Mahogany, Not Monogamy

Psychologists administer a number of psychological tests at the LRC. Then psychiatrists prescribe drugs as part of the patients' treatment. Alone in the nurse's office, I often read various charts, and I notice a reference to these psychological tests in almost every file.

The Beck Hopelessness Scale (BHS) is a very brief inventory that is designed to assess three aspects of hopelessness among suicidal patients: feelings about the future, loss of motivation, and overall confidence. Another test with a similar purpose is the Suicide Probability Scale (SPS). One patient, name of M.Z., had allegedly murdered his wife and was diagnosed with major depressive disorder and schizoid personality disorder.

M.Z. was taking aripiprazole, an antipsychotic, and escitalopram, an antidepressant. M.Z. attempted suicide; once at home and again as an inpatient at the LRC. He strangled himself for sexual arousal, engaging in the act of autoerotic asphyxiation, according to his chart.

Moving right along.

My personal favorite, the Al Pacino of psychological tests, is the Psychopathy Checklist: Screening Version, commonly referred to as PCL:SV. This test is used to assess the possible presence of a lone psychopath in a civic and/or correctional setting, the PCL:SV serving as a method of criminal evaluation.

Bruce completed the PCL:SV. Don't know his score. A few key emotional traits of psychopaths include a superficial charm, egocentrism, a lack of empathy, and a lack of remorse. Aside from borderline intelligence, Bruce came off as a harmless dude.

The HCR-20 is unavoidable, an instrument that is designed to determine whether or not a patient is at risk for violence. Each patient, I believe, is given this assessment because staff must be aware of a potential threat. Here is a list of the items in the HCR-20:

Historical Scale:

H1 Previous Violence

H2 Young Age at First Violent Incident

H3 Relationship Instability

H4 Employment Problems

H5 Substance Use Problems

H6 Major Mental Illness

H7 Psychopathy

H8 Early Maladjustment

H9 Personality Disorder

H10 Prior Supervision Failure

Clinical Scale:

C1 Lack of Insight

C2 Negative Attitudes

C3 Active Symptoms of Major Mental Illness

C4 Impulsivity

C5 Unresponsive to Treatment

Risk Management Scale:

R1 Plans Lack Feasibility

R2 Exposure to Destabilizers

R3 Lack of Personal Support

R4 Noncompliance with Remediation Attempts

R5 Stress

With the HCR-20, Austin received a high score. More than six of these items applied to him, evidence that staff needs to make sure Austin stays out of trouble. Reading his chart, I found he used to be a good welder and he likes to work cattle. Success, the key to Austin's future, remains unattainable because of his behavior.