Federal judges question novel diagnoses used to civilly commit sex offenders

Federal judges in Wisconsin are raising their eyebrows over psychiatric diagnoses that some contend were invented or are being overused for the sole purpose of civilly incarcerating sex offenders after their criminal sentences have expired.

The diagnoses at issue are "Paraphilia Not Otherwise Specified-Nonconsent" and "Personality Disorder Not Otherwise Specified with Antisocial Features." Neither diagnosis is included in the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), nor are they typically invoked in mainstream psychology or psychiatry.

In the more alarming of the two court cases, the court in Brown v. Watters stated that the state's psychologist had invented the diagnosis he was using in the case, "Paraphilia Not Otherwise Specified-Nonconsent." Dennis Doren, who is well known in the sex offender industry, "acknowledged that the psychiatric community did not recognize the former disorder and that he had created it himself because he perceived a gap in the American Psychiatric Association's Diagnostic and Statistical Manual," according to the court's ruling.

A paraphilia is defined in the DSM as a chronic pattern of intense, sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects, suffering or humiliation, or children or other nonconsenting persons. Doren has expanded that definition to include habitual rapists.

The other case ruled on by the federal appellate court was McGee v. Bartow, involving a diagnosis of "Personality Disorder Not Otherwise Specified with Antisocial Features." Michael McGee claims that this is a "bogus disorder" invented by state psychologists to justify his continued confinement after he completed his sentence.

Neither ruling decided the merits of these challenges to the state’s Sexually Violent Predator (SVP) laws. They decided only that the issues raised enough concern that the appellants were entitled to another day in court.

The two cases, both in the U.S. District Court for the Eastern District of Wisconsin, are Bruce Brown v. Steve Watters, Case No. 06C0753, 2007 U.S. Dist. LEXIS 53344, and Michael McGee v. Byran Bartow, Case No. 06-C-1151, 2007 U.S. Dist. LEXIS 24700.

POSTSCRIPT: For subsequent rulings in these cases, see my blog post of May 2, 2008.

Thanks to Tom Zander, JD., Psy.D., of Wisconsin for alerting me to these cases.

Also see Dr. Zander’s article, Civil Commitment Without Psychosis: The Law's Reliance on the Weakest Links in Psychodiagnosis, available online at the Journal of Sexual Offender Civil Commitment: Science and the Law.

Report blames sick culture for preventable deaths in CA prisons

One in six deaths in California prisons last year may have been preventable, according to a report released yesterday, and much of the systemic failures stem from a sick attitude toward prisoners.

"Across the board we see delays in diagnosis and access to care and needed tests; misfiled, incomplete or illegible medical records; lack of space, sanitation and staffing; … failures by clinicians to recognize and evaluate 'red flag' symptoms, follow published guidelines, perform basic physical examinations, or respond to patient complaints," wrote the federal receiver who conducted the investigation.

"You can't expect clinicians to practice good medicine if they don't have good medical records, if they don't have lab results to help diagnosis, if they don't have a pharmacy system to support the right order of medications, if you don't have a culture within [the state prisons] that says, 'My goodness, these are human beings and they ought to be treated as human beings,' " the receiver told the Sacramento Bee.

Topping the list was deaths from asthma, which the receiver called "unconscionable" in 21st century California.

Other causes of preventable death included:

• Acute pancreatitis - medical staff disregarded a man's nine complaints over three days of severe abdominal pain, because they thought he was lying
  

• Heart ailment - a man reported chest pains in the middle of the night but didn't see the doctor for eight hours
  

• A hernia condition – a man with recurring stomach pain, vomiting and a history of hernias had a five-week delay in a referral to a specialist (a consistent pattern found in the investigation)
  

For more information, visit the federal receiver's website. More online coverage is also available at the Los Angeles Times, the Sacramento Bee, and the blog Witness L.A.

Also check out the receiver’s interesting slide show on medical care at San Quentin.

What's it take to become a forensic psychologist?

Profilers. Silence of the Lambs. The criminal mind. So eerie, so glamorous.

***** NOTE: AN UPDATED VERSION OF THIS ESSAY IS AVAILABLE HERE. *****

I get many emails and phone calls from students interested in pursuing forensic psychology as a career. So, by popular demand, here is a brief overview.

First, what is a forensic psychologist?

Forensic psychologists are licensed clinical psychologists who specialize in applying psychological knowledge to legal matters, both in the criminal and civil arenas. Forensic psychology is a subdiscipline of psychology, with its own professional organizations, training programs, and research journals. Forensic psychologists are found in academia, public service, and the private sector.

Forensic psychologists are called upon to assist in a wide variety of legal matters, including the mental state of criminal defendants (insanity, competency, etc.), jury selection, child custody/family law, violence risk prediction, mediation/dispute resolution, discrimination, civil damages, social science research (e.g., recovered memory), and civil commitment.

What is the state of the field?

Forensic psychology is a rapidly growing discipline. Currently, the American Psychology-Law Society has about 3,000 members, and the number continues to grow. Many experienced psychologists are seeking to respecialize into this field in order to escape the confines of managed care. Students are attracted to the field by our culture's growing absorption with all matters criminal, as well as fictional depictions such as TV's The Profiler and Criminal Minds.

The growth of forensic psychology is not without controversy. Some have accused forensic psychologists of being hired guns or even - less politely - "whores." Recent federal court decisions are causing increasing scientific scrutiny of psychological evidence. This in turn is leading to the development of increasingly rigorous training programs, instruments, and procedures that will allow us to withstand such adversarial scrutiny.

In the long run, well-trained forensic psychologists will likely fare well in the increasingly skeptical marketplace of the future.

What skills must a forensic psychologist have?

Forensic psychologists are psychological scientists. The investigatory component requires strong detective skills. We must compare data from multiple sources in order to test alternative hypotheses. The emphasis is on written reports and court testimony that are scientifically valid and can withstand scrutiny in the adversarial environment of the courtroom.

Becoming a successful forensic psychologist requires, at minimum, the following:

• solid clinical psychology training and experience

• firm grounding in scientific theory and empirical research (understanding of scientific validity, research design, statistics, and testing)

• critical thinking

• thorough knowledge of social and cultural issues

• legal knowledge (including mental health law, case law, and courtroom procedures)

• excellent writing skills

• strong oral presentation skills (and ability to maintain composure in stressful circumstances)

So, how can I sign on?

At the present time, there is no single acceptable training model for forensic psychologists.

The dominant model continues to be one in which a student obtains a doctoral degree in clinical psychology, and subsequently pursues a postdoctoral specialization in forensics. However, more and more graduate schools are beginning to adopt forensic tracks. An online list of institutions offering various types of Ph.D./Psy.D. programs in forensic psychology is available here.

Some newer programs also offer terminal master's degrees in forensic psychology, although it is unclear how master's level clinicians will fare in a field dominated by professionals with more advanced degrees.

Only a handful of formal postdoctoral specialization programs exist nationwide, and these programs are quite small and selective, typically accepting only one to two candidates per year. These rigorous programs are aimed at training future leaders in the field.

Some people also pursue dual degrees in psychology and law. There are a few such joint degree programs, and some law schools offer a scaled-down, one-year Master of Legal Studies degree. Having a dual degree may make one more competitive, but for most practitioners it is not realistic or cost-effective.

A more thorough discussion of the pros and cons of different types of educational programs is available in the brand-new edition of Psychological Evaluations for the Courts.

The Journal of Forensic Psychology Practice has just (Vol. 7 #2, 2007) published a point-counterpoint pair of articles on whether forensic psychology should necessarily require a doctoral degree:

"Raising the bar: The case for doctoral training in forensic psychology," by Carl B. Clements, Ph.D., ABPP, and Emily E. Wakeman, MA

"The time is now: The emerging need for master's-level training in forensic psychology," by Matt Zaitchik, Ph.D., Garrett Berman, Ph.D., Don Whitworth, Ph.D., & Judith Platania, Ph.D.

What tips do you have for trainees?

• Apply for forensic-related internships, such as at forensic hospitals, correctional facilities, and community mental health settings.

• Tailor your doctoral dissertation to a psychology-law topic in your area of professional interests.

• Become a student member of the American Psychology-Law Society, an interdisciplinary organization devoted to scholarship, practice, and public service in psychology and law.

• Purchase and read Psychological Evaluations for the Courts, a critical resource in forensic psychology.

• Stay current by regularly reading the leading journals in the field, among them Law and Human Behavior, Behavioral Sciences and the Law, and Psychology, Public Policy, and Law.

Becoming successful in this field is an arduous endeavor. However, for those with the energy, stamina and critical thinking skills, it can be a rewarding occupation.

But what about criminal profiling?

Oh, yes. That question.

Unfortunately, one of students’ biggest misconceptions about forensic psychology is that we do criminal profiling. This mythology comes directly from movies and TV shows such as Silence of the Lambs, Criminal Minds, and The Profiler.

In reality, most law enforcement agencies do not regularly use criminal profiling methods. When they do, they typically employ profilers with extensive backgrounds in law enforcement rather than in psychology. Perhaps more importantly, many scholars dispute that profiling even qualifies as a scientific method meriting inclusion in the behavioral sciences.

So, if your primary interest is in criminal profiling, the field of forensic psychology may not be for you.

***** NOTE: AN UPDATED VERSION OF THIS ESSAY IS AVAILABLE HERE. *****

CA could lead in criminal justice reform

Three bills on Governor's desk

Three of the most common causes of wrongful conviction are mistaken eyewitness identification, false confessions, and fabricated statements of informants.

California is poised to address all three of those problems, through major criminal justice reform bills now sitting on the Governor's desk. The bills would:

• require electronic recording of police interrogations in serious felony cases (Senate Bill 511)

• appoint a task force to draft guidelines for police line-up procedures to increase the accuracy of eyewitness identifications (Senate Bill 756)

• require the corroboration of testimony from jailhouse informants (Senate Bill 609)

The ACLU of Northern California has a quick and easy online form that allows people to send a letter to Gov. Arnold Schwarzenegger, urging him to make California a leader in criminal justice reform by signing these bills into law.

Congressional journal highlights APA torture debate

The struggle over the role of psychologists in military interrogations is reaching the halls of Congress. Today's issue of Congressional Quarterly features an article by Shawn Zeller, entitled "Torture Issue Ties Up Psychologists Association":

You'd think that psychologists, of all people, would know torture when they see it. But the leaders of the American Psychological Association, the profession's governing body, have been trying for more than two years to quell a faction of vocal dissidents who say the group tacitly condones U.S. military and intelligence use of coercive tactics.

The latest blow-up came last month at the association's annual meeting in San Francisco. The dissidents, calling themselves Psychologists for an Ethical APA, pushed for a moratorium on psychologist participation in military interrogations. The association's governing council eventually rebuffed that crusade, winning adoption instead of a new policy barring psychologists from participating in more than 20 kinds of torture techniques - including "mock executions, water-boarding or any other form of simulated drowning or suffocation, sexual humiliation, rape," or "cultural or religious humiliation."

But the dissident psychologists aren't satisfied, by a long shot. They're angry that the association "avoided saying outright that all aversive interrogation techniques are prohibited," says Steven Reisner, a leader of the disaffected group who's a New York University psychoanalyst. What's more, he says, the APA's vote means psychologists may still participate in aversive methods as long as they aren't employed in a formal interrogation - effectively condoning controlled use of methods such as sleep deprivation, which other groups have condemned as torture. It's the dissidents' belief that the APA is striving to protect the professional standing of members who work for the Pentagon or CIA - and to keep the association's own relationship with those agencies in good repair.

Reisner's group is fighting on two fronts. It's asking APA members to withhold their dues until the association produces a more forceful denunciation of torture and aversive interrogation techniques. And Reisner says he and his colleagues also plan to lobby state psychological associations to adopt stricter rules. They have also provided information about the APA’s internal debate on the issue to the Senate Armed Services Committee.

The article continues at Congressional Quarterly's web site.

Exiles in their own land: Sex offenders and the history of banishment in Western culture

Adam and Eve were banished from Eden. Much later, in 12th-century England, criminals could use banishment to escape death providing they had fled to a sacred place for sanctuary. Still later, convicts were banished to far-away prison colonies, among them the United States and, later, Australia. Banishment served the same function as execution, but “without the blood.” This form of banishment ended with the ebbing of new frontiers.

Now, in sex offender residency laws, we are seeing a new form of banishment – internal exile – that may fundamentally change the U.S. criminal justice system and the broader culture.

So argues Corey Rayburn Yung, a law professor at the John Marshall Law School, in a cogent analysis of the history and legal status of banishment.

At this point, residency restrictions have not seen their full effects. As I write, parole agents armed with GPS devices are fanning the state of California, knocking on ex-offenders’ doors and telling them to move. (See today’s Contra Costa Times for the latest news coverage as well as an interesting map illustrating the scope of the banishment in the San Francisco Bay Area.)

As large, urbanized states begin to enforce the restrictions, exile communities will develop. It is frightening to think of the unintended consequences of creating communities made up almost entirely of male sex offenders, where sexual deviancy will become the norm. Or of forcing those who reject these offender ghettos to disappear underground, where they will go unmonitored and unemployed, creating another recipe for recidivism.

Yung’s article, from the current issue of the Washington University Law Review, is available online.

Photo: Masaccio's Die Vertreibung Adams und Evas aus dem Paradies, public domain at Wikimedia