Am

J Psychiatry

we were our aim evidence

fered

August

LETTERS

1978

while intoxicated. ence of alcohol toxicated drivers same predictive

continuing an ideological debate. To the contrary, was to set forth considered conclusions from the and offer testable propositions. The reader is of-

the

experimental

conclusions

and

It appears tional

135:8,

that

wisdom

data

judge

from

our

Dr.

which

to draw

their

own

laws.

propositions.

Lemere

is a supporter

ofalcoholism,

with

which

cavil.

But

we do remonstrate against disdain for the data. For example, Dr. Lemere states that ‘few’ alcoholic patients may regain control over drinking. We presented data from 74 published ‘



due to publication

of the Rand

empirical data by Hingson and found ‘ ‘one’ ‘ alcoholic in Boston been adversely influenced by the

But the hyperbole about piece of a larger issue. At cumspect gratulations unfortunately speculative.

solely

not

drinking

is the

to conventional

whether

correct

controlled stake

Here

again

are only have

is but a small

development

of

or our

conventional

new

formulations

formulate

models

data.

invite

We

wisdom.

the

with

of

correct.

logical

readers

Therefore,

wisdom

rigor

robust

our

logic

conBut is one

the issue

Dr.

Lemere

Rather,

and

to examine

be

a cir-

science of alcoholism. We appreciate the of Dr. Lemere for our lack of dogmatism. he concludes that the nature of alcoholism Indeed it can only remain speculative when

appeals is

report.

associates (1). They who might possibly Rand report!

we

is

need

to

experimental and

our

laws

relying

on the

E. MANSELL

data.

of the Rand Report Boston residents. J

PATTI50N,

very

similar

to

that

of

those

individuals

Laws

as Predictive

Evaluation

Calif.

Laws

Target SIR: because

rence

Involuntary they rely

of certain

hospitalization on the prediction

events,

e.g.

,

laws

have been criticized rather than the occur-

prediction

of dangerousness.

I

recently attended a conference where a well-known and respected speaker stated that with other laws ‘ ‘the criminal is not jailed until the crime is committed. ‘ ‘ Critics of involuntary hospitalization laws argue that because of our limited ability to predict harmful behavior toward self or others, the number of ‘ ‘false positives’ ‘ is high and a large number of people who would never do harm are deprived of important civil liberties. It is implied that these predictive laws differ significantly from other laws that society uses to maintain social order.

The argument that mental health laws are unique they are concerned with the prediction of behavior valid one and and philosophy

have these ample,

it is not

dence,

nor is it illegal

vehicle. time.

illegal

It is illegal There

because is not a

results from a misunderstanding of the of our legal structure. A great many

been passed because laws prohibit will

of a prediction result in injury

to be intoxicated for most people

to be intoxicated

is nothing

intrinsically

who

are

intent laws

that the behavior or harm. For cx-

in one’s place of resito operate a motor

and harmful

drive

at the about

same driving

in-

R.

PINTA,

M.D.

of Patients

Referred

for Psychiatric

Ohio

Treatment

SIR: In their article ‘ ‘The Evolution of Psychiatric Services in a Health Maintenance Organization’ ‘ (March 1977 issue), Thomas E. Bittker, M.D. , and T. Scott Idzorek, M.D., indicate that their pneintake evaluation of patients referred for psychiatric treatment includes a personal history questionnaire, symptom checklist, Beck Depression Inventory,

M.D.

Ir’ine,

in-

of certain

Columbus,

1. Hingson R, Scotch N, Goldman E: Impact on alcoholics, treatment personnel, and Stud AIc 38:2065-2076, 1977

influ-

that

voluntarily hospitalized under current mental health legislation. What has happened is that state legislatures have given many laws the appearance of being nonpredictive by prohibiting specific behaviors that are actually antecedents of the behavior they are really designed to regulate. The preventive aspect of the law has served an important regulatory function since antiquity. Unless one is willing to argue for the repeal of many similar laws, criticism of involuntary hospitalization laws will have to be on grounds other than their predictive nature. EMIL

Hospitalization

the

predictability

REFERENCE

Involuntary

under

prediction

injury or property damage. The applies to most regulatory traffic a concealed weapon is a felony only to be causative of some other wrongfound in possession of a concealed deprived offreedom on the predicwould have led to injury or harm to

carrying

Other

vehicle

of the

EDITOR

events are those that prohibit the possession of safe cracking tools, syringes, etc. I believe it is reasonable to ask how many people who carry weapons would use the weapon in the commission of a crime, and how many people who operate motor vehicles while intoxicated are actually involved in accidents. I know of no studies that have carefully investigated the accuracy of the predictions used in formulating these laws, but I suspect the number offalse positives would

studies on controlled drinking involving several thousand alcoholics. Is that ‘ ‘few’ ‘ or “many’ ‘? And what logical inferences might be drawn from those data? Then Dr. Lemere complains of the ‘ ‘vast majority’ ‘ who have been hurt by

relapse

Similarly,

others.

a motor

because

THE

will cause reasoning

because this is believed doing. Many people weapon are consequently tion that this behavior

of the conven-

we do not

Operating

is illegal

TO

Symptom

Questionnaire,

and

an MMPI.

Although it is not the primary thrust of their article, I would like to question the inclusion of the MMPI in this manncr. In my experience some physicians who desire psychometric assessment will request the MMPI but it is more ap-

propriate

to request

either

psychological

testing

or psycho-

logical consultation. When requesting psychological testing, the MMPI will be part of the test battery which will also include projective tests like Tree-House-Person, a sentencecompletion test, and a test for CNS dysfunction like the

Bender-Gestalt. quested, ister;

When

the this

psychological

consultant

will

is generally

the

the MMPI

is not intended

psychometric

instrument

consultation

determine model

in

which

tests

medicine.

or designed

In

is

re-

to admineither

to constitute

case

the only

administered.

To request only the MMPI is peculiar and is like ordering a WBC but not a differential: it provides some information but more is available. Perhaps the MMPI is frequently requested because

it is an

patients

quickly

with each

a personality scale, e.g.

objective

test

by an untrained ,

tomed

to laboratory

ments

of parameters

profile the data

data

that

can

be

assistant

drawn up; there are quantified.

that

presumably

provide

administered

are subscores for Physicians accus-

numbers

feel more

to

and can be scored

and measure-

comfortable

with 995

Involuntary hospitalization laws as predictive laws.

Am J Psychiatry we were our aim evidence fered August LETTERS 1978 while intoxicated. ence of alcohol toxicated drivers same predictive contin...
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