Psychiatrists ramp up opposition to forensic misuse of DSM

"Pedohebephilia" would make bad situation worse, they warn  

As you will recall, at a recent debate members of the American Academy of Psychiatry and the Law (AAPL) were virtually unanimous in giving the thumbs-down to three controversial sexual disorders being proposed for the fifth edition of psychiatry’s diagnostic manual.

Piggy-backing on that sentiment, the Academy's official journal has just published two additional calls for caution. 

DSM's forensic influence cannot be ignored

Ralph Slovenko, an eminent professor of law and psychiatry at Wayne State University Law School, leads off with an editorial that counters a key claim of the proponents of diagnostic expansion. The oft-repeated claim is that the legal implications of a diagnosis are irrelevant, and should not be considered.

Rebutting this head-in-the-sand mentality, Slovenko gives a comprehensive overview of the DSM's impact in myriad areas of the law, from parental termination to disability determinations. As evidence of the DSM's vast influence, he cites language written into the statutes in 16 states mandating its use for various purposes.

As his overview makes clear, courts and legislatures across the United States have ignored the fine print in the introduction to the Diagnostic and Statistical Manual, stating that use of the manual for forensic purposes risks misunderstanding and misuse.

A case in point: Use of a made-up category, "Paraphilia Not Otherwise – Hebephilia," as justification for preventive detention of men who have served prisont time for sexual relations with adolescent.

No basis for fictional "hebephilia" disorder

Next, two psychiatrists who were influential in developing the current edition of the DSM launch a full-on assault on the use of the bogus diagnosis "hebephilia" in sexual predator civil commitment proceedings.

Michael First, editor and co-chair of the DSM-IV-TR, and Allen Frances, chair of the DSM-IV Task Force, clarify the intention of diagnosing paraphilias, or sexual deviances, and why diagnosing offenders against adolescents with "hebephilia" (a diagnosis that does not exist in any formal diagnostic system) is a flagrant abuse of psychiatric nomenclature. This is not the first time these authors have tried to set the record straight, but their current analysis is especially detailed and unequivocal.

The alleged diagnosis paraphilia not otherwise specified, hebephilia, arose, not out of psychiatry, but rather to meet a perceived need in the correctional system. This solution represents a misuse of the diagnostic system and of psychiatry. That a large number of forensic mental health workers have been mistrained to regard paraphilia NOS as a valid diagnostic category in SVP proceedings should not be construed as proper representation of the views of the entire mental health field. Similarly, the very preliminary studies conducted by a few research groups should not be construed to indicate that hebephilia has any solid scientific support. Hebephilia is not an accepted mental disorder that can be reliably diagnosed and should not be treated as such in SVP proceedings.

First and Frances issue a strong call against adding the pretextual diagnosis of "pedohebephilia" to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders:

Among several radical proposals made by the DSM-5 Sexual Disorders Workgroup is the backdoor introduction of the hebephilia diagnosis into the DSM-5 by expanding the existing well-accepted pedophilia category to include sexual arousal to pubescent individuals and renaming the broadened construct pedohebephilic disorder. There is no apparent need or compelling rationale to include hebephilia in DSM-5 beyond the research interests of a few scientists and the questionable use of hebephilia in SVP proceedings.

Despite opposition from forensic psychiatry, no doubt the wheels will grind on. After all, as legal scholar Charles Patrick Ewing describes in Justice Perverted, preventive detention has taken on a life of its own, becoming a lucrative and self-perpetuating industry. More on psychology's role in that very soon….

Related resources:

On my website, I have created a page of resources on the hebephilia controversy. But if you really want to immerse yourself in these diagnostic controversies, the place to visit is the "DSM-5 Paraphilias Controversy." On one page, blogger Andrew Hinderliter has amassed an impressive array of literature on the disputed paraphilias, including not only hebephilia, hypersexuality, and sexual sadism but also related hot-button topics such as transvestic fetishism.

My comprehensive historical review of hebephilia is now available online. Or, for a shorter version, there's always my oldie but goodie blog post, from Halloween of 2007: "Invasion of the hebephile hunters: Or, the story of how an archaic word got a new lease on life."

Justice Perverted: Critical primer on sex offender policy

At a time when many U.S. states are teetering on the verge of bankruptcy and essential public services are being slashed and burned, does it make sense to spend billions and billions of dollars on largely symbolic laws that do little or nothing to prevent or deter sex offending?

Not according to Charles Patrick Ewing, a forensic psychologist and law professor at the University at Buffalo Law School.

I plan to say more about this book's implications for forensic psychologists in an upcoming post. For now, suffice it to say that I highly recommend this timely book to my readers; my review at Amazon is HERE.

Juvenile justice: Online resource

I stumbled across this fantastic resource for anyone interested in issues and trends in juvenile justice. The authors include Laurence Steinberg, Elizabeth Cauffman, Thomas Grisso, and other distinguished leaders in the field. Each article presents solid evidence on an aspect of juvenile justice, much of it in contradiction to what policymakers and the general public believe:

For example, contrary to widespread belief, as Elizabeth Cauffman notes, the causes of crime among male and female offenders are far more similar than different; as Peter Greenwood points out, there is no truth to the notion that, when it comes to delinquency prevention, "nothing works"; and, as explained by Alex Piquero, the causes of disproportionate minority contact are far more complicated than is often claimed both by those who insist that disparities in contact with the system are entirely due to racial bias on the part of the system and by others who contend that the disparities simply reflect racial differences in criminal involvement.

Making these resources available for free to the public is The Future of Children, a joint project of the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution. The mission of The Future of Children is to translate the best social science research about children and youth into information that is useful to policymakers, professionals, and members of the general public.

Click on the below links to go to the full articles, which are available in html and pdf versions for viewing, downloading, or printing. 

• Introduction by Laurence Steinberg

• Adolescent Development and the Regulation of Youth Crime by Elizabeth S. Scott and Laurence Steinberg

• Improving Professional Judgments of Risk and Amenability in Juvenile Justice by Edward P. Mulvey and Anne-Marie R. Iselin

• Disproportionate Minority Contact by Alex R. Piquero

• Juvenile Crime and Criminal Justice: Resolving Border Disputes by Jeffrey Fagan

• Understanding the Female Offender by Elizabeth Cauffman

• Adolescent Offenders with Mental Disorders by Thomas Grisso

• Juvenile Justice and Substance Use by Laurie Chassin

• Prevention and Intervention Programs for Juvenile Offenders by Peter W. Greenwood

Steffan's Alerts #2: Informants, sex offenders and prisoner reentry

Click on a title to read the article abstract; click on a highlighted author's name to request the full article.

Comparison of online and offline sex offenders

In a meta-analysis of data drawn from nine studies, Kelly Babchishin, Karl Hanson, and Chantal Hermann report on demographic and psychological characteristics of online and offline sexual offenders in a new issue of Sexual Abuse: A Journal of Research and Treatment. The authors suggest that online offenders, although exhibiting more sexual deviancy, may also have more self-control and psychological barriers to contact sexual offending than offline offenders.

Online offenders and contact sex offenses

In the same issue, Michael Seto, Karl Hanson, and Kelly Babchishin detail their findings about online sexual offenders’ past contact sexual offenses and future sexual recidivism from two meta-analyses. Approximately half of online sexual offenders self-reported a prior contact sexual offense, whereas 1 in 8 had an official record of a past contact sexual offense. A small number of online sexual offenders committed some type of sexual recidivism in follow-up periods of up to 6 years.

The world of confidential informants

Ever wonder about the lives of confidential informants? In this issue of Justice Quarterly, Mitchell Miller provides insights from interviews of 84 informants from five southern states. A typology for better understanding the motivations of confidential informants is offered.

• Related post: NPR series on confidential informants

Prisoner reentry

Mark Berg and Beth Huebner, in another Justice Quarterly article, examine family ties and employment—two of the many areas related to recidivism—among offenders who are transitioning from prison to the community. They suggest that familial ties may play an important role in assisting offenders to lead a prosocial lifestyle.

Measuring sexual recidivism following prison-based treatment

Based on a sample of low-risk sexual offenders in New Zealand, Sarah Beggs and Randolph Grace demonstrate that reductions in sexual recidivism following prison-based treatment can be measured successfully through self-report psychometric tests and structured clinical rating scales. Average time at risk for recidivism was 12 years for this cohort. In their article, just published online in the Journal of Consulting and Clinical Psychology, the authors conclude, in part, that amelioration of dynamic risk factors for sexual offending leads to reduced sexual recidivism.

Steffan's alerts are brought to you by Jarrod Steffan, Ph.D., a forensic and clinical psychologist based in Wichita, Kansas. For more information about Dr. Steffan, please visit his website.

Positive approach key to sex offender change

Trailblazing authors have walked the walk for 40 years

John distorts his offense history and refuses to accept his sexual deviance. Although the other members of his treatment group vigorously challenge him, they are not fully transparent in their own disclosures. The therapist feels stymied. What should she do?

First, she should abandon confrontation and negative labeling. Next, she should race lickety-split for her computer and order a radical new book that will help her succeed as a therapist and also feel better about herself.

The visionary book is Rehabilitating Sexual Offenders: A Strength-Based Approach, written by the team at Rockwood Psychological Services in Canada. Under the leadership of Bill Marshall, a pioneer in the field, the program has successfully treated sex offenders for 40 years. Unlike most sex offender treatment programs, Rockwood has a negligible refusal rate and a negligible dropout rate. Offenders enter therapy, they complete therapy, and when they get out they are very unlikely to reoffend.

Therapist is the key

As psychologists know from the general treatment research, the therapeutic alliance is a primary factor in successful therapy, with more impact than any specific theory or technique. With sex offenders, who are often mistrustful and reluctant to enter therapy or disclose information that may be used against them, the therapist is even more critical, accounting for between 30% to 60% of change.

Like anyone else (only more so), John isn’t going to benefit from confrontation or shaming. Instead of being critical or judgmental, an effective sex offender therapist is empathetic, warm, respectful, and even humorous at times.

Toss out those iatrogenic labels

Language is powerful. When we call people names -- pedophile, rapist, offender, sex offender, deviant – we encourage their negative and harmful beliefs about themselves. That certainly doesn’t reduce shame or foster change.

Instead, the Rockwood authors (Bill Marshall, his son Liam Marshall, Geris Serran, and Matt O’Brien) focus on strengths, invoking a vocabulary heavily influenced by the positive psychology movement and motivational interviewing.

Their guiding principle:

Inside every offender is a good person waiting to throw off the burden of his dysfunctional past. It is the therapist’s job to facilitate the emergence of that good person.

(Ironically, they do use the term “psychopath,” if only to say that scores on the Psychopathy Checklist  are NOT predictive of treatment failure or recidivism. Of the 70 offenders in their outcome research who scored high on psychopathy, only one reoffended during the 8-year follow-up period.)

The authors do not mince words in critiquing the dominant treatment approach that emphasizes deficits and avoidance. When treatment fails, they say, it is most likely because it was too confrontational. When confronted, patients learn to say what the therapist wants to hear, rather than to genuinely engage.

Denial: Not necessarily a bad thing

One of the most unusual features of the Rockwood program is its emphasis on helping men who continue to deny their offenses despite having been convicted. The therapists do not challenge these offenders to admit their crimes. In fact, they don’t think admissions are that big a deal. They offer several reasons for this:

• Given what we know from the false-confession literature, some deniers truly are innocent. And it is impossible to know which ones.

• Forcing an offender to match his account to his victim’s is silly, because we know from research that victim accounts are highly unreliable. 

• Men who deny offending or offer excuses actually have lower rates of recidivism. As Shadd Maruna found in his research with criminal offenders in the UK, excuse-making is related to good mental health as well as to guilt, which (unlike shame) suggests prosocial values.

For those engaged in treatment, the manual gives loads of practical advice on how to structure and run a program. For forensic evaluators on the outside looking in, who have watched in mounting horror as iatrogenic practices are systematically mislabeled as “treatment,” this book lays out the research that can help you explain real treatment to judges, jurors, and attorneys.

Rehabilitating Sexual Offenders is an auspicious debut for the American Psychological Association series, Psychology, Crime, and Justice, edited by Shadd Maruna. I can’t wait to see what’s next.

If you found this review helpful, please visit my Amazon review (HERE) and click on "yes" (this review was helpful). 

The art on this page is by Ricky Romain, an internationally acclaimed human rights artist in the UK whose work focuses on themes of justice, alienation and sanctuary. Mr. Romain has kindly given permission to showcase his art here. I encourage you to check out his extensive online gallery (HERE).

 

Encephalon carnival 84: Psychology-neuroscience roundup

The dominant theme of this month's Encephalon blog carnival is that no matter how straightforward something may appear, it is not always that simple. Among the intriguing offerings:

• Taylor Burns at Cognoculture discusses some of the misconceptions about testosterone in a brief essay, Testosterone and human aggression. 

• Dave Deriso at The Artful Brain examines Cotard syndrome in What is Truth? And What is ‘Walking-Dead’ Syndrome?. 

• In The Mathematician in the Asylum, forensic psychologist Romeo Vitelli at Providentia explores the life of Andre Bloch, a leading French mathematician who spent 30 years in an asylum after knifing three family members to death.   

Hosting the 84^th edition of Encephalon is Janet Kwasniak, who blogs about consciousness at “Thoughts on Thoughts.” Janet is in France, but wherever you are the content is just a click away – HERE.