Mitchell slated for epic competency hearing

In what is shaping up as one of the longest and most intricate competency hearings in history, Brian David Mitchell has finally been slated for a hearing in late November that is expected to last 10 days.

Mitchell, you will recall, is accused of kidnapping Elizabeth Smart of Utah back in 2002. A self-proclaimed prophet, he allegedly planned to make her one of his wives. (Unlike Jaycee Lee Dugard, who was held hostage for 18 years and bore two children with her abductor, Ms. Smart was held captive for only nine months and reportedly readjusted well.) Wanda Eileen Barzee, Mitchell's estranged wife and codefendant, was found incompetent about five years ago and has been at the Utah State Hospital ever since; no date has been set for her competency hearing.

Prosecutors and defense attorneys are sparring over who will testify at the upcoming hearing.

The prosecution submitted a list of 39 witnesses. It included expert witnesses, police officers, and staff members at the Utah State Hospital, as well as "former friends, acquaintances, co-workers, ecclesiastical leaders and family members," according to a story in the Deseret (Utah) News.

Defense attorneys contend that many of these witnesses should be excluded because they do not have any information about Mitchell’s current state of mind. The relevant time frames in a competency determination are the present and short-term future, not the distant past.

Dr. Michael Welner, a forensic psychiatrist from New York City, is expected to be the star witness for the prosecution.

Welner is a renowned expert who has testified in a number of high-profile criminal cases. An associate professor at NYU School of Medicine and an adjunct professor at Duquesne University Law School in Pennsylvania, in 1996 he founded a monthly periodical, the Forensic Echo. Two years later, he founded what is billed as the first forensic peer-review consultation practice, The Forensic Panel. In a procedure designed to minimize examiner bias, panel members must expose their work to the scrutiny of peers to minimize examiner bias. One of his more controversial creations is the "Depravity Scale," which attempts to quantify evil. Welner is also a frequent media commentator.

In his "voluminous" report, Welner reportedly opines that Mitchell may meet criteria for narcissistic personality disorder or other personality disorders. Typically, as opposed to severe psychotic disorders such as schizophrenia, the personality disorders are not deemed severe enough to make a person incompetent to stand trial.

For further reading, I highly recommend Judge Judith Atherton's 2005 competency opinion in the case, a thoughtful analysis of competency as it pertains to religiosity. Evaluations by esteemed forensic psychologists Jennifer Skeem and Stephen Golding and psychiatrist Noel Gardner are discussed. I have made it available HERE.

Related resources:Deseret News: Mitchell attorneys want fewer witnesses

The Recurrence of an Illusion: The Concept of "Evil" in Forensic Psychiatry, by James L. Knoll, IV (critical commentary on Dr. Welner's Depravity Scale)

Bentall: Diagnoses are psychiatry's star signs

"Let's listen more and drug people less"

Heading over to the Guardian of UK today to check the comments on my essay on the Jaycee Lee Dugard case, I was excited to stumble across a new essay by Richard Bentall. For those of you who don't know him, in my opinion Bentall is one of the most important voices in the mental health field today. His new book, Doctoring the Mind, is an outstanding, empirically based critique of modern biological psychiatry, and its abysmal failure -- all hype to the contrary -- to improve the human condition. His Guardian essay, excerpted below, briefly summarizes his main arguments:

. . . Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."

Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses . . . – have hardly changed since the Victorian period. . . .

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.

When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. . . . This . . . is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.

Many studies have also reported an association between trauma in early life and psychosis. These effects are large [and] understandable in the light of psychological research. . . .

The cruel and ineffective treatments that characterised psychiatry in the mid-20th century -- for instance, prefrontal leucotomy and insulin coma therapy -- would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. . . . There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

The full essay is online HERE. I highly recommend his book, too.

My Guardian commentary on Jaycee Dugard saga

The Guardian of UK asked me to write a comment on the extraordinary saga of Jaycee Lee Dugard. I'm posting the first few paragraphs here, with a link to the Guardian website for the full article and the comments, many of which are quite interesting. (I posted a couple of my own comments to the comments.)

In these harsh economic times, the saga of Jaycee Lee Dugard is especially riveting to the public imagination. Our horror and revulsion unite us. Who can we blame? How could this monster hide amongst us while committing unspeakable acts against innocent children?

Our collective furor and thirst for vengeance run counter to the principles of our justice system, under which a criminal defendant is presumed innocent until proven guilty. Psychiatric issues will make justice especially slow for Phillip Garrido, the registered sex offender who is accused of holding Dugard hostage for 18 years, after kidnapping her in June 1991 when she was just 11. (Garrido and his wife Nancy have both denied the charges.)

Initial evidence points toward a psychosis. In an interview from jail, Garrido called Dugard's story "heartwarming" and referenced secret documents and "hundreds and hundreds of thousands" of lawsuits. And that is just the tip of the iceberg. The wonders of the internet allow us to travel back in time and enter his mind, via rambling blog posts about voices in his head, mind control, and religious delusions of himself as the savior.

Ironically, more than a year ago Garrido referenced the potential for psychotic symptoms to cause violence against children. A woman who drowned her three children in the San Francisco Bay was, he wrote, "led by a powerful internal and external (hearing) process that places the human mind under a hypnotic siege that in time leads a person to build a delusional belief system that drives them to whatever course of action they take."

My Guardian (UK) commentary continues HERE. Please feel free to add your comments and opinions at either the Guardian website or here.

Excerpt from Garrido's Voices Revealed blog

MMPI feud hits prime time

MMPI-2-RF version and Fake Bad Test at issue

The Minnesota Multiphasic Personality Inventory is the most widely used and best known personality test in the world. Daily, it is introduced in court in everything from child custody cases to civil lawsuits to criminal proceedings. Despite the fact that public tax monies sponsored its original development, it's become a major cash cow for the University of Minnesota, raking in about $1 million a year in royalties. But now, media focus on a bitter professional dispute is causing some in the field to wonder whether the legendary test has seen its day.

"Feud over famed test erupts at U," blared the headline on an in-depth investigation by Maura Lerner of the Minneapolis/St. Paul Star-Tribune.

At issue is last year's "dramatic makeover" of the highly profitable septuagenarian. The slimmed-down MMPI-2-RF (restructured form) has just 338 questions rather than the old test's 567.

Leading the critics is James Butcher, a retired psychologist whose career centered around the old MMPI-2. He claims the MMPI-2-RF is so radically altered that it amounts to a new instrument. "These folks have made a new test and they are using the name MMPI ... with all the 70 years of tradition to market [it]." If he's right, of course, then all of the myriad studies and normative data on the old test are irrelevant to interpreting scores on the MMPI-2-RF.

Of even more direct relevance to us forensic folks is the controversy surrounding the new "Fake Bad Scale." As I've blogged about previously (links below), the "FBS" is being used to brand personal injury claimants as malingerers. Critics say the 43-item scale "discriminates against women and is prone to 'false positives.' "

Defenders of the new test deride critics as "the Mult Cult" (a twist on Multiphasic). And, to be fair, some do have a vested interest in the previous edition: Butcher earns a 30 percent cut of the $600,000 annual royalties on the MMPI-2's computerized interpretation system.

All of the hoopla has led to a series of formal investigations. In one, a university audit revealed that most of the MMPI research grant money was going to projects involving advisory board members of University Press's test division, who in some cases had even reviewed their own grant proposals.

The Press's solution to the controversy, according to the Star Tribune, is to "let the marketplace decide."

Hmmm. Is the marketplace really the best judge of good science?

The hoopla is likely to benefit the MMPI's competitors. In forensic circles, the test's former monopoly hold is giving way as the Personality Assessment Inventory and other newer instruments gain ground.

Whatever side we practicing psychologists choose, the major test distributors won't care. They distribute them all, and they will continue to rake in enormous sums of money. Don't you just love those over-the-top shipping and handling fees charged by you-know-who?

Related blog posts:

• New MMPI scale invalid as forensic lie detector, courts rule: Injured plaintiffs falsely branded malingerers? (March 5, 2008)
• Latest on controversial "Fake Bad Scale" (February 23, 2009)
• "Fake Bad Scale": Lawyers advocate exposing in court (May 20, 2008)

Dallas bans 6-packs

No, not beer.
Or soda.
Or abs.

Six-pack photo lineups -- perhaps the single largest cause of wrongful convictions.

Frustrated with a string of wrongful convictions, the Dallas police department is now the nation's largest force to use sequential blind photo lineups -- a widely praised technique designed to reduce mistakes made by witnesses trying to identify suspects.

Dallas is not the first department to use the pioneering method. But experts hope that by using it in the county that leads the nation in exonerating wrongly convicted inmates, Dallas will inspire other departments to follow suit.

"If Dallas can do it ... then others are going to rise to the occasion," said Iowa State psychology professor Gary Wells, a national expert on police lineups.

The department switched to sequential blind lineups in April. Before that, Dallas police administered most lineups using the traditional six-pack -- law-enforcement lingo for mounting six photos onto a folder and showing them to a witness or victim at the same time. In sequential blind lineups, mug shots are shown one at a time. Detectives displaying the photos also don't know who the suspect is, which means they can't purposely or accidentally tip off witnesses.

Showing possible suspects all at once tends to make a witness compare the mug shots to one another, Wells said. But if they are shown sequentially, "witnesses have to dig deeper, compare each person to their memory and make more of an absolute decision."

An analysis of 26 recent studies shows that presenting mug shots sequentially instead of simultaneously produces fewer identifications but more accurate ones, Wells said.

Nationally, more than 75 percent of DNA exonerees who have been released since 1989 were sent to prison based on witness misidentification, according to The Innocence Project.

Here is the complete AP story: Dallas police pioneering new photo lineup approach.

Hat tip: Sol Fulero

Upcoming trainings

American Psychology-Law Society

Mark your calendars for the upcoming AP-LS conference, to be held March 18-20, 2010 in Vancouver, BC. The deadline for conference submissions is October 5. Information about the conference is available at the conference website. Proposals for posters, papers, and symposium can be submitted HERE.

Risk for Sexual Violence Protocol (RSVP)

On October 22, Stephen Hart is going to be down in Portland, Oregon, giving an all-day training on his newly developed instrument, the RSVP (which replaces the Sexual Violence Risk-20 instrument). Dr. Hart is well worth catching. A member of the Mental Health, Law, and Policy Institute at Simon Fraser University in Canada, he is an internationally renowned researcher, forensic psychologist and past president of the American Psychology-Law Society. More information on the training is at the website of Northwest Forensic Institute.