Keith Rose looks at a risk instrument that is fundamentally flawed and cannot be used as a measure of what an individual may do in the future.
Is your budgie a psychopath? How would you tell? What is a psychopath? The Oxford English Dictionary defines ‘psychopathy’ as follows; psychopathic personality; an antisocial personality characterized by the failure to develop any sense of moral responsibility and the capability of performing violent or antisocial acts.
How do you diagnose a psychopathic budgie? Qualified, well trained psychiatrists state: 'conduct a series of risk assessments over a reasonable period of time to enable suitable treatment to be decided on and then carried out'. Prison Service psychologists' state: 'ask questions around 20 main headings … and psychopathic budgies are untreatable anyhow'.
The psychologists 'magic questions' come from the Hare ‘Psychopathy Check List’ (revised). The Hare PCL-r is centred on questions under 20 headings which determine if an individual can be classed as a psychopath. Each heading scores up to 2 points, giving a maximum score of 40. Any score above 28 in Texas reputedly incurs the death penalty in murder cases. It is frequently used in the UK prison service just before a prisoner or long term mental patient is about to be released. The bulk of the items scored are historic and cannot change, so use of this test as a predictor of future behaviour automatically rules out the possibility of change; a 20 year-old subjected to the Hare PCL-r would carry an unchanging score for the rest of their lives.
Professor Robert Hare, the author of the Hare PCL-r, highlights the fundamental flaw which leads to his test being widely misapplied, if not actually abused, as follows: "The use of the PCL-r in the criminal justice system ... sometimes leads to the conclusion that it is primarily a risk instrument rather than what it really is, a measure of a psychological construct". (Source: page 87, Technical manual PCL-r Ed. July 2005).
Legal authorities like parole boards obviously crave reliable indicators that a person under scrutiny presents a low risk of re-offending. What Professor Hare points out so succinctly is that use of the Hare PCL-r as a risk instrument is flawed; it cannot show intent; it cannot be used for risk assessment, a measure of what an individual may do in the future.
Nevertheless, that is exactly the use it is being put to by prison service psychologists, pure cod-psychology. Professor Hare sounds a further note of caution by stating that: "Whilst psychopathy is a clinical construct ... the factors responsible for psychopathy are not well understood" (Source: page 7, Technical manual PCL-r 2. Ed. July 2005). In other words, reliance on the PCL-r should not be considered absolute.
The PCL-r is also routinely used as a tool to identify prisoners said to be suffering from a ‘Dangerous, Severe, Personality Disorder’ suitable for admission to a DSPD unit. Pre-2002, if one scored over 30 one was labelled as 'psychopathic' suffering from DSPD. Post-2002, the score was lowered to 25. Curiously, the Home Office have consistently denied that the PCL-r result is a diagnostic tool, perhaps due to the fact that the Hare PCL-r tests are invariably conducted by trainee psychologists, usually unqualified and inexperienced, and prone to errors and mistakes.
So appalled by the use, abuse and misuse of the PCL-r in prisons was Dr Bob Johnson, former Head of Therapy at Ashworth Hospital and Consultant Psychiatrist to the Home Office, that he created an analysis of the medical and legal flaws in the PCL-r. This is available as a free download at 'www-TruthTrustConsent.com'. Moreover, anybody can purchase the full Hare PCL-r complete with question book, technical manuals and analysis books from 'Multi Health Systems' at 'www-mhs.com' from around £140.
The Hare PCL-r main headings:
Conceivably the most disturbing fact about the Hare PCL-r is the reliance on the opinion of the questioner, and the simple fact that no human can ever achieve a zero score.
Returning to the opening question: is your budgie a psychopath? Probably not, as it is a social bird usually living in a flock and not prone to random acts of violence. Cats, on the other hand, come close to the maximum score of 40, failing only on item 19, revocation of conditional release.
Other notable maximums of the Hare PCL-r include: George W Bush (for obvious reasons), Tony Blair (sectioned, not retired), Gordon Brown (vetoed prisoners’ pay rise), Michael Howard (something of the night), David Blunkett (obviously), anybody from Yorkshire (centuries of inbreeding) and the entire armed forces of the USA (collateral damage).
Hare PCL-r 2nd Ed. July 2005; Dr Bob Johnson MA, PhD, MBCS, DPM, MRCS, MRCPsych, MRCGP, Diploma in Psychotherapy, Neurology & Psychiatry (Psychiatric Institute of New York), Former Head of Therapy, Ashworth Hospital, Former Home Office Consultant Psychiatrist, The James Naylor Foundation 'Unsafe at Any Dose' 'Emotional Health' (ISBNs 0-95519851-8 & 0-9551985-0-X respectively); Panorama BBC 1, 3rd March 1997
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