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