February 28, 2013

A tale of two prison systems: Whither the future?

Group therapy, San Quentin Prison, California
California's beleaguered prison system got more bad headlines today for suppressing a report warning that prison suicide-watch practices were actually fostering suicide. The suppressed report, by a national expert on prison suicide, described suicidal prisoners being stripped of their clothes, placed in “safety smocks,” and then held for days "in dim, dirty, airless cells with unsanitized mattresses on the floor," according to today's Los Angeles Times. The horrific conditions encouraged prisoners "to declare they were no longer suicidal just to escape the holding cells. Many of them took their own lives soon after."

The state directed its consultant, Lindsay Hayes, to write a sanitized version of his report to give to a court monitor and lawyers for prisoners, according to court records reviewed by Times reporter Paige St. John. And when prisoner lawyers were nonetheless able to get a copy of the full report, which called the treatment of suicidal prisoners "punitive" and "anti-therapeutic," the state made an unsuccessful effort to have a judge order the report destroyed.

There were 32 prison suicides in California in 2012, above the national average in the United States.

Convict sunbathing on porch of his bungalow,   
Bastoy Prison (photo credit: Marco Di Lauro)
Meanwhile, more than 5,000 miles and an ocean away, sits a peaceful island prison which has not seen a single suicide in its two decades of operation. Bastoy, an island prison in Norway, with no bars or concertina fences, bills itself as "the first ecological prison in the world."

It might not seem fair to compare California prisons with those in Norway, a small and homogeneous nation with only 4,000 prisoners all told. But Norway's forward-looking penal philosophy is worth a gander. The idea is to build people up into productive citizens, rather than to tear them down. To "generate hope instead of despair" in the words of Erwin James, himself a former prison lifer in the UK who recently toured Bastoy and wrote about it for the Guardian

Debarking from the ferry, James found an atmosphere more akin to a religious commune than the British prisons he was accustomed to. "There is a sense of peace about the place," he wrote, describing the brightly painted wooden bungalows where the island's 115 prisoners live in groups of up to six, cooking their own meals with money earned from prison jobs and food purchased at the "well-stocked mini-supermarket."

A quick dip after work, Bastoy Prison
Norway has no death penalty or life sentences; the maximum sentence is 21 years. Prisoners can apply to Bastoy when they are down to the last five years of their sentences. They must commit to non-violence and a drug- and alcohol-free lifestyle.

Who wouldn't take a deal like that, to live in an idyllic beach resort while learning the life skills necessary to reintegrate into society? Even when the sea ice was frozen solid last winter, not a single convict walked away.

"In closed prisons we keep them locked up for some years and then let them back out, not having had any real responsibility for working or cooking," explains director Arne Nilsen, a clinical psychologist. "In the law, being sent to prison is nothing to do with putting you in a terrible prison to make you suffer. The punishment is that you lose your freedom. If we treat people like animals when they are in prison they are likely to behave like animals. Here we pay attention to you as human beings."

The proof of Norway's philosophy is in the pudding: Balstoy's re-offense rate of just 10 percent is by far the lowest in Europe. Compare that to California, where seven out of ten released prisoners bounce back into custody within three years, the highest rate in the United States.

Click on image to see 5-minute YouTube feature on Bastoy
One of the guards showing James around the island looks at him with disbelief when he tells her that prison officer training in the UK lasts only six weeks. In Norway, the training takes three years. Here in California, meanwhile, basic training lasts 16 weeks, with a focus on "effective use of force," "restraint devices" and "cell searches."

Ad for prison suicide smock
And what, pray tell, are the guards in Norway spending all of that time studying?

"There is so much to learn about the people who come to prison," the guard explains to James. "We need to try to understand how they became criminals, and then help them to change."

With a rehabilitative philosophy like that, let's just hope that Bastoy -- and not California or the UK -- represents the way of the future. After all, by treating prisoners with respect and humanity, Norway is also creating a safer world.
Hat tip: Jane

February 26, 2013

Tipping points: Of life, death and psychological data

Forensic psychologists and the machinery of execution

Andre Thomas, Texas
When Andre Thomas killed his wife and children, he was careful to use three different knives so that "the blood from each body would not cross-contaminate, thereby ensuring that the demons inside each of them would die," as Marc Bookman explained it in an eloquent Mother Jones report. Then, he cut out their hearts and went to the police station to confess. While awaiting trial, he cut out one of his eyes. Later, he cut out the other, eating it in order to keep the government from using it to spy on his mind.

In response to changing social mores and international condemnation (only a handful of countries remains in the business of killing their wayward citizens), the U.S. Supreme Court in 2002 exempted the mentally retarded from execution, following up three years later by exempting juveniles. With this narrowing of the contours of capital punishment, the question of how mentally impaired one must be to avoid execution is increasingly in the forefront. That makes severe mental illness "the next frontier" of capital jurisprudence, in the words of psychology-law scholar Bruce Winick.

How insane?

Executing the floridly insane constitutes cruel and unusual punishment, barred under the Eighth Amendment of the U.S. Constitution. However, the "Ford standard" for competency to be executed is very low; a condemned person need merely understand the link between his crime and his punishment. In Thomas's case, the government insists that he is not insane enough to be spared, despite chronic auditory hallucinations, delusions, and treatment for paranoid schizophrenia. 

Making this case especially ironic is that Thomas has become a poster child for the need for new laws allowing preemptive detention of people whose mental illness makes them dangerous. "At least twice in the three weeks before the crime, Thomas had sought mental health treatment," reports the Texas Tribune in a series on mental health and the criminal justice system. "On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him. Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment."

John Errol Ferguson, Florida
With the U.S. Supreme Court declining to draw a bright line, the question of exactly how rational a condemned prisoner's understanding must be in order for an execution to proceed has become central to legal appeals by psychotic prisoners like Thomas. Another current example is the case of John Errol Ferguson, a mass killer in Florida whose October execution was stayed due to concerns about his mental state. Ferguson's long history of paranoid schizophrenia is undisputed; the question is whether his grandiose and religious delusions interfere with his understanding that the state is going to kill him for his crimes, and that when he dies he will be, well, dead.

Ferguson's lawyers have argued that the killer lacks rational understanding, because he believes he is "the Prince of God" and will be returned to Earth post-execution to save the world from a communist plot. The state of Florida counters that all that is required to be competent for execution is that a prisoner have an "awareness" that he is set to be executed for crimes he committed. To resolve the dispute, Florida's governor appointed a panel of experts to collectively evaluate Ferguson; a lower court also heard extensive testimony from prison personnel and other mental health experts, including malingering expert Richard Rogers, who administered a large battery of malingering tests and opined that Ferguson was not faking mental illness. Ultimately, the circuit court found little to distinguish Ferguson's belief system from typical religious ideation:
"There is no evidence in the record that Ferguson’s belief as to his role in the world and what may happen to him in the afterlife is so significantly different from beliefs other Christians may hold so as to consider it a sign of insanity."

How intellectually impaired?

Meanwhile, with the categorical exemption of prisoners with mental retardation from the death row rosters, courts around the nation are seeing pitched battles over intelligence scores that can make the difference between life and death. On each side of the IQ Wars in so-called Atkins hearings (named for the 2002 U.S. Supreme Court decision barring execution of the developmentally disabled) are neuropsychologists whose testimony delves into the technicalities of margins of error, practice effects, and the now-familiar Flynn Effect. This latter phenomenon of IQ inflation, in which scores on any given IQ test rise by about three points per decade, creates a situation in which a person on the cusp of mental retardation might score over 70 -- making him eligible for execution -- on an older IQ test but not on a newer one.

Ronell Wilson, New York
Take the case of Ronell Wilson in New York, who murdered two undercover police officers. His nine-day Atkins hearing earlier this winter featured seven experts dissecting nine IQ scores obtained over a 13-year period. In its 55-page opinion, the U.S. District Court spent many pages explaining why a 95 percent confidence interval (a range of two Standard Errors of Measure on either side of a score, something commonly reported in clinical practice) was inappropriate in Atkins claims, because it could place people into the range of mental retardation even if they score well above 70 on IQ tests. The court instead opted for a 66 percent confidence level. Either way, it was all much ado about nothing: "Even after taking into account the possibility of measurement error, the Flynn Effect, and (to a limited extent) the practice effect," Wilson's IQ scores ranging from 70 to 84 were "simply too high to qualify him under the definition of significantly subaverage intellectual functioning."

As Peter Aldhous reports in the New Scientist, the outcomes of these IQ battles vary widely by jurisdiction (and quality of lawyering, I would imagine). Overall, 38 percent of Atkins claims are successful, according to a study at Cornell Law School, but the success rate is 81 percent in North Carolina compared with only 12 percent in Alabama. A convicted killer named Earl Davis with IQ scores of 75, 76, 65 and 70 was spared execution on the basis of the Flynn effect. But that same effect was not persuasive in the case of Kevin Green of Virginia, whose mean IQ score was actually three points lower than Davis's (71, 55, 74 and 74); Green was executed in 2008.

Texas, meanwhile, which has carried out more than one-third of all executions in the United States since capital punishment was reinstated, has come up with its own unique standard of mental retardation, based on the character Lennie from John Steinbeck's Of Mice and Men. Wrote the Texas Court of Criminal Appeals in a 2004 explication of the level of mental retardation necessary to avoid the death penalty: 
"Texas citizens might agree that Steinbeck's Lennie should, by virtue of his lack of reasoning ability and adaptive skills, be exempt. But, does a consensus of Texas citizens agree that all persons who might legitimately qualify for assistance under the social services definition of mental retardation be exempt from an otherwise constitutional penalty?"

A technical spectacle

Whereas in the real world intelligence and insanity are continuous variables, the law chooses to treat them as dichotomous. Psychologists assist in promoting this legal fiction, helping to sort the condemned into discreet categories of sane or insane, mentally retarded or able-minded. Although the tests we used are supposedly objective, data in this highly polarized area can be skewed to favor one outcome or the other. Neuropsychology experts hired by the defense may focus on the Flynn Effect and argue for large confidence bands around IQ scores. Meanwhile, at least one "go-to" psychologist for prosecutors in Texas took a decidedly different approach, systematically skewing data so that more marginally functioning men were made eligible for execution.

Denkowski's Atkins cases, Texas Observer
George Denkowski developed his own method of evaluating Atkins claims, based on his idea that individuals on Death Row may do poorly on traditional tests because of cultural and social factors rather than lack of intellectual ability. So he discounted evidence that defendants, for example, could not count money or take care of their basic hygiene, reasoning that maybe they just were not taught those skills. With an inmate named Daniel Plata, for example, Denkowski bumped up his IQ score from 70 to 77 and his score on a test of adaptive functioning from 61 to 71. He even  published an article in the American Journal of Forensic Psychology in 2008 in which he explained this system of clinical overrides. Complaints by fellow psychologists that his technique had no scientific basis eventually led the Texas State Board of Examiners of Psychologists to issue a reprimand and to bar him from conducting future intellectual disability evaluations in criminal cases. He admitted no legal wrongdoing but agreed to a $5,500 fine -- a pretty lightweight penalty considering that two of the 29 condemned men he evaluated were executed.

Unethical as his method was, it did give attention to the issues of race and class, which may hide in plain sight when appeals revolve around the technical interpretations of psychological test data. It is Constitutionally impermissible for race to be considered in capital cases. But it stretches credulity to believe race played no role, for example, in the case of eye-plucking Andre Thomas: Thomas is African American, his late wife was white, all of the jurors were white, and four jurors had acknowledged opposition to interracial marriages. In the very last sentence of his closing argument for the death penalty, reported Bookman in the Mother Jones piece, the prosecutor asked jurors whether they would be willing to risk Thomas "asking your daughter out, or your granddaughter out?" This in the town of Sherman, which burned its entire Black district to the ground in 1930 during a race riot triggered by -- what else -- rumors that a Black man had raped a white woman.

Trauma as common denominator

Setting aside the technical criteria for insanity and mental retardation, if one could boil capital cases down to one common denominator, it would be trauma. In my experiences working in the capital trenches, I have found that most Death Row denizens survived horrific childhoods dominated by physical, sexual and emotional torture and neglect, combined with multi-generational patterns of mental illness and violence, all overlaid with hard-core substance abuse.

As forensic psychiatrist Pablo Stuart described this phenomenon in an interview with reporter Scott Johnson at Oakland Effect, a journalism project focusing on violence in Oakland, California, “the fact that there is such consistency on these cases is significant. Some of these people, they just never had a chance.”

* * * * *
Related resources:

The Mother Jones report on Andre Thomas is HERE; the audio podcast, read by M*A*S*H star Mike Farrell, can be downloaded or listened to HERE.
My 2009 posts on the Andre Thomas case are HERE and HERE.
My prior posts on the Ford standard of competency and the U.S. Supreme Court's decision in the case of Leon Panetti (with links to court rulings and lots of related resources) are HERE, HERE and HERE. The U.S. Supreme Court's 2007 opinion in Panetti v. Quarterman is HERE. A 28-minute educational video, "Executing the Insane: The Case of Scott Panetti," is available HERE.

My 2010 post on the Denkowski case is HERE.

Psychologist Kevin McGrew's master archive on the Flynn Effect is HERE.

Related books include Michael Perlin's Mental Disability and the Death Penalty: The Shame of the States (the first chapter of which can be previewed HERE) and Daniel Murrie and David DeMatteo's Forensic Mental Health Assessments in Death Penalty Cases.

February 11, 2013

Exercise: Priming students to detect covert biases

In an eye-opening exercise in my graduate forensic psychology course, I had two groups separately analyze a sanitized forensic report. The subject of the report was a 16-year-old boy named "John" who had committed a relatively minor sex offense; the evaluation issue was treatment amenability. After independent group discussions, the two groups shared their impressions as follows:

Group A: "John has a conduct disorder and is narcissistic. His misconduct appears to be escalating. There are ominous warning signs of budding psychopathy. He is at a crossroads in his life; he could go bad fast."

Group B: "This report is biased. The evaluator has joined with John's mother, and is channeling the mother's antagonism toward John. There is evidence of racism, homophobia, and political conservatism. The evaluator’s antipathy toward John feels personal – perhaps he has a wayward teenage son?"

The two groups looked across the table at each other, flabbergasted. Some suspected a trick. "Did you really give us the same report to read?" one student queried.

Yes, everyone had read the identical report. And, in case you wondered, group selection was random; there were no baseline differences that would explain the groups' divergent opinions.

Rather, the difference was in how the two groups were primed to read the report. Their instructions:

Group A: "Read the report with the goal of trying to understand John. What makes him tick? Does he have any potential clinical diagnoses? What is your prognosis for his future?"

Group B: "Read the report with the goal of trying to understand the perspective of the report writer. Do you see any problems with his method or his analysis? If so, do they suggest any potential biases?"

This was no abstract academic exercise. Channeling John’s hateful mother, this seminal report reads like something torn from the pages of an Anne Rule novel, replete with enough (uncorroborated) animal torture and arson to excite any true believer in the infamous McDonald Triad. Going unchallenged at the time, the report had a hugely prejudicial impact on decision-makers. For years to come, institutional bureaucrats and forensic experts quoted liberally from it to bolster their opinions that John was dangerous.

This is not an isolated or unusual case. Alarmist reports like this have remarkable staying power, their uncorroborated claims taking on a life of their own as they ripple through their subjects' lives, eschewing rational analysis or contestation. The power of a single forensic evaluator is truly frightening at times.

Cutting through the hype

So how did a group of graduate students manage to see through the hype that had buffaloed seasoned professionals, to take the measure of the evaluator and expose his subterranean biases? Remarkably, all it took was a simple admonition to think critically, and to be alert to potential biases.

Ideally, we should always be exercising these analytical faculties. We should train ourselves to simultaneously process at least two units of analyses, asking ourselves both:

A. What does this report tell us about its subject?

B. What are the limitations of this report? How might its findings be unreliable, and perhaps flawed by unreliable or insufficient information, unconscious assumptions and biases, or other factors?

Cognitive biases

In the class exercise, Group A was focused only on Question A, whereas Group B focused on Question B. When forensic experts review a report, our approach should be bidirectional, and incorporate both perspectives.

Constructive skepticism benefits from an understanding of cognitive biases and how they work. In the instant case, the most obvious of these was confirmatory bias. This is the tendency to actively seek out and assign more weight to information that confirms one's prior beliefs, discounting or ignoring disconfirmatory data. Clinicians who fall under the spell of psychopathy theory, for example, tend to see psychopaths lurking behind every bush. A clue to the author's preconceptions in John's case was found in a footnote citing Stanton Samenow’s The Criminal Mind, an influential but decidedly polemic treatise that vigorously disavows social factors in crime and -- as its title implies -- caricatures criminals as a breed apart from normal human beings. 

Once you detect such selective perception in play, you may see related cognitive biases which the discerning expert should always be on the lookout for in forensic (and other) reports. These include, but are not limited to:

  • Salience bias, in which inordinate attention is paid to exotic or highly distinctive information, at the expense of ordinary features of a case that may be important. In John's case, the evaluator overweighted the mother's fanciful tales about John's early childhood ("He never cried liked a normal baby!"), while ignoring more proximate evidence of John's confusion over his sexuality. In criminal cases, salience bias often contributes to racial stereotyping.

  • Hindsight bias, or the tendency to see events as more predictable than they were before they took place. Using hindsight, forensic experts are prone to overvalue known facts that tend to explain an event; a countermeasure is to deliberately consider information that supports alternate conclusions. 

  • Availability bias, in which the probability of an event is judged by how easy it is to think of examples. Especially when combined with ignorance of base rates, this can lead to a tendency to overpredict dramatic events, even when -- as in the case of black swans -- their likelihood is actually low.

  • Illusory correlation, in which a relationship is imagined between variables that are in fact unrelated. In John's case, the mother's dramatic tales -- even if true -- may have had little or nothing to do with John's teenage misconduct. However, when read by subsequent decision-makers in a cultural climate that privileges psychopathy as an explanation for criminal conduct, they had an enormously prejudicial impact. 

(Wikipedia maintains an exhaustive list of these decision-making biases, along with links to their definitions.

To avoid perpetuating biases, forensic evaluators should train themselves to think like "Agent J" in Men in Black. Rather than jumping to superficially plausible conclusions, try to consciously develop alternate hypotheses and test their fit with the evidence. This scientific mindset kept Agent J (Will Smith) from assuming that little Tiffany, a blonde girl carrying quantum physics textbooks through the ghetto at night, was the innocent party just because she did not superficially resemble the monsters who were also out and about. Here is the scene from Men in Black that I show in my class, in which Agent J explains his logic in shooting Tiffany -- rather than the monsters -- during a simulation training:

Thanks to Maya for finding this Men in Black graphic.

February 7, 2013

Fremantle to host Australian forensic conference

I hope all of you Aussies out there are aware of the exciting forensic psychology conference coming up in April. The theme is timely: "The Times are a Changin': Controversies, Competencies, and DSM-5." Robert Krueger, a personality researcher at the University of Minnesota and a member of the Personality Disorders Workgroup for the DSM-5, will give a keynote focusing on issues specific to using the DSM-5 personality disorders in court. The other keynote speaker is Jane Goodman-Delahunty of Charles Sturt University, a prominent psychologist and attorney who will speak about psychological injuries from workplace harassment. The setting, for those of you who might want to travel to Australia to attend, is the western city of Fremantle, which bills itself as the best preserved 19th Century seaport in the world. (The conference alternates between eastern and western Australia; when I gave a keynote there two years ago, it was held in the idyllic resort setting of Noosa, in southern Queensland.) The website for the April 18-20 event is HERE; the full program  can be downloaded HERE. Don't procrastinate too long, as early-bird registration ends March 18.

Panorama of the Swan River Settlement (Fremantle), 1831 (Source: Wikipedia Commons)

February 5, 2013

Texas SVP jurors ignoring actuarial risk scores

Expert witness for defense makes a (small) difference, study finds

The fiery debates surrounding the validity of actuarial tools to predict violence risk begs the question: How much influence do these instruments really have on legal decision-makers? The answer, at least when it comes to jurors in Sexually Violent Predator trials in Texas:

Not much.

"Despite great academic emphasis on risk measures - and ongoing debates about the value, accuracy, and utility of risk-measure scores reported in SVP hearings - our findings suggest these risk measure scores may have little impact on jurors in actual SVP hearings."

The researchers surveyed 299 jurors at the end of 26 sexually violent predator trials. Unfortunately, they could not directly measure the relationship between risk scores and civil commitment decisions because, this being Texas, juries slam-dunked 25 out of 26 sex offenders, hanging in only one case (which ultimately ended in commitment after a retrial).  

Instead of the ultimate legal outcome, the researchers had to rely on proxy outcome measures, including jurors' ratings of how dangerous an individual was (specifically, how likely he would be to commit a new sex offense within one year of release), and their assessment of how difficult it was to make a decision in their case.

There was no evidence that jurors' assessments of risk or decision difficulty varied based on respondents' scores on risk assessment tools, which in each case included the Static-99, MnSOST-R and the PCL-R. This finding, by the prolific team of Marcus Boccaccini, Daniel Murrie and colleagues, extends into the real world prior mock trial evidence that jurors in capital cases and other legal proceedings involving psychology experts are more heavily influenced by clinical than actuarial testimony.

What did make a difference to jurors was whether the defense called at least one witness, and in particular an expert witness. Overall, there was a huge imbalance in expert testimony, with almost all of the trials featuring two state experts, but only seven of 26 including even one expert called by the defense.

"Skepticism effect"

The introduction of a defense expert produced a "skepticism effect," the researchers found, in which jurors became more skeptical of experts' ability to predict future offending. However, jurors' lower risk ratings in these cases could also have been due to real differences in the cases. In SVP cases involving legitimately dangerous sex offenders, defense attorneys often have trouble finding experts willing to testify. In other words, the researchers note, "the reduced ratings of perceived risk associated with the presence of a defense expert may be due to nonrandom selection … as opposed to these defense experts' influencing jurors."

A back story here pertains to the jury pool in the Texas county in which civil commitment trials are held. All SVP trials take place in Montgomery County, a "very white community," an attorney there told me. A special e-juror selection process for SVP jurors whitens the jury pool even more, disproportionately eliminating Hispanics and African Americans. Meanwhile, many of those being referred for civil commitment are racial minorities. The potentially Unconstitutional race discrepancy is the basis for one of many current legal challenges to the SVP system in Texas.

Once a petition for civil commitment as a sexually violent predator is filed in Texas, the outcome is a fait accompli. Since the inception of the state's SVP law, only one jury has unanimously voted against civil commitment. Almost 300 men have been committed, and not a single one has been released.

Overall, the broad majority of jurors in the 26 SVP trials were of the opinion that respondents were likely to reoffend in the next year. Based on this heightened perception of risk, the researchers hypothesize that jurors may have found precise risk assessment ratings irrelevant because any risk was enough to justify civil commitment.

In a previous survey of Texas jurors, more than half reported that even a 1 percent chance of recidivism was enough to qualify a sex offender as dangerous. To be civilly committed in Texas, a sex offender must be found "likely" to reoffend, but the state's courts have not clarified what that term means.  

Risk scores could also be irrelevant to jurors motivated more by a desire for retribution than a genuine wish to protect the public, the researchers pointed out. "Although SVP laws are ostensibly designed to provide treatment and protect the public, experimental research suggests that many mock jurors make civil commitment decisions based more on retributive motives - that is, the desire to punish sexual offenses—than the utilitarian goal of protecting the public…. Jurors who adopt this mindset may spend little time thinking about risk-measure scores."

All this is not to say that actuarial scores are irrelevant. They are highly influential in the decisions that take place leading up to an SVP trial, including administrative referrals for full evaluations, the opinions of the evaluators themselves as to whether an offender meets civil commitment criteria, and decisions by prosecutors as to which cases to select for trial.

"But the influence of risk scores appears to end at the point when laypersons make decisions about civilly committing a select subgroup of sexual offenders," the researchers noted.

Bottom line: Once a petition for civil commitment as a sexually violent predator is filed in Texas, it's the end of the line. The juries are ultra-punitive, and the deck is stacked, with government experts outnumbering experts called by the defense in every case. It remains unclear to what extent these results might generalize to SVP proceedings in other states with less conservative jury pools and/or more balanced proceedings.

  • The study, "Do Scores From Risk Measures Matter to Jurors?" by Marcus Boccaccini, Darrel Turner, Craig Henderson and Caroline Chevalier of Sam Houston State University and Daniel Murrie of the University of Virginia, is slated for publication in an upcoming issue of Psychology, Public Policy, and Law. To request a copy, email the lead researcher (HERE).