October 20, 2013

Documentary explores town's polarization over transgender murder

Forensic psychologist key element in gay panic defense

For 20 minutes, Brandon McInerney sat patiently behind Larry King in their junior high school computer classroom. Then, the budding white supremacist pulled out a handgun and shot his transgender classmate twice in the back of the head. Larry died two days later, on Valentine's Day.

The 2008 murder polarized the community of Oxnard, California. The chasm widened during the highly publicized trial three years later, when a pair of private defense attorneys managed to turn the homicide into a reverse civil rights case for beleaguered heterosexuals and white people. With the help of a forensic psychologist, they were able to convince seven out of 12 jurors that Larry King had provoked his own death through his gender transgression. After the mistrial, several jurors became outspoken advocates for Brandon, wearing "Save Brandon" bracelets and raising money for his retrial.

Director Marta Cunningham
"He [Brandon] was solving a problem," explained juror Diane Michaels, an OR nurse. “Where are the civil rights of the one being taunted by another person who’s cross-dressing? He had no one he could turn to because the school was so pro-Larry King’s civil rights, but where was Brandon’s civil rights?"

"It was the high heels, the makeup, the behavior," agreed Karen McElhaney, a fellow juror and a surgical nurse, as the jurors bonded over wine and hors d'oeuvres at one of their homes.

Through such candid interviews with family members, teachers, students (including two eyewitnesses), attorneys and jurors, first-time film director Marta Cunningham explores the conflicting ideologies regarding both gender diversity and social tolerance that Larry King’s murder graphically exposed. Cunningham spent four years and collected 350 hours of footage for Valentine Road (the name of the street on which Larry is buried), a Sundance award-winner debuting on HBO. She hopes that schools will use the film as an educational tool to promote tolerance. 

Forensic psychologist blames the victim

This blog's readers will be especially interested in the role of the forensic psychologist, who helped sell the victim-blaming theme at trial. The testimony of Donald Hoagland gave the jurors an "expert" imprimatur on which to hang their hat.


 ABC News trial coverage featuring voice of 
forensic psychologist Donald Hoagland as he testifies

"What Larry was doing was an extreme form of bullying, an extreme form of sexual harassment," Donald Hoagland told the filmmaker. "Guys don’t hit on guys. Brandon was thinking he needed to get rid of Larry. He needed to save everyone from this scourge that had come upon this school."

At the trial, Hoagland testified that the cross-dressing victim's flirtation threw 14-year-old Brandon into a fit of homicidal rage. He testified that King's declaration that he was changing his name to Leticia triggered a dissociative state in which Brandon temporarily lost track of reality, according to the Ventura County Star.

The fatal flaw with that gay panic theory of the crime is that McInerney made advance plans to kill King. He announced his plan to several people the day beforehand, according to testimony during the eight-week trial, and also acquired and loaded the gun and brought it with him to school. He shot King twice in the back of the head during a first-period class.

Jurors who voted against a murder conviction said that Larry King's request to be called by a girl's name gave Brandon a "green light" to execute him. One juror even wrote to the judge after the trial to protest the "witch hunt" against the killer, citing the victim’s "long history of deviant behavior."

"They made a murder victim the cause of his own murder," marvels Detective Dan Swanson, a hate crime expert who testified at the trial.

Prosecutor Maeve Fox, who ultimately agreed to a plea deal of 21 years for Brandon, said the case exposed the deep layer of intolerance in society, an intolerance that is even carried into the jury box.

Unfortunately, the documentary gives short shrift to another central factor in community support for Brandon. A decision by the prosecutor's office to try the 14-year-old suspect as an adult led to widespread public opposition. Brandon faced 51 years to life in prison if convicted in adult court. A coalition of dozens of gay and lesbian groups even joined the chorus of pleas to try the boy as a juvenile.

Cunningham's direction is understated. Rather than hitting the viewer over the head with a message or point of view, she allows the characters to speak for themselves, interspersing their dialogue with artful sketches, news footage and school surveillance video. The resulting nuanced tale forces audience members to think for themselves about the moral implications of the tragedy.

Ultimately, Valentine Road is a sad and haunting story about two lost boys struggling for identity in a violent world. For the two boys were alike in many ways, both of them abused, neglected and lacking competent adult mentorship as they navigated the perilous journey to adulthood. Larry had been bullied since the third grade for his effeminacy; Brandon was dependent on a bullying father who physically abused him, while his methamphetamine-abusing mother was homeless. 

Yet for all its pathos the film also shines a ray of hope. Even as the defense team vigorously promoted a victim-blaming narrative, youths from the local community came together to honor Larry King and to use his death to promote a message of tolerance. One can only hope that the film will be shown far and wide, and will contribute to that worthy endeavor.

VALENTINE ROAD WILL AIR OCTOBER 24 ON HBO. IT IS ALSO AVAILABLE ON DEMAND. CLICK HERE FOR THE FULL SCHEDULE.

RELATED STORY: "The Hidden War Against Gay Teens," Alex Morris, Rolling Stone, Oct. 10, 2013

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My prior coverage of the case: 
Hat tip: John Lewis

October 16, 2013

Militarization: When the extraordinary becomes ordinary

In line with the human rights theme of this year's Blog Action Day (it's exciting to be coordinating with 2,000+ other bloggers from around the world!),* let me share four brief anecdotes. They may seem unrelated but, ultimately, they do connect. I promise.

#1: Cheye Calvo, mayor of the small town of Berwyn Heights, Maryland, was in his bedroom one night, changing clothes for a meeting. His mother-in-law was in the kitchen, cooking a tomato-artichoke sauce. Suddenly, Calvo heard an explosion and the sound of gunfire. Heavily armed men clad in black burst into the house. He saw his mother-in-law lying face-down on the kitchen floor at gunpoint. His two beloved black Labradors lay dead in pools of blood. Clad only his boxer shorts, the mayor was bound and forced to kneel on the floor. This was it, he thought. He was about to be executed, but he knew not why.

* * * * *

#2: In the Washington Heights neighborhood of New York City, an alert neighbor observed a man forcing a woman into her apartment. Police were called. They burst in and found the woman in handcuffs, a man hiding in her closet with rope and two pairs of women's panties in his backpack. Daryl Thomas was a resident of the neighborhood, a husband and a father, and a computer system manager for a Manhattan law firm. When questioned by Senior Detective Harold Hernandez, he was forthcoming. No, this was not his first sexual assault; he had committed seven or eight similar attacks in the neighborhood in recent months. Yes, he was willing to show police the precise locations. The detective had one major problem: He was unaware of any serial rape spree in the 33rd precinct. If the victims had reported the crimes, the Manhattan Special Victims Unit would have notified the precinct of the pattern, so police could be on the lookout for a suspect matching Thomas’s description.

* * * * * 

Police prepare to enter Carey apartment
#3: After dental hygienist Miriam Carey attempted to ram a barricade near the White House and was shot to death on Oct. 3, her one-year-old baby in the car, police descended upon her home town of Stamford, Connecticut, armed with helicopters, bomb trucks, Hazardous Materials trucks and machine guns. The 100-odd personnel from the U.S. Secret Service, the FBI and state and local police sealed off the area and evacuated nearby residents before donning Haz-Mat suits with self-contained breathing apparatuses and entering Carey’s apartment. Rather than bombs, guns or Al Qaeda literature, they reportedly found prescriptions for the antipsychotic risperidone and the antidepressant escitalopram, medications consistent with Carey's diagnosis of postpartum depression with psychosis.

* * * * * 

Ohio State University's MRAP
#4: Ohio State University has just obtained a military surplus Mine-Resistant, Ambush-Protected (MRAP) armored personnel carrier. Explaining the acquisition, the campus police chief points out that stadiums are at risk for terrorist attacks, according to the Department of Homeland Security. The MRAP may also be used for crowd control at football games. The vehicle cost about half a million dollars to produce and is designed to withstand "ballistic arms fire, mine fields, IED's, and Nuclear, Biological and Chemical environments." To make its appearance less ominous, its desert tan is being repainted black and its roof-mounted machine gun being removed. The university joins the ranks of cities across America -- from Preston, Idaho to Cullman, Alabama to Boulder, Colorado and Murrieta, California -- that are cashing in on Department of Homeland Security grant money to buy such intimidating vehicles. In Dallas County, Texas, for example, the sheriff’s department plans to use its new MRAP to serve drug warrants

So what's the connection?

All four anecdotes relate to an insiduous shift in U.S. policing over the past few decades, toward greater and greater militarization.

The emergence of SWAT


Young people born in the 1980s may find it hard to believe that back in 1970, there was only one SWAT team in the entire United States -- in Los Angeles, California. Today, SWAT teams are a cultural icon. Almost all cities and most small towns have these paramilitary forces. By and large, the role of SWAT teams is far removed from the Hollywood image of hostage rescue or mass shooting intervention. Rather, they are being deployed – tens of thousands of times per year – in drug raids and to serve routine warrants, according to a new book by award-winning in investigative journalist Radley Balko

Cheye Calvo, the mayor of Berwyn Heights, Maryland (Anecdote 1), was a victim of one such raid. Mistaken drug raids are far from rare. The judiciary's progressive weakening of checks and balances in regard to warrants and searches has fostered a police culture in which "extraordinary violence" is meted out with impunity. The shooting of dogs "at the slightest provocation," Balko writes, is part of a larger problem of an us-against-them "battlefield mentality" in which many police see the citizenry as the enemy.

Allure of the techno-warrior


"Why serve an arrest warrant to some crack dealer with a .38?" asked one U.S. military officer who trained police SWAT teams in the 1990s. "With full armor, the right shit, and training, you can kick ass and have fun."

As this quote implies, SWAT raids -- conducted hundreds of times per year in cities large and small -- foster a masculine culture of violence and a worship of a "techno-warrior" image of policing. SWAT raids are the ultimate in power, an adrenaline rush that is quickly habit-forming. Recruitment videos that emphasize this culture may, in turn, be changing the type of individual who seeks to become a police officer.

Texas SWAT team terrorizes organic farmers in August
Balko traces the militarization of police to the "drug war" ideology that began under President Nixon and escalated under Ronald Reagan. One specific clause in an omnibus crime bill of 1984, not considered particularly controversial at the time, ultimately produced a seismic shift in American policing. The asset forfeiture law allowed police to seize property, auction it off, and divide up the bounty, just so long as federal agents were even remotely involved in the investigation.

Asset forfeiture created a huge incentive for police to go after people in order to seize their property. Drug enforcement brought in boatloads of cash, much of which was reinvested into more battle gear. Police departments competed with each other for drug revenue, to the neglect of investigating violent crimes such as rape, robbery and murder. So, we end up with situations like the one a few years back in Oakland, California, in which a lack of investigative prioritization allowed a serial rapist on parole to remain free to prey on young African American girls until he finally made the mistake of gunning down four police officers.

Detective work is no fun


Many police officers are appalled by the insidious militarization of police. Betty Taylor, police chief of a small Missouri town, recalled how she became troubled by the economic disparity between the "drug guys," flush with property seizures and endless federal grants, and the struggling sex crimes unit that she had established.

"When you think about the collateral effects of a sex crime, of how it can affect an entire family, an entire community, it just didn’t make sense," she told Balko. "The drug users weren't really harming anyone but themselves. Even the dealers, I found much of the time they were just people with little money, just trying to get by." Her opinion solidified when she was recruited onto a SWAT team, and witnessed first-hand the lasting terror that the raids produced in vulnerable children.

"I thought, how can we be the good guys when we come into the house looking like this, screaming and pointing guns at the people they love? ... Good police work has nothing to do with dressing up in black and breaking into houses in the middle of the night…. When you get into that [us-versus-them] mentality, there are no innocent people. There's us and there's the enemy. Children and dogs are always the easiest casualties."

Downgrading crime


The case of Daryl Thomas (Anecdote 2) involved more than neglect of violent crimes. As Detective Hernandez discovered, police brass in his precinct -- and throughout New York City -- were systematically downgrading crimes from serious felonies to minor misdemeanors, in order to improve their CompStat crime statistics. A model that has been adopted throughout the United States as well as in England and Australia, CompStat had the unintended consequence of fostering competition among precincts for lower statistics. Only seven categories of major crime are counted in crime statistics and made publicly available, so police can reduce crime rates by, for example, reclassifying attempted rape as criminal trespass.

The Thomas case was handled quietly, with no media attention. Thomas was convicted and sentenced to 50 years in prison. But Hernandez, frustrated by the constant battles with his own superiors, took an early retirement. "Unfortunately, this is the culture for the young cop coming into the department. He doesn't see the bigger picture," he said. "If it's going to allow him to have a day off, and they won't ride him or harass him, he'll go along with it. And New Yorkers are being victimized, and no one responds to their complaints."

While major crimes were being downgraded to misdemeanors, Manhattan police were also being encouraged to trump up minor cases -- drinking in public or driving without a seatbelt -- in order to bolster their statistics. Police officer Adrian Schoolcraft surreptitiously recorded his superiors giving these directives; with the collusion of a department psychologist, he eventually found himself drummed out of the force on trumped-up psychiatric grounds. (You can hear excerpts from his secret tapes on This American Life.)

Culture of fear


Putting the case of dental hygienist Miriam Carey (Anecdote 3) in historical context illustrates just how much has changed in the past few decades. 

Back in 1976, Chester M. Plummer became the first person shot to death by White House guards. Plummer and Carey were similar in some respects. Both were African American. Both were described as apolitical. And both manifested signs of psychiatric decompensation. With her postpartum psychosis, Carey had apparently incorporated President Obama into a delusional belief system. Plummer, a decorated Army veteran, former high school football star and part-time cabbie, had been examined by a psychiatrist after being arrested for indecent exposure; the doctor thought Plummer's recent divorce had triggered a psychiatric crisis. On July 25, 1976, Plummer scaled a fence while holding a three-foot pipe. He was shot to death after ignoring the guards’ orders to stop.

What happened -- or didn't happen -- next is where the difference in culture emerges. Blogging at The Nation, Rick Perlstein compares the two cases to highlight the extreme overreaction of police today to any threat, however contained.

"There’s terrorism now, they say. But there was terrorism then, nearly every month -- 89 bombings attributed by the FBI to terrorism in 1975, culminating in that awful LaGuardia bomb; and a veritable wave in the winter and spring 1976, much of it around the trial of Patty Hearst: of an FBI office in Berkeley, Standard Oil of California headquarters in San Francisco. Americans didn’t freak out, or shut down, or exhibit symptoms of PTSD. They had a massive outdoor national 200th birthday party."

Writing in The Baffler, Chris Bray makes a similar point in regard to the shutdown of Boston after the explosion at the marathon that killed three people.

Police outside Carey residence in Stamford, CT
In the aftermath of the 1993 World Trade Center bombing, the 1995 Oklahoma City bombing, the 1996 bombing at the Atlanta Olympics, and the paired 2001 attacks on the World Trade Center and the Pentagon, here’s what didn’t happen: whole cities weren’t locked down, armored personnel carriers with police logos didn’t rumble in, and SWAT teams in combat uniforms and body armor didn’t storm through the suburbs for a loosely ordered set of (ultimately hapless) house-to-house searches. Somehow, though, 2013 was the year it became appropriate to close cities, turning off taxis, buses, and trains and telling residents that the governor was suggesting -- okay, strongly suggesting -- that they not leave their homes until the police said so. One of those familiar moments in which officials ask the public to be on the lookout turned into a remarkable new moment in which officials ask the public to cease to exist in its public form so that the police can have the streets.

That leaves Anecdote 4, about armored personnel carriers, which pretty much speaks for itself.

"We are in the midst of a historic transformation," wrote Eastern Kentucky University professor Peter B. Kraska in 2007 in regard to police militarization. "Attempting to control the crime problem by routinely conducting police special-operations raids on people’s private residences is strong evidence that the U.S. police, and crime-control efforts in general, have moved significantly down the militarization continuum." 

The irony is that this militarization is occurring simultaneously with a great diminution in violent crime in the United States. In particular, despite the public's perception of police work as dangerous, the job of law enforcement is getting safer all the time.

The American Civil Liberties Union is looking into the broader implications of the spread of military culture into domestic policing in the United States. The agency believes that militarization has come at the cost of trampled human rights and a greater risk of violence, according to a report in the Columbus (Ohio) Dispatch. The study is due out next year.

That strikes me as a bit too late. Pandora's box has long been opened, and there's no going back.

So, don’t be too surprised if you happen to spy a mine-resistant, ambush-protected, armored personnel carrier rolling down your street in the near future. It's only a matter of time.

Sources and recommended resources:

Radley Balko (2013), Rise of the Warrior Cop: The Militarization of America’s Police Forces 

Peter Kraska (2007), Militarizing the American Criminal Justice System: The Changing Roles of the Armed Forces and the Police

Graham Rayman (June 8, 2010), Village Voice, NYPD Tapes 3: A Detective Comes Forward about Downgraded Sexual Assaults: When even attempted rapes are being downgraded to misdemeanors, is the public safe?

Rick Perlstein (Oct. 3, 2013), Nation, Culture of Fear: Miriam Carey’s Tragedy, and Our Own

Ira Glass, This American Life, “Right to Remain Silent” (well worth a look or, better yet, a listen)

Sarah Stillman (August 12, 2013), New Yorker, Taken: Under civil forfeiture, Americans who haven’t been charged with wrongdoing can be stripped of their cash, cars, and even homes. Is that all we’re losing? 

* * * * *

*Blog Action Day is an international event in which thousands of bloggers around the world pledge to participate. This year's theme, in coordination with Amnesty International, is human rights. If you want to see a true smorgasbord of human rights topics streaming in live, check out the web page.

October 8, 2013

Study: Risk tools don't work with psychopaths

If you want to know whether that psychopathic fellow sitting across the table from you will commit a violent crime within the next three years, you might as well flip a coin as use a violence risk assessment tool.

Popular risk assessment instruments such as the HCR-20 and the VRAG perform no better than chance in predicting risk among prisoners high in psychopathy, according to a new study published in the British Journal of Psychiatry. The study followed a large, high-risk sample of released male prisoners in England and Wales.

Risk assessment tools performed fairly well for men with no mental disorder. Utility was decreased for men diagnosed with schizophrenia or depression, became worse yet for those with substance abuse, and ranged from poor to no better than chance for individuals with personality disorders. But the instruments bombed completely when it came to men with high scores on the Psychopathy Checklist-Revised (PCL-R) (which, as regular readers of this blog know, has real-world validity problems all its own). 

"Our findings have major implications for risk assessment in criminal populations," noted study authors Jeremy Coid, Simone Ullrich and Constantinos Kallis. "Routine use of these risk assessment instruments will have major limitations in settings with high prevalence of severe personality disorder, such as secure psychiatric hospitals and prisons."

The study, "Predicting future violence among individuals with psychopathy," may be requested from the first author, Jeremy Coid (click HERE).  

September 25, 2013

California prisons careening closer to cliff

For a minute there, it looked like California's prisons were on the verge of positive reforms. But the current situation in the state's massive prison system -- one of the largest in the world -- is far from encouraging. It's been a kaleidoscope of bad news lately.

Chemical weapons

Private prison company annual report (credit Huff Post)
Guards have been videotaped tossing chemical grenades and pumping pepper spray into the cells of psychotic prisoners, some of them screaming and delirious. In one case, the prisoner's offense was not taking his psych meds; an asthmatic prisoner was sprayed for refusing to leave a holding cage, according to AP news coverage. A federal judge will rule next week on whether the public has a right to see the disturbing videos as part of a legal case challenging abusive discipline of mentally ill prisoners and inadequate mental health care for prisoners on death row. An expert observer described the chemical arsenals possessed by California guards as "shocking."

Realignment woes

Another snippet from the Correctional Corp of America
Meanwhile, things are getting worse in many of the state's 58 county jails. The state's "realignment plan," in which nonviolent offenders stay in county jails rather than going to prison, is causing lots of headaches for jails and prisoners alike. The idea was to reduce prison overcrowding while keeping prisoners closer to home and within range of reintegration services. But the plan shifts the burden onto cash-strapped counties that are ill-equipped to handle a large influx of convicts. In state prisons, convicts get yard time and some educational or vocational programming. In many jails, in contrast, they can sit in a room the size of your bathroom for five years or more. Sheriffs are complaining of a rise in violence, and forecasting a rash of lawsuits like those dogging the state prisons. According to an ACLU report, rather than reforming incarceration policies, counties are scrambling to add new jail beds. One exception is in progressive San Francisco, where jailers, prosecutors and defense attorneys alike have embraced realignment as an opportunity to create community-based alternatives to incarceration.


Hunger strike

Private prisons benefit from immigration crackdowns
After two months, prisoners ended their hunger strike over long-term isolation without any tangible victories. In a remarkable show of solidarity, the strike initially included more than 30,000 prisoners from around the state. By the end, the numbers had dwindled to about 100. The strike was called off after two legislators – Loni Hancock and Tom Ammiano -- announced they would hold public hearings into the prisoners’ complaints over the security housing units, or SHUs. Hancock said that concerns over the use and conditions of solitary confinement in California's prisons "can no longer be ignored."

Private prisons

Finally, and perhaps most disturbingly, on Monday a massive private prison corporation announced that state Governor Jerry Brown had signed a deal to ship 1,400 prisoners to its private facilities. The GEO Group, formerly the infamous Wackenhut Corrections Corporation, is a Florida-based corporation that manages 96 facilities with about 73,000 beds worldwide, including in the USA, Australia, South Africa and the United Kingdom.  

Click on image to visit Huffington Post infographic and related resources
The states of fiscal emergency in the public sector encourage governments to contract with private prisons that promise cost savings. But private prison corporations like Geo Group and the Corrections Corporation of America are short-sighted quick fixes. They encourage prison growth by mandating that governments guarantee them a certain minimum occupancy. It's kind of like when the American Psychological Association contracts with hotels in a convention city; if not enough psychologists rent rooms, the APA must pay the difference. In a report released this month, In the Public Interest found that nearly two-thirds of contracts between private prison companies and state and local governments included such quotas. Arizona recently paid $3 million to a prison company for failing to meet a 97 percent occupancy quota, the Huffington Post reported.  

The Post, one of the few media outlets to regularly cover this disturbing trend, has published an infographic illustrating the widespread nature of these contracts, which discourage criminal justice reform by "leaving taxpayers footing the bill for lower crime rates." As part of its coverage, the Post took a peak at annual shareholder reports of the Corrections Corp. of America that reveal its "aggressive business strategy based on building prison beds, or buying them off the government, and contracting them to government authorities." (The drop quotes in the post are just a few of the nuggets they unearthed.)

"Profits, after lining the pockets of shareholders, are used to create more beds and to lobby state and federal agencies to deliver inmates to fill them," the Post reports. "The resulting facilities can be violent and disgusting."

As one example, the Post reported on the horrendous conditions that quickly developed after the Corrections Corp. of America bought a formerly public prison in Ohio. Educational programming for prisoners and salaries of staff were slashed, violence and drug use skyrocketed, and correctional officers jumped ship en masse, leaving newcomers to run the facility. Prisoners in isolation were left to wallow in their own filth, with no access to running water or toilets.

September 22, 2013

Efficacy of sex offender treatment still up in the air

Sex offender group treatment, Larned State Hospital, Kansas
"Did he complete treatment?"

That is a front-burner question for judges and jurors in sexually violent predator trials. Understandably, before they decide to release someone who has been convicted of sexually molesting a child, they want reassurance that he is sincerely remorseful and has acquired the tools to turn his life around. In short, they want a certificate of rehabilitation attesting to his low risk.

But does formal sex offender treatment really lower risk?

A systematic review found no scientifically rigorous studies that establish a link between treatment completion and a reduced risk of reoffending among men who have sexually abused children.

This isn't altogether fresh news. We knew from earlier research reviews that:
  • Any effect of treatment was modest, at best
  • Treatment works best for the tiny minority of very high-risk offenders, while possibly aggravating risk for the broad majority of men at lower risk of recidivism 
  • Older offenders, due mainly to their very low risk, derive no tangible benefits from treatment
But considering both the prevalence and the harm of child sexual abuse, there is surprisingly little high-quality research on effective interventions. Partly, this is because of the lock-'em-up-and-throw-away-the-key mentality of policy makers. And partly it is because of the ethical difficulties in implementing random-design procedures, a hallmark of the scientific method, because men assigned to a control group would be denied treatment that could reduce their risk and in some cases shorten their prison terms.

Patient at "treatment program" in Minnesota
Scouring research databases, a six-member, international research team was able to locate only three well-designed experimental studies. These included one with adults, one with adolescents and one with children. In only the study with adolescents was treatment shown to reduce recidivism. That project used multisystemic therapy, a very promising approach that integrates the family and larger community in the treatment. 

Even broadening the search to include observational studies that lacked experimental designs, the research team found only five studies with a low enough risk of research bias to be deemed reliable. None of the five observational studies demonstrated that formal treatment -- primarily cognitive behavioral therapy with relapse prevention -- impacts sexual reoffending.

High-bias studies, in which the study design introduced a high probability of unreliable findings, were excluded. An example of such research bias would be a study in which treated and untreated offenders differed on a variable known to affect risk. When subjects are  not randomly assigned to treatment or control groups, any observed differences between groups may be due to factors outside of the treatment itself.

Treatment in most formal sex offender programs is cognitive behavioral, and relies primarily on manual-based group therapy. For example, group exercises challenge distorted thinking, denial and minimization.

The research team found no  minimally adequate studies whatsoever on the efficacy of pharmacological treatment with antiandrogen drugs, more popularly known as "chemical castration." They found this omission "particularly striking," in light of the prominence of this method in public debates. 

Can treatment cause harm?

Given "the overall unimpressive treatment effects" that were found, the researchers cautioned clinicians working with sex offenders to consider the potential negative effects of treatment:
"Journeymen" by Ricky Romain (reproduced with permission)
"Under certain circumstances, with some people and some interventions, treatment could increase the risk of sexual reoffending. For instance, prolonged or intense interventions for offenders at low risk of relapse, or grouping low risk offenders with those at high risk for reoffending, could result in adverse outcomes."

They especially cautioned against unnecessary treatment of children. With recidivism risk very low among untreated children, treatment may lead to "unjustified stigmatization and could negatively affect the child’s development…. If these children are subjected to excessively intense or inappropriate therapy, this could increase the risk for future antisocial behavior."

The team was headed up by prominent researcher and professor Niklas Långström and included Canadian researcher R. Karl Hanson, psychologist Pia Enebrink, forensic psychiatrist Eva-Marie Laurén and researchers Jonas Lindblom and Sophie Werkö. The research was commissioned and partially funded by the Swedish government.

The Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse, ratified by 27 countries so far, mandates effective treatment to sexual abusers of children, individuals at higher risk of committing such offences, and children with sexual behavior problems.

This mandate is a bit of a problem, given the inconclusive evidence that the dominant treatment approach works.

Manualized, one-size-fits-all approach

My own belief is that the one-size-fits-all approach of manualized group therapy, driven in part by a shortage of highly qualified and talented clinicians in bureaucratic institutions, can never meet the needs of a heterogeneous population of offenders. Indeed, in the hands of poorly trained technicians, much of what passes for "treatment" is actually punishment in disguise. As anthropology professor Dany Lacombe noted in her insightful ethnographic study,  sex offender treatment can paradoxically cement deviance through its obsessional fixation on sex. As an 18-year-old patient told Lacombe:
"They want to hear that I always have fantasies and that I have more bad ones than good ones. But I don't have bad ones that often. I make up the bad ones. I make them really bad because they won’t leave me alone." 
"Contained" by Ricky Romain (with artist permission)
Genuine treatment, as we all should remember from our graduate school training, is all about the empathic relationship -- not the technique. Indeed, although more and more psychologists have internalized the insurance industry's mantra that cognitive-behavioral therapy (CBT) is the "evidence-based" treatment of choice for a variety of conditions, this is not actually true. For example, in a new randomized clinical trial published in the American Journal of Psychiatry, psychodynamic therapy performed just as well in the treatment of depression.

The research team cautioned that their failure to find significant effects of treatment should not be interpreted to mean that treatment as currently implemented is ineffective. The low base rates of recidivism among sex offenders make it difficult to find treatment effects without very large sample sizes and long follow-up periods, they point out.

Additionally, an early study out of California provided some evidence that it was not the formal completion of treatment per se that reduced risk but, rather, the internalization of treatment messages and a desire to change -- something that is harder to measure. 

The research team issued a call for large-scale, multinational randomized controlled trials. In the meantime, in the absence of solid proof that manualized cognitive-behavioral group therapy works as intended, they recommend a shift to more individualized assessment and treatment.

That's a solid, and very welcome, recommendation.

The study is: "Preventing sexual abusers of children from reoffending: Systematic review of medical and psychological interventions" by Niklas Långström, Pia Enebrink, Eva-Marie Laurén, Jonas Lindblom, Sophie Werkö and R Karl Hanson. It is freely available online from the British Medical Journal (HERE). 

Subscribers: View the conversation and add your comment by scrolling to the bottom of the original blog post (HERE). 

September 6, 2013

Free, one-stop shopping: Bulletin showcases new violence articles

The first monthly bulletin from the Alliance for International Risk Research just hit my email box, collating August's journal offerings on violence risk assessment and management. A quick sampling from the 17 articles listed:
  • Large MM, Ryan CJ, Callaghan S, Paton MB, and Singh SP (2013) Can violence risk assessment really assist in clinical decisionmaking? Australian & New Zealand Journal of Psychiatry (online first Aug 2013)
  • Rettenberger M, Haubner-Maclean T, and Eher R (2013) The contribution of age to the Static-99 Risk Assessment in a population-based Prison sample of sexual offenders. Criminal Justice & Behavior (online first June 2013)
  • Lund C, Hofvander B, Forsman A, Anckarsater H, and Nilsson T (2013) Violent criminal recidivism in mentally disordered offenders: a follow-up study of 13-20 years through different sanctions. International Journal of Law and Psychiatry, 36, 250-257
  • Caldwell MF (2013) Accuracy of Sexually Violent Person Assessments of Juveniles Adjudicated for Sexual Offenses Sexual Abuse (online first March 2013).
AIRR's goal is to make information about the latest research on violence risk assessment available to researchers, practitioners, and policymakers for free. I you don't have access to an academic database you still have to find a way to access the articles themselves, but that can generally be done through a request of the author.) If you haven't already signed up to receive your monthly email, you can do so by clicking HERE