Intellectual competence and the death penalty

That's the title of a new blog some of you will be interested in. Produced by Kevin McGrew, director of the Institute for Applied Psychometrics, its focus is "psychometric measurement issues and research related to intelligence testing that may have bearing on capital punishment cases for individuals with an intellectual disability."

The blog is just a few months old, but it's already loaded with resources pertinent to capital litigation, including recent court cases as well as professional journals, associations, blogs, and experts. It's even got a poll you can take, indicating what topics you would like Dr. McGrew to tackle next. The professor clearly enjoys blogging, as he's already running at least two other IQ-related forums.

Clicking on the image at left will take you directly to the site, which today just happens to feature my blog.

Should forensic psychologists have minimal training?

Would you trust a "master's level dentist" to pull your tooth? Or a "bachelor's degree attorney" to defend you in court?

Not hardly.

Terminal master's degree programs in forensic psychology represent just this type of degradation in quality, says Carl Clements, a psychology professor at the University of Alabama, who argues that forensic psychology training should remain at the traditional doctoral or postdoctoral level.

But critics like Clements are spitting in the wind. Paralleling forensic psychology's breakneck growth and immense popularity, degree programs -- including many online, distance-learning options -- are sprouting up like mushrooms after a heavy rain. And just like mushrooms, they will be impossible to eliminate.

The field's perceived glamour, including the allure of the mythical profiler, has produced a bumper crop of impressionable young people willing to shell out cash for a forensic degree. Massive prison growth, along with prisoner's rights cases mandating mental health evaluation and treatment, have produced abundant jobs for psychologists.

Educational institutions have responded with alacrity. New training programs take a variety of forms, according to a survey in the current issue of Training and Education in Professional Psychology:

• PhD in clinical psychology with specialty track in forensic psychology (about 10 programs)
• PsyD in clinical psychology with forensic specialty track (about 10 programs)
• PhD in nonclinical (e.g., social or experimental) psychology with forensic or legal emphasis (about 10)
• Joint psychology-law degree programs (6)
• Master's degree in forensic psychology (12)
• Bachelor's degree in forensic psychology (John Jay College of Criminal Justice)
• Undergraduate psychology-law courses (increasingly common and popular)

In addition to all of these different degree options, more and more predoctoral internships offer forensic rotations. About 17% of APA-accredited internships now offer a major forensic rotation, with another 47% offering a minor rotation, according to the Association of Psychology Postdoctoral and Internship Centers (APPIC).

Yet with all of this rapid growth, there is no consensus as to what training models and curricula are adequate in order to prepare students for real-world forensic practice. With that in mind, David DeMatteo of Drexel University and colleagues are proposing a set of core competencies for doctoral-level forensic psychology training curricula. At minimum, they say, students should get training and experience in the traditional areas of substantive psychology and research methodology, along with specialized advanced training in:

• Legal knowledge
• Integrative law-psychology knowledge
• Ethics and professional issues in forensic psychology
• Clinical forensic psychology

Aren't all of these areas already integrated into current forensic psychology degree programs?

Again, not hardly.

Reviewing the curricula for the roughly 35 [as of his review] doctoral or joint-degree programs with training in forensic psychology, DeMatteo and colleagues found* only three programs that included all four components. For example, only about 40% offered courses falling under "legal knowledge." More alarmingly, only three programs reported offering courses specifically addressing ethical and professional issues in forensic psychology.

So, will all of the self-described forensic psychologists emerging from these newly minted degree programs be able to find work in the field? I predict that those who travel the traditional path of postdoctoral specialization will fare the best. Those with terminal master's (or even bachelor's) degrees will be restricted to lower-level occupations such as correctional counselor or social services case manager. While they may meet the demands of the prison industry for warm bodies with letters after their names, these practitioners certainly won't be called as experts in court.

But there is a greater danger in these bare-bones forensic training programs. Not only do they offer false promises to students, but they sacrifice the intensive clinical training, including experience working with severely mentally ill populations, that is a key foundation for forensic work. The lack of adequate training in the law and in ethics will likely cause even more disastrous outcomes when these professionals take on forensic cases.

I know, I know. I am just spitting in the wind, too. Financial exigencies always win out.

Related resources:

What's it take to become a forensic psychologist?

*SOURCE: David DeMatteo, Geoffrey Marczyk, Daniel Krauss & Jeffrey Burl (2009), Educational and training models in forensic psychology. Training and Education in Professional psychology 3 (3), pp 184-191. Request from the author HERE.

Court roundup: Lots of action this week

In addition to the high-profile competency hearing in Iowa that I blogged about yesterday, this week featured lots of other legal happenings of relevance to forensic psychology. Issues included:

• The Zoloft defense
• Repressed memory
• Transsexual prisoners
• Child pornography sentencing

Here are some highlights, with links so you can read more if you are interested:

"Zoloft made me do it"

In a New York trial that is drawing national attention, a defendant is blaming a 2006 attack on his girlfriend on symptoms of withdrawal from the antidepressant Zoloft.

To bolster his defense, Brandon Hampson is expected to call Dr. Stefan Kruszewski, a Harvard Medical School graduate. Dr. Kruszewski testified at a pretrial hearing that Zoloft can cause "significant side effects," including agitation, aggression and grandiosity.

It's going to be yet another case of dueling experts: An associate clinical professor at Harvard is expected to testify that "Kruszewski's opinion is not generally accepted by experts in the field and was based on flawed research methods," according to an article by Vesselin Mitev in the New York Law Journal. In an unusual payment arrangement, Pfizer (the drug's manufacturer) will compensate Dr. Douglas Jacobs $7,500 for his testimony.

The trial harkens back to a rash of cases in which violence and suicidality were attributed to the effects of Prozac. Severe side effects from withdrawal from other antidepressants such as Paxil are well documented.

Transsexual prisoner rights

In a history-making ruling in the United Kingdom, a preoperative male-to-female transsexual has won the right to be housed in a women's prison. The prisoner, known only as "A," will have to be housed in segregation. "A" is serving a life sentence for killing a boyfriend and trying to rape a woman.

Under the ruling by a judge on London's High Court, holding "A" in a men's prison is a breah of human rights under the European Convention on Human Rights.

The Telegraph of UK has the story. My March 2008 post on transgender prisoners is here.

Repressed memories under assault

The infamous priest Paul Shanley of Boston, one of the central figures in the clergy sex abuse scandal, is back in court challenging his conviction by claiming that theories of repressed memories are not reliable or valid.

Shanley was convicted after a 27-year-old man claimed the priest had regularly raped him when he was just six years old, but that he blocked out the memories for two decades until he saw media reports about the clergy scandal unfolding in Boston.

Reports Denise Lavoie of the Associated Press:

Shanley's lawyer, Robert Shaw Jr., argues that Shanley deserves a new trial because the jury relied on misleading, 'junk science' testimony about repressed memories by prosecution witnesses. 'His conviction rests upon a theory that is false, that has not been shown to exist and has been rejected by the scientific community,' Shaw said. 'They needed repressed memories to normalize for the jury what was otherwise an extraordinary assertion - that he could be completely oblivious that this ever happened and then remember it 20 years later."

The appeal, to be heard by Massachusetts' high court, "is being closely watched by experts on both sides of the issue," Lavoie reports. "Nearly 100 scientists, psychiatrists and researchers have signed a friend-of-the court brief denouncing the theory of repressed-recovered memories. Another group has submitted a brief supporting the theory."

Judges protest child porn sentencing

Federal judges testified before a U.S. Sentencing Commission in Chicago about severe mandatory sentences for child pornography possession. Astonishingly, the punishment for watching a single video can be higher than that for raping a child repeatedly over many years, one judge testified.

The Wall Street Journal's Law Blog has coverage.

Rare chance to view dueling experts live

Accused coach killer's Iowa competency hearing

Courtesy of the Des Moines Register, we have a rare opportunity to watch two experienced mental health experts testify in court about competency to stand trial. The experts were the featured event in this week's highly publicized hearing for Marc Becker, the mentally disturbed man accused of gunning down esteemed Iowa football coach Ed Thomas in front of about 20 students this past June.
















Click on either image above to watch that expert's testimony. Dr. Michael Taylor's video (left) is about 79 minutes, the first 15 minutes of which are the testimony of a psychiatric nurse at the jail (manually move the time bar to 15 to start with Taylor). Dr. Dan Roger's video (right) lasts about 57 minutes.

The experts agreed that Becker is most likely schizophrenic. They differed vastly, however, on whether he evidenced symptoms of psychosis.

Testifying for the prosecution on Thursday, psychiatrist Michael Taylor said he found no evidence whatsoever of current psychotic symptoms. Dr. Taylor described the defendant as "a calm, relaxed, pleasant young man, well spoken, articulate, able to communicate clearly, able to joke."

"There's absolutely no hint in Mr. Becker's appearance or behavior that would raise any suspicion of any psychiatric disorder," Taylor testified.

On the other side of the aisle, defense-retained psychologist Dan Rogers described the defendant as "floridly psychotic," paranoid, and delusional. "He starts with a perfectly good thought and it just becomes filled with illogical concepts as he tries to proceed," he testified.

While the public may see this as an example of hired guns who will say whatever they are hired to say, an alternate possibility is that Becker presented differently to the two experts. Dr. Rogers evaluated Becker on two occasions, 32 days and 45 days after the offense. Dr. Taylor did not evaluate Becker until more than two months after the crime. By that time, Becker was being medicated with a high dosage of the antipsychotic Invega.

Becker appeared highly sedated in court, raising another competency issue: If his medication dosage is lowered so that he can stay awake in court, his psychosis will worsen, Dr. Rogers predicted.

Of note in this case is the informative, factually accurate coverage being provided by Jennifer Jacobs of the Des Moines Register. In Thursday's article, she quoted the illustrious Daniel Murrie of the Institute of Law, Psychiatry and Public Policy at the University of Virginia School of Medicine, talking about how uncommon incompetency findings are (only an estimated 20% of cases in which the issue is raised).

In her previous story, Ms. Jacobs quoted competency guru Thomas Grisso (of Evaluating Competencies fame) and cited recent empirical research on incompetency findings:

"Each year, about 7,000 defendants nationwide are involuntarily committed to public psychiatric hospitals for treatment intended to make them well enough to stand trial, according to a 2008 report in the American Journal of Forensic Psychiatry. About 78 percent are released in less than three months, according to a 2003 report by the Missouri Institute of Mental Health. Another 20 percent are released between three months and 12 months after committal, and 2 percent are released after 12 months."

After hearing from the two experts, Judge Stephen P. Carroll put the case against Becker on hold while he contemplates his competency ruling.

Hat tip: Luis Rosell

The Deification of Matthew Shepard

What the gay-rights movement has lost by making Shepard its icon

Guest essay by Gabriel Arana, The American Prospect*

Since Matthew Shepard was brutally murdered a decade ago, his story has achieved the status of parable, illustrating how ugly anti-gay bigotry really is. Every year, thousands of high school students across the country perform Moises Kaufman's play, The Laramie Project, which recounts the aftermath of Shepard's murder through the eyes of the local residents. Shepard's story has been the subject of three screen productions, a documentary, and countless investigative reports. That he was discovered tied to a pole on a dirt road only encouraged Christian analogy, one not-so-subtly invoked by the 2007 Phil Hall theatrical production, Matthew Passion.

As Shepard's father said at the trial of the two men eventually convicted of killing Shepard, "My son has become a symbol."

This familiar story -- Matthew as a pure, meek victim of anti-gay bigotry -- remains an orthodoxy unquestioned by all but the most ardent gay-rights opponents. In fact, Shepard was a deeply troubled young man. He had a severe drug and alcohol problem, suffered from bouts of depression, and failed out of school numerous times. He spent his money on partying, leaving him unable to pay bills. He contracted HIV, most likely through unsafe sex. These darker details are conspicuously absent from the prevailing narrative about Shepard's life.

There's no question that Shepard's murder was the result of bigotry. But by ignoring Shepard's flaws, supporters of gay rights make a critical mistake. The allegorical Matthew of vigils and plays is a not a person with conflicting desires and motivations. He's a one-dimensional caricature. If Shepard's story is intended as a lesson on the tragic consequences of gay bigotry, the ardent refusal to cast him as anything but an unblemished victim provides another: In order to win rights, gay people not only have to be just like you, they have to be better than you.

In her new book, The Meaning of Matthew, Judy Shepard acknowledges her son's shortcomings. But despite her frank acknowledgement of his problems, she ultimately falls back on eulogistic platitudes: He made everyone "feel that they were the only ones in the world at that moment." He liked to "ruffle a few feathers" and "had a promising future." Her son "put an everyday face on the gay rights movement."

It's understandable that a grieving mother remembers her son in the best light. But Matthew Shepard's status as a gay everyman was determined -- first by the media, then by gay-rights groups -- with little knowledge of who he was. He looked like an attractive, angelic, white college student from the heart of conservative America. He was found tied to a pole and beaten, hovering near death. The story could have written itself -- and it did: Numerous media outlets erroneously reported that Matthew had been "crucified" when in reality he was found on the ground.

Over 1,400 members of the LGBT community are victims of a hate crime every year, which includes violent attacks as well as harassment. Why, then, is Shepard the "face" of gay rights? The implication is that all the other candidates weren't quite right: not urban New Yorkers dying of AIDS in the 1980s, not inner-city black adolescents whose parents kicked them out of the house, not leather daddies marching on Washington. The pictures of other gays, lesbians, and transgender people did not prove sufficiently salable to make it onto rally placards.

At worst, anointing Shepard the "everyday" face of gay rights is a concession to other types of bigotry -- against trans men and women, racial and ethnic minorities, gay men with AIDS. At the very least, it demonstrates a willingness to appeal to mainstream tastes in order to earn political capital. It's the type of pragmatic bargain that organizations like the Human Rights Campaign and Equality California make all the time: You give us rights, and we'll hide the drag queens.

The "perfect icon" problem is not exclusive to the gay-rights movement. We revere Martin Luther King Jr. -- a peaceful reformer who couched his calls for civil rights in terms of brotherhood and Christian values -- instead of Malcolm X, a secessionist and Muslim who blamed whites for slavery and black oppression. There is also a reason the long-haired and beautiful Gloria Steinem is a better known feminist than Judith Butler, the androgynous queer theorist. All these figures have similar messages, but we choose to elevate those who are less threatening. Cast as a small, good-natured kid who loved everybody, Shepard is the epitome of nonthreatening.

This deification is part of what happens when a personal narrative turns political.

Judy Shepard calls comparisons of her son to Christ "inappropriate," but that framing has helped make him the patron saint of hate-crime legislation. The fight for this legislation is at least part of the "meaning" of Matthew. The Matthew Shepard Act is currently under consideration in the House after being stymied under George W. Bush, who threatened to veto it. If it passes, gay-rights groups can declare a victory. But what will have been vanquished? Even his mother acknowledges that "a dyed-in-the-wool and determined bigot isn't about to log onto the Internet to check state or federal statutes before bashing someone's head in."

What hate-crime laws do provide are stricter sentencing guidelines, feeding a criminal-justice system that has imprisoned more than 1 percent of the U.S. population and unfairly targets minorities. The courts imprison blacks at six times the rate of whites, and Hispanics, at more than double the rate of whites; the rate of black incarceration under President George W. Bush was higher than it was in South Africa during apartheid. If the face of anti-gay violence were a racial or ethnic minority, would we still be pushing for hate-crimes legislation that props up the criminal-justice system?

As Jos Truitt at Feministing.com points out, activists' energy would be better spent on empowering victims and combating the homophobia that motivates hate crimes. Groups like the Human Rights Campaign, which are spearheading the effort to get the Matthew Shepard Act passed, should focus instead on education programs and passing the Employment Non-Discrimination Act. Harsher murder sentences can't bring back the dead, but nondiscrimination laws and education programs can help LGBT Americans who are still living. It's hard to see how Shepard's memory is "honored" by a legalistic redefinition of federal sentencing guidelines or how this accomplishes anything concrete for gay rights.

Judy Shepard is entitled to remember her son however she likes. The rest of us have no such excuse. In an objective sense, the "meaning" of Matthew is not to be found in the passage of legislation, candlelight vigils, or passion plays. The real tragedy of Matthew Shepard's death is that it was senseless: He did not die for hate-crimes legislation or to become a martyr. The public can craft a narrative in which trauma finds redemption in politics, but ultimately the meaning we find in Shepard's death says more about society and the gay-rights movement than it does about Judy Shepard's son.

Essay reprinted with written permission from Gabriel Arana, "The Deification of Matthew Shepard," The American Prospect Online. The American Prospect, 1710 Rhode Island Avenue NW, 12th Floor, Washington, DC 20036. All rights reserved. Graphics credits: (1) Matthew Shepard collage, via the blogosphere, origin unknown; (2) The Passion of Matthew Shepard, by Fr. William McNichols, c/o Maryknoll Magazine.

UPDATE: Read on for a thought-provoking counterpoint opinion by "Urbanite," in the Comments section (the second comment).

WSJ: "Sex-Registry Flaws Stand Out"

Amid the continuing media frenzy over the Jaycee Lee Dugard case, and the alarmist misinformation about recidivism being spewed on some national television shows, I want to make sure my readers don't miss today's excellent article in the Wall Street Journal discussing the case within the context of California's failed sex offender registration policies.

The case of Phillip Garrido, who allegedly held Jaycee Dugard in his backyard for 18 years despite monthly law-enforcement visits, is forcing California officials to acknowledge a fundamental problem with the state's sex-offender registry: The list keeps expanding, while the number of officials who monitor sex offenders has grown at a much slower rate.

There are now so many people on the registry it's difficult for law enforcement to effectively track them all, and "it's more helpful for law enforcement to know...who the highest-risk offenders are," said Janet Neeley, a deputy California attorney general and member of the state's sex offender board.

A December study of roughly 20,000 registered sex offenders on parole in California found 9% posed a "high risk" of reoffending, and 29% posed a "moderate-high" to "high" risk, said Ms. Neeley. But law-enforcement officials and academics say vast resources are spent monitoring nonviolent offenders rather than keeping closer tabs on more-dangerous ones.

California's sex-offender registry has ballooned to more than 90,000 people now from about 45,000 in 1994, according to the California attorney general's office. Not only has the number of law-enforcement officers failed to keep pace, but recent state budget cuts have forced some local agencies to cut officers assigned to sex offenders, according to the California Commission on Peace Officer Standards and Training....

Last year, California's Sex Offender Management Board criticized the system as it stands in a 225-page assessment, highlighting failures in the collection and analysis of data on sex offenders. It's "difficult if not impossible" to track the effectiveness of registry laws, the report said.

Mr. Garrido, who allegedly kidnapped the 11-year-old girl in 1991, was considered high-risk because of a 1977 conviction for rape and kidnapping. But he received about the same number of visits from officers at his Antioch, Calif., home as the 200 or so other sex offenders in Antioch and adjacent Pittsburg, said the Contra Costa County Sheriff, even though many weren't convicted of violent offenses. During dozens of visits to Mr. Garrido's home, authorities never found the tents and shacks hidden behind a backyard fence.

The growing sex-offender list can dilute the amount of attention on the most dangerous offenders, said Nora Demleitner, the dean of Hofstra University Law School who studies sentencing. Some sex offenders "tend to be not dangerous at all," she said. "You have them register as sex offenders, so when you're law enforcement, all these people look the same. If you had much more focused sex-offender laws, maybe they would have been bothered to go into the shack" in Mr. Garrido's back yard.

California has been trying to sharpen its focus, but federal and state laws passed in 2006 offer conflicting rules for monitoring sex offenders, Ms. Neeley said.

Under its law, California has chosen to use a program called Static 99, which categorizes sex offenders based on their likelihood to reoffend. To predict risk, it looks at things like the nature of the crime, the offender's relationship with the victim and whether the offender has been able to form long-term intimate relationships. But the system hasn't been introduced by most local jurisdictions for those convicted before 2007.

Provisions in the federal Adam Walsh Act aim to move monitoring in the opposite direction, so that it's based solely on an offender's type of conviction, not on a complex assessment of risk.

That's problematic, said Jill Levenson, an associate professor at Lynn University in Florida who studies sex-offender registries, since it "overestimates risk for most people, and underestimates risk for people who pleaded down," or struck plea deals by admitting to lower-level crimes.

Now, the state Sex Offender Management Board is recommending that California forgo some federal funds and not adopt the law, which would add to the number of crimes requiring registration.

"There is no available evidence to indicate that expanding California's list of registerable crimes would promote public safety," the board wrote in a recommendation, noting the federal law would create at least $32 million in costs to the attorney general's office and law-enforcement agencies without improving the system.

Monday's San Francisco Chronicle also had a good article describing how Garrido got out of prison after his first kidnap-rape, and explaining that he would not have been treated so leniently under today's laws.

Will Texas arson case change death penalty debate?

Pundits are predicting that an in-depth New Yorker expose on the Cameron Todd Willingham case may change the face of the death penalty debate.

David Grann's article, "Trial by Fire: Did Texas execute an innocent man?" is set for publication Sept. 7. Already, it is generating comment, such as this excellent op-ed in the New York Times by columnist Bob Herbert:

It was inevitable that some case in which a clearly innocent person had been put to death would come to light. It was far from inevitable that this case would be the one. "I was extremely skeptical in the beginning," said the New Yorker reporter, David Grann, who began investigating the case last December.

As I blogged about last year, Cameron Todd Willingham was executed in 2004 when Texas' governor ignored a report calling into question the scientific evidence underlying his conviction.

"There's nothing to suggest to any reasonable arson investigator that this was an arson fire," wrote renowned arson expert Gerald Hurst in that report. "It was just a fire."

Now, a report commissioned by Texas to investigate mishandling of forensic evidence is "devastating” to the prosecution's theory, writes Herbert. According to scientist Craig Beyler, the determination of arson had absolutely no scientific basis. In his scathing report, Beyler equated the fire marshall's approach to that of "mystics or psychics."

Unfortunately, it's all a bit too late for Willingham. After hearing from a jailhouse snitch and others, a jury deliberated only an hour before convicting him. As Herbert wrote, Willingham "insisted until his last painful breath that he was innocent," refusing a plea bargain that would have spared his life.

Click on the image below to see a 4-minute video narrated by Grann, featuring footage shot by fire investigators and discussing flaws in the original investigation.

Click on this image to see video footage of the arson investigation

Further resources:

Scott Henson over at Grits for Breakfast has extensive coverage of the case.

Mitchell slated for epic competency hearing

In what is shaping up as one of the longest and most intricate competency hearings in history, Brian David Mitchell has finally been slated for a hearing in late November that is expected to last 10 days.

Mitchell, you will recall, is accused of kidnapping Elizabeth Smart of Utah back in 2002. A self-proclaimed prophet, he allegedly planned to make her one of his wives. (Unlike Jaycee Lee Dugard, who was held hostage for 18 years and bore two children with her abductor, Ms. Smart was held captive for only nine months and reportedly readjusted well.) Wanda Eileen Barzee, Mitchell's estranged wife and codefendant, was found incompetent about five years ago and has been at the Utah State Hospital ever since; no date has been set for her competency hearing.

Prosecutors and defense attorneys are sparring over who will testify at the upcoming hearing.

The prosecution submitted a list of 39 witnesses. It included expert witnesses, police officers, and staff members at the Utah State Hospital, as well as "former friends, acquaintances, co-workers, ecclesiastical leaders and family members," according to a story in the Deseret (Utah) News.

Defense attorneys contend that many of these witnesses should be excluded because they do not have any information about Mitchell’s current state of mind. The relevant time frames in a competency determination are the present and short-term future, not the distant past.

Dr. Michael Welner, a forensic psychiatrist from New York City, is expected to be the star witness for the prosecution.

Welner is a renowned expert who has testified in a number of high-profile criminal cases. An associate professor at NYU School of Medicine and an adjunct professor at Duquesne University Law School in Pennsylvania, in 1996 he founded a monthly periodical, the Forensic Echo. Two years later, he founded what is billed as the first forensic peer-review consultation practice, The Forensic Panel. In a procedure designed to minimize examiner bias, panel members must expose their work to the scrutiny of peers to minimize examiner bias. One of his more controversial creations is the "Depravity Scale," which attempts to quantify evil. Welner is also a frequent media commentator.

In his "voluminous" report, Welner reportedly opines that Mitchell may meet criteria for narcissistic personality disorder or other personality disorders. Typically, as opposed to severe psychotic disorders such as schizophrenia, the personality disorders are not deemed severe enough to make a person incompetent to stand trial.

For further reading, I highly recommend Judge Judith Atherton's 2005 competency opinion in the case, a thoughtful analysis of competency as it pertains to religiosity. Evaluations by esteemed forensic psychologists Jennifer Skeem and Stephen Golding and psychiatrist Noel Gardner are discussed. I have made it available HERE.

Related resources:Deseret News: Mitchell attorneys want fewer witnesses

The Recurrence of an Illusion: The Concept of "Evil" in Forensic Psychiatry, by James L. Knoll, IV (critical commentary on Dr. Welner's Depravity Scale)

Bentall: Diagnoses are psychiatry's star signs

"Let's listen more and drug people less"

Heading over to the Guardian of UK today to check the comments on my essay on the Jaycee Lee Dugard case, I was excited to stumble across a new essay by Richard Bentall. For those of you who don't know him, in my opinion Bentall is one of the most important voices in the mental health field today. His new book, Doctoring the Mind, is an outstanding, empirically based critique of modern biological psychiatry, and its abysmal failure -- all hype to the contrary -- to improve the human condition. His Guardian essay, excerpted below, briefly summarizes his main arguments:

. . . Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."

Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses . . . – have hardly changed since the Victorian period. . . .

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.

When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. . . . This . . . is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.

Many studies have also reported an association between trauma in early life and psychosis. These effects are large [and] understandable in the light of psychological research. . . .

The cruel and ineffective treatments that characterised psychiatry in the mid-20th century -- for instance, prefrontal leucotomy and insulin coma therapy -- would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. . . . There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

The full essay is online HERE. I highly recommend his book, too.

My Guardian commentary on Jaycee Dugard saga

The Guardian of UK asked me to write a comment on the extraordinary saga of Jaycee Lee Dugard. I'm posting the first few paragraphs here, with a link to the Guardian website for the full article and the comments, many of which are quite interesting. (I posted a couple of my own comments to the comments.)

In these harsh economic times, the saga of Jaycee Lee Dugard is especially riveting to the public imagination. Our horror and revulsion unite us. Who can we blame? How could this monster hide amongst us while committing unspeakable acts against innocent children?

Our collective furor and thirst for vengeance run counter to the principles of our justice system, under which a criminal defendant is presumed innocent until proven guilty. Psychiatric issues will make justice especially slow for Phillip Garrido, the registered sex offender who is accused of holding Dugard hostage for 18 years, after kidnapping her in June 1991 when she was just 11. (Garrido and his wife Nancy have both denied the charges.)

Initial evidence points toward a psychosis. In an interview from jail, Garrido called Dugard's story "heartwarming" and referenced secret documents and "hundreds and hundreds of thousands" of lawsuits. And that is just the tip of the iceberg. The wonders of the internet allow us to travel back in time and enter his mind, via rambling blog posts about voices in his head, mind control, and religious delusions of himself as the savior.

Ironically, more than a year ago Garrido referenced the potential for psychotic symptoms to cause violence against children. A woman who drowned her three children in the San Francisco Bay was, he wrote, "led by a powerful internal and external (hearing) process that places the human mind under a hypnotic siege that in time leads a person to build a delusional belief system that drives them to whatever course of action they take."

My Guardian (UK) commentary continues HERE. Please feel free to add your comments and opinions at either the Guardian website or here.

Excerpt from Garrido's Voices Revealed blog

MMPI feud hits prime time

MMPI-2-RF version and Fake Bad Test at issue

The Minnesota Multiphasic Personality Inventory is the most widely used and best known personality test in the world. Daily, it is introduced in court in everything from child custody cases to civil lawsuits to criminal proceedings. Despite the fact that public tax monies sponsored its original development, it's become a major cash cow for the University of Minnesota, raking in about $1 million a year in royalties. But now, media focus on a bitter professional dispute is causing some in the field to wonder whether the legendary test has seen its day.

"Feud over famed test erupts at U," blared the headline on an in-depth investigation by Maura Lerner of the Minneapolis/St. Paul Star-Tribune.

At issue is last year's "dramatic makeover" of the highly profitable septuagenarian. The slimmed-down MMPI-2-RF (restructured form) has just 338 questions rather than the old test's 567.

Leading the critics is James Butcher, a retired psychologist whose career centered around the old MMPI-2. He claims the MMPI-2-RF is so radically altered that it amounts to a new instrument. "These folks have made a new test and they are using the name MMPI ... with all the 70 years of tradition to market [it]." If he's right, of course, then all of the myriad studies and normative data on the old test are irrelevant to interpreting scores on the MMPI-2-RF.

Of even more direct relevance to us forensic folks is the controversy surrounding the new "Fake Bad Scale." As I've blogged about previously (links below), the "FBS" is being used to brand personal injury claimants as malingerers. Critics say the 43-item scale "discriminates against women and is prone to 'false positives.' "

Defenders of the new test deride critics as "the Mult Cult" (a twist on Multiphasic). And, to be fair, some do have a vested interest in the previous edition: Butcher earns a 30 percent cut of the $600,000 annual royalties on the MMPI-2's computerized interpretation system.

All of the hoopla has led to a series of formal investigations. In one, a university audit revealed that most of the MMPI research grant money was going to projects involving advisory board members of University Press's test division, who in some cases had even reviewed their own grant proposals.

The Press's solution to the controversy, according to the Star Tribune, is to "let the marketplace decide."

Hmmm. Is the marketplace really the best judge of good science?

The hoopla is likely to benefit the MMPI's competitors. In forensic circles, the test's former monopoly hold is giving way as the Personality Assessment Inventory and other newer instruments gain ground.

Whatever side we practicing psychologists choose, the major test distributors won't care. They distribute them all, and they will continue to rake in enormous sums of money. Don't you just love those over-the-top shipping and handling fees charged by you-know-who?

Related blog posts:

• New MMPI scale invalid as forensic lie detector, courts rule: Injured plaintiffs falsely branded malingerers? (March 5, 2008)
• Latest on controversial "Fake Bad Scale" (February 23, 2009)
• "Fake Bad Scale": Lawyers advocate exposing in court (May 20, 2008)

Dallas bans 6-packs

No, not beer.
Or soda.
Or abs.

Six-pack photo lineups -- perhaps the single largest cause of wrongful convictions.

Frustrated with a string of wrongful convictions, the Dallas police department is now the nation's largest force to use sequential blind photo lineups -- a widely praised technique designed to reduce mistakes made by witnesses trying to identify suspects.

Dallas is not the first department to use the pioneering method. But experts hope that by using it in the county that leads the nation in exonerating wrongly convicted inmates, Dallas will inspire other departments to follow suit.

"If Dallas can do it ... then others are going to rise to the occasion," said Iowa State psychology professor Gary Wells, a national expert on police lineups.

The department switched to sequential blind lineups in April. Before that, Dallas police administered most lineups using the traditional six-pack -- law-enforcement lingo for mounting six photos onto a folder and showing them to a witness or victim at the same time. In sequential blind lineups, mug shots are shown one at a time. Detectives displaying the photos also don't know who the suspect is, which means they can't purposely or accidentally tip off witnesses.

Showing possible suspects all at once tends to make a witness compare the mug shots to one another, Wells said. But if they are shown sequentially, "witnesses have to dig deeper, compare each person to their memory and make more of an absolute decision."

An analysis of 26 recent studies shows that presenting mug shots sequentially instead of simultaneously produces fewer identifications but more accurate ones, Wells said.

Nationally, more than 75 percent of DNA exonerees who have been released since 1989 were sent to prison based on witness misidentification, according to The Innocence Project.

Here is the complete AP story: Dallas police pioneering new photo lineup approach.

Hat tip: Sol Fulero

Upcoming trainings

American Psychology-Law Society

Mark your calendars for the upcoming AP-LS conference, to be held March 18-20, 2010 in Vancouver, BC. The deadline for conference submissions is October 5. Information about the conference is available at the conference website. Proposals for posters, papers, and symposium can be submitted HERE.

Risk for Sexual Violence Protocol (RSVP)

On October 22, Stephen Hart is going to be down in Portland, Oregon, giving an all-day training on his newly developed instrument, the RSVP (which replaces the Sexual Violence Risk-20 instrument). Dr. Hart is well worth catching. A member of the Mental Health, Law, and Policy Institute at Simon Fraser University in Canada, he is an internationally renowned researcher, forensic psychologist and past president of the American Psychology-Law Society. More information on the training is at the website of Northwest Forensic Institute.

Ayres exposer wins award

The prosecution of prominent psychiatrist William Ayres for child molesting, which I blogged about most recently HERE, owes in large part to the tireless efforts of author and reporter Victoria Balfour. Now, Ms. Balfour's investigation has won her an Award for Excellence in the Media for meritorious public service from the Institute of Violence, Abuse, and Trauma and the Leadership Council on Child Abuse & Interpersonal Violence.

In its award letter, the Council commended Balfour for performing "a valuable service to society by using the power of the media as a catalyst for pursuing justice."

Balfour will be honored at the 14th International Conference on Family Violence, Abuse and Trauma on September 25 in San Diego, California.

Meantime, word is out that the San Mateo County (California) District Attorney's Office has decided to retry Ayres after extensive talks with jurors who deadlocked in favor of conviction on most counts.

Ayres, 77, is a former president of the American Academy of Child and Adolescent Psychiatry who treated hundreds of delinquent boys sent to him by the county's juvenile justice system. He was charged with molesting six of these former patients under the guise of giving them medical exams.

More on Balfour and the Ayres case is available at the William Ayres Watch blog.

Criminalizing our nightmares, destroying civilization

We all know what an unmitigated disaster the Drug Wars have been. Here at Ground Zero (California), prison guards live large while public schools crash and burn. (We used to have among the best schools in the United States; now we are at the bottom.) Membership in the guards' union has soared from 2,600 to 45,000, while correctional salaries rose from $15,000 to -- in some cases -- $100,000 a year or more. (Laura Sullivan at NPR has an informative piece on Folsom Prison as an exemplar of this process. Folsom used to rehabilitate its prisoners; now it's a "merry-go-round" with no escape.)

Have we learned from the failed Drug Wars? Nope. Instead, we are on the cusp of a new and massive criminalization effort, this time targeting the bogeyman sex offender.

So predicts Corey Rayburn Yung, prolific scholar at John Marshall Law School in Chicago, in a new article, "The Emerging Criminal War on Sex Offenders." Yung reviews the history of "criminal wars," mainly the War on Drugs, to identify three essential features:

• Marshaling of resources
• Myth creation
• Exception making

He predicts that the changes being wrought by the Adam Walsh Child Protection and Safety Act ("AWA") of 2006 may bring "repercussions as substantial as the drug war has had on American criminal justice and society."

The ratchet effect

By now, we really should know better than to allow this further destruction of our civil society. Even the Economist of London, hardly a bastion of liberal politics, is lambasting the laws. The August 6 issue includes both a leader and a more in-depth article explaining why America’s sex laws are "unjust and ineffective." As the subhead puts it:

"An ever harsher approach is doing more harm than good, but it is being copied around the world"

As with the Drug Wars, the laws are driven by the "ratchet effect":

"Individual American politicians have great latitude to propose new laws. Stricter curbs on paedophiles win votes. And to sound severe, such curbs must be stronger than the laws in place, which in turn were proposed by politicians who wished to appear tough themselves. Few politicians dare to vote against such laws, because if they do, the attack ads practically write themselves.

"In all, 674,000 Americans are on sex-offender registries -- more than the population of Vermont, North Dakota or Wyoming…. [A]t least five states require registration for people who visit prostitutes, 29 require it for consensual sex between young teenagers and 32 require it for indecent exposure. Some prosecutors are now stretching the definition of 'distributing child pornography' to include teens who text half-naked photos of themselves to their friends.

"How dangerous are the people on the registries? A state review of one sample in Georgia found that two-thirds of them posed little risk. For example, Janet Allison was found guilty of being 'party to the crime of child molestation' because she let her 15-year-old daughter have sex with a boyfriend. The young couple later married. But Ms Allison will spend the rest of her life publicly branded as a sex offender."

Yung too discusses some of these unintended consequences, including the harm to innocent parties. Other examples can be found daily in the popular press. For example, today's Raleigh (North Carolina) News and Observer reports on the travesty of convicted sex offenders being denied the right to worship, and one church choosing to move its children's programs off-site to protect a sex offending parishioner.

As I've reported before, the sexual predator hysteria is creating a widespread phobia of men in contact with children. Columnist Jeanne Phillips (Dear Abby), for example, is fueling panic about the dangers of public men's rooms. As San Francisco Chronicle columnist Jon Carroll sardonically responded:

"When did the idea get out that men's rooms were a secret hotbed of molestation? I mean, there are some men's rooms -- including, apparently, one in the Minneapolis airport -- where consensual homosexual activity between adults has been known to happen. But that's not at all the same thing as child molesting; that's just a form of speed dating. Men's rooms, may I say, are boring. Ain't nothing going on in them. Molestation typically happens in other places, usually in a private home. And statistically it's no more common than it was 30 years ago. As I've said before, if you're looking for the people most likely to molest your child, look at the members of your own family, because that's how it usually happens. People don't want to admit that, so they invent phantom pedophiles in the nation's men's rooms."

But above and beyond all of these unintended consequences, I predict that years from now we will look back and realize not just what we already know -- that we destroyed many lives unnecessarily, bankrupted our schools and other public institutions, and curtailed civil liberties on a massive scale -- but, more fundamentally, we actually created the creature we feared.

Creating the bogeyman: "Mike"

Let's take "Mike." An average, red-blooded 19-year-old American, he dated a cute 16-year-old girl. Like thousands of other young men, he was arrested, and forced to register as a "sex offender" for life. No matter that his behavior was not deviant. Three years is a standard age gap between young men and women for dating in our culture, as it has been forever. I happened to see the obituary of an 89-year-old man who before his demise had celebrated his 70th wedding anniversary. His wife was 86. Do the math. If he had been born 70 years later, he'd be a sex offender for life. Unable to live freely, work, or even attend church, he probably wouldn't have led such a successful life. After all, as social psychologists can tell you, the environment is at least as important to behavior as any psychological characteristics. Probably far more so.

Back to Mike. As I said, there's nothing wrong with Mike. But no matter. Like everyone else, he must undergo mandatory "treatment" for "statutory perpetrators" (yes, that's what treatment providers are calling guys like Mike).

The treatment of choice is cognitive-behavioral therapy. Its mantra, as Dany Lacombe of Simon Fraser University in Canada found in an ethnographic study of one prison-based treatment program, is:

"Once a sex offender, always a sex offender."

"Sex offending is like diabetes," a program therapist tells the assembled sex offenders. "It will not go away. You cannot be cured. We don't use the C word here. But can you be managed? Yes. Treatment is all about managing your risks to re-offend."

Despite little empirical support for this approach, Mike will be trained to understand his "cycle" of offending and develop a relapse prevention plan that focuses on controlling "deviant sexual fantasies." He will have to generate a log of sexual fantasies. If he denies deviant fantasies, or doesn't see the connection between his fantasies and his offending, he will be accused of not cooperating. He will learn to create deviant fantasies "to keep the therapists at bay."

As Lacombe quoted one 18-year-old, in the article in the British Journal of Criminology:

"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."

Through the treatment process, Mike and others will learn to think of themselves as "beings at risk of reoffending at any moment." Indeed, if treatment is successful, Mike will become a virtual "confessional machine," "expected all his life to narrate his darkest fantasies to criminal justice officers and significant others who are enlisted to help him control his risk."

The iatrogenic process

As you probably know, iatrogenesis refers to the situation in which treatment creates or exacerbates an illness or adverse condition. In the context of sex offender treatment and management, here's how the process works:

1. Saturate popular culture with hypersexual advertising and degrading, misogynistic pornography.
2. When men succumb to the allure and experimentally transgress, label them as lifelong "sex offenders."
3. Through mandatory "treatment," reprogram them into dark and dangerous deviants, "a species entirely consumed by sex."
4. Finally, restrict their freedoms so severely that few if any prosocial life courses remain open.

Through exercises of moral regulation, then, the government, law enforcement, media, and therapists collude to transform sex offenders into a strange and different "other," no longer recognizable in their ordinariness.

While this makes Mike more closely match the public's conception of the bogeyman sex offender, is this helpful in the long run, either to him or to society more broadly? By brainwashing thousands of men to think of themselves as nothing more than perpetual sexual deviants, might we not be producing the very risk we have imagined and then sought to ameliorate?

Related articles by Corey Rayburn Yung:

The Sex Offender Registration and Notification Act and the Commerce Clause, Federal Sentencing Reporter, Vol. 21, No. 2, 2008

Banishment By a Thousand Laws: Residency Restrictions on Sex Offenders, Washington University Law Review, Vol. 85, p. 101, 2007

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

New prison research

Beyond Supermax: The Mississippi experience

Having worked in a prison segregation housing unit, I can tell you that such housing units wreak havoc on the fragile psyches of mentally ill prisoners. In a new article, prison authority Terry Kupers (author of Prison Madness) and a group of 13 colleagues explore what happened when Mississippi was forced through class-action litigation to remove mentally ill prisoners from Parchman's "Unit 32" and to provide them with treatment. The result? Not surprisingly, the prison saw "large reductions in rates of misconduct, violence, and use of force."

The abstract of Beyond Supermax Administrative Segregation: Mississippi's Experience: Rethinking Prison Classification and Creating Alternative Mental Health Programs is available at Criminal Justice and Behavior's "online first" site.

Researching prisoner rape

As you may imagine, getting accurate information on the prevalence and features of sexual assault in prison is a difficult task. Among the many challenges are "working cooperatively with state agencies while maintaining independence, gaining access to prisons and prisoners, securing necessary institutional approvals, and collecting generalizable data on a highly sensitive topic." The federal Prison Rape elimination act (PRea) of 2003 increases opportunities for research, however, and a group of scholars tells us how it is done. Lead author Valerie Jenness of UC Irvine is a noted authority on hate crimes. In this article in Criminal Justice Policy Review, Accomplishing the Difficult but Not Impossible: Collecting Self-Report Data on Inmate-on-Inmate Sexual Assault in Prison, she and co-authors describe their research procedures, in the hopes of reversing the recent decline of in-prison research by encouraging other researchers to sally forth.

Additional resources:

• Online resources on sexual victimization in prison

• U.S. Bureau of Justice Statistics special report on prison rape

Norfolk sailors receive partial pardons

Remember the case of the Norfolk 4, which I've blogged about before? That's the 1997 rape-murder case that has become an exemplar of wrongful convictions, the topic of a book by confession scholar Richard Leo and an upcoming screenplay by bestselling author John Grisham.

Yesterday, Virginia Governor Tim Kaine issued partial pardons to three of the four sailors, paving the way for their imminent releases. The fourth sailor was released in 2005. In his statement, the governor noted that the men's confessions contradicted forensic evidence, that no physical evidence linked the men to the crime scene, and that another man had confessed and asserted that he acted alone. That man's DNA matched evidence found at the scene.

The case was highly unusual in that even a group of former FBI agents was lobbying for the pardon.

But guess what? The pardons are only "partial" rather than full vindications. That means the men's convictions will stand, and they will be required to register as sex offenders. And all of you readers know what that means: Even though most intelligent people know they were innocent, they will have a hard time finding anywhere to live, and very few employers will have the courage to hire them.

The New York Times has the story.

Related blog resources:

• My book review of The Wrong Guys (Dec. 8, 2008)
• Another fascinating disputed confession case (Sept. 24, 2007)

Juvenile risk article available to my readers

I recently blogged about an upcoming article in Criminal Justice and Behavior on the use of actuarial tools to predict juvenile sex offender recidivism. (They don’t work.) Thomas Mankowski, the criminology editor at Sage Publications, who also runs the website of the International Association for Correctional and Forensic Psychology (which owns Criminal Justice and Behavior) just so happens to be a follower of this blog, and he kindly offered to let my readers download the article for free. You should be able to download the entire article ("Assessment of Reoffense Risk in Adolescents Who Have Committed Sexual Offenses: Predictive Validity of the ERASOR, PCL:YV, YLS/CMI, and Static-99" by Jodi Viljoen and colleagues) for free by clicking on the download button, above. I also recommend that you check out the IACFP's blogs section; it's got lots of great news and commentary. Thanks, Tom!

30% discount on IACFP membership

Tom is also offering my blog readers a special rate of 30% off membership in the Association for Correctional and Forensic Psychology. The IACFP is an organization of behavioral scientists and practitioners concerned with delivery of high-quality mental health services to criminal offenders, and with promoting and disseminating research on the etiology, assessment, and treatment of criminal behavior. Membership benefits include subscriptions to Criminal Justice and Behavior (click HERE for a free sample issue) and a quarterly newsletter, The Correctional Psychologist, free access to more than 55 criminology journals online, and discounts on various books, educational materials, and conferences. With the discount, a one-year membership is $52.50; student membership is $25. Click HERE to take advantage of this offer. When checking out, enter the Promo Code JULY30% in the "Comments and Special Instructions" field. (Orders are processed manually, so the regular fee appears during checkout but you will be charged the discounted amount.)