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Forensic Pathology: The In’s and Out’s

Operating Theatre

Forensic pathology is yet another important field within the forensic sciences, yet not for those with a weak stomach. If you have ever seen how they conduct an autopsy you’ll know what i’m talking about, and for those of you that haven’t, just imagine systematically slicing open sections of the body and organs, including removing the brain, emptying the stomach and a few other things that although necessary, look very macabre – like something out of Silence of the Lambs.

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It has been some time since i’ve had any chance to add content to this website, and there are still a number of areas that are inactive courtesy of the website re-design i did not get to finish as yet. Below is my latest paper written for my post graduate study, and as i have finally received marks for it i can now share it with all of you. Reference list is available upon request, happy reading.

In this paper one will first introduce Social Learning Theory (SLT), before examining the case of Nigel, a 19 year old male who is currently serving a six year custodial sentence for assault and robbery and identifying the maladaptive behaviour patterns Nigel is exhibiting before conceptualising them in the vein of SLT. Further to this a rehabilitation program shall be discussed which will include the reasons for a SLT approach, the objectives of the program in regards to Nigel and finally how we would measure positive and negative outcomes. Lastly, before concluding the essay, one will examine current research in the field and establish how successful the rehabilitation program is likely to be in Nigel’s situation.

While Social Learning Theory was first conceptualised by Miller and Dollard (1941) it is a Canadian psychologist by the name of Albert Bandura whose writings are envisioned to be the most appropriate and in depth for analysis of this case. Having been working in the field for over four decades, Bandura has written extensively on SLT in general, but has also focused a significant amount of his attention on aggressive behaviour and by extension criminal behaviour. To successfully identify and target the antisocial behaviours that Nigel exhibits it is important to first explain the acquisition, instigation and maintenance of behaviour within a Social Learning Theory framework. To this end there are three main sections within SLT that will be introduced and explained, before we move on to Nigel’s individual case, as outlined in Bandura (1976) and they are; how behaviour is attained (acquisition), why these behaviours are executed (instigation) and lastly why these actions continue to be displayed (maintenance).

Within behaviour acquisition there are two facets that need to be explained; observational learning, which includes familial and subcultural influences as well as symbolic modeling, and learning by direct exposure. Familial influences are those from within an individual’s family such as parents, sisters, brothers etc. while subcultural influences are those such as peer groups. Peer groups could be anything from your group of friends to the church you belong to or even a government or military organisation. Further to this symbolic modeling is another method through which behaviour is acquired and this is where an individual acquires behaviour through the media i.e. by watching television or reading about others actions in the newspaper. Lastly, learning via direct exposure is theorised to affect behaviour acquisition which is a simple idea that does not require further explanation.

Behaviour instigation is the next element of SLT that needs to be described and it contains items such as aversive treatment, incentive inducement, instructional control and delusional control. Aversive treatment is any action committed against an individual that causes frustration levels to rise and these can include physical assaults, verbal threats and insults, the thwarting of behaviour that is directed towards an individual’s goals as well as adverse reductions in reinforcement levels. Furthermore, incentive inducement is where behaviour is motivated by the pull of expected rewards, where the reward could be something tangible or symbolic i.e. money from a theft or social status within a peer group respectively. Lastly, both instructional and delusional control can affect behaviour instigation; this is where social obedience is rewarded and dissention punished while delusional control is where an individual can have internalised delusions that somehow control their reasoning, resulting in overt actions.

Lastly how behaviour is maintained will be discussed and this final section of SLT has three main multifaceted sections which include direct external reinforcement, vicarious or observed reinforcement and self-reinforcement. Within direct external reinforcement there are four subcategories that need to be explained and these are tangible rewards where behaviours such as theft are maintained by the actual item being stolen i.e. those that steal and benefit from it are likely to continue this behaviour. It also includes social and status rewards where the individual gains social standing or a higher status within their relevant peer group as well as expressions of injury where an individual continues to commit certain actions due to the behavioural reinforcement received from witnessing signs of suffering in those being persecuted. Alleviation of aversive treatment is the last method of direct external reinforcement and this is where an individual who is being exposed to distressing or dangerous situations externalises certain behaviour in an attempt to eliminate said exposures i.e. an individual who finally fights back against a bully is likely to have their behaviour reinforced.

Vicarious or observed reinforcement is the next element of maintenance and it is a much simpler concept compared with the aforementioned as it only has one facet that needs consideration. Actions are maintained in this situation by watching the actions of others and not only learning from their behaviours but by examining the outcomes and whether the person was punished, rewarded or ignored.

Self-reinforcement is the last method by which behaviour maintenance is hypothesised to occur and this includes three individual, yet broad, components. Firstly, self-reward maintains behaviour, where the reward can be something as simple as personal pride or praise from an authority figure, and secondly self-punishment can have a similar effect where self-contempt, remorse or even fear of reprisal can preserve learnt actions. Thirdly, disengagement of self-deterring consequences is theorised to maintain behaviour and this in itself has a large number of subcategories all of which are important. First to consider is that of reconstruing aggression by palliative comparison where an individual defends their behaviour by pointing to more extreme examples of the behaviour they have instigated. Second off the mark is justification of behaviour in terms of higher principles where a person, for example, tries to put the onus for their actions on a message from God. Thirdly, displacement of responsibility needs to be considered where an individual attributes blame to an authority figure by stating they were ‘Just following orders’ while number four, diffusion of responsibility, is where an individual attempts to avoid their responsibility by division of decision making and labour or acting as a group. Fifth and sixth are dehumanisation of, and attribution of blame to victims, where a person ignores individual characteristics of another applying a stereotypical image and claiming to have been forced into action by a villainous person or adversary who is often the victim themselves, respectively. The final two aspects that need consideration in the maintenance of behaviour are misrepresentation of consequences and graduated desensitisation. This is where an individual tends to overlook or deny the injurious consequences of their actions focusing their attention to the positive outcomes and desensitisation over an extended period of time where the individual rarely realises the cognitive behavioural changes that have occurred within them.

Now that we have a solid explanation of how SLT theorises behaviour is acquired, instigated and maintained it is time to examine the maladaptive behaviours that Nigel has been exhibiting and conceptualise them within the SLT framework to enable us to establish what the treatment program needs to address.

To start with, Nigel has been in trouble with the police since his early teens and has spent time in juvenile institutions for a variety of offences, many of which include violence. This isn’t particularly surprising given both his parents were alcoholics and he was subjected to frequent physical and psychological abuse. Such influences would fall within the familial group and likely helped him to acquire his own behaviours of excess in regards to alcohol. Further to this, Nigel’s father has also spent time in prison and although it is not clear what the offences were that landed him there it is likely they were similarly violent acts. Given this, it has been shown that Nigel’s chances of growing up his own behaviours of excess as well as with maladaptive violent behaviour are significantly higher than those not exposed to the same levels of violence (Ireland & Smith, 2009) and that such exposures would lead Nigel to have aggressive ways of responding in social problem solving arenas (Gale, 2003).

In addition to the fact that Nigel has obviously learnt maladaptive behaviours that involved excessive use of alcohol and general violence the psychological trauma he has been exposed to by his parents has helped breed a personality that appears callous, sullen and uncooperative. There is evidence in the field that suggests children as well as adolescence who are subjected to parental maltreatment are significantly more likely to have not only interpersonal relationship problems but also maladaptive socioemotional and psychosocial responses. Furthermore, those that are exposed to such neglect before their fifth birthday generally have larger and more conspicuous signs of social dissociation (Ethier & Milot, 2009; Morrel, Dubowitz, Kerr & Black, 2003). Due to this persona coupled with aggressive modes of responding Nigel also has poor social skills and states that he can’t stand people looking down on him. It is likely his peer group are all similarly troubled individuals who influence his acquisition, instigation and maintenance of behaviour as he would not only gain social status within his group for his violent offending but also garner a sense of satisfaction when inflicting physical pain on other individuals.

From a SLT perspective, once Nigel had acquired his personality traits and modes of behaviour there are a large number of different avenues that could be maintaining his actions. There are direct external reinforcement avenues such as the previously mentioned social or status rewards as well as expressions of injury in the individuals he is persecuting but also self-reinforcement including personal pride for smiting his ‘foe’. It is envisioned that there are three main actions that need to be addressed in the case of Nigel to alleviate some, if not all, of his offensive behaviour. Firstly his aggressive behaviour, in particular his social problem solving skills, i.e. his method of responding needs to change to nonviolent approaches. Secondly, his behaviours of excess need to be addressed as his drinking is likely linked to not only aggressive outbursts but also to his social skills and possibly his criminal acts. Lastly it would be ideal if cognitive change could be implemented also as Nigel appears to have a number of faulty cognitions that have been bred into him by familial influences that prevent him from acting in socially appropriate ways.
This leads us to the most pertinent line of questioning discussed thus far; what sort of treatment or rehabilitation program should Nigel be on and why? It also by extension leads one to remark on the objectives of said program and discuss how positive and negative outcomes will be measured.

As Nigel presents with a sullen and uncooperative personality a rehabilitation program modeled on SLT framework is likely to give him the greatest chance of undergoing change and this is for a number of reasons. The primary reason is that Nigel is unlikely to benefit from any sort of insight-oriented psychotherapy as individuals who partake in such treatment firstly have to be willing to change and due to this they cooperate with the therapist. The second reason is that Nigel is unlikely to have the cognitive abilities required to actually have insight into his own problems and behaviour and is more likely to deny that he has any problems. Traditional treatments simply fail to engage with these types of people and that includes those with ritualised, aggressive or addictive behaviour patterns.

For this reason a sophisticated token economy approach is theorised to be the most appropriate rehabilitation or treatment tool available for individuals such as Nigel as it has had a large number of positive effects on an array of persons ranging from the mentally ill to adolescence and children (Hollin, 1994; Hall & Baker, 1973; Hall, Baker & Hutchinson, 1977; Kazdin & Bootzin, 1972). In Nigel’s case one theorises that a token economy similar to that used in the ‘Achievement Place’ residential program designed by Phillips, Phillips, Wolf and Fixsen (1973) would be most effective in modifying his behaviour. This particular token economy awarded points on a daily basis when individuals first began participating, before awarding points on a weekly basis only and then the final stage where all privileges became free. If persons in this study were able to successfully handle the final stage of this program they were deemed ready to return home.

In this instance given the length of sentence that Nigel has been given it would be fairly easy to implement a program similar to this that could run for an extended period of time, preferably in such a manner that the three stages of the program were stretched over a period of time leading up to his earliest possible parole date. Ideally once paroled, if Nigel were able to be placed in some sort of residential facility where his behaviour could continue to be monitored for a period of time, his chances of behavioural change would be at their highest.

While this particular approach will work with even the most uncooperative of individuals the objectives of any treatment or rehabilitative program needs to be tailored to each offender’s personal situation and requirements. In Nigel’s case there are both primary objectives and secondary objectives which are important but some will follow on from others. Ideally from a behavioural change standpoint one would like to see Nigel’s aggression levels drop dramatically and this would be seen as a primary objective. Further to this his abuse of alcohol needs to be addressed as a primary objective as this is not only linked to violent outbursts but likely to his criminal behaviour in general. If these two objectives can be obtained then Nigel’s social skills should improve by extension as it is more likely for him to have positive social experiences where he doesn’t feel the urge to lash out violently.

When it comes to actually measuring the outcomes the best approach will be to use a number of different methods including self-report questionnaires, prison employee observations and official reports of indiscretions Nigel has committed and while the official reports are straightforward the other two elements need to be carefully thought through. In the case of the prison employee observations it will be necessary to develop a series of questions relating to Nigel’s behaviour before treatment begins with follow up questions to note any changes. Ideally follow up interview sessions with prison employees would take a very small amount of time and be administered on a monthly basis to add an extra level of observation.

When considering the self-report questionnaires however it would be advisable to use three measures; one to measure personality and emotional variables, one to measure level of dependence on alcohol and addictive behaviour and one to measure levels of aggression and aggressive behaviours. For this purpose the three psychometric tests envisioned to be the most valid are the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen & Kaemmer, 1989), the Structured Addictions Assessment Interview for Selecting Treatment (ASIST; Addiction Research Foundation, 1990) and the Aggression Questionnaire (AQ; Buss & Durkee, 1957; Buss & Perry, 1992; Buss & Warren, 2000).
When considering when to utilise these measures ideally all three would be administered before the token economy began, or if Nigel initially refused to partake directly after the token economy had been introduced. Every second month after the introduction of the token economy Nigel would then be submitted to only the ASIST and AQ measures while the MMPI-2 would be administered at the start of each new stage of the rehabilitation program and once more before he was paroled. This would enable adequate baseline numbers to be collected and also allow one to establish when changes in aggressive and addictive behaviour and the like have been implemented.

To add credence to this particular approach it is important to have a brief look at other research into token economies and how successful or unsuccessful they have been. While those such as Milan, Wood and McKee (1979) had success introducing a token economy approach with incarcerated felons their joy was short lived as all participants stopped their educational courses once the token economy ceased. However this is more a failing of the type of change they were trying to implement rather than the token economy approach itself, something the authors seem to have picked up on as they stated the plan requires re-evaluation.

Others such as LeBlanc, Hagopian and Maglieri (2000) found that by utilising a token economy with a mildly retarded individual who had inappropriate social interactions and aggressive behaviour they were able to implement behavioural modification to the point that when they started scaling back the reinforcement stages the behavioural change remained. In other settings similar results were able to be found such as LePage (1999) whose token economy approach with psychiatric patients between the ages of 18 and 20 found that the use of a token economy reduced negative events such as violence by a significant 43%. Lastly, while the research is not the most recent, Walls and Nicholas (1973) found positive results for psychiatric patients, mentally and socially retarded individuals as well as juvenile and adult offenders in their review of 31 token economy approaches.

In closing, Nigel’s case is unlikely to be a unique one in the true sense of the word as there are likely many an individual who is incarcerated that has similar, if not the same, maladaptive behaviour patterns. However given his young age it may be possible for permanent behavioural change to be implemented given an adequate level of treatment, preferably including residential placement after being paroled. Phillips, Phillips, Wolf and Fixsen (1973) found in their token economy rehabilitation program that those who partook recidivated 19% of the time while those that didn’t recidivated 53% of the time – a substantial and significant difference that brings hope to this field. While token economy programs within corrections institutions are difficult to implement and design successfully, they are envisioned to be a distinctly powerful tool when it comes to behaviour modification and further research including longitudinal designs needs to be executed to develop such approaches in order to maximise benefits for not only the incarcerated individuals but for the safety and wellbeing of fellow inmates, corrections officers, police officers and the general community.

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