Training update: March 25 in Seaside, California

Ethics and forensic diagnosis

For you Californians, I’ve got some good news on the training that I am giving at the Forensic Mental Health Association conference March 24-26 in Seaside. The organizers have just doubled my time slot: I will now be presenting for the entire afternoon of Thursday, March 25. If you are free that day, there is still time to sign up. Registration information is online HERE.

My topic is Ethical Considerations in Psychiatric Diagnoses in Forensic and Correctional Settings. I will give an overview of ethics issues in the use of diagnostic labels in court and in correctional settings before focusing specifically on controversial diagnoses that are often invoked in adversarial legal contexts. Diagnoses of focus will include Antisocial Personality Disorder and the sexual paraphilias, including pedophilia and the novel diagnoses being proposed for the upcoming DSM-5 (e.g., "Paraphilic Coercive Disorder" and "Pedohebephilia").

Please note that the time listed in the program brochure for my training is incorrect. My new, expanded time slot is from 1:30 to 5:00 p.m.

This year's legal track, focusing on competency to stand trial in California (see my previous blog post), has also been expanded and will include some exciting new presenters.

All types of continuing education credits are being offered for professionals in the fields of mental health, law, and law enforcement.

New critique of proposed hypersexuality disorder

Although the construct of hypersexuality is becoming popular with clinicians, strong empirical evidence for its validity is lacking, according to a new critique in the Archives of Sexual Behavior. The author, Jason Winters, is a research psychologist involved with the High Risk Sex Offender Program of the Forensic Psychiatric Services Commission in Vancouver, BC.

As with other disorders being proposed for DSM-5, due out in 2013, the boundary between normalcy and supposed pathology is fuzzy and arbitrary, writes Winters. Findings from a recent Internet survey he conducted suggest that more than four out of every ten men and one out of five women might meet the "excessive sexuality" criterion, operationalized as an average of seven or more orgasms per week.

And if behaviors that interfere with other responsibilities are evidence of pathology in the sexual realm, why not create formal mental disorders for other types of preoccupations? For example, why not pathologize a tenure-track professor who prioritizes academic work over family and friends? (I was glad Winters did not mention excessive blogging as an example of a potential mental illness, but then I remembered that Internet Addiction has already been proposed for the DSM.)

The criterion of engaging in sexual behavior to enhance mood is similarly problematic:

[I]f we are to accept that repeatedly engaging in sexual behaviors to enhance mood is symptomatic of a distinct sexual disorder, then we must also be willing to accept that repeatedly engaging in non-sexual rewarding behaviors for a similar effect is symptomatic of other corresponding mental disorders…. [But] the DSM does not include disorders of watching too much television, or shopping, exercising, or working too much.

As Winters points out, an unstated bias against sexual expression outside of a traditional monogamous marital dyad seems the basis for calling some sexual behaviors -- such as one-night stands, anonymous sex, and multiple partners -- evidence of disease.

Ultimately, he concludes that while excessive sexuality may be problematic and distressing for some, and in such cases merits clinical attention, a new diagnosis may be of "dubious value."

Except, I might add, to the civil commitment industry, increasingly desperate for new diagnoses to justify the civil commitment of sex offenders who do not qualify for recognized mental illnesses.

Police interrogations: AP-LS issues landmark white paper

Boy's "psychological torture" points to need for reform

In 1998, the Crowe family in Escondido, California awakened to their worst nightmare. Twelve-year-old Stephanie was lying in a pool of blood on her bedroom floor, dead from multiple stab wounds. Police quickly zeroed in on a suspect -- Stephanie's 14-year-old brother Michael. After a series of grueling interrogations, Michael ultimately admitted he may have killed his sister. He and two friends were arrested for murder.

Only through serendipity were the boys' charges dismissed more than a year later, when DNA evidence proved that a mentally ill transient had committed the murder. That man, Richard Tuite, was ultimately convicted of manslaughter.

Now, the Ninth U.S. Circuit Court of Appeals has reinstituted the families' civil rights case against the police, dismissed by a federal judge several years ago. Writing for the three-judge panel, Justice Sidney R. Thomas described the shocking nature of the interrogations:

One need only read the transcripts of the boys' interrogations, or watch the videotapes, to understand how thoroughly the defendants' conduct in this case "shocks the conscience." Michael and Aaron [Houser] -- 14 and 15 years old, respectively -- were isolated and subjected to hours and hours of interrogation during which they were cajoled, threatened, lied to, and relentlessly pressured by teams of police officers. "Psychological torture" is not an inapt description.

"Psychological torture" and "brutal and inhumane" were descriptions given by a juror in the real killer's criminal trial after he viewed the videotaped interrogations. (I show the heartwrenching video, which is no longer available commercially, in my forensic courses.) Dr. Richard Leo, an expert in coerced confessions and author of Police Interrogation and American Justice (read my review HERE), echoed the juror's sentiments, describing Michael's interrogation as "the most psychologically brutal interrogation and tortured confession that I have ever observed." So did Dr. Calvin Colarusso, Director of Child Psychiatry Residence Training Program at the University of California, San Diego, who evaluated Michael and described the interrogation as "the most extreme form of emotional child abuse that I have ever observed in my nearly 40 years of observing and working with children and adolescents."

The appellate victory will allow the families' federal civil rights case to move forward to a jury trial or a settlement. In an interesting angle, the justices also reinstated the claim against a psychologist whom police consulted during the interrogation. The plaintiffs allege that Dr. Lawrence "Deadlift" Blum, a police psychologist, conspired with Escondido police, helping them formulate a "tactical plan" that they followed in their interrogation. Blum admitted in a deposition that he told a police detective that 15-year-old Aaron Houser, Michael's friend, was a "Charlie Manson wannabe."

The ruling coincides with publication of a landmark article sponsored by the American Psychology-Law Society (AP-LS) on the scientific status of coerced interrogations and false confessions. The article, written by leading scholars Saul M. Kassin, Steven A. Drizin, Thomas Grisso, Gisli H. Gudjonsson, Richard A. Leo, and Allison D. Redlich and published in this month's Law & Human Behavior after an extensive process of vetting and review, is only the second such paper authorized by AP-LS in its 42-year history. The first was a 1998 white paper on eyewitness identification. As William C. Thompson, criminology and law professor at the University of California at Irvine, notes in the introduction to the special issue:

That paper (Wells, Small, Penrod, Malpass, Fulero, & Brimacombe, 1998) proved extremely influential in subsequent policy debates about line-ups and other eyewitness identification procedures. By providing an intellectual framework for analysis of systemic factors that affect eyewitness accuracy, and by distilling specific policy recommendations from a broad array of research, it set the agenda for policy discussion and channeled those discussions in productive directions. The paper was the foundation for a subsequent National Institute of Justice policy paper. Many of its recommendations, such as procedures for composing line-ups and instructing witnesses, are beginning to be implemented nationwide.

The AP-LS hopes the current review article will have a similar effect on the field. After methodically reviewing the state of the science, the authors make a number of critical recommendations for reform aimed at reducing the number of false and/or coerced confessions. These include:

• Mandatory electronic recording of interrogations, with the camera angle focused equally on the suspects and detectives
• Limits on the duration of interrogations
• Limits on the presentation of false information and evidence
• Special protections for vulnerable suspects, including juveniles and those with cognitive and/or psychiatric impairments
• Scrutiny of "minimization" tactics, in which police pursue "themes" that minimize suspects' perceived moral, psychological, and/or legal culpability
  

Michael Crowe's exoneration came about as a result of what author Edwin Borchard described in a 1932 tome on wrongful convictions as "sheer good luck." The scholars who collaborated on this white paper hope that their recommendations will reduce the role of such serendipity, by giving police, prosecutors, judges, and juries the scientific information necessary to reduce egregious injustices like the one in Escondido 12 years ago.

Images: (1) Michael Crowe's interrogation, (2) Richard Tuite, the real killer, (3) Michael Crowe with his sisters; Stephanie is on the left.

Hat tip: Adam Alban

Brian David Mitchell will pursue insanity defense

In the wake of last week's competency finding, a date of Nov. 1 has been set for Brian David Mitchell's federal trial in the kidnap-rape of Elizabeth Smart of Utah. The defense has indicated it plans to mount an insanity defense. As reported by the Associated Press today, a parallel case in state courts has stalled over the question of Mitchell's competency.

I'm still wading through Judge Kimball's 149-page ruling on competency, which I highly recommended to any of you who do competency work. In describing Mitchell as a cunning malingerer, the decision has plenty of implications for the insanity trial as well.

Latest hebephilia critiques: Point-counterpoint

I've just updated my Hebephilia and the DSM-5 Controversy resources page with two new articles in the Archives of Sexual Behavior critiquing the proposed diagnosis of pedohebephilia.

Green: Moral standards masquerading as science

In his boldly titled "Sexual Preference for 14-Year-Olds as a Mental Disorder: You Can’t Be Serious!!," prominent psychiatrist and sexologist Richard Green pulls no punches. Green, who teaches at the Imperial College of London, served on the Gender Identity Disorders subcommittee for DSM-IV. Back in the 1970s he was a forceful advocate for removing homosexuality from the manual of mental illnesses, a struggle he references in his current critique:

The parody of science masquerading as democracy made a laughing stock of psychiatry and the APA when it held a popular vote by its membership on whether homosexuality should remain a mental disorder. Decreeing in a few years time that 19-year-olds who prefer sex with 14-year-olds (5 years their junior) have a mental disorder … will not enhance psychiatry’s scientific credibility.

As he points out, the age of legal consent in several European countries falls within the range that the proposed pedohebephilia disorder would make pathological for the older participant:

If the general culture is accepting of participation by the younger party, but psychiatry pathologizes participation by the older party, then the mental health profession pronounces a moralistic standard and, if successful, becomes an agent of social control.

Green goes on to catalog "biased terms" and "logically frail arguments" in the proposal. In this, he joins a growing chorus of voices sounding the alarm about myriad problems with the proposed pedohebephilia diagnosis.

O'Donohue: Let's go even further

Coming at it from the opposite angle of most critics is William O'Donohue, a psychology professor at the University of Nevada at Reno and co-editor of the second edition of the widely consulted text Sexual Deviance.

O'Donohue argues for keeping it simple: "any sexual attraction to children … is a pathological, abnormal condition." His proposed diagnosis reads as follows: "The person is sexually attracted to children or adolescents under the age of 16" as evidenced by (1) self report, (2) laboratory findings, and/or (3) past behavior. Whether the person has acted on his or her attractions would not matter. The number of victims would not matter. And internal distress would not be required.

O'Donohue expresses a lack of concern over the inevitable false positive errors that such a broad net would ensnare. He argues that we should be more concerned about false negative errors -- pedophiles who escape diagnosis when the criteria are too narrow, for example when more than one known victim is required. And he applauds the move to expand pedophilia to include hebephilia, or attraction to pubescent minors.

Prosecution-retained evaluators in U.S. civil commitment cases will be salivating at the prospects for this one. But consider the source. O'Donohue is the psychologist who has argued for subjecting gay and lesbian parents to special scrutiny in child custody evaluations. (Respected child custody experts Jonathan Gould, David Martindale, and Melisse Eidman wrote an outstanding counterpoint, summarizing the empirical research as indicating that "sexual orientation is not a pertinent factor when considering the best psychological interests of children." In the interest of full disclosure, I share that view, as I wrote in an article published in the same journal a few years earlier.)

And, despite his support for diagnostic expansion, even O'Donohue concedes that the psychometric properties of the proposed diagnosis remain unknown. In other words, neither its reliability nor its validity have been empirically established. A wee problem, that.

A list of published articles on the hebephilia debate, with links to the publisher's web pages, is HERE. For the newest additions, look for the "NEW" icon towards the bottom of the page.

Stalker slain -- "WWBD?"

You evaluate a man who engaged in repetitive stalking of a high school girl. He spied on her, followed her around (rationalizing it as “for her own good”), and even climbed in her bedroom window at night and watched her sleep. He acknowledges a powerful desire to kill her.

Ominous, right? When we encounter men like this, they raise our hackles.

But in pop culture -- movies, music, and videos -- this possessive, condescending, and downright creepy behavior is often glorified as "true love." Such is the case with Edward in the blockbuster Twilight movie series, marketed with great fanfare to young teenage girls.

Appalled by the sexually predatory behavior modeled by Edward in Twilight, freelance Web designer Jonathan McIntosh of Rebellious Pixels asked himself, "What would Buffy do?" Buffy, of course, being the strong woman heroine of the popular TV series Buffy the Vampire Slayer.

If you haven’t seen the resultant video mashup, stop whatever you're doing and take the six minutes to watch it.



The brilliant and hilarious video has been translated into 16 languages and watched by millions of people worldwide. As reported in the L.A. Times, Buffy v. Edward reveals Edward’s supposed charm for the creepy stalker behavior it is:

[T]he Slayer has little patience for the expertly coifed Edward, dazzling or otherwise. "Being stalked isn’t a big turn-on for girls," Buffy tells him. When Edward tries to explain that he's on "a special diet," Buffy replies, "What are you doing? Here, at this table, talking to me like we're some kind of talking buddies?"

McIntosh's essay explaining his project is HERE.