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:

Mental health expert witnesses slammed in court

A pint-sized hired gun

Are accusations of bias on the rise?

Hired gun.
Charlatan.
Quack.
Hack.

It's every expert witness's worst nightmare. Vitriolic accusations of bias hurled at us on the witness stand, just because the cross-examining attorney doesn't like our opinion, or we have the audacity to charge for our services. (Have you heard of auto mechanics, plumbers or attorneys being called "whores" because they don't work for free?)

Unfortunately, it goes with the territory.

Now, a group of psychologists has tried to figure out just how big a part of the legal landscape accusations of bias against mental health expert witnesses are. The researchers scoured the LexisNexis legal database for insinuations of bias, with an eye to quantifying and categorizing the name-calling. In an article just published online in the journal Psychological Services, prominent forensic psychologists John Edens and John Petrila and four colleagues divided accusations of bias into five major categories:

Starting with a list of 46 different ways of calling an expert biased, the authors searched and found 160 legal cases in which attorneys and judges made disparaging comments about forensic mental health experts. In these cases, 185 individual case participants made a total of 245 separable statements asserting a lack of objectivity and impartiality among mental health experts and/or the fields of psychology and psychiatry more generally.

• FOR SALE: In the largest category, 28 percent of the total, experts were disparaged as financially biased (e.g., "hired guns" or "prostitutes").

• PARTISANSHIP: Following close behind, with 27 percent  of cases, were accusations of advocacy, or having an "axe to grind."

• PSEUDOSCIENCE: About 14 percent of cases involved accusations of non-scientific testimony (e.g., "charlatans" or "junk science").

• MYSTICISM: Psychologists and psychiatrists were accused of babbling nonsense (e.g., "witch doctor," "voodoo" or "hocus pocus") in 6 percent  of the cases.

• NONSPECIFIC BIAS: About one fourth, or 24 percent, of cases involved nonspecific accusations or other types of allegations of bias. 

Interestingly, in more than a fourth of the cases, the disparaging comments were a basis for an appeal, typically by the defense calling foul over prosecutorial slurs against mental health experts. Such appeals were relatively unsuccessful, with only 18 percent of cases being reversed in part due to on-the-record accusations of expert bias. All of the successful appeals were in criminal trials, eight involving sanity or diminished capacity. 

Uptick in nasty name-calling?

Similar to a 1999 study by Doug Mossman, which was the only other known study to look at this issue, the researchers noticed a steady upward trend in disparaging comments in more recent years.

It might be tempting to get depressed by this study, which at first blush seems to validate what we all know and fear. However, if we think about it, the results could be seen as mildly encouraging.

First of all, if a thorough search of the massive LexisNexis database could locate only 160 cases, then blatant accusations of bias may be rarer than we think.

Secondly, there are a heck of a lot more expert witnesses in court these days than ever before. Courts and attorneys increasingly rely on forensic psychologists and psychiatrists to assist in a wide range of psycholegal areas, from child custody to tort damages to criminal sentencing and civil commitment. As well, we are increasingly called upon to explain broader social science research, such as the accuracy of eyewitness identification, to judges and juries. So, as the authors acknowledge, any increase in accusations of bias could just be an artifact of our growing presence in court.

Third, and perhaps most importantly, there really are hacks and quacks, charlatans and hired guns among are ranks. The methodology of the current study did not enable analysis of whether the accusations of partiality or bias were legitimate. In other words, attorneys may not have been just engaging in legal gamesmanship in some of these cases; they might have been righteously upset over actual bias or pseudoscientific methodology on the part of forensic psychologists or psychiatrists.

Hopefully, that's a study someone else will take up on another day.

For now, we're left with a couple of take-home messages:

First, this is not a field for the thin-skinned. We must steel themselves to have our objectivity challenged, sometimes very rudely and without basis.

More fundamentally, assuming that these accusations are tapping into popular perceptions and prejudices, forensic professionals need to work harder to reduce both actual bias and the perception of bias in our work.

The articles are:

" 'Hired Guns,' 'Charlatans,' and Their 'Voodoo Psychobabble': Case Law References to Various Forms of Perceived Bias Among Mental Health Expert Witnesses" by John F. Edens, Shannon Toney Smith, Melissa S. Magyar, Kacy Mullen, Amy Pitta and John Petrila, Psychological Services, 2012. 

" 'Hired Guns,' 'whores,' and 'prostitutes': Case law references to clinicians of ill repute" by Doug Mossman, Journal of the American Academy of Psychiatry and the Law, 1999. 

Forensic psychologist blackballed over competency opinions

Imagine that every time you evaluated a criminal defendant, a partisan advocate was standing by your shoulder, ready to accuse you of bias if you thought the defendant was incompetent to stand trial. To make matters worse, imagine you were assigned those defendants most likely to be impaired, due to developmental disabilities that interfere with their ability to understand their cases or work with their attorneys.

That's the pressure being applied to Ray Hendrickson, a respected forensic psychologist in the state of Washington. Accusing him of bias, local prosecutors have succeeded in getting him barred from examining criminal defendants in one Washington county.

"We have made it very clear that we don't approve of Dr. Hendrickson,"' a representative of the Pierce County (Tacoma) prosecutor's office told the local newspaper.

Prosecutors accuse Hendrickson of endangering public safety by finding too many defendants incompetent to stand trial. Hendrickson is a lead psychologist and training director at the Center for Forensic Services at Western State Hospital, one of two state hospitals where criminal defendants undergo competency and sanity evaluations and treatment under Washington’s centralized system.

The beleaguered psychologist is one of the only in-house experts qualified to evaluate defendants who have developmental disabilities as well as mental illness. As a hospital spokesperson pointed out, such defendants often are found incompetent to stand trial because they are too impaired to understand their cases or assist their attorneys in their defense.

The hospital said it acceded to prosecutors' demands under duress, because state law entitles the prosecuting attorney to approve one of the two experts appointed to conduct a competency or sanity evaluation.

To challenge Hendrickson, prosecutors pored over felony cases in which defendants were found incompetent to stand trial. Hendrickson was involved in almost half of 30 such cases over a 3-year period, they claim. One case highlighted in the news involved a developmentally disabled man accused of stabbing his girlfriend. After being found unrestorable to competency, the man was ultimately released from the hospital.

(The local news article incorrectly states that defendants found incompetent to stand trial on violent felony charges typically have their cases dismissed. In actuality, most stand trial after undergoing competency restoration treatment; only a small percentage are found unrestorable after one year of treatment, making them eligible for civil commitment if they remain dangerous.)

Defense attorneys are livid, calling the attack on Hendrickson a naked power play intended to strip criminal defendants of their right to an impartial evaluation. This is at least the second time in recent memory that Pierce County authorities have successfully objected to a respected and skilled evaluator with whom they did not see eye to eye.

Such partisan interference will only increase the pressure faced by many evaluators in state hospital settings, where beds are increasingly scarce, to find defendants competent in order to help the criminal justice process speed things along.

Having done my forensic postdoctoral fellowship in the forensic unit at Western State Hospital in the 1990s, I find this news especially sad. Back when I was there, the unit was a top-notch training site, where evaluators were given the resources, training and support to perform neutral, high-quality forensic evaluations.

Although even back then the state evaluators had a reputation of prosecutorial bias, in reality we had the independence to let the chips fall where they may. As prosecutors were fond of eliciting from us under direct examination, we didn't have to worry about earning referrals, and we got paid the same no matter which side won or lost a case.

But if prosecutors blackball experts with whom they disagree, it will be hard for them to honestly claim that their hand-picked psychologists are truly independent.

Even more ominous is a bill being considered by the state’s legislature that would require only one expert -- approved by the state -- in competency cases. The defense could request a second expert under the proposed law, but such a request would not be automatically granted.

Such a move might seem to make fiscal sense. But, given the poor rates of agreement among competency evaluators, it may be penny-wise but pound-foolish. According to a new study out of Hawaii, for example, competency evaluators disagree in about two or three cases out of every ten. That's in part because competency is nuanced. Evaluators tend to concur in obvious cases involving florid psychosis, but may arrive at different opinions in gray cases in the middle of the competency continuum.

Since judges tend to rubber-stamp experts' opinions, having only one evaluator will substantially increase rates of error. Some cases will be unnecessarily delayed while defendants undergo needless (and costly) treatment; at the other end of the spectrum, some defendants will  be unfairly convicted, undergoing trials without understanding the proceedings or being able to assist their attorneys.

Winnowing the process down to one potentially idiosyncratic opinion, or forcing out well qualified evaluators based upon their rates of incompetency findings, will make the process more unreliable and, in the end, hinder justice.

Related blog post:

How competent are the competency evaluators? Largest real-world study finds modest agreement among independent alienists (Jan. 21, 2011)

Hat tip: Ken Pope

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:

• NPR expert panel: Weighing the value of a test for psychopaths
• Psychopathy: A Rorschach test for psychologists? (blog post)

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.

Texas capital case highlights racial bias in psychology

Is it fair to forecast future danger based on demographics?

Even as Troy Davis's execution tonight draws attention to Georgia's death penalty, Texas remains  the undisputed execution capital of the United States. And in Texas, psychologists are integral to the process because of the prerequisite of proving future danger.

Texas psychologist Walter Quijano

It is here that Texas psychologist Walter Quijano stepped in, testifying in more than 100 capital cases. And in case after case, called by both the prosecution and the defense, he testified that defendants on trial for their lives were especially dangerous if they happened to be African American or Latino.

Like Davis's execution, Quijano’s racially imbued risk assessments are also in the international spotlight, after the U.S. Supreme Court's grant of a 30-day reprieve from death for Duane E. Buck, a convicted double-murderer who had already eaten his last meal when he got the news.

To his credit, former Texas Attorney General John Cornyn agreed with defense attorneys that infusing race into criminal sentencing is unfair. When Quijano's testimony was called to his attention some time back, he red-flagged seven cases as meriting a new sentencing hearing. (The government now argues that Buck's case is different from the others for procedural reasons.)

Duane Buck

The "infusion of race as a factor for the jury to weigh in making its determination" violates a defendant's "constitutional right to be sentenced without regard to the color of his skin," the top prosecutor stated in reference to another of the seven cases. "Discrimination on the basis of race, odious in all respects, is especially pernicious in the administration of justice."

Quijano, a native of the Philippines, said in an interview with CNN correspondent Raju Chebium back in 2000 that his opinion about the dangerousness of Blacks and Latinos derives from the fact that they are overrepresented in prisons. "When you look at a problem, you have to consider all the factors that you identify and not ignore (selected ones) because of political reasons."

But using incarceration rates as evidence for violence risk is circular logic. It conveniently ignores other factors that contribute to the vastly disproportionate incarceration of non-white men. These include racial profiling, poverty, economic discrimination, and most of all the racial bias endemic within all stages of the criminal justice system.

Quijano's self-styled risk method is not the only instance in which psychologists use a demographic factor to elevate risk. But hopefully the Buck case will draw attention to the larger issues of fairness and social justice that the practice raises.

Leading psychiatrists critique proposed sexual disorders

• Dangerous.
• Unnecessary.
• Sloppy.
• Inaccurate.

These adjective express the sentiment of prominent forensic psychiatrists about a set of controversial new sexual disorders being proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Four critiques in the current issue of the flagship journal of the American Academy of Psychiatry and Law follow two well-attended meetings in which forensic psychiatrists were "decidedly negative" toward the proposed paraphilias, in the words of psychiatrist Howard Zonana.

Pandering to legal pressure 

A primary concern of forensic psychiatrists is that the proposals are being developed not based on clinical need or scientific discovery but, rather, to meet demands from the legal system. Specifically, broadening of paraphilias will make it easier to:

• Increase prison terms for Internet pornography users 
• Win civil detention for repeat sex offenders who have no genuine mental disorders

"The sexual disorders in the current and proposed DSM contain a potpourri of categories that increasingly intersect with the criminal justice system," notes Zonana, a psychiatry professor at Yale:

"Caveats saying the DSM is designed for clinical and not legal purposes notwithstanding, our classification system has difficulty distinguishing what we consider criminal behavior from culturally unacceptable behavior and mental disorder. Several current proposals continue this trend and seem more responsive to criminal justice concerns than mental illness considerations. They also lack sufficient specificity to warrant being called a disorder."

Loosening categories will reduce accuracy

J. Paul Fedoroff echoed Zonana's concern about legal influence, and also highlighted the reduction in accuracy that the diagnostic expansions will engender:

"The [proposals] raise more questions than answers. The proposed revisions to current DSM-IV-TR criteria will decrease the specificity of ascertained and diagnosed conditions by dramatically loosening the diagnostic categories. While the proposed changes may increase diagnostic reliability, they will certainly decrease diagnostic accuracy. Given the consequences of mistaken diagnosis, the proposed revisions are both unhelpful and dangerous."

Federoff, chair of  AAPL's Sexual Behaviors Committee, also directs both the Sexual Behaviors Clinic at Royal Ottawa Mental Health Care Centre and the forensic research program at the University of Ottawa Institute of Mental Health Research. 

Hypersexuality: Pathologizing young adults

Both Zonana and Federoff critiqued the conceptual and practical problems with the big three proposals that were resoundingly rejected in an audience poll after a debate at last year's AAPL meeting. These include hypersexuality, pedohebephilia and paraphilic coercive disorder (which the DSM revisers recently agreed to shelve). Wrote Zonana:

"The amount of time a person spends thinking about and engaging in sexual behavior varies enormously across the life cycle, with a sharp peak in adolescence and early adulthood. The most striking feature of the current criteria for hypersexuality is that, in my experience, it will be especially hard to find a young adult of college age who does not meet all of the criteria. The same will be true of many adults. The amount of time adolescents spend fantasizing and engaging in sex-related behavior is enormous.... To call this a mental disorder will include far too many false positives."

Pedohebephilia: Confusing illegality with disorder

Zonana, Federoff, and two other prominent forensic psychiatrists – Johns Hopkins University psychiatry professor Fred Berlin and Columbia University professor Michael First – all criticized the proposal to expand pedophilia to include adults with sexual interests in minors who have reached puberty.

"What is the great need to expand the definition to make more diagnoses?" asked Zonana. "Their rationale seems to conflate law enforcement with mental illness even more. There certainly are no new good treatments to justify a need to identify more cases."

“Our culture has initiated a 'war on sex offenders' and the legal system has geared up to wage it. Since we have made the diagnosis almost completely overlap with the crime, we have become overly enmeshed with legal goals.”

Federoff agreed:

"With the broadening of the age range of interest that will satisfy the diagnosis, more people will be labeled. By definition, expansion of the range of diagnostic criteria reduces sensitivity (true positives). Is this a good idea?"

Critical voices encouraged

Introducing the critiques, Richard B. Krueger, a psychiatry professor at Columbia University and medical director of the New York State Psychiatric Institute's Sexual Behavior Clinic, invited others to submit input – especially in published form:

"We hope that these articles will stimulate further discussion and submission of thoughtful criticism. Forensic psychiatrists are particularly well suited to offer commentary concerning the use or misuse of paraphilia diagnoses in legal proceedings, and observations on any aspect of the proposed criteria would be welcome. Indeed, editors of relevant journals have been generous in publishing commentary and articles. The Journal of the American Academy of Psychiatry and the Law, Sexual Abuse, the Archives of Sexual Behavior, the Journal of Sex Research, and The Journal of Sexual Medicine have published criticisms of DSM-5. There is still time to submit comments. Even if suggestions are not actually incorporated or reflected in the revised criteria, the published record would be valuable and relevant for the future."

While I would certainly echo Krueger's encouragement, I am skeptical that some members of the DSM-5 Sexual Disorders Work Group will willingly give up their pet diagnoses – especially the scientifically suspect pedohebephilia construct that is already being misused on a widespread basis in Sexually Violent Predator cases.

As psychiatrist John Sadler noted in his book dissecting the conflictual history of the DSM's, Values and Psychiatric Diagnosis, the DSM committees claim openness and seek input, “but how such input is to influence the actual decision-making process is not discussed.”

At any rate, Krueger makes the excellent point that having a formal record of the opposition will be important in the future. If any of these three proposals makes it into the DSM-5, vigorous Daubert challenges by increasingly sophisticated attorneys will be certain to follow. Indeed, use of any of the paraphilias in court only calls attention to the scientifically weak underpinnings of the entire category. As Zonana points out:

"The work group has a difficult set of disorders to contend with. The category lacks a principled basis for considering inclusions and exclusions, which makes it vulnerable to societal pressures rather than advances in science. The proposals discussed should not be accepted in their current form, as they create more problems than they solve."

Daubert challenges will be especially likely in that the American Psychiatric Association has decided not to conduct any formal field tests of the proposed paraphilias. This means that even their interrater reliability -- far easier to establish than actual scientific validity (accuracy) -- will remain in doubt. Unofficial field trials being conducted at the Sand Ridge Detention Center in Wisconsin and in California will not alleviate this concern, as the coordinators of these trials have a vested interest in a positive outcome. It's something like hiring the fox to guard the chicken coop.

I predict that the paradoxical consequences of this shaky endeavor are going to come back and bite organized psychiatry in the future. As I wrote in the conclusion to my historical review of hebephilia's sudden emergence:

Significant unintended consequences are likely if novel syndromes of primary benefit to the sex offender commitment industry are incorporated into the upcoming edition of the DSM. First, at a time of mounting controversy over partisan influence and lack of scientific rigor in the DSM diagnostic system, critics will seize on this as a glaring example of arbitrary and unscientific use of psychiatric diagnosis in the service of a pragmatic goal. This could have the paradoxical effect of reducing the scientific credibility of the DSM and the fields of psychiatry and psychology more broadly. In the forensic arena, where the diagnosis will most often be invoked, it may paradoxically invigorate defense challenges on the grounds that psychiatry is being deployed in a pretextual manner. In the end, hebephilia will come to haunt not only those who are civilly committed on pretextual grounds, but the entire mental health field, for years to come.

As always, the Journal of the American Academy of Psychiatry and Law is available online for free downloading. The current issue includes some other interesting articles, including a critique by forensic psychologist Brian Abbott of a current push in the sex offender industry to combine actuarial scores with clinical judgment. I encourage you to check it out (HERE). 

Feed that hungry judge!

Photo credit: vistavision (Creative Commons)

Attorneys: If you want your client released from jail, make sure the judge just had a bite to eat.

That is the take-home message from a new study of experienced judges in Israel. Judges were much more likely to grant parole right after they had a lunch or snack break:

The team studied more than 1,000 parole decisions made by eight experienced judges in Israel over 50 days in a ten-month period. After a snack or lunch break, 65 percent of cases were granted parole. The rate of favorable rulings then fell gradually, sometimes [to] as low as zero, within each decision session and would return to 65 percent after a break.

Jonathan Levav, a professor at Columbia Business School who co-authored the study, said the more rulings a judge makes, the greater the tendency to “rule in favor of the status quo,” but a snack break can interrupt that tendency.

The current study left unsettled the issue of whether it was the food itself or the rest period that came with it that improved the judges' dispositions toward the hopeful convicts. Previous research has shown that both glucose and mental breaks can restore mental functioning.

The study adds to a growing body of evidence on psychological bias in judicial decision-making.

• The study, "Extraneous factors in judicial decisions" by Shai Danziger, Jonathan Levav and Liora Avnaim-Pesso, was just published online by the Proceedings of the National Academy of Sciences. A press release with additional information on the study and its authors is HERE.

Psychopathy: A Rorschach test for psychologists?

• Compassion
• Empathy
• Impulsivity
• Excitement-seeking

What do these personality traits have in common?

If you are high on any or all of them, you may be less likely to rate other people as psychopathic on the Psychopathy Checklist (PCL-R).

The PCL-R is the most widely used measure of psychopathy in the world. But in real-world forensic settings, scores vary widely depending upon which side retained the evaluator. This finding is called the "partisan allegiance" effect.

In a new twist, these same researchers that brought you partisan allegiance have found that an evaluator's personality may impact her judgments of psychopathy. Evaluators low on compassion and thrill-seeking as measured by a widely used personality test, the NEO Personality Inventory-Revised, are more likely than others to rate criminals as psychopathic.

That’s ironic, because according to the theory of psychopathy, it's supposed to be the psychopath -- not the psychologist -- who has a deficit in empathy.

The exploratory study, forthcoming in the journal Assessment, was based on a small sample of 22 individuals who were given nine hours of training by a clinical psychologist with substantial research and forensic practice experience with the PCL-R. "The daylong session was an attempt to replicate typical PCL-R training procedures," the study authors explain.

The researchers emphasize that their findings are preliminary and need to be replicated and extended. But if they hold up, they have intriguing implications not only for the psychopathy measure but also for other psychological tests with elements of subjectivity in scoring or interpretation.

The study did not examine the accuracy of the low versus high scorers. But if low-scoring evaluators are more empathetic, this implies that they may be more accurate in interpersonal assessment contexts.  

Subterranean class conflict?

Future research might examine class background, race and philosophical  beliefs to see if these influence scoring of the Psychopathy Checklist. In my informal observations, professionals who look for psychopaths under every rock tend to lack understanding of, or empathy for, those on the bottom.

Here's how that looks in practice:

The upper middle-class professional walks into the evaluation room, oblivious to the blinders and unconscious biases she brings to the table. Her subject, in contrast, is far from oblivious. With his more acute empathetic skills, the lower-class or minority individual accurately reads the professional's bias against him, which she transmits through nonverbal and other deniable cues. He also realizes that she holds all the power, and that her judgments will affect his future in very tangible ways.

He reacts with defensiveness, suspicion, or muted hostility -- especially if she is working for "the other side." But not recognizing his reaction as part of an interactional dance that she herself set in motion, the evaluator interprets his stance as evidence of intrinsic personality defect. She may see him as glib, superficially charming, conning, or manipulative -- all facets of Factor 1 (the personality dimension) on the Psychopathy Checklist.

In this interaction, all of the power belongs to the person who gets to do the labeling. Scoring and labeling the offender becomes a circular process through which the evaluator -- especially when primed by adversarial allegiance -- can  project her own class- or race-based prejudices, distancing herself from the evil other, while at the same time denying complicity. An obfuscating tautology is proffered as a simple explanation for complex and multi-determined antisocial acts.

There is more to the construct of psychopathy, of course. I focus here on its potential subjectivity because this is a facet that proponents rarely acknowledge, especially in public. Forensic experts owe a duty to explain the subjectivity of the PCL-R when it is introduced in court, where the label "psychopath" can be the kiss of death. When labeled as psychopaths:

• Juveniles are more likely to face harsh punishment in adult court.
• Sex offenders are more likely to be preventively detained.
• Capital murder defendants are more likely to receive the death penalty.

So, the next time a promising young student proposes to study psychopathy or "the criminal mind," you might give her a gentle nudge in a more fruitful direction: Rather than treading this tired old path, she might contribute more to the field by studying the psyches of professionals who assign such diagnostic labels in the first place. 

• The study is: On Individual Differences in Person Perception: Raters' Personality Traits Relate to Their Psychopathy Checklist -Revised Scoring Tendencies. The authors are Audrey K. Miller, Katrina A. Rufino, Marcus T. Boccaccini, Rebecca L. Jackson and Daniel C. Murrie. Assessment, forthcoming.

• Of related interest: Social Class, Contextualism, and Empathic Accuracy, by Michael W. Kraus, Stéphane Côté and Dacher Keltner, Psychological Science, November 2010.

Untattoo You

What happens when you cross the Avon Lady with a Neo-Nazi murder defendant?

Guest essay by Sam Sommers*

Several colleagues and students forwarded to me this story from the NY Times describing a criminal defendant in Florida whose attorney successfully petitioned the court to pay for a cosmetologist to help him cover up his swastika tattoos with makeup before trial each morning. The basis for the request was the defense's (quite reasonable) concerns that jurors would have a hard time remaining impartial as they sat in judgment of someone adorned by Neo-Nazi symbols.


The case raises a wide range of interesting questions involving the psychology of law, physical appearance, first impressions, and daily interaction–the very issues often at the heart of this blog. Questions such as:

Should the court have agreed? 

While the unusual nature of the request is what has rendered it newsworthy, similar issues arise in a wide range of cases. Defendants often change clothes before entering court in order to prevent them from having to appear in front of the jury in a prison jumpsuit. Similarly, defendants in custody may be unshackled outside of the presence of the jurors so as to avoid undue bias.

The question becomes, though, should such accommodation apply to tattoos? After all, the defendant in the Florida case presumably chose to decorate himself in Neo-Nazi images. Should the taxpayers foot the bill to cover up decisions that the defendant made of his own free will? Moreover, the prosecution alleges that the attacks in question were motivated by hate: one assault victim was attacked allegedly for associating with a Black man; the homicide victim was gay. Reactions to the case might be different had the defendant gotten the tattoos earlier in life and long since forsworn the ideology associated with them. This wasn't the case here.

Can the issue be reframed? 

Many people I've spoken with have suggested, as alluded to above, that since the defendant chose these tattoos, he should be stuck with the repercussions of that decision. But the issue becomes more complex when you consider that the question for the court was not simply whether the defendant should be allowed to cover his tattoos, but rather whether the court would pay for it. Because a tattooed defendant with the money for his own removal/cover-up would be free to do as he wished.

Most people I've talked to have trouble with the idea that the court would pay for a Neo-Nazi charged with hate crimes to cover up swastika tattoos. But when the same question is reframed, most of the same people agree that a poor defendant charged with capital crimes should be entitled to just as vigorous a defense as a wealthier defendant in the same situation. Pitched this way, the issue becomes more complicated.

Couldn't the judge just remind the jurors to stick to the evidence and ignore the defendant's appearance? 

Sure. And as the division director for the Florida attorney's office argues in the Times article, "We believe the jurors listen to judges' instructions."

But while I have no doubt that jurors often try to follow the rules they're given, examples to the contrary abound. For instance, years ago I published a few research studies indicating that evidence still impacts a jury even after it has been ruled inadmissible. Moreover, judicial instructions to avoid prejudice or partiality have not been sufficient to eliminate other forms of disparity, such as the increased likelihood that a defendant in a capital trial will be sentenced to death when his victim is White as opposed to non-White.

It remains the case that sometimes jurors decide they'd rather not hew to the letter of the judge's instructions. And other times, jurors aren't even aware in the first place of the biases that they're supposed to be avoiding.

If this defendant gets money to change how he looks, what about other defendants similarly disadvantaged by appearance? No good legal debate is complete without the proverbial slippery slope argument, so where do we go from tattoo guy? Should relatively unattractive defendants be allowed to ask for makeovers? Given stereotypes about overweight individuals and self-control, what about an obese defendant in a negligence case? Clearly, the slope isn't so slippery as to allow a defendant from a traditionally disadvantaged minority group to appear in court in whiteface, but where should the line be drawn?

When symphony orchestras wanted to reduce bias in the hiring of musicians, they had candidates audition behind a screen so that gender was not apparent. Accordingly, one of my students in class last week asked, why not do the same to mask the demographics and background of a criminal defendant? Not a proposal that you're likely to see anytime soon in a courtroom near you, but interesting fodder for discussion nonetheless.

So I now turn the question to you, dear readers... Court-sponsored tattoo cover-ups: misguided use of public funds or necessary protection of defendant rights?

Sam Sommers is an award-winning social psychology professor at Tufts University who has served as an expert witness on bias.

*This essay originally appeared on Dr. Sommers' Psychology Today blog, The Science of Small Talk. Reposted with the written permission of Sam Sommers.

Previous guest essay by Sam Sommers: On police, profiling, and Henry Gates (July 28, 2009)

How competent are the competency evaluators?

Largest real-world study finds modest agreement among independent alienists

A bad forensic report by a bad evaluator sets bad events in motion.

True story: A judge ordered a robbery suspect to undergo evaluation. A drive-by psychologist opined that the defendant was incompetent to stand trial due to schizophrenia and attention deficit/hyperactivity disorder (ADHD). The judge rubber-stamped the evaluator's opinion. The defendant was shipped off to the dysfunctional state hospital system for competency restoration treatment. There, the psychologist's diagnoses were rubber-stamped. The unruly defendant was shot full of powerful antipsychotics, given a few months of bus therapy, and proclaimed competent. The defendant had never been psychotic in the first place. Years later, he remained just as mentally retarded as ever.

"Penny-wise, pound-foolish" is the expression that comes to mind. The courts try to save money by appointing only one psychologist per case, and by paying a ludicrously small sum that encourages shoddy practices. But cleaning up the resultant messes is costly, inefficient, and fundamentally unfair.

Competency evaluations are the bread and butter of forensic work. An estimated 60,000 defendants per year -- roughly 5% of the total -- are evaluated to see whether they understand their legal situations and can rationally assist their lawyers in their defense. But for all of the importance of accurate assessments, both to a smoothly running court system and to the rights of the mentally ill to a fair trial, surprisingly little is known about the real-world accuracy of forensic evaluators.

In the case I just outlined, the judge viewed psychologists and psychiatrists as equal and interchangeable, all inherently reliable and trustworthy. At the other extreme, some believe forensic opinions are as random as a chimp with a typewriter.

Hawaii: Exemplar or exception?

Only one U.S. state squarely addresses the problem of reliability in competency evaluations. In the Aloha State, when a doubt is raised as to a defendant's competency, three separate evaluators must conduct independent evaluations. One evaluator is a state employee; the other two are independent. One must be a psychiatrist. By law, the three cannot talk with each other about the case.

This makes Hawaii the perfect setting to examine the real-world reliability of competency evaluators. In a study just accepted for publication in Law and Human Behavior, three investigators took advantage of this opportunity to conduct the largest naturalistic study ever of evaluators' agreement about competency to stand trial.

It should not be a surprise that Daniel Murrie and Marcus Boccaccini are two of the investigators. Not the types to run Psych 101 undergrads through artificial lab experiments, these two are committed to examining forensic practice in the courtroom trenches. I've blogged about their previous work exposing "partisan allegiance" effects in the real-world application of the Psychopathy Checklist (PCL-R). For the current innovative study, they teamed up with W. Neil Gowensmith of the Hawaii courts' forensic services unit.

Examining 729 reports authored by 35 evaluators, they found that all three evaluators agreed in just under three out of four -- or 71 percent -- of initial competency referrals. Agreement was a bit lower -- 61 percent -- in cases where defendants were being reevaluated after undergoing competency restoration treatment.

Consistent with the results of a hot-off-the-press meta-analysis of 50 years of competency research, evaluators believed that the broad majority of defendants referred for evaluation, about 73 percent, were competent to stand trial. This figure was somewhat lower for defendants being reevaluated after an initial finding of competency, with evaluators opining competence in about half of such restoration cases.

Why do evaluators differ?

As far as why agreement is not higher, the study raised more questions than it answered. The researchers sifted through the data looking for patterns, but none jumped out. Evaluators did not lean one way or the other by discipline (psychologist vs. psychiatrist) or by employer (state versus private practice). Defendant demographics were not explanatory. Nor were evaluator disagreements about diagnosis.

It would be interesting to conduct qualitative analyses of the 216 cases in this study to see whether those in which evaluators differed were more complex and ambiguous than the others. I suspect that to be the case.

Competency is nebulous. It exists along a continuum, so there is no precise cut point at which a defendant is automatically "competent" or "incompetent" to go forward with his legal case. Thus, evaluator agreement will never be perfect, nor -- necessarily -- should it be.

How did the judges rule?

One of the more intriguing aspects of the study was its exposition of how judges ruled after being presented with three reports. Not surprisingly, when evaluators were unanimous or split 2-1, the judges tended to go with the majority. But unlike the judge in the vignette I described earlier, many Hawaiian judges were independent thinkers who did not just rubber-stamp the evaluators' opinions.

When they disagreed with the opinions of the court-appointed psychologists and psychiatrists, it was typically to find a defendant incompetent. In fact, in a few cases the judges found defendants to be incompetent even when all three evaluators believed a defendant was competent. In this way, they elevated defendants' due-process rights over prosecutorial efficiency. But maybe that's just Hawaii.

Moving forward

I found the results somewhat encouraging. When not subjected to partisan allegiance pressures, forensic practitioners agreed about three-fourths of the time about whether a defendant was competent to stand trial or not.

Still, if these results are generalizable, it means evaluators will disagree in about two or three cases out of every ten. So in jurisdictions that appoint only a single evaluator, the researchers point out, many judges may be unwittingly rubber-stamping an idiosyncratic -- and even patently incorrect -- opinion:

[T]o the extent that there is a factually correct answer to the question of whether or not a defendant is competent to stand trial, relying on one evaluator increases the likelihood that the court reaches an incorrect decision (by following an incorrect single opinion that would have been revealed as a minority opinion if other evaluations were available). In some instances, this may result in delaying a trial while a defendant is unnecessarily hospitalized. In other instances this may result in a defendant proceeding to trial when additional evaluator(s) would have opined the defendant was unable to participate meaningfully in that trial….

The justice system needs to continue to wrestle with how to handle these competing demands -- efficient use of resources versus fair consideration of defendants' right to due process.

Murrie and Boccaccini are on a roll. Let's hope they keep churning out this ground-breaking line of research, examining the real-world vagaries of forensic practice, and that others climb down from the ivory towers and jump on their bandwagon.

As they note, "naturalistic studies of field reliability are an essential first step in gauging wide-scale quality across all manner of forensic practice and targeting areas for improvement."

MLK to psychologists: We need creative maladjustment

In honor of today's holiday, I am excerpting portions of a speech by Martin Luther King Jr. to psychologists, which remains prophetically relevant to our field today. I have made the entire speech, "The Role of the Behavioral Scientist in the Civil Rights Movement," available for download (HERE).

... For social scientists, the opportunity to serve in a life-giving purpose is a humanist challenge of rare distinction.... Social scientists, in the main, are fortunate to be able to extirpate evil, not to invent it....

On crime and urban violence

After some years of Negro-white unity and partial success, white America shifted gears and went into reverse. Negroes, alive with hope and enthusiasm, ran into sharply stiffened white resistance at all levels and bitter tensions broke out in sporadic episodes of violence. New lines of hostility were drawn and the era of good feeling disappeared....

Science should have been employed more fully to warn us that the Negro, after 350 years of handicaps, mired in an intricate network of contemporary barriers, could not be ushered into equality by tentative and superficial changes.... Negroes could contain their rage when they found the means to force relatively radical changes in their environment. [But] without a more effective tactic for upsetting the status quo, the power structure could maintain its intransigence and hostility. Into the vacuum of inaction, violence and riots flowed and a new period opened....

Urban riots ... are a distorted form of social protest. The looting which is their principal feature serves many functions. It enables the most enraged and deprived Negro to take hold of consumer goods with the ease the white man does by using his purse. Often the Negro does not even want what he takes; he wants the experience of taking. But most of all, alienated from society and knowing that this society cherishes property above people, he is shocking it by abusing property rights. There are thus elements of emotional catharsis in the violent act....

The policymakers of the white society have caused the darkness; they create discrimination; they structured slums; and they perpetuate unemployment, ignorance and poverty. It is incontestable and deplorable that Negroes have committed crimes; but they are derivative crimes. They are born of the greater crimes of the white society. When we ask Negroes to abide by the law, let us also demand that the white man abide by law in the ghettos. Day-in and day-out he violates welfare laws to deprive the poor of their meager allotments; he flagrantly violates building codes and regulations; his police make a mockery of law; and he violates laws on equal employment and education and the provisions for civic services. The slums are the handiwork of a vicious system of the white society; Negroes live in them but do not make them any more than a prisoner makes a prison. Let us say boldly that if the violations of law by the white man in the slums over the years were calculated and compared with the law-breaking of a few days of riots, the hardened criminal would be the white man....

The unemployment of Negro youth ranges up to 40 percent in some slums. The riots are almost entirely youth events--the age range of participants is from 13 to 25. What hypocrisy it is to talk of saving the new generation--to make it the generation of hope--while consigning it to unemployment and provoking it to violent alternatives.

When our nation was bankrupt in the '30s we created an agency to provide jobs to all at their existing level of skill. In our overwhelming affluence today what excuse is there for not setting up a national agency for full employment immediately?

... These are often difficult things to say but I have come to see more and more that it is necessary to utter the truth in order to deal with the great problems that we face in our society....

On taking a stand

There are those who tell me that I should stick with civil rights, and stay in my place. I can only respond that I have fought too hard and long to end segregated public accommodations to segregate my own moral concerns. It is my deep conviction that justice is indivisible, that injustice anywhere is a threat to justice everywhere....

On some positions cowardice asks the question, 'Is it safe?!' Expediency asks the question, 'Is it politic?' Vanity asks the question, 'Is it popular?' But conscience must ask the question, 'Is it right?!' And there comes a time when one must take a stand that is neither safe, nor politic, nor popular. But one must take it because it is right....

On the role of the social scientist

Negroes have been oppressed for centuries not merely by bonds of economic and political servitude. The worst aspect of their oppression was their inability to question and defy the fundamental precepts of the larger society. Negroes have been loathe in the past to hurl any fundamental challenges because they were coerced and conditioned into thinking within the context of the dominant white ideology.... For the first time in their history, Negroes have become aware of the deeper causes for the crudity and cruelty that governed white society's responses to their needs. They discovered that their plight was not a consequence of superficial prejudice but was systemic.

The slashing blows of backlash and frontlash have hurt the Negro, but they have also awakened him and revealed the nature of the oppressor. To lose illusions is to gain truth. Negroes have grown wiser and more mature and they are hearing more clearly those who are raising fundamental questions about our society whether the critics be Negro or white. When this process of awareness and independence crystallizes, every rebuke, every evasion, become hammer blows on the wedge that splits the Negro from the larger society.

Social science is needed to explain where this development is going to take us. Are we moving away, not from integration, but from the society which made it a problem in the first place? How deep and at what rate of speed is this process occurring? These are some vital questions to be answered if we are to have a clear sense of our direction....

The problem is deep. It is gigantic in extent, and chaotic in detail. And I do not believe that it will be solved until there is a kind of cosmic discontent enlarging in the bosoms of people of good will all over this nation....

On creative maladjustment

There are certain technical words in every academic discipline which soon become stereotypes and even clichés. Every academic discipline has its technical nomenclature. You who are in the field of psychology have given us a great word. It is the word maladjusted. This word is probably used more than any other word in psychology. It is a good word; certainly it is good that in dealing with what the word implies you are declaring that destructive maladjustment should be destroyed. You are saying that all must seek the well-adjusted life in order to avoid neurotic and schizophrenic personalities.

But on the other hand, I am sure that we will recognize that there are some things in our society, some things in our world, to which we should never be adjusted. There are some things concerning which we must always be maladjusted if we are to be people of good will. We must never adjust ourselves to racial discrimination and racial segregation. We must never adjust ourselves to religious bigotry. We must never adjust ourselves to economic conditions that take necessities from the many to give luxuries to the few. We must never adjust ourselves to the madness of militarism, and the self-defeating effects of physical violence.

In a day when Sputniks, Explorers and Geminies are dashing through outer space, when guided ballistic missiles are carving highways of death through the stratosphere, no nation can finally win a war. It is no longer a choice between violence and nonviolence, it is either nonviolence or nonexistence. As President Kennedy declared, 'Mankind must put an end to war, or war will put an end to mankind.' And so the alternative to disarmament, the alternative to a suspension in the development and use of nuclear weapons, the alternative to strengthening the United Nations and eventually disarming the whole world, may well be a civilization plunged into the abyss of annihilation. Our earthly habitat will be transformed into an inferno that even Dante could not envision.

Thus, it may well be that our world is in dire need of a new organization, The International Association for the Advancement of Creative Maladjustment. Men and women should be as maladjusted as the prophet Amos, who in the midst of the injustices of his day, could cry out in words that echo across the centuries, 'Let justice roll down like waters and righteousness like a mighty stream'; or as maladjusted as Abraham Lincoln, who in the midst of his vacillations finally came to see that this nation could not survive half slave and half free; or as maladjusted as Thomas Jefferson, who in the midst of an age amazingly adjusted to slavery, could scratch across the pages of history, words lifted to cosmic proportions, 'We hold these truths to be self evident, that all men are created equal. That they are endowed by their creator with certain inalienable rights. And that among these are life, liberty, and the pursuit of happiness.' And through such creative maladjustment, we may be able to emerge from the bleak and desolate midnight of man’s inhumanity to man, into the bright and glittering daybreak of freedom and justice.

I have not lost hope. I must confess that these have been very difficult days for me personally. And these have been difficult days for every civil rights leader, for every lover of justice and peace.

King was assassinated seven months after giving this speech at the American Psychological Association's 1967 convention.