Postcards from the Id

Risk Assessment - Prediction of Future Domestic Violence

My post the other day dealt with efforts to improve the ability to evaluate future risk of violence, based on an article indicating future trends may include biological/genetic markers as data points.  I read this article today which encourages the use of data already collected by medical facilities to try and determine who might be at risk for experiencing domestic violence.  The article indicates an analysis of data accumulated from over 500,000 patients over at least a four-year period yielded certain data points useful in the prediction of later victimization.  From the article:

Particular risk factors were strongly linked with a future diagnosis of abuse. The risk was highest after being seen in hospital or the emergency department for these events:

For women:

• injuries
• alcoholism
• poisoning

For men:

• mental health conditions such as depression and psychosis

The article I linked to did not offer any specifics regarding the statistics used, the predictive strength of the data, etc.  Regardless, for me the larger point is that with ever-increasing technology, there are larger, more sophisticated databases being developed and maintained (aka "data mining").  This data can serve all sorts of useful purposes in terms of giving clinicians direction in screening, treatment, etc.  In the research above, for example, a doctor at a hospital, normally under tremendous time constraints, may be alerted that a particular patient who has arrived at the emergency room meets the criteria for high-risk abuse victim.  The doctor may then screen this particular more thoroughly, or create an environment more conducive to the patient divulging the abuse, agreeing to a consult, etc.  The point is not that certain issues shouldn’t be screened with certain people; it is that with limited time and resources, we want to direct services and resources to individuals who need them most.  The ever-increasingly capacity to gather data allows for the identification of patterns, as well as to whom those patterns apply.

Star Wars Soundtrack and Favorite Music From Movies

As this post over at Wired shows, John Williams’s Star Wars music from Star Wars: A New Hope is consistently ranked at or near the top of every movie score survey (and rightfully so).  Williams perfectly captures the sense of wonder, adventure, and whimsy that was so strong in Star Wars, particularly given the immense impact the movie had at that time.  Dozens of sci-fi/fantasy/space opera movies have been churned out since 1977, but it was Star Wars that paved the way for this type of film, and the music was an important part of the reason.

I’ve read this elsewhere, but I agree: music compositions written for film seem to get the short shrift in terms of artistic credit.  Why this is, I don’t know, but it’s rare that a film score composer is ever mentioned as a great composer, period; it’s always qualified.  Seems ridiculous to me, since I really enjoy listening to the scores of many movies on my iPod, and many movies are far more memorable than they otherwise would have been if the music didn’t contribute so mightily to the overall experience.

In no particular order, here are a few movies besides Star Wars (off the top of my head) where I think the music score (not soundtracks!) played a significant role in the cementing of the movies’ reputation as a classic, or at least perfectly fit the theme and feel of the film:

1) Jaws
2) Rocky
3) Raiders of the Lost Ark
4) The Last of the Mohicans
5) The Bad News Bears
6) Blade Runner
6) Alien
7) Conan the Barbarian
8) Gladiator
9) Superman
10) Halloween

Not surprisingly, I have most of these on my iPod.  I also have other scores to movies such as Braveheart, King Kong (the Peter Jackson version), Gettysburg (extremely under-rated), The Dark Knight, Casino Royale, and Hoosiers, Wanted, and 300.  There’s a few others I’d like to get my hands on at some point, including Rudy, The Witness,   

Incidentally, you can look at the AFI list of the 250 movies nominated for best score of all time, as well as the 25 winners, here.  The list is quite interesting, especially because it dates my movie-watching experience as post-1975.  Sure, I’ve seen plenty of pre-1975 films, and would rank many in my all-time favorites list.  But when it comes to a more specialized list such as this, my thinking skews towards films I’ve seen in theaters, on awards shows, etc.  The only quibbles I have with the list is that several movies are listed that would seem to be far more memorable for their soundtrack than their score: these ought to be different lists.  The other problem is that Halloween is not on the list, while The English patient is this list, let alone on any list at all that doesn’t include the word “Crappiest” in the title.

In the meantime, I may write up something on my favorite soundtracks at a later date.  Brief preview: Swingers, Once, and Purple Rain will be in the mix!  And if anyone has a film score they think I've overlooked or might be interested in checking out, feel free to leave a comment.

Research Into Predicting Violent Behavior

Research into predicting future behavior, particularly violence and criminal recidivism, has been enormous over the last couple of decades.  To be sure, there as been tremendous improvement in figuring out the variables associated with an increased or decreased risk for future violent behavior, especially when compared to the old days of clinicians basing their opinions on impressions from interviews (which generally worked no better, statistically, than chance).  However, the ability to predict future violent acts is still a work in progress - no one can say for sure what any individual will do in the future; all a well-conducted evaluation can provide at this point is the risk level of an individual to act out in the future. 

Believe me, everyone involved in risk assessment would like even more precise tools and models than those currently available, even given the improvements over the last 10-20 years.  According to this article, inclusion of specific genotype levels may also play a role in assessing an individual’s risk of violence.  From the article:

Risk variables used in the analyses were antisocial personality disorder (ASPD), borderline personality disorder (BPD), the comorbidity of ASPD and BPD, childhood adversities, alcohol consumption, age, and the monoamine oxidase A (MAOA) genotype. In addition to these factors, the temperament dimensions were also assessed using the Tridimensional Personality Questionnaire (TPQ).

The MAOA genotype appears to have an interactive effect with age and alcohol use, according to the authors.  That is, if an individual’s MAOA genotype is found to be “high-activity,” then low age and a high degree of alcohol consumption will increase that person’s risk of violence.  On the other hand, if their MAOA genotype is considered “low-activity,” then age and alcohol do not impact the individual’s risk level.

The neurological advances in all of these areas are amazing (though this stuff is getting out of my area of knowledge).  The good news is that being able to identify genetic markers seems to be incredibly useful across a range of areas, and will likely continue to become easier to do over time.  Having more specialized knowledge about a person’s genetic make-up, along with behavioral markers that have been documented, will provide additional support for specific interventions, and not just in this narrow area (obviously, health care possibilities are endless).

As an example, if a child is exhibiting behaviors consistent with Conduct Disorder, and they prove to have genetic markers such as the one identified above, it may make sense to start addressing issues related to substance abuse in treatment, even if they haven’t met any formal criteria for alcohol abuse to this point.  Given that alcohol would pose a particular problem for this individual, attempting to head off later alcohol abuse before it leads to later violence may prove effective, especially for the individual in question.  A lot of this stuff will need to be sorted out as the science continues to progress in this area, and a body of ethical guidelines will need to be developed along with it in order to prevent an abuse of this science.  Otherwise, we may have some sort of genetic-screening version of Minority Report, where people are convicted of things they haven’t done based on what their genetic profile says they will do in the future.  No, we don’t want that.  But, being aware that certain combinations of genes, behaviors, and/or other variables will more lead to bad consequences, and providing interventions to head those bad consequences off, now that would be okay. 

But I Need My Big Mac Now!!!

 

Via Marginal Revolutions comes this link to Strange Maps, which has an entry addressing the number and locations of all of the McDonalds in the United States.  According to the site, the farthest point from the closest McDonalds is somewhere in rural South Dakota:

There are over 13,000 McDonald’s restaurants in the US, or about 1 for every 23,000 Americans. But even market penetration this advanced doesn’t mean that McDonald’s is everywhere. Somewhere in South Dakota is the McFarthest Spot, the place in the US geographically most removed from the nearest McD’s (*). If you started out from this location, a few miles north of State Highway 20 (which runs latitudinally between Highways 73 in the west and 65 in the east), you’d have to drive 145 miles to get your Big Mac (if you could fly, however, it’d be only 107 miles).

I also like the post's discussion of how closely the map of the various McDonald's locations mirrors that of the population at large.  Check out the link simply for the map, but here is the last paragraph:

Out west, the Arches are fewer and further between, with the exception of the heavily populated coastal areas. To achieve identical density to the rest of the country, this sparsely burgered part of the country would have to be sandwiched between them so that southern California and western Texas would almost touch, and Seattle would be a day’s drive from Minneapolis. The blackest holes in the western McTapestry are the Nevada desert, some mountainous parts of Oregon and Idaho, and the plains of South Dakota – home to the aforementioned McFarthest Spot.

Interesting post, and interesting site, especially if, like me, you enjoy maps.

Mental Exertion Decreases Motivation To Exercise

According to this study, using mental and emotional resources to solve problems or cope with issues at work decreases an individual’s ability to motivate themselves to exercise.  According to the authors of the study, using willpower to address one task leaves you with less willpower to tackle other tasks.  From the article:

Martin Ginis and her colleague Steven Bray used a Stroop test to deplete the self-regulatory capacity of volunteers in the study. (A Stroop test consists of words associated with colours but printed in a different colour. For example, "red" is printed in blue ink.) Subjects were asked to say the colour on the screen, trying to resist the temptation to blurt out the printed word instead of the colour itself.

"After we used this cognitive task to deplete participants' self-regulatory capacity, they didn't exercise as hard as participants who had not performed the task. The more people "dogged it" after the cognitive task, the more likely they were to skip their exercise sessions over the next 8 weeks. "You only have so much willpower."

The authors go on to note that using up cognitive resources is not an excuse to forego other healthy activities, such as exercise. Certain activities, such as listening to music, were reported to recharge one’s batteries, and making specific plans (like scheduling exercise every night at 7 pm) also counteracted this effect.  Willpower was also compared to a muscle, in that the more one uses it and exercises it, the more it develops. 

This seems to be a researched-based confirmation of what many people have intuitively observed.  Many people struggle with maintaining a diet, working out as scheduled, etc. when they are coping with situational stressors, such as crap at work.  In fact, the technical term for this concept in the research is ego depletion.  I'm not too familiar with the various areas in which this issue has been researched, but I do think that many people have observed edo depletion in their own lives.

I personally have found that once in a groove, I am able to maintain a pattern of diet an exercise for a significant period of time.  It’s only when I’m thrown off by some situational factor (such as travel) that the pattern gets disrupted.  Of course, it may then take awhile to get back into that groove.  I also wonder if people who exercise first thing in the morning have an advantage in this regard.  That is, they get their workout in before any stressor can impact their day.  As a clinician, I wonder to what extent ego depletion impacts therapeutic progress.  First, is the therapy session itself less productive than it otherwise might be (and to what degree) due to the will power being used by clients just to get through their day?  More generally, will clients have some difficulty applying what they've learned in therapy to their lives due to ego depletion?  Certainy something a therapist should take into account...

Mandatory Coffee Knowledge

Live Science has a brief post on the ten things you need to know about coffee.  Nothing in there about the potential increase in cognitive ability, but maybe they made the list before they drank their first cup of the day...

Wired’s Top-10 Geeky Movie Plot Holes

I thought this article was a lot of fun, especially since I remember thinking some of these very things when watching these movies.  “But, but, but how can...?” ran through my mind on more than a few occasions watching the films on this list.  The good news is that, when I was younger and took this sort of thing more seriously, these types of plot holes provided tons of fun debates and efforts to “solve” the problem. 

This post has generated a ton of responses in the comments section, many of them funny.  I’m glad someone answered the question a poster asked regarding Lord of the Rings: “Why didn’t Frodo just hitch a ride with the giant eagle, and fly to Mt. Doom to destroy the Ring?” Ahh, because, Young Grasshopper, The Eye was Always Watching!  Always!  Remember the 300 or so quick cuts to The Eye during the movies, showing it searching for the Ring all over Middle Earth?  Remember how The Nine were drawn to the Ring?  Remember how Gandalf, Aragorn, and the others led a last battle against Mordor in the hope that Sauron would take His Eye away from its search just long enough to give Frodo a shot at slipping through?  Anyway, that’s why - the eagle would have been spotted long before it had a chance to get Frodo to the drop point.

My favorite loop hole not on the list?  It’s from The Terminator movies, especially the first one.  When the Terminators time travel back to disrupt the events that lead to the existence of John Conner, why not go back to 1880, and kill his great-grandfather?  That way, there is no technology that could even conceivably be used to stop a terminator.  The only explanation I can think of is that the machines did not want to potentially jeopardize their own existence by tampering with history too early, where there would be less control over the subsequent impact.  But, I’m open to other theories (besides the idea that a terminator dodging 19th century technology from people on horseback would not have been nearly as entertaining a film).

Raising The Issue of Competency To Stand Trial

I’ve discussed this issue before, but since so much of my work involves assessing defendant’s competency to stand trial, I read a lot about various aspects of this issue.  I find it helpful to review even the basics, as having additional work experience often provides an opportunity to consider something I have already learned in a new light.

In this case, I’ve been reading parts of a new book on Competency Evaluations, Evaluation of Competence to Stand Trial, by Patricia Zapf and Ronald Roesch.  A well-written, detailed book, I’ve read a few sections to either refresh my memory on certain issues, or look for additional information.  In this case, I came across a brief section of book pertaining to raising the issue of the competency of a defendant.

This is pretty well-established law, according to everything I’ve read on the subject: the issue of competency must be raised by any officer of Court (that is, the judge, prosecution, or defense) if there is a bona fide doubt as to the defendant’s competence.  According to Zapf and Roesch, this standard was established by the Supreme Court in 1966, during the case of Pate vs. Robinson.  I’ve also heard of cases where the initiation of the question regarding competency has originated from pre-trial services staff (such as a pre-trial officer gathering background information), and in one case I heard about, it was a Spanish interpreter who informed the judge that the defendant was speaking Spanish, but wasn’t making any sense.

  The book notes (as have other books, and also what I’ve personally observed) that the threshold for establishing a bona fide doubt is low: virtually all courts will order an evaluation if the issue is raised.  The legal system wants a fair, accurate trial for the defendant, and judges do not want cases turned over on appeal.  According to Zapf and Roesch, the case Drope vs. Missouri (1975) noted three issues related to a defendant’s competency; if even one of these observations are made, it may be sufficient to warrant an evaluation:

1) a defendant’s irrational behavior

2) a defendant’s demeanor at trial

3) any prior medical opinion on competence to stand trial

In addition, it should be noted that these issues may warrant an evaluation at any point during the legal process.  That is, a defendant may be competent at the start of a trial; should his presentation or functioning change during the course of the trial, the necessity of an evaluation remains. 

Personally, I’ve observed that there is, in general, a fairly low threshold for referring a defendant for a competency evaluation, at least within the federal system.  I’ve had individuals sent for a evaluation who have no mental health or legal history, but presented as tearful during an appearance in court, and acknowledged they were depressed.  I’m not offering judgment either way in this respect; it is a judge’s decision whether an individual warrants an evaluation.  I also understand (and appreciate) that legal professionals generally acknowledge that the mental health knowledge involved with respect to issues related to competency, responsibility, etc. are beyond their training.  Requesting for an evaluation is often simply an acknowledgment that there is an issue present; while it may not be severe, non-mental health clinicians are not always aware of this.  As a simple example, some diagnoses sound pretty significant, even though they are not necessarily all that severe, or relevant to the issue of competency.   Of course, we still doa full evaluation of an individual’s competency to stand trial, but when a defendant is relatively healthy mental health-wise, there is generally less to assess than with a defendant who presents with multiple issues and a lengthy treatment history.

The only other observation I’ll note at this time is that I’ve come across a few questions from time to time about the high number of people found competent to stand trial, when compared to individual’s found incompetent.  The data suggests that approximately 70-80% of defendant’s evaluated for competency are, in fact, found competent.  Only 20-30% are found incompetent.  This is primarily due to two factors: 1) the threshold for referring an individual for an evaluation is low; and 2) The threshold for being competent is low.  That is, lots of people meet the criteria to warrant an evaluation.  Conversely, not much is legally required to be found competent.  Most individuals are found competent because they are competent, even when they have some sort of mental health issue.  It takes a fair degree of impairment to be found incompetent.  I’ve gone into all of this before, so help yourself to previous postings on this subject!

On Creating a Deathbed Masterpiece

Just a quick link here to a WSJ article by Terry Teachout.  The article discusses the history of the final artistic efforts of masters who are about to pass away, and know it.  Mr. Teachout writes about the differences in creating a masterpiece (such as writing, painting) versus performing a masterpiece (music, acting), and he touches on the possible reasons why there hasn’t been more efforts to provide one, final triumph.  A very interesting article, especially in noting the examples he provided.

I agree with the article that any involved effort might well be too draining, especially considering what an artist is experiencing physically if they are about to die.  In addition, it seems that many who are performance artists are not only not aware of there impending death, they also die due to some sort of tragic circumstance, many times earlier than their time (drug overdose, accident, etc.).  I have no idea of how true that is, it’s just a perception on my part.  Take jazz, for example - how many jazz greats died before their time, due to circumstances where they may not have been healthy (and knew it), but certainly weren’t aware they were about to pass on.  Therefore, no opportunity to

In any event, it’s worth a read!

Self-Esteem As A Concept

Even though my current primary role at work is as an evaluator, I still do a bit of therapy.  More important, I enjoy therapy and the unique challenges it presents.  One concept I’ve always found both challenging and interesting in my work as a therapist is self-esteem, which is an issue that does not play any significant role in the forensic work that I do.  A simple way of thinking about self-esteem is this: A person forms a sense of identity about oneself, and decides whether they like it or not.

As a therapist, I’ve seen low self-esteem play a significant, if not primary, role in the poor choices people have made (often consistently).  While on a cognitive level many individuals will grasp that their decision-making process hasn’t been logical, they will nevertheless continue down that same path; often it is an impaired sense of self-worth that is a driving force in this negative pattern.

On the flip side, I’ve seen people (including professionals) throw the phrase “low self-esteem” around like it’s going out of style - three simple words that explain (and excuse) just about anything.  In most cases, the picture is more complicated than that, while in others the concept doesn’t even really apply.  As an example, I’ve seen individuals who have displayed a fair amount of psychopathy described as having low self-esteem; the logic appears to state: “Poor guy, he doesn’t care enough about himself to hold a job, get married, etc.”  In many cases like this, the problem is actually too much self-esteem, with the logic actually being: “Why should I hold a job like all those suckers?  I’m better than that!”

One book I’ve found very helpful is titles, amazingly enough, Self-Esteem.  Written by Matthew McKay and Patrick Fanning, it is a very hands-on book written for the lay person, with plenty of common sense descriptions of different aspects of self-esteem, as well as exercises designed to improve self-esteem in areas needing it.  Regarding that last bit, one thing I like about this book is that it provides a useful conceptualization of low self-esteem in terms of a two-pronged issue: situational self-esteem versus characterological self-esteem.  A person with low situational self-esteem will notice difficulties in only certain areas, while other areas are satisfactory.  Characterologically low self-esteem is a more fundamental view of oneself in a global way, and therefore the impact is more pervasive. 

An example of situational self-esteem might be a college student who accurately sees themselves as an adequate student, friend, and boyfriend.  However, due to some sort of cognitive distortion that developed earlier, they inaccurately see themselves as much weaker/less talented athletically than they actually are (maybe the guy was a really late bloomer, and had significant negative athletic experiences prior to catching up?).  Conversely, a person with characterologically low self-esteem sees themselves as “bad or “wrong” in virtually all areas of functioning: socially, academically, athletically, etc.  This is a much bigger challenge, and requires significantly more work.

To wrap this post up, one mistake I’ve made as a therapist in the past is to work with a client on addressing an issue before we’ve established whether the client A) believes they are capable of improvement in that area, and/or B) believes they are worthy of improvement in that area.  These points cannot be overemphasized.  If an individual rationally grasps that improving their social skills will be helpful, but has a self-view that they cannot be any better than they already are, skill development will be a waste of time.  The same applies to an individual who does not see themselves as deserving of a better social life.  Facilitating change in either (or both) of these areas will be a necessary precursor to any increase in behavioral ability.