Category Archives: News and politics

January 7, 2017 · 2:05 pm

Can Mental Health Practitioners Predict Future Violence?


Yesterday, a gunmen killed five and wounded at least eight others at the baggage claim for a Florida airport. Initial news reports allege the shooter had recently experienced psychotic-like symptoms. I am sure that in the coming days we will learn more details about the shooting and about the recent history of the shooter. Among the details there will be plenty of questions. Did anyone know this might happen? Could someone—especially in positions of power (FBI? Mental Health?)—have prevented it by reporting or removing access to guns?

Of course, it is easy to ask these questions and develop opinions after the fact. And yet we need to ask them if there are possibilities to learn from possible mistakes. What follows attempts to give the public a brief but better understanding of risk assessment when mental illness and violence combine. (NOTE: this is not a comment on the above sad situation or those cases where violence is unrelated to mental health.)

A little history of predicting future violence

Violence risk assessment is part of the sub-division of forensic psychology and psychiatry. Expert witnesses are used in court proceedings to report on the existence of mental illness, the probability of imminent dangerous behavior, and the options for most effective/least restrictive treatment required to reduce illness and increase safety.

How do clinicians make these opinions? In the not-too-distant past, expert witnesses usually used their wisdom shaped by years of experience. Much to the chagrin of experts, it turns out that clinical intuition isn’t all that effective. For some professionals, it is little better than chance! (Interested readers can check out Monahan’s 1984 oft-quoted research quoted in this rebuttal article.) Other options include actuarial methods (collecting risk factors just like an insurance company does to determine how much to charge your 18 year old son for car insurance) and test data. Both of these methods seek to eliminate feelings in the decision-making process. Actuarial data can certainly help us. Knowing someone has a history of violence and criminal behavior helps us predict future behavior. Knowing someone has schizophrenia may slightly increase risk of violence, but no more than it would for those who have problems managing impulses. And this would not be a reason to lock someone up (though it may be a reason to limit access to handguns). Assessment tools filled out by the person suspected of violence have a couple of problems with them but the main one is that very few of the most violent have been identified in treatment as possibly benefiting from assessment. And when we do give these assessments, the data rarely is clear—this kind of response means they will be violent, this one means they will not. We’re far better at identifying “faking good” or “faking bad” results than we are in determining whether the results mean future violence.

The best assessment to date requires that we have adequate history, survey of known risk factors, interviews, and test data. But as I said above, if the person suspected has not been in treatment or has done well to present as being merely disturbed but not dangerous, what can be done?

One More Complication

In our current society, we believe deeply that individuals have the right to self-determination. This means they have the right to refuse treatment. This right trumps nearly every other value. It doesn’t matter if the treatment would really help. The person is permitted to refuse. The only exceptions are involuntary commitments to address imminent danger to self or other. And as soon as the danger passes, the treatment can be refused again even if the treatment might avoid a relapse.

Bottom line for Practitioners

We can do better in responding to risk factors that might lead some to violence. We can learn more about these factors. We can equally promote confidentiality and privacy for our most distressed clients and yet be quick to warn others when signs of imminent violence are present. We can ask better questions. We can use non-cognitive approaches to get a better picture of their internal experiences. And yet, we can only work with the information we have. Contrary to popular belief, we are not prophets. In addition, most of our outpatient clients are not even remotely dangerous (in 27 years of clinical work, I have only needed to report two clients for imminent risk to others).

What we can do is assert the need for better and more available treatment options.

Family members are really the frontline of help for most distressed individuals. They are more likely to hear the murmurings that might indicate violence. This requires greater public education about the nature of mental illness and violence risk assessment and the kinds of ways to respond. Church leaders can also be better educated as to what kinds of options are available for those parishioners who are struggling with similar kinds of emotional distress. Let us be willing to lead the way in educating our communities and churches about mental health challenges and healthy responses. If we did a better job surrounding those with severe mental illness (and isolating them less) we would likely have less mental health induced violence.

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November 7, 2016 · 6:56 pm

Election Anxiety after November 8?


In a little more than 24 hours we should learn the identity of our next President of the United States (We hope; recall the hanging chads and drama of the 2000 election). And we hope we will be able to take a collective sigh and return to daily life without being bombarded by attack ads and new revelations about the character (or lack thereof) of the candidates.

It has, by every account, been an especially long and  difficult election season. We are tired. We want it over. But will the angst really disappear on Wednesday?

Probably not. But maybe you can do something about your own anxiety and distress.

  1. Detach from social media.
  2. Engage in a face-to-face conversation with a person about their history and future. Find out what excites or energizes them.
  3. Detach from the faux breaking news sites. If you want to look, look to stories that have depth of reporting and which avoid clickbait titles.
  4. Engage other important stories of our day, both here and beyond our borders.

Remember, your true safety does not come from a president or a king. Your future is truly in God’s hands. Do talk to him about your angst. Do ask him to intervene. But also listen and look for evidence that God’s kingdom is expanding. Look for where he has placed you “for such a time as this.”

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May 17, 2016 · 6:34 pm

Immigrant or refugee? 


Most Americans can tell the story of how their forefathers and mothers came to this country to settle as new Americans. They came for opportunity. They came to be with other family already arrived. But not everyone comes here out of desire to leave their own country. Some come only because home became “the mouth of a shark” (first heard this poem in a presentation by Diane Langberg this Spring).

To this point, you might find this Fresh Air podcast aired today with listening to. The Pulitzer Prize winning author frequently refers to his identity as a refugee, one who is in the US due to US waged war in Vietnam. Does he look like a refugee? As a professor and someone who appears to be well off, he appears as American as anyone else. And yet, his experience is one of being a refugee.

What is the difference between an immigrant and a refugee? Not quality of life but it seems free choice. And I would add the component of time. His heirs will likely feel proud of their heritage but feel they are less refugee and more American. I do suspect, however, that it was easier for Irish and other Europeans to quickly integrate into the American persona than it is for most non-Caucasians.

What would make you feel more like an immigrant and less like a refugee? Or vice versa?

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December 7, 2015 · 11:51 am

A Meditation for you during gun control/rights debate


The American conversation is all about the guns these days. Let everyone have open carry. Disarm everyone who has weapons designed for war. These are some of the arguments we might hear.

Everyone has an opinion as to what to do about the problem of gun violence and terrorism. The Rev. Jerry Falwell, Jr. suggested that everyone who could should arm themselves, including his students at Liberty University. Taking a different point of view, The New York Times posted this editorial on their front page suggesting that we not only ban certain weapons but also require those who already own them to turn them in.

While the discussions often center on what rights the 2nd amendment to the constitution allows, let us not forget that these discussions, for Christians, must be had in the context of how God calls us to be with those who persecute us and how he calls us to act when we see oppression around us. While we discuss the best way to defend ourselves and our families, and when we discuss what to do about the overwhelming problem of gun violence in this country, consider meditating on these two passages and have them shape your discussion of how we ought to respond as individuals and as a community:

Romans 12:14-21 (NLT)

14 Bless those who persecute you. Don’t curse them; pray that God will bless them. 15 Be happy with those who are happy, and weep with those who weep. 16 Live in harmony with each other. Don’t be too proud to enjoy the company of ordinary people. And don’t think you know it all!

17 Never pay back evil with more evil. Do things in such a way that everyone can see you are honorable. 18 Do all that you can to live in peace with everyone.

19 Dear friends, never take revenge. Leave that to the righteous anger of God. For the Scriptures say,

“I will take revenge;
    I will pay them back,”
    says the Lord.

20 Instead,

“If your enemies are hungry, feed them.
    If they are thirsty, give them something to drink.
In doing this, you will heap
    burning coals of shame on their heads.”

21 Don’t let evil conquer you, but conquer evil by doing good.

Isaiah 58:2b-4a, 6-14 (NLT)

They come to the Temple every day
    and seem delighted to learn all about me.
They act like a righteous nation
    that would never abandon the laws of its God.
They ask me to take action on their behalf,
    pretending they want to be near me.
3 ‘We have fasted before you!’ they say.
    ‘Why aren’t you impressed?
We have been very hard on ourselves,
    and you don’t even notice it!’

“I will tell you why!” I respond.
    “It’s because you are fasting to please yourselves.
Even while you fast,
    you keep oppressing your workers.
4 What good is fasting
    when you keep on fighting and quarreling?

6 “No, this is the kind of fasting I want:
Free those who are wrongly imprisoned;
    lighten the burden of those who work for you.
Let the oppressed go free,
    and remove the chains that bind people.
7 Share your food with the hungry,
    and give shelter to the homeless.
Give clothes to those who need them,
    and do not hide from relatives who need your help.

8 “Then your salvation will come like the dawn,
    and your wounds will quickly heal.
Your godliness will lead you forward,
    and the glory of the Lord will protect you from behind.
9 Then when you call, the Lord will answer.
    ‘Yes, I am here,’ he will quickly reply.

“Remove the heavy yoke of oppression.
    Stop pointing your finger and spreading vicious rumors!
10 Feed the hungry,
    and help those in trouble.
Then your light will shine out from the darkness,
    and the darkness around you will be as bright as noon.
11 The Lord will guide you continually,
    giving you water when you are dry
    and restoring your strength.
You will be like a well-watered garden,
    like an ever-flowing spring.
12 Some of you will rebuild the deserted ruins of your cities.
    Then you will be known as a rebuilder of walls
    and a restorer of homes.

13 “Keep the Sabbath day holy.
    Don’t pursue your own interests on that day,
but enjoy the Sabbath
    and speak of it with delight as the Lord’s holy day.
Honor the Sabbath in everything you do on that day,
    and don’t follow your own desires or talk idly.
14 Then the Lord will be your delight.
    I will give you great honor
and satisfy you with the inheritance I promised to your ancestor Jacob.
    I, the Lord, have spoken!”

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November 18, 2015 · 12:44 pm

Treating a whole population with suspicion always ends badly


I’m currently reading Spectacle, the telling of the story of Ota Benga, a Congolese man held captive in 1906 at the Bronx Zoo and placed on display in the zoo’s monkey house. This tragic story reveals our ugly history where Americans, by-in-large, believed in the superiority of the White races. But in chapter five, the author talks about another incident, The Brownsville Affair, during that same year. It is this affair that I wish to highlight.

The Brownsville Affair

In late July of that year, there was an altercation between a black member of the infantry division and a white man. The white man was killed. A mob ensued and when it was over, three more lay dead. Fast forward a few weeks into August and suddenly a bartender (white) is killed. The suspicion is instantly laid on the infantry, despite their white officers reporting that every infantry member was in his bed at the time. Evidence was planted to try to incriminate the men. When the men were interrogated, they denied any involvement and of course could not say who had killed the bartender.

But the people of Brownsville continued to accuse the men. And the decision was made to castigate them all for a so-called “conspiracy of silence.” The decision went all the way to President Theodore Roosevelt who signed the order having 167 men dishonorably discharged as punishment for a crime they did not and could not have committed. Here Pamela Newkirk recount Roosevelt’s comments

Despite pleas from black leaders, including Booker T. Washington, Roosevelt would sign the order denying the men–who had been deprived of legal counsel or a hearing–back pay, pensions, and eligibility to serve in the future. Roosevelt, considered a racial moderate for his time, unapologetically defamed the innocent men, saying, “Some of the men were bloody butchers; they ought to be hung.”

Not until Nixon, did this injustice be made right (and then the “justice” did not include any form of restitution.

The Trajectory When We Dehumanize others

Notice the trajectory:

  • One person of a group (a minority group) does something wrong.
  • Later, another ambiguous thing happens and blame is laid at the feed of an entire population.
  • Facts are not sought out but evidence is created and “justice” delivered because “these people” are butchers.

Is it any wonder that such minorities don’t feel particularly warm feelings when thinking about national pride. How could they? We’d like to think we are well beyond the years that we would place a human in a zoo to be gawked at. Indeed, we are. We’d also like to believe we are well beyond the years where we would demonize and be suspicious of an entire population of people. We are not there yet. There might be people who are butchers among the innocent. So, let’s ensure they don’t remain among us and accuse them of a conspiracy of silence for not pointing the guilty out. Let’s keep them all out just to be sure.

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September 19, 2015 · 12:33 pm

What can we do about the refugee crisis?


If you have any connection to the outside world you know that the Middle East, North Africa, and Europe is undergoing a refugee crisis of massive proportions. Syrian and Iraqi refugees are finding their way to Europe to try to escape the violence, hunger, and lack of basic resources resulting from ongoing conflicts in both countries. For years, Lebanon, Jordan, and Turkey have borne most of the brunt of the burdan from the crisis, but now refugees are risking their lives crossing the Mediterranean to Europe. What was a regional conflict is now a wider political and economic challenge. 

If you are like me you read the stories, see the pictures, dig into the complexities of the problem and end up feeling helpless or hopeless. Someone has to do something. But what? Is there anything you and I can do to help? We know we can pray and we know we can give money to aid organizations. However, I suspect we often fail to do either of these things because will my prayers or fifty dollars do anything, realluy? 

Can we do anything else? Here are a few things I think merit consideration as doing our part. They may not do anything at all in the big picture, but then again, they may help you take one more step, even if only helping you to pray more pointedly and persistently. 

  1. Choose to be continuously educated. It is easy to make sweeping generalizations about those who are fleeing violence, about those in host countries, about the various armed militias. Sometimes we are right but far too often we develop simplistic formulas for the problem and solutions. Read outside of your normal news sources. If you are in the U.S., check out the stories by BBC and Al Jazeera news corps. Especially look for news stories about the refugees, who they are and what they are looking for. Many journalists in this area tweet out their stories/blogs. Find them and read them. Don’t allow hopeless feelings keep you from bearing witness to the tragedies nor from calling on God to intervene.
  2. Study the Scriptures regarding the God who loves refugees, hears their cries (think Exodus) and his son who was himself a refugee (check out Matthew 2). What is God’s mind on caring for those who have nothing and who will cost us something if we do care for them? Too often we can become consumed with political and economic realities and forget that God’s word calls us to love immigrant and outsider among us. In doing so, challenge your common assumptions about how we should relate to Muslim outsiders. 
  3. Learn a lay-counselor trauma training model.  The American Bible Society has a program, Healing Wounds of Trauma. This program is Scripture-engaged, dialogical, lay-oriented, and cascade oriented. You can get trained by attending a low-cost equipping session (4-5 days) and then train others (hence the cascade effect). You do not need to be a counselor but plenty of counselors love this model because it is so easily transferrable. Translated and contextualized into many languages, you can teach in English and the participants can teach in their own communities in their own language. Wait, you migh think, I don’t know any refugees in my community. While there may not be any Syrian refugees (then again, there many well be!), immigrants and refugees are all around us. Find out who is serving them (e.g., Lutheran Social Services, World Relief, etc.) and see if you can use this materials with them. This particular program isn’t the only one out there but it is effective and budget friendly. 
  4. Of course, give and pray. Once you get connected to local refugee serving organizations, you will have a better sense of who is serving in your community and how your time, talent, and treasure could be used. 

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November 5, 2013 · 2:05 pm

Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

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December 7, 2012 · 11:49 am

Update on the Complexities of Goma, DRC…And Why You Should Care


Followers of this blog will know that I have been to Eastern Congo and am passionate about the people there. You also know that there is a rather ugly and complex struggle for power in that region. This link to a Huff Post opinion piece provides an insight to some of those current complexities from an insider’s perspective. For example, some found the M23 group as elevating safety over that of the government soldiers. And yet, the M23 group may be funded by outsiders with evil intent.

I highly recommend you read it. You might ask why, since what goes on in the DRC has little to do with your life. You should care because,

  1. the extent of the recent decades of disaster there will boggle your mind and overshadow nearly every other disaster you care about
  2. these are our brothers and sisters and we are called to love our neighbor

The author, Julia Lewis, concludes her essay this way

The sad fact is that violence in the DRC is constant. As Congolese activist Vava Tampa recently reported in an article on CNN, the conflicts in DRC

… have claimed nearly the same number of lives as having a 9/11 attack every single day for 360 days, the genocide that struck Rwanda in 1994, the ethnic cleansing that overwhelmed Bosnia in the mid-1990s, the genocide that took place in Darfur, the number of people killed in the great tsunami that struck Asia in 2004, and the number of people who died in Hiroshima and Nagasaki — all combined and then doubled.

What will happen next in DRC? Anything is possible — and we need the world to keep listening. As many as 5.4 million people died in the last Congo war. That is fact, not fiction. And we cannot afford for it to happen again.

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October 8, 2012 · 5:49 am

Mis-speaking, lying, or telling a truth you didn’t mean to tell? Reasons why we say things we regret


If you have been following American presidential politics, you will understand references to candidate faux pas like Romney’s “47%” or Obama’s “guns and religion.” [Check out this link for a comparison of the two].

Ever wonder why these gaffes happen? Is it a matter of mis-speaking as so often is claimed? Or is the candidate saying what he/she believes only to discover in the light of day that they wished they hadn’t been so honest? As I look at the possibilities, I see 4 reasons candidates  say things they later must apologize for.

1. They mis-speak. Let’s deal with this one first since it is most often claimed as the reason for the faux pas. Anyone can get their tongue twisted around. My father once quoted Isaiah 40:31 during a sermon and said, “ings as wiggles” instead of “wings as eagles.” This is the usual form of mis-speaking. We can get numbers, facts, and ideas twisted around. Mis-speaking is usually fairly obvious to hearers and quickly fixed once it is brought to one’s attention.

2. They say what they think but later wish they hadn’t. Quite often we say what we think but then wish we hadn’t been so forthright. When it comes out, we recognize (immediately sometimes but not always) that what we said doesn’t sound very good. Sometimes we don’t always recognize what we believe until our own ears hear it. We look down upon a group of people (in the presidential examples, religious conservatives and recipients of public funds) and stereotype them as a group because that is how we have imagined them for some time.

3. They are mis-informed. There are times we say something but have mis-understood the facts. For example, there is a commonly repeated stat that 50% of evangelical marriages end in divorce. This is not true, but someone could repeat the stat as fact but later retract it once they learned the stat was not true. Sometimes we hold a stereotype but later discover better facts and change our opinions.

4. They lie to please others or win a point. Have you ever said something because it earned you some point, even if you didn’t fully believe it. Consider a fight with a family member. Did you ever stretch the truth to win a point, “You always… You never…” Or, maybe you said something that would please your audience. You made a joke about another group of people in order to win a laugh. You suggested you agreed with an opinion even though you did not.

So, sometimes we regret speaking what we believe. Other times we regret saying things for ulterior motives. Can you think of other reasons why we say things we wish we could take back? How would you react if a politician said,

What I said was patently false. I said it because I got caught up in pandering to my audience. It was wrong not only to speak falsehoods but also wrong to give in to people-pleasing. I apologize for these two wrongs and I endeavor to speak only the truth, even if it costs me your support or the presidency.

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August 22, 2012 · 3:14 pm

Playing fair in politics? Is it possible?


Getting tired yet of the lies and distortions of the current presidential election race? Tired of the Republican/Democrat fights? Tired of biased media? Would you just like a bit of humility and truth? Well, you might want to read Dr. Sam Logan’s new post over at our Biblical Seminary blog.

His point? Start with yourself. Start by telling the whole truth and nothing but the truth about those with whom you disagree. Imagine pointing out the successes of those in an opposing political or theological party. Imagine pointing out an error without hyperbole or exaggeration.

The section that caught me up short was reviewing what the Westminster Divines saw as violations of the 9th commandment. Sobering. Let Christians be known for telling the whole truth, in love, no matter the personal consequences. Let us not give in to fear-mongering just because others do. And even when it might cost us friends, let us acknowledge the good points our enemies make. Let us play fair even if others do not.

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