender compares with other offenders does not provide meaningful information about the offender’s actual risk. Indeed, such testimony can be highly misleading. For example, told that "Mr. Smith scored in the 97th percentile," judges and jurors may understandably believe this to be an estimate of actual risk, when the less frightening reality is that the person's odds of reoffending are far, far lower (probably no greater than 16 percent), even if he scores in the high-risk range. Seeing such statements in reports always flashes me back to a slim little treatise that was required reading in journalism school, How to Lie With Statistics.

Rather, what the trier of fact needs is a well calibrated test, such that predicted probabilities of recidivism match up with actual observed risk. The newly developed MnSOST-3 is promising in that regard, at least for offenders in Minnesota, where it was developed. In contrast, the popular Static-99 tools have always overestimated risk.

When the Static-99 premiered, it featured a single table of misleadingly precise risk figures. High scorers were predicted to reoffend at a rate of 52 percent after 15 years, which made it easy for government evaluators to testify that an offender with a high score met the legal criteria required for civil commitment of being "likely" to reoffend.

The instrument’s developers now admit that this original risk table "turned out to be a gross simplification."

Indeed, with each of a series of new iterations over the past few years, the Static-99's absolute risk estimates have progressively declined, such that it would be difficult for the instrument to show high enough risk to support civil detention in most cases. However, in 2009 the developers introduced a new method that can artificially inflate risk levels by comparing an offender not to the instrument's aggregate norms, but to a specially created "high risk" subsample (or "reference group") with unusually high recidivism rates.

Some evaluators are using this method on any offender who is referred for possible civil commitment. For example, I was just reviewing the transcript of a government expert's testimony that he uses these special high-risk norms on offenders who are referred for "an administrative or judicial process." In some cases, this amounts to heaping prejudice upon prejudice. Let's suppose that an offender is referred in a biased manner, due to his race or sexual orientation (something that happens far more often than you might think, and will be the topic of a future blog post). Next, based solely on this referral, this individual's risk level is calculated using recidivism rates that are guaranteed to elevate his risk as compared with other, run-of-the-mill offenders. This method has not been peer reviewed or published, and there is no evidence to support its reliability or validity. Thus, it essentially amounts to the claim that the offender in question is at an especially high risk as compared with other offenders, just "because I (or we) say so." 

The admission of poor stability across samples should make it more difficult to claim that this untested procedure -- which assumes some level of commonality between the selected reference group and the individual being assessed -- is sufficiently accurate for use in legal proceedings. Given some of the sketchy practices being employed in court, however, I am skeptical that this practice will be abandoned in the immediate future.

The article is: "Absolute recidivism rates predicted by Static-99R and Static-2002R sex offender risk assessment tools vary across samples: A meta-analysis" by Leslie Helmus, R. Karl Hanson, David Thornton, Kelly M. Babchishin and Andrew J. R. Harris. Click HERE to request a copy from Dr. Hanson. 

October 15, 2012

Amnesty issues scathing report on prolonged solitary confinement

Critique follows lawsuit alleging psychological torture at infamous Pelican Bay  

Tucked away in a remote corner of Northern California is one of the most brutal behavioral experiments of the modern era: Upwards of 500 men housed for more than a decade straight in tiny, windowless, concrete tombs.

Pelican Bay, which opened in 1989, was specifically designed to foster maximum isolation. Prisoners are denied phone calls, contact visits, and recreational or vocational programming. But the designers did not plan for the sensory deprivation to be perpetual; stays in the "SHU" (Segregated Housing Unit) were originally intended to last 18 months or less.

Now, in a scathing report, Amnesty International has lambasted conditions in the SHU as "cruel, inhuman, or degrading" punishment that violates international law on the treatment of prisoners.

California holds more than 3,000 prisoners in SHU's, with more than 1,000 at Pelican Bay. No other U.S. state is believed to have held so many prisoners for such long periods in indefinite isolation, the Amnesty International investigators found.

A spokesman for the prison system responded with the rather outlandish nonsequitur that California has no solitary confinement, because SHU prisoners are able (if they have funds) to buy televisions and watch cable channels, including ESPN.

The Amnesty report follows on the heels of a class-action lawsuit filed by the Center for Constitutional Law on behalf of 10 SHU prisoners who claim that long-term isolation is slowly destroying their bodies and minds, in violation of international standards against torture and inhumane treatment.

The lawsuit, Ruiz v. Brown, alleges that prisoners have no means to escape solitary confinement, other than to become government informants against prison gangs, which would put them and their families at risk.

While the prison system claims these are the "worst of the worst," the men claim they are being held in solitary confinement as punishment for their lack of cooperation with prison administrators, based on very thin evidence of gang affiliation. For several, their housing status alone prevents them from being eligible for parole.

Evidence of their supposed continued gang affiliation, the lawsuit says, includes:
  • Saying "hello" to a prisoner from a different gang
  • Possessing a drawing of an Aztec tattoo
  • Possessing a pamphlet in Swahili, a language spoken by 60 million Africans that is categorized by the Department of Corrections as a "banned language"
  • Having a Black Power tattoo
  • Having a book about George Jackson (Paul Liberatore's The Road to Hell: the True Story of George Jackson, Stephen Bingham, and the San Quentin Massacre)
Plaintiff Paul Redd, for example, has spent 33 of the past 35 years in solitary confinement, the last dozen at Pelican Bay. He would be eligible for parole if not for his purported status as a "captain" in the Black Guerrilla Family despite no evidence of any gang activity in the past six years. His SHU status is allegedly based on old confidential memoranda stating he had communicated with other BGF members, plus possession of drawings, collages and booklets related to George Jackson and the Black Panthers.

A hunger strike last year, supported by up to 6,600 prisoners at 13 other prisons around the state, led to raised hopes, but so far no meaningful reform.

Psychological effects of long-term isolation

What happens when you lock humans inside a concrete sensory deprivation chamber for a period of decades, denying them all physical connection, human warmth, and even glimpses of nature?

In their lawsuit, prisoners who have spent a mind-boggling one to two decades in solitary confinement describe an inexorable descent into hopelessness and despair, with crippling loneliness and a constant struggle to stave off psychosis. They report pervasive insomnia, anxiety, hallucinations, mood swings, violent nightmares, panic attacks and a profound rage that they attempt to stifle by numbing all feeling. One prisoner described feeling like "walking dead," while another said he hears disembodied voices and feels like he is "silently screaming 24 hours a day."

Plaintiff Danny Troxell, for example, reports that he does not initiate conversations, is not motivated to do anything, and feels as if he is in a stupor much of the time. He often becomes "blank" or out of touch with his feelings.

These symptoms echo the findings of mental health experts who examined Pelican Bay prisoners as far back as 1995, six years after the prison opened, in connection with an earlier lawsuit (Madrid v Gomez) over the mental health effects of solitary confinement. At that time, Stuart Grassian, MD, an expert on segregation psychosis, found many men were already deteriorating into psychosis, paranoia, suicidality, and other psychological reactions to their unnatural isolation. Craig Haney, meanwhile, found that nearly all of the prisoners he sampled during that period reported symptoms of psychological distress such as intrusive thoughts, oversensitivity to external stimuli, difficulties with attention or memory, profound depression and social withdrawal.

Over time, prisoners can barely recall what it feels like to experience physical contact with another human being. Luis Esquivel, for example, has not shaken another person’s hand in 13 years and fears that he has forgotten the feel of human contact; "he spends a lot of time wondering what it would feel like to shake the hand of another person," according to the class-action lawsuit.

And what about mental health treatment?

"Every two weeks, a psychologist walks past the prisoners' cells, calling out 'good morning,' or 'you okay?' The psychologist walks past eight cells in approximately 30 seconds during these 'rounds.' "

Last year, a Special Rapporteur with the United Nations declared that prolonged solitary confinement constitutes torture, and that even 15 days in solitary confinement violates an individual’s human rights.

In the wake of its investigation, Amnesty is calling for ratcheting down isolation so it is only used as a "last resort" for severely unruly prisoners who endanger others, immediate removal of prisoners who have already spent years in the isolation units, and improving conditions for those who remain by allowing them more exercise and opportunity for human contact and phone calls to their families.

The Amnesty report can be found HERE; the amended petition in Ruiz v. Brown is HERE. An online petition in support of the SHU prisoners' demands is HEREThe featured artwork is by Gabriel Reyes, one of the plaintiffs in the class-action lawsuit. More information on Reyes and his art is HERE.

Related blog posts:

October 4, 2012

Long-awaited HCR-20 update to premiere in Scotland

The long-awaited international launch of the third version of the popular HCR-20 violence risk assessment instrument has been announced for next April in Edinburgh, Scotland.

The HCR-20 is an evidence-based tool using the structured professional judgment method, an alternative to the actuarial method that predicts violence at least as well while giving a more nuanced and individualized understanding. It has been evaluated in 32 different countries and translated into 18 languages.

A lot has changed in the world of risk prediction since the second edition premiered 15 years ago. Perhaps the major change in the third edition is the elimination of the need to incorporate a Psychopathy Checklist (PCL-R) score; research determined that this did not add to the instrument's predictive validity. Additionally, like the sister instrument for sex offender risk assessment, the RSVP, the HCR:V3 will focus more heavily on formulating plans to manage and reduce a person's risk, rather than merely predicting violence.

The revision process took four years, with beta testing in England, Holland, Sweden and Germany. Initial reports show very high correlations with the second edition of the HCR-20, excellent interrater reliability, and promising validity as a violence prediction tool.

The HCR:V3 will be launched at a one-day conference jointly organized by The Royal Society of Edinburgh and Violence Risk Assessment Training. Developers Christopher Webster, Stephen Hart and Kevin Douglas will be on hand to describe the research on the new instrument and its utility in violence risk assessment.

More information on the April 15, 2013 training conference is available HERE. A Webinar PowerPoint on the revision process is HERE.