Monday, September 2, 2013

protecting the integrity of psychiatry

Even eight months after it was published, the New Yorker surprises me with The Science of Sex Abuse. Rachel Aviv looks at how convicted sex offenders can be committed indefinitely for treatment. Her piece is long; do read the whole thing. Tidbits I found interesting:
Child-pornography sentencing laws have been passed rapidly, with little debate; it’s nearly impossible, politically, to object to harsh punishments for perverts. Melissa Hamilton, a law professor at the University of Houston Law Center, told me that lawmakers have treated pornography possession as if it were an “inchoate crime.” She said, “It has become a kind of proxy—a way to incapacitate men who we fear have already molested someone, or will in the future.”
Ah, yes. Putting people in prison because we fear they will commit a crime. On my everything is a gateway post, commenter Allison G says it is "illogical" to wait for someone to commit a crime before putting the person in prison. Illogical? 2006, Congress passed the Adam Walsh Child Protection and Safety Act, which its sponsor described as the “most comprehensive child crimes and protection bill in our Nation’s history.” It allows the federal Bureau of Prisons to keep inmates in prison past their release date if it appears that they’ll have “serious difficulty in refraining from sexually violent conduct or child molestation if released.” Their extended confinement is achieved through civil commitment, a legal procedure more often used to hospitalize patients who have severe mental illness, usually bipolar disorder or schizophrenia.... 
Since the nineties, twenty states have passed similar statutes, known as sexually-violent-predator laws, for offenders who suffer from “volitional impairment”—a legal term that does not correspond to any medical diagnosis.
Outrageous. We keep people in prison because of a crime they have not yet committed--and even the best guesses that they will commit the crime are still only guesses--and we use a made-up diagnosis to do it. 
When relying only on clinical interviews, mental-health professionals predict dangerous behavior at a rate not much better than chance. ... The demand for ways of predicting future criminal behavior has spawned a cottage industry of actuarial instruments, which predict sexual violence about as well as the S.A.T. forecasts freshman grades. Neither correlation is particularly strong. But the instruments confer a stamp of scientific precision on a judgment that psychologists have proved ill-equipped to make.
Only guesses...spawning a cottage industry. Always interesting to see who makes money from the misfortune of others.
During the past fifteen years, the American Psychiatric Association has repeatedly objected to the civil commitment of sex offenders. In 1999, a task force created by the organization wrote that “confinement without a reasonable prospect of beneficial treatment of the underlying disorder is nothing more than preventative detention.” Six years later, another task-force report asserted that the laws represent a “serious assault on the integrity of psychiatry.” 
I'm all for protecting the integrity of psychiatry and I'll get to it right after we stop assaulting the civil rights of people who have not yet committed the crime they are doing time for. I'd get to it sooner if I knew psychiatry weren't besmirching its own reputation by jumping on the bandwagon to develop those tools to predict the unpredictable.
The science of perversion is decades behind the rest of the field. The diagnostic criteria for sexual disorders were tested on only three patients before being added to the Diagnostic and Statistical Manual of Mental Disorders, in 1980. No field trials have since been conducted....
Michael First, the editor of the two most recent editions of the D.S.M., told me that there is no scientific research establishing that abnormal desires are any harder to control than normal ones. “People choose to do bad things all the time,” he said. “Psychiatry is being coƶpted by the criminal-justice system to solve a problem that is moral, not medical.”
No wonder the integrity of psychiatry needs protection. 

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