Newtown, CT: Latest massacre brings more hand-wringing

Our nation's collective inertia surrounding mass killings is perhaps best illustrated in a YouTube clip splicing together speeches by Presidents Obama, Bush (II) and Clinton. Lots of hand-wringing and calls for prayer. Little in the way of concrete strategies.

Not that there is any simple fix. The causes are complex and additive: Easy access to super-lethal weapons, inadequate treatment resources for the mentally ill, and -- perhaps most of all -- a culture that glorifies violence.

Children in Karachi, Pakistan commiserate over shared pain

We are, after all, the world's leading imperial power. We aren't surprised at the spectacles of violence in Imperial Rome. Yet are we that different? We exert global control largely through military might, and celebrate violence in the service of a righteous cause. Where is the outrage over our country's slaughter of at least 176 children (almost 10 times the number killed in Newtown) by unmanned drone strikes in Pakistan over the past seven years? Those children are considered expendable, "collateral damage" in pursuit of a legitimate, larger goal. As rabble-rousing filmmaker and author Michael Moore Tweeted, "A county that officially sanctions horrific violence is surprised when a 20-year-old joins in?" Yet, amazingly, children on the other side of the world, in Karachi, Pakistan, held a candlelight vigil in solidarity with the children of Sandy Hook.

Untreated mental illness

As shown in a Mother Jones interactive map of 65 mass murders since 1962, a majority of the killers were mentally ill, and displayed signs of such before their rampages. High-quality, affordable, dependable and stable treatment, in which the clinician forges a real human connection with the patient, can save lives. And the great thing is, prevention does not necessitate prediction. We don't need to be able to do the impossible, and pinpoint which depressed, psychotic, manic, alienated or socially withdrawn man (yes, the shooters are overwhelmingly male) might have become the next Adam Lanza. Or the next suicide, an act twice as prevalent as homicide. Yet, high-quality treatment is scarce, and getting scarcer. Instead, jails and prisons are primary sites for the impersonal medication maintenance that passes for treatment these days.

Misplaced emphasis?

Back-to-back slaughters at the movie theater in Aurora, Colorado, the shopping mall in Portland, Oregon and now Sandy Hook Elementary School in Newtown, Connecticut -- among others -- give an impression of an alarming rise in mass shootings in the United States. Surprisingly, that perception may be inaccurate.

Tracking murders in which four or more people were killed in one incident, criminologist James Alan Fox found that the numbers rise and fall from year to year, but without trending in any direction. On average, there are about 20 mass murders per year in the United States, bringing the deaths of about 100 people, according to an interview in the San Francisco Chronicle. The deadliest in U.S. history, by the way, was way back in 1927, when a 55-year-old school board treasurer in Michigan set off dynamite that killed 38 elementary school children and six adults.That paled in comparison to Anders Breivik's 2011 bombing and shooting attacks in Norway, which killed 77 people, most of them teenagers.

Another prominent criminologist, Jack Levin, agrees with Fox that the focus on mass murder is misplaced, especially vis-à-vis the gun control debate. The broad majority of the 8,000+ people killed by guns in the U.S. each year die singly, often at the hands of family members or due to interpersonal disputes or drug-related conflicts. One-off incidents notwithstanding, schools remain far safer statistically than homes, streets or roadways.

Blaming "the media"

If the attention is being misfocused, that brings us to the role of "the media" in mass violence. It is certainly plausible that the media frenzy surrounding each new outbreak contributes to copycat crimes. If you are angry and alienated, why not go out in a blaze of glory rather than with a silent whimper. Teach society a lesson; be remembered.

Yet I cringe when I hear blame heaped at the feet of "the media." As a former daily newspaper journalist I can attest to the fact that "the media" as a monolithic, all-powerful entity is a fiction. Sure, over-the-top TV news crews (who hardly merit the title of journalist) mercilessly badger victims' families in the interest of titillating viewers. But despite increasingly narrow ownership of the major news outlets by a handful of enormous conglomerates, newspapers, magazines, and even blogs still feature plenty of thoughtful analyses and investigative reports. And although these narratives have some influence in shaping public perceptions, they ultimately reflect more than construct the larger realities in which they are embedded. "They," in other words, are us.

The half-life of vigorous public discourse seems to be roughly a month. Then, another event generates headlines, and we're spastically chasing that thread. Until another tragedy strikes, and the spiral starts over. All the while, there is so much noise (to use Nate Silver's terminology) that the signal can be hard to detect. As Ohio public defender Jeff Gamso muses,

People will speak of evil. They will talk about gun control and how this proves we need more -- or less -- of it. They will talk about security, as if wrapping ourselves in plastic will keep us all safe when all it will really do is suffocate us.... If you would hate, hate the fact that we are reactive, always trying desperately to prevent what happened yesterday. And doing it badly. 

Perhaps this time will be different. Perhaps this latest in a string of rampages represents a tipping point. But I kind of doubt it. It's far easier to propose arming school teachers than to directly challenge the culturally embedded fermentation of entitlement and alienation that kindles rageful violence that gives no quarter.

Further resources:

My NPR commentary after the Aurora massacre can be heard online or by downloading the MP3 podcast HERE.

For you Twitter folks, I've Tweeted a series of media analyses on Sandy Hook that I found particularly insightful. You can find them at my Twitter site or in the Twitter feed in the right-hand column of my blog's home page.

My blog posts after previous mass shootings include:

• Aurora massacre: To speak or not to speak? (July 22, 2012)
• Arizona rampage: Analyzing the analyzers (Jan. 23, 2011)
• Virginia Tech: Can school shootings be prevented? (April 19, 2007)

And here, finally, is an oldie but goodie on the futility of trying to predict rare events:

Systems failure or black swan? New frame needed to stop memorial crime control frenzy (Oct. 19, 2010)

Training: Controversies in sexually violent predator evaluations

I am excited to announce that the American Psychology-Law Society has accepted a panel that I put together on "Emergent controversies in civil commitment evaluations of sexually violent predators." I hope some of you will join me at the annual conference in Portland, Oregon on March 7-9.

The symposium will address three areas of controversy in the sex offender civil commitment field:

• Mental abnormality and psychiatric diagnosis in court (my topic)

• Recidivism risk assessment (addressed by my esteemed colleague Jeffrey Singer)

• Volitional control (Frederick Winsmann, clinical instructor at Harvard Medical School, will present a promising new assessment model)

Here's the symposium abstract:

Over the past three decades, Sexually Violent Predator litigation has emerged as perhaps the most contentious area of forensic psychology practice. In an effort to assist the courts, a cadre of experts has proffered a confusing array of constantly changing assessment methods, psychiatric diagnoses, and theories of sex offending. Now, some federal and state courts are beginning to subject these often-competing claims to greater scrutiny, for example via Daubert and Frye evidentiary hearings. This symposium will alert forensic practitioners, lawyers and academics to some of the most prominent minefields on the SVP battleground, revolving around three central areas of contestation: psychiatric diagnosis, risk assessment, and the elusive construct of volitional control. The presenters will review recent scholarly literature and court rulings addressing: (1) the reliability and validity of psychiatric diagnoses in sexually dangerous person litigation, (2) forensic risk assessment tools and how risk data should be reported to triers of fact, and (3) how best to address the issue of volitional impairment, a Constitutionally required element for civil commitment. The focus will be on how to assist the courts while remaining within the limits of scientific knowledge and our profession's ethical boundaries.

The conference schedule hasn't been issued yet so I don’t know which day our panel is presenting, but I will keep you posted when I find out, probably in January. In the meantime, if you are looking to pick up Continuing Education (CE) credits, the pre-conference workshops are a good way to get some high-quality forensic training:

• The ever-informative Randy Otto on "Improving Clinical Judgment and Decision Making in Forensic Psychological Evaluation," with a heavy focus on identifying and reducing bias (full-day workshop) 

• Paul J. Frick on "Developmental Pathways to Conduct Disorder: Implications for Understanding and Treating Severely Aggressive and Antisocial Youth" (full-day workshop)

• Amanda Zelechoski on "Trauma-Informed Care in Forensic Settings" (full-day workshop)

• Kathy Pezdek on "How to Present Statistical Information to Judges and Jurors" (half-day workshop)

• Steven Penrod on "Things That Jurors (and Judges) Ought to Know About Eyewitness Reliability" (half-day workshop)

Portland is a lovely city, especially in the spring, so register now, and mark your calendars for what is sure to be a lively and educational event.

Judge bars Static-99R risk tool from SVP trial

Developers staunchly refused requests to turn over data

For several years now, the developers of the most widely used sex offender risk assessment tool in the world have refused to share their data with independent researchers and statisticians seeking to cross-check the  instrument's methodology.

Now, a Wisconsin judge has ordered the influential Static-99R instrument excluded from a sexually violent predator (SVP) trial, on the grounds that failure to release the data violates a respondent's legal right to due process.

The ruling may be the first time that the Static-99R has been excluded altogether from court. At least one prior court, in New Hampshire, barred an experimental method that is currently popular among government evaluators, in which Static-99R risk estimates are artificially inflated by comparing sex offenders to a specially selected "high-risk" sub-group, a procedure that has not been empirically validated in any published research. 

In the Wisconsin case, the state was seeking to civilly commit Homer Perren Jr. as a sexually dangerous predator after he completed a 10-year prison term for an attempted sexual assault on a child age 16 or under. The exclusion of the Static-99R ultimately did not help Perren.  This week, after a 1.5-day trial, a jury deliberated for only one hour before deciding that he met the criteria for indefinite civil commitment at the Sand Ridge Secure Treatment Center.*

Dec. 18 note: After publishing this post, I learned that the judge admitted other "actuarial" risk assessment instruments, including the original Static-99 and the MnSOST-R, which is way less accurate than the Static-99R and vastly overpredicts risk. He excluded the RRASOR, a four-item ancestor of the Static-99. In hindsight, for the defense to get the Static-99R excluded was a bit like cutting off one's nose to spite one's face.

The ruling by La Crosse County Judge Elliott Levine came after David Thornton, one of the developers of the Static-99R and a government witness in the case, failed to turn over data requested as part of a Daubert challenge by the defense. Under the U.S. Supreme Court's 1993 ruling in Daubert v. Merrell Dow Pharmaceuticals, judges are charged with the gatekeeper function of filtering evidence for scientific reliability and validity prior to its admission in court.

Defense attorney Anthony Rios began seeking the data a year ago so that his own expert, psychologist Richard Wollert, could directly compare the predictive accuracy of the Static-99R with that of a competing instrument, the Multisample Age-Stratified Table of Sexual Recidivism Rates," or MATS-1. Wollert developed the MATS-1 in an effort to improve the accuracy of risk estimation by more precisely considering the effects of advancing age. It incorporates recidivism data on 3,425 offenders published by Static-99R developer Karl Hanson in 2006, and uses the statistical method of Bayes's Theorem to calculate likelihood ratios for recidivism at different levels of risk.

The state's attorney objected to the disclosure request, calling the data "a trade secret."

Hanson, the Canadian psychologist who heads the Static-99 enterprise, has steadfastly rebuffed repeated requests to release data on which the family of instruments is based. Public Safety Canada, his agency, takes the position that it will not release data on which research is still being conducted, and that "external experts can review the data set only to verify substantive claims (i.e., verify fraud), not to conduct new analyses,"  according to a document filed in the case.

Thornton estimated that the raw data will remain proprietary for another five years, until the research group finishes its current projects and releases the data to the public domain.

While declining to release the data to the defense, Hanson agreed to release it to Thornton, the government's expert and a co-developer of the original Static-99, so that Thornton could analyze the relative accuracy of the two instruments. 

The American Psychological Association's Ethics Code requires psychologists to furnish data, after their research results are published, to "other competent professionals who seek to verify the substantive claims through reanalysis" (Section 8.14).

At least three five researchers have been rebuffed in their attempts to review Static-99 data over the past few years, for purposes of research replication and reanalysis. As described in their 2008 article, Hanson's steadfast refusals to share data required Wollert and his colleagues, statisticians Elliot Cramer and Jacqueline Waggoner, to perform complex statistical manipulations to develop their alternate methodology. (Correspondence between Hanson and Cramer can be viewed HERE.) Hanson also rejected a request by forensic psychologists Brian Abbott and Ted Donaldson; see comments section, below.


Since the Static-99 family of instruments (which include the Static-99, Static-99R, and Static-2000) began to be developed more than a decade ago, they have been in a near-constant state of flux, with risk estimates and instructions for interpretation subject to frequent and dizzying changes.

It is unfortunate, with the stakes so high, that all of these researchers cannot come together in a spirit of open exchange. I'm sure that would result in more scientifically sound, and defensible, risk estimations in court.

The timing of this latest brouhaha is apropos, as reports of bias, inaccuracy and outright fraud have  shaken the psychological sciences this year and led to more urgent calls for transparency and sharing of data by researchers. Earlier this year, a large-scale project was launched to systematically try to replicate studies published in three prominent psychological journals.

A special issue of Perspectives on Psychological Science dedicated to the problem of research bias in psychology is available online for free (HERE).

*Hat tip to blog reader David Thompson for alerting me that the trial had concluded. 

Documentary targets family courts and custody evaluators

Stuck in the middle of nowhere on a case, I happened to catch the new documentary No Way Out But One, depicting injustices against abused women and children in U.S. family courts. Of potential interest to blog readers, the film critiques the role of child custody evaluators as usurping the authority of fact finders by substituting their own judgments for the facts.

No Way Out highlights the internationally known case of Holly Collins, who fled with her son Zachary and daughter Jennifer in 1994 after her husband was granted sole custody by a court in Minnesota. According to the film, the judge ignored evidence of domestic violence and child abuse, including a skull fracture to the boy. After a circuitous flight through Canada and Guatemala, Collins eventually won asylum in the Netherlands. By the time the FBI caught up with the family, the children were adults. In the film, they convincingly describe chronic abuse at the hands of their father. Holly's dynamic daughter, Jennifer, the inspiration for the film, is executive director of Courageous Kids, which empowers children to go public about family court abuse (her blog is HERE).

The Collins children, grown up

The Collins's long-running custody battle featured allegations of Parental Alienation Syndrome, a controversial syndrome in which one parent (most often the mother) is accused of alienating the children from the other parent. Collins was also labeled with another highly contentious diagnosis, Munchausen by Proxy, after she sought medical treatment for her children, whom she says were being injured by their father’s abuse and neglect.

Due in part to Collins's supposed attempts to alienate the children, the father was granted full custody in 1993, and Collins was initially denied even phone or mail contact. Eventually, she was granted supervised visitation, but neither she nor her children were allowed to talk about the father’s abuse. In the film, Collins describes how she and the children secretly exchanged notes by placing them in the refrigerator; in the notes, the children begged for help and she finally promised to rescue them.

Collins became the first American ever granted asylum by the Netherlands. She ultimately married a Dutch man and had four more children. After the FBI located her, she returned to the United States in an effort to vindicate herself. Ultimately, the kidnapping charge was dismissed; she pled guilty to one count of contempt of court in exchange for a sentence of 40 hours of community service.

According to the film, Collins is just one of thousands of mothers forced to go on the run in order to protect their children from abusive fathers who have been granted custody of their children.

Jennifer (L) and Holly Collins (R) with filmmakers Nolan and Waller

Ironically, the film's debut on the Documentary Channel coincides with the publication of a similar story by another woman who is also named Collins. Frances Collins's book, Seashell Prisoners, chronicles her flight from Texas to the Honduras to protect her 3-year-old granddaughter. Her eight-year odyssey ultimately ended in arrest and incarceration.

The film is stoking up antipathy between the battered women's and father's rights camps, with the latter expending significant effort in to debunk the claims of Collins and her children that they were subjected to family violence.

Award-winning filmmaker Garland Waller told a Huffington Post columnist that she chose the Holly Collins case "because I believed her story would break through the barricade set up by the mainstream press." The film expands on last year’s award-winning short, Small Justice, produced on a shoestring by Waller, a communications professor at Boston University, and her husband Barry Nolan, a TV writer and reporter.

In the Huffington Post interview, Waller went on to say that what most surprised her in her involvement with this project was the dumbfounded reaction of members of the general public:

"They just can't believe that … family courts would give custody -- time and time again -- to abusers. But I suppose I really shouldn't be surprised. In both the tragedy of the Catholic Church sex abuse scandal and the Jerry Sandusky thing, ‘good’ people turned a blind eye to the abuse of children. It's the same thing in family courts. It is just heart-breaking that so often when terrified children summon the courage to speak up and tell what is happening to them, even though the abuser has warned them of the terrible consequences if they ever talk... even though we teach children to speak up and to tell the truth...when they speak up against this one awful thing, we just don't listen."

I don’t see any more upcoming airings on the DocumentaryChannel, but the DVD will be going on sale soon, from Passion River Films.  

For people who are trying to stay positive and collaborative while going through a stressful divorce, a Florida law firm has put together a set of helpful tips from top relationship experts: "Coping with Divorce." 

Free access: British Journal of Forensic Practice

This week only, the British Journal of Forensic Practice is offering open access to all of its content. The journal covers a wide range of criminal justice topics, making it of potential interest for forensic practitioners, correctional professionals, academics, and those in allied fields. From my brief perusal, the journal appears to offer a refreshingly humanistic perspective, focusing on rehabilitation and critical analysis of current approaches. A few examples of recent articles and issues that caught my eye, all accessible this week (I've included links):

• Qualitative viewpoints in forensic practice – a special themed issue

• Treatment in forensic practice – a special themed issue, focused mainly on sex offenders

• Including the excluded: high security hospital user perspectives on stigma, discrimination, and recovery by Anna Williams, Estelle Moore, Gwen Adshead, Anthony McDowell, James Tapp

• Ganging up on gangs: why the gang intervention industry needs an intervention by James Densley

• How does the delivery of multisystemic therapy to adolescents and their families challenge practice in traditional services in the Criminal Justice System? by Zoë Ashmore, Simone Fox

• Is offender rehabilitation a form of punishment? by Tony Ward

• The alcohol treatment needs of violent and non-violent prisoners by Nicola Bowes, Adele Sutton, Serena Jenkins, Mary McMurran 

• Assessing the functions of self-harm behaviours for dangerous and severely personality disordered males in a high secure hospital by Jen Gallagher, Kerry Sheldon

• Reducing prisoner vulnerability and providing a means of empowerment: evaluating the impact of a Listener Scheme on the Listeners by Rani Dhaliwal, Julia Harrower

• Attitudes towards male and female sex offenders: a comparison of forensic staff, prison officers and the general public in Northern Ireland by Caitriona Higgins, Carol Ireland

• What we know about men who download child abuse images by Kerry Sheldon 

• Good Lives sexual offender treatment for mentally disordered offenders by Theresa A. Gannon, Tracy King, Helen Miles, Lona Lockerbie, Gwenda M. Willis

And that, folks, is just the tip of the iceberg. You'll need to browse the content yourself (HERE) to find the articles of special resonance with you.

APA rejects "hebephilia," last standing of three novel sexual disorders

To hear government experts on the witness stand in civil detention trials in recent months, the novel diagnosis of "hebephilia" was a fait accompli, just awaiting its formal acceptance into the upcoming fifth edition of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM).

They were flat-out wrong.

In a stunning blow to psychology's burgeoning sex offender processing industry, the Board of Trustees of the American Psychiatric Association rejected the proposed diagnosis outright, not even relegating it to an appendix as meriting further study, its proponents' fall-back position.

The rejection follows the failure of two other sexual disorders proposed by the DSM-5's paraphilias subworkgroup. These were paraphilic coercive disorder (or a proclivity toward rape) and hypersexuality, an inherently hard-to-define construct that introduced the committee members' value judgments as to how much sex is within acceptable limits.

After abandoning those two disorders, the subworkgroup clung tenaciously to a whittled-down version of its proposed expansion of pedophilia to cover sexual attraction to early pubescent youngsters (generally in the age range of 11-14), ignoring widespread opposition from both within and outside of the APA.

The buzz is that senior psychiatrists in the APA were unhappy with the intransigence of psychologists in the subworkgroup who communicated the belief that if they just stuck to their guns, they could force the ill-considered proposal into the new manual, despite a lack of scientific support.

All three proposed sexual disorder expansions were widely critiqued by mental health professionals, especially those working in the forensic contexts in which they would be deployed. They led to a spate of critical peer-reviewed publications (including a historical overview of hebephilia by yours truly, published in Behavioral Sciences and the Law), and an open letter to APA leadership from more than 100 professionals, including prominent forensic psychologists and psychiatrists in the U.S. and internationally.

The unequivocal rejection sends a strong signal of the American Psychiatric Association's continuing reluctance to be drawn into the civil commitment quagmire, where pretextual diagnoses are being invoked as excuses to indefinitely confine sex offenders who have no genuine mental disorders. In marked contrast with the field of psychology, psychiatry leaders have expressed consistent concerns about the use of psychiatric labels to justify civil detention schemes.

Next time around, the APA might want to do a better job selecting committee members in the first place. The "paraphilias subworkgroup" was heavily biased in favor of hebephilia because of its domination by psychologists from the Canadian sex clinic that proposed the new disorder in the first place, and is the only entity doing research on it. But what a waste of time and energy to create a committee that comes up with wild and wacky proposals that are only going to end up getting shot down when the rubber meets the road.

Backpedaling on paradigm shift

As regular readers of this blog know, the DSM-5 developers' grand ambitions to bring forth a revolutionary "paradigm shift" produced alarm among mental health professionals and consumer advocacy groups both in the United States and internationally. The British Psychological Society, the UK's 50,000-member professional body, issued a strongly worded critique, and a coalition of psychological associations garnered more than 14,000 signatures on a petition opposing the wholesale lowering of diagnostic thresholds for disorder.

Yesterday's news release marked an about-face, with the APA now stressing that diagnostic changes in the DSM-5 were intended to be "very conservative."

"Our work has been aimed at more accurately defining mental disorders that have a real impact on people’s lives, not expanding the scope of psychiatry," said David J. Kupfer, MD, chair of the DSM-5 Task Force.

Consistent with this, several of the proposed changes that generated the most widespread alarm were rejected. The Board of Trustees rejected the highly controversial "attenuated psychosis syndrome" that could have created an epidemic of false positives, stigmatizing eccentric young people and lowering the threshold for prescribing potentially harmful antipsychotic drugs. It also backed away from an equally controversial, and complex, revamping of the personality disorders. These conditions, as well as a contentious Internet gaming disorder, will all be placed in "section 3" of the new manual as conditions meriting further study.

Allen Frances, the DSM-IV Task Force chair and a high-profile critic of the DSM-5 project, called the spin that the DSM-5 will have minimal impact on psychiatric diagnosis and treatment "misleading":

"This is an untenable claim that DSM 5 cannot possibly support because, for completely unfathomable reasons, it never took the simple and inexpensive step of actually studying the impact of DSM on rates in real world settings…. Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSM's teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and 'behavioral addictions' will soon be mislabeled as psychiatrically sick and given inappropriate treatment."

Among the controversial diagnostic changes that will go forward in the DSM-5, due to be published in mid-2013:

• Asperger’s syndrome is being eliminated as a separate disorder (it will be folded into an autism spectrum disorder)
• Depression is being expanded to include some grief reactions
• A brand-new "disruptive mood dysregulation disorder" has critics fearing psychiatric labeling of children who have temper tantrums

Two other sets of changes have particular relevance to forensic practitioners. Substance abuse disorders have been reframed as "behavioral addictions," which Frances warns could be a "slippery slope" leading to "careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets."

Posttraumatic stress disorder (PTSD) will be included in a new chapter on trauma and stress-related disorders, with four distinct diagnostic clusters instead of the current three, and "more attention to the behavioral symptoms that accompany PTSD." Some worry that the reconfigured PTSD may lend itself to misuse of the hot-button diagnosis in forensic cases.

Yesterday’s APA news release outlining the changes can be found HERE. My hebephilia resource page is HERE.