Historic hunger strike by Supermax prisoners continues

Gangs are bad, right? And prison gangs are worse?

Yet, when members of California prison gangs try to retire, California punishes them. They are shipping to a solitary housing unit (SHU) at Pelican Bay, one of the worst prisons in the state. They are locked in isolation cells for months or even years while being forced to undergo lengthy “debriefings” where they must snitch on other prisoners. Many become mentally ill.

The conditions of extreme isolation and deprivation are so severe that they violate the U.S. Constitution and international laws on torture, according to prisoners who on July 1 began a hunger strike in protest.

The prisoners were supported by up to 6,600 prisoners at 13 other prisons around the state. But even with some of the strikers reportedly nearing death this week, prison officials adamantly refuse to sit down at the table and negotiate. In fact, they are putting an evil spin on the strikers by claiming they are being coerced by prison gangs.

The prisoners' demands include an end to long-term solitary confinement, expansion of constructive activities and privileges (such as phone calls and the right to take one photo of themselves per year), and abolition of the prison’s gang debriefing policy.

One of the striking prisoners is Hugo Pinell, an African American organizer who has been imprisoned since 1971 for his role in the San Quentin uprising that led to George Jackson's death. Pinell has been at the Pelican Bay SHU for 20 years.

This is at least the third in a series of protests by U.S. prisoners in recent months. Last December, thousands of prisoners in Georgia used mobile phones to organize what has been called the largest prison labor strike in U.S. history, in at least six prisons across the state. Prisoners on death row in Ohio then went on a hunger strike and won some changes in their conditions, according to a lengthy report by Al Jazeera. 

Al Jazeera has more background on the strike (HERE). To get involved by contacting state officials or taking other supportive action, visit the blog of Prisoner Hunger Strike Solidarity.

Related blog post:

• Supermax: Hell on earth ... or not so bad

Loughner case shines spotlight on forced meds practices

Under what circumstances may the U.S. government drug a captive against his will?

A round of high-profile court skirmishes over the forcible medication of attempted assassination suspect Jared Loughner may help resolve legal ambiguities on this issue.

Two decades ago, in the landmark case of Washington v. Harper, the U.S. Supreme Court ruled that convicted prisoners may be forcibly medicated without a judicial hearing, if prison officials deem them dangerous to themselves or others. All that is needed is an informal administrative hearing behind the walls, a proceeding that many liken to a kangaroo court.

But pretrial detainees – who are presumed innocent – have greater rights when it comes to forced medications to restore their competency to stand trial. In the 2003 case of U.S. v. Sell, the high court specified certain conditions that must be met before someone may be forced to take medications designed to render him or her trial competent:

The Constitution permits the Government involuntarily to administer antipsychotic drugs to render a mentally ill defendant competent to stand trial on serious criminal charges if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the trial’s fairness, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.

Government "end run"?

In the Loughner case, defense attorneys accused the government of trying to make an end run around these legal requirements by claiming that Loughner was dangerous. The incidents of alleged dangerousness claimed by the government included cursing and throwing a plastic chair on March 14, spitting and lunging at his lawyer, Judy Clarke, on April 4, and throwing chairs in his cell on May 28.

All of these incidents took place at the prison hospital in Springfield, Missouri where Loughner was sent after being diagnosed with paranoid schizophrenia and determined to be incompetent to stand trial. Loughner’s attorneys said they were denied access to their client, and only found out after the fact that the prison had held a hearing on June 14 and unilaterally decided to forcibly administering antipsychotic medication. Loughner is taking the oral antipsychotic Risperidone under threat that if he refuses, he will be forcibly injected with the potent drug Haldol.

In an emergency motion filed June 24 seeking to force a halt to the medications, the defense team said three isolated instances of misconduct during five months in custody are hardly sufficient to show present dangerousness. They accused prison staff of administering the antipsychotic not to reduce Loughner’s danger, but to restore him to competency, in violation of Sell. They asked that the prison be ordered to use other means of reducing Loughner’s danger if necessary, such as restraints, isolation, or minor tranquilizing drugs.

Courts must remain mindful that the dangerousness rationale and its purported justifications don’t become muddled with the attempt to administer psychotropic medications for purposes of treatment and restoration of competency…. To permit the prison to make these treatment decisions without Sell’s guidance and protections not only jeopardizes a significant liberty interest, it jeopardizes a fair trial.

They cited the landmark case of Riggins v. Nevada. In that case, the U.S. Supreme Court held that a Nevada man was deprived of a fair trial by being forcibly medicated to keep him competent during trial. The medications interfered with the content of his testimony and his ability to follow proceedings and communicate with counsel; they also impacted his outward appearance such that he no longer appeared insane, despite the fact that he was claiming insanity at the time of his crime.

"I didn’t go to medical school"

A federal judge summarily denied the defense motion, saying he did not want to second-guess the prison clinicians.

"I defer to medical doctors," U.S. District Judge Larry A. Burns said at an emergency hearing requested by the defense. "I have no reason to disagree with doctors. I didn't go to medical school."

But because the issue of whether forced drugging is permissible is a legal issue, not a clinical one, this seems like improper deference.

Luckily, the 9th Circuit Court of Appeals had more sense, issuing an emergency order July 2 to halt the medications until the issue could be fully litigated.

The appellate court pointed to its 2005 ruling in of United States v. Rivera-Guerrero, holding that forced administration of medications to pretrial detainees is of “clear constitutional importance.” In that case, the 9th Circuit ruled that in federal cases that such orders are too important even to be issued by lower magistrate judges, as opposed to district court judges.

Should pretrial detainees get greater deference?

At a hearing before a three-judge panel on Thursday, the appellate justices focused on the distinction raised by Loughner’s defense team between forcibly medicating a convicted prisoner and medicating a pretrial detainee.

“Why should someone presumptively innocent not be treated with greater personal deference” than a convicted prisoner, asked Judge Alex Kozinski, chief judge of the 9th Circuit, according to the Wall Street Journal.

"Is the goal of rendering the defendant competent different from medicating him for dangerousness?” asked Judge Kim McLane Wardlaw, touching on another area of murkiness. "Are these different goals? How do you separate them out?"

Loughner’s attorneys argue that not only will their client's fair-trial rights be affected, but he could also suffer irreparable harm from the strong drugs because they alter the chemical balance in the brain and can have serious, even fatal, side effects.

With the immediate urgency out of the way, the appellate panel did not give a date for their ruling on the medication issue.

Where is this heading?

This skirmish holds the promise of clearing up confusion over when the government may forcibly drug a captive without a formal court hearing. But, no matter which way this skirmish ends, Loughner will likely never be released from custody. His case may take one of several directions.

One likely next step is that he will be granted a Sell hearing, as his attorneys seek. If so, it seems likely that forced medications will be authorized. After all, if ever there was a compelling government interest in seeing that a defendant goes to trial, it is here. The 22-year-old Arizona man faces 49 felony charges in a Jan. 8 shooting rampage that killed six people and wounded 13, including U.S. Representative Gabrielle Giffords.

If he is given antipsychotic medications, Loughner will most likely be rendered competent to stand trial, probably within a year. The standard for competency to stand trial requires only that a defendant have a factual and rational understanding of the proceedings and an ability to rationally assist his attorney in his own defense.

Once Loughner is found mentally competent, his attorneys will likely raise the defense of insanity. In order to be found insane, his mental disorder must have prevented him from knowing that his actions were wrong at the time he committed them. If he is found insane, he will be committed to a locked psychiatric hospital.

In contrast, if he is found guilty he faces the death penalty. However, there is a good chance that attorneys will negotiate a plea deal that spares his life. This is what happened in the case of Ted Kaczynski, the Unabomber. Such a resolution has the advantage of avoiding the internationally embarrassing spectacle of the U.S. government trying and executing someone who was floridly psychotic at the time of his crimes.

There is also the remote possibility that Loughner will not be restored to competency and so will never face trial. This could happen either if his attorneys succeed in fighting forced medications (a highly unlikely event), or in the event that medications do not work to restore his sanity. In either of these circumstances, prosecutors could seek to have him civilly committed to a psychiatric hospital.

Bottom line, he will never be released back into the community.

I have made the June 24 defense motion available HERE. My previous essay on the Loughner case, “The Arizona rampage: Analyzing the analyzers,” can be found HERE. My other prior coverage of legal wrangling in this case is HERE.

Steffan's Alerts #6: Tattoos, bias, homicides and death penalty attitudes

Professional biases in diagnosing child sexual abuse

In a new issue of Child Abuse and Neglect, Mark Everson and Jose Miguel Sandoval surveyed 1,106 child maltreatment professionals in order to explore personal biases and attitudes that might account for how professional judgments of child sexual abuse differ based on the same evidence.

Does information about the death penalty alter attitudes?

In a new issue of Crime and Delinquency, Scott Camp and colleagues report data suggesting that the answer is "yes" but the extent of the effects depends on personal characteristics.

Branding of the criminal lifestyle through tattoos

Alicia Rozycki Lozano and colleagues examine the connection between prison tattoos and criminality in their new article in the International Journal of Offender Therapy and Comparative Criminology. As a group, offenders with prison tattoos are at higher risk for recidivism and incur more institutional infractions than do offenders with non-prison tattoos or no tattoos, the authors report.

Risk assessment among homicide offenders

Several articles in the new issue of Homicide Studies might pique your interest: 

• Amy Nivette reports on the limitations of using cross-national research to identify predictors of homicide.

• Sharon Smith and colleagues of the Centers for Disease Control and Prevention used qualitative analyses to derive four categories that they hope will improve understanding of sexually motivated homicides.

• Melanie-Angela Neuilly and colleagues present a classification tree analysis, based on  320 homicide offenders in New Jersey, that they contend is useful in predicting recidivism.

• Jeff Gruenewald compared homicides committed by extremists with those perpetrated by other types of persons in the United States. He found both similarities and differences.

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

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.

Top forensic psych’s shameful secrets: A cautionary tale

An investigative report on the secret life of a prominent forensic psychologist is generating controversy on professional listservs. Some want to let sleeping dogs lie. Others, including this blogger, believe the sordid tale contains valuable lessons for the field.

Photo credit: Seattle Times

Stuart "Stu" Greenberg was at the pinnacle of a highly successful career when he committed suicide in 2007 after being caught using a secret camera to spy on women – including fellow psychologists -- in his office bathroom.

Greenberg was a respected leader in forensic psychology. Former president of the American Board of Forensic Psychology, he had functioned as a professional gatekeeper in heading the committee that wrote a national certification exam for the field. He was a sought-after speaker who published articles on ethics in peer-reviewed journals. In court, his opinion could decide the fate of a parent seeking custody of her child. Charging $450 an hour, he had amassed an estimated $1.7 million in personal worth and owned at least two houses and a boat.

But in last weekend's Seattle Times, investigative reporters Ken Armstrong and Maureen O'Hagan reveal new details of Greenberg's less savory side. They go so far as to paint the Seattle psychologist as a "toxic force -- a poison coursing through the state's court system," who destroyed lives while building a career based on "hypocrisy and lies."

Previously sealed records dug up by the newspaper -- including a 1990 disciplinary case -- attest to Greenberg's power and "cunning," the reporters write:

His word could determine which parent received custody of a child, or whether a jury believed a claim of sexual assault, or what damages might be awarded for emotional distress…. [The records] show how he played the courts for a fool. He played state regulators for a fool. He played his fellow psychologists for a fool. And were it not for a hidden camera, he might have gotten away with it.

The report describes how Greenberg coerced Washington state's Examining Board of Psychology into sealing public records of a 1990 disciplinary action against him. The case involved alleged misconduct in four separate child custody cases. The Board imposed a three-year ban on his conducting such evaluations. But "within a year of getting his disciplinary history sealed, Greenberg was giving seminars to other psychologists on the ethics of parenting evaluations," the report says.

As an example of the destruction wrought by Greenberg, the reporters interviewed the complainant in one of the four cases. Surgical nurse Cathy Graden said she had no fears of losing custody of her 4-year-old son after her divorce. What she didn't know was that Greenberg and the lawyer for her ex-husband were limited business partners in a speculative investment venture:

The report Greenberg filed in court eviscerated Graden. It said she posed a grave danger to her son; that she was "probably" sexually abusing him; that she was psychologically unstable and possibly paranoid….In court, testifying, Greenberg described Graden as "quasi-psychotic," but said the diagnosis was tricky, because Graden might appear "quite normal." She would likely deny doing anything wrong to her son, Greenberg said, or alternatively, she "might genuinely not remember."

By the time Greenberg finished, Graden, out in the hallway, had been stripped of all defenses -- and without a clue to what had just happened. If she appeared normal -- well, Greenberg said she would. If she denied hurting her son -- that was part of her disorder. If she challenged Greenberg's work or motives -- she was paranoid. At the end of the hearing … the judge ordered the boy turned immediately over to his father, with Graden allowed to visit only if supervised by a therapist.

Graden finally got her son back when he was nine years old, but only because his father was killed in a work accident.

"Inscrutable field with immense power"

The Seattle Times piece is slanted. It castigates the entire field for the alleged criminal and unethical conduct of one individual. As we all know, there are honorable and dishonorable people in all professions. In my locale, the FBI is investigating a group of rogue police who allegedly sold drugs, ran a brothel and took money from a lawyer to make staged arrests of fathers in child custody cases. Yet the media do not paint all law enforcement with that same dirty brush. And some of the supposed misdeeds for which the reporters lambast Greenberg, such as lacking the clairvoyance to know that a priest he evaluated was lying about the extent of his sexual misconduct, are hardly evidence of turpitude. Nowhere is a spokesperson for our field given space to clarify or comment about the implications.

But in calling forensic psychology "an inscrutable field with immense power," the reporters tap into a popular conception with a kernel of truth.

Power is a corrupting force. Just as Greenberg wielded immense power over the fates of parents and children, forensic psychologists today abuse their power and destroy lives when they invent diagnoses to further pretextual goals, present personal opinion and prejudice masked as science, or testify that they know with mathematical certainty that a person will commit a future crime. Such misconduct is common in certain forensic contexts. In fact, its routine nature presents an obstacle to intervention. I know of one colleague whose attempts to complain about psychologists' improper opinions in court were rebuffed by a licensing board on the grounds that the opinions -- while improper -- were not sufficiently unusual.

Greenberg's tale may thus serve as a cautionary one about why the field should not collectively look away when we see colleagues abusing their power. Individually or as a group, it is our ethical duty to intervene when we see colleagues misbehaving -- stepping beyond the bounds of science, engaging in activities that seem biased, or (as in Greenberg's case) mistreating women or others with less social currency. Perhaps if Greenberg's superficial aplomb had not blinded colleagues to his faults, he could have been redeemed and this public tragedy averted.

Professional condemnation of Greenberg's misconduct serves other purposes. It demonstrates respect for the members of the public who were negatively affected, as well as for our own women colleagues who allegedly suffered sexual exploitation and betrayal by a colleague whom they trusted. It may encourage exploration in our professional literature about the existence of corruption, which always creeps into situations involving power and authority, and how this problem might be addressed.

It may also be useful for each of us to reflect personally on the lessons here. Many of us work largely alone. Without professional accountability, it is easy to go astray. The stakes are high, the material troubling, the settings adversarial. In these difficult circumstances, it is incumbent upon all of us to behave honorably and ethically, to avoid even the appearance of bias, to be transparent in explaining the basis of our often-consequential opinions, and to admit the limits of our knowledge.

In other words, to recognize the inherent power imbalances, and to strive for humility and honesty.

A collection of primary documents and news reports on Greenberg's case can be found at The Liz Library. Also at that site are direct quotes from psychologists' (supposedly) internal debates on the case as culled from two professional listservs. (Note that the presentation is biased and misleading; by publishing mainly one side of a vigorous debate, they misrepresent psychologists as overwhelmingly opposed to public airing of this troubling case. But it's still worth checking out.)

Sexual violence prevention: Recommended journal issue

The current issue of the International Journal of Law and Psychiatry features an excellent collection of diverse scholarship on the prevention of sexual violence. Papers address the empirical and moral foundations of prevention from the perspectives of law, psychiatry, criminology, psychology, and public policy. Here's a preview of a couple of the articles I've read so far….
 

Paraphilia battle pivotal to future of U.S. civil liberties

Jerome Wakefield, a professor at New York University and an influential theorist of mental disorder, provides a searing analysis of the messy paraphilia debacle that the DSM-5 task force has waded into. After providing a brief history, he dissects the current proposals to show how their conceptual invalidity will open the door to widespread abuse in forensic practice:

 

Needless to say, prosecutors availing themselves of civil commitment processes and wishing to keep offenders from release find it in their interest to argue for the most expansive possible interpretation of the DSM criteria for paraphilic disorders -- lending enormous weight to the details of the diagnostic criteria…. The convenience of these criteria in forensic evaluations seems more than offset by the potential for prosecutorial abuse and the long-term undermining of the credibility of the distinction – sanctioned by the Supreme Court as a constitutionally crucial one – between mental disorder-driven behavior and other motives for criminal behavior.

Wakefield joins the ranks of other respected figures to recognize the high stakes involved in the battle over whether sex crimes equate to mental disorder. As he bluntly puts it, the struggle over how sexual paraphilias are defined is “tactically central to the future of civil liberties in our country.” If the government can indefinitely detain men who have served prison time for sex crimes based on bogus psychiatric labels that supposedly impair their volitional control, it's only a matter of time before other groups are rounded up, too. 

Of all of the controversial paraphilias, Wakefield asserts, the “most flawed and blatantly overpathologizing” is pedohebephilia, which would expand pedophilia to encompass attraction to pubescent minors. Arguments by its proponents are both weak and misleading, he writes:

The first argument for the expanded category is that hebephilia is similar to pedophilia in that both involve attraction to physically immature individuals. This is about as valid an argument as saying that both dyslexia and illiteracy involve difficulties reading, thus illiteracy should be considered a disorder. The kind of immaturity involved in pubescence is vastly different from the kind in prepubescence from the specific perspective of its ability to trigger normal sexual interest, so in fact the dissimilarity is more important than the similarity…. The other two arguments – that some prosecutors are currently using the diagnosis “Paraphilia Not Otherwise Specified (Hebephilia)” and that the ICD [the World Health Organization’s diagnostic system] allows sexual preference for early pubescence as a disorder – ignores the critical question of whether these uses are valid…. Hebephilia as a diagnosis violates the basic constraint that disorder judgments should not be determined by social disapproval. This is a case where crime and disorder are being hopelessly confused.

Although the sexual disorders work group has backed down on two of its three most controversial proposals, it is clinging tenaciously to pedohebephilia, the brainchild of the Canadian laboratory that employs two members of the work group. Hopefully, a newly established scientific review committee for the DSM-5 will heed the increasingly strong warnings emitting from mainstream social scientists and psychology-law practitioners such as Wakefield, and have the common sense to squelch this ridiculous proposal. Otherwise, as Wakefield puts it, “the forensic tail [will be] wagging the validity dog, and we are likely to get criteria that possess a misdirected pseudo-validity that will not serve us in the long run and set a dangerous precedent for future tensions between civil liberties and civil commitment for mental disorder.”

Inevitable recidivism: An urban legend

Tamara Rice Lave, a law professor at the University of Miami, tackles the essential premise underlying current social policy toward sex offending: that apprehended sex offenders (especially child molesters) will continue to re-offend. As Lave shows, the courts and the public accept this premise with an unquestioning and almost religious fervor, ignoring a growing body of empirical evidence to the contrary.

Inevitable recidivism has saturated the media, political and popular discourse, and thus it has become the dominant frame due to its availability…. This sets up a dialectical process in which the public believes that sex offenders inevitably recidivate; the media write stories that bolster this belief, and politicians pass laws that are responsive to this belief. The effect is to have inevitable recidivism become a socially constructed fact.

When actual evidence of sex offender recidivism is examined, a huge gap exists between what is assumed and what the data actually shows because most sex offenders do not in fact recidivate. Thus there is a galaxy of sexually violent predator laws and an entire branch of Supreme Court jurisprudence that is founded upon a demonstrable urban legend.

The special issue, Beyond Myth: Designing Better Sexual Violence Prevention, was co-edited by professors Eric Janus (author of Failure to Protect, an essential text on sex offender law and policy) and John Douard. Both are, like myself, firm believers that we should be focusing scarce resources on primary prevention of sexual violence rather than on misguided campaigns rooted in moral panic and hysteria. Such campaigns are not only ineffectual, but they may actually increase the very problems they are aimed at solving.

The articles are:

Jerome C. Wakefield:  DSM-5 proposed diagnostic criteria for sexual paraphilias: Tensions between diagnostic validity and forensic utility [request from author HERE]

Tamara Rice Lave: Inevitable recidivism: The origin and centrality of an urban legend  [full text available online HERE]

A preview of all of the articles in the special issue, Beyond Myth: Designing Better Sexual Violence Prevention, is HERE. Clicking on a preview of an article allows one to email the author to request a reprint.

Brits: American psychiatry needs new theoretical frame

Ever since the American Psychiatric Association launched its multi-million dollar diagnostic industry with the publication of the DSM-III in 1980, the approach to successive editions has been to tinker, fiddle, and tweak: Change a diagnostic threshold here; reword a criterion there; remove an outdated label and add two or three more in its place.

Meanwhile, the underlying structure is so shoddy and out of touch with reality that the best thing to do would be to tear the whole thing down and start over. That's the message of the British Psychological Society, the UK’s 50,000-member professional body for psychologists, responding to the latest draft of the Diagnostic and Statistical Manual. The APA had invited the Society to comment on the DSM-5, currently due out in 2013.

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation…. The putative diagnoses presented in DSM-5 are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.

The Society critiqued a range of proposed changes in the DSM, including major changes to the personality disorders as well as (of particular relevance to forensic practitioners) the sexual paraphilias. Particular concern was expressed over a proposed "attenuated psychosis syndrome." This proposal is "very worrying" to the British psychologists, as it will "stigmatize eccentric people" and lower the threshold for prescribing potentially harmful antipsychotic medications.

More broadly, the Society commented, the DSM diagnostic system's limited focus leads practitioners to ignore the relational and environmental contexts for psychological problems:

The Society recommends a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly evidenced causal factors.

Retreat from diagnostic labeling urged

Rather than "applying preordained diagnostic categories," the Society recommends cataloging specific symptoms or complaints, such as "hearing voices" or "feelings of anxiety."

Statistical analyses of problems from community samples show that they do not map onto past or current categories…. While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognized, … understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served.... We believe that a description of a person’s real problems would suffice…. There is ample evidence from psychological therapies that case formulations (whether from a single theoretical perspective or more integrative) are entirely possible to communicate to staff or clients. We therefore believe that alternatives to diagnostic frameworks exist, should be preferred, and should be developed with as much investment of resource and effort as has been expended on revising DSM-IV.

The 26-page statement is available HERE.