Delusional campaign for a world without risk

Convicted sex offender Anthony Sowell seemed run-of-the-mill. He scored a low "1" on the Static-99, the popular actuarial tool designed to quantify risk for sexual recidivism. Now, he is suspected in the murders of 11 women whose remains were found at his Cleveland, Ohio home. (His publicly leaked risk evaluation is HERE.)

John Albert Gardner III, who like Oscar-winning film director Roman Polanski was convicted of molesting a 13-year-old girl, looked almost as routine. Paroling after a 5-year prison stint, he scored a "2" on the Static. Now, he stands charged with the highly publicized San Diego rape-murder of teenager Chelsea King.

While the United States crashes and burns -- jobs disappearing, home values plummeting, public school teachers begging for basic supplies like paper and pencils -- politicians are hosting emergency hearings to determine "what went wrong."

Who you gonna blame? The Static-99

The same California politicians who enthusiastically enacted a law -- the ambitiously titled Sex Offender Control and Containment Act of 2006 -- mandating the use of this scientifically flawed actuarial tool are now jumping all over prison bureaucrats for mandating its use to determine which paroling sex offenders should be most carefully monitored. Maybe they should have listened to those who have been saying all along that actuarial tools are not a panacea.

When I got a call from a news reporter exploring that angle, I found myself in the amusing position of (half-heartedly) defending the Static-99. As I tried to explain to the reporter (who then misquoted me), finding a needle in a haystack ain’t easy. At the risk of sounding perseverative: it's the statistical problem of low base rates. If only about one of every ten paroling sex offenders will reoffend sexually, picking out that one is difficult. And picking the one who will commit an exceedingly rare crime like the Chelsea King murder is virtually impossible. The hysterical masses can't seem to grasp that:

• The broad majority of men who are apprehended and prosecuted for a sex offense are never rearrested for another, and
  

• The broad majority of sex crimes are committed by men who fly below the radar because they have never been apprehended before. To catch these guys, you'd have to engage in massive over-prediction, producing an epidemic of what we call "false positives."

And that's just what the mobs are calling for. As one man in the crowd lobbying for the new "Chelsea's Law" put it, anyone who "touches a child" should automatically lose all Constitutional rights.

Be careful what you wish for. Even in a fascist police state, bad stuff will still happen. In fact, a misplaced emphasis on eliminating risk will paradoxically decrease public safety, by eliminating primary prevention programs that actually work to reduce crime. In California, prison officials told an emergency meeting of the Assembly Select Committee on Prisons and Rehabilitation Reform they would need $1 billion more each a year to return every paroled sex offender to prison on the basis of minor violations like Gardner's. That would mean taking even more pencils away from teachers in a state near bankrupted by its massive prison infrastructure.

All aboard the opportunist train

It's understandable why parents of crime victims like Chelsea King lobby for tougher laws. It's a way to deny their impotence and channel their feelings of sadness, guilt and rage.

And it's similarly easy to understand why politicians jump on the bandwagon. Powerless to fix our shattered economy and lacking the political will to tackle more complex social problems, they seize on random horrors to make themselves look good. Illusory efficacy wins votes.

And then the other opportunists jump on board. Crime Victims United used this week's hearing to lobby against early release of nonviolent prisoners. (Can you say non sequitur?)

Not to be outdone, a group of embittered forensic psychologists have jumped on the Chelsea bandwagon. Forming a secret "consortium," they have complained to the state Attorney General's Office that if they were still evaluating paroling prisoners for potential civil commitment as Sexually Violent Predators (SVP's), they would have done a better job of protecting the public. The evaluators, who are shielding their identities through an attorney, claim that the state's new contract bidding policy for SVP evaluations "results in the loss of life of untold victims" "for the sake of economic expediency." Their propaganda, aired on the incendiary Larry King Live show, conveniently omits mention of their pecuniary interest: Many of these state contractors were billing more than $1 million per year, again while school teachers begged for budget crumbs.

Cultural Myopia and moral relativism

Underlying these empty moral campaigns are a set of intertwined myths and lopsided values:

• Rare sex crimes are a significant threat to public safety. As the mob vents its impotent rage against the government and its spawn -- the mythical sexual predator -- the fact remains that the biggest killer of 15- to 24-year-olds worldwide remains motor vehicle accidents. The is followed closely by suicides, the fourth-leading killer of children over age 10 in seven developed nations.

• Only sex crimes count. Is sexual assault really all that much worse than murder, torture, or other serious crimes? Why is it treated so differently? Are legislatures assigning as much resources to combating the "pseudocommander mass murderer" or the burgeoning militia movement stoked up by its racist hatred of Obama?

• Only a certain type of sex crime counts. Many of the same angry folks who want to suspend the Constitutional rights of some accused sex criminals are busy defending others. When the Chelsea King case broke, the reaction to another breaking sex crime story was its polar opposite. Responding to news that star football quarterback Ben Roethlisberger was accused of a second rape, media pundits went wild on lying, gold-digging women who falsely accuse men of rape. In fact, some of the men who most vitriolically despise sexual predators are rapists themselves. Rape is endemic on many college campuses, with fraternity boys virtually immune from prosecution. As an excellent National Public Radio series describes, young men face few consequences for using alcohol as weapon with which to sexually assault naive young women who are then often forced to quit school. If we really want to make the world a safer place, we need to look a little closer to home. Instead of focusing on an easy bogeyman, let's put our efforts into primary prevention of rape and child molestation. And if we truly want to stop criminals from reoffending, let's not eliminate rehabilitation programs in prison!

• Science is capable of eliminating (or at least drastically reducing) risk. The search for blame has become reflexive. Whenever anything bad happens, the what-went-wrong tenor of media coverage encourages finger-pointing, public wrath, and -- ultimately -- pointless (or worse) legal tweaks by opportunist politicians. When hoodlums sneak into a zoo and taunt a tiger into attacking them, it's the zoo's fault for not building high enough fences. (Remember that 2007 case?) When a speeding truck careens over the side of a bridge, traffic engineers get blamed. "They" -- shorthand for the amorphous "government" -- can never do enough to protect their citizens from all conceivable danger.
  

It's hard to accept that random danger is a part of life. Sometimes, bad stuff just happens.

"Dismantling Hate" show features this author

On August 24th 2008, a young singer-songwriter named Geo Vaughn was walking down the street in New York City when he was set upon and viciously attacked by six young men.

Random? Probably.

Senseless? Not in the minds of the attackers, who believed they had a legitimate basis to punish Geo. After all, he is gay.

Premiering today is "Dismantling Hate," an episode of the award-winning educational television program In The Life on antigay violence. The show features an interview with your very own blogger on the motivations of antigay offenders (the topic of my doctoral research and several subsequent publications).

In the Life, "the longest-running television show documenting the gay experience," is a three-time Emmy Award nominee out of New York that airs nationally on public televison.

Click on the above image to view the short segment.

Teen sexting resources

"Sexting" is a hot topic these days, especially in the wake of this month's U.S. Third Circuit Court of Appeals ruling in Miller v. Mitchell that it is unconstitutional to prosecute teens for child pornography solely based on their cell phone photos. The highly publicized Pennsylvania case illustrated the unintended consequences of current sex offender hysteria. The district attorney's office in Wyoming County had threatened to prosecute a teenage girl on felony child pornography charges unless she underwent mandatory reeducation. An appellate court barred the prosecutor from retaliating against young Ms. Doe for invoking her constitutional right not to attend the education program.

Related resources:

• An excellent overview by Tamar Lewin of the New York Times, "Rethinking Sex Offender Laws for Youth Texting"

• A TV news video of forensic psychology students speaking about teen sexting at a state government hearing in Connecticut

• The website of the Center for Safe and Responsible Internet, containing a wealth of information and resources on the widely hyped teen sexting phenomenon
  

Canada: Parent complaints deterring custody evaluators

Speaking of censorship...

Fear of complaints by disgruntled parents is deterring professionals from working in the child custody arena, creating a "major social and legal problem," according to a group of lawyers and forensic evaluators in Canada. The group is urging the Canadian government to change the law in order to restrict disciplinary complaints.

A plea signed by 11 psychologists, psychiatrists, lawyers and social workers “urges changing the rules so disciplinary bodies can only consider complaints from such parents if they have been first approved by the judge in the case or by the other, winning parent, or have been screened to weed out frivolous grievances,” according to an article in the National Post. As reporter Tom Blackwell explains it:

Experts are appointed jointly in custody cases to interview, observe and sometime conduct psychological testing on family members to help determine who is best able to care for the children of divorces. The work can take months and cost the parties up to $75,000. The lobby group is not looking to gain "immunity" for assessors from disciplinary charges, only to curb the high number of spurious complaints, said Nick Bala, a Queen's University law professor.

Hat tip: Ken Pope

UK: Lie detection critic silenced by lawsuit

Hearing voices lately? If not, that could be because corporate interests are using the legal system to keep critical voices from speaking out about controversial new tools in our field, according to European scholars.

A Swedish phonetics professor says when he challenged the premises underlying an Israeli voice risk analysis (VRA) lie detection system that the British government has spent 2.4 million pounds pilot testing, the manufacturer threatened his publisher into withdrawing a manuscript from press. The government wants to employ voice stress analysis to detect benefits fraud; here in the United States, police frequently use similar technologies in criminal interrogations.

Francisco Lacerda, the Stockholm University professor, said the censorship "showed how English law was damaging science abroad as well as in the UK," according to an article in the Times of London.

Responding to a series of similar high-profile defamation actions against scientists, a group called the Libel Reform Coalition is campaigning for changes in Britain's law. A Coalition petition, signed by about 44,000 people when I last checked, is online HERE; I encourage you to check out the group's website and sign the petition.

"DSM-5 and sexual disorders: Just say no"

Psychology urged to oppose psychiatric monopoly

When one introduces new chickens into an existing flock, the flock establishes a pecking order. The older birds peck the new ones into submission. With lower status, the new birds feel -- to anthropomorphise a bit -- inferior.

That's what happened when the upstart field of psychology pushed its way into the bastions of psychiatry. Psychiatrists bristled at the intrusion. Psychologists of necessity submitted to psychiatric authority. Now, years later, psychologists vastly outnumber higher paid psychiatrists in many mental health niches, but as a profession we still have an inferiority complex. Thus, we let a single psychiatric association in the United States dictate how mental functioning and impairment are conceptualized.

As the chorus of critical voices over the American Psychiatric Association's poorly drawn draft DSM-5 manual grows ever louder, some are urging psychology to issue a formal opposition paper. For example, Stephen Diamond, a clinical and forensic psychologist in Los Angeles, writes in Psychology Today that our profession's apathy "is a big part of the problem":

While clinical psychology has to some extent leaped onto this same biological bandwagon driven by contemporary psychiatry, seeking prescription privileges, some psychologists and other non-medical mental health professionals have practically written off the value and importance of psychodiagnosis today -- in part precisely due to its inherent medicalization, biological bias, dehumanizing labeling, and notorious inaccuracy…. [I]t is time for the leadership of the American Psychological Association to take a far more active and public role in the revision and direction of the DSM-5…. What, if anything, [is] the American Psychological Association is doing about DSM-V? Or about the hypermedicalization of psychology?

Allen Frances, the psychiatrist who chaired the DSM-IV task force, has become one of the most vocal critics of the manual's proposals. He too is calling on organized psychology to step up before it is too late. Taking his campaign directly to psychology and the general public, he hosts a "DSM5 in distress" column in the popular magazine Psychology Today that shines a spotlight by turn on various problematic aspects of the draft manual. In his recent call for an organized response from psychology, he writes that:

the American Psychiatric Association (APA) came to hold the DSM franchise only by historical accident…. Now that the DSMs have attained such importance, there have been repeated questions about the appropriateness of its continued sponsorship by more than just one professional organization…. The numerous problems that have bedeviled the development of DSM5 again raise the question whether the American Psychiatric Association should be sole steward of an official diagnostic system that impacts on all mental health disciplines…. Individual psychologists and the professional associations within psychology can play an important role in pointing the way forward for DSM5 and in protecting it from costly mistakes.

Perilous forensic consequences

Frances is increasingly focusing on the monumental potential for negative and unintended consequences in the forensic realm of the proposed changes:

The most obviously detrimental suggestions are in the paraphilia section, where the proposed change to the definition of paraphilia and the likely suggestion to introduce a new diagnosis of "paraphilic coercive rapism" will greatly compound the significant mischief already initiated by a seemingly trivial change in DSM-IV. More generally, even small changes in wording can result in large forensic confusion once parsed by lawyers in their peculiarly rigorous and tendentious fashion. The wording of every suggested option in DSM5 needs careful review by forensic experts.

"DSM-5 sexual disorders make no sense"

In a more recent column, Frances specifically targets the Big 3 sexual disorders that I have extensively blogged about. Of all of the DSM-5 work groups, he writes:

the Sexual Disorders Work Group has strayed furthest off the reservation. It has made a series of radical and dangerous suggestions that need to be dropped.... Each of the Work Group's suggestions is based on the thinnest of research support-usually a handful of studies often done by members of the committee making the suggestion. None has been subjected to, or could possibly survive, anything resembling a serious risk/benefit or forensic analysis.

As he points out, there are few researchers and little good research on sexuality. Consensus on the bounds of "normalcy" does not exist, and cultural bias plays a major role in what is defined as pathological (a point cogently made by Richard Green in his critique of the proposed hebephilia diagnosis). Especially important for my readers, "decisions regarding the diagnosis of sexual disorders can have profound and unanticipated forensic ... implications."

Regarding the three paraphilia proposals that will have the most impact in civil commitment proceedings in the United States, Frances had the following to say:

"Paraphilic Coercive Disorder"

This proposal was explicitly rejected for DSM IIIR and was given no serious consideration for DSM IV. The problem is the impossibility of reliably distinguishing between the small group of hypothesized "paraphilic" rapists (who would be given a mental disorder diagnosis) and the much larger group of rapists who are simple criminals.

The distinction has taken on huge significance because [of] SVP statutes mandating indefinite (usually in practice lifelong) inpatient civil psychiatric commitment for individuals who have (1) completed their prison sentence for a sexually violent crime, (2) have a diagnosed mental disorder, and (3) are deemed likely to repeat.... Although the SVP statutes have twice passed Supreme Court tests, they rest on questionable constitutional grounds and may sometimes result in a misuse of psychiatry.

Most disturbingly, an ad hoc and idiosyncratic suggested diagnosis -- Paraphilia Not Otherwise Specified -- has become a frequent justification for the psychiatric commitment of rapists who are really no more than simple criminals. Raising this diagnosis to official status would greatly compound this misuse of civil psychiatric commitment.

"Hypersexuality Disorder"

This is the strangest of constructs.... The fundamental problem with "hypersexuality" is that it represents a half baked, poorly conceptualized medicalization of the expected variability in sexual behavior.... The authors are trying to provide a diagnosis for the small group whose sexual behaviors are compulsive -- but their label would quickly expand to provide a psychiatric excuse for the very large group whose misbehaviors are pleasure driven, recreational, and impulsive. The offloading of personal responsibility in this way has already captured the public and media fancy and would spread like wildfire. Making an official mental disorder category of "hypersexuality" would also have serious unintended forensic consequences inthe evaluations of sexually violent predators (SVP).

"Pedohebephilia"

This new category would extend the traditional definition of Pedophilia ... to include pubescent teenagers. Clearly, sex with underage teenagers is reprehensible and deserves appropriate punishment under the penal code. It is, however, anything but clear when (and if) sexual behaviors with teenagers should qualify as a mental disorder. This diagnosis would be subject to the same misuses in SVP cases as has been described above.

With such widespread and vigorous opposition, it's hard to imagine these nutty proposals slipping into the DSM-5. But, stranger things have happened in the field of psychiatry.

Related article:

DSM-5 and "Psychosis Risk Syndrome": Not Ready For Prime Time
Dr. Frances' latest piece, in Psychiatric Times, is on Psychosis Risk Syndrome, one of the scariest diagnostic proposals. If adopted, it would likely lead to a wave of false-positive errors in which teenagers are wrongly identified as future schizophrenics and placed on dangerous antipsychotic medications.

Hat tips: Ken Pope, Andrew H.
Graphics credit: Raul Crimson (Creative Commons license 2.0)