mental health

Scared Straight: does it work?

The TV was playing in the background while my medic crew was eating dinner, and we soon found ourselves sucked into a reality show in which juvenile offenders were given a weekend-long introduction to prison life, in an effort to dissuade them from lives of crime. 

These were not hardcore offenders: their crimes included "lied to parents" and "stole," both of which are common features of many people's young lives. But they had been signed up by their parents as prisoners/reality show participants, so they were dressed in prison scrubs, yelled at, made to exercise, deprived of sleep, given inspirational speeches, then yelled at some more. None of it was much worse than, say, fire academy, but I when I went to fire academy, I was an adult who was there of his own free will, with the promise of a job at the end. 

Some of the kids break down crying as the adult men yell in their faces, and the camera zooms in and lingers on their wet cheeks, their exhaustion and distress. The program has succeeded: they've been broken. Cue the dramatic music and go to commercial. 

"I wonder if those programs really work," I asked. It took about 30 seconds on a phone to find out. 

Not only do they not work, but 1) they're worse than doing nothing, and 2) we've known this for decades. According to the U.S. Justice Department:

A study by Anthony Petrosino and researchers at the Campbell Collaboration analyzed results from nine Scared Straight programs and found that such programs generally increased crime up to 28 percent in the experimental group when compared to a no-treatment control group. 

The Justice Department discourages the use of Scared Straight programs, and in a report on crime prevention programs presented to the U.S. Congress, it placed these interventions in the "does not work" category. This report was released in 1997, nearly twenty years ago. 

According to an article in Psychology Today:

Why do scared straight programs backfire? No one knows for sure, but there are at least two possibilities. First, many of the kids who participate probably were not that inclined to join gangs or commit crimes to start with. Having convicts yell in their faces and tell them about prison rape may make them think, paradoxically, "Joining a gang must be pretty attractive if the authorities are going to such extremes to scare me out of it."

I have another theory. Scared Straight programs might seem to work in the short run, but ultimately they help young people self-identify as criminals. When I finished fire academy, the last thing in the world I wanted to do was go through another fire academy. But once some time passed, I began to think of it as a challenge I had overcome, something to be proud of. More importantly, it bonded me to the other people who had been through the same experience. I was part of the fire department family, a rare group who had emerged from the forge of that experience, transformed and toughened. I belonged.  

In our efforts to scare young people on to a pro-social path, we may be pushing them into criminal behavior they might otherwise have avoided. We are literally creating criminals, destroying human lives. Everyone involved in making that TV show knows it, but hey, reducing young black men to tears is good television. And that is utterly amoral and revolting. 

Through a filter darkly

On the heels of my recent post about the app Prisma, which renders photographs in the style of other artworks, I read an article that asserts that the filter you use on Instagram may be an indicator of depression

In a recent study, researchers Andrew Reece of Harvard University and Chris Danforth of University of Vermont built an algorithm which looked at patients’ Instagram feeds. They were able to diagnose depression with an accuracy rate of 70%. Their algorithm is better than a general practitioner’s assessment of depression after a face-to-face visit, which is only about 50% accurate.

There's a popular science fiction trope in which someone (or some entity) captures surprising patterns in the wealth of data that forms an online corona around each of us. It's not all that fictional; the technology exists right now, and is probably only limited by existing norms, and in certain places, legislation. Many people remember the consumer backlash when Amazon was caught altering prices based on user profiles; they dropped the practice, but so-called "dynamic pricing" is still in use elsewhere. 

All this had me thinking about pattern recognition in everyday life: how we all have areas of expertise in which an ostensibly-meaningless quantum of data (like an instagram filter) gives us unusual insight. One of the cool things about getting older is that I find my pattern-recognition is much more finely tuned than it was in earlier years. 

For example, my job brings me in contact with many people who are addicted to different drugs, particularly narcotics. I see patterns that clue me into a medical history of addiction much more quickly than would have been possible earlier in my career. I doubt I'm consciously aware of all the aspects of the pattern I'm perceiving - I just get a strong inclination, which is usually proven correct. 

I'm also, sadly, much more able to detect a pattern that says someone in front of me is about to die. You don't always get to choose the things you get good at. 

It's a better story with me in it

There's been some recent attention on a comedian who lied about being in the World Trade Center during the attacks on 9/11/01. After telling many people a tale of his survival, it turned out he was several miles away when the WTC was hit. 

There were a couple interesting stories in the Washington Post about the phenomenon of people inserting themselves into the narrative of those events. I found this one particularly engaging: I was a psychiatrist in post-9/11 New York. Patients lied all the time about that day. Another piece considers why people would lie to place themselves close to the event, drawing a connection with Munchhausen Syndrome, in which people fake illness (often creating elaborate ruses of lengthy treatments) in an apparent bid for attention and sympathy. 

Many of us, as kids, slapped on a bandaid in hopes of getting a sympathetic word from a parent. When we suffer a personal setback, other people's words can be a balm against our suffering. We're wired to seek connectedness, understanding. Sympathy is a powerful demonstration of our importance to others. 

Much has been made, in some political circles, of a "culture of victimhood." Maybe we're just as much a culture in which people are starved for connection, and seeking understanding anywhere they can get it. Or maybe this is just human nature, displayed in endless variations through the ever-turning rotoscope of our civilization.