Book Recommendation: The Center Cannot Hold

"The Little Engine that Could"

If you're deciding what to read next, I strongly recommend Elyn R. Saks' The Center Cannot Hold: My Journey Through Madness. I guarantee you won't forget it soon.

Saks is an acclaimed professor of law and psychiatry. She also struggles with severe symptoms of schizophrenia. She risked her reputation in academia in order to give hope to others like herself, and to counter the negative stereotypes about mental illness held by both the general public and mental health professionals:

"I wanted to dispel the myths ... that people with a significant thought disorder cannot live independently, cannot work at challenging jobs, cannot have true friendships, cannot be in meaningful, sexually satisfying love relationships, cannot lead lives of intellectual, spiritual, or emotional richness."

The topic is inherently compelling, and Saks masterfully describes what it is like to be tormented by inner demons, to be forcibly restrained on a hospital bed, to require medications that alter one's mental state and can cause horrific, irreversible side effects. She articulately describes her years of talk therapy, in which she came to understand the functional underpinnings of her psychotic thoughts, for example in warding off feelings that would have been consciously threatening.

I enjoyed her dry humor in highlighting the condescension and absurdities of the mental health system. In one case she reviewed during a legal internship, the patient was restrained because he refused to get out of bed. In another case, a young man was deemed delusional because he continually spoke with "imaginary lawyers" - who turned out to be none other than Saks and her colleague.

For years, in order to excel, Saks had to lead a double life. Swirling around her, constantly threatening, was the stigma of mental illness. While writing an academic paper on restraints, she asked a professor, "Wouldn't you agree that being restrained is incredibly degrading, not to mention painful and frightening?" With a kind and knowing look, the professor responded: "These people are different from you and me. It doesn't affect them the way it would affect us."

This book is especially important reading for mental health professionals in the United States, where medication reigns supreme (it has become practically taboo to recommend psychotherapy for severe psychosis, despite ongoing research establishing its efficacy) and coercion often trumps choice. Saks contrasts her experience of being hospitalized in the United States with her experience in England, where restraints have not been in widespread use for more than 200 years. In doing so, she gives us a deeper appreciation of the trauma induced by coercive and sometimes brutal treatment.

"The Little Engine that Could" is what her close friend Steve Behnke calls her, referring to her indomitable spirit even in the face of hospital clinicians' dire predictions about her future.

I highly recommend this courageous and brilliant memoir.

A 45-minute video of Saks' talk at this year's American Psychological Association convention is available online at her personal website. Other books by Saks include Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002) and Jekyll on Trial: Multiple Personality Disorder and the Criminal Law (1997).

Vigilantes: Coming soon to a community near you

Facing global environmental catastrophe, economic decline, and war without end, who can resist strapping on a nine millimeter and blasting bad guys?

Viewers are flocking to "The Brave One," which remains on the top 10 list with $35 million in gross sales so far. Women, especially, are loving Jodie Foster as Erica Bain, a liberal-turned-vigilante killer on the mean streets of New York.

It's "a pro-lynching movie that even liberals can love," says the New York Times.

Americans have always loved a good vigilante yarn. But the allure increases in times of uncertainty and perceived powerlessness. And people are more fearful of crime than ever, despite dramatic drops in crime since Charles Bronson ("Death Wish") blasted a path through the same city more than 20 years ago. Especially, these days, our collective fear and hatred turns to "terrorists" and criminal predators. (For a great analysis of the history and allure of the vigilante film, see Eric Lichtenfeld's piece in Slate.)

Nothing wrong with letting off a little steam. But recent news events cause me to doubt that the vigilante mood is shut off when people leave the theater.

Last month, two men in a small Tennessee town torched the residence of a man convicted of a child pornography charge. The man's hapless wife died in the fire.

A month earlier, in a scene reminiscent of the Salem witch trial days, a crowd of angry neighbors descended on a New Hampshire home, taunting the woman resident as a "molester" and "skinner" (prison lingo for a child molester) before tossing a burning scarecrow on her front porch.

These incidents are not isolated. Other vigilante attacks on sex offenders, the most vilified pariahs in modern society, include the following:

• A vigilante killed two sex offenders and visited the homes of another four in Maine. He had gotten their addresses from an online sex offender registry. (He then shot himself to death.)

• A vigilante in Bellingham, Washington killed two recently released sex offenders. He too had found their names through an online sex offender registry.

• A drunken father and son broke into the house of a paroled sex offender in New Jersey and began beating another man whom they mistakenly took as the sex offender. Yet again, the vigilantes had found their victim through a "Megan’s Law" community notification law.

• In Bakersfield, California, a knife-wielding vigilante tried to break down the door of a sex offender whose name, photograph and address had been distributed in the neighborhood by police. Police shot the vigilante dead.

Are you picking up on a common theme here? Something to do with community notification laws?

Publishing the names and addresses of people who are villainized as "sex offenders" is almost like handing out murder licenses to violent and unstable people.

As law scholar John LaFond put it: "These [community notification] laws are almost a confession by the state that we have done all that we can, you must now take the defense of your family into your own hands."

Even those who believe all sex offenders deserve to die might not feel so strongly if they knew how some people got onto the sex offender registries, which fail to distinguish based on the severity of the offense.

For example, what about the middle-aged family man convicted of statutory rape at age 16 for his consensual relationship with his 15-year-old girlfriend?

That man is no more of a threat to children than is any other randomly selected man on the street. He is certainly less of a threat to public safety than the vigilantes who are gunning for him.

Prison culture: Think of a state

Think quick: Which U.S. state most symbolizes prison culture?

If you're like me, the state that came to mind was either Texas or California.

But the acquittal of a group of guards in the death of a 14-year-old boot camp resident is shining a spotlight on the Sunshine State, which houses the third-largest prison population in Prison Nation.

Last week's acquittal was reminiscent of a similar case eight years ago in Florida, in which prison guards were acquitted of stomping prisoner Frank Valdes to death in his cell, even though guards' boot prints were found all over his back.

Yesterday, Time magazine recalled that earlier verdict in a scathing expose on "the rot of Florida's corrections culture." As the article points out, mentally ill prisoners are at especially high risk of abuse:

"Despite its Sunshine State image, Florida's prisons and juvenile detention centers are often associated with the more troubled corrections systems of its Deep South neighbors. While no one is asking Florida to coddle its prisoners, adult or juvenile, many fear it has yet to break its dark habit of coddling abusive guards and other officials watching over those prisoners."

"The state is facing lawsuits alleging that its prisons subject too many inmates, including the mentally ill, to a prisoner 'warehousing' culture of unlawfully extreme isolation and deprivation, usually with little or no rehabilitation efforts to prevent recidivism. Other suits decry what one calls excessive as well as 'malicious and sadistic' use of pepper spray and other chemicals to keep mentally ill prisoners under control. In many cases the sprays have burned off inmates' skin, according to the suit."

It's one of a series of Time exposes on prison problems. Earlier this year, the magazine spotlighted both the crisis in California prisons and the burgeoning trend toward solitary confinement that literally drives some prisoners crazy. (I have more information on "segregation psychosis" on my website.)

Photo credit: The Black Commentator

Hot off the press: Mental health and criminal justice

The new issue of Criminal Justice, the American Bar Association magazine (Vol. 22 No. 3), features a roundup of cutting-edge topics at the intersection of psychology-law. The articles are written by notables in their fields and, best of all, they are available online and for free:

Mental Health and Criminal Justice: An Overview

By Andrew E. Taslitz

The Supreme Court's Recent Criminal Mental Health Cases Rulings of Questionable Competence

By Christopher Slobogin

For decades the subject of mental illness and criminal law languished in the legal "backwaters" at the U.S. Supreme Court. That changed in 2003 when the Court accepted the case of Sell v. United States (a defendant's right to refuse medication), followed quickly by two more seminal decisions in Clark v. Arizona (2006) (the scope of psychiatric defenses) and Panetti v. Quarterman (2007) (the definition of competency to be executed). But has this sudden interest in mental illness issues resulted in good law? The author argues to the contrary and details where and how the Court has erred.

Prosecutor as "Nurse Ratched"?: Misusing Criminal Justice as Alternative Medicine

By Gerald E. Nora

Traditionally, prosecutors approach claims of mental impairment by criminal defendants with skepticism, contesting competency defenses and sentencing mitigation. More recently, though, they find themselves as "diversionary gatekeepers" - seeking alternatives to trials and prison for those who more aptly belong in the medical arena. The author, a Cook County ( Illinois) state's attorney, finds neither role satisfactory and argues for reforms that will limit a prosecutor's responsibility for addressing a defendant's mental health needs through the justice system.

The Promise of Mental Health Courts: Brooklyn Criminal Justice System Experiments with Treatment as an Alternative to Prison

By Matthew J. D'Emic

Judge D'Emic tracks the establishment of one of the country's first courts to use diversionary treatment in dealing with mentally ill criminal defendants. He maps the defendant's journey from intake through assessment and treatment to "graduation" from the program.

Executing the Mentally Ill: When Is Someone Sane Enough to Die?

By Michael Mello

An opponent of the death penalty, Prof. Mello presents this personal account of advocating for mentally ill death row inmates. While detailing his clients' descent into madness and the tortured disconnect between the fantasy world of the insane and a justice system bent on accountability, the author looks at the impact of three high-profile cases.

Mental Health Status and Vulnerability to Police Interrogation Tactics

By William C. Follette, Deborah Davis, and Richard A. Leo

The authors offers a psychological explanation of how police interrogation methods affect the "average" person's ability to understand and exert his or her Miranda rights and what makes the mentally ill so much more susceptible to police coercion and likely to falsely confess.

Sex offender news roundup

Florida court strikes down residency restrictions

In a surprising decision, an appellate court in Florida has struck down the city of Jacksonville's residency restrictions for convicted sex offenders. After the state passed a law preventing offenders from living within 1,000 feet of parks, schools, libraries, or day care centers, the city of Jacksonville expanded the distance to 2,500 feet. In striking down that municipal ordinance, the court said it lacked any "rational basis" and thus violated the due process rights guaranteed in the U.S. Constitution.

For an analysis and a link to the ruling, see the Sex Crimes blog.

California police dragnet closing in

Who came up with the myth that sex offenses primarily happen in parks or at schools, as opposed to behind the closed doors of someone’s home? Whatever its origin, it sure is popular these days.

With the state's Supreme Court poised to hear a desperate appeal from four sex offenders who are being threatened with prison because they live too close to parks or schools, parole agents are fanning out across the state and making arrests. Some 855 sex offenders up and down the state are facing reincarceration over the next two weeks if they don't find a new place to live, according to the California Department of Corrections and Rehabilitation.

Andy Furillo of the Sacramento Bee has the full story.

Appellate court overturns deportation

An adult who engages in a sexual act with a minor has not necessarily committed a crime of "moral turpitude" meriting automatic deportation, the Ninth U.S. Circuit Court of Appeals has ruled.

The decision reversed an immigration court's order deporting Alberto Rene Quintero-Salazar, a Mexican national who came to the United States in 1990 and became a lawful permanent resident four years later. His wife, three children and two stepchildren are all U.S. citizens and he argued that his deportation would create an undue hardship for them.

According to the court, a crime of moral turpitude meriting automatic deportation requires willfulness or "evil intent" involving some level of depravity or baseness so far contrary to the moral law that it gives rise to moral outrage. In contrast, the sexual conduct criminalized by the California statute under which Quintero-Salazar was convicted could include consensual sex between two high school students, conduct that is legal in other states, and conduct that would be legal in California if the adult and minor were married.

Steven Ellis of the Metropolitan News-Enterprise has the details on the case, Quintero-Salazar v. Keisler, No. 04-73128.

Photo credit: "Bogeyman" by faedrake (Creative Commons license)

More bad news from California: Jails designated as "treatment facilities"; mental health courts vetoed

Wouldn't it be great if, instead of supporting more prisons, California's governor signed legislation authorizing mental health treatment that might reduce the need for prisons in the future?

Sadly, that's just a fantasy.

After my post yesterday about Gov. Schwarzenegger vetoing three criminal justice reform measures, an alert subscriber notified me about two other forensic treatment-related decisions in which the governor came down on the wrong side:

SB 568: Jails designated as "treatment facilities"

With state mental hospitals crammed full of civilly committed sex offenders and the like, there's no longer room to treat mentally ill defendants who are too crazy to have their day in court. So, with the backing of the state's sheriff's departments, Gov. Schwarzenegger signed emergency legislation allowing the jails to forcibly medicate defendants who are incompetent to stand trial.

As I explained in my original post on this bill back in June, some forensic psychologists are concerned about this law. Jail psychiatric services are minimal; prisoners with severe mental disorders will be denied the type of around-the-clock services in a therapeutic setting that they may need to be restored to trial competency.

California's move toward minimizing treatment services may encourage other states to do the same. foisting additional fiscal burdens onto cash-strapped county governments. It's all part of the trickle-down effect of the criminalization of the mentally ill that began in the 1970s with the defunding of community mental health programs and escalated with the prison boom of the 1980s and 1990s.

SB 851: Mental health courts nixed

Gov. Schwarzenegger also placed himself on the wrong side of the national mental health court movement by vetoing a bill that would have expanded such courts in California. In vetoing SB 851, he cited the fiscal costs, estimated by the Department of Corrections at $14 million per year. He also claimed that mental health courts would "allow people who have committed crimes to avoid punishment completely because of a mental health issue." (Never mind that defendants often find the stringent treatment requirements of such courts more onerous than just doing their time.)

Let's look at some numbers. California's prison budget this year was a whopping $10 billion. That does not include another $7.4 billion just authorized for 40,000 new prison beds, or the estimated $330 million per year in interest on those construction bonds. Indeed, California is spending so much on keeping people locked up that in five years, annual prison spending will shoot past higher education expenditures.

If my math is correct, the annual budget for the mental health courts would be only about one-tenth of one percent of this year's prison operating budget.

If Gov. Schwarzenegger was interested in reducing recidivism, as he claims, he would be willing to expend that measly sum to provide mentally ill prisoners with the treatment that might rehabilitate them and allow them to lead productive lives. Keeping the mentally ill out of prison is not only humanitarian, but would reduce the need for new prison beds, providing big cost savings to us tax-paying citizens in the future.

But that's assuming that the governor was willing to stand up to the correctional industry, the state's most powerful lobby. No California governor has done that and survived.

Hat tip to Robert Canning for alerting me to these developments.