Saturday, May 5, 2012

Prison Psychiatry News

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  • prison mental health - Google News
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via prison gangs - Google News on 5/5/12

Gang member gets 40 years for summer stabbing
Chicago Tribune
A Greeley gang member will spend much of his adulthood in prison, after essentially being raised in the gang culture, which led to his involvement in a brutal stabbing last summer. Weld District Court Judge Thomas Quammen on Friday sentenced Alexander ...

via prison gangs - Google News on 5/5/12

Last 18th Street Gang member takes deal in organized crime case
Chicago Tribune
12, 1994 and March 17, 2011, the suspects participated in the enterprise, whose purpose was "financial gain through illegal activities; to establish and maintain respect, power, control and influence over the entire gang subculture in prison and in the ...

and more »

via prison gangs - Google News on 5/5/12

Gang conviction merits 123 months
Daily Commercial
A 27-year-old Zellwood man, arrested last year as part of an investigation into two neighborhood-based street gangs in Lake and Orange counties, has been sentenced to 123 months in federal prison. Brandon Denard Smith pleaded guilty in February to ...

via prison mental health - Google News on 5/5/12

Sportsnet.ca
10-plus years prison term for ex-OSU QB
Chillicothe Gazette
Watson postponed his sentencing and gave Schlichter more time to have his mental health assessed. Schlichter had asked for prison drug abuse counseling after he was sentenced. In April, Schlichter signed paperwork allowing his brain and spinal cord to ...
Ex-NFL, Ohio St. QB faces 10-plus years for ticket schemeUSA TODAY

all 185 news articles »

via Prison News on 5/5/12
They are among 1,500 to 2,500 Palestinian prisoners who started refusing food 19 days ago, demanding a halt to imprisonment without charges, an end to solitary confinement and reinstating family visits from Gaza.

via prison mental health - Google Blog Search by Break the Chains on 5/4/12
The resulting report, released last October, concluded that far too many prisoners were on round-the-clock lockdown. Relatively modest changes in classification, review, and mental-health policies, it said, would "significantly ...

via prison mental health - Google Blog Search by By Julie Small on 5/4/12
“Half the prison population is either going to be needing a high level of medical care because they have serious long-term conditions or they're going to have serious mental health conditions,” said Kelso. California's efforts to ...

via prison mental health - Google Blog Search by admin on 5/4/12
Prison Planet.com. May 4, 2012. Police and court records reveal that three of the five suspects entrapped and arrested by the FBI in a supposed plot to blow up a bridge in Ohio suffer from mental health problems, according to a report posted ...

via prison mental health - Google Blog Search by Political prisoners of thailand on 5/4/12
Somyos' wife, who visits him once a week in prison, said the 50-year-old journalist seems to have been treated acceptably in prison, but his mental health is deteriorating. In his testimony, Somyos argued that the two February ...

via candidaabrahamson by candidaabrahamson on 5/5/12
My friend Evelyn has potential to be a terminally tedious grandparent. She talks about her grandkids as if we–meaning the world–are merely fortunate that these children have chosen to grace us with their presence. I try to act appropriately grateful. I have heard about merit scholarships, acceptances to magnet schools, stellar performances on the recorder [...]

via prison gangs - Google News on 5/5/12

The Star
Jail for ringleader and his Sheffield drug gang
The Star
A DRUGS gang leader who controlled a 'drugs empire' with a 'mixture of fear and bluster' has been locked up for 23 years. James Flinders, aged 48, led an operation across South Yorkshire and North Nottinghamshire but was snared by police as members ...

and more »

via prisons - Google News on 5/5/12

Daily Mail
Goudhurst Timpson academy for prisoners opened by Kenneth Clarke
Kent News
PRISONERS at a new employment training academy in Kent have called the scheme “life changing”. Secretary of State for Justice Kenneth Clarke and Prisons Minister Crispin Blunt attended the official opening of the new Timpson Academy on Monday.
Government to urge retailers to employ prisonersThe Guardian
Prisoners can be honest and motivated workers, Ken Clarke tells business as he ...Daily Mail
Businesses 'should help prisoners get work'BBC News
Telegraph.co.uk -The Independent -The Press Association
all 227 news articles »

via prisons - Google News on 5/5/12

Alton Daily News
Panel right to advise against closing prisons
Morris Daily Herald
The commission said the women's prison in Dwight and the maximum prison in Tamms should stay open, along with a developmental center in Jacksonville, mental health centers in Tinley Park and Rockford and a youth detention facility in Murphysboro.
Panel: Don't close prisons, other facilitiesDubuque Telegraph Herald
Legislative panel: Don't close prisons, mental facilities in IllinoisRockford Register Star
Ill. panel: Don't close prisons, mental facilitiesBloomington Pantagraph
Carmi Times -WBEZ
all 33 news articles »

via Faktensucher by curi56 on 5/5/12
Canada: The Ktunaxa – Living the Language – Al Jazeera English.
http://aje.me/Ij1Hio Video
Can the internet save a language? For the Ktunaxa nation, an indigenous people inhabiting parts of north-western America, the answer may just be ‘yes’.
The Ktunaxa language is related to no other on earth and only a handful of people speak it fluently. Most of them are members of the oldest generation, something that has spurred a race against time for a community that must record and preserve as much of the language spoken today as possible. In a few years, it might already be too late.

via Faktensucher by curi56 on 5/5/12

Information about Tony Medina.

via Prison News on 5/5/12
Gay couples are one step closer to having civil unions in Colorado after another Republican-led House committee approved legislation that appears to have enough support to get to the governor's desk.

via prison gangs - Google News on 5/4/12

Yorkshire Post
Prison vow over sham marriages as Yorkshire gang sentenced
Yorkshire Post
A WARNING has been issued to criminals planning sham marriages in Yorkshire after a gang was jailed yesterday, including a man who had kept a crib sheet on his bride to be. Pakistani Tahir Naqqash was due to marry Slovak mother-of-four Zlatica Balogova ...

and more »

via prison gangs - Google News on 5/4/12

Gang member to spend up to three years in juvenile detention
Yakima Herald-Republic
A Yakima gang member known as "Little Maniac" will serve up to three years for shooting a grandmother and her grandson, and for a separate shooting incident involving a 6-year-old girl. The 54-year-old woman and her grandson were walking home from a ...

and more »

via prison gangs - Google News on 5/4/12

Study of prison chaplains sheds light on faith behind bars
San Antonio Express
The study said state prisons hold the bulk of the country's convicts (1.4 million), but little has been released to the public on religion in these institutions. Chaplains in state prisons fulfill a range of functions. Nearly all said they lead worship ...

via prison gangs - Google News on 5/4/12

NewsNet5.com
16 arrested in Lorain gang sweep
Chronicle-Telegram
In order to charge the suspects with participating in a gang, the police and prosecutors must prove that the men have extensive criminal backgrounds and have ties to a gang. Each suspect faces two to eight years in prison for that charge, ...
More arrests expected in Lorain gang sweepThe Morning Journal
Lorain: Violent criminal sweep nets 19 in murders of nineWKYC-TV

all 14 news articles »
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Study of prison chaplains sheds light on faith behind bars - San Antonio Express-News

Study of prison chaplains sheds light on faith behind bars - San Antonio Express-News

Study of prison chaplains sheds light on faith behind bars

Kansas City Star
Updated 11:55 p.m., Friday, May 4, 2012


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Movies and television portray hardened criminals cursing God and everyone else.
In reality, many inmates worship God and practice their faith behind bars.
A recent 50-state survey of chaplains by the Pew Research Center's Forum on Religion & Public Life offered a rare look at the worshipers behind bars.
The study said state prisons hold the bulk of the country's convicts (1.4 million), but little has been released to the public on religion in these institutions.
Here are some of the major findings:
Chaplains in state prisons fulfill a range of functions.
Nearly all said they lead worship services, perform religious instruction, do spiritual counseling and organize religious programs. Fifty-seven percent considered the first three their most important functions, but only a third said this is where they spend most of their time.
The chaplains are overwhelmingly Christian (mainly Protestant), male and middle-aged. They also are well-educated, with 62 percent having advanced degrees.
And most like their jobs. Two-thirds said they were very satisfied, and only 6 percent were very or somewhat dissatisfied.
If there seems to be one essential, but challenging, aspect of most prison religion programs, it is in the area of rehabilitating inmates and preparing them for re-entry into society.
More than seven in 10 chaplains considered access to high-quality religion-related prison programs — and support from religious groups after inmates are released — to be “absolutely critical” to successful rehabilitation.
Of chaplains who work in prisons that have rehabilitation or re-entry programs, 57 percent said their quality has improved in the past three years, and 61 percent said participation has increased.
The study gives considerable attention to the topic of religious extremism in prisons.
The researchers explained: “Since the 9/11 terrorism attacks, religious extremism has been a topic of high public interest in the United States. Some experts specifically have raised concerns that prisons could be a breeding ground for home-grown terrorists and have suggested that prison chaplains and other prison administrators need to monitor religious activity more closely.”
Estimates of how common extreme religious views are tend to vary with the security level of the facility and the chaplain's background.
Protestant chaplains were more likely than Catholic or Muslim chaplains to say that religious extremism is either very or somewhat common, and the view was stronger among white evangelical Protestant chaplains than white mainline Protestants.
Nevertheless, 76 percent of chaplains said religious extremism rarely or almost never poses a security threat.
An open-ended question tried to assess what chaplains regarded as extreme. The answers were wide-ranging.
The most common reply was racism disguised as religious dogma, which included racial intolerance or prejudice. This went both ways, as both black and white inmates expressed racial superiority.
Other answers included hostility toward gays and lesbians, negative views of women and intolerance toward sex offenders.
An almost equal number of chaplains said extremism included religious intolerance, such as expressions of religious superiority and attempts to coerce others into their beliefs.
A majority of chaplains said that attempts by inmates to convert other inmates are either very common (31 percent) or somewhat common (43 percent).
It doesn't always work, but the chaplains either said a lot of inmates change religions (26 percent) or some change religion (51 percent). Among those who reported at least some switching, about half said the number of Muslims is growing, followed closely by Protestant Christians and pagan and Earth-based religions.
The chaplains estimated that two-thirds of the inmates in the prisons where they worked were Christians and 5 percent to 9 percent were Muslim, followed by other groups. They said most religious groups have remained relatively stable in size but there was shrinkage of 20 percent among Catholics and 17 percent among the unaffiliated.
However, the researchers cautioned, “Chaplains' perspectives on the religious makeup of inmates may reflect a number of different influences, including their degree of exposure to various groups in the course of their work.”
Requests for religious accommodations, such as religious books or texts and meetings with leaders from inmates' faith, are most always granted. About half of the requests for specific religious diets and religious items or clothing usually are granted but special hairstyles or grooming is mostly denied.
Some chaplains regarded some requests as bogus or extreme, such as seeking raw meat for a Voodoo ritual, said one chaplain. Others said some so-called religious groups were a cover for nonreligious activities, such as gangs that claim to be religious and promote violence.


Read more: http://www.mysanantonio.com/news/local_news/article/Study-of-prison-chaplains-sheds-light-on-faith-3535633.php#ixzz1u01ARX7X
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Hebephilia update: DSM-5 workgroup stubbornly clinging to pet diagnosis - by Karen Franklin, Ph.D. on 5/4/12 | Mike Nova's starred items

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via In the news by Karen Franklin PhD by Karen Franklin, Ph.D. on 5/4/12
Salvador Dali*: The Average Bureaucrat
A few weeks ago, I reported on an open letter to the American Psychiatric Association, calling for it to reject three controversial expansions of sexual paraphilia diagnoses that are being promoted by government evaluators in civil commitment cases.

A lot has happened since then. The only one of the three controversial diagnoses still in the running for official status has been altered for the umpteenth time. An esteemed journal is issuing a scathing critique. And the open letter is generating buzz in the blogosphere.

The open letter has garnered more than 100 signatures, many from prominent forensic psychologists and psychiatrists in the U.S. and internationally. If you intend to sign on but haven’t yet, act now because I understand it will be submitted very soon. (Click HERE to review the text; click HERE to email your name and professional title to co-author Richard Wollert.)

Hebephilia gets yet another makeover

This week, the Sexual Disorders Workgroup for the upcoming fifth edition of the APA's diagnostic manual toned down its proposal to turn sexual attraction to young teens into a mental disorder. As psychiatrist Allen Frances explains at his DSM5 in Distress blog, hebephilia is still there -- you just have to read the small print to see it:
Dali: Enchanted Beach with Three Fluid Graces





















Confronted by universal opposition from the rest of the field, the DSM 5 group has been forced progressively to whittle down their pet, but they so far have refused to just drop it altogether. 'Hebephilia' first lost its free-standing independence and was cloaked as Pedohebephilia. When this didn't fly, the term was dropped altogether in the title but the concept was slipped into the definition of Pedophilia -- which was expanded out of recognition by having a victim age cut-off of 14 years. No one accepted this outlandish suggestion and now finally the work group comes back with ‘early pubescent children' and tries to keep 'hebephilia' as a term in the subtype. The instability of the criteria sets associated with this concept is additional evidence that the fervor for its adoption stems from emotional loyalty rather than reasoned review of its weak conceptual and research base. How can the group vouch for the reliability of the diagnosis when the concept and criteria are changing every month? This is no way to develop a diagnostic system.
The staunch insistence on this transparent attempt to turn statutory rape into a mental disorder owes in large part to the makeup of the sexual disorders workgroup. As Frances notes, "the most wayward of all the DSM 5 work groups" is "lopsidedly dominated" by psychologists from a sex clinic up in Toronto, whose ambition is "to find a place in DSM 5 for their pet diagnosis."
Although the group's other outlandish proposals, Paraphilic Coercive Disorder and Hypersexuality, have been shelved for the time being, Frances worries that putting them in the appendix "for further study" is still risky:
Recognizing that the jig is up on the grand design, members of the DSM 5 sexual disorders work group have been heard saying they may have to settle for an Appendix placement for their three hothouse creations. This would create forensic dangers. We have learned from the abuse of "Paraphilia Not Otherwise Specified" in Sexually Violent Predator cases that any (even remote) legitimization by DSM 5 is certain to be misconstrued and misused in the courtroom.

Come on guys. This is absolutely absurd just on the face of it…. So back to the drawing board, DSM 5 sexual disorders work group. The grand dream is lost -- now at least make sure you don't mess up on the fine print.
On the professional listservs today, some conspiracy theorists were speculating that the new wording signifies a plot to enhance the standing of physiological testing in sex offender assessment. The latest proposed criteria for "pedophilia, hebephilic type" require "equal or greater sexual arousal from prepubescent or early pubescent children than from physically mature persons." How to determine that fuzzy standard? Enter the penile plethysmographer, a new niche career track, penis cuff at the ready to measure who is aroused by what.

"There is withering criticism already that the DSM is being expanded to sell more drugs," wrote one colleague. "Now it appears that psychiatry and psychology are conspiring to use the DSM to spur PPG tests -- tests which risk leaving patients with traumatic and indelible memory traces. Do most psychiatrists really want to open this door?!"

Orwellian thought police?

The mere idea of allowing the American Psychiatric Association to dictate "normal" sexuality frightens English Professor Christopher Lane. Lane, whose book Shyness: How Normal Behavior Became a Sickness exposed the unscientific inner workings of the DSM-III committee, expressed shock over the first listed criterion for the shelved disorder of hypersexuality: "Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior." On his Side Effects blog, Lane mused:
Dali: Femme a Tete de Roses
"Excessive time"? What exactly does that mean, and according to whose standards? That's not a small or trivial matter to settle when the APA is talking in vague generalities about the nation’s libido -- how much sex it wants and how much sex the APA thinks it should think about wanting. The APA is talking about how much time Americans can devote to sexual fantasy before it suggests that we’re mentally ill if our preoccupations are stronger than those set by the relevant task force.

Does that initiative seem to overreach a bit, even to the point of sounding almost Orwellian? It does so to me. If we're to have criteria, are quotas next, including for fantasy? It’s as if the East Coast offices of the APA had morphed into those of the Thought Police in Orwell's 1984, warning citizens that they’d overstepped their "sexual thought quota" for the week and must be rationed -- or punished accordingly.
Lane analyzed hebephilia through his characteristic historical lens:
It's an archaism, a throwback literally to 19th-century psychiatry, but refers to practices that were as central to the Classical age -- and thus to Western democracy -- as were Socrates, Plato, and especially Plato’s Symposium, one of the foundational books in the West on eros and love.

The APA is already trying to determine how long normal grief should last before it’s thought pathological. Its brisk, jaw-dropping answer: two weeks. Do we really want the same organization dictating how often we can think about sex? These kinds of proposals can only end badly.
Leading journal tackles the controversy

The good news this week, which should have all of us jumping up and down with joy, is that the APA has caved in under massive public pressure and dropped its plan for a new psychosis risk disorder. This disorder would have put thousands if not millions of youngsters at risk of being dosed up with dangerous antipsychotic drugs based on a suspicion that they might go crazy in the future. Mixed Anxiety Depression has also bit the dust.

Dali: Daddy Longlegs of the Evening Hope
But, as featured in a special issue of the esteemed Journal of Nervous and Mental Diseases due out in June on the raging diagnostic controversies, there are still many battles ahead as the bloated DSM-5 enters the final stretch. The special issue will tackle diagnostic inflation, pharmacological conflicts of interest, controversies with the newly revamped personality disorders, and problems with diagnostic reliability in the recent field trials. Hebephilia, often neglected amidst controversies with wider impact such as psychosis risk syndrome and the pathologization of normal grief, merited an article in this special issue.

In "Hebephilia and the Construction of a Fictitious Diagnosis," forensic psychologists Paul Good and the late Jules Burstein make a strong case for abandoning this faux disorder, which will only make the APA more of a laughingstock in the future.

Good and Burstein catalog an assortment of empirical problems. These range from the difficulty of reliably measuring "recurrent and intense" sexual arousal to problems determining the pubertal status of a young teenage victim. They also challenge the very idea that sexual attraction to pubescent minors is a mental illness, rather than merely illegal.

Although the Sexual Disorders Workgroup hides behind a fictive notion of a pure and ethereal "science," Good and Burstein clearly believe that hebephilia, if added to the DSM-5, will be mainly invoked in a partisan manner in forensic proceedings, in order to justify harsher punishment and involuntary civil detention. Because of its power to do harm, they say, its scientific grounding should be especially strong. If it does manage to worm its way into the DSM, they say, it should still be challenged in court:
We believe the admissibility of the proposed revision to DSM-5 that would include Hebephilia as a type of Pedophilia could be challenged in a court of law based on current legal standards. For example, since there is no professional consensus or general acceptance in the scientific community to support the notion of Hebephilia as a mental disorder, it would have difficulty passing the Frye test for admissibility. Similarly, without a widely established body of peer-reviewed, validation research and repeated studies showing inter-rater reliability in the laboratory and among clinicians in the field, Hebephilia would also have difficulty meeting the criteria specified in the Daubert standard.
Indeed, this is just what has been happening to hebephilia in federal court, where at least three civil detention petitions in a row have been thrown out due to the level of controversy in the field over this purported condition.

With all of this tumult, it seems that the DSM-5 excesses are producing a backlash against the American Psychiatric Association and, indeed, fueling disenchantment with the whole enterprise of psychiatric diagnosis.

As Frances writes, the turnaround on psychosis risk syndrome came about due to a combination of:
  • extensive criticism from experts in the field
  • public outrage
  • uniformly negative press coverage
  • abysmal results in DSM-5 field testing
For the first time in its history, DSM 5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM 5 retreats. Today's revisions should be just the first step in a systematic program of reform.… This is certainly no time for complacency. Much of the rest of DSM 5 is still a mess. The reliabilities achieved for many of the other disorders are apparently unbelievably low and the writing of the criteria sets is still unacceptably imprecise.
Who needs reliability?

Frances calls for slowing down the process to allow for additional field testing and, more importantly, an independent scientific review of all the remaining controversial DSM-5 changes. But the DSM-5 folks are taking a different tack. Faced with field trial results showing very poor reliability -- not much better than chance -- for many of their proposed diagnoses, they want to change the definition of what counts as minimally adequate.

Dali: Autumn Cannibalism
It’s pretty ironic: The DSM-III went down in history for elevating the importance of reliability at the expense of validity. Remember, diagnostic reliability just means that similarly trained raters see a certain symptom presentation and call it by the same label. It says nothing about external validity, or whether the label is meaningful in explaining a real-world phenomenon. But reliability is basic. If a diagnostic label cannot be reliably applied, you can't even start talking about its validity. And now, the same psychiatric organization that reified the kappa reliability statistic as the be-all, end-all of science is trying to tell us that traditional kappa levels are unrealistically high for psychiatric research.

Historically, psychiatric reliability studies have adopted the Fleiss standard, in which kappas below 0.4 have been considered poor. In the January issue of the American Journal of Psychiatry, Helena Kraemer and colleagues complained that this standard is unrealistically high, and lobbied for kappas as low as 0.2 -- traditionally considered poor -- to be deemed "acceptable."

Former DSM-III guru Robert Spitzer and colleagues object to this proposal in a letter in the latest issue of the Journal. "Calling for psychiatry to accept kappa values that are characterized as unreliable in other fields of medicine is taking a step backward," they state. "One hopes that the DSM-5 reliability results are at least as good as the DSM-III results, if not better."

Alas, just wishing won't make it so. Despite its grandly stated ambitions, the DSM-5 will likely go down in history as a major gaffe by American psychiatry in its continuing struggle for world dominance.

Remember to check out the open letter
and send in your name, if you are in agreement with it.

Further reading:
*Salvador Dali: "One day it will have to be officially admitted that what we have christened reality is an even greater illusion than the world of dreams."
___________________________________________________________________

See also:


Friday, May 4, 2012

Allen Frances, M.D.: "The grand dream is lost - now at least make sure you don't mess up on the fine print." - DSM 5 Rejects 'Hebephilia' Except for the Fine Print | Psychology Today

DSM 5 Rejects 'Hebephilia' Except for the Fine Print | Psychology Today

DSM5 in Distress
The DSM's impact on mental health practice and research.
by Allen Frances, M.D.
*
Friday, May 4, 2012

In the news by Karen Franklin PhD: Open letter opposing DSM-5 paraphilias expansion

In the news by Karen Franklin PhD: Open letter opposing DSM-5 paraphilias expansion
Tuesday, April 10, 2012

_______________________________________________

Posted by at 4 comments:

Friday, May 4, 2012

Elsevier Selected as New Publisher of The American Journal of Geriatric Psychiatry - PR Newswire - The Sacramento Bee

Elsevier Selected as New Publisher of The American Journal of Geriatric Psychiatry - PR Newswire - The Sacramento Bee

Elsevier Selected as New Publisher of The American Journal of Geriatric Psychiatry

By Elsevier
Published: Wednesday, May. 2, 2012 - 3:56 am
PHILADELPHIA, May 2, 2012 -- /PRNewswire/ --
Official journal of the American Association for Geriatric Psychiatry
Elsevier, a world-leading provider of scientific, technical and medical information products and services, announces that it has entered into an agreement with the American Association for Geriatric Psychiatry (AAGP) to publish The American Journal of Geriatric Psychiatry (AJGP) beginning in January 2013.
"We are extremely pleased to be entering into this relationship with Elsevier," commented Chris M. deVries, Chief Executive Officer/Executive Vice President of the American Association for Geriatric Psychiatry. "The Journal serves as a primary vehicle for disseminating critical information to our national - and global - community of clinicians, educators, and researchers in the rapidly evolving fields of geriatric psychiatry and mental health. Therefore we are enthusiastic about making our content more readily accessible and discoverable through Elsevier's innovative tools, whether readers are at work, at home, or on the go."
AJGP is the authoritative source of information for the rapidly developing field of geriatric psychiatry. Each monthly issue contains peer-reviewed articles on the diagnosis and classification of psychiatric disorders in later life, epidemiological and biological correlates of mental health of older adults, and psychopharmacology and other somatic treatments. With a 3.566 Impact Factor it ranks in the top third of both the Psychiatry and Geriatrics/Gerontology categories according to Thomson Reuters' Journal Citation Reports®.
The decision to publish with Elsevier was the result of a meticulous review process. According to Editor-in-Chief Dilip V. Jeste, MD, "Key factors driving our decision were the advantages offered by Elsevier's global reach and its expertise in all phases of the publishing process. We anticipate that AJGP's position as the premier journal devoted specifically to geriatric psychiatry will be strengthened through this new association, benefiting our authors, editors, reviewers, and ultimately our readership."
About the Editor-in-Chief
Dilip V. Jeste, MD, Editor-in-Chief, is the Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, Director of the Sam and Rose Stein Institute for Research on Aging, and Chief of the Geriatric Psychiatry Division at the University of California, San Diego. He serves as Director of NIMH-funded Advanced Center for Innovation in Services and Intervention and Research focusing on psychosis in late-life and Director of the Education Division of the NIH-funded Clinical and Translational Research Institute at UCSD. Dr. Jeste is President-Elect of the American Psychiatric Association.
About The American Association for Geriatric Psychiatry
The American Association for Geriatric Psychiatry is a national association representing and serving its members and the field of geriatric psychiatry. AAGP promotes the mental health and well-being of older people through professional education, public advocacy, and support of career development for clinicians, educators, and researchers in geriatric psychiatry and mental health. http://www.aagponline.org
About Elsevier
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include SciVerse ScienceDirect, SciVerse Scopus, Reaxys, MD Consult and Mosby's Nursing Suite, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
Media Contact:Rachael Zaleski +1-215-239-3658rachael.zaleski@elsevier.com
SOURCE Elsevier


Read more here: http://www.sacbee.com/2012/05/02/4458981/elsevier-selected-as-new-publisher.html#storylink=cpy
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Allen Frances, M.D.: "The grand dream is lost - now at least make sure you don't mess up on the fine print." - DSM 5 Rejects 'Hebephilia' Except for the Fine Print | Psychology Today

DSM 5 Rejects 'Hebephilia' Except for the Fine Print | Psychology Today

DSM5 in Distress
The DSM's impact on mental health practice and research.
by Allen Frances, M.D.

DSM 5 Rejects 'Hebephilia' Except for the Fine Print

Now the devil is in the details.
Published on May 3, 2012 by Allen J. Frances, M.D. in DSM5 in Distress
The prize for the most wayward of all the DSM 5 work groups must surely go to the sexual disorders group—creators of three remarkably off-beat proposals. Fortunately, they have gradually been forced to abandon their entire wish list because each of the proposals triggered near universal opposition from forensics experts and sexual disorders researchers. First to go was Hypersexuality (AKA sex addiction); next rape (AKA coercive paraphilia); and this week the work group has finally admitted in all but the fine print that statutory rape (AKA 'hebephilia') is also not a mental disorder. But before rejoicing, we must get down to three errors in the fine print that need to be rectified before the section will be safe from forensic misuse.

1) Defining Pedophilia: Serious forensic mischief still lurks in the recently proposed wording. Here is the problematic DSM 5 criterion:

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"A. Over a period of at least 6 months, an equal or greater sexual arousal from prepubescent or early pubescent children than from physically mature persons, as manifested by fantasies, urges, or behaviors."
The phrase 'equal or greater" strikes just the wrong note. The interpretation (or misinterpretation) of these three small words can have huge consequences concerning the constitutionality of involuntary psychiatric commitment as it is applied in Sexually Violent Predator (SVP) cases. SVP statutes explicitly require that mental disorder be distinguished from simple criminality. The sex offender must be mentally disordered to qualify for SVP commitments. In our country, it is never constitutional to force simple criminals into psychiatric hospitals to keep them off the streets as a form of preventative detention.
This crucial distinction (made explicitly by the Supreme Court) seems to be completely lost on the DSM 5 Sexual Disorders work group. An accurate definition of 'Pedophilia' must separate the rarely encountered, mentally disordered 'pedophile' from the much more common run-of-the-mill sex criminal. 'Pedophilia' requires that the offender be intensely and recurrently sexual aroused by prepubescent kids and that they are his preferred or obligatory source of sexual excitement. The contrast is with the simple criminal who preys on kids opportunistically because they are vulnerable or available or perhaps because he is disinhibited by drugs.
This brings us back to the lack of precision in the DSM 5 wording. A drug addled criminal may be attracted 'equally' to just about anything that walks—that doesn't make him a mentally disordered 'Pedophile'. Before diagnosing Pedophilia, there must be an established fixation on prepubescent kids .
The solution is pretty straightforward. The DSM 5 wording should substitute 'preferred or obligatory' for 'equal or greater'. The phrase 'preferred or obligatory' is central to the concept of paraphilia, already appears in the differential diagnosis section in DSM IV, and deserves greater prominence in the DSM 5 criteria set. "Equal or greater" will perpetuate the great confusion about Paraphilia that has plagued the proper application of SVP statutes. And one wonders how "equal or greater" would ever be measured reliably—lets hope this isn't meant as an excuse for expanding phallometric testing beyond its proper competence.

2) Restricting Pedophilia to prepubescent children: Adding 'early pubescent' youngsters is an unwarranted and radical change from the standard definition of Pedophilia. It reflects the fact that the DSM 5 work group is lopsidedly dominated by researchers connected to one center. They have displayed a stubborn ambition to find a place in DSM 5 for their pet diagnosis: 'hebephilia' supported by the unproven suggestion that men attracted to pubescent kids have a mental disorder. Aside from its deep conceptual flaws and extremely thin research base, the proposal ignores the fact that statutory rape is committed for a whole variety of other much more common reasons (eg opportunistic crime, a vulnerable victim, unavailability of other partners, immaturity, substance disinhibition, date rape, etc.). Paraphilia would explain only a vanishingly small proportion of the sexual crimes committed with pubescent victims who are under the age of consent. And we already know that 'hebephilia' has been much abused in SVP hearings by evaluators who casually pin the mental disorder label on simple criminals to end run the constitutional protections against preventive detention.
Confronted by universal opposition from the rest of the field, the DSM 5 group has been forced progressively to whittle down their pet, but they so far have refused to just drop it altogether. 'Hebephilia' first lost its free standing independence and was cloaked as Pedohebephilia. When this didn't fly, the term was dropped altogether in the title but the concept was slipped into the definition of Pedophilia—which was expanded out of recognition by having a victim age cut-off of 14 years. No one accepted this outlandish suggestion and now finally the work group comes back with 'early pubescent children' and tries to keep 'hebephilia' as a term in the subtype. The instability of the criteria sets associated with this concept is additional evidence that the fervor for its adoption stems from emotional loyalty rather than reasoned review of its weak conceptual and research base. How can the group vouch for the reliability of the diagnosis when the concept and criteria are changing every month? This is no way to develop a diagnostic system.
The work group may try to justify inserting 'early pubescent children' on the grounds that it is mentioned in ICD-10. This is misleading in three ways: first, ICD-10 is inconsistent- its research criteria include only prepubescent children; only its clinical description mentions 'early pubertal children'; second, the goal of DSM-5 is to achieve compatibility with ICD-11 (not ICD-10) and my understanding is that the ICD-11 workgroup has already identified the phrase 'early pubertal children' as an error that will be corrected ; and third, ICD is much freer to be loose in its language because it not much used for forensic purposes (let alone in SVP commitment hearings that bear so consequentially on the proper application of our constitution and the proper uses of psychiatry in our society.

3) Drop the subtype: "Hebephillic Type—sexually attracted to early pubescent children (Tanner Stage 2-3)".
Come on guys. This is absolutely absurd just on the face of it. Do clinicians really know what the Tanner stages are? Even if you did, how would you possibly ever determine the Tanner stage of the victim. And how reliably can the different Tanner stages be diagnosed? One waggish critic scorned the Tanner stages as a futile exercise in 'splitting pubic hairs'. Putting Tanner stages in DSM 5 is really that silly. So back to the drawing board, DSM 5 sexual disorders work group. The grand dream is lost- now at least make sure you don't mess up on the fine print.
And one more thing. Recognizing that the jig is up on the grand design, members of the DSM 5 sexual disorders work group have been heard saying they may have to settle for an Appendix placement for their 3 hothouse creations. This would create forensic dangers. We have learned from the abuse of ' Paraphilia Not Otherwise Specified' in SVP cases that any (even remote) legitimization by DSM 5 is certain to be misconstrued and misused in the courtroom.
I commend you to an excellent discussion of this and many other issues pertaining to the DSM 5 Paraphilia section in an Open Letter authored by Richard Wollert and Thomas Zander. Mental health professionals concerned with these issues can sign on in an effort to improve the DSM 5 paraphilia so that it doesn't continue or greatly worsen the confusion we caused by the poorly written section in DSM IV. .
See: http://bit.ly/LetterDSM
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