Showing posts with label unintended consequences. Show all posts
Showing posts with label unintended consequences. Show all posts

November 16, 2010

No reliable method to determine pedophilia, study finds

http://www.psychologytoday.com/blog/witness/201011/no-reliable-method-determine-pedophilia-study-finds
Good news for sex deviants seeking jobs with TSA

Lest you think that TSA hiring agents can protect airline passengers from sexual groping by weeding out the deviant from the "normal," they cannot. There's no accurate way to know. My full report on a new study about diagnosing pedophilia, and how it relates to the viral TSA controversy, is online at Psychology Today.

The study is: "Pedophilia: An evaluation of diagnostic and risk prediction methods," by Robin J. Wilson, Jeffrey Abracen, Jan Looman, Janice Picheca, and Meaghan Ferguson, in Sexual Abuse: A Journal of Research & Treatment

And don't miss Jonathan Mann's new video, "I don't like the TSA"

October 28, 2010

Yet another year of (yawn) Halloween security theater

Evidence and common sense no match for hype

For many, Halloween is a blast. Trick-or-treating, giving out candy, dressing up, perhaps even throwing a party.

But for many convicted sex offenders, it is the most dreaded night of the year. Group roundups, dusk-to-dawn curfews with the lights out, mandatory "no candy" signs on their doors and spot checks for compliance are among the various techniques of control ostensibly designed to protect the public.

Contary to the sex offender hysteria on All Hallows Eve, however, sex offenders are not out snatching and molesting children on Halloween. And they never have been.

Last year, a published study proved what most experts already knew: There is no Halloween spike in sex crimes against children.

"The wide net cast by Halloween laws places some degree of burden on law enforcement officers whose time would otherwise be allocated to addressing more probably dangerous events," noted Jill Levenson of Lynn University in Florida, one of the study's authors. Her research, published in the journal Sexual Abuse, examined crime trends over a 9-year period.

The researchers used data from the National Incident-Base Reporting System to examine crime trends in 30 U.S. states over a 9-year period. They found no increased rate of sexual abuse during the Halloween season. Also, the number of reported incidences did not rise or fall after police implemented current procedures.

Unfortunately, empirical evidence seems incapable of bringing common sense to bear. Probation officers and others continue to implement ridiculous roundups and other once-a-year restrictions on sex offenders, instead of focusing on the real threat to children, which I'll get to in a moment.

Around the nation this Halloween, parole and probation officers will continue to order convicted sex offenders not to answer their doors, decorate their porches, or wear costumes on Halloween. Sex offenders are being ordered to post "NO CANDY HERE" signs on their doors. Others must attend special Halloween "counseling sessions" or "movie nights" where they will be monitored (and, incidentally, protected from false accusations). The restrictions are so widespread and so varied that I no longer have the time or energy to catalog them as I have done on my professional blog in past years. (If you are interested, just do a Google news search for "Halloween sex offender roundup.")

This despite at least one federal court ruling that the restrictions were overly broad, and ridicule from late-night TV pundits of some of the sillier Halloween restrictions.

The farcical crackdowns are a prime example of what Scott Henson at Grits for Breakfast calls "security theater," that is, "hyping (and pretending to solve) a threat that in reality is extremely remote, even to the point of diverting resources from policing activities like DWI enforcement that would protect more people and save more lives."

Why Halloween, we might ask? After all, most sex offenders target people they know, not children off the street. And the crackdowns on registered sex offenders miss the mark anyway, because the overwhelming majority of new sex offenses are committed by men who have never been caught for a past sex offense. Furthermore, registered sex offenders feel so branded and ostracized that most are ducking and hiding today.

But the scare feeds into a deep-rooted cultural fear of the bogeyman stranger. This fear is memorialized in the timeworn Halloween legend of tainted candy that has endured despite myriad attempts at correction. As Benjamin Radford of the Skeptical Enquirer pointed out about the persistence of that stranger-danger myth:

"Despite e-mail warnings, scary stories, and Ann Landers columns to the contrary, there have been only two confirmed cases of children being killed by poisoned Halloween candy, and in both cases the children were killed not in a random act by strangers but intentional murder by one of their parents."

The sad part of both myths is that children are taught a message of fear: Strangers, or even their own neighbors, might try to poison or molest them.

Oh, yes. What is the real danger facing children this Halloween?

It's one your mother always warned you about: Getting hit by a speeding car while crossing a dark street. Car accidents kill about 8,000 children every year in the United States. And children are more than twice as likely to be killed by a car while walking on Halloween night than at any other time of the year.

So this Halloween, show compassion toward a publicly identified sex offender. But please, children, don't get too friendly with cars.

Recommended reading:

Stranger danger and the decline of Halloween, Wall Street Journal opinion piece by Lenore Skenazy (author of Free Range Kids)

I can't believe that this is the fourth year in a row that I have posted a Halloween sex offender roundup. Prior posts:

2007: Beware the Halloween bogeyman!

2008: Pendulum swing on Halloween hype? (Oops! That one was just wishful thinking.)

2009: Halloween "security theater" endures

2010: Psychology Today blog post

October 26, 2010

Europeans first to shoot down controversial paraphilia

Resounding 100-to-1 vote against "pedohebephilia"

I was impressed by the unanimity of opposition to the sexual paraphilias among forensic psychiatrists at their annual conference last week in Tucson, Arizona.

But as it turns out, the sex experts of Europe had the Americans beat, both in numbers and timing.

At last month's meeting of the International Association for the Treatment of Sexual Offenders (IATSO) in Oslo, Norway, the vote was approximately 100 to 1 against the controversial diagnosis of "pedohebephilia," according to two reliable sources. The lone dissenting voice was a member of the DSM-5 committee.

I hope the DSM revisers are listening. If not, they are going to end up the laughingstock of the world.

Richard Green, MD: "Hebephilia is a Mental Disorder?"

The vote at the IATSO conference, where European psychiatry is strongly represented, came after a talk by Richard Green, a prominent psychiatrist, sexologist, and professor at the Imperial College of London. Green served on the Gender Identity Disorders subcommittee for DSM-IV, and was a leading advocate for removing homosexuality from the DSM back in the 1970s. In a published critique of the hebephilia proposal, he pointed out the parallels:
The parody of science masquerading as democracy made a laughing stock of psychiatry and the APA when it held a popular vote by its membership on whether homosexuality should remain a mental disorder. Decreeing in a few years time that 19-year-olds who prefer sex with 14-year-olds (5 years their junior) have a mental disorder … will not enhance psychiatry’s scientific credibility.
He has also pointed out that the age of legal consent in several European countries falls within the range that the proposed disorder would make pathological for the older participant.

A separate audience poll at the IATSO conference on the proposed diagnosis of hypersexuality was more mixed, with about a third favoring the diagnosis, a third opposing it, and a third undecided, according to one of my sources.

NPR report on AAPL debate

Meanwhile, National Public Radio has reported on Saturday's AAPL vote against the paraphilias. Reporter Alix Spiegel blogged about it on NPR's health blog, "SHOTS," under the heading "Forensic Psychiatrists Don't Favor Some Proposed Sexual Diagnoses."

These negative votes will have no a direct impact on the DSM-5, now due out in 2013. In the case of the controversial sexual paraphilias, one Canadian research group is dominating the process and most of the upcoming field trials will be done at government detention facilities where insular opinion runs heavily in favor of the diagnoses.

Proponents of the paraphilia revisions are urging supporters to lobby the DSM committee. It seems that, as we have seen in the past, lobbyists may have an inordinate impact, overshadowing valid science.

But if the American Psychiatric Association kowtows to this special interest niche and ignores the broader consensus of psychiatrists and other mental health professionals around the world, this will certainly reduce the credibility of the manual in years to come.

UPDATE: My Psychiatric Times coverage of the debate, "Forensic Psychiatrists Vote No on Proposed Paraphilias," is online HERE.

October 24, 2010

Psychiatrists vote no on controversial paraphilias

By an overwhelming majority, a group of seasoned forensic psychiatrists who work with sex offenders voted last night against three controversial new sexual disorders being proposed for the DSM-5.

The votes were 31-2, 31-2, and 29-2, respectively, against Paraphilic Coercive Disorder, Pedohebephilia, and Hypersexual Disorder. The votes came at the end of a debate at the annual meeting of the American Association of Psychiatry and Law (AAPL) in Tucson, Arizona.

The rejection is symbolic, but sends a strong message to the DSM-5 developers. One of the six debate panelists, Richard Krueger, is a member of the Paraphilias SubWorking Group. Two other panelists serve as advisors to the committee. In the audience were prominent forensic psychiatrists who took stances regarding similar proposals during previous revisions of the DSM.

The American Psychiatric Association, to which most forensic psychiatrists belong, publishes the influential Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition. But psychiatrists have not played a central a role in the 20-year-old sex offender civil commitment industry, which is lobbying for these new diagnoses. Much of the planned field testing will be done at civil commitment sites.

The debaters

Arguing for and against Hypersexual Disorder were two prominent psychiatrists with decades of experience in assessing sexual disorders. Richard Krueger, on the "pro" team, is a Columbia University professor and medical director of the Sexual Behavior Clinic at the New York State Psychiatric Institute. John Bradford, an advisor to the DSM-IV and past president of AAPL, is a Distinguished Fellow of the APA, last year earning its prestigious Isaac Ray Award. The University of Ottawa professor is founder and clinical director of the Sexual Behaviors Clinic in Ottawa. He expressed concern about how clinicians would determine how much sexual preoccupation is excessive, and voiced worry that homosexual men might be disproportionately given the label.

Two Wisconsin psychologists debated "Paraphilic Coercive Disorder," which would apply to rapists. Thomas Zander took the "con" position while David Thornton of the Sand Ridge Secure Detention Center for sexually violent predators was "pro." This is the third time that the American Psychiatric Association has considered such a diagnosis.

Tackling Pedohebephilia were two Northern Californians, forensic psychiatrist Douglas Tucker ("pro") and your faithful blogger ("con"). The controversial proposal would expand pedophilia from its current definition, in which the target of sexual attraction must be prepubescent, to young pubescents as old as 14.

The debate was organized by forensic psychiatrist Lynn Maskel, a clinical professor at the University of California-San Diego.

Clinical versus forensic utility?

The three-member "con" team focused on two main themes:
  • All three proposed diagnoses lack a sufficient scientific basis.
  • They are highly likely to be misused in the forensic context, the primary site for their application.
The "pro" debate team repeatedly insisted that these diagnoses are being proposed based on their scientific merit, not their utility to government evaluators in civil commitment cases. They said these new diagnoses are needed so people suffering with these conditions can get adequate treatment.

The clinical needs argument is a red herring. Clinicians are not turning away patients with problematic sexual behaviors because the proper billing code is missing from the Diagnostic and Statistical Manual of Mental Disorders. Rapists will not flock in for needed treatment when they hear that a Paraphilic Coercive Disorder label is now available for them.

The audience of forensic psychiatrists clearly did not buy the clinical justification. As more than one audience member asked the panel, If the rationale is strictly clinical, why are attorneys serving as advisors to the work group?

Back in 1986, the last time Paraphilic Coercive Disorder was proposed for the DSM, it was defeated in large part due to the opposition of forensic psychiatrists (not pesky feminists, as the historical revisionists would have it). Hopefully, history will repeat itself with respect to all three of these poorly conceptualized and dangerous proposals.

The debate was audiotaped, and will be available for purchase from AAPL. The texts of the proposed diagnoses can be viewed at the DSM-5 website. My resource page on Hebephilia is HERE. Thomas Zander’s article, Inventing Diagnosis for Civil Commitment of Rapists, is online HERE.

Photo: (L to R) John Bradford, Karen Franklin, Thomas Zander, David Thornton, Douglas Tucker, Richard Krueger. Photo credit: Luis Rosell.

UPDATE: My Psychiatric Times coverage of the debate, "Forensic Psychiatrists Vote No on Proposed Paraphilias," is online HERE.

October 19, 2010

Systems failure or black swan?

New frame needed to stop "Memorial Crime Control" frenzy

It's the same thing again and again:
  • A rare but horrific tragedy befalls a high-status victim, usually a child
  • Media pundits point fingers and place blame
  • A supposed flaw in the legal system is pinpointed
  • Opportunistic politicians enact knee-jerk legislation to "fix" the "hole"
This process explains wave after wave of "memorial crime" laws, such as Jessica's Law, the AMBER Alerts, Three Strikes, and Megan's Law. Borne on a tide of moral panic, the symbolic laws are costly, have no impact on crime or public safety, and sometimes even backfire.

These laws are implictly driven by "Routine Activities" logic. Under the Routine Activities theory of crime, crime results from a convergence of: (1) motivated offenders, (2) available targets, and (3) the absence of a capable guardian. So, goes the theory, you can stop heinous behavior by reducing opportunity.

But this is an upside-down approach to rare events that are anything but routine, argue criminologists Timothy Griffin and B. Grant Stitt of the University of Nevada in an intriguing article in Critical Criminology. Far more logical and productive would be to interpet these events as statistical inevitabilities or -- as Nassim Nicholas Taleb calls them -- "Black Swans."
Good public policies and sensible lifestyle choices can minimize the risk of serious criminal victimization, but not absolutely. Unfortunately, current American public policies such as child protection legislation are driven not by the realization of this apparently simple truth, but by its denial….

If public officials could embrace the grim reality that a certain number of certain types of crimes are inevitable, it could move the public discourse away from a futile search for a misguided solution and toward a mindset of rational problem management. The policy implication of random activities theory is that public safety officials and the general public need to be prepared to accept the fact that, for some categories of crime, there are few if any "‘solutions’" beyond what we are currently doing, and that our visceral reaction to 'Black Swan crimes' in the form of memorial crime control legislation is futile and possibly self-defeating….

[T]he proper application of random activities theory, rather than resulting in a depressing resignation toward tragic crime, could actually ... be liberating. Random activities theory could be a powerful heuristic in the public discussion of crime control because it enables experts to identify and categorize a class of crime that have stubbornly resisted repeated public attempts at suppression. It is a rhetorical tool that can defuse at least some of the excessive attention lavished on unavoidable crimes and allow the public discourse to move toward the preponderance of crime which is more amenable to public policy remedy….

In times of inexplicable tragedy, people cannot be faulted for taking what solace they can in whatever beliefs and comforts they can muster, but these are the arenas of religion, philosophy, and personal reflection -- not the justice system. The history of memorial crime control in the United States shows that whatever catharsis it provides is always short-lived. There will always be one more "Black Swan crime" to fuel reactionary demands for legislative response, and the failed policy cycle continues….

The message might lack visceral appeal, but most people do have, at some level, an intuitive appreciation of "‘acts of God," "adversity," or just plain bad luck.
Unfortunately, while I am by nature an optimist, the brazen assault on rationality that is taking place in the United States at this moment in history may belie the authors' optimism in appeals to common sense. Citizens who cling en masse to superstition, stubbornly reject established science, and believe that our president is a Muslim are proving themselves fairly unamenable to sane discourse.

I still recommend the article.

The abstract of the article, "Random Activities Theory: The Case for 'Black Swan' Criminology," is HERE. Request a copy of the article from the authors by clicking HERE (for Timothy Griffin) or HERE (for B. Grant Stitt).


Hat tip: David Stubbins

October 10, 2010

Rare juror speaks out after sexual predator trial

Civil commitment unfair, says law-and-order Floridian

Juror Number 6 is a conservative, law-and-order Republican. But she was appalled when she realized that in the United States, someone can be indefinitely detained not for what he has done, but for what he might do in the future.

Kathy Martin spoke to a news reporter after she and her five colleagues refused to civilly commit a convicted sex offender. Robert Richard Sanzone, age 34, had finished the prison term imposed in 2004 for having sex with one 15-year-old girl and trying to coax a second girl into sexual intimacies.

Martin said that she was struck by the similarities between the 2002 film Minority Report and Florida's Jimmy Ryce Act, under which sex offenders who are determined to still be a danger to society may be held indefinitely for so-called treatment.

"I didn't realize in America you could be given an indefinite sentence," the registered nurse told reporter Richard Prior of Florida's St. Augustine Record. “I'm not a bleeding-heart liberal, but I would like to think someone can't incarcerate me because they think I might do something."

Martin said she and the other members of the 5-woman, 1-man jury were skeptical of the reliability of the Static-99 actuarial risk assessment tool.

She also expressed concern about civilly committing someone for having consensual sex with a teenager.
"This is supposed to be about violent sexual predators, and I kept waiting for the violence to come up. I kept waiting for one of the witnesses to say he threw (them) against the wall or pushed (them) to the ground or pulled a knife. When I realized that wasn't going to happen ... well, I listened politely to the closing argument, but by that time I'd made up my mind."
Florida's Jimmy Ryce Act was passed in 1998 after Juan Carlos Chavez raped, beat, dismembered, and murdered 9-year-old Jimmy Rye in 1995. Chavez is currently awaiting execution on Florida's death row. The Ryce Act parallels sexually violent predator civil commitment laws in 20 U.S. states.

The articulate juror said she understands why horrific crimes lead to new laws, but she doesn't like that knee-jerk practice.
"When a brutal case occurs, the public wants to do something. It makes us feel better that we passed a law. This law has unintended consequences that can come back and bite someone's behind. I think these laws are just feel-good measures."
Two psychologists, Amy Swan and Mary Anne Etheridge, testified in favor of civil ccommitment for Sanzone. Dr. Etheridge diagnosed Sanzone with "fetishism" -- in this case toward underwear -- as well as the ubiquitous antisocial personality disorder.

Psychologist Deborah Leporowski, the lone defense witness, disputed the prosecution psychologists' estimation of Sanzone's risk, and said many of his early problems could be attributed to teenage impulsivity and immaturity.

Sanzone will remain on special sex offender probation for many years, and will be banned from schools, playgrounds, or other places where children congregate.

Richard Prior's fascinating interview with juror Kathy Martin is HERE.

October 1, 2010

Reader feedback on latest actuarial article

I want to draw readers' attention to a reaction I received today from Brian Abbott, a psychologist and a leading expert on actuarial risk assessment of sex offenders. He has posted an insightful comment on last week's blog essay, "Static redux: Sandgropers jumping off rickety ship." Whereas I was sanguine in my commentary on a new article critiquing the Static-99 family of instruments ("Alice in Actuarial-Land" by Shoba Sreenivasan, Linda Weinberger, Allen Frances, and Sarah Cusworth-Walker), Dr. Abbott expressed dismay. He sees it as a bold and dangerous attempt to legitimize the pseudoscientific clinical-actuarial approach. As he points out, with actuarial instruments forecasting lower risks of sexual recidivism, government evaluators are finding it increasingly difficult to predict the high levels of danger required for civil commitment. They may thus resort to pseudoscientific logic to inflate sex offenders' risk scores. Dr. Abbott's comment is located HERE. I invite you all to share your comments as well.

August 16, 2010

APA Dispatch II: Whither juvenile forensics?

The U.S. Supreme Court ruling this May in Graham v. Florida, restricting life without parole sentences for juveniles, relied in part upon scientific evidence from developmental psychology and neuroscience. In ruling that juveniles are categorically different from adults, the high court was assisted by amicus briefs from the American Psychological Association and other professional organizations including the American Psychiatric Association and the National Association of Social Workers.

The APA's position, which the Supreme Court also validated in its 2005 ruling in Roper v. Simmons outlawing the death penalty for juveniles, is that juveniles' diminished culpability is based on three basic differences from adults:
  1. Immaturity: Juveniles are more impulsive and less likely to reason judiciously about risk
  2. Vulnerability: They are more likely to be influenced by peer pressure
  3. Changeability: They are still developing, and are more amenable to rehabilitation than adults
At this week's APA convention, the American Psychology-Law Society (Division 41) hosted a cutting-edge track on juvenile justice. The dynamic sessions raised intriguing issues about how the growing acceptance of adolescent immaturity and difference will affect forensic practice in the juvenile justice system.

Bryan Stevenson: "Huge implications" of Graham case

In an eloquent presentation, NYU law professor Bryan A. Stevenson, founder of Alabama's Equal Justice Initiative, expressed optimism that Graham and the twin case of Sullivan v. Florida, in which he was counsel, signal that the tide is turning away from the punitive Superpredator hysteria of the 1980s. He encouraged the APA to continue its public policy advocacy by bringing legal attention to the impacts of trauma, violence, and neglect on youngsters.

Hopefully, the capacity crowd of psychologists will attend to the implications of Stevenson’s other take-home messages: Mass incarceration has radically changed American society, creating a class of "new untouchables." And the victims of this sea change are overwhelmingly poor and minority. Indeed, he asserted, wealth -- not criminal culpability -- largely drives criminal sentencing. In Louisiana, for example, of the juveniles serving life without parole for crimes other than homicide at the time of the Graham decision, 94 percent are African American. Most are incarcerated for rape, with 71 percent of the victims being white.

Tom Grisso: "Forensic examiners beware"

Forensic psychology guru Tom Grisso sounded a more cautionary note about Graham's implications. The high court's adoption of a categorical approach to juveniles is at odds with the discretionary, individualized method at the core of forensic assessment, he pointed out.

Grisso demonstrated his point through a mock cross-examination. On the stand, the mock expert conceded that the research of Laurence Steinberg, Elizabeth Cauffman, and others on adolescent immaturity is now widely accepted in the field, as shown by Supreme Court's rulings in Graham and Roper. Next, Grisso produced a New York Times op-ed co-authored by Steinberg, reiterating Roper's conclusion that psychologists "are unable to distinguish between the young person whose crime reflects transient immaturity and the rare juvenile offender who may deserve the harsh sentence of life without parole." In the script, the expert was left speechless and incapable of defending her individualized opinions about risk.

Grisso said forensic psychologists must be aware of this debate, and think about how to answer such questions in court. The outlook for prediction is not as bleak as the APA's advocacy efforts might suggest, he asserted, as experts do have a reliable basis on which to give probability estimates, especially about more short-term risk.

Good news for juveniles with a sex crime

A panel of juvenile sex offender experts was more upbeat about the implications of the scientific research on adolescent difference. As with general criminality, they said, research has not identified methods to accurately predict which juveniles will reoffend sexually. Indeed, none of the factors that predict sex offender recidivism in adults (multiple victims, male victims, young child victims, personality disorder, sexual deviance, etc.) predict recidivism for juveniles.

But this inability to differentiate is not bad news, because what we can say is that the overwhelming majority -- 93 percent -- of juveniles who have committed a sex crime will not reoffend sexually as adults.

An audience member who works in the civil commitment industry expressed incredulity at the cumulative research, saying many of the men in his civil detention facility began their offending careers in their teens.

That may be true, responded researcher Michael Caldwell. But the directionality cannot be reversed. All NBA stars may have played basketball in the ninth grade. But we cannot predict by watching a group of ninth-graders play basketball which, if any, of the players will become basketball superstars.

(A summary of the presentation, "Juvenile Offenders are Ineligible for Civil Commitment as Sexually Violent Predators," is online HERE; it contains a slough of good references. The PowerPoint presentation is HERE.)

Judges launch crusade to save children of color

The most optimistic presentation I attended was a symposium of family court judges who are at the forefront of a movement to reduce the vastly disproportionate representation of minority children in the child welfare system, from which many graduate to juvenile delinquency and adult criminal courts.

The remarkable Hon. Katherine Lucero of San Jose, California said she became active in this movement when she realized she was serving as part of the vast "cradle-to-prison pipeline," processing children who would end up poor, homeless, drug addicted, illiterate, pregnant at a young age, delinquent, and -- ultimately -- incarcerated. When she looked out at her courtroom filled with children of color, her training that justice is blind was cognitively dissonant, making her feel like she was living "in a delusion."

The equally inspiring Hon. Nan Waller of Portland, Oregon said the movement challenges the basic historical tenet of the child welfare system, which promotes removal from families -- so-called "child rescue" -- rather than family strengthening. Most of the mothers who lose their children are suffering from severe trauma that they medicate with drugs. Rather than "cookie-cutter" quick-fixes, including automatic referrals for psychological evaluations and parenting classes, these women need support and help obtaining even basic resources such as housing, transportation, and health care, the judges said.

Assisted by a research and advocacy project of the National Council on Juvenile and Family Court Judges, these and other judges are using a combination of model courts, wraparound services, community interventions, training in implicit race bias at all levels of the system, and other creative methods to reduce the number of children who are placed in foster care. Already, their data show they are having an impact in their respective communities.

Alarming call for preventive detention of children

In the discussion period following their presentation, the judges said they are turning away from ordering psychological reports except when a parent has a genuine, severe mental disorder. They gave two reasons for this. First, psychological evaluations are costly. Second, and more important, the judges do not find it helpful to "slap" pathologizing psychiatric labels on parents. They expressed curiosity as to whether and how we in the field of psychology are working to address the effects of poverty and racism in the populations we serve.

Sadly, the honest answer is that many forensic practitioners and scholars are not adequately addressing the impact of larger social forces -- poverty, race, trauma -- on the people we evaluate, treat, and/or study. Perhaps the sparse attendance at the judges' presentation as compared with other seminars in the forensic juvenile justice track is an indicator of this neglect.

Indeed, at a more well-attended session came a chilling proposal at the polar opposite extreme: To establish a system to preventively detain dangerous juveniles. Raising this "public safety" proposal was attorney Christopher Slobogin, a co-author of the forensic psychology stalwart Psychological Evaluations for the Courts. It will formally air in a book, Juveniles at Risk: A Plea for Preventive Justice, forthcoming from Oxford University Press. Slobogin has good intentions, I am sure; he believes such a model will treat juveniles more fairly and help stem the erosion of the separate juvenile justice system.

But the proposal has potentially far-reaching unintended consequences. It myopically ignores what the family court judges and attorney Stevenson are so painfully aware of: The differential treatment of poor and minority children. It is hard to accurately predict juvenile risk, and actuarial risk prediction tools are especially inaccurate when applied to juveniles. This is just the type of nebulous decision-making situation in which implicit (unconscious) biases are most salient, research shows. Forensic psychological evaluations would provide a scientific veneer, masking racial and class biases in deciding who is labeled as dangerous and who is not.

Rather than locking up kids for crimes they have not (yet) committed, we should be working to give young victims of trauma and abuse -- and their families -- the practical resources and tools they need to lead productive lives. Let's hope the field of psychology and public policymakers heed the pleas of the judges and attorneys in the trenches who are fighting to save kids before they get sucked into the "cradle-to-prison pipeline" in the first place.

August 2, 2010

Global alarm mounts: "Will anyone be normal?"

What do some of the world's top mental health experts have in common with best-selling British author Sir Terry Pratchett, the former prime ministers of Australia and Norway, and Kurt Vonnegut Jr.'s son, memoirist Mark Vonnegut? All are issuing calls of alarm over the DSM-5, the American Psychiatric Association's upcoming diagnostic manual, in a special issue of the Journal of Mental Health.

Due to their important public policy implications, the Journal is making the lineup of commentaries available to the public for free. In a press release, the Journal points out that the previous DSM revision led to a wave of false "epidemics" of such conditions as attention deficit hyperactivity disorder, autistic disorder, childhood bipolar disorders, and that the new edition may lead to more of the same.

"The publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is one of the most highly anticipated events in the mental health field," explains Managing Editor Daniel Falatko. "This is the first major rewrite of DSM in 16 years and history has warned us that even small changes to this manual can have extraordinary repercussions in the diagnosis and treatment of mental health issues."

The theme running throughout the special issue is widespread fears in the psychiatric community that the expansion of diagnostic guidelines will allow everyone to qualify for psychiatric disorders, which in turn will lead to greater prescription of psychiatric drugs, many of which have unpleasant and dangerous side effects.

At a joint briefing, mental health experts expressed particular fear over the proposed "psychosis risk syndrome" diagnosis, which could falsely label young people who may only have a small risk of developing an illness.

"It’s a bit like telling 10 people with a common cold that they are 'at risk for pneumonia syndrome' when only one is likely to get the disorder," said Dr. Til Wykes of the Institute of Psychiatry at Kings College London.

The free articles, some by psychiatric patients, include:
Related news articles:
I have blogged extensively about the controversies surrounding the DSM-5. These prior blog posts can be conveniently accessed HERE.

Hat tip: Jane

July 20, 2010

Under duress, Georgia scales back sex offender law

Long-time blog subscribers may recall the case of Janet Allison, who became a homeless, jobless leper because she allowed her pregnant daughter's boyfriend to move into the family home. The state of Georgia has now scaled back that residency restriction law in an effort to prevent the courts from overturning it altogether.

Georgia had lost a series of legal challenges brought by human rights activists over the nation’s most draconian sex offender law. Attorney Sarah Geraghty of the Southern Center for Human Rights, which has been on the forefront of efforts to stem the tide of "fear-based" laws, gave a keynote speech about the law's inhumanity at the annual meeting of the Association for the Treatment of Sexual Abusers back in 2008.

About 13,000 -- or 70 percent -- of the men and women on Georgia’s sex offender registry will now be able to "live and work wherever they want," according to a report by Greg Bluestein of the Associated Press in yesterday's Atlanta Journal-Constitution. Residency restrictions will still apply to about 5,000 sex offenders who committed their offenses after 2003, but they will vary in scope. Among the changes, elderly and disabled offenders may also be exempted from residency requirements.

Iowa has also scaled back some of its restrictions under pressure from courageous prosecutors in that Midwestern state. As I blogged about back in 2007, Iowa prosecutors lobbied for repeal of residency restrictions because of their negative unintended consequences of encouraging sex offenders to disappear, making them more dangerous. "Most legislators know in their hearts that the law is no good and a waste of time, but they’re afraid of the politics of it," a spokesman for the Iowa prosecutors' association said at the time.

Related blog posts:
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July 15, 2010

"Consumed With Sex": Sex offender treatment in risk society

Tuesday's post on sex offender treatment has been reposted on several discussion boards and listservs and is getting some hits from Alltop, a kind of cool online psychology news service. In doing research for an article I am writing about sex offense prevention, I just came across another one that may interest many of you. It's based on ethnographic research by Dany Lacombe, a professor of sociology and anthropology at Simon Fraser University, at a sex offender treatment program up in Canada.

Dr. Lacombe ended up dubbing the program Sex Offender School because of the way that it indoctrinated sex offenders into internalizing a high-risk identity as "a species entirely consumed by sex." Her observational analysis, "Consumed With Sex: The Treatment of Sex Offenders In Risk Society," published in the British Journal of Criminology, is fascinating. Here is the abstract:
This ethnography of a prison treatment programme for sex offenders examines the meaning of rehabilitation in the context of the 'new penology.' As it explores how cognitive-behaviourism structures treatment, it uncovers a therapeutics grounded in risk that actively constructs the identity of the sex offender. It shows how the management of risk relies on techniques of introspection and self-discipline—a patient's internalization of his crime cycle and relapse prevention plan—that target primarily sexual fantasies. These self-policing techniques radically transform the sex offender into a species entirely consumed by sex.
I recommend the entire article, which can be requested directly by emailing Dr. Lacombe.

July 10, 2010

Normality endangered: "Psychiatric fads and overdiagnosis"

That's the title of this week's Psychiatric Times commentary by Dr. Allen Frances, chair of the DSM-IV Task Force and psychiatry professor emeritus at Duke University. The column begins:
Fads in psychiatric diagnosis come and go and have been with us as long as there has been psychiatry…. In recent years the pace has picked up and false "epidemics" have come in bunches involving an ever-increasing proportion of the population. We are now in the midst of at least 3 such epidemics -- of autism, attention deficit, and childhood bipolar disorder. And unless it comes to its senses, DSM5 threatens to provoke several more (hypersexuality, binge eating, mixed anxiety depression, minor neurocognitive, and others).

Fads punctuate what has become a basic background of overdiagnosis. Normality is an endangered species. The NIMH estimates that, in any given year, 25 percent of the population (that’s almost 60 million people) has a diagnosable mental disorder. A prospective study found that, by age thirty-two, 50 percent of the general population had qualified for an anxiety disorder, 40 percent for depression, and 30 percent for alcohol abuse or dependence. Imagine what the rates will be like by the time these people hit fifty, or sixty-five, or eighty. In this brave new world of psychiatric overdiagnosis, will anyone get through life without a mental disorder?
While focusing on the alarming spread of psychiatric diagnoses among children, as he has in the past Dr. Frances touches on the forensic implications of diagnostic freneticism:
Mental disorder labels can provide cover for societal problems. Criminal behavior has been medicalized (eg, rape as a psychiatric disorder) because prison sentences are too short and such labeling allows for indefinite psychiatric commitment.
Frances concludes:
The DSM-5 bias to thrust open the diagnostic floodgates is supported only by flimsy evidence that does not come close to warranting its great risks of harmful unintended consequences. It is too bad that there is no advocacy group for normality that could effectively push back against all the forces aligned to expand the reach of mental disorders.
The full essay is HERE.

June 28, 2010

How sex offender registries endanger kids

"Shred Your Sex Offender Map"
-- Forbes.com

That's the advice of Lenore Skenazy, author of the book Free-Range Kids and founder of the movement with the same name. Writing in her "Oddly Enough" column at Forbes, she gives three reasons why "the sex offender registry is making our kids LESS safe":
Recently I consulted my local Serial Killer Registry and found out I'm living next door to a guy who killed three lunchroom ladies when they refused to give him seconds on the chili!

Oh please. I'm kidding. There's no registry of murderers out there. There's no armed robber registry either. Not even one for drunk drivers. No, the only easily available registry for all Americans to consult is the Sex Offender Registry. Because ex-sex offenders are so much scarier than murderers?

No, the reason there's now a sex offender registry in every state ... is that sex offenders have become the focus of intense parental fear. Who could blame us moms and dads, when we hear about kiddie kidnappings 24/7 on the news? The problem is not with nervous parents. The problem is with the registries. Turns out, they're worse than useless.

They are making our kids LESS safe. How? Well, there are three big problems with the registry.
Skenazy's column, explaining the three essential problems, continues HERE.

June 21, 2010

Online alert: Ethics and peer review articles

I said I was done blogging about the psychopathy controversy for awhile. But I did want to alert readers to the fact that the International Journal of Forensic Mental Health has opened up its two articles so that you can download them for free for a limited time. Those articles pertain to ethics and the peer-review process. The articles are:

Click on either title to go to the downloadable pdf.

June 17, 2010

Psychopathy brouhaha: It's a wrap (I hope!)

Today's Scientific American has more on the censorship controversy I've featured here in recent weeks. As regular readers know, the flap centers around allegations that psychopathy researcher Robert Hare tried to silence critics by threatening to sue. The controversial article was finally published this month in the American Psychological Association publication Psychological Assessment, but the fallout continues.

The column by J.R. Minkel, oddly titled "Fear Review," features a rundown, including commentary by prominent scholar Stephen Hart:
People familiar with the matter say the scale's author, Robert Hare of the University of British Columbia, deserves only partial blame for the delay, to be shared with the American Psychological Association (APA), the journal's publisher. But they say Hare's use of legal threats has at best subverted the peer review process that is the crux of modern scientific progress, and could at worst encourage junior researchers in the field of forensic psychology to pursue other lines of research.

"I find this action to be completely inconsistent with the man I had [great] respect and affection for," says Stephen Hart of Simon Fraser University in British Columbia, a collaborator and former student of Hare's. "People I speak with automatically think, 'Well, what's in that article that makes him so upset? What's he so afraid of?'
After reading all of the publicly available materials on the controversy, as well as numerous email posts on professional listservs, here's how I boil things down to the essence:
  • The Skeem and Cooke article is an important scientific analysis of the theoretical construct of psychopathy, which is increasingly being used as a weapon in court with grave consequences for those it is deployed against.
  • Not surprisingly, Robert Hare disagrees with Skeem and Cooke. Specifically, he does not agree with their claim that his Psychopathy Checklist or the underlying psychopathy construct centralizes criminality.
  • Hare claims that Skeem and Cooke distorted his work. In a written response, he gives three examples of alleged distortions. Presumably, since he was preparing his response for publication, he picked the best examples he could find to illustrate his complaint. Yet, these are nowhere near as egregious as I had imagined they would be, given his threat to sue.
  • Hare accuses two well respected psychology-law leaders, Norm Poythress and John Petrila, of being biased and misinformed. But nothing in his response supports this. Poythress and Petrila, in their article in the International Journal of Forensic Mental Health that set this whole ball in motion, were careful not to take sides in the underlying scientific debate over psychopathy. Rather, they focused on the threat to academic freedom and science posed by threats to sue: "Academic freedom rests on the premise that advances in science can only occur if scholars are permitted to pursue free competition among ideas. This assumes that scholars have the liberty to do their work free from limitations imposed by political or religious pressure or by economic reprisals."
  • Hare has claimed elsewhere that his "lawsuit threat was meant only to get the 'attention' of APA, Skeem, and Cooke and force changes to the article." In his essay, he expresses bafflement at the ensuing, lengthy delay in the article's publication. To claim that his threat to sue did not contribute to the lengthy delay is either disingenuous or naïve. Especially in the wake of other controversies, such as the Rind debacle in which the U.S. Congress blasted the APA's publication and peer review process, the Association is undoubtedly very gun-shy and reactive over lawsuit threats.
The bottom line:

After analyzing all sides of the issue, I find that the Skeem and Cooke article is an important and timely contribution to the field, and that threats to sue over such publications set a dangerous precedent. As Poythress and Petrila point out in their commentary, potential negative effects of defamation threats against scientific researchers include -- among other things -- that:
  1. researchers avoid critical research out of fear of lawsuits,
  2. academics avoid volunteering as peer reviewers, and
  3. journal editors self-censor on controversial topics
Censorship -- or even the appearance of censorship -- is especially dangerous when it involves critique of a construct that may be used in a partisan manner in the forensic arena.

Hare is entitled to express his opinion, but nothing in his public response changes these bottom lines. Rather, as Jennifer Skeem notes in today's Scientific American piece, all of this peripheral controversy distracts from the scientific critique of psychopathy, including her critique that was silenced for three years before finally seeing the light of day.

I sure hope this is my last blog post for a while on this topic!

PRIVATE NOTE TO TODAY'S "ANONYMOUS" BLOG COMMENTER:
I regret that I had to reject your comment about the pecuniary angle from publication.
While I found it quite interesting, I had no easy way to substantiate its accuracy.

GENERAL NOTE TO COMMENTERS:
I encourage comments, but it's nice to know who is talking;
please consider signing your name (or at least a pseudonym).

June 12, 2010

New York Times covers psychopathy debacle

I had no idea when I broke the news of this censorship controversy that it would generate so much mainstream attention. First Science ran with it, and today it's made the New York Times; I am told other major U.S. and international news outlets have made inquiries. I hope this affair will serve as a dramatic lesson to others who might think about making legal threats when someone criticizes their work. The move certainly backfired against psychopathy guru Robert Hare.

Certain theories have weightier real-world implications than others. When a capital case defendant is labeled a "psychopath" in court, it can literally mean the difference between life and death. Similarly, the pejorative label has serious consequences for someone facing lifelong civil detention as a sexual predator. Thus, critical analysis of the reliability and validity of the underlying theory is essential. Researchers whose work lends itself to partisan forensic application should expect scrutiny.

Here's what Benedict Carey, health beat reporter at the New York Times, had to say:
Academic disputes usually flare out in the safety of obscure journals, raising no more than a few tempers, if not voices. But a paper published this week by the American Psychological Association has managed to raise questions of censorship, academic fraud, fair play and criminal sentencing -- and all them well before the report ever became public.


The paper is a critique of a rating scale that is widely used in criminal courts to determine whether a person is a psychopath and likely to commit acts of violence. It was accepted for publication in a psychological journal in 2007, but the inventor of the rating scale saw a draft and threatened a lawsuit if it was published, setting in motion a stultifying series of reviews, revisions and legal correspondence.

"This has been a really, really troubling process from the beginning," said Scott O. Lilienfeld, a psychologist at Emory University and a collaborator with one of the paper's authors. "It has people wondering, 'Do I have to worry every time I publish a paper that criticizes someone that I’ll get slapped with a lawsuit?' " The delay in publication, he said, "sets a very dangerous precedent" and censors scientific discourse….

Dr. Hare's clinical scale, called the Psychopathy Checklist, Revised, is one of the few, if not the only, psychological measures in forensic science with any scientific backing…. Dr. Skeem and Dr. Cooke warned in their paper that the checklist was increasingly being mistaken for a complete definition of psychopathy -- a broader personality construct that includes deceitfulness, impulsivity and recklessness, though not always aggression or illegal acts. The authors contended that Dr. Hare's checklist warps that concept by making criminal behavior a more central component than it really is…. {NOTE: The New York Times later issued a correction of the above portion that is in red; clearly, it's wrong to call the PCL "one of the few, if not the only," forensic psychology measures with any scientific backing!}

"When we first wrote the paper," [Jennifer Skeem] said, "we saw it simply as a call to the field to recognize we were going down a path where we were equating an abstract concept with a checklist, and it was preventing us from looking at the concept more closely."
Carey's full article is HERE. I will be sure to keep readers posted on any further developments.

POSTSCRIPT

This evening, readers alerted me that Robert Hare has posted a lengthy response giving his side of the controversy. His essay, "On Fairness in Academic Debate: A Commentary on Poythress and Petrila (2010) and Related Matters," claims that Poythress and Petrila's critical opinion piece in the International Journal of Forensic Mental Health (see my May 30 blog post) was biased and one-sided. He presents a timeline of the events surrounding the lengthy delay in publishing the underlying psychopathy article by Skeem and Cooke in Psychological Assessment, and gives specific examples of their allegedly egregious misrepresentations of his work. He comments:
… Poythress and Petrila and Hart failed to give an impartial and complete account of the situation. Their actions resulted in publication and circulation of a seriously biased account of events, and a commentary in the June 11 issue of Science, which noted that there are several sides to every issue…. I have no arguments with their thoughtful and commendable views about the nature of scientific debate and peer review, and about the potential fallout from threats of litigation…. I would welcome a formal investigation of the entire matter by an appropriately impartial body. I also would be willing to engage in open debate with the parties involved…. Contrary to the characterizations of others, I made extensive efforts to use the academic system in this case, but [the Skeem and Cooke] article went beyond the boundary of fair academic debate and criticism. The nature of the issue and the authors' refusal to correct their egregious statements gave me no reasonable alternative….

Would I do it again, given similar circumstances? Perhaps not, for like a whistle-blower the focus soon turns to the person who made the complaint and not on the issues and events that led to the complaint. Further, many in the scientific community believe that there are no grounds for litigation concerning academic works, no matter what the circumstances. I’ve learned from this experience that not all academics and scientists play by the accepted rules of science, and that legal redress for those claiming injustice is frowned upon by many as rocking the academic/scientific boat, however leaky it may be; a professional Catch-22 that serves to deny academics the legal rights enjoyed by the rest of the population.
His full statement is HERE. Again, I encourage readers interested in this subject to read Skeem and Cooke's Psychological Assessment article, rebuttal, and surrebuttal and form your own opinions.