Book Recommendation: The Center Cannot Hold

"The Little Engine that Could"

If you're deciding what to read next, I strongly recommend Elyn R. Saks' The Center Cannot Hold: My Journey Through Madness. I guarantee you won't forget it soon.

Saks is an acclaimed professor of law and psychiatry. She also struggles with severe symptoms of schizophrenia. She risked her reputation in academia in order to give hope to others like herself, and to counter the negative stereotypes about mental illness held by both the general public and mental health professionals:

"I wanted to dispel the myths ... that people with a significant thought disorder cannot live independently, cannot work at challenging jobs, cannot have true friendships, cannot be in meaningful, sexually satisfying love relationships, cannot lead lives of intellectual, spiritual, or emotional richness."

The topic is inherently compelling, and Saks masterfully describes what it is like to be tormented by inner demons, to be forcibly restrained on a hospital bed, to require medications that alter one's mental state and can cause horrific, irreversible side effects. She articulately describes her years of talk therapy, in which she came to understand the functional underpinnings of her psychotic thoughts, for example in warding off feelings that would have been consciously threatening.

I enjoyed her dry humor in highlighting the condescension and absurdities of the mental health system. In one case she reviewed during a legal internship, the patient was restrained because he refused to get out of bed. In another case, a young man was deemed delusional because he continually spoke with "imaginary lawyers" - who turned out to be none other than Saks and her colleague.

For years, in order to excel, Saks had to lead a double life. Swirling around her, constantly threatening, was the stigma of mental illness. While writing an academic paper on restraints, she asked a professor, "Wouldn't you agree that being restrained is incredibly degrading, not to mention painful and frightening?" With a kind and knowing look, the professor responded: "These people are different from you and me. It doesn't affect them the way it would affect us."

This book is especially important reading for mental health professionals in the United States, where medication reigns supreme (it has become practically taboo to recommend psychotherapy for severe psychosis, despite ongoing research establishing its efficacy) and coercion often trumps choice. Saks contrasts her experience of being hospitalized in the United States with her experience in England, where restraints have not been in widespread use for more than 200 years. In doing so, she gives us a deeper appreciation of the trauma induced by coercive and sometimes brutal treatment.

"The Little Engine that Could" is what her close friend Steve Behnke calls her, referring to her indomitable spirit even in the face of hospital clinicians' dire predictions about her future.

I highly recommend this courageous and brilliant memoir.

A 45-minute video of Saks' talk at this year's American Psychological Association convention is available online at her personal website. Other books by Saks include Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002) and Jekyll on Trial: Multiple Personality Disorder and the Criminal Law (1997).

Hot off the press: Mental health and criminal justice

The new issue of Criminal Justice, the American Bar Association magazine (Vol. 22 No. 3), features a roundup of cutting-edge topics at the intersection of psychology-law. The articles are written by notables in their fields and, best of all, they are available online and for free:

Mental Health and Criminal Justice: An Overview

By Andrew E. Taslitz

The Supreme Court's Recent Criminal Mental Health Cases Rulings of Questionable Competence

By Christopher Slobogin

For decades the subject of mental illness and criminal law languished in the legal "backwaters" at the U.S. Supreme Court. That changed in 2003 when the Court accepted the case of Sell v. United States (a defendant's right to refuse medication), followed quickly by two more seminal decisions in Clark v. Arizona (2006) (the scope of psychiatric defenses) and Panetti v. Quarterman (2007) (the definition of competency to be executed). But has this sudden interest in mental illness issues resulted in good law? The author argues to the contrary and details where and how the Court has erred.

Prosecutor as "Nurse Ratched"?: Misusing Criminal Justice as Alternative Medicine

By Gerald E. Nora

Traditionally, prosecutors approach claims of mental impairment by criminal defendants with skepticism, contesting competency defenses and sentencing mitigation. More recently, though, they find themselves as "diversionary gatekeepers" - seeking alternatives to trials and prison for those who more aptly belong in the medical arena. The author, a Cook County ( Illinois) state's attorney, finds neither role satisfactory and argues for reforms that will limit a prosecutor's responsibility for addressing a defendant's mental health needs through the justice system.

The Promise of Mental Health Courts: Brooklyn Criminal Justice System Experiments with Treatment as an Alternative to Prison

By Matthew J. D'Emic

Judge D'Emic tracks the establishment of one of the country's first courts to use diversionary treatment in dealing with mentally ill criminal defendants. He maps the defendant's journey from intake through assessment and treatment to "graduation" from the program.

Executing the Mentally Ill: When Is Someone Sane Enough to Die?

By Michael Mello

An opponent of the death penalty, Prof. Mello presents this personal account of advocating for mentally ill death row inmates. While detailing his clients' descent into madness and the tortured disconnect between the fantasy world of the insane and a justice system bent on accountability, the author looks at the impact of three high-profile cases.

Mental Health Status and Vulnerability to Police Interrogation Tactics

By William C. Follette, Deborah Davis, and Richard A. Leo

The authors offers a psychological explanation of how police interrogation methods affect the "average" person's ability to understand and exert his or her Miranda rights and what makes the mentally ill so much more susceptible to police coercion and likely to falsely confess.

Hot off the press: Two new forensic psychology texts

Psychological Evaluations for the Courts, Third Edition: A Handbook for Mental Health Professionals and Lawyers

Authors: Gary Melton, John Petrila, Norman Poythress, and Christopher Slobogin

Book description: "The definitive reference and text for both mental health and legal professionals is now in a thoroughly updated third edition. This volume offers a uniquely comprehensive discussion of the legal and clinical contexts of forensic assessment, along with best-practice guidelines for participating effectively and ethically in a wide range of criminal and civil proceedings. Extensively revised, the third edition analyzes recent legal developments concerning the admissibility of expert testimony, the insanity defense, sexual predators, the death penalty, outpatient commitment, medication refusal, juvenile justice, antidiscrimination laws, special education laws, and more. It also presents new empirical findings and instruments related to risk assessment, criminal and civil competencies, child custody, and feigning mental illness."


Practical Approaches to Forensic Mental Health Testimony

Authors: Thomas Gutheil and Frank Dattilio

Book description: "A practical hands-on guide to testifying in court on mental health issues, this text offers a vital tool for the novice as well as the most seasoned practitioner. Prepared by two of the field's leading scholars and practitioners, this original work cuts through dense forensic mental health theory and addresses the actual, concrete approaches to ethical and effective testimony that experts need in court. Rich in multiple examples of courtroom dialogue, direct and cross examination, collaboration with attorneys, and the craft of effective testimony, this text describes the common pitfalls and various traps that experts so frequently encounter and tells you how to avoid them. Strategies and techniques are clearly illustrated and arm readers with exactly what they need to be successful in their testimony. This book is a must-read for anyone serious about excelling in court."

New book highlights prisoner reentry obstacles

Marked: Race, Crime, and Finding Work in an Era of Mass Incarceration
by Devah Pager, Princeton University sociologist

From my Amazon review:

If this depressing book cannot convince people that racism is alive and well in America today, I don't know what could. Dr. Pager reports on an empirical research project in which teams of well-put-together white and black college students went job-hunting in and around Milwaukee, with one member of each team "marked" as an ex-convict. What she found is astonishing. Black job applicants WITHOUT drug convictions fared no better than white ex-cons WITH convictions; with "two strikes" against them, black men with a (bogus) drug conviction had slim odds of getting a call-back from a prospective employer. This problem was especially pronounced in the suburbs, which are gaining an increasing proportion of jobs despite the fact that many job-seekers remain in the cities. Dr. Pager includes informative and well-written chapters on the state of mass incarceration in the United States today, as well as the massive and growing problem of prisoner reentry. With more than 600,000 people pouring out of prisons each year, Dr. Pager's book is a must-read for anyone concerned with the public policy aspects of the reentry problem. This is yet another excellent entry into the recent crop of books cataloging the collateral consequences of mass imprisonment. (See my Amazon list "Prison World" for more.)

Rape prosecution - an uphill battle

I’ve come across several stories lately pertaining to the difficulty of prosecuting rape cases. Many of you readers will have heard about the recent Nebraska trial in which the judge forbade witnesses – including the alleged victim – from using the word rape (or related words such as “victim,” “assailant,” or “sexual assault kit”). That trial resulted in a hung jury.

You are less likely to have heard about international data coming out of New Zealand, Australia, Great Britain, Scotland, and elsewhere about astonishingly low rape conviction rates in recent years. For example, data from Victoria, NZ indicate that only one of six rapes reported to police proceeds to prosecution and less than one-fourth of those result in a rape conviction. With only a tiny proportion of rapes being reported in the first place, this attrition has led to what some call the “virtual decriminalization” of sexual violence.

While these stories were coming across my desk this month, I happened to be in the middle of a provocative analysis by law professor and former sexual assault prosecutor Andrew Taslitz. Rape and the Culture of the Courtroom uses social science research to explain why rape prosecutions remain so difficult, despite the rape reform laws of the 1980s. Through linguistic analysis of actual cases, Taslitz shows how subtle innuendos, proxies, and other linguistic devices can cue jurors to place the victim into certain cultural narratives, such as that of “slut” or “scorned woman” – in other words, “liar.”

Taslitz’ linguistic analysis jives with my experiences in court. When I’ve been retained as an expert for the government (prosecution) in rape cases in which the defense was consent, I’ve been amazed at how rarely jurors convict even when the evidence is pretty solid and the woman has no plausible reason to lie. Taslitz emphasizes that even jurors who are consciously pro-feminist may fall prey to appeals to subconscious cultural scripts about virtuous womanhood.

Taslitz’ blueprint for legislative reforms includes such controversial ideas as allowing rape victims to present their stories in an uninterrupted narrative, using “intermediaries” rather than defense attorneys to question the victims, and having linguistic experts explain to jurors the effects of subconscious biases on decision-making.

My full review of the book is on Amazon.

The Nebraska trial of Pamir Safi, an Army reservist, is featured at Time Magazine’s online site.

Photo credit: fabbio (Creative Commons license).

ForenSnips

Model prisoner reentry program

New York has been selected as one of seven states to receive a grant from the National Institute of Corrections to implement a model prisoner reentry program. The goal is to reduce recidivism “by promoting an effective transition process through the coordination of criminal justice and human service programming.”

See the full article in the Rochester Democrat & Chronicle.

Book review

A review of Jonathan Simon’s new book, Governing Through Crime: How The War On Crime Transformed American Democracy And Created A Culture Of Fear (Oxford University Press), is online at the the Law and Politics Book Review, sponsored by the Law and Courts Section of the American Political Science Association.

New book on offender rehabilitation

A new book by two leading criminologists, Shadd Maruna and Tony Ward, promises to make an important contribution to criminology. Here’s the blurb for Rehabilitation:

“Over the last two decades, empirical evidence has increasingly supported the view that it is possible to reduce re-offending rates by rehabilitating offenders rather than simply punishing them. In fact, the pendulum’s swing back from a pure punishment model to a rehabilitation model is arguably one of the most significant events in modern correctional policy. This comprehensive review argues that rehabilitation should focus both on promoting human goods (i.e. providing the offender with the essential ingredients for a 'good' life), as well as reducing/avoiding risk.

“Offering a succinct summary and critique of the scientific approach to offender rehabilitation, this intriguing volume for students of criminology, sociology and clinical psychology gives a comprehensive evaluation of both the Risk-Need Model and the Good Lives Model.

“Rehabilitation is a value-laden process involving a delicate balance of the needs and desires of clinicians, clients, the State and the public. Written by two international leading academics in rehabilitation research, this book argues that intervention with offenders is not simply a matter of implementing the best therapeutic technology and leaving political and social debate to politicians and policy makers.”

More information on this book is available at Psychology Press’s new on-line “Forensic Psychology and Psychiatry Arena.”