Arizona rampage: Analyzing the analyzers

It's an endless loop tape, spinning us in a vortex of irrationality so all-encompassing it almost starts to seem normal.

After every high-profile crime, experts charge out of their corners with their pet solutions: Restrict high-capacity gun magazines. Increase mental health services. Revise school or workplace procedures.

Conservative media psychiatrist Sally Satel is even using the Arizona tragedy as a platform for laws requiring schools and businesses to report to authorities any student or employee who it "ejects or otherwise removes …. out of concern about behavior and dangerousness." Talk about a civil liberties nightmare!

Memorial crime control

Such opportunistic crime-control advocacy works best during moments of public crisis. When the hysteria reaches critical mass, politicians appease anxious constituencies through yet another feel-good law. Then, the latest crisis dies down and people get back to their normal lives. Watching Fox-TV, they remain blissfully shielded from the dark side of memorial crime control.

Rather than capturing the monsters of the public's imagination -- lunatic rampagers, sexual predators, and homicidal gangsters -- this inexorable web of draconian laws ends up ensnaring the most vulnerable, mainly young African American and Latino men from poor communities.

Do you recognize the name Rodrigo Caballero? Unlikely. He is just one tiny speck in a mass of captive and unknown dark bodies, a 16-year-old mentally ill California boy sentenced to 110 years in prison for attempted murder. Any cathartic efforts of memorial crime control are short-lived, while the costly and unanticipated social costs live on. Young Mr. Caballero isn't due out of prison until 2110, long after he and all of the rest of us will be dead.

No profile of would-be assassins

There will always be the next rare event to fuel this cycle of knee-jerk response, ostensibly aimed at protecting us from every remote contingency. Hindsight bias is a powerful heuristic that obscures an unfortunate truth: It is very hard to accurately predict -- much less prevent -- individual-level violence. As I wrote four years ago, after Cho Seung-Hui's deadly rampage at Virginia Tech:

Many people -- and especially many adolescent and young adult men -- are troubled. Many are severely depressed. Many express disturbing, violent fantasies. Fortunately, only a tiny fraction commit lethal acts against others. And unfortunately, those who do often do not stand out ahead of time.

This is what forensic psychologist Robert Fein found when he conducted a Secret Service study of all political assassins and would-be assassins in the United States over the past 60 years. Contrary to popular mythology, the assassins fit no singular "profile." They were neither monsters nor martyrs, Fein said:

The reality of American assassination is much more mundane, more banal, than assassinations depicted [in movies].

The myth of the deranged killer

Jared Loughner’s delusional ramblings, revealed to the world by intrepid Internet sleuths, are the only explanation some people need. But they are something of a red herring.

First, as advocates for the mentally ill are quick to point out, the link between psychosis and violence is far from settled. Most people with severe mental disorders do not become violent. Any increased risk is miniscule compared with the risk posed by use of alcohol or drugs, according to large-scale studies. As Vaughan Bell puts it in his lucid summary of this research:

Psychiatric diagnoses tell us next to nothing about someone's propensity or motive for violence…. It's likely that some of the people in your local bar are at greater risk of committing murder than your average person with mental illness.

But even when an assassin does harbor delusional beliefs, this is not sufficient explanation. Loughner's gender likely played a role, too, as men commit far more violence than women. Yet we would never think we had explained the Tucson rampage with the statement: "Loughner was a man."

In fact, the Secret Service study found that the assassins who were delusional -- about one-fourth of the total -- acted based on the same types of motivations as non-delusional assassins. As reporter Douglas Fox summarized:

Some hoped to achieve notoriety by killing a well-known person. Others wanted to end their pain by being killed by Secret Service. Still others hoped to avenge a perceived, idiosyncratic grievance unrelated to mainstream politics. Some hoped, unrealistically, to save the country or call attention to a cause. And some hoped to achieve a special relationship with the person they were killing.

Selecting one's lens: Micro or macro?

In our professional role, forensic psychologists use a micro lens, focusing on the individual level of analysis. But when commentators focus solely on individual-level factors, they divert the public from contextual factors that may be more amenable to prevention.

In other words, at the micro level there is no question that Loughner is a troubled young man. But at the macro level, his choice of targets certainly reflects the political tensions in the United States and especially in Arizona, which even the local sheriff described as a "Mecca for prejudice and bigotry."

Sarah Palin is able to evade responsibility for her violent rhetoric by strategically refocusing on the culturally entrenched myth of the dangerous schizophrenic, and calling Loughner "deranged" and "evil."

Ironically, it is the mentally unstable like Loughner who are most vulnerable to extremist rhetoric, and other memes floating around in our cultural ethos. As prominent forensic psychologist and law professor Charles Patrick Ewing noted:

These influential politicians and commentators who use violent rhetoric and images -- such as putting a member of Congress in the crosshairs, telling supporters that it is time to 'reload' and suggesting that voters unhappy with Congress resort to 'Second Amendment remedies' -- must realize that they have an incredibly wide audience. At least some members of that audience (both sane and insane) will view their inflammatory statements as an invitation to violence…. The blame for these killings does not lie with the perpetrator alone."

"Stochastic terrorism" is the term invoked by one professor of communications to describe this phenomenon, of "use of mass communications to stir up random lone wolves to carry out violent or terrorist acts that are statistically predictable but individually unpredictable."

What if Abdul had done it?

That the micro lens is a deliberate choice becomes clearer if we ask ourselves how media coverage might be different if a Muslim from the Middle East had shot U.S. Rep. Gabrielle Giffords. Would the focus still be on individual pathology? Or would it be on his political affiliations and the content of his rhetoric?

The din of rhetoric about mental illness drowns out the voices of those framing Loughner's attempted assassination as an act of political terrorism. People like Jesse Muhammed, Sahar Aziz, and Cenk Uygur, who asks incredulously:

Is this a joke? He shot a politician in the head. He called it an "assassination." What part of that was unclear? … [W]hy does the act have to be either psychotic or political? It's obviously both.… The conservative hate-mongers don't create psychos…. [But] they channel their fear, anger and paranoia…. They load them up with violent imagery, whether it's talk of cross-hairs or second amendment remedies or the tree of liberty being refreshed with blood. Then when they get a violent reaction they pretend to be surprised and outraged that anyone would suggest they were the least bit culpable. The reality is that it is a simple formula -- violent imagery in, violent results out.

In the final analysis, the causes of violence are multifaceted and difficult to disentangle. And it is impossible to predict which troubled, angry and alienated young man will engage in lethal violence. But one thing is certain: More laws are not the answer. They cast too wide a net, and distract from the search for deeper solutions.

Related blog posts:

Loughner update: Skirmishing over competency (March 22, 2011) 

Can school shootings be prevented? (April 19, 2007)
Systems failure or black swan? New frame needed to stop memorial crime control frenzy (Oct. 19, 2010)
Backlash growing against criminal profiling (Sept. 14, 2010)

How competent are the competency evaluators?

Largest real-world study finds modest agreement among independent alienists

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

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

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

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

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

Hawaii: Exemplar or exception?

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

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

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

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

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

Why do evaluators differ?

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

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

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

How did the judges rule?

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

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

Moving forward

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

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

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

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

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

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

MLK to psychologists: We need creative maladjustment

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

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

On crime and urban violence

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

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

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

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

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

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

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

On taking a stand

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

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

On the role of the social scientist

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

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

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

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

On creative maladjustment

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

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

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

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

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

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

fMRI controversies: Special journal section

A special section of the Association for Psychological Science's journal, Perspectives on Psychological Science, is dedicated to controversies surrounding functional Magnetic Resonance Imaging, or fMRI, technology. The articles* are:

• Neuroimaging: Voodoo, New Phrenology, or Scientific Breakthrough? Introduction to Special Section on fMRI by Ed Diener -- In response to the widespread interest following the publication of Vul et al (2009), Perspectives Editor Ed Diener invited researchers to contribute articles for a special section on fMRI, discussing the promises and issues facing neuroimaging.

• Mistreating Psychology in the Decades of the Brain by Gregory A. Miller -- Scientists tend to consider psychology-biology relationships in two distinct ways: by assuming that psychological phenomena can be fully explained in terms of biological events and by treating them as if they exist in separate realms. These approaches hold up scientific progress and have important implications for clinical practice and policy decisions (e.g., allocating research funds).

• Brain Imaging, Cognitive Processes, and Brain Networks by Brian D. Gonsalves and Neal J. Cohen -- The growth of neuroimaging research has led to reflection on what those techniques can actually tell us about cognitive processes. When used in combination with other cognitive neuroscience methods, neuroimaging has promise for making important advancements. For example, neuroimaging studies on memory have raised questions not only about the regions involved with memory but also about component cognitive processes (e.g., the role of different attention subsystems in memory retrieval), and this has resulted in more theorizing about the interactions of memory and attention.

• Mapping Mental Function to Brain Structure: How Can Cognitive Neuroimaging Succeed? by Russell A. Poldrack -- To understand the anatomy of mental functions, researchers may to need to move away from commonly used brain mapping strategies and begin searching for selective associations. This will require more emphasis on the structure of cognitive processes, which may be achieved through development of formal ontologies (e.g., the Cognitive Atlas) that will describe the “parts” and processes of the mind. Using these ontologies in combination with large-scale data mining approaches may more directly relate mental processes and brain function.

• The Appeal of the Brain in the Popular Press by Diane M. Beck -- Why do people like the brain so much? Brain-related articles in the press, especially ones about fMRI research, tend to be very popular with the general public, but many of these articles may result in misinterpretations of the science. Part of the popularity may be attributed to their deceptively simple message: Perform an action and a certain area lights up. In addition, people are more confident in “biological” images than in the behavioral phenomena on which the images are based. In order to maintain trust with the public, scientists have a responsibility to provide the press with descriptions of research and interpretations of results research that are clear, relevant, and scientifically accurate.

• Frontiers in Human Neuroscience: The Golden Triangle and Beyond by Jean Decety and John Cacioppo -- The development of neuroimaging has created an opportunity to address old questions about brain function and behavior in new ways and also to uncover new questions. The knowledge that emerges from neuroimaging studies is more likely to be beneficial when combined with techniques and analyses that break down complex constructs into structures and processes, measures that gauge neural events across different times, and animal studies.

• Bridging Psychological and Biological Science: The Good, Bad, and Ugly by Arthur P. Shimamura -- The advent of functional neuroimaging has brought both praise and criticism to the field of psychological science. Although most studies relying on fMRI are correlative, they do offer some clues about the biology underlying psychological processes. However, it is not sufficient to show which area of the brain is involved in a particular cognitive process; rather theories need to address “how?” questions (e.g., How does the hippocampus contribute to remembering?) in order to best bridge psychological and biological science.

*Note: Click on any of the highlighted author names to send an email to the author, requesting a copy of the article.

Hat tip: Ken Pope

Linguist lambasts DSM-5 proposal as gibberish

Leave it to an asexual linguist to lay bare the convoluted nature of the paraphilia diagnoses being proposed for the DSM-5. Andrew Hinderliter, a former English teacher and grad student at the University of Illinois, says his activism regarding the DSM's Hypoactive Sexual Desire Disorder led him to stumble across disturbing global flaws in the DSM-5 sexual disorders morass.

The wording of the proposed new definition of "paraphilia" (sexual perversion) is so nonsensical that one must ignore the literal text in order to apply it the way the authors say they intend, Hinderliter writes in his new article, "Do Not Disregard Grammar," in the Journal of Sex and Marital Therapy. That article follows a companion piece published in the Open Access Journal of Forensic Psychology.

As I have blogged about previously, the members of the sexual disorders workgroup for the DSM-5 seems oblivious to the potentially disastrous forensic implications of their proposals. Vague and careless wording is not so critical in the clinical arena where, presumably, everyone is working toward the same goals. However, as attorneys know well, in the forensic context every little word matters -- a lot.

"Given that a person can be deprived of procedural due process rights -- possibly for the rest of their life --on the basis of a diagnosis of paraphilia NOS, caution and careful wording in defining paraphilia in DSM-5 is all the more important,” Hinderliter cautions.

Perhaps the workgroup has the clandestine aim of introducing chaos into the civil commitment system for sex offenders. If so, it couldn't be doing a better job. Get ready for skirmish after skirmish over nebulous terms such as "phenotypically normal," "generalized" and "intense."

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.