Follow me on Twitter

I haven't been able to carve out much blogging time lately, despite an ever-growing list of worthy topics. If you would like more frequent updates from me, you can subscribe to my Twitter feed. Tweets are just brief headlines, directing you to other articles on the web. To give you a sample, I have just tweeted about (among other things):

• Guarding Grandpa: Illinois spending money it doesn't have to keep convicts who can barely walk behind bars
• Supreme court may decide if juveniles 14-and-under can be sentenced to life without parole
• Tucson rampage -- Wall Street Journal asks: Is There Really a Link Between Violence and Mental Illness?
• Autistic children immune to contagious yawn
• Dark side of Oxytocin: Hormone of the clan, not of universal brotherhood
• Secondhand TV linked 2 eating disorders among girls in Fiji
• New drug stockpile enough to kill 80 people
• Lucasville Five Hunger Strike Begins
• On Bradley Manning, Solitary Confinement, and Selective Outrage
• The Nazi and the Psychiatrist

For lots more interesting news, I also recommend you check out Vaughan Bell's great blog, Mind Hacks. His weekly "Spike Activity" roundup will keep you up to date on psychology news and views from around the globe.

Child abuse assessment: Special issue

Forensic psychologist Eric Mart has guest edited a special issue of the Journal of Psychiatry and the Law on assessment and testimony in cases of child abuse. The articles address both scientific and practical aspects of child abuse assessment, testimony, and research. They include:

Maternal Filicide and Mental Illness in Italy: This retrospective review co-authored by Geoffrey McKee, who has written books on filicide, and Alesandra Bramante compares the forensic characteristics of mothers with and without severe mental illness who killed their children.

Interviewing Immigrant Children for Suspected Child Maltreatment: Lisa Aronson Fontes examines challenges posed in forensic interviews of immigrant children when there is a suspicion that these children may be victims of child abuse or neglect. Suggestions are made
for interviewers regarding the interview setting, preparations, building rapport, conveying respect, narrative training, pacing the interview, and trauma symptoms that may stem from issues unrelated to the abuse.

Persistent Problems with the "Separation Test" in Munchausen Syndrome by Proxy: Munchausen syndrome by proxy remains a controversial diagnosis because information is easily tainted to make the mother appear responsible for her child’s symptoms. Loren Pankratz critiques (and offers alternatives to) the “separation test,” a scientifically problematic procedure that is often used to gather evidence against the mother.

Common Errors in the Assessment of Allegations of Child Sexual Abuse: Finally, the special issue editor himself tackles common errors in the complex, challenging, and high-stakes undertaking of assessing CSA allegations. After reviewing frequent causes of substandard investigations, the illustrious Dr. Mart provides ideas for research-based methods to improve the situation.

Little New England state serious about its motto

"Live Free or Die" even applies to sex offenders

In most of the 20 U.S. states with civil commitment statutes for sex offenders, the costs are staggering. As I have reported previously, millions of dollars are being spent to prosecute and detain certain recidivist sex offenders, while public school teachers must beg for basic supplies like pencils and paper.

New Hampshire is a dramatic exception. Since passing its civil commitment law four years ago, it has civilly committed only two men.

Yes, only two. William Ploof and Thomas Hurley. Both, not surprisingly, had sexually assaulted boys, not girls or women.

The dearth of commitments was a big surprise, according to an AP article by Norma Love. The state’s Corrections Commissioner had set aside 10 psychiatric beds and thought those would be overrun. The chief public defender had hired three new attorneys and a legal secretary and opened a new office in anticipation of a flood of cases. He's since laid off most of the new staff.

Of the many hundreds of cases referred to prosecutors for review, just eight have been found to merit prosecution. In the United States as a whole, more than 5,000 sexual predators are confined indefinitely.

Some attribute New Hampshire's reticence to preemptively detain citizens to its civil libertarian philosophy, as manifested by its state motto. The state does not require seatbelts or helmets and rarely pursues the death penalty.

But also, there seems to be no rabid political or citizen lobby like elsewhere. A spokeswoman from the Coalition Against Domestic and Sexual Violence, for instance, said her group is fine with the law's implementation. Amanda Grady told the AP reporter that she trusts New Hampshire's prosecutors to pick the option that best fits the individual case -- whether it be monitoring felons through parole, civil commitment or the state's sex offender registry.

Could this be a little spark of rationality and common sense (as opposed to moral panic) in crime policy in 21st century America? If so, three cheers for The Granite State.

Supermax: Hell on earth or . . . not as bad as we thought?

I thought everyone knew that being locked up alone in a tiny cell -- sometimes for years at a stretch -- is bad for one's psyche.

But I was wrong. Based on a one-year project with the Colorado Department of Corrections, a group of researchers says there is a dearth of evidence to support the popular notion that solitary confinement exacerbates psychiatric symptoms among mentally ill prisoners. Although the prisoners they studied did manifest problems, these were preexisting and so could not be attributed to the effects of administrative segregation confinement, the researchers contend.

I was dubious when I heard the researchers present their study, "One-Year Longitudinal Study of the Psychological Effects of Administrative Segregation," at the APA's annual convention last year. Having worked in a Segregated Housing Unit ("SHU") for mentally ill prisoners, I saw with my own eyes the rapid and profound mental deterioration of mentally ill prisoners assigned to the SHU.

Even prisoners who had no preexisting mental disorders fell apart when subjected to prolonged isolation. I will never forget one youngster, a first-timer incarcerated for violating probation in a minor stolen property case, who was sent to the SHU for protection after he reported being raped by his cellmate. They ended up taking him out on a stretcher following a serious suicide attempt. The last time I saw him, when I visited him on the medical ward of a maximum-security prison, he was completely changed from the happy-go-lucky kid I had known.

But he started out healthy. Maybe, contrary to popular wisdom, the mentally ill -- at least those in Colorado -- have more robust psyches than everyone else. Or maybe they are asocial or masochistic. Anyway, I'm just telling you my own personal anecdotes. That's not science.

Study under fire

The report just came out, and already it is generating a lot of heat from those who fear it will be used to legitimize continued warehousing of mentally ill prisoners in SHU's. The ACLU has issued a statement pointing out that the Colorado findings contradict a sizeable body of research, not to mention common sense.

Two leading experts on prison conditions, psychiatrists Terry Kupers and Stuart Grassian, are publicly assailing the study as fatally flawed. They criticize the researchers for not conducting interviews with the prisoners who were the subjects of the year-long study.

"The methodology of the study is so deeply flawed that I would consider the conclusions almost entirely erroneous," said Kupers, author of Prison Madness: The Mental Health Crisis Behind Bars. "And far from finding 'no harm,' there were many episodes of psychosis and suicidal behavior during the course of the study -- the researchers merely minimize the emotional pain and suffering because they judge the prisoners to have been already damaged before they arrived at supermax."

Grassian, the former Harvard professor who coined the term segregation psychosis and who has done research with hundreds of prisoners in solitary confinement, said he notified the researchers of several severe methodological flaws, including a failure to analyze contradictory data, but the flaws were not addressed.

Grassian said the prison's own records document almost two incidents of suicidal or self-destructive behavior for every three prisoners in solitary confinement (63%), compared with less than one incident for every ten prisoners (9%) in the general population.

Since the supermax craze took off in the early 1990s, almost every U.S. state has signed on to the dubious concept, and an estimated 25,000 American prisoners are now locked 24/7 in these tiny, antiseptic cubicles. Although SHU housing was originally intended for relatively short terms of confinement, nowadays prisoners may remain in these constantly lit and electronically surveilled sensory deprivation holes for years -- or even decades. A federal court recently agreed to hear a challenge brought by a man named Tommy Silverstein who has spent a whopping 27 years in solitary confinement.

If they had just talked with the prisoners …

While the Colorado correctional researchers were busy tabulating survey data instead of talking with the prisoners themselves about their subjective experiences, a graduate student at the University of California at Berkeley took the exact opposite approach, and -- not surprisingly -- came to diametrically opposed conclusions.

Keramet Reiter's series of in-depth interviews with former SHU prisoners in California, far and away the world's leader with about 3,330 SHU prisoners, was part of her research into the rise of supermaximum confinement in America.

The settings that the men chose was telling in and of itself: After years in tiny, concrete-filled boxes, almost all asked to meet her either outdoors of close to a window.

Reiter told UC reporter Cathy Cockrell that she was moved by the former prisoners' tragic accounts of the effects of sensory deprivation.

"People spoke of having no clocks, daylight, or seasons to mark the passage of time; growing pale from lack of sunlight; and being amazed at the sight of a single bird, insect, or even the moon, after months or years of virtually no exposure to the natural world."

But, hey, maybe if they had been mentally ill to start with, they wouldn't have minded ad-seg so much. Just a serene vacation, away from the hubbub and stress of general population housing.

Not a vacation I would ever want to take but, hey, that's just me.

Further readings:

• Keramet Reiter: Parole, snitch or die: California’s supermax prisons and prisoners, 1987-2007, July 7, 2010

• Atul Gawande, New Yorker magazine: Hellhole: The United States holds tens of thousands of inmates in long-term solitary confinement. Is this torture? March 30, 2009

• National Public Radio series: "Life in Solitary Confinement"

• Solitary Watch: On Bradley Manning, Solitary Confinement, and Selective Outrage, by Jean Casella and James Ridgeway, Jan. 2, 2011

Drawings: (1) Prisoner sketch by Herman Wallace, Louisiana State Penitentiary, Angola; (2) prisoner sketch, Pelican Bay, California; (3) prisoner sketch, Tommy Silverstein, ADX federal supermax, Florence, Colorado; (4) prisoner sketch, Pelican Bay, California; (5) my (comparatively crude) sketch of a suicidal prisoner whom I observed chained to the floor of a bare concrete "protective" cell.

My Psychology Today post, at my blog Witness, is HERE. For more frequent posts by me on this and other topics, subscribe to my Twitter feed, HERE.

Another Texan joins growing club of exonerees

30 years in prison for rape he did not commit

He could have been free six years ago. But he could not get past even the first of the sex offender treatment program's "four R’s" -- Recognition, Remorse, Restitution and Resolution.

Instead, Cornelius Dupree Jr. continued to stubbornly insist he was innocent of the robbery and rape for which he went to prison 30 years ago.

Today, Dupree finally won back his good name, becoming the latest in a flood of exonerated convicts in Dallas, Texas. District Attorney Craig Watkins, the first African American elected prosecutor of any county in the state, actively supports innocence projects. Like Dupree, the majority of the exonerated men are African American and were convicted of sexual assaults.

By local tradition, many of the other exonerated men attended Dupree's court hearing on Tuesday. Many said they too had been convicted based on eyewitness misidentification, the most common cause of wrongful convictions.

The moral: Do not assume that someone who has been convicted of a crime is lying, just because he or she is denying guilt. Every once in a while, it's true.

An Associated Press article with more case details is HERE.
The Dallas Morning News has an excellent series on the DNA exonerations, HERE.

Prison therapy: It's all in the name

Look at the above picture. What do you see? You should see a monkey in a cage. (More precisely, a capuchin monkey rescued from a laboratory.)


Now look at the second picture. If you again see a cage (or two), your eyes are playing tricks on you. These are not cages. They are "therapeutic modules." It's the California prison system's response to a judicial mandate to provide treatment to mentally ill prisoners.

Using the correct term is important, according to a psychiatric expert quoted by Jack Dolan in today's Los Angeles Times: "If you call them cages, people inside might feel like animals and respond accordingly."

Pictured here is music therapist Daniel Tennenbaum, wearing a flak vest as he strums a sing-along rendition of Otis Redding's "Sitting on the Dock of the Bay":

... I had nothin to live for
And look like nothing's gonna come my way ...
Look like nothing's gonna change
Everything still remains the same ...

I'm just sitting on the dock of the bay
Wasting time

One wonders whether the "therapeutic module" euphemism is truly for the benefit of the prisoners, or more for the psychologists providing window dressing, who want to think that therapeutic healing is possible under such cruel and inhumane conditions.

And if mere renaming can alter reality, then Mina over at Psydoctor8 has a better idea. We could refer to the prisons as "Hawaii." Then, the prisoners might feel like hula dancers instead of caged animals.

Best wishes for the holidays

As you may have noticed, I am taking a holiday break from blogging. Until my return, I want to wish all of you -- and especially my loyal subscribers -- a wonderful holiday season and a new year of peace and happiness.

Juvenile In Justice: An online gallery

Art professor Richard Ross is traveling the United States and photographing juvenile institutions. The project, Juvenile In Justice, is partially funded by the Guggenheim Foundation and the Annie E. Casey Foundation and will be published next year. The 196 photos in the online gallery are well worth checking out. While you are there, visit his related collection, Architecture of Authority. Stunning stuff.

From the top: Los Angeles, California; Cook County, Illinois; Biloxi, Mississippi

Blogger challenges my post on sex offender risk assessment

My report on a promising new method for assessing sex offender recidivism risk prompted a reaction from Robin Wilson over at a new blog by the publishers of Sexual Abuse, the journal of the Association for the Treatment of Sexual Abusers (ATSA).

My interest dissolved into disappointment when I realized that the response sidestepped substantive discussion of the new research, a collaborative project by scholars in the United States, New Zealand, and Australia finding that accuracy of risk prediction can be enhanced by using age-stratified tables.

Instead of engaging with the scientific merits of this study, Dr. Wilson focused on the Static-99 actuarial tool, chastising me for being overly critical of that approach:

Dr. Franklin has something of a penchant for the flamboyant. Actually, I often appreciate a bit of bluster, but I think we also need to avoid bias and unnecessary sideswipes at our colleagues. In the spirit of honesty, let me say that I work in a civil commitment center and that I am a certified trainer for the Static-99 group of measures. So, my potential bias is on the table.

Is having an opinion a form of bias?

The term bias refers to a partiality that interferes with the ability to be fair or objective. Expressing a point of view does not make one biased. Rather, the articulation of informed opinion advances professional practice. Indeed, such "expert opinion" is precisely what courts seek from forensic psychologists when they solicit our testimony. An expert witness is expected to have a firm grounding in the applicable science, and to be able to critically analyze its strengths and weaknesses as it applies to a specific issue or case.

It is that process of reflection -- invoking complementary theoretical perspectives from criminology, sociology, anthropology and international studies relevant to forensic psychology -- that germinates many an idea for this blog. I welcome critical engagement with these ideas, but hope that interlocutors can themselves refrain from diversionary ad hominem arguments.

Why pick on the Static-99?

Dr. Wilson's main theme is that I am unduly critical of the Static-99 and its developers.

The Static-99 website promotes the tool as "the most widely used sex offender risk assessment instrument in the world." As Dr. Wilson himself notes in another publication, its "prolific use in sexual offender civil commitment proceedings" is one reason it generates so much debate.

But Dr. Wilson is correct in pointing out that many of the Static-99's flaws apply equally to its cousins. In referencing the Static-99, I in no way intend to exempt other actuarials from critique. Indeed, in previous posts I have discussed problems with the MnSOST-R and have reported the results of studies on the relative accuracy of the Static-2002, Risk Matrix 2000, RRASOR and other actuarial tools.

Dr. Wilson makes an essential point in defense of the Static-99. By encouraging us to anchor our risk estimates in empirical data, he reminds us, actuarials serve as a counterbalance against clinicians' inherent tendency to vastly overestimate sex offender risk:

Maybe, what Dr. Franklin should be highlighting more is the fact that some evaluators are falling prey to partisan concerns. A well done sex offender risk assessment [using an actuarial instrument] should say the same thing, regardless of who you are working for.

In principle, Dr. Wilson is entirely correct. Sadly, from my vantage point as a forensic psychologist working in the courtroom trenches, I see endemic partisan allegiance in this arena. The Static-99 is being systematically deployed to provide a scientific veneer for highly questionable practices in the service of civil commitment.

The problem is not just a handful of rogue evaluators. The latest permutation of the Static-99 fosters such misuse. I am referring to the developers' advice to assign sex offenders to one of four categories with different levels of actuarial risk. As I pointed out in a previous post, this procedure introduces a large element of clinical judgment into a procedure whose very existence is predicated on doing away with such subjectivity. In the polarized Sexually Violent Predator arena, evaluators now have an easy way to elevate their estimate of an offender's risk by comparing the individual to the highest-risk group rather than to the lower recidivism figures for sex offenders overall. This practice reflects a tautology, or logical fallacy. In a civil commitment proceeding the evaluator essentially says: "This offender is high risk. Just look at the recidivism rates for offenders in the high-risk group to which I have assigned him."

The Static-99 developers may be quite well intentioned, as Dr. Wilson says. But subjective intent is far less important than real-life effects. The road to Hell, as they say, is paved with good intentions. I will not be alone in cheering when I hear that the Static-99 developers have stepped up and publicly condemned the systematic misuse of their instruments in courthouses all across the United States.

If Dr. Wilson's point was to chastise me for the use of the term reliability where I meant to say accuracy, I stand corrected. (I have made the correction to the original post.) However, I make no apologies for expressing an informed viewpoint and, indeed, I unflinchingly embrace such a role as part of my professional obligation. The goal of my blog is not to convince people that I have all the answers. Rather, I am happy if I encourage critical reflection and stimulate people to read the original source material. In so doing, I hope I am doing my part to advance science and combat bias.

The award-winning Texas blog Grits for Breakfast has a more favorable reaction, with links to additional topics of interest.

Another severe attack at Napa Hospital

Less than two months after a psychiatric technician was strangled to death, another staff member has been beaten unconscious at Napa State Hospital, California's largest psychiatric hospital. Already abysmal staff morale is sinking lower as tensions rise among the captive patients, whose privileges have been curtailed since October's slaying.

Four years ago, the U.S. Attorney General's Office negotiated a consent decree mandating sweeping changes aimed at improving patient care and reducing suicides and assaults at the troubled hospital. A federal probe had revealed widespread civil rights violations, including generic "treatment" and overuse of seclusion and restraints. Napa, the only state psychiatric hospital in Northern California, houses defendants undergoing competency restoration treatment and those found not guilty by reason of insanity.

Earlier this year, another scandal hit the hospital, when its executive director was arrested on 35 felony charges stemming from the alleged molestation of a foster son. He was suspected of molesting at least four other boys going back to the 1970s.

Lee Romney of the Los Angeles Times, who has provided the best coverage of California's troubled state hospital system over the past few years, reported that patients at Napa are increasingly agitated in the wake of greater restrictions on their movement, exacerbating an already bleak picture:

Since 2006, the state's mental hospitals have been under a federal court order to improve conditions for patients. Yet safety for both patients and staff has deteriorated markedly at Napa State Hospital over the last year, data show. The other state hospitals subject to the federal consent judgment have also experienced a rise in violence since the state began implementing changes in care.

In case you need a job, by the way, the hospital is hiring.

Hat tip: Kathleen

News flash: Epic trial ends with sanity verdict

It took a jury only five hours to decide that Brian David Mitchell does not meet Utah's legal definition of insanity, and to find him guilty of all charges in the 2002 kidnapping of Elizabeth Smart.

The high-profile case teems with issues of import to forensic psychology and psychiatry, including malingering and the boundary between delusions and extreme religious beliefs.

The trial, as in the many past hearings, featured dueling experts. On one side was prominent New York City psychiatrist Michael Welner, who said Mitchell was sane and malingering a mental disorder to escape criminal liability. Defense attorneys criticized both Welner's fees, a whopping $750,000 (no, that's not a typo), and his methods. For example, he had FBI agents conduct about 30 interviews on his behalf, according to an Associated Press report by Jennifer Dobner.

On the other side was psychologist Richart DeMier, who evaluated Mitchell for 45 days at a federal prison in Missouri in 2008 and diagnosed him with paranoid schizophrenia. During his full day of testimony, DeMier was vigorously questioned about the sometimes-muddy distinctions between delusions and extreme religious views, a central issue throughout this case. He testified that the distinction is not an exact science, and that mental illness is not always black and white, according to a report in the Deseret News.

Experts also dueled ferociously at Mitchell's competency hearing last year. At one point during testimony by Jennifer Skeem, a forensic psychologist from California who grew up in Utah, the proceedings "seemed less about issues relating to Mitchell's competency and more about what she believed was 'character assassination' " by Welner, according to a Deseret News report. "I'm not a hired gun who intentionally collaborated with an unethical defense team," Skeem told the court.

Crazy or not, the self-styled prophet maintained his typically bizarre behavior during the reading of the verdict, loudly singing the hymn, "He Died, the Great Redeemer Died."

Judge Kimball’s 149-page competency ruling, which I highly recommended to any of you who do competency work, is HERE.

My previous coverage of this fascinating case, with links to other reports, includes:

• Mitchell to plead insane (July 6, 2010)
• Mitchell labeled as malingerer, ruled competent (March 1, 2010)
• "Legal pointillism": New approach to competency (Dec. 8, 2009)
• Record-breaking fee for competency report? (Dec. 4, 2009)
• Utah court: OK to forcibly medicate accused kidnapper (Dec. 17, 2007)

Graphics credit: Scott Snow, KSL

Crazy Like Us: The Globalization of the American Psyche

A successful virus is adaptive. It evolves as needed to survive and colonize new hosts. By this definition, contemporary American psychiatry is a very successful virus. Exploiting cracks that emerge in times of cultural transition, it exports DSM depression to Japan and posttraumatic stress disorder to Sri Lanka.

Journalist Ethan Watters masterfully evokes the heady admixture of moral certainty and profit motive that drives U.S. clinicians and pharmaceutical companies as they evangelically promote Western psychiatry around the globe. On the ground in Sri Lanka following the tsunami, for example, hordes of Western counselors hit the ground running, aggressively competing for access to a native population "clearly in denial" about the extent of their trauma. Backing up the foot soldiers are corporations like Pfizer, eager to market the antidepressant Zoloft to a virgin population.

Watters has done his homework. Each of his four examples of DSM-style disorders being introduced around the world is rich in compelling historical and cultural detail. Despite their divergences, each successful expansion hinges on the mutual faith of both the colonizers and the colonized that Western approaches represent the pillar of scientific progress.

My review of Crazy Like Us, an engaging and enlightening book that I highly recommend, continues HERE.

Watters' Jan. 8, 2010 essay in the New York Times, "The Americanization of Mental Illness," is HERE.

Age tables improve sex offender risk estimates

First, how old is the bus driver?

If 30 people are riding on a bus, and 30 more people board the bus, how old is the bus driver?

The answer, many second-graders will assure you, is 60. (They know your question involves numbers, but they don't quite get the concept.)

Clinical psychologists are a bit like that. Most of us were not drawn to the field by a deep and abiding passion for numbers. This puts some in a quagmire when they jump into forensic work, and courts order them to predict future events with a high degree of mathematical precision.

Illusion of certainty, certitude in illusions

Since passage of the Psychologist Full Employment Act,* I have observed a growing group-think among government sex offender evaluators in particular. At the annual meetings of the Association for the Treatment of Sexual Abusers (ATSA), crowds flock to hear self-appointed gurus give the latest in a series of ever-changing instructions about how to use their pet formulas, freely available online, that promise to take the guesswork out of risk assessment.

Psychologists who lack statistical sophistication are especially likely to swoon over fancy-sounding terms such as receiver operating characteristics (ROC) and to overlook the gaping flaws in current actuarial methodology. Instead of deriving from sound scientific principles such as random sampling, the tools are strung together from a motley collection of random data, much of it never published or subjected to peer review. As I have reported in the past, the Static-99 family of instruments are not very accurate, and tend to err in the direction of overestimating risk.

So, what about that bus driver?

Getting back to the bus driver: Let's say the second-graders happened to be right, and he really is 60 years old. What are the odds that he will be arrested for a sex crime, given that he recently served time for sexual assault? (I know, I know. What bus company would have hired him? But, play along with me here.)

If you asked a randomly selected passenger aboard the bus, the answer would be close to 100%.

But as you know, the public drastically overestimates sex offender recidivism rates. Let’s say that in reality, the average sex offender who scores in the low range on actuarial risk instruments has a 5% chance of sexual recidivism, while the average high-scoring offender has a 29% risk. Obviously, without knowing more about the bus driver, all you can say is that his risk of reoffense is somewhere between 5% and 29%.

But that too would be wrong. Because of his age, the bus driver's recidivism risk over the next eight years is more in the range of 2.7%.

Which is probably lower than the risk of a passenger getting trampled if you hollered out, “Eek! Sex offender!”

Good news: Age-stratified tables improve accuracy

The single most robust finding of two centuries of criminological research is that desistance from crime is near universal. As they age, criminals stop offending. This holds true across all eras, cultures, and offender groups. Sex offenders are not exempt from this pattern. As their libidos decline, they too settle down or burn out. Unfortunately, this “age invariance effect,” as it has been called, has trouble filtering down into the muddy waters of the sex-offender industry. (See my online review of the book Desistance in the Open Access Journal of Forensic Psychology for more discussion of this.)

When age is not properly taken into accounting in estimating risk, the risk for older offenders -- such as our bus driver -- is overestimated, while the risk of younger offenders is underestimated.

Now, a collaboration by scholars from the United States, New Zealand, and Australia reveals that the accuracy of sex offender risk prediction can be significantly improved by using age-stratified tables to calculate risk.

The researchers tapped into an electronic database of all sex offenders in New Zealand who were released from prison over a 15-year period. They combined the data on those 5,880 offenders with recidivism data on 3,425 offenders published by Static-99 developer Karl Hanson in 2006, to develop what they call a "Multisample Age-Stratified Table of Sexual Recidivism Rates" (MATS-1).

Using Bayes's Theorem, the researchers were able to calculate likelihood ratios for different levels of risk. (Bayes's Theorem speaks to the probability of an event, taking into account both the phenomenon's base rate and the accuracy of a test. Cognitive scientists regard the Bayesian method as the gold standard, often using it synonymously with rational reasoning.)

Overall, the recidivism base rate of their combined international sample was 9% over a 10-year period, which is consistent with other reported research. Dividing offenders into three levels of risk based on their scores on actuarial risk instruments, the researchers found that those with low risk scores had an average 5% risk of reoffense within eight years, as compared with 12% for medium-risk offenders and 29% for offenders with high scores. By dividing sex offenders into various age groups, they were able to come up with more precise estimates of risk (see below table).



Evaluators should use this type of age-stratified procedure when giving estimates of recidivism risk, particularly for older offenders, the researchers advise. Estimating an offender's probability of recidivism based on the observed proportion of recidivists in a population is more accurate than relying on a set of untested assumptions. It is also much simpler and easier to explain to a trier of fact.

I highly recommend the article, published in the current issue of Sexual Abuse, which goes into a great deal of detail about the method and its superior stability and accuracy. The authors are Richard Wollert of Washington State University and the Mental Health Law and Policy Insitute at Simon Fraser University in Canada, Elliot Cramer, a statistician and professor emeritus from the University of North Carolina-Chapel Hill, Jacqueline Waggoner of the University of Portland, Alex Skelton of the New Zealand Department of Corrections, and James Vess of Deakin University in Australia. Request reprints from the first author (HERE).

Related blog posts:

• Delusional campaign for a world without risk (April 3, 2010)
• Static redux: Sandgropers jumping off rickety ship (Sept. 23, 2010)
• SVP industry sneak peek: Problems in Actuaryland (Oct. 4, 2009)
• New study: Do popular actuarials work? (April 20, 2010)
• Study: Actuarials fail to predict sexually violent recidivism (March 5, 2010)

For a good introduction to Bayesian reasoning, see Eliezer Yudkowsky's tutorial, "An Intuitive Explanation of Bayes' Theorem."

*The Psychologist Full Employment Act is the label conferred on the Sexually Violent Predator (SVP) laws by a leading psychology-law scholar in a recent plenary address.

Prison overcrowding: Chickens coming home to roost

U.S. Supreme Court to hear critical California case

When is the last time you heard of prisoners and prison guards teaming up in a legal case?

They are united on the same side in a case set to be argued in front of the U.S. Supreme Court on Tuesday.

The case concerns prison overcrowding in California, where about 164,00 prisoners are crowded into facilities designed to hold less than half that number. The state is fighting a federal district court that the massive population must be cut by 40,000 to allow for minimally adequate mental health and medical treatment.

“The case is being widely watched across the U.S, as other states grapple with California-style problems: tough sentencing laws that filled up prisons even as the economy battered state budgets,” write Joanna Chung and Bobby White in today’s Wall Street Journal. Eighteen states have filed briefs backing California in the case of Schwarzenegger vs. Plata, arguing that releasing prisoners would threaten public safety.

The issue of inadequate mental care in California prisons has been in the courts since 1991, when Ralph Coleman filed a lawsuit that was eventually merged with prisoner Marciano Plata’s similar lawsuit of 2001. The district court appointed an independent expert to oversee prison health care. That expert, law professor Clark Kelso, believes the court-ordered reductions in the prisoner population are needed to achieve "sustainable constitutional health care" in the face of continued prison construction.

As Chung and White report:

The rare alliance of California's powerful prison guard union and the inmates illustrates the severity of the situation, legal experts say. "It should not be a surprise to anyone that the chickens have come home to roost after a series of disastrous policy choices that has landed California in this position," says David Fathi, director of the American Civil Liberties Union's National Prison Project, which has filed a brief on behalf of the inmates….

Tough sentencing laws enacted by the state during the 1990s, including the three-strikes-and-you're-out law, as well as a parole crackdown that's returned violators to return to prison even for minor infractions, fueled the dramatic rise of California's prison population….

When Edmund G. "Jerry" Brown Jr. first was governor in the 1970s, California's prisons housed more than 20,000 inmates. When Mr. Brown, who won back his old job in this month's elections, returns to office in January, he will oversee more than 160,000….

The California Correctional Peace Officers Association, the 30,000-strong prison guard union, says the state's current strategy of building more prisons at home and shipping overflow inmates to out-of-state private penitentiaries won't solve the long term trend. Ryan Sherman, an association spokesman, says: "You can't build your way out of this.... We need real reform, not a numbers game."

Mr. Sherman wants the state to invest in more medical staff and equipment to address the poor conditions that instigated the lawsuits. While the prison population rose dramatically over the last few year he says the state never kept pace with investments in doctors and nurses and better health facilities.

Meanwhile, the state California faces a $6 billion shortfall for the current fiscal year ending June 30 and a $19 billion shortfall for the next fiscal year, according to the nonpartisan state Legislative Analysts Office.

"The way that California ends up dealing with this problem will be an example for other states with massive budget problems and overcrowded prisons to watch and learn from," says Anthony S. Barkow, head of New York University law school's center on criminal law, which filed a brief on behalf of the inmates.

Hat tip: Kathleen

Postscript: An update on Tuesday's hearing can be found HERE. Meanwhile, as reported HERE, California is responding to the threat of a population cap by frantically shipping prisoners to private prisons in other states. Medical and mental health care is much worse in these privately run institutions, where violence is not only tolerated but may be encouraged, according to an Associated Press news story (with video of an incident in a private prison in Idaho). (By the way, did you know that the private prison industry, hankering for more captive bodies, helped author Arizona's anti-immigrant law? That fascinating story is HERE.) KALW radio has some good background on the crisis, including an audiotaped report on medical care at San Quentin.

The Psychology of jury voir dire

How many times have you debriefed jurors after they rendered their verdict and been surprised by what they told you? Jurors don't deliberate based on facts and argument. They deliberate based on their perception of the facts and arguments. And it is the juror's belief system that accounts for the varying way that jurors perceive facts and arguments.

That is the start of an informative how-to piece in The Jury Expert by psychologist Matthew L. Ferrara, a trial consultant based in Austin, Texas.

The current issue of The Jury Expert has several other interesting articles, including:

• Police deception during interrogation and its surprising influence on jurors' perceptions of confession evidence by Krista D. Forrest & William Douglas Woody

• Do we need Einsteins in the jury box? The role and impact of juror IQ by Alison Bennett

• What the literature tells us about the jury foreperson by Traci Feller

Photo: "The Jury," John Morgan, 1861 (Public domain; source: Wikimedia commons)

Death row logjam in California

L.A. Times: Critical shortage of appellate lawyers

With 700 prisoners, California's Death Row is the largest in the United States. But almost half of the condemned will not be executed any time soon; they are still waiting for attorneys to handle their appeals.

Despite a glut of attorneys in the state, few are willing or qualified to tackle post-conviction appeals. Each condemned prisoner gets an automatic appeal to the state supreme court, after which they can file a habeas corpus petition challenging their conviction. The wait for habeas counsel averages 10 to 12 years, a bottleneck that the state's high court calls "critical."

The work is draining both emotionally and financially, say the few attorneys who do habeas work.

"It's a big toll on people to have clients on death row," attorney Lynne Coffin told Los Angeles Times reporter Maura Dolan. "Even if they are nowhere near execution, they are very needy. Most have no family connections anymore, no money, no friends, so the lawyer becomes the source of everything."

Coffin, who at 61 years old handles capital cases almost exclusively, said witnessing the executions of two clients was disturbing. "And I am not going to any more."

The full story, in today's L.A. Times, is HERE.

High cost a factor in public support for death penalty alternatives

Meanwhile, a national poll of 1,500 registered voters shows growing support for alternatives to the death penalty. A majority of voters (61 percent) would choose a punishment other than the death penalty for murder, including life with no possibility of parole and with restitution to the victim’s family (39 percent), life with no possibility of parole (13 percent), or life with the possibility of parole (9 percent), said the center, which opposes capital punishment.

Sixty-eight percent of those surveyed said cost was a very or somewhat convincing argument against the death penalty. Voters ranked emergency services, creating jobs, police and crime prevention, schools and libraries, public health care services, and roads and transportation as more important budget priorities than the death penalty. Two-thirds of those surveyed would favor replacing the death penalty with life with no possibility of parole if the money saved were used to fund crime prevention programs.

The survey was conducted by the Death Penalty Information Center, which opposes capital punishment. It can be found HERE.

How the Black man became schizophrenic

Psychiatry, the DSM, and the Black Power movement

Once upon a time, a strange thing happened at the Ionia State Hospital in Michigan: A diagnosis of schizophrenia exited the body of a white housewife, flew across the hospital, and landed on a young Black man from the housing projects of Detroit, burrowing into his body and stubbornly refusing to leave.

As you may know, Black men in the United States (as well as in the United Kingdom) are disproportionately diagnosed with schizophrenia. What you may not know is when this pattern emerged, or why.

Up until the 1950s, the overwhelming majority of those diagnosed with schizophrenia were white. They were the delicate or eccentric -- poets, academics, middle-class women like Alice Wilson in Jonathan Metzl's The Protest Psychosis, "driven to insanity by the dual pressures of housework and motherhood."

Then, in the mid-1960s, the Long Hot Summers hit urban America. Smoldering anger over racism and poverty erupted into mass rioting and harsh repression. In Detroit, a police raid on a party triggered an uprising that left 43 dead, 1,189 injured, and more than 7,000 arrested. Convinced that they would never win civil rights through sit-down strikes, a nascent Black Power movement became increasingly militant.

Coincidentally, just as this urban unrest was reaching its zenith, the American Psychiatric Association was busy revising its Diagnostic and Statistical Manual of Mental Disorders (DSM). Published in 1968, the DSM-II was touted as a more objective and scientific document than its 1952 predecessor.

"However, the DSM-II was far from the objective, universal text that its authors envisioned," writes Metzl, a psychiatry and women's studies professor and director of the Culture, Health and Medicine Program at the University of Michigan. "In unintentional and unexpected ways, the manual’s diagnostic criteria -- and the criteria for schizophrenia most centrally -- reflected the social tensions of 1960s America. A diagnostic text meant to shift focus away from the specifics of culture instead became inexorably intertwined with the cultural politics, and above all the race politics, of a particular nation and a particular moment in time."

The psychoanalytically imbued "schizophrenic reaction" of the DSM-I was an illness meriting pity and compassion rather than fear. In contrast, the DSM-II's more biologically oriented schizophrenia was menacing and required containment. In particular, the language that described the paranoid subtype foregrounded "masculinized hostility, violence, and aggression," implicitly pathologizing militant protest as mental illness.

Almost overnight, the previous class of schizophrenics at Ionia State Hospital was relabeled with depressive disorders. As the formerly schizophrenic exited the hospital en masse in the wake of the Community Mental Health Centers Act of 1963, their places were taken by a new class of schizophrenics -- volatile young Black men from inner-city Detroit.

A mountain of archived charts from the defunct asylum at Ionia provided the raw material for The Protest Psychosis. In his four years of sifting through the treasure trove of data, Metzl found clear evidence of shifting racial and gender patterns in diagnosis. Because the DSM-II was published in the days before computers, clerk typists simply used hatch marks (/) to mark out the old diagnoses, leaving them clearly legible alongside the new.

Randomly selecting a subset of charts of white women patients, Metzl found schizophrenic diagnoses crossed out, and replaced with labels such as Depressive Neurosis or Involitional Melancholia.

In contrast, the charts of African American men saw Psychopathic Personality crossed out to make way for the DSM-II’s schizophrenia, paranoid type.

Neither set of patients had undergone a sudden metamorphosis. Their observable symptoms and behaviors, as documented by their chart notes, remained the same. The only thing that changed was the diagnostic manual.

Metzl is a lyrical writer who has thought deeply and profoundly about this topic. His asylum tragedy does not point fingers or blame the individual psychiatrists of the asylum. They, too, were victims of time and place, just doing their job. Doing it, indeed, by the book.

Lessons learned, or lessons lost?

The lessons of Ionia can be applied to almost any diagnostic saga. Today, the message -- if we choose to listen -- is especially profound. As Ethan Watters explores in Crazy Like Us, American psychiatry is sweeping the globe like a virus, importing PTSD to Sri Lanka and Western-style depression to Japan.

Big Pharma is responsible for much of this McDonald's-like expansion. The pharmaceutical industry is far and away the most profitable business in the United States, and accounts for almost half of the $650 billion-plus global market. In its quest to enlarge profits, this industry perpetually seeks to expand the range and scope of illness. As Christopher Lane describes in Shyness, this expansion is especially easy with psychiatric illnesses, because of their nebulous nature and subjective boundaries.

But Big Pharma did not revamp schizophrenia back in 1968. Nor were nefarious doctors consciously seeking to re-enslave a rebellious race. Like treatment providers today, psychiatrists undoubtedly saw themselves as helpers, even as they functioned as agents of social control, naturalizing today’s long-term containment and incapacitation of African American men.

Psychiatry, as Metzl points out, is inherently focused on the molecular. With their focus on matching individual symptoms to diagnostic codes, the psychiatrists who replaced one diagnosis with another were blind to how institutional racism shaped their choices. Nor did they reflect on their own internalization of the era’s cultural anxiety over menacing Black men, an anxiety that linked mental illness, protest, and criminality.

A focus on the micro-level blinds the actors to the larger forces at play, which construct the very frames governing observations and actions. Larger social and institutional forces rather than conscious intent on the part of individual actors typically drive bias, especially in the 21st century. This explains why “cultural competence” training programs are at best useless, and at worst reinforcing of stereotypes.

We are currently entering another period of diagnostic revision. What I find fascinating is how earnestly the proponents of new and expanded psychiatric diagnoses believe that they are agents of progress, advancing better science as opposed to ideologically driven agendas. Mesmerized by their own brilliance, they wear blinders that prevent them from seeing the larger cultural systems in which their ideas are embedded.

But science is never pure. There is no one objective truth. There are myriad ways to categorize and catalog. Bias is inherent in what is foregrounded and what, in turn, is neglected or ignored. Reification, in which hypothetical categories are transformed into tangible and real objects, keeps us from recognizing and naming the larger systems that dictate these choices.

Occasionally, a historian like Metzl comes along to sift through archival evidence and shine a spotlight on historical biases. But the biases inherent in the present moment remain largely invisible. With the arrogance inherent in power, privileged scientists have no need to confront their own cultural assumptions, or reflect upon how the world might look from the perspectives of their subjects.

Sadly for all of us, as the old axiom goes, those who do not learn from history are doomed to repeat it.

The book is: The Protest Psychosis: How Schizophrenia Became a Black Disease. An online essay adapted from the book is HERE. Metzl is also the author of Prozac on the Couch, Prescribing Gender in the Era of Wonder Drugs and editor of a book forthcoming from NYU Press, Against Health: How Health Became the New Morality. A University of Michigan press release about his published work on "medicalization" is HERE.

If you enjoyed this essay, please visit my abbreviated review at Amazon and click on "YES." This essay is also available at my Psychology Today blog, Witness and at AfroDaddy: A Black Man's Survival Guide (sadly, that site is now defunct, but the post is still available via the ever-amazing Wayback Machine).

"How to Lie to Your Court Appointed Psychologist"

"Keep it simple, shallow and stupid --

the more pathetic the better"

YouTube's "GrannyWolf 007" identifies himself on his Star Chamber blog as Ryan Murray of Toronto, a cook. ("I govern the heat in meat and cheese until I judge it to be delicious.")

Hat tip: Joe Plaud