January 12, 2011

Linguist lambasts DSM-5 proposal as gibberish

Leave it to an asexual linguist to lay bare the convoluted nature of the paraphilia diagnoses being proposed for the DSM-5. Andrew Hinderliter, a former English teacher and grad student at the University of Illinois, says his activism regarding the DSM's Hypoactive Sexual Desire Disorder led him to stumble across disturbing global flaws in the DSM-5 sexual disorders morass.

The wording of the proposed new definition of "paraphilia" (sexual perversion) is so nonsensical that one must ignore the literal text in order to apply it the way the authors say they intend, Hinderliter writes in his new article, "Do Not Disregard Grammar," in the Journal of Sex and Marital Therapy. That article follows a companion piece published in the Open Access Journal of Forensic Psychology.

As I have blogged about previously, the members of the sexual disorders workgroup for the DSM-5 seems oblivious to the potentially disastrous forensic implications of their proposals. Vague and careless wording is not so critical in the clinical arena where, presumably, everyone is working toward the same goals. However, as attorneys know well, in the forensic context every little word matters -- a lot.

"Given that a person can be deprived of procedural due process rights -- possibly for the rest of their life --on the basis of a diagnosis of paraphilia NOS, caution and careful wording in defining paraphilia in DSM-5 is all the more important,” Hinderliter cautions.

Perhaps the workgroup has the clandestine aim of introducing chaos into the civil commitment system for sex offenders. If so, it couldn't be doing a better job. Get ready for skirmish after skirmish over nebulous terms such as "phenotypically normal," "generalized" and "intense."

January 11, 2011

Follow me on Twitter

I haven't been able to carve out much blogging time lately, despite an ever-growing list of worthy topics. If you would like more frequent updates from me, you can subscribe to my Twitter feed. Tweets are just brief headlines, directing you to other articles on the web. To give you a sample, I have just tweeted about (among other things):
  • Guarding Grandpa: Illinois spending money it doesn't have to keep convicts who can barely walk behind bars
  • Supreme court may decide if juveniles 14-and-under can be sentenced to life without parole
  • Tucson rampage -- Wall Street Journal asks: Is There Really a Link Between Violence and Mental Illness?
  • Autistic children immune to contagious yawn
  • Dark side of Oxytocin: Hormone of the clan, not of universal brotherhood
  • Secondhand TV linked 2 eating disorders among girls in Fiji
  • New drug stockpile enough to kill 80 people
  • Lucasville Five Hunger Strike Begins
  • On Bradley Manning, Solitary Confinement, and Selective Outrage
  • The Nazi and the Psychiatrist
For lots more interesting news, I also recommend you check out Vaughan Bell's great blog, Mind Hacks. His weekly "Spike Activity" roundup will keep you up to date on psychology news and views from around the globe.

Child abuse assessment: Special issue

Forensic psychologist Eric Mart has guest edited a special issue of the Journal of Psychiatry and the Law on assessment and testimony in cases of child abuse. The articles address both scientific and practical aspects of child abuse assessment, testimony, and research. They include:

Maternal Filicide and Mental Illness in Italy: This retrospective review co-authored by Geoffrey McKee, who has written books on filicide, and Alesandra Bramante compares the forensic characteristics of mothers with and without severe mental illness who killed their children.

Interviewing Immigrant Children for Suspected Child Maltreatment: Lisa Aronson Fontes examines challenges posed in forensic interviews of immigrant children when there is a suspicion that these children may be victims of child abuse or neglect. Suggestions are made
for interviewers regarding the interview setting, preparations, building rapport, conveying respect, narrative training, pacing the interview, and trauma symptoms that may stem from issues unrelated to the abuse.

Persistent Problems with the "Separation Test" in Munchausen Syndrome by Proxy: Munchausen syndrome by proxy remains a controversial diagnosis because information is easily tainted to make the mother appear responsible for her child’s symptoms. Loren Pankratz critiques (and offers alternatives to) the “separation test,” a scientifically problematic procedure that is often used to gather evidence against the mother.

Common Errors in the Assessment of Allegations of Child Sexual Abuse: Finally, the special issue editor himself tackles common errors in the complex, challenging, and high-stakes undertaking of assessing CSA allegations. After reviewing frequent causes of substandard investigations, the illustrious Dr. Mart provides ideas for research-based methods to improve the situation.

January 8, 2011

Little New England state serious about its motto

"Live Free or Die" even applies to sex offenders

In most of the 20 U.S. states with civil commitment statutes for sex offenders, the costs are staggering. As I have reported previously, millions of dollars are being spent to prosecute and detain certain recidivist sex offenders, while public school teachers must beg for basic supplies like pencils and paper.

New Hampshire is a dramatic exception. Since passing its civil commitment law four years ago, it has civilly committed only two men.

Yes, only two. William Ploof and Thomas Hurley. Both, not surprisingly, had sexually assaulted boys, not girls or women.

The dearth of commitments was a big surprise, according to an AP article by Norma Love. The state’s Corrections Commissioner had set aside 10 psychiatric beds and thought those would be overrun. The chief public defender had hired three new attorneys and a legal secretary and opened a new office in anticipation of a flood of cases. He's since laid off most of the new staff.

Of the many hundreds of cases referred to prosecutors for review, just eight have been found to merit prosecution. In the United States as a whole, more than 5,000 sexual predators are confined indefinitely.

Some attribute New Hampshire's reticence to preemptively detain citizens to its civil libertarian philosophy, as manifested by its state motto. The state does not require seatbelts or helmets and rarely pursues the death penalty.

But also, there seems to be no rabid political or citizen lobby like elsewhere. A spokeswoman from the Coalition Against Domestic and Sexual Violence, for instance, said her group is fine with the law's implementation. Amanda Grady told the AP reporter that she trusts New Hampshire's prosecutors to pick the option that best fits the individual case -- whether it be monitoring felons through parole, civil commitment or the state's sex offender registry.

Could this be a little spark of rationality and common sense (as opposed to moral panic) in crime policy in 21st century America? If so, three cheers for The Granite State.

January 6, 2011

Supermax: Hell on earth or . . . not as bad as we thought?

I thought everyone knew that being locked up alone in a tiny cell -- sometimes for years at a stretch -- is bad for one's psyche.

But I was wrong. Based on a one-year project with the Colorado Department of Corrections, a group of researchers says there is a dearth of evidence to support the popular notion that solitary confinement exacerbates psychiatric symptoms among mentally ill prisoners. Although the prisoners they studied did manifest problems, these were preexisting and so could not be attributed to the effects of administrative segregation confinement, the researchers contend.

I was dubious when I heard the researchers present their study, "One-Year Longitudinal Study of the Psychological Effects of Administrative Segregation," at the APA's annual convention last year. Having worked in a Segregated Housing Unit ("SHU") for mentally ill prisoners, I saw with my own eyes the rapid and profound mental deterioration of mentally ill prisoners assigned to the SHU.

Even prisoners who had no preexisting mental disorders fell apart when subjected to prolonged isolation. I will never forget one youngster, a first-timer incarcerated for violating probation in a minor stolen property case, who was sent to the SHU for protection after he reported being raped by his cellmate. They ended up taking him out on a stretcher following a serious suicide attempt. The last time I saw him, when I visited him on the medical ward of a maximum-security prison, he was completely changed from the happy-go-lucky kid I had known.

But he started out healthy. Maybe, contrary to popular wisdom, the mentally ill -- at least those in Colorado -- have more robust psyches than everyone else. Or maybe they are asocial or masochistic. Anyway, I'm just telling you my own personal anecdotes. That's not science.

Study under fire

The report just came out, and already it is generating a lot of heat from those who fear it will be used to legitimize continued warehousing of mentally ill prisoners in SHU's. The ACLU has issued a statement pointing out that the Colorado findings contradict a sizeable body of research, not to mention common sense.

Two leading experts on prison conditions, psychiatrists Terry Kupers and Stuart Grassian, are publicly assailing the study as fatally flawed. They criticize the researchers for not conducting interviews with the prisoners who were the subjects of the year-long study.

"The methodology of the study is so deeply flawed that I would consider the conclusions almost entirely erroneous," said Kupers, author of Prison Madness: The Mental Health Crisis Behind Bars. "And far from finding 'no harm,' there were many episodes of psychosis and suicidal behavior during the course of the study -- the researchers merely minimize the emotional pain and suffering because they judge the prisoners to have been already damaged before they arrived at supermax."

Grassian, the former Harvard professor who coined the term segregation psychosis and who has done research with hundreds of prisoners in solitary confinement, said he notified the researchers of several severe methodological flaws, including a failure to analyze contradictory data, but the flaws were not addressed.

Grassian said the prison's own records document almost two incidents of suicidal or self-destructive behavior for every three prisoners in solitary confinement (63%), compared with less than one incident for every ten prisoners (9%) in the general population.

Since the supermax craze took off in the early 1990s, almost every U.S. state has signed on to the dubious concept, and an estimated 25,000 American prisoners are now locked 24/7 in these tiny, antiseptic cubicles. Although SHU housing was originally intended for relatively short terms of confinement, nowadays prisoners may remain in these constantly lit and electronically surveilled sensory deprivation holes for years -- or even decades. A federal court recently agreed to hear a challenge brought by a man named Tommy Silverstein who has spent a whopping 27 years in solitary confinement.

If they had just talked with the prisoners …

While the Colorado correctional researchers were busy tabulating survey data instead of talking with the prisoners themselves about their subjective experiences, a graduate student at the University of California at Berkeley took the exact opposite approach, and -- not surprisingly -- came to diametrically opposed conclusions.

Keramet Reiter's series of in-depth interviews with former SHU prisoners in California, far and away the world's leader with about 3,330 SHU prisoners, was part of her research into the rise of supermaximum confinement in America.

The settings that the men chose was telling in and of itself: After years in tiny, concrete-filled boxes, almost all asked to meet her either outdoors of close to a window.

Reiter told UC reporter Cathy Cockrell that she was moved by the former prisoners' tragic accounts of the effects of sensory deprivation.

"People spoke of having no clocks, daylight, or seasons to mark the passage of time; growing pale from lack of sunlight; and being amazed at the sight of a single bird, insect, or even the moon, after months or years of virtually no exposure to the natural world."

But, hey, maybe if they had been mentally ill to start with, they wouldn't have minded ad-seg so much. Just a serene vacation, away from the hubbub and stress of general population housing.

Not a vacation I would ever want to take but, hey, that's just me.

Further readings:

Drawings: (1) Prisoner sketch by Herman Wallace, Louisiana State Penitentiary, Angola; (2) prisoner sketch, Pelican Bay, California; (3) prisoner sketch, Tommy Silverstein, ADX federal supermax, Florence, Colorado; (4) prisoner sketch, Pelican Bay, California; (5) my (comparatively crude) sketch of a suicidal prisoner whom I observed chained to the floor of a bare concrete "protective" cell.

My Psychology Today post, at my blog Witness, is HERE. For more frequent posts by me on this and other topics, subscribe to my Twitter feed, HERE.

January 4, 2011

Another Texan joins growing club of exonerees

30 years in prison for rape he did not commit

He could have been free six years ago. But he could not get past even the first of the sex offender treatment program's "four R’s" -- Recognition, Remorse, Restitution and Resolution.

Instead, Cornelius Dupree Jr. continued to stubbornly insist he was innocent of the robbery and rape for which he went to prison 30 years ago.

Today, Dupree finally won back his good name, becoming the latest in a flood of exonerated convicts in Dallas, Texas. District Attorney Craig Watkins, the first African American elected prosecutor of any county in the state, actively supports innocence projects. Like Dupree, the majority of the exonerated men are African American and were convicted of sexual assaults.

By local tradition, many of the other exonerated men attended Dupree's court hearing on Tuesday. Many said they too had been convicted based on eyewitness misidentification, the most common cause of wrongful convictions.

The moral: Do not assume that someone who has been convicted of a crime is lying, just because he or she is denying guilt. Every once in a while, it's true.

An Associated Press article with more case details is HERE.
The Dallas Morning News has an excellent series on the DNA exonerations, HERE.