Predicting a flawed manual that "will haunt psychiatry for many years to come," the chair of the DSM-IV Task Force has issued an urgent call to the American Psychiatric Association to change course on its revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) before it is too late.
Allen Frances' strongly worded appeal in the Psychiatric Times predicts the DSM-V -- scheduled for publication in May 2012 - will usher in a flood of new mental disorders that will medicalize normality, producing "a bonanza for the pharmaceutical industry but at a huge cost to the new false-positive patients caught in the excessively wide DSM-V net.""In my experience, experts on any given diagnosis always worry a great deal about missed cases but rarely consider the risks of creating a large pool of false positives—especially in primary care settings. The experts' motives are pure, but their awareness of risks is often naive. Psychiatry should not be in the business of inadvertently manufacturing mental disorders."
Frances makes special note of the potential for "unpredictable and consequential" unintended consequences in forensic settings:"Years after the DSM-IV was completed, we learned about the enormous unintended impact of a seemingly slight wording change we made only for technical reasons in the section on paraphilias. A misreading of our intentions in making the change had led to great confusion -- with forensic evaluators using the diagnosis of paraphilia not otherwise specified to justify the sometimes inappropriate lifetime psychiatric commitment of rapists who had no real mental disorder."
This prediction is prophetic in light of current lobbying efforts by the paraphilias subworkgroup to create a new "pedohebephilic disorder" category that could vastly expand sex offender diagnosis, proving a bonanza for the sexual offender civil commitment industry.
Frances is highly critical of the "inexplicable secrecy and the lack of openness to outside influence and criticism" surrounding the DSM-V revision process."Restricting the free flow of ideas creates enormous blind spots that greatly increase the risk of damaging unintended consequences…. The advisory group is far too small and select to reduce, rather than encourage, heated debate. In producing a new edition of the DSM, your harshest critics eventually turn out to be your best friends because they are most likely to help you avoid pitfalls."
He is urging the American Psychiatric Association to create an external committee to review what is going on with the DSM and make recommendations to avoid serious negative consequences in the future.
Frances' important article, A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences, is available HERE.
An accompanying Q&A, DSM-V Badly Off Track, is HERE.
Some of my related blog posts are HERE.
DSM-V: Urgent warning and call to action
Essential reading on sex offender civil commitment
Failure to Protect: America's Sexual Predator Laws and the Rise of the Preventive State
by Eric S. Janus, William Mitchell College of Law
I just got around to reading this insightful book, and I wanted to recommend it to all of my blog readers. Law professor Eric Janus cogently explains why sexual predator legislation, despite its allure of zero tolerance for sexual violence, makes for very bad public policy.
Predator laws will never work, he argues, because they target only a tiny fraction of sexual violence. An empty "cleansing ritual," they require no fundamental societal change. But they are far from harmless. They siphon vast sums of money away from other programs that could do more good for more people. And they reinforce a distorted notion of sexual assailants as mainly stranger rapists with abnormal psychological makeups.
On a potentially more dangerous level, they provide a template for the resurrection of preventive laws on a massive scale. Janus reminds us of the historical struggle that went into dismantling earlier preventive detention laws that locked up outsiders for what they might (or might not) do. These included slave laws, the internment of Japanese-Americans during World War II, and eugenic programs to forcibly sterilize and incapacitate "mental defectives." Sexual predator civil commitment laws are especially dangerous because we can all unite around hating the archetypal sexual bogeyman, and the "science" of risk prediction has a scientific and naturalized veneer that makes preventive detention seem more palatable.
One of Janus' most interesting arguments is that -- perhaps accidentally-- the sexual predator laws have become a powerful force for the politically conservative agenda of dismantling hard-fought feminist rape reforms. The "tabloid model of gender violence" epitomized in these laws favors biological and psychological explanations over sociocultural ones, and supports the patriarchal rape myth that rapists "lack control" over their sexual impulses.
My review continues HERE. (As always, I appreciate "Yes" votes at Amazon, as they help with my ratings and the placement of my book reviews.)
Excerpts from the book are online HERE.
Saturday, May 30, 2009
Can 'gatekeeper effect' bolster weak opinions?
The much ballyhooed Daubert decision of 1993 was intended to minimize the effect of so-called "junk science" in the courtroom. ("Junk science," by the way, was a term popularized by the book Galileo's Revenge, part of an orchestrated corporate attack on class action litigation, but that's a story for another day.) But Daubert may be having a paradoxical effect instead, of lending greater credibility to expert witness opinions.
That is the premise of the lead article in Psychology, Public Policy and Law, by Nick Schweitzer and Michael J. Saks of the Law and Social Psychology Research Group at Arizona State University.
The "gatekeeper effect" is the label being given to this phenomenon, of jurors giving extra weight to scientific evidence just because it has been vetted by judges.
Remember that formal rules of evidence are aimed at excluding improper evidence from jurors' consideration. And under the U.S. Supreme Court's ruling in Daubert, judges have become more and more responsible for filtering evidence prior to its admission.
Two experiments tested whether mock jurors (as usual, university undergrads rather than real-life jurors or eligible jurors) were more persuaded by evidence when they thought a judge had filtered it. The findings: A key predictor of how much stock the jurors put in scientific evidence was whether they thought a judge had deemed it acceptable.
Why is this potentially problematic? Judges, as many of us know, are not always well prepared to serve as filterers of scientific evidence. Some of them do not do it well. Also, in many jurisdictions, Daubert is not the law, so jurors may be assuming incorrectly that the evidence they hear has passed through a filtering system.
Concludes the article, "When judges allow expert testimony to reach the jury, they are implicitly lending credence to the testimony, increasing its persuasiveness. This tips the scales toward the party offering the expert witness, perhaps affecting the jury's verdict. Ironically, a landmark Supreme Court decision motivated in large part by a desire to shield jurors from 'junk science' could serve to heighten the impact of false or misleading scientific evidence when judges allow it through the courtroom gates."
I find it a bit troubling that jurors may be persuaded by expert testimony that is false, misleading, or scientifically weak, based on incorrect assumptions about the process. I don't, however, find it too terribly surprising.
The article, "The gatekeeper effect: The impact of judges' admissibility decisions on the persuasiveness of expert testimony," is available upon request from lead author N.J. Schweitzer.
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