Sunday, April 29, 2012

Obama Budget: Grow Prisons and Keep Gitmo | Mother Jones

Obama Budget: Grow Prisons and Keep Gitmo | Mother Jones


Obama Budget: Grow Prisons and Keep Gitmo

As broke states try to shed nonviolent inmates, the federal detention machine looks to expand.

| Wed Feb. 22, 2012 4:00 AM PST
Prison
President Obama's budget request for fiscal year 2013 includes cuts to everything from Medicare and Medicaid to defense and even homeland security. But federal prisons are among its "biggest winners," according to an analysis by the Federal Times. The Bureau of Prisons (BOP) is seeking a 4.2 percent increase, one of the largest of any federal agency, which would bring its total budget to more than $6.9 billion.
So what kind of criminals are we spending all this money to incarcerate? If you're thinking terrorists and kidnappers, think again. According to the Sentencing Project, only 1 in 10 federal prisoners is locked up for a violent offense of any kind. More than half are drug offenders—hardly surprising, since federal prosecutions for drug offenses more than doubled between 1984 and 2005. The 1980s also produced mandatory minimum sentences, which meant we were not only sending more people to prison, we were keeping them there far longer—a perfect formula for an exploding prison population.
"Increasing funding for more prison beds has been shown to be a self-fulfilling prophecy," notes the Justice Policy Institute. "If you build it, they will come."
Indeed, the federal prison population ballooned from fewer than 25,000 inmates in 1980 to 210,000 in 2010—an eightfold increase—while the federal prison budget grew by a whopping 1,700 percent. Nowadays, as state prison populations have begun to fall for the first time in decades—the product of a steady decline in violent-crime rates, lawsuits over prison conditions, and deficits that have forced state officials to rethink their incarceration policies—the number of federal inmates continues to grow by about 3 percent a year. The projected 2013 federal prison population is 229,268 inmates—6,500 or more than in 2012. "Increasing funding for more prison beds has been shown to be a self-fulfilling prophecy," notes the Justice Policy Institute. "If you build it, they will come."
According to Obama's new budget, new federal prisons opening in Mississippi and West Virginia will house some 2,500 of those additional prisoners. Another 1,000 will be placed in private prisons—which now hold 18 percent of federal prisoners, far more than most state systems. The remainder of the new inmates will presumably be jammed into the existing federal prison facilities, which are already operating at 142 percent of capacity.
Factored into the budget request is $44 million in savings from an expansion of programs that let prisoners shave time off their sentences by behaving well and participating in educational and vocational programs, plus a compassionate release program for seriously ill inmates who have served most of their time—a smart move for the BOP, since it would shift its costliest medical cases onto Medicaid. But there's no guarantee that these "program offsets" will pass, especially given that Congress nixed similar proposals last year.
Conspicuously absent from the Obama budget is an item the administration requested for 2011 and 2012: money to purchase and retrofit a disused Illinois prison to serve as Gitmo North, a home for detainees now held at Guantanamo Bay. Since late 2009, Obama has floated plans to buy Thomson state prison and convert it into a second supermax for Gitmo residents who were tried and convicted on American soil. But Congress has yet to come through with the cash, and it seems, at least in this budget, that the White House has thrown in the towel.
If the federal government acquires Thomson, it will not be for the purpose of replacing Guantanamo, but "to meet critical federal prison capacity needs," a Department of Justice spokesperson told TPM. In other words, we could end up with Gitmo on top of a new federal supermax like the one in Florence, Colorado—the closest thing to a torture chamber that exists in America today.The Sentencing ProjectChart courtesy of the Sentencing Project

Is this a trial or a pulpit? | The Chronicle Herald

Is this a trial or a pulpit? | The Chronicle Herald

Is this a trial or a pulpit?

April 29, 2012 - 4:05am By VANESSA GERA The Associated Press WARSAW, Poland

Norway trial: Muslims question focus on Breivik's sanity - World - NZ Herald News

Norway trial: Muslims question focus on Breivik's sanity - World - NZ Herald News

World

Norway trial: Muslims question focus on Breivik's sanity

12:29 PM Sunday Apr 29, 2012
Accused Norwegian Anders Behring Breivik. Photo / AP
Expand

Accused Norwegian Anders Behring Breivik. Photo / AP

Muslim leaders in Norway say they are concerned that the anti-Islamic ideology of Anders Behring Breivik, the far-right fanatic now on trial for killing 77 people, is being overshadowed by questions about his mental state.
The self-described anti-Muslim militant shocked Norway on July 22 with a bombing and shooting rampage targeting the government headquarters and the Labor Party's annual youth camp. Since he has admitted to the attacks, the key issue for the trial is to determine whether Breivik is sane enough to be held criminally responsible.
"I'm not a psychiatrist, but what is important is what he has done. That should be the focus, not how crazy he is," said Mehtab Afsar, head of the Islamic Council in Norway, an umbrella organisation of Muslim groups in the country.
"He wants to get rid of Muslims and Islam from Europe. That is his main message. So I don't see the point of using so much energy on is he normal, is he insane?" Afsar told The Associated Press.
Breivik has told the court his victims had betrayed Norway by opening the country to immigration.
He called for a "patriotic" revolution aimed at deporting Muslims from Europe.
In a 1,500-page manifesto he posted online before the attacks, Breivik frequently cited anti-Islamic bloggers who say Muslims are gradually colonising Europe. But so far, much of the trial has focused on his mental health, rather than his ideology.
Some Muslims question the validity of pathologising Breivik, saying the Norwegian is easily comparable to Islamic terrorists.
"Nobody questioned Osama bin Laden's sanity," said Usman Rana, a doctor and newspaper columnist, following Friday prayers at one of Oslo's largest mosques, the Sufi-inspired World Islamic Mission.
The mosque, richly decorated inside and out with blue and white tiles and Arabic calligraphy, is open to passers-by, and a reporter was allowed free access as long as shoes were removed.
A few hundred men and boys of all ages attended prayers, many arriving in a rush to make it in time for the call to prayer. Switching easily between greeting friends in Urdu and in Oslo-dialect Norwegian, Rana questioned the excessive focus on Breivik's mental state.
"I believe he is sane, definitely. Those who think he is insane don't know anything about terrorism," Rana said.
The first of two psychiatric reports concluded that Breivik is psychotic and suffering from paranoid schizophrenia, the second report deemed him sane enough to go to prison for his crimes, which he has admitted.
The 33-year-old Norwegian has admitted all his actions and freely explained to prosecutors the planning and execution of his terror attack, only refusing to explain anything concerning other members of Knights Templar, his alleged anti-Islamic militant network. Prosecutors believe the network does not exist.
Breivik's emotionless appearance in court as witnesses give gruesome testimony and bereaved families sob audibly has left many baffled at his state of mind, wondering if he is exercising superhuman self-control or simply feels no emotions.
"The reason we are focusing on him as a crazy person is because we have difficulties accepting that 'one of us' could do such a thing. In many ways a natural reaction, but still wrong," said Shoaib Sultan, an adviser on extremism at the Norwegian Center against Racism.
Norway is becoming increasingly diverse. According to official statistics, 13 per cent of the 5 million population are either born abroad or children of immigrants. Most of them have European backgrounds, but large groups have also come from Asia and Africa. The government does not register people by faith, but just over 100,000 people, or 2 per cent of the population, are members of Islamic communities in Norway.
A report by the government-run Central Statistics Bureau showed attitudes toward immigrants became more positive following the July 22 attacks. Those disagreeing with the statement that "immigrants are a source of insecurity in society" jumped from 48 per cent to 70 per cent, the agency said.
But just after the bombing, before the perpetrator was known, many Muslims say they were harassed by Norwegians who thought Islamist terrorists were behind the attack.
When it became clear that an ethnic Norwegian was to blame, questions were raised about whether the threat of right-wing extremist violence had been underestimated.
"There's nothing new in the hatred of Behring Breivik, except for his gruesome actions," Sultan said.
-AP

World Psychiatry Journal - World Psychiatric Association - Volume 11, Number 1 - February 2012

World Psychiatric Association / English

- Volume 11, Number 1 - February 2012

EDITORIAL
Bereavement-related depression in the DSM-5 1
and ICD-11
M. MAJ

SPECIAL ARTICLES
Validity of the bereavement exclusion to major 3
depression: does the empirical evidence support
the proposal to eliminate the exclusion in DSM-5?
J.C. WAKEFIELD, M.B. FIRST
An attachment perspective on psychopathology 11
M. MIKULINCER, P.R. SHAVER


FORUM: ADVANTAGES AND DISADVANTAGES
OF A PROTOTYPE-MATCHING APPROACH
TO PSYCHIATRIC DIAGNOSIS


Prototype diagnosis of psychiatric syndromes 16
D. WESTEN
Commentaries
Prototypes, syndromes and dimensions of 22
psychopathology: an open agenda for research
A. JABLENSKY
Toward a clinically useful and empirically based 23
dimensional model of psychopathology
R.F. KRUEGER, K.E. MARKON
A practical prototypic system for psychiatric 24
diagnosis: the ICD-11 Clinical Descriptions
and Diagnostic Guidelines
M.B. FIRST
Prototypal diagnosis: will this relic from the past 26
become the wave of the future?
A. FRANCES
Are you as smart as a 4th grader? Why the 27
prototype-similarity approach to diagnosis is a
step backward for a scientific psychiatry
J.C. WAKEFIELD
Nosological changes in psychiatry: hubris 28
and humility
O. GUREJE
Prototype diagnosis of psychiatric syndromes 30
and the ICD-11
J.L. AYUSO-MATEOS
Prototype matching together with operational 31
criteria would make a better approach
to psychiatric classification
P. UDOMRATN
RESEARCH REPORTS
Generalizability of the Individual Placement and 32
Support (IPS) model of supported employment
outside the US
G.R. BOND, R.E. DRAKE, D.R. BECKER
Age at onset versus family history and clinical 40
outcomes in 1,665 international bipolar-I disorder
patients
R.J. BALDESSARINI, L. TONDO, G.H. VÁZQUEZ,
J. UNDURRAGA, L. BOLZANI ET AL
MENTAL HEALTH POLICY PAPERS
Lessons learned in developing community mental 47
health care in North America
R.E. DRAKE, E. LATIMER
Mental health services in the Arab world 52
A. OKASHA, E. KARAM, T. OKASHA
PERSPECTIVES
The crisis of psychiatry – insights and prospects 55
from evolutionary theory
M. BRÜNE, J. BELSKY, H. FABREGA, J.R. FEIERMAN,
P. GILBERT ET AL
Neurophysiology of a possible fundamental 58
deficit in schizophrenia
J.M. FORD, V.B. PEREZ, D.H. MATHALON
CORRESPONDENCE 61
WPA NEWS
Papers and documents available on the WPA 63
website
The new WPA leadership

Psychiatric diagnosis: pros and cons of prototypes - World Psychiatric Association

World Psychiatric Association / English

Psychiatric diagnosis: pros and cons of prototypes
vs. operational criteria


EDITORIAL

Mario Maj
President, World Psychiatric Association

The development of operational diagnostic criteria for
mental disorders in the 1970s was a response to serious concerns
about the reliability of psychiatric diagnosis. Initially
intended only for research purposes, the operational approach
was subsequently proposed also for ordinary clinical
practice by the DSM-III. That this approach increases the
reliability of psychiatric diagnosis in research settings is now
well documented. Much less clear, even in the US, is whether
the approach is commonly used by clinicians in ordinary
practice, thus really resulting in an increase of the reliability
of psychiatric diagnosis in clinical settings. It has been, for
instance, reported that several US clinicians have difficulties
to recall the DSM-IV criteria for major depressive disorder
and rarely use them in their practice (e.g., 2). Furthermore,
some of the DSM-IV cut-offs and time frames have been
found not to have a solid empirical basis (e.g., 3) and to
generate a high proportion of sub-threshold and “not otherwise
specified” cases (e.g., 4).
More in general, it has been maintained that a “prototype
matching” approach is more congruent with human (and
clinical) cognitive processes than a “defining features” approach
(e.g., 5). The spontaneous clinical process does not
involve checking in a given patient whether each of a series
of symptoms is present or not, and basing the diagnosis on
the number of symptoms which are present. It rather involves
checking whether the characteristics of the patient
match one of the templates of mental disorders that the clinician
has built up in his/her mind through his/her training
and clinical experience.
Moreover, some recent research focusing on various
classes of mental disorders (i.e., personality disorders, eating
disorders, anxiety disorders) suggests that a diagnostic system
based on refined prototypes may be as reliable as one
based on operational criteria, while being more user friendly
and having greater clinical utility (e.g., 6).

World Psychiatric Association / The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification

World Psychiatric Association / The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification

June 2011
The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification
This article describes the results of the WPA-WHO Global Survey of 4,887 psychiatrists in 44 countries regarding their use of diagnostic classification systems in clinical practice, and the desirable characteristics of a classification of mental disorders. The WHO will use these results to improve the clinical utility of the ICD classification of mental disorders through the current ICD-10 revision process.

>> Please click here to read the full report


Over two-thirds of global psychiatrists indicated that they
prefer a system of flexible guidance that would allow for
cultural variation and clinical judgment as opposed to a system
of strict criteria, and this was true of global users of both
the ICD-10 and the DSM-IV. Opinions were divided about
how best to incorporate concepts of severity and functional
status, suggesting that these areas would be an important
focus of further testing, while most respondents were receptive
to a system that incorporated a dimensional component
in the description of mental disorders. In spite of the recent
controversies about the medicalization of normal suffering
(17), most global psychiatrists felt that a diagnosis of depression
should be assigned even in the presence of potentially
explanatory life events.
Although the large majority of psychiatrists worldwide
appeared to endorse the possibility of a global, cross-culturally
applicable classification system of mental disorders, results
of this survey point to several areas of caution.

Foundations of Forensic Mental Health Assessment - JAAPL

Foundations of Forensic Mental Health Assessment

Foundations of Forensic Mental Health Assessment (FMHA) is the first in a series of 20 short and user-friendly books devoted to situations involving criminal, civil, juvenile, and family law that are encountered by forensic mental health clinicians and mental health law professionals. The series is authored by three respected forensic psychologists, who begin this introductory text by summarizing scientific and ethics-based developments in forensic mental health during the past quarter-century. The authors' stated goal is to identify an aspirational best practice paradigm for FMHA that satisfies scientific advancement, ethics and professional standards, and legal relevance. Despite this goal, they repeatedly acknowledge that the aspirational standard may not always be attainable.              

Mental Illness, Criminality, and Citizenship Revisited - JAAPL

Mental Illness, Criminality, and Citizenship Revisited

A central hypothesis of this study was that persons who have experienced such significant life disruptions would have both common and different experiences of citizenship according to the nature of the disruption and that there would be both common and different experiences of citizenship across disrupted groups. By testing this hypothesis, the research team proposed to identify common elements of citizenship and the community integration and inclusion associated with it. The team would also be able to identify areas of citizenship support for persons with mental illness in general, especially those with the dual burden of criminal charges.
Over the course of this citizenship research, some colleagues have criticized the use of citizenship as an applied theoretical framework on the grounds that citizenship is too narrowly associated, in practice, with the political and legal elements of being a citizen.11 The research team believed that a more multifaceted view of citizenship would emerge from this study, including those facets related to civic participation.12

Money Motivates Mental Health Moves: DSM-5, Meet Makers of Medicine | candidaabrahamson

Money Motivates Mental Health Moves: DSM-5, Meet Makers of Medicine | candidaabrahamson

Money Motivates Mental Health Moves: DSM-5, Meet Makers of Medicine

In the interest of full disclosure, let me be perfectly clear.
As a therapist, I use the DSM (Diagnostic and Statistical Manual of Mental Disorders), the ‘mental health bible’ that helps diagnose and define treatment, frequently. I find it pivotal in making diagnoses, and then in providing a shared language to discuss those diagnoses with consulting psychiatrists, with other treaters, with educators. I share it with clients to assist them in understanding their illnesses and potential treatments, and it’s a useful tool to help third-party payers understand the needs of the patients.
Really, overall I’m a fan, and I rely upon it.
Which is probably why I find myself so frustrated with the current process of updating the (ready for this one?) DSM-IV-TR (don’t ask) to the DSM-5.
Perhaps I’m an innocent (highly unlikely), but I had counted on the American Psychiatric Association (APA), the group responsible for the updating of the DSM (soon this will be an alphabet soup), to keep the process relatively untainted.
I had counted wrong.


Again in the interest of full disclosure, I had already found myself frustrated with several of the committee on the DSM-5‘s decisions. In an act of tremendous restraint, I won’t go over again my opposition to doing away with the bereavement exclusion [but won't deprive you of a hyperlink to my mini-rant], nor will I carry on again about the potential inclusion of Hypersexuality and Internet Addiction [ok--link here if you can't keep yourself away]. But the APA’s process of updating ‘the mental health bible’ crawled under my skin once again–not for its lack of full disclosure, really, as much as its seeming indifference to what the disclosure indicated.
Just for some background: There are 141 panel members on the 13 DSM-5 panels and 29 task force members. The members of these 13 panels are the ones in charge of revisions to diagnostic categories and inclusion of new disorders.
So far, so good.
Until you look a bit further, and realize the DSM-5 process has enough ties to big money (pharmaceutical money, of course), to make good old Bernie Madoff, who, it turns out, had very few ties to actual money, squirm with jealousy.
In “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists,” Lisa Cosgrove, PhD, from the Edmond J. Safra Center for Ethics at Harvard University, and Sheldon Krimsky, PhD, from the Department of Public Health and Community Medicine at Tufts University, write the following astonishing facts about the DSM’s financial connections to big pharm:
Three-fourths of the work groups continue to have a majority of their members with financial ties to the pharmaceutical industry. It is also noteworthy that, as with the DSM-IV, the most conflicted panels are those for which pharmacological treatment is the first-line intervention. For example, 67% . . . of the panel for Mood Disorders, 83% . . . of the panel for Psychotic Disorders, and 100% . . .[Note to reader: this 100% is a personal favorite of mine. How can you beat it?] of the Sleep/Wake Disorders (which now includes “Restless Leg Syndrome”) have ties to the pharmaceutical companies that manufacture the medications used to treat these disorders or to companies that service the pharmaceutical industry.


So if I’ve got this right [and I have a good sense that I do; it isn't as difficult as the proverbial rocket science], and if I return for the moment to the DSM-5′s exclusion of the bereavement clause, which means, just to sum up, that after two weeks of grief symptoms (which, it is already known and accepted, overlap with depressive symptoms), a bereaved person can be diagnosed with depression, I could be looking at something like this, if I were take the most Machiavellian view. Depression, as opposed to grief, can be treated with and has found to be responsive to psychotropic medications. Thus turning grief into a depression yields more prescriptions, which could potentially benefit any of that high percentage of doctors sitting on the committee with connections to the companies that make these meds.
I don’t really think that the 67% of the Mood Disorders committee members insisted on turning grief into a mood disorder with the thought that they would profit financially, hoping that the pharmaceutical companies they’re connected would step in to provide psychotropics to the bereaved. Not for a moment. But it might be difficult for those committee members to completely keep that idea out of their heads. That’s why conflicts of interests are problems.
Krimsky himself clarified that his article was not meant to be a ‘witch hunt.’ He said, “I don’t believe that anyone on the panel is purposefully making decisions that favor industry. The issue is more subtle and just as impactful. We all have the potential for bias in a conflicted situation, and we’re all really defended against looking at those biases, and therein lies the danger.”
I enjoyed some of the APA’s responses to the Krimsky-Cosgrove article. Take David Elkins, president of the American Psychological Association’s Society for Humanistic Psychology (a society I, myself, had never heard of until the other day, but one with a title that piques my interest. And–who knew?–it’s division #32 of the American Psychological Association. I think my time could be well spent finding what the first 31 divisions are.).
When asked what he had to say in response to the fact that seven in 10 DSM-5 task force members have drug company ties, Elkins was eloquent.
He was, not to put too fine a point on it, “dismayed.”
I love a man of few words.
But it gets better. The APA medical director and CEO is one Dr. James Scully. And he says–and I don’t want people to miss this:
We wanted to include a wide variety of scientists and researchers with a range of expertise and viewpoints in the DSM-5 process. Excluding everyone with direct or indirect funding from the industry would unreasonably limit the participation of leading mental health experts in the DSM-5 development process.
Ok, I admit it. Those are my own italics. I can’t help it; it’s priceless.
So, according to Scully, it’s worse than we even thought. Looking for a mental health expert? Just know she’s connected to the pharmaceutical companies. So much so, that if you keep anyone connected to the drug makers out of a given process, you’ve lost your expertise base.
Now I feel better about the whole thing.
And the truth is that this isn’t as much of a shock to me as it might have been. One incident proves little, but it made an impression on me, and, woven into the tapestry of the Scully argument, bolsters my concern about the infiltration of the drug companies into clinical practice.
The consulting psychiatrist and I met together with a patient to get all views on the table at once, and to present a cohesive treatment plan. We met in the psychiatrist’s office, where the doctor kindly proffered me a pen as I searched my purse for one I couldn’t find [of course, now that I didn't need them, I could locate my glasses, my bottle of baby aspirin, and the receipt for the panty hose I'd been meaning to return--but couldn't find the receipt].
This was no plain pen–it was a Paxil pen–with the medicine’s name and logo written large upon it. The pad of paper he provided was dominated by Effexor’s name–and, I kid you not, he had a Seroquel mug. My patient and I sanitized our hands from a plastic bottle emblazoned with ‘Pristiq,’ and I actually watched time pass on a cheap plastic clock with Abilify’s name plastered across the face.
I stayed put, for I was certain, had I gone to the restroom, I would have been met with toilet paper carrying Zyprexa’s name, and that, really, was the limit.



And here’s the thing: This office isn’t unusual in its collection of tchotchkes advertising psychotropics or other meds. It’s all over.
In the interest of full disclosure, let me clarify: I thought this was an excellent psychiatrist. Probably he’s sitting on the Mood Disorders committee of the DSM-5, offering his expert opinion, and writing down notes on his Zoloft clipboard.
Because if you cut him out of the DSM-5 process just because he’s connected to the pharmaceutical companies–really, who do you have left?
You know what? In the interest of full disclosure I tell you: I’ve never heard of the APA’s society for humanistic psychology, but I’m right there with its president. When it comes to how the DSM-5 is being compiled, I too am–in a word–”dismayed.”
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13 Responses to Money Motivates Mental Health Moves: DSM-5, Meet Makers of Medicine

  1. Pingback: Money Motivates Mental Health Moves: DSM-5, Meet Makers of …
  2. Dismayed, indeed. What an alarming post. The big question is, what can we do?
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  3. psachno says:
    Your posts are so educational! Thanks for all this info–AND for your references.
    Can I sign a petition if I am unlicensed? (Probably not, hey?)
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  4. Paul says:
    Very good, informative article. I don’t think the bereavement exemption issue is as one-sided as you present it, however. By removing that exemption, it doesn’t cause all mourners to gain the diagnosis of depression. What it does is *allow* the diagnosis of depression. While it would be silly to say that everyone who suffers from the symptoms of depression for several weeks after a loved one has died is clinically depressed, it would be equally silly to say that it is impossible for someone who had a loved one die to become depressed. Removing the exemption allows help-seeking individuals who are indeed suffering from a depressive episode triggered by the death of a loved one to get help. Right now, that group of people don’t qualify for the diagnosis, and therefore might not be able to get insurance reimbursement for help.
    I had the worse deppresive episode of my life for about 6 months after my cat died. Luckily for me, my diagnosis is type-II bipolar which doesn’t have a (pet) bereavement exclusion clause, b/c I was suffering terribly and I was able to recover with the combination of medicine and therapy. I’m not saying that there aren’t potential negative consequences of removing the bereavement exemption, but I really don’t think you should lump it in with the negative consequences of undue involvement by the industry in the revision process.
    If nothing else, removing the exemption, along with some other things like changing from a more categorical to dimensional approach, represents a change in the dsm-III/iv philosophy of mental disorders being discrete disease entities with an implied fully biological etiology. I’m not saying this will hamper the industry or slow down the monetezation of mental illness, but it is an interesting trend worth watching.