In this month's issue, we draw on decades of Reason journalism about policing and criminal justice to make practical suggestions about how to use the momentum of this summer's tumultuous protests productively. Check out Damon Root on abolishing qualified immunity, Peter Suderman on busting the police unions, Jacob Sullum on ending the war on drugs, Zuri Davis on restricting asset forfeiture, C.J. Ciaramella on regulating use of force, Alec Ward on releasing body cam footage, Jonathan Blanks on stopping overpolicing, Stephen Davies on defunding the police, and Nick Gillespie interviewing former Reasoner Radley Balko on police militarization.
"'The only thing we've accomplished is becoming the world's largest incarcerator, sending people with mental health and addiction issues to prison…,' [NAACP director Robert] Rooks said."
Mike Riggs
"Black Behind Bars"
November 2011
"Please just send one police car, please don't have your weapons drawn, please take him to the hospital." These are the words that many families with a mentally ill loved one have learned to say when crisis strikes. Sabah Muhammad and her siblings have spoken them several times since 2007, the year her brother was diagnosed with paranoid schizophrenia. He had been a standout student and star running back at his high school near Atlanta, but everything changed around his 18th birthday. "He would become catatonic, barely moving, just staring into space," Sabah explains. "Sometimes he locked himself in his room for weeks, refusing food, except to come out of his room at 3 a.m. to make toast that he blackened to carbon 'to get the poison out.'"
Mute and malnourished, he would not allow family to take him to a psychiatrist—but he desperately needed help. The only option in the Muhammads' Atlanta jurisdiction was a 911 call to report a psychiatric emergency, which tended to bring the police, multiple squad cars with lights flashing, and the ominous specter of armed agents encountering a young black man in a delusional state. So Sabah and her family would call the police, and pray.
The data justify their dread. Between 25 and 50 percent of all people killed annually by police are in the midst of a mental health crisis when they're slain, according to a report by the Treatment Advocacy Center (TAC), a Virginia-based nonprofit dedicated to improving treatment for people with serious mental illnesses.
Nationwide, a person with a psychotic illness is 16 times more likely to be killed during a police encounter than a person without such a condition. And even encounters that do not end in death have dire consequences such as violent confrontations, arrests, and incarceration.
Police are often the first responders because there is no one else who can attend to a person in crisis. "I don't think we have any option but to be social workers, marriage counselors, coaches," Joann Peterson, a retired New Haven police captain, told the Connecticut Mirror in June. At the same time, having police on the front lines of such incidents wastes community resources, overburdens law enforcement, and, when things go badly, criminalizes severe behavioral disruption due to illness.
The answer to such tragedies seems obvious: reduce encounters between police and people with mental illness or, at least, change their nature. "Cop culture has always been, 'We're the people who respond to a crisis, jump out of the car, and take immediate action,'" New York Police Department Assistant Chief Matthew Pontillo told colleagues at a Police Executive Research Forum in 2015. "And we're saying, 'No, that's not the correct paradigm anymore.'" While wholesale replacement of police officers with social workers is unrealistic, there are police-based programs that respond humanely to people who are in crisis.
The best-known example is Crisis Intervention Team (CIT) training for police. The program was created by authorities in Memphis, Tennessee, following the tragic death of 27-year-old Joseph DeWayne Robinson in 1987. Robinson's mother called the police because her son was cutting himself with a large knife, inflicting over 100 wounds on his body, and threatening to kill himself. When police arrived, Robinson reportedly lunged with the knife, and they fired. According to some accounts, Robinson was high on crack; others said he had paranoid schizophrenia; together or separately, these states could make someone psychotic and agitated.
The disaster spurred the city of Memphis to develop a system for diverting people with mental illness from the criminal justice system. The Memphis Model of CIT training has three parts. The first involves 40 hours of training in mental health for self-selected police officers. Often, it turns out, those who enroll also have a mentally ill family member. That is true of about 45 percent of program participants, according to Police Lt. Col. Vincent Beasley. The second part entails clear lines of communication so that the specialized CIT will be dispatched to all mental health emergencies. The third is a mental health facility with a guaranteed acceptance policy where the police can bring a distraught individual. Today, there are 2,700 CIT programs, accounting for 15–17 percent of all police agencies in the country.
During CIT training, officers learn to recognize tense situations and to defuse them by not confronting people, yelling directions, or making quick movements. The idea is to "slow the situation down," to keep people from feeling cornered or under threat. (To reduce tension, police on the Tucson CIT drive unmarked cars and do not wear uniforms, for example.) Officers are trained to recognize the signs of psychosis and suicidal despair. They learn about post-traumatic stress disorder and extreme reactions to drugs, such as PCP or methamphetamine, that can produce intense agitation or paranoia. They understand that people with schizophrenia or people who are manic may be responding to hallucinations or may refuse to cooperate with police requests because voices tell them not to.
Perhaps deployment of a CIT-trained officer could have prevented the death of Queens resident George Zapantis in June. The 29-year-old man, who suffered from bipolar illness, was dressed as a gladiator and wielding a large sword in his mother's basement. Police tased him multiple times after a neighbor called them, and he died of a heart attack.
Perhaps a different response would have saved Tony Timpa, 32, who called Dallas police from the parking lot of a porn shop in 2016. Off his antipsychotic medication, Timpa was afraid and anxious. Police arrived to find him already handcuffed by security guards of a nearby store. Yet in a sickening foreshadowing of George Floyd's death, they had him lie face down, and an officer pressed a knee into his back for 15 deadly minutes.
Or perhaps better training would have discouraged police from fatally shooting 29-year-old Osaze Osagie, who had schizophrenia and was autistic, in 2019. When officers arrived at his apartment near Penn State, at the behest of his worried family, Osagie bolted out the door holding a knife. In the chaos, one of the officers opened fire.
Data on the CIT program offer mixed reassurance. A 2014 meta-analysis revealed no differences in arrests or use of force between officers who were and who were not trained; a 2019 review of research found rampant variability within training programs; and another analysis, from the Police Executive Research Forum, found that participants sometimes spent as little as eight hours in training. In New York City, where half of the police force has undergone CIT training since 2015, 16 people with mental illness have been killed in encounters with law enforcement since the training began, exceeding the number killed in the five years prior to initiation of the program.
The problem, scholars conclude, is poor fidelity to the three-part Memphis Model. When CITs operate within small regions with close adherence to the parameters—most notably, when they're paired with fortified community-based mental health services—they tend to be more effective. San Antonio, for example, built a "Restoration Center" for psychiatric and substance abuse emergencies and a 22-acre campus for short-term in-patient stays with detox units and a medical clinic. Police were then able to divert more than 100,000 people from jail and emergency rooms to treatment between 2008 and 2016.
Miami-Dade is a large county that was able to follow the tripartite strategy. Shootings by police have declined by 90 percent since CIT training was implemented in 2010, but the program accomplished something more: It shined a light on the high incidence among police of depression and suicide. According to Judge Steven Leifman, who established the Miami-Dade program, officers who go through the training "have been more willing to recognize their own stress [and] reach out to the program's coordinator for mental-health advice and treatment for their own traumas."
Other cities deploy crisis teams that are solely mental health–based; police are not part of the first line at all. One of the nation's longest-running examples of this is CAHOOTS (Crisis Assistance Helping Out On The Streets). It was created 31 years ago as part of an outreach program of the White Bird Clinic in Eugene, Oregon—once a countercultural medical clinic founded in 1970 as a refuge for hippies on LSD trips and other drug-taking youth. Calls for help are routed to staff 24/7 by the local 911 dispatcher. A medic and a mental health professional respond as a team to incidents such as altercations, overdoses, and welfare checks. They wear jeans and hoodies and arrive in a white van stocked with supplies like socks, soap, water, and gloves. Should a situation spin out of control, they call for CIT-trained police back-up, though last year only 150 out of 24,000 field calls required back-up. People who need further attention are taken to a crisis care facility operated by the mental health department—no trips to jail or to overflowing emergency rooms.
Mental health teams can bring some much-needed relief to municipal budgets. According to TAC, police officers across 355 law enforcement agencies spent slightly over one-fifth of their time responding to people with mental illness or transporting them to jail or psychiatric emergency rooms, at a cost of $918 million in 2017. The CAHOOTS flagship program in Eugene operated on a $2 million budget in 2019 and saved the locale about $14 million in ambulance transport and emergency room care. Within the year, a number of cities (including San Francisco, Los Angeles, New York, and Durham, North Carolina) will be launching programs similar to CAHOOTS.
The best crisis intervention programs help reduce the toll of police involvement gone awry, but the only way to take encounters out of the hands of police in all but the most dangerous instances is to repair the mental health system itself, which is a notoriously tattered network of therapists, psychiatrists, hospitals, residential settings, and support services, and work to prevent ill people from lapsing into crisis in the first place.
For a glaring manifestation of the current failure, look to the criminal justice system. In 44 states, a jail or prison holds more mentally ill individuals than does the largest state psychiatric hospital. A person with a severe condition, such as schizophrenia or bipolar disorder, is 10 times more likely to be in a jail or prison than a hospital bed.
But once the crisis is underway, the people who show up at the scene must do the right thing. Balancing the proper role of police officers—as guardians vs. warriors—is now a subject of intense national debate. The mounting sense that America's criminal justice system needs fixing should find its fullest expression in the duty to protect and serve those who are mentally ill or emotionally disturbed.
The post Rethink Crisis Response appeared first on Reason.com.
]]>(Dr. Sally Satel, who has guest-blogged here before, was kind enough to write up this item on a topic that has long interested me; I'm delighted to pass it along: -EV)
In 2007, Eugene Volokh, the host of this site, published an essay in the Harvard Law Review titled "Medical Self-Defense, Prohibited Experimental Therapies, and Payment for Organs" in which he argued that the government should need "a very good reason" to prevent sick people from saving their own lives.
That insight impels the Right to Try movement, which seeks to give terminally ill patients the right to try drugs that show promise but not have received FDA approval and which has received sympathetic hearings from President Trump and Vice President Pence. One of the leaders of Right to Try reform, the libertarian Goldwater Institute, said it best: "We just fundamentally do not believe that you should have to apply to the government for permission to try to save your own life."
That principle has vital implications for patients needing bone marrow and kidney transplants.
Each year, 2,000 to 3,000 individuals with leukemia and other forms of bone marrow disease die while waiting to receive another person's bone marrow cells. It's not that strangers are indifferent to their plight, but that suitable biological matches are hard to find. And even when a match is found, there is a 1-in-2 chance that the needle-in-a-haystack donor either can't be located by registry personnel or, incomprehensibly, refuses to donate even though he had earlier volunteered to be tested.
We can enlarge the pool of potential donors while increasing the likelihood that compatible donors will follow through if they are paid—or if sick patients (or charities acting on their behalf) have the Right to Buy, as I call it.
But there is an obstacle to buying. The 1984 National Organ Transplant Act, or NOTA, bans exchange of "valuable consideration"—that is, anything of material worth—for solid organs, such as kidneys and livers, as well as for bone marrow.
The Institute for Justice, a libertarian public-interest law firm, fought the prohibition. It sued the Justice Department on behalf of families afraid their ill loved ones would die because they couldn't get a bone marrow transplant.
In a unanimous 2012 ruling, a three-judge panel of the U.S. Court of Appeals for the 9th Circuit rejected the federal government's argument that obtaining bone-marrow stem cells through a needle in a donor's arm violates NOTA. The judges based their decision on the fact that modern bone-marrow procurement, a process known as apheresis, is akin to drawing blood. Indeed, filtered stem cells, they held, are merely components of blood, no different from blood-derived plasma, platelets and clotting factors, all of which are replenished by the body within weeks of a donation. Because it's legal to compensate blood donors, it's also legal to pay bone marrow donors, the court ruled.
Unfortunately, the Department of Health and Human Services rejected the court's ruling. In 2013, it proposed a rule that would extend the NOTA prohibition to bone marrow stem cells. Under the proposed regulation, anyone who accepted material gain for giving bone-marrow stem cells would be subject to NOTA's penalties, facing imprisonment for up to five years. According to HHS, compensation runs afoul of NOTA's "intent to ban commodification of human stem cells" and to "curb opportunities for coercion and exploitation, encourage altruistic donation and decrease the likelihood of disease transmission."
The solicitor general could have asked the Supreme Court to review the 9th Circuit's bone-marrow decision, but he declined. Perhaps he grasped the central folly of HHS's position: How could the agency justify its worry about "opportunities for coercion and exploitation" and the "likelihood of disease transmission" when it came to bone marrow cells, yet not apply those same concerns to plasma?
For three years, HHS has been silent on its proposed rule. Meanwhile, people are dying because nonprofits that want to begin paying donors on behalf of needy patients can't move forward until they are assured that the agency can't shut them down. The Institute for Justice is considering a legal challenge over the HHS delay, which is causing needless deaths.
But perhaps the lawsuit can wait. With a new administration that is skeptical of overregulation, HHS Secretary Tom Price could withdraw the proposed rule. Ideally, Congress would thwart future regulatory blockades by amending NOTA to stipulate that marrow stem cells are not organs covered by the act.
Changes to NOTA should also be made for other organs. I feel strongly about this on fundamental grounds of liberty but also because, in 2005, I needed to save my own life. I developed kidney failure but could not find a donor. Thank goodness, an angel, or as some readers know her, Virginia Postrel, heard about my predicament and gave me a kidney. And this summer another living saint, Kimberly Hendrickson, who saw how desperate I was many years ago, offered me one of hers when the first transplant began to fail. Every day, 12 people die because no one was able to come to their rescue and, had a patient offered money for an organ, both the patient and the donor who accepted the money would face felony charges.
Congress could take the bold step of revising NOTA to permit donors who are willing to save the life of a stranger through kidney donation to receive valuable consideration from governments or nonprofit organizations. Or, lawmakers could take the intermediate step of creating a pilot program allowing doctors to study the effect of such measures, as proposed last May by Rep. Matthew Cartwright (D-Pa.), who introduced the Organ Donor Clarification Act of 2016.
Rather than large sums of cash, potential rewards could include a contribution to the donor's retirement fund, an income tax credit or a tuition voucher, lifetime health insurance, a contribution to a charity of the donor's choice, or loan forgiveness. Only the government, or a government-designated charity, would be allowed to disburse the rewards. Consequently, all patients, not just those with financial means, could benefit. The funds could potentially come from the savings from stopping dialysis, which costs roughly $80,000 a year per person.
The pilot programs, to be designed by individual medical centers, could also impose a waiting period on prospective donors, thereby cooling any impulsivity. Prospective donors would be fully informed about the risks of surgery and carefully screened for physical and emotional health, as all non-compensated kidney donors are now.
The idea of the government standing between a dying person and his salvation is deeply troubling. I know. We need to at least test better ways to recruit more marrow and kidney donors.
Dr. Sally Satel is a resident scholar at the American Enterprise Institute and editor of "When Altruism isn't Enough: The Case for Compensating Kidney Donors."
The post Right to try, right to buy, right to test appeared first on Reason.com.
]]>Last Friday, Dzohkar Tsarnaev was sentenced to death on six of 17 capital counts. The immature teen brain was mentioned in the closing summary presented by the defense. From the perspective of sound science in the courtroom, the teen brain defense in the Boston bomber case was feeble. Nevertheless, it is part of a larger project of criminal justice reform that invokes mechanical explanation of brain function in the service of exculpation of blame or mitigation of guilt.
Some prominent neuroscientists appear to long for a "shift from blame to biology." They claim that human beings are victims of neuronal circumstances. This would mean that punishment, let alone the death penalty, would be invalidated as both a concept and practice because criminals do not choose their bad behavior freely. According to Stanford biologist Robert Sapolsky, "Our growing knowledge about the brain makes the notions of volition, culpability, and, ultimately, the very premise of the criminal justice system, deeply suspect."
Neuroscientist David Eagleman of Baylor College of Medicine welcomes a time when "we may someday find that many types of bad behavior have a basic biological explanation [and] eventually think about bad decision making in the same way we think about any physical process, such as diabetes or lung disease." As this comes to pass, he predicts, "more juries will place defendants on the not-blameworthy side of the line."
But is this the correct conclusion to draw from neuroscientific data? After all, if every behavior is eventually traceable to detectable correlates of brain activity—which, we suspect, may be possible at some point in the distant future—does this mean we can one day write off all criminal behavior on a don't-blame-me-blame-my-brain theory of crime?
We doubt it. We agree with University of Pennsylvania law professor Stephen Morse that as long as an actor's values and beliefs are causally relevant to his or her actions, then moral agency exists in the ordinary sense. If people can step back from competing desires, make a reasoned decision among them, and act on the basis of that decision, they possess capacities sufficient for holding them morally accountable—both within the common sense realm of human interaction and under the law.
This is not to deny, in other words, that some murderers have something wrong with their brains. But unless neuroscience can show that a killer was unable to reason and respond to reason or to control himself, it will not succeed as a path toward exculpation. Nor, from a sound-science perspective, should it be used to mitigate because, at this phase of our knowledge, functional brain imaging cannot tell us anything about criminal responsibility that conventional methods cannot already provide.
What's more, are we, as humans, even capable of giving up on—or substantially modifying—our intuitions about retribution?
We are skeptical. Humans' innate sense of justice is deep. Given its manifestation across diverse cultures as well as in children as young as one year old, justice—and punishment—may well be evolutionary imperatives.
One key purpose of punishment is to make perpetrators suffer in proportion to the harm that they have caused the victim and society. When retribution is applied in the real world, it carries great practical value, too.
For one thing, it strengthens citizens' shared norms of moral obligation to one another. Boston Police Commissioner William Evans expressed this view when he said, "I think we sent a strong message that we're not going to tolerate terrorism. They're not going to blow up our Marathon, they're not going to blow up our city, we're not going to tolerate terrorism in our country, and that's the strong message we sent here today."
One of those norms is that victims should be valued as human beings. Consider the following vignette that we use in our recent book, "Brainwashed": A serial rapist, John, attacks Mary, is found guilty, and is sent to prison. A few months later, John is treated with "Castrex," a fictional new anti-rape medication guaranteed to permanently eradicate sexually aggressive urges.
Castrex works after just a few doses, and several weeks later, John is freed. He is no longer a danger to anyone. His rehabilitation was a success. But John's light punishment would have woeful repercussions for Mary, her family, and the community at large.
When society fails to condemn aggressors or simply slaps them on the wrist, victims may feel unavenged and therefore devalued and dishonored. If perpetrators die before they can be judged or are killed in prison before they can be adequately punished, victims and their families may understandably feel enraged. Criminals who do not "pay their debt" can spur victims and their families to contemplate vigilantism and sometimes even undertake it.
Contrary to common perception, such feelings do not always arise out of a sense of vengeful bloodlust. The motivation to punish wrongdoers can instead be motivated by grief or by a solemn sense of duty to set things right. Indeed, many of the Boston jurors were tearful and shaken after delivering their verdict.
Communities, too, resist what they perceive to be inadequate punishment. Consider, as we did in "Brainwashed," the 2011 trial of Casey Anthony, the twenty-five-year-old Florida woman who never reported her two-year-old daughter missing. Widely believed to have killed her child or at least abetted in her death, Anthony received death threats after she was exonerated for murder.
Likewise, jurists often speak of their moral duty to satisfy the victims and their families. When a U.S. district court judge sentenced disgraced New York City financier Bernard Madoff, who swindled thousands of investors of billions of dollars, to a term of 150 years, he explained to the press that the exceptionally long sentence for an elderly man who would probably die within a decade or so was a symbolic way to help the victims heal.
Beyond victims, the legal system itself suffers when criminals are not punished, although not just any punishment will do. The penalty must seem proportionate to the offense. In a system perceived as unfair, juries may ignore judges' instructions, and police officers may impose their own judgment on whether to arrest or abuse suspects or to trump up charges against them. For their part, witnesses may refuse to participate in investigations or to testify. Jurors are more susceptible to nullification—that is, to acquitting defendants who are legally guilty—when the verdict dictated by law is contrary to their sense of justice, morality, or fairness.
Also, victims need to be heard. And surely they were in the Boston Bomber trial. More generally, the idea of a victim impact statement was developed so that the sentencing judge could hear directly about the anguish suffered by victims and their loved ones. Sometimes victims want an apology from their violators—not in place of a penalty, but in addition to it.
Here is where Tsarnaev, who showed minimal remorse, may well have sealed his fate. He generally remained aloof, stony-faced, and passive throughout hours of victim testimony, including the exhibition of many photos of gruesome blast injuries. On occasion, he was observed smiling with his lawyers and appeared to have flashed an obscene hand gesture at a surveillance camera.
In the end, most of the jurors were not persuaded by the idea that Tsarnaev's late brother manipulated him into placing a live bomb. It would be interesting to know if the few who did believe that Tsarnaev was pressured were themselves swayed by the neuroscientist's testimony. Ultimately, the psychological narrative of a young, committed terrorist prevailed.
The post The adolescent brain defense: The Tsarnaev death sentence and beyond appeared first on Reason.com.
]]>Now, in the sentencing phase of the trial, the defense called Jay N. Giedd last week. Geidd, chief of brain imaging in the Child Psychiatry Branch, National Institute of Mental Health, is a prominent child and adolescent psychiatrist who specializes in brain imaging.
As we predicted in our earlier post, the expert witness described the development of the prefrontal cortex, the area instrumental in planning, impulse control, and judgment, relative to the limbic, or emotion-regulating, systems of the brain. Dr. Giedd indicated that the average teen's prefrontal cortex—recall, Tsarnaev was 19 when he participated in the bombing—is only half as developed as it will be by the time its owner reaches his late twenties. As a result, the capacity of the prefrontal cortex to override the aggression or excitation mediated by the limbic portions of the brain tends to be weak during the adolescent years.
Dr. Giedd also spoke of teens' predilection for choosing smaller, short-term rewards over long-term gains: They are "less worried about longer-term consequences." The implication here is that Tsarnaev's brain, like all teen brains, was especially sensitive to pressure by peers and loved ones. The approval of his domineering older brother Tamerlan, this narrative suggests, was made even more compelling for Dzohkar because of the way his brain functioned.
On cross-examination, though, Dr. Geidd acknowledged large variations in brain development across individuals. He further granted that "Even under age 10, they can do quite well with planning and consequences" and that there is much we don't yet know about drawing strong connections between features of the brain and a given teen's behavior. Trying to grasp the brain's complexity, he noted, is "humbling business."
It is also humbling to try to infer a killer's state of mind—that is, his motives and understanding of right and wrong. Here, the immature brain strategy loses much of its force: still developing or not, teens' basic moral schema are formed well before age 19. One does not need a fully formed brain to know that blasting nails and ball bearings into a crowd has lethal and personally tragic consequences. Any nine year-old who is not intellectually deficient grasps the finality of death and understands that killing innocent people is wrong. Although many teens might impulsively go on a joy ride or two with older friends or foolishly stay out late the night before a morning exam, virtually none seriously consider murdering others, let alone undertake the act of doing so.
How did the jury seem to respond to the information about the teen brain? We can't tell from news reports whether the defense invoked vivid brain images (though we imagine that such exhibits would have been noted in the press coverage), but according to Jack Lepiarz, WBUR reporter, the testimony on the teen brain did not seem "sexy" relative to the gore-filled exhibits of jagged wounds and torn limbs presented by the prosecution during the guilt phase.
But how much influence would images wield if they had indeed been shown? During the earlier days of neurolaw, judges and prosecutors worried that brain scans would be too compelling, or "prejudicial," to juries. That might have been the case a decade ago when multi-colored brain scans were a novelty in media coverage. Perhaps by now, however, many laypersons have become inured to them.
Recall the case of Herbert Weinstein discussed in the previous post. He was the executive who strangled his wife during an argument and then pushed her out the window of their Manhattan high-rise to make her death look like a suicide. Weinstein, as we noted, was discovered to have a large fluid-filled cyst in the right orbitofrontal cortex. Reportedly, the prosecutor was not impressed with the hypothesis that the cyst led him to commit murder, but he agreed to a plea deal because he thought the jury would be persuaded by the images.
In a 2009 case of an Illinois defendant named Brian Dugan, the judge, too, was concerned about the prejudicial power of brain scans. Dugan faced the death penalty for the kidnapping, rape, and murder of a 10-year-old girl. To vacate his death sentence, the defense team turned to fMRI to buttress the claim that he was a psychopath, a morally disabled man whose sickness was such that he could not feel right from wrong or that he did not care about the distinction.
As a psychopath, Dugan would have known that killing and raping an innocent person was against the law, but he would have been poor at empathizing emotionally and perhaps even regarded the misery he'd inflicted on others as being "their problem, not mine." Under testing conditions, Dugan's fMRI showed diminished activity in the "paralimbic system," an interconnected set of emotion-processing structures in the brain.
At trial, however, the judge did not allow the psychologist called by the defense, Dr. Kent Kiehl of the University of New Mexico, to display scans of the defendant's abnormal paralimbic activity; he worried that they might confuse or mislead the jury. As a compromise, he allowed Kiehl to show jurors a diagram of the findings and to explain their meaning. In the end, the jury was unmoved and sentenced Dugan to death.
In the courtroom there are, of course, so many variables that impinge on jurors' views: the quality of the lawyering, the strength of witness testimony, the appeal of the defendant himself, and so on. In controlled lab studies, scientists have explored whether brain images can seduce participants into accepting logically flawed statements, but the findings have been mixed. Other work on prospective jurors suggests that scans may sometimes, but not always, lessen the amount of punishment participants mete out to presumed criminals. The scans, it seems, hold less persuasive power than neurobiological language to dampen observers' intuition about blaming the perpetrator.
Some scientists argue that brain-based explanations of immoral or antisocial actions are effective antidotes against stigma. If people view mental illnesses as diseases of the brain, their reasoning goes, they may be less likely to blame offenders for their misbehavior. Research supports this possibility but there is a largely unappreciated flip side: attributing people's bad behavior to bad brains (or genes) rather than poor character or a bad childhood leads others to believe that these individuals are more dangerous and resistant to treatment or rehabilitation. Biological explanations of mental illness and addiction further fuel pessimism about the likelihood of recovery and the effectiveness of treatment.
Thus far, then, it would appear that its influence on the jury may well have been minimal. If so, this is all for the good. No game-changing information was imparted by the neuroscientist's testimony last week. For one thing, the testimony was about teens as a group, not about Tsarnaev himself; nor was it about a defect per se. Also, his crime has a compelling psychological explanation that no neuroscience story can readily explain away.
Nor did his testimony tell us much that psychologists—and many parents—have not already known for decades, namely, that many adolescents prioritize short-term rewards over long-term punishments. Tsarnaev was almost certainly influenced by his brother and swayed by his emotional appeals, but he repeatedly elected to follow his brother's directives. His efforts were planned and protracted, and his actions sustained by a set of internally consistent, if profoundly hateful, beliefs. Tsarnaev's story is a human tragedy, a tale of devastating personal choices about which developmental neurophysiology has precious little to add.
The post Neuro-expert testifies for Tsarnaev appeared first on Reason.com.
]]>Dzhokhar Tsarnaev, convicted earlier this month in the 2013 Boston Marathon bombing, faces the death penalty on 17 separate counts. Later this week, according to the Boston Herald, his lawyers will call a neuroscientist—perhaps the first of several—as a witness. Almost certainly this will be part of a strategy to show that Tsarnaev, who was 19 when he committed the crime, possessed an "immature teen brain," which made him especially susceptible to the influence of his deceased radicalized brother, Tamerlan.
By saying that Tsarnaev possessed an "immature teen brain," the defense is citing a well-established neuroscientific finding that the killer's brain, like all teenage brains, was still in a formative stage. Indeed, researchers have shown that the human brain is not fully developed until the mid-20s.
The "immature brain" and its implications for reduced culpability has become a staple of the juvenile justice movement. The National Juvenile Justice Network has asserted that brain science "gives advocates and lawyers working on behalf of juveniles scientific proof for their claims."
At least five percent of all murder cases that go to trial feature the introduction of have neuroscience evidence, according to Nina Farahany, professor of law at Duke University. Ten years ago, that percentage was less than 0.01 percent. Fully 24 percent of capital cases invoke neuroscience as part of a mitigation strategy.
Here are two classic examples of functional imaging used in a legal context:
One is the case of Herbert Weinstein, a retired executive. In 1991, he killed his wife in a pique and threw her body out the window of their Upper East Side Manhattan apartment. In a positron emission tomography (PET) scan, Weinstein's left frontal lobe showed a gaping black void the size of a quail egg. It was a fluid-filled cyst that had formed within the weblike tissues surrounding the brain. Over many years, the cyst had expanded slowly into the underside of the frontal lobe, displacing and compressing brain tissue that in the scan glowed red and green, colors representing regions of "hypometabolism," or decreased energy use.
According to the defense, this compression produced a severe impairment in Weinstein's ability to appreciate the difference between right and wrong. In contrast, most radiologists who examined the evidence concluded that Weinstein's cyst exerted little effect on the functioning of his brain. When surgeons offered to remove the cyst, Weinstein declined. Nonetheless, the judge decided to admit some of the neurological evidence at trial. Prosecutors then agreed to let Weinstein plead guilty to manslaughter; he was sentenced to seven to 14 years. During his time in prison, Weinstein was a model prisoner. Some scholars theorize that the prosecutors allowed a plea because they worried that the scans would be unduly persuasive to a jury.
The second is the case of a 41-year-old school teacher who developed a strong interest in child pornography and uncontrollable sexual urges (including impulses toward his step-daughter) following the appearance of a tumor in his right orbitofrontal cortex. Doctors excised the growth, and the patient's pedophilic urges disappeared completely. Yet a year later, his sexual appetite returned. Sure enough, a brain scan demonstrated that the tumor had grown back. The tumor was almost certainly a cause of the teacher's intense sexual urges; at the very least, it probably released a brake on a preexisting desire. After the tumor was found, the teacher was not held responsible for violating the terms of a pre-scan conviction for child molestation.
In both of these cases a single defendant's criminal behavior was attributed to an organic defect that led, the defense argued, to uncontrollable deficiencies in the person's capacity to make choices or exercise his self-control. The immature brain defense, however, is another matter altogether. This defense is applied not to a given defendant's brain but rather to an entire class of brain—the adolescent brain.
The first high-profile application of the immature teen brain arose in a landmark 2005 U.S. Supreme Court case, Roper v Simmons. At age 17, Christopher Simmons broke into a home and surprised the resident, Shirley Crook, whom he killed by taking her to a wooded area and shoving her, bound and gagged, into a river.
Simmons's defenders traced these actions to the neurobiology of the typical adolescent brain. In a joint amicus brief, the American Medical Association, the American Psychiatric Association and other organizations explained that the adolescent reward system is more sensitive than that of an adult. As a result, teens find sensation-boosting and pleasurable activities, including the approval of peers, extremely compelling.
In Simmons, the Court ruled five to four that executing people for a crime they had committed as a minor violates the constitutional ban on cruel and unusual punishment. Subsequently, in Graham v. Florida in 2010, the Court banned sentences of life without parole for juveniles convicted of nonlethal crimes. In a 2012 majority ruling against mandatory sentencing of life without parole for juvenile killers, the majority cited neuroscience.
These decisions for those under 18 make sense. After all, adolescents' personalities are less formed than adults', less predictive of their life-long character and often more amenable to treatment. Moreover, depriving teens who murder of the possibility of parole not only denies them education and training in some prisons but also robs them of an incentive to improve themselves.
These facts are compelling, but they have one thing in common: They are the products of social and psychological investigation and experience, not brain science.
So, why invoke neuroscience when it adds little and arguably nothing to the scientific picture? For rhetorical effect: Numerous studies reveal that claiming "my client's brain made him do it" weakens ascriptions of responsibility in a way that "his lousy childhood made him do it" does not. To many laypersons, neurological terms suggest largely fixed internal processes that lead inexorably to only one behavior; some data suggest that vivid brain scans may bolster the thrust of such mechanistic explanations.
In the case of the adolescent brain, the mechanisms revolve around several well-established observations about the rates at which certain neural tracts and brain regions develop. In short, the neural communication between the prefrontal cortex (a brain region needed for decision-making and impulse control) to the amygdala (an area that helps to mediate fear) is still being refined. And the nucleus accumbens, which is involved in motivation and reward, is more sensitive in teens than in people in their mid-20s.
In all likelihood, the jury will be shown impressive-looking Technicolor brain scans. But what they will see is merely a biological retelling of a well-established behavioral story. Volumes of data on teen behavior and cognition already tell us that when adolescents consider their options for action under calm circumstances, they make decisions that are comparable with those of adults, but when peer pressure enters the picture, they are more likely to choose rashly.
What's more, the defense will not be talking about a particular neural or mental condition of Tsarnaev as a young man, but of teens as a class. How many teens are murderously violent? Extremely few. And although they might skateboard down railings and not plan well for their SATs, deliberately causing bloody mayhem in the name of a cause requires a moral mindset that transcends the impulsive acts of your average teen.
To be sure, there are rare occasions when a defendant who is severely mentally ill possesses a defective brain that impedes his or her ability to exercise control or reason, or to form intent or be deterred -the legal requirements for criminal responsibility.
Critically, however, today's brain images alone can't tell us who these teens are. If brain scans are to play a scientifically legitimate role in determining criminal responsibility of a defendant or in reducing a defendant's sentence, they need to be able to assist us in answering legal questions. That means, at bottom, that these scans must be amenable to being deciphered in such a way that they bear narrowly on potentially excusing or mitigating mental states, such as damaged capacity for reason or an impaired ability to form intent or exert self-control.
Thus far, no brain scans have been able to do this.
In the next posts, we will discuss brain scans and the courtroom more broadly and how they have been used in other cases. We'll also comment on expert witness testimony regarding the adolescent brain.
Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute. Scott O. Lilienfeld is a professor of psychology at Emory University. They are the authors of "Brainwashed—The Seductive Appeal of Mindless Neuroscience" (Basic, 2013).
The post The 'immature teen brain' defense and the Dzhokhar Tsarnaev trial appeared first on Reason.com.
]]>The letter voiced a second powerful warning: not to mistake normal reactions–intense sadness or sleeplessness, jumpiness, and so on–for mental abnormality. The letter was posted online and picked up by a New York Times science reporter who fast-tracked the controversy into Sunday's paper, five days after the attacks. As Gerald Rosen, a Seattle psychologist and one of the letter's authors told the reporter, "The public should be very concerned about medicalizing what are human reactions."
By then, though, the trauma industry had shifted into high gear. Roughly 9,000 counselors raced to lower Manhattan, advocating, in the words of one observer, "intervention for any person even remotely connected to the tragedy."
Spencer Eth, a psychiatrist at St. Vincent's Catholic Medical Centers in New York City, foretold "huge increases in the prevalence of traumatic grief, depression, post-traumatic stress disorder [PTSD], and substance abuse in the New York City metropolitan area at the least…[the] psychiatric toll will be enormous." Richard Mollica, a Harvard psychiatrist, forecast that "starting around the Thanksgiving holiday and through the New Year, a major mental health crisis will emerge in the city and surrounding area." The president of the New York State Psychiatric Association predicted that psychiatric problems would continue to emerge over several years, including among those who were watching television coverage of the attack.
Granted, these urgent statements were made soon after the attacks, while our collective nervous system was still reverberating from the shock. Yet weeks and months later, when cooler heads might have prevailed, the warnings remained frantic and grim. In June 2002, for example, the Office of Mental Health projected that two million New Yorkers, or one in four, would need counseling. And one year after the attack, the president of the Washington, D.C., Psychiatric Society was still worried about mental health manpower: "There are not enough psychiatrists, psychologists, social workers, or other crisis counselors to treat the fallout from a massive, unimaginable horror."
The dire predictions of psychological injury prompted a Washington Post reporter to correct the misimpression: "Even though it is commonly believed that post-traumatic stress disorder is universal among trauma victims–a fallacy that some mental health counselors are perpetuating in the aftermath of this tragedy–epidemiological studies show otherwise." In response to the apprehension about whether people could cope, a skeptical reporter with USA Today was finally forced to ask, "Does everyone who goes through trauma need a therapist?"
The answer, of course, is no.
The Trauma Industry
Therapism is a worldview that valorizes openness and emotional self-absorption; it assumes that vulnerability, rather than strength, characterizes the American psyche, and that a diffident, anguished, and emotionally apprehensive public requires a vast array of therapists, self-esteem educators, grief counselors, workshoppers, healers, and traumatologists to lead it through the trials of everyday life.
In fact, there is no evidence that large segments of the population are in psychological free fall. On the contrary, researchers who follow the protocols of social science find most Americans–young and old–faring quite well. If they're crashing and burning, they don't seem to know it. This has proven true even in the wake of terrible disasters.
Trauma counseling flowered with the Oklahoma City bombing of 1995–where counselors reportedly fought over patients "because there were simply not enough to go around"–and the TWA Flight 800 air disaster of 1996. After the Columbine High School massacre in 1999, counselors logged 1,500 hours talking to students in the first week alone, according to Time. This "psychological debriefing" involves a counselor–who has never before met any of his victim-clients–conducting group-therapy with those individuals for a few hours, encouraging them to emote. Typical questions include "What were the first thoughts that raced through your mind at the time of the crisis?" and "What was the worst moment for you?"
This bears little resemblance to its precursor: military operational debriefing. After a significant battle in World War II, soldiers were "debriefed" by their superiors. The aim was to establish what happened for historical purposes, identify plans that had gone awry or well, share experiences, boost morale, and facilitate troops' rapid return to duty. The mitigation of distress was a welcome byproduct, but operational debriefing was not designed as a psychological aid.
In the 1960s and 1970s these frontline principles were translated into peer-to-peer support activities for rescue workers. Firefighters, paramedics, and other emergency workers who routinely witnessed horrible scenes of carnage and risked their lives in the line of duty would gather to review the logistics of an operation and talk about their experiences.
Over time, the debriefing process was extended to civilians. As a form of psychological first aid, it joined–and sometimes displaced–traditional crisis work, which had grown out of crisis theory elaborated in the 1960s. The basic tenets of crisis theory are that people who have endured a life-threatening event are not sick and that crisis intervention is not necessarily a mental health service. The main job of a crisis worker or counselor is to help the client find concrete, realistic solutions to the problems created by the event.
This perspective differs fundamentally from the more recent model created by Jeffrey T. Mitchell, a former paramedic and firefighter. In the late 1980s Mitchell began to market his crisis philosophy that virtually all victims are at risk for trauma-induced mental illness. If crisis workers shore up people who are basically sound though temporarily in disarray, psychological debriefers give a mixed message. On one hand, they tell victims that stress reactions are normal, and yet warn that without their intervention such reactions can easily blossom into PTSD.
All manner of setbacks qualify a worker for psychological help. According to Psychotherapy Finances, a newsletter for entrepreneurial therapists, "workplace trauma isn't just about bank robberies or shooting sprees…for every high-profile incident there are thousands you never hear about." When a tasteless cartoon about firemen appeared in the New York Post two years after the attacks, the Fire Department of New York City sent counselors to a company that had lost men on 9/11. "We wanted to make sure the guys were all right," a FDNY official told the New York Daily News.
Business and corporate managers have jumped on the psychological debriefing bandwagon, persuaded by its purveyors that without their help productivity will suffer and mental health costs will soar. Organizations that do not offer debriefing for workers exposed to on-the-job trauma "may put themselves in medical-legal jeopardy," warns Landy Sparr, a psychiatrist at Oregon Health and Sciences University. Some psychologists even tell employers that they have 48 hours to act after a disaster, otherwise employees may "jump ship" or "come down against the company."
Trauma Tourism?
The International Critical Incident Stress Foundation (ICISF), based near Baltimore, is the largest psychological debriefing training outfit in the world. With a virtual monopoly on debriefing training, ICISF appears to be prospering both at home and abroad. Its clients include the FBI, the Coast Guard, the American Red Cross, and U.S. Air Force bases worldwide. It has training programs in Canada, Europe, the Caribbean, Central and South America, and Australia.
Anyone with a high school diploma is eligible for the foundation's course. In some circumstances, an ICISF certificate grants the bearer access to disaster sites that an advanced clinical degree does not. For example, in 1995 a group of psychiatrists from Yale that included respected experts in traumatic stress offered to help with victims of the Oklahoma City bombing. Emergency officials turned them away because they lacked certification from the International Critical Incident Stress Foundation.
The certificate, then, doubles as a coveted passport to disaster sites–even though it is awarded to anyone who has paid the $190 course fee and shown up for the lectures. Is it any coincidence that critics of the crisis management business have taken, tongue-in-cheek, to calling volunteer crisis counselors "trauma tourists"? There is no doubt that the volunteers are well meaning, but neither is it any secret that some of them have a voyeuristic urge to be part of a historic moment or a media event.
"Disaster vultures" was the name given to overly enthusiastic mental health professionals who rushed into the scene at the Oklahoma City bombing in 1995. "Their credibility in the future would be their claim to have worked in Oklahoma City," a dismayed local psychologist observed.
Psychological debriefing is an enterprise that has operated outside of conventional clinical boundaries and oversight. Richard Gist, a psychologist with the Kansas City, Missouri, fire department and an outspoken critic of the trauma industry, describes it as a prolific and parochial subculture of providers whose understanding of these highly complex issues is often limited to proprietary instruction in the form of traveling seminars, trade magazines, and paperback books, rather than the refereed venues of empirically guided professional practice.
In the summer of 2002, one of us (Satel) spent two days in a frigid hotel ballroom outside Baltimore with about 200 men and women–nurses, social workers, rescue volunteers–seeking ICISF certification in the basics of crisis counseling. Much of what the instructor said was obvious: that routines should be preserved after a crisis,
that too much alcohol is bad, that depriving yourself of sleep is unhealthy, and so on. The "experts" had appropriated common sense as if it were their own special province.
Then came a session on psychological debriefing, also known as critical-incident stress debriefing–the centerpiece of trauma counseling. Our instructor acknowledged that debriefing had come under attack, but promptly dismissed the critics, maintaining that psychological debriefing was proven to thwart the development of PTSD.
The instructor peppered us with a series of half-truths and outright misstatements. We were told, for example, that PTSD "rarely goes away by itself," that there are no factors that predispose a person to develop PTSD, and that people who "hold it in do worse"–all untrue statements. The course manual stated that debriefing compensates for "the failure of the [victim's] usual coping strategies." Moreover, unless psychological debriefing took place soon after the crisis, a "trauma membrane" would form around the victim and "thicken" so that he would no longer be receptive to help. (Ironically, the psychiatrist Jacob Lindy, who treated survivors of the devastating Beverly Hills Supper Club fire outside Cincinnati in 1977, coined the term trauma membrane to describe not a debriefing-resistant cocoon but a small network of trusted friends who buffer the victim from additional stress. A properly functioning trauma membrane, in Lindy's sense, might well act to keep debriefers away.)
We also learned how to conduct a psychological debriefing by breaking up into groups of eight. Each group was provided its own tragic scenario. In ours, we were supposed to be telemarketers busy on the phones one morning when an employee's drunk and jealous ex-husband burst into the work area with a gun and shot one of us in the shoulder. After the injured worker was taken away in an ambulance, the rest of us gathered to be debriefed by our eighth colleague, who was assigned the role of an outside debriefer. Following the directions in our course manual, the role-playing debriefer encouraged us to talk about how scared we were, rehashing in the most graphic language how the blood had spurted from our colleague's wound, how we had panicked and had thought we would all be killed. This was our "opportunity for catharsis, an opportunity to verbalize trauma," said the manual.
First, Do No Harm
Such opportunities are precisely what the 19 psychologists' open letter warned about when it spoke of therapists "descending on disaster scenes with well-intentioned but misguided efforts." And with good reason. Research shows these efforts at debriefing to be ineffective in preventing the development of PTSD or related symptoms, and, at times, to actually be harmful.
Most random-assignment studies of individuals who have suffered accidents, assaults, or burns show the same degree of improvement, whether patients were debriefed in a one-on-one session by a therapist or instead received general support or no intervention at all. Two such studies, however, found that debriefing actually impeded recovery. In one, debriefed burn victims were three times as likely as the control group to develop PTSD after one year. In the other study, a three-year follow-up of car accident victims, anxiety, level of functioning, physical pain, and degree of preoccupation with the accident improved more slowly in the debriefed patients than in the control group.
Britain's National Health Service, the North Atlantic Treaty Organization, and the World Health Organization all cautioned against the use of debriefing as possibly harmful. In the fall of 2002, the National Institute of Mental Health (NIMH), in collaboration with the Red Cross and the U.S. Departments of Defense, Justice, and Veterans Affairs, released a report on psychological interventions in the wake of disaster. "A sensible working principle in the immediate [aftermath] is to expect normal recovery," said the report.
How can debriefings make things worse? First, venting emotions and reviewing experiences repeatedly in the immediate aftermath of a crisis can interfere with victims' natural adaptive instinct to distance themselves emotionally. They may start ruminating about the event–fixating on why it happened, how life is now ruined, whether revenge is possible–thus intensifying intrusive memories and overall distress.
Second, debriefing might lead people to believe that they have now received "treatment" for distress and no longer need to, or should, disclose their anxieties to family and friends. This deprives victims of the comfort and reassurance that are usually best supplied through established, intimate relationships. Paradoxically, knowing that professional debriefers are involved may even cause family and friends to hang back.
Third, by warning participants of the kinds of reactions that could develop over the coming weeks, debriefers might inadvertently prime victims to interpret otherwise normal reactions as pathological or as the beginning stages of PTSD. As the psychiatrist Simon Wessely has remarked, "The toxic effect of counseling is that some people begin to see themselves as having a mental health problem when they do not."
Where Are All the Patients?
In October 2001 Sharon Kahn, a senior psychologist at Coney Island Hospital, manned the phones at a televised call-in show sponsored by PBS and called Reach Out to Heal. Experts described the symptoms of traumatic stress, and viewers were urged to phone in with questions and to get referrals for help.
Kahn took calls all evening. She referred a grand total of two people for therapy. The vast bulk of the calls were queries about the resumption of regularly scheduled programming.
Across the country, mental health professionals braced for epic caseloads after September 11. Yet in the end, the demand for their services was modest. According to the New York Academy of Medicine, which conducted numerous surveys after the terrorist attacks, roughly 19 percent of New Yorkers said they saw a mental health professional within the eight weeks after the event–but this was little more than the 17 percent who did so eight weeks before the attack. "Existing therapeutic relationships and informal sources of support were the primary mental health resources for most people within the first few months," according to Dr. Sandro Galea of the Academy.
According to an Academy study published in 2004, there was no evidence that the predicted waves of delayed PTSD were surfacing, at least within the first five months after the attacks. Mental health service use declined steadily within the first five months after attacks to virtually pre-9/11 levels. "The increase was not clinically significant," Dr. Joseph A. Boscarino, the study's lead author, told The New York Times, "We expected higher use rates."
For about a year after the attacks, star-studded public service announcements were ubiquitous in subways, buses, and newspapers around New York City. "Whatever you are struggling with, you are not alone," the actor Alan Alda intoned on radio stations serving New York City. "Now is the time to feel free to feel better." The ads were sponsored by Project Liberty, the name given to the crisis counseling program in New York City funded by the Federal Emergency Management Agency (FEMA) and run by the New York State Office of Mental Health.
Project Liberty's four thousand counselors offered reassurance and advice. They met with groups of people and with individual clients. They made house calls, arranged to meet clients on park benches or at their workplaces. When the New York State Office of Mental Health applied for its first FEMA counseling grant right after September 11, it estimated that 1.5 million New Yorkers would need counseling. A grant of $23 million came through promptly in October. As of June 2002, about 120,000 had sought assistance, not even one-tenth the projected number. Yet around that time, FEMA announced another grant, of $132 million–nearly six times as large–in response to a second request for counseling funding. This time, the Office of Mental Health projected that two million New Yorkers, or one in four, would need counseling ("to allow necessary healing to continue").
In the late spring of 2003, about a year after the second FEMA grant was awarded, $90 million remained unspent, according to the New York Daily News. Recruiting clients was a priority. "In New York City," said Rachel Yehuda of Mount Sinai School of Medicine, "the strong feeling was that if [the clients] don't come to you, you've got to go to them. The idea was to institute portable Project Liberty units of people to walk the streets looking for people to help." In the winter of 2002 Lynne Rosen, a psychotherapist in Brooklyn, got a part-time job offer in just that spirit. She was contacted by a representative of a Queens-based mental health center to "reach out" to the traumatized residents of Brooklyn and Staten Island. The center would pay her with funds obtained from Project Liberty. Rosen's assignment was to sit in the waiting room of a general practitioner's office and approach patients as they came in for their medical appointments. She was to ask them where they had been on September 11 and whether they were having any psychological problems because of it. If so, she was to refer them to a center therapist.
The center wanted Rosen to talk to the patients about PTSD, she said, "even if they responded to the question about symptoms with a definite no." So she asked the center's representative how he justified such aggressive conduct. "'We all continue to be deeply affected by September 11,' he told me indignantly," Rosen said, "and he lectured me that future psychiatric symptoms could still develop." Rosen turned down the offer because she could not picture herself "accosting these unsuspecting people and burdening them with unnecessary anxiety about an event that happened over six months ago and that they said did not have a lasting effect on their well-being."
Private charities made mental health services a priority after September 11. They "have taken perhaps the most aggressive stance ever in pushing mental health therapy for families and others affected by the attacks," noted The Washington Post. In the summer of 2002 various New York City?based charities, along with the Red Cross, announced combined grants of almost $250 million over five years (including the FEMA support) to "address the enduring problem of psychic damage–grief, stress, trauma–in the aftermath of September 11." A year later these same charities announced a collaborative effort "to encourage people affected by the 9/11 attacks to take advantage of financial assistance for confidential mental health and substance abuse assistance."
Pessimism, Pathologizing, and Profiteering
This money was pouring forth even as evidence consistently showed that most people were improving with time. Polls taken by the Pew Research Center, the Marist Institute for Public Opinion, ABC/Washington Post, and RAND within six months of the attacks all showed declines in problems such as sleeplessness, trouble concentrating, and intense worry about future attacks. Volumes of data on traumatic response confirm that rates of stress and PTSD decline with time.
Why did the money keep flowing? Partly because mental health planners, lacking data on nonpathological responses to terrorist attacks, relied on models that were inappropriate–chiefly from the Oklahoma City bombing and other mass disasters where death or injury was widespread. The victims of such events bore little resemblance to the vast majority of New Yorkers, who, while deeply shaken, even devastated, were never in mortal peril.
In addition, officials believed more people would use trauma services in the future. "Based on our experience, we know that thousands more need these services but have not come forward," the administrator of the American Red Cross's September 11 Recovery Program announced. Once they recognized that they needed help or got over their fear of being criticized for seeking it, the assumption was, many more New Yorkers would be getting therapy. Fully three years after the attacks, the Mental Health Association of New York City was still advertising counseling services for reactions to 9/11.
Continued funding was also justified by the expectation that symptoms had yet to manifest themselves. Joshua Gotbaum, the chief executive of the September 11th Fund, informed the public that "many people affected by September 11 will need some form of counseling and that many of them will not realize it for months or even for years." Dr. Paul Ofman, chairman of emergency services at the Red Cross in Greater New York, also expected to see delayed reactions: "While for some people, the impact on their mental health is evident right away," he told The New York Times, "for a noteworthy minority of individuals, the impact won't become evident until months or even years after the disaster."
Finally, money flowed because service providers were eager to take it. Daryl Regier of the American Psychiatric Association issued a canny prediction when he told the Times, "There are going to be people coming out of the woodwork to capitalize on this large amount of money that's available, some of whom will be completely legitimate." And, Regier added, some of whom will not be. As Reuters reported, "A whole new era of mental health services could be opening up for longer-term care [for stress relating to the terrorist attacks] in what could be a boon for individual counselors and the companies who act as industry middlemen."
Ending an Ethos of Therapism
In New York City on September 11 there was a strong, spontaneous show of collective resolve and organization. Near Ground Zero, members of one tenant association helped direct the streams of people running from the World Trade Center; they formed an "urgent needs" team to check on homebound residents; they acted as volunteer cashiers in stores when paid employees could not get to the area. The calm and orderly behavior of workers evacuating the World Trade Center towers themselves surely kept the death and injury tolls from rising. In the largest waterborne evacuation in our history, half a million people left lower Manhattan. Barges, sailboats, and ferries, with no instructions, put into the port as the towers burned. "If you're out in the water in a pleasure craft and you see those buildings on fire," the Rutgers sociologist Lee Clarke said to The New York Times, "in a strictly rational sense, you should head to New Jersey. Instead people went into potential danger and rescued strangers."
According to the sociologist Henry Quarantelli, a pioneer in the field of disaster research, such constructive responses are typical. "Mythical beliefs to the contrary," he writes, "disaster victims do not panic, they are not passive, they do not become caught up in [selfish and] antisocial behavior, and they are not behaviorally traumatized." Monica Schoch-Spana, a medical anthropologist with the Johns Hopkins Center for Civilian Biodefense Strategies, laments the predominance of the "pathological model." So often, she says, officials and mental health planners neglect the positive human elements that crisis elicits, such as "reasoned caution, resourcefulness, adaptability, resiliency, hopefulness, and humanitarianism."
In our trauma-conscious society, many mental health professionals seem eager to take charge of managing the collective anxiety surrounding terrorism and its aftermath. But perhaps one of the lessons from September 11 is that the clinician's role in a shocked and heartbroken world is actually quite limited.
Consider what we know about human response to crisis. Under threat, citizens are ravenous for information and require practical resources. They need a social scaffolding in the form of civic order and some minimal infrastructure to support the bedrock institutions and relationships–families, communities, and houses of worship–that have always served them in times of uncertainty and immense sorrow.
One of the lessons of 9/11 is that therapists must find a balance between offering their services and promoting them too eagerly, between letting people know help is available and suggesting that they need help when they do not. On September 11 the helpers toiled in good faith, powered by genuine concern. But they also endorsed one of the mistaken tenets of therapism: that people are fragile. In their zeal to help, they underestimated our natural fortitude.?
The post The Mental Health Crisis That Wasn't appeared first on Reason.com.
]]>