Scipsy

Firearm availability and homicide

Patterns related to homicides committed with fire arms raise the natural question of the relationship, or non-relationship, between firearm availability and levels of homicide, and whether increased firearm availability is associated with increased overall levels of homicide, in particular. From a theoretical perspective, no dominant theory exists that explains the relationship between gun ownership and homicide, or indeed crime in general, as guns can confer both power to a potential aggressor and to a potential victim seeking to resist aggression.

On the one hand, the availability of guns can increase the level of a crime or it can make it more lethal: the “facilitation” hypothesis suggests that having access to a gun can empower potential offenders who, without a gun, would not commit a crime such as assault or robbery, and accessibility to a gun can transform “simple” family or community disputes into tragedies. The “weapon instrumentality” hypothesis suggests that, besides raising the crime level, gun availability increases the likelihood of a crime having a violent outcome. For example, use of a gun during an assault or robbery will increase the likelihood of death or serious injury because it provides perpetrators with the opportunity to inflict injury or death at long distances and it makes it easier to assault multiple victims than the use of other weapons such as a knife or blunt object.


On the other hand, a “deterrence” hypothesis suggests that gun availability can disrupt or deter criminal aggression and prevent the completion of a crime by neutralizing the power of an armed perpetrator or by shifting the balance of power in favour of the victim when confronted by an unarmed perpetrator. An axiom of this hypothesis is that gun availability does not represent a major driving force for offenders per se: they are already determined to commit a crime and they get hold of guns, through well established and hidden channels, to achieve their criminal goals.

The provision of reliable quantitative support to either of these hypotheses is one of the most difficult areas of homicide research, with a number of methodological problems, including: identifying reliable measures of gun ownership, availability, accessibility and use; the need to differentiate between different owners of guns (households, individuals, affiliates to organized crime groups or gangs, etc.) and different type of guns (handguns, shotguns, rifles, etc.); accounting for correlations that arise between firearm availability and homicide rates that may be caused by a third factor (such as a rise in homicides due to increased presence of organized crime); the difficulty in estalishing causal relationships between changes in gun availability and corresponding changes in homicide levels (what comes first?); the difficulty of taking into account different legislative frameworks on firearms and state capacity to enforce them when conducting comparative studies.
Notwithstanding such challenges, a significant body of literature tends to suggest that firearm availability predominantly represents a risk factor rather than a protective factor for homicide. In particular, a number of quantitative studies tend towards demonstrating a firearm prevalence-homcide association.


In figure 3.5, analysis of data from 45 cities and urban areas located in developing countries or in countries in transition collected between 1996 and 2008 shows that gun availability (as asked about in victimization surveys) is significantly associated with rates of assault with firearms: the more individuals in possession of weapons, the more frequent armed assaults take place (similar associations were found between percentage of gun ownership and prevalence of assault, robbery and gun robbery rates). Due to lack of data on homicide rates in the same cities, it is not possible to directly relate gun availability with murders. However, it can be assumed that assaults and robberies that occur in cities with high levels of gun availability may be more serious or deadlier than assaults or robberies carried out in cities with lower levels of gun availability. These data do not prove a causal relationship between firearm availability and gun assaults (in theory, higher gun ownership could also be a consequence of higher assault rates, i.e. a defensive strategy of citizens to deter potential aggressors). At the very least, however, the relationship between gun availability and violent crime, including homicides, does appear to be something of a vicious circle.

The relationship between overall homicide rates and the proportion of homicides committed by firearm is shown in figure 3.6 where the data again emphasize strong regional patterns. Countries in the Americas tend to show a strong correlation between homicide rates and the percentage of homicides by firearm. In contrast, in countries in Asia, Europe and Oceania there appears to be a looser relationship between homicide level and percentage of killings perpetrated with a gun: homicide rates tend to cluster at under 10 per 100,000 population but they show a broader distribution in terms of percentage of homicides by firearms, which ranges from values close to zero up to 70 per cent. (figure 3.6 does not include countries in Africa due to data availability limitations in this region).
It should be stressed that the percentage of homicides by firearm is the compound outcome of at least three aspects: availability of guns; preference of crime perpetrators to use guns in crime; and their willingness to inflict fatal injury. In addition, from a global perspective, the significant order of magnitude difference between global estimates of civilian firearm ownership (hundreds of millions, according to estimates by Small Arms Survey, 2007) and annual firearm homicides (hundreds of thousands) indicates that the majority of civilian firearms are not misused and are owned for legitimate purposes.
Nonetheless, the high overall homicide rates combined with a very high proportion (more than 60 per cent) of homicides by firearm seen in regions such as Central and South America shows that, depending on the context, the availability of firearms and therefore easy access to guns can play a significant role in influencing homicide rates. In such contexts, a certain proportion of civilian firearms (utilized by a certain proportion of the population) may be considered a major “enabler” of homicide events.

From the UNODC (United Nations Office on Drug and Crime) 2011 Global Study on Homicide.

Who will get PTSD?

PTSD may be a relatively new phrase, but the problem it describes is as old as any history of war.

About new researches that try to predict who would develop PTSD and the complex issues that could arise from this.

Who will get PTSD?

PTSD may be a relatively new phrase, but the problem it describes is as old as any history of war.

About new researches that try to predict who would develop PTSD and the complex issues that could arise from this.

Guess What’s Cooking in the Garage

Designing genomes will be a personal thing, a new art form as creative as painting or sculpture.

Guess What’s Cooking in the Garage

Designing genomes will be a personal thing, a new art form as creative as painting or sculpture.

Throughout history, the really good scientists were misfits. It’s okay to be a misfit as long as your science is good.

Margie Profet.

I’m not sure what I feel about this, but reading The Mysterious Case of the Vanishing Genius, the story of Margie Profet, really left me with a weird mix of emotions.


Psychiatry’s Bible Revised

We cut nature up, organize it into concepts, and ascribe significances as we do, largely because we are parties to an agreement to organize it in this way—an agreement that holds throughout our speech community and is codified in the patterns of our language." - Benjamin Lee Whorf

Most people don’t know what the Diagnostic and Statistical Manual of Mental Disorders (DSM) is. The first time I heard of it was in a Chuck Palahniuk’s novel several years ago (I think it was ‘Survivor’, but I don’t remember really).

The DSM is without any doubt, the most important book in psychiatrists’ clinical practice. It’s a reference guide full of lists of symptoms that define mental disorders. The DSM determines the type of diagnoses clinicians make. Psychiatrists move inside the boundaries defined by the DSM.

The book has undergone several revision, the current version is the DSM-IV-TR, published in 2000 that contains little updates compared with the previous version, the DSM-IV, published in 1994. So the upcoming version, the DSM-5, will be the first substantial change to psychiatric diagnosis in more than 20 years, (and some say more than 30).

The new version will probably be published in May 2013, and in 2010 the American Psychiatric Association posted a draft on their Web site open for comments. A good thing, if you ask me, that has allowed a large number (500000) of people to read and comment on such an important book.

The APA received several criticism about the new criteria and diagnoses. I will try to sum up some of them. 

But first I need to adress a simple yet important fact: there are no biological tests for mental disorders. Maybe there will be, one day, but for now psychiatry has a diagnostic system without objective tests.

Psychiatric diagnoses are descriptive diagnoses based on lists of symptoms on which there is a certain degree of agreement. Nevertheless some research showed that these criteria are not always reliable.

Different disorders have many common symptoms making difficult to distinguish what diagnosis best applies, and it is suggested that the same disorder can display different symptoms in different cultures or environments.

The new version of the DSM tries, at least in part, to adress this problem, eliminating some less distinct diagnoses or merging them under more comprehensive categories. This is one of the reasons the DSM-5 will no more contain a distinct diagnosis for Asperger’s syndrome, Autistic disorder, childhood disintegrative disorder (CCD) or pervasive developmental disorder not otherwise specified (PDD-NOS), thought to be too similar to each other. There will be instead the diagnosis for Autism Spectrum Disorder that will encompass all these disorder in one larger categories.

The attempt to achieve more accurate diagnoses has led the DSM-5 Task Force to implement in the new version a rating system to grade the severity of the patients’ symptoms. Doubts have been cast: how will insurance companies respond? Will they demand that the patient’s symptoms meet a certain severity to agree in order to cover for the treatment? Will psychiatrists use this system in their clinical practice given that it will probably require more tests, evaluations, paperwork and time?

If you would like to make it short, there are two kinds of critics:

Some psychiatrists contend that the volume still contains more disorders than actually exist, encouraging superfluous diagnoses—particularly in children. Others worry that the stricter, more precise diagnostic criteria may inadvertently give insurance companies new ways to deny medication to patients who need it. - Psychiatry’s “Bible” Gets an Overhaul

I personally think that, without losing sight of the second kind of critics (because it’s very important), we should acknowledge that it’s more a matter of public policy and less a matter of scientific validity.
The APA conducted some “field trials” to test the reliability of the new diagnoses. The results has not yet been published but the APA gave a preview during its annual meeting in Philadelphia. 
The APA uses a statistic called kappa to measure the reliability of different diagnoses. The higher the value of kappa, the more reliable the diagnosis, with 1.0 representing perfect reliability. The APA considers a diagnosis with a kappa of 0.8 or higher miraculously reliable; 0.6 to 0.8 is excellent; 0.4 to 0.6 is good; 0.2 to 0.4 “could be accepted” and anything below 0.2 is unacceptably unreliable. - Field Tests for Revised Psychiatric Guide Reveal Reliability Problems for 2 Major Diagnoses
The kappas of many diagnoses look strong, for example the new Autism Spectrum Disorder has a kappa of 0.69.
But for Generalized Anxiety Disorder and Major Depressive Disorder things don’t look that good. The kappa for Generalized Anxiety Disorder is about 0.2 and that for Major Depressive Disorder is 0.3. These are worrying results, seen that these are two of the most common disorders. 

Some ask (doubting) if the American Psychiatric Association is best equipped to develop and monitor such an important diagnostic system, one that can profoundly influence the lives of many people, alone. Criticisms have pointed out that the APA has refused to subject the new criteria to a more large and independent scientific review.

At least one previous research (Cosgrove, Krimsky, Vijayaraghavan & Schneider, 2006) has showed how the majority (56%) of the psychiatrists who contributed to the diagnostic criteria produced for the DSM-IV and the DSM-IV-TR had one or more financial associations with companies in the pharmaceutical industry. Pharmaceutical companies are not so likeable, so some people see conspiracy in these matter. But others say that:

This is not true. The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role. - Break Up the Psychiatric Monopoly

Anyway there are several reasons for concern. One of this is the proposal to eliminate the “bereavement exclusion”a criteria now in use in the DSM-IV for the diagnosis of Major Depression which recognizes that depressive symptoms are sometimes normal in recently bereaved individuals. This is not just a failure in recognizing the difference between a proportionate response to a devastating emotional event and a mental illness that carry the risk to make a caricature of psychiatry, but also a problem that could lead to overdiagnosis and overmedication. 

From the online release of the draft version of the DSM-5, a enormous quantity of articles have criticized the new diagnostic system, and even if sometimes these criticisms misread or simplify too much the problems, it is clear that something is wrong.

The DSM taxonomy, representing putative categories that demarcate boundaries between normality and abnormality, seems to be wide-ranging, making efforts to describe many supposed human aberrations.

Psychiatric labels can influence perception powerfully. Categorization or labeling can assist in understanding and organizing phenomena in our complex social world, convey information in a simplified manner, and aid in making predictions. Additionally, psychiatric labels may assist in understanding the cause of behavior, facilitate communication among professionals, and provide a framework through which behavior can be described, explained, and treated.
However, to the extent that psychiatric labels facilitate understanding of behavior, they also have the potential to bias judgment. 

Iatrogenic symptoms in psychotherapy. A theoretical exploration of the potential impact of labels, language, and belief system (2002) by Boisvert and Faust.

Psychiatric labels can lead to erroneous interpretations about patients experiences as resulting from his/her disorder; too readily personality attributions about the cause of the problems; overattributing greater maladjustment than what actually is; tendency to focus on the client rather than on the situation thinking that the problems reside inside the person, etc. Psychiatric labels can also “contribute to negative self-perceptions and stereotyping, jeopardize social acceptance, and generate negative attitudes in the public" (ibidem).

Even without considering all these possible negative consequences of the DSM taxonomy, it should be acknowledged that the DSM has a large impact in many ways, including shaping ideas and expectations about mental disorder and people affected by them.

I think that the current version of the DSM is flawed in many ways and I think the new version will not be a great improvement (if it will be an improvement at all).

To achieve a more reliable diagnostic system it’s needed a more scientific approach, more studies investigating the validity of the proposed criteria that lead to actual changes in those criteria when changes are needed, more openness to independent scientific review, and also more contributions from outside the fortress of psychiatry : psychologists, for example, could be a big step forward, but I think also to epidemiologists and neuroscientists.

Without a tremendous shift of approach, the DSM will remain an almost totally arbitrary cookbook of symptoms.

Some thoughts about the new Tumblr policy against self-harm blogs.

Tumblr is planning a new policy against self-harm blogs. This includes “blogs that glorify or promote anorexia, bulimia, and other eating disorders; self-mutilation; or suicide.

Tumblr will prohibit to post content that actively promotes or glorifies self-injury or self-harm and will start posting ““public service announcement”-style language whenever users search for tags that typically go along with pro-self-harm blogs.

Some years ago I went to a little conference about this issue. I was studying psychology and I ran a tiny blog, so I was interested in the matter. An Italian blogs platform (recently closed) promoted this event in which a bunch of so-called experts were invited to give their opinions. Let’s say it was a complete failure, and the two executives of the blog-publishing service that were present admitted it was a failure, and I could see that their expectations had been dramatically disappointed. Of course none of the “experts” understood anything about what they were asking to them. One of these experts is a well known psycho-something that never misses an opportunity to show up in any talk show, saying common-sense things as if they were groundbracking truths. Another is a psychiatrist (a famous one, besides teaching in a university, he runs a professional organization and an institute for cognitive psychotherapy) that later I had the great displeasure to know because he was a promoter of “riparative therapies”, the criminal practices aimed to turn an homosexual back into a straight person. I wrote a post about this on my blog, and he came claiming I was defaming him.

It was some years ago (2007, sigh!), but those “experts” were still back in the 70’s (and maybe even further). They stated that internet is bad for people, that it reinforces maladaptive behaviors and narcissism, and that it promotes mental illness. They were (are) morons.

I remember that that blogs platform was facing the same dilemma Tumblr is facing now, censoring or let the things as they are. They were well aware that if they had decided to censore those kind of blogs, those users would have simply changed platforms. 

I feel the same about the new Tumblr policy. I’m not saying that they are making the wrong decision, in fact I’m very glad they acknowledged this issue and decided to think about something to do, but I’m worried that even if their new policy could really eradicate this kind of blogs (and I’m not entirely sure it can, they say it will work searching for key words tipically associated with pro-self-harm blogs, and we all know how simple it is to bypass this kind of filters), those users would just migrate to some other blog platform. 

I haven’t a solution to this issue. I’d like to read some serious researches on the subject, but from what I saw there aren’t any. 

I ask myself if this kind of blogs can actually promote something, if they can really influence other people, if a girl who is at risk for anorexia, or a boy at risk for self-harm, can really be pushed by those blogs, or if those girls and boys would find a way of expressing their problem anyway. I ask myself what is the real function of this kind of blogs for the people who write them, if besides being a way of expressing themselves and their emotional distress they are also a way of creating a bond with other people who face similar issues, a way (not an adaptive one) to feel less alone and therefore even a way to try to auto-medicate.

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After writing this post I searched for posts about the new policy and I spent several minutes reading the opinions of some of those who run this kind of blog. It was somehow educative.