"Dr. Phil" controversy highlights public confusion over psychology

The uproar over Phillip McGraw's intrusive interaction with Britney Spears raises a number of interesting issues about clinical psychology and the privacy rights of hospital patients.

As most of you know by now, McGraw barged into Spears' hospital room January 5, apparently without an invitation from the beleaguered pop star. After soliciting her appearance on his TV advice show, he issued a public statement about her condition.

In the wake of this incident, some have accused McGraw of violating doctor-patient confidentiality. But McGraw is not a doctor, nor was Spears his patient.

Much of the public confusion on this point is due to the TV personality's use of the title "Doctor." Like Laura Schlessinger, the conservative radio pundit with a Ph.D. in physiology who calls herself "Dr. Laura," anyone with a doctoral degree is technically a doctor (of philosophy). But to engage in therapy as a clinical psychologist, a person must also be licensed in the appropriate state. While McGraw holds a doctoral degree in psychology, he is not licensed as a psychologist or a mental health practitioner in any state.

Once upon a time, McGraw really was licensed as a clinical psychologist. In 1989, the Texas board that licenses psychologists disciplined him for an inappropriate "dual relationship" with a 19-year-old patient. (McGraw denies the young woman's claim that the relationship was sexual.) The Texas Board of Examiners of Psychologists ordered him to take an ethics class and have his practice supervised for a year. He subsequently stopped practicing therapy and started a jury consultation firm, Courtroom Sciences Inc. (CSI). It was in this capacity that he met Oprah Winfrey, then fighting a lawsuit by the beef industry, who boosted him into the world of show biz.

His haranguing style of voyeuristic quasi-therapy has proved enormously popular. Last year, he netted 6.7 million viewers and earned a whopping $45 million.

What’s the attraction? Some scholars have compared it to a religious conversion narrative, involving a confession, a testimonial, a moral authority (Dr. Phil), and an instant cure.

"It's the quintessential cultural product," said media consultant Ellen McGrath, also a psychologist. "Get some quick advice and change your life. You, too, can hit the psychological jackpot…. It's a spectator sport to watch someone be humiliated. It's the psychological version of Who Wants to Be a Millionaire."

Bottom line: Since McGraw (much like Britney Spears) is a celebrity icon rather than a licensed professional, he is not governed by any code of medical ethics or by the state and federal rules and regulations that apply to licensed clinical psychologists.

What about the hospital? Some have suggested that Cedars-Sinai Medical Center may have violated Spears' privacy rights when they allowed McGraw into her hospital room with her permission. But even that claim is somewhat tenuous, since her parents invited him into the hospital.

Ironically, amidst all of the fury over whether McGraw or the hospital violated any legal or ethical rules, other professionals who are exploiting Britney Spears' problems have escaped reproach. For example, three clinical psychologists and psychiatrists are quoted in an online gossip magazine as publicly diagnosing Spears with everything from mania to borderline personality disorder to a "genetic predisposition" to depression.

The Ethics Code of the American Psychological Association has several sections addressing drive-by assessments conducted without benefit of personal evaluation.

Ethical Standard 9.01 states that, in general, psychologists should only provide opinions about someone's psychological characteristics after having conducted an examination adequate to support their statements or conclusions. More broadly, Principle E, "Respect for People's Rights and Dignity," states that psychologists respect "the rights of individuals to privacy, confidentiality, and self-determination."

These self-same spokespersons for psychology and psychiatry call themselves by their first names, a la "Dr. Phil," and one is even premiering his own online TV show tonight - a live celebrity rehab show.

Between "Doctor" Phillip McGraw and the rest of these spokespeople, it's no wonder some members of the the public are confused, not to mention a bit leery of the mental health profession.

For more information:

"Do the rules apply to Dr. Phil?" New York Times, Jan. 10, 2008

"Analyze This," Dallas Observer, April 13, 2000 (background on McGraw’s career; information on legal cases involving Dr. Phil can be found here and here).

"Patient in the spotlight," Newsweek, Jan. 8, 2008

"Spears clan calls foul on Dr. Phil's blabbermouth," E! Online, Jan. 9, 2008

Photo credit r5d4 (Creative Commons license)

Historic hearings to commence on Calif. death penalty

Amid renewed national controversy over capital punishment, the California Commission on the Fair Administration of Justice is holding public hearings beginning tomorrow on the death penalty in California. At the first hearing, a lineup of luminaries will present evidence about racial, ethnic, and geographic disparities in who is sentenced to die.

The Commission was created by the state Senate in 2004 to investigate the causes of wrongful conviction and wrongful executions, and to recommend reforms to make California's criminal justice system "just, fair, and accurate." Composed of law enforcement, prosecutors, defense attorneys, judges, and citizens, the Commission has already issued a series of unanimous recommendations on other criminal justice issues, including:

• Eyewitness Identification
• False Confessions
• Use of Jailhouse Informants
• Scientific Evidence
• Professional Responsibility and Accountability of Prosecutors and Defense Lawyers
• Remedies for Wrongful Conviction
• Fair Administration of the Death Penalty

(Click on any of the above links to see the related report.) A press release about the death penalty hearings, slated for January, February and March, is here.

Guest commentary: Prisoners of panic

Yesterday's Los Angeles Times featured a great opinion piece on the costly and out-of-control effects of tough-on-crime rhetoric. It was written by Joe Domanick, a senior fellow at the USC Annenberg Institute for Justice and Journalism. Mr. Domanick, author of "Cruel Justice: Three Strikes and the Politics of Crime in America's Golden State," is currently at work on a book about California's prison system. With his permission, I'm posting the entire piece.

Guest commentary by Joe Domanick

Prisoners of panic: Media hype and political quick fixes have swelled our inmate population

from the L.A. Times, January 6, 2008

How much more folly, absurdity, fiscal irresponsibility and human tragedy will we endure before we stop tolerating the political pandering that has dictated our criminal justice law and policy over the last two decades?

The pattern has become all too clear. Our politicians, fearful of being labeled "soft on crime," react to sensationalistic coverage of a crime with knee-jerk, quick-fix answers. Only years later do the mistakes, false assumptions and unexpected consequences begin to emerge, and then the criminal justice system is forced to deal with the mess created by the bad lawmaking.

For example, remember the great crack scare of the 1980s? When basketball superstar Len Bias, who'd been drafted by the Boston Celtics as a franchise player, died of a crack overdose, the media went wild in covering it. Alarmed by the sudden increase in crack use and fearful that the drug was highly addictive and disposed users to commit violence, Congress mandated tough minimum sentences for crack-related crimes. A defendant convicted of possessing a small amount of crack could receive the same sentence as one possessing 100 times that amount of powder cocaine. Because crack users were disproportionately African American (and powder cocaine users were disproportionately white), 85% of those receiving dealer-like sentences for possession or sale of small amounts of crack were black -- an outcome that helped to fuel widespread perceptions among blacks that there was a double standard of justice in the U.S.

In December, the overly harsh and misguided sentencing policy concocted during the "war on drugs" in the 1980s was finally modified. The U.S. Supreme Court ruled that judges were no longer bound by the strict sentencing guidelines, freeing the jurists to craft punishment that best fits the crime and the background of the defendant.

The 1990s produced its own racially tinged crime panics. Led by John J. Dilulio Jr., a political scientist at Princeton University, and William J. Bennett, a former secretary of Education in the Reagan Cabinet, law-and-order proponents declared that the U.S. was being overrun by a new generation of remorseless "super-predators" spawned by crack-head mothers in violence-infested ghettos. Stories of kids committing heinous crimes were common in the media. One of the most sensational occurred in Chicago in October 1994. Two boys, one 10 years old, the other 11, dropped 5-year-old Eric Morse from the 14th floor of a housing project, killing him, because he refused to steal candy for them.

In response to such crimes, politicians across the country passed anti-super-predator laws. In many states, including California, the age kids could be tried as adults was lowered to 14, and in 48 states, the decision to try juveniles as adults was taken away from judges and given to prosecutors. As a result, the number of people under 18 tried as adults rose dramatically through the 1990s, and a small percentage of them were even sentenced to prison. Ironically, the predicted crime explosion caused by super-predators never materialized. Juvenile arrests declined by more than 45% from 1994 to 2004, according to FBI statistics.

But the ultimate example of media hype meeting irresponsible politicians to produce bad public policy is California's three-strikes law. It was chiefly written by Fresno photographer Mike Reynolds after the murder of his daughter, Kimber, in 1992.Introduced in the Legislature, the bill languished until the rape and murder of 12-year-old Polly Klaas in 1993. A network of right-wing talk-radio hosts reacted to the killing by fiercely promoting Reynolds' measure, which had provisions like no other three-strikes bill in that virtually any crime, no matter how petty, could be prosecuted as a third strike.

In 1994, the Legislature unanimously put the measure on the November ballot, and Proposition 184 passed easily. The law would eventually send thousands of Californians to prison for 25 years to life, some for such third-strike crimes as attempting to steal a bottle of vitamins from a drug store, buying a macadamia nut disguised as a $5 rock of cocaine from an undercover cop and shoplifting $2.69 worth of AA batteries.

Today, Californians are still paying the price for that folly and other like-minded laws, not just in the ruined and wasted lives of people sentenced under these laws, but in other ways. There are now tens of thousands of inmates in California convicted of nonviolent crimes and serving out long second- and third-strike sentences, as well as thousands more behind bars because minor crimes were turned into felonies with mandatory minimum sentences.

All these laws have contributed to severe overcrowding in the state's prisons -- as high as 200% of capacity -- that has produced conditions of such "extreme peril" for prisoners and guards that Gov. Arnold Schwarzenegger was forced to declare a systemwide state of emergency in 2006. Since 2003, the inmate population has grown 8%, to about 173,000. But the budget of the Department of Corrections and Rehabilitation has skyrocketed 79%, to $8.5 billion, becoming the fastest-growing category in the state budget and a factor in opening up a $14-billion budget deficit.

The get-tough-on-crime laws also have helped create a crisis in California's prison healthcare system, where spending has risen to $1.9 billion a year, up 263% since 2000. A large part of the problem is that the prison population is aging because inmates are serving the longer sentences approved by lawmakers, and with aging comes more medical problems. The system became so understaffed and dysfunctional that a federal judge ruled that it was causing at least one avoidable death a week through sheer neglect and ineptitude. He has seized the entire prison medical system and placed it under his direct supervision.

Faced with the huge budget deficit and judicial threats to cap the state's prison population, Schwarzenegger's office has been floating the idea of early release for about 22,000 inmates convicted of nonviolent crimes. That 13% cut in prisoners, however, would require legislative approval, something that is by no means certain. The story of crime and punishment in California -- and the country -- since the 1980s, after all, has been quick-fix answers fueled by media hype. Let's hope that such proposals as releasing nonviolent inmates receive serious attention rather than panicky headlines that lead to bad criminal justice laws.

The death machine: "One thoroughly screwed-up system"

Just in time for next Monday's U.S. Supreme Court hearing on a challenge to the three-drug cocktail used in most U.S. executions, Time magazine has issued a scathing denunciation of the state of capital punishment in the United States. This follows negative publicity in Newsweek magazine a couple of months ago (see my blog post of Nov. 25, 2007). Perhaps wind is on my mind due to the incredible windstorm we're having here in the San Francisco Bay Area today, but I'm sensing winds of change in the air.

Here are some tantalizing excerpts from the no-holds-barred Time piece:

In a perfect world, perhaps, the government wouldn't wait 30 years and several hundred executions to determine whether an execution method makes sense....

Any other government program that delivered 3% of what it promised -- while costing millions of dollars more than the alternative -- would be a scandal, but the death penalty is different. In its ambiguity, complexity and excess, the system expresses a lot about who we are as a nation....

Our death penalty's continued existence, countering the trend of the rest of the developed world, expresses our revulsion to violent crime and our belief in personal accountability. The endless and expensive appeals reflect our scrupulous belief in consistency and individual justice….

We add safeguards one day, then shortcut them the next. One government budget contains millions of dollars for prosecutions, while another department spends more millions to defend against them. Indeed, the very essence of ambiguity is our vain search for a bloodless, odorless, motionless, painless, foolproof mode of killing healthy people….

We now have a situation in which a majority of the states that authorize the death penalty seldom if ever use it. Last year only 10 states carried out an execution. And even that number overstates the vigor of the system. If you don't count executions of inmates who voluntarily dropped their appeals and asked to be killed -- essentially government-assisted suicides -- the state count falls to eight….

The ungainly, ambivalent collapse of the death penalty seems unfitting for a punishment whose very existence is largely symbolic. But the trend is unmistakable.

The Supreme Court is part of this slow-motion shutdown of the death-penalty machine. In recent years the court has banned executions of mentally retarded inmates and of prisoners who committed their crimes as minors. The mere fact that the court is hearing the lethal-injection cases is historic because the institution has always been reluctant to inquire into the business end of the death penalty….

The discussion itself is another sign of the nation's ambivalence about the ultimate, irreversible punishment. And as long as we're ambivalent, we'll continue to have the system we have made for ourselves--inefficient, beyond repair and increasingly empty.

Hat tip to Sentencing Law & Policy for alerting me to this article.

Colorful juries more competent

At a holiday party, the topic of jury duty came up. Immediately, everyone started competing to tell how they "got out of" serving. That's too bad, I thought. These folks would all make fine jurors.

Last month, I was involved in a trial in which a group of citizens who did not shirk their civic duty voted to free a teenager facing life for a murder he did not commit. The defense attorney described the jury fondly as "colorful."

What's color got to do with it? Quite a bit, as it turns out.

A colorful, or racially diverse, group actually thinks better than a more homogeneous one. In a recent study, mixed-race juries performed better on all areas assessed, including:

• Amount of information considered
• Factual accuracy of deliberations
• Thoroughness of analysis
• Open-mindedness (especially about race)

Traditionally, people have assumed that the difference is because minority jurors bring different life experiences and perspectives to the group. As Supreme Court Justice Thurgood Marshall put it more than 30 years ago, exclusion of "any large and identifiable segment of the community" removes "varieties of human experience" from the mix: "It is not necessary to assume that the excluded group will consistently vote as a class in order to conclude . . . that its exclusion deprives the jury of a perspective on human events that may have unsuspected importance in any case."

But new evidence suggests there is more to it than that: White jurors actually think more efficiently when they are faced with the prospect of being part of a diverse group. It's as if the goal of not being perceived as prejudiced, or of being accepted by others, switches the brain from autopilot to full-concentration mode.

In contrast, all-white juries tended to be lazy, inaccurate, superficial, and unwilling to discuss uncomfortable topics (especially race). At least that's what Samuel Sommers, the author of a recent study, found.

Interestingly, even bringing up the issue of race during voir dire questioning of potential jurors may increase open-mindedness and thoughtfulness, Sommers observed. (Asking questions like, for example, "Do you have any biases or prejudices that might prevent you from judging an African American defendant fairly?")

This makes sense, because modern racism is largely subtle and unconscious. In other words, people behave in biased ways while consciously thinking of themselves as fair-minded. So if you activate race as a salient issue, whites will more likely make conscious efforts to avoid prejudice.

The court-sponsored research used mock jurors who were drawn from actual jury pools in a Michigan county. The jurors were presented with a video of a Court TV case involving an African American man accused of sexually assaulting a white female.

Such research suggesting the superiority of multicultural juries is not likely to dissuade prosecutors from their frequent practice of removing Blacks through peremptory challenges. After all, predominately white juries are more punitive, especially toward non-white defendants. More thorough and efficient deliberations generally work in favor of the accused, especially if he is African American.

That's apparently what happened in the trial I just mentioned. After much deliberation, the "colorful" jury migrated from leaning toward guilt to outright acquittal.

Although I didn't get to be a fly on the wall inside of that deliberation room, I can imagine the scenario based on what I experienced when I served on a similarly colorful jury earlier this year. Unlike in the mock jury study described above, the case in which I was a juror did not explicitly involve race. The defendant, the victim, and the arresting officers all were white. Yet, as Justice Marshall predicted, the jury's diversity provided perspectives that would not otherwise have been considered. Several white jurors walked into the deliberations room ready to cast their vote (for guilty), thinking that the case was cut-and-dried. After a sometimes-heated discussion that lasted for days, they came to realize there was more to the case than initially met the eye. The vast economic and educational range - another great thing about American juries - also increased the range and quality of the deliberations.

I hope the above-described research is extended in the future to cases like this, in which race is not an explicit issue but still broadens (or colors, if you will) the deliberations.

* * * * *

The study is: Samuel Sommers (2006), "On racial diversity and group decision making: Identifying multiple effects in racial composition on jury deliberations," Journal of Personality & Social Psychology, Vol. 90, No. 4, pp. 597-612.

Other resources:

"Racial Bias in Jury Selection is Common Yet Denied, Study Finds"

"Jurors deliberate competently, study finds"

Samuel Sommers & Michael Norton (2006), "Race-based judgments, race-neutral justifications: Experimental examination of peremptory use and the Batson challenge procedure," Law & Human Behavior.

Jury & Democracy Project

"Harmful effects of unintentional racism"

Antonio et al (2004), "Effects of racial diversity on complex thinking in college students," Psychological Science, Vol. 15, pp. 507-510.

Joel Lieberman and Bruce Sales, Scientific Jury Selection (see my review at Amazon.com)

Intriguing new book: Psychology of women's violence

The second edition of Anna Motz's Psychology of Female Violence: Crimes Against the Body is now available for download as an ebook. The print version is forthcoming from Taylor & Francis. From the book's description:

What are the causes of violence in women? What can be done to help these women and their victims? Why does society deny the fact of female violence? This book explores the nature and causes of female violence from the perspectives of psychodynamic theory and forensic psychology. This fully updated and expanded second edition explores developments in research and services for violent women. The Psychology of Female Violence will be valuable to trainees and practitioners working in the fields of clinical and forensic psychology, women's studies, sociology, psychiatric nursing, social work, probation, counselling, psychoanalysis, the criminal justice system and criminology. Recent high profile cases of female violence are discussed alongside clinical material and theory.

Topics in the new edition include:

• The Victoria Climbié Inquiry
• The controversy surrounding Munchausen's Syndrome by Proxy
• Dangerous and Severe Personality Disorder in women
• The impact of pro-anorexia and pro-bulimia websites
• Clinical issues of working with women who kill
• Designing therapeutic services for women in secure mental health settings
• Women who sexually and physically abuse children
• Infanticide
• Fabricated and induced illness
• Self Harm