Recently one of our readers wondered what I thought of a study that was recently reported in Scientific American Mind. It was a study that was done in a forensic psychiatric hospital, looking at the correlation between tattoos and a diagnosis of antisocial personality disorder. Briefly, they examined 36 inpatients for the presence or abscence of tattos and then did semi-structured interviews to assess them for antisocial personality disorder. Unsurprisingly, they found that people with tattos were more likely to be diagnosed with antisocial personality disorder and to have histories of substance abuse and suicide attempts.
My first thought when I read this report was: "This was a forensic fellows' research project."
Psychiatrists in training to be forensic psychiatrists are encouraged to do some type of research project during their fellowship. Since the fellowship only lasts for a year, it can be difficult doing any kind of in-depth or groundbreaking studies. The tattoo project is not a ground-breaking study. The main reason it probably got published was because it was done on forensic inpatients (although Scientific American Mind confuses them with prisoners, they aren't). The research subjects were patients, not prisoners. They were committed to the hospital after being found legally insane (therefore, not a criminal at all) or incompetent to stand trial (mentally unfit to go to court, therefore their guilt is undetermined).
The most interesting aspect of this study was the one that was not addressed at all in the paper:
How did they determine that the patients, all of whom by definition were seriously mentally ill, were competent to give informed consent to a research project?
This question is at the cutting edge of forensic psychiatry these days, a field which is concerned with competency assessments and capacity for decision-making. There are particular ethical difficulties that arise when the research is being conducted on institutionalized subjects like patients and prisoners. I've already blogged about this in detail in my post Guinea Pigs Behind Bars. (Be sure to check out the link to the guinea pig costume web site. I still love it.)
You can download the entire study by clicking on the pdf link at the Wiley web site here.