Wednesday, December 13, 2006

I'm not a Forensic Psychologist

by Tory Butterworth

A couple of weeks ago on the TV show, "Criminal Minds," a profiler was approached by a High School student who was afraid he would murder someone. Later in the show, a different profiler evaluated this young man and said, "In my opinion, it's not if he'll kill, it's when."

This episode illustrates one of my quandaries in writing this blog. I've been considering blogging on diagnoses such as "bipolar" and "schizophrenia" which get bandied about on TV, often incorrectly. I've hesitated because I'm afraid readers will assume I'm someone who specializes in criminal minds. As a therapist, I work with the mentally ill. As a group, the mentally ill are somewhat more likely to be violent than people who are mentally healthy. However, most mental patients (90% or so) aren't violent.

In the orientation group I co-led at a community mental health agency, we quickly learned to screen out the criminal population, sending them to the forensic treatment unit. I discovered that in establishing a therapeutic alliance, I assume a basic truthfulness from the client. If someone told me the FBI was after them, I wouldn't necessarily believe they were being chased, but I would assume the client thinks he or she is. With forensics clients I learned to assume they were lying in order to pull off a scam. My first job when working with them was to figure out what they were trying to get away with.

Forensic patients are masters at scoping out a group, identifying like-minded individuals, and forming alliances to help them undermine the authority of the group leaders. Amazingly, they were often able to pull this off in a single two-hour group session. The bulk of patients who come more or less willingly to community mental health, not forced there by a court order, were focused on their own pain and didn't have much attention left for others in the group. Most of them lacked the social skills to form a rebellion even if they wanted to start one.

Getting back to the "criminal minds" episode, the profiler who performed the evaluation didn't realize the mistake he was making in predicting future behavior. His job starts with a past act, a murder that's already happened, and he works backward to identify who did it. He rarely meets the 100 to 1000 people that match his profile who haven't killed anyone. He doesn't collect data on what differentiates them from the killers.

The fact this young man, frightened of his own impulses, was looking for help before he'd killed anyone, speaks to me of something in his character that differentiates him from those who take out their sadistic fantasies on others. Clients who are successful in therapy have to look at their own pain, rather than blaming it on others or covering it up with unhealthy behavior. This act of moral courage often differentiates those who remain sick from those who get better.

As a therapist, I'm predicting I could work with him.

14 comments:

Kristine said...

Very interesting post this morning, Tory. It amazes me how often the TV shows get it wrong. I also wonder why the public is much more forgiving about this sort of thing in TV shows as opposed to in books, where the author is expected to get every fact correct.

Joyce said...

Great post, Tory.
The problem with TV shows is that they are on to entertain. If they portrayed what really happens, no one would watch. It's even causing problems in the courtroom because juries think all the evidence should be just like on CSI. Maybe every year, these shows should devote one episode to how things happen in real life.

Nancy said...

My daughter is currently working in an ICU unit from which few patients emerge miraculously. One of her biggest challenges is helping families through the end-of-life issues that most refuse to consider--because TV shows tell stories of miracle cures in every episode. It's made her job much tougher.

Thanks for this blog, Tory. It's a guide for writers who employ therapists in their books.--Not all therapists are capable of coping with Hannibel Lechter!

Tory said...

Kristine: maybe it's an indirect compliment, they expect book authors to be smarter?

Joyce: Maybe TV shows need to start with a qualifier, "Certain details have been changed to protect from boredom."?

Nancy: That's similar to my research job, getting renal dialysis patients to talk to their families about end-of-life treatment. TV shows can bias the ways we see statistics. If a doctor says, "S/he has a 1 in 100 chance of survival," families often think that means they have a running shot. Really, that's doctor's way of saying, "There's no hope." Maybe another blog on that some day?

Cathy said...

I'm another to point out the unreliability of information on television. It gives you the illusion that you're learning something about life, but mostly you're learning about what the commercials are trying to sell.

Maybe those who read novels are taking the time to learn more about reality? Interesting point.

Anonymous said...

Well said, Tony. As a licensed investigator specializing in computer forensics and electronic evidence, I am still struck speechless at some of the things seen on shows such as "CSI", which give a *very* skewed impression to potential clients. More than once, I've explained a full bore examination of a subject hard drive can and has taken more than 40 hours, I can almost count on a stunned gasp and "But, on CSI, they do it in five minutes". It's reached a point where prosecutors have come to fear what has been termed "The CSI Effect" on jurors.

It's scary. Very scary.

Joyce said...

William, I read an article recently about the CSI effect http://www.usatoday.com/news/nation/2004-08-05-csi-effect_x.htm.
Jurors expect a preponderance of physical evidence, which in most cases, doesn't exist. Not every case has DNA, fibers, hair, etc.

People also expect more from the police in regard to investigations. We had a person who had their car stolen and recovered and they didn't believe it when the officer told them there wouldn't be an investigation. The guy wanted someone to print the vehicle and "collect evidence," just because they do it on TV.

Rob said...

Gideon said, later in the show, that he might be wrong. He just doubted it.

If that were a young child, I'd agree with you that he could be worked with. If his pathology had not been so great, I'd agree with you that therapy might accomplish a lot, even at an older age.

Mostly what you describe as forensic patients are people with anti-social personality disorder -- the ability to manipulate, undermine, lie, and read a group is classic. What's your success rate with them? Honestly?

Sociopathy is not the only source of criminal behavior, though heaven knows it doesn't help. One of my students was a borderline. You know the "I wish the patient were sitting in someone else's office?" method of diagnosis? I was the "other instructor" x5.

The young man in the TV show certainly had some antisocial traits (I think, I don't remember examples or the whole show, but ASPD came up in our discussion), but that wasn't his "major malfunction." He exhibited a dangerous sexual dysfunction. What's the success rate with pedophiles? We don't have any real reliable and consistent forms of therapy for that kind of sexual dysfunction.

I just had to call a CYS-equivalent because umpteen years of incarceration and therapy didn't do frack and the family didn't want to believe the charges were true so they let him sleep in the little kid's bed with her.

A 17 year old sociopath sexual deviant? My wife, who used to be a therapist but then got out when asked to declare a rapist "cured" because the insurance ran out, declared the poor kid "nearly hopeless."

As a paramedic who saw too much of the seamy side of life, I consider my wife the optimist in the family.

I'm not saying I wouldn't try to treat the guy. I would. That such situations are possible terrifies me and offends my sense of what's right and what's just. I just don't think there's much hope, and that it will be "when, not if" at much better odds than I'd ever care to bet against.

I felt sorry for Jeffrey Dahmer. He didn't want to do what he did, either. Unfortunately, that didn't mean much. The poor guy was just screwed. Bad wiring, though I don't think his parents are quite as blameless as they're usually portrayed. I may be wrong.

For some people, a structured, controlled environment is the only hope they have at a decent life. That sucks so bad, but it's true.

Rob said...

BTW: Criminal Minds tends to rip off standard case studies for a lot of it's episodes.

Profiler and Millennium did the same thing for their first two seasons. We used to play "Name the case they're basing this episode on."

I think it was Millennium that was working it's way through a book by Douglas -- in order. Maybe it was Profiler....

Hotch tends to quote from the FBI Crime Classification Manual by Ressler, Dougless, and the Burgesses. If Hotch doesn't, Reed often does. Honestly, if they quote statistics and it's not covered in the CCM, I can't vouch for them one way or the other, but when they do, it's usually verbatim.

The writers of Criminal Minds are mixing and matching some cases. The kid doesn't match any case study I read. It's more of a "What if you caught a serial killer early?" type question to go along with the more standard serial killers in that episode.

As for CSI and the like...

No forensics lab is that well funded. Do you have any idea what the DNA backlog is like in most places? The cases are set up so they can be solved, and the timing is absurd. The basic science, though, they get right on CSI most of the time. I think it was CSI: NY where I called "2-4 DiNitroPhenol poisoning" of the roller skater before the 1st commercial. It was one of my unknowns in organic chemistry and a weight-loss medicine in the '50s before people died from overdoses. The LD50 and the minimum therapeutic dose are fairly close. Oopsie.

CSI: Miami has horrid scientific inaccuracies. CF the siphoned gasoline ignited by a cell phone spark. Come on! I've been known to scream at the TV on Monday nights.

Now we watch Studio 60 instead.

Whoever the BATFE adviser was for CSI: Miami, the guy hated us rocketry hobbyists. Any bomber always had an Estes Astron Alpha sitting around. Of course, the two national rocketry organizations did sue the BATFE and they won. I suppose that might be why the guy was so angry....

Meryl Neiman said...

Rob,

I did not see the TV show, but mental illness is a disease and thus treatable. Not every patient gets better, but many can. The sociopath is different.

I have a friend who suffers from severe depression. She is treated for it, but she still to this day keeps a secret stash of pills somewhere. It's her safety valve -- her way out if things get too dark. She has a seven year old daughter. When she is at her worst, and contemplating suicide, she often considers having to take her daughter with her into death. This woman is a wonderful mother. Nobody could love a kid more. And yet when she is the hellish grip of depression, she contemplates the abominable. If it were not for anti-depressant medication there is no way that she would be alive today.

Tory said...

Rob: I wouldn't diagnose the character portrayed on "criminal minds" was an antisocial personality disorder, psychopath, or pediophile. I don't work with forensic clients, so I don't know success rates on them.

However, I would be willing to work with this client because he appeared highly motivated to change. I'll go out on a limb and say that motivation to change is the largest single factor in whether I can help someone or not. Unfortunately, antisocial personality disorders, psychopaths, and pediophiles are rarely motivated to change.

And I hope people don't get the idea the point of my blog was to trash "criminal minds." I like the show and I found the episode rivetting. I think discussing a show afterwards is probably the best compliment you can give it.

Tory said...

Meryl: thanks for chiming in!

Lumping Jeffrey Dalmer and your friend who suffers from depression into the same bag of, "people with mental illness," is doing both a huge disservice!

Rob said...

I suffer from depression. I'd debate the "treatable" part. Therapy hasn't done crap. Drugs help some. Mostly, I've just decided to have as much fun as I can, no matter how miserable I feel.

From what I've seen, wanting to change isn't sufficient to really change a lot of things, especially my depression. Heaven knows I'm highly motivated.

Of course, as a biochemist, I also view all forms of mental dysfunction as illness. The borderline or ASPD are also ill. They just happen to have an illness that, among other things, takes away the desire to change. Dahmer desperately wanted to change. That's in the literature. He hated the way he was, and even wanted to be locked up so that he couldn't kill.

Most OCDers I know want desperately to change, but that doesn't seem to help.

Ok, so that's not quite true. I can't tell if most of the OCDers I know want to change, mostly because they're parrots. The human ones I'll vouch for. The avian? We've had several die miserably from plucking (avian equivalent of trichotillomania...I bet they wanted to change. Interestingly, at least one human and all the lovebirds with OCD do better with antibiotics, although after a while, the antibiotics stop working. Sigh.

My wife asked if you were primarily a behaviorist in orientation? She wanted to bet me, but I wouldn't take the bet.

Anonymous said...

Screenwriters are notorious for inaccuracies, and admit to taking little time to ensure their depictions are accurate, thus giving others in the writing profession a blackeye. Unfortunately screenwriting is pretty much a closed shop and any chance of making substantive inroads, and thus influencing change, are minimal at best.