Psychiatrists are doctors, not omniscient prophets

By Emily Liebert

Two recent jury verdicts suggest a trend that will severely undermine psychiatric care in this country. The verdicts maintain, in essence, that psychiatrists are accountable for any harm done to society by their patients. In each of these cases, the psychiatrist being sued was found guilty for not foreseeing and preventing the actions of his patient. Clearly, this is absurd.

Psychiatry is based on a relationship of complete confessional freedom and trust. If that relationship is destroyed because of legal and medical idealists, the whole field will be irrevocably subverted.

On Thurs., Oct. 8, a federal jury in Bridgeport, Conn. found a Manhattan psychiatrist, Dr. Douglas Ingram, negligent for not warning anyone that Dr. Joseph De Masi, who was Ingram's patient at the time, had confessed to having feelings of pedophilia.

De Masi had begun seeing Ingram during his own third year of medical residency, where he was training to be a child psychiatrist. In 1986, De Masi admitted to having sexual fantasies about children and asserted that children were not damaged by sexual relations with adults. Ingram asked De Masi whether he had ever molested a child, planned to do so, or was having fantasies about a particular child. The answer to each question was no. Therefore, Ingram did not attempt to prevent De Masi from practicing because he was bound by doctor-patient confidentiality.

Last month, a similar case had an equally disturbing verdict. In 1995 Wendell Williamson, a paranoid schizophrenic, killed two people he had never met on a street near the campus of the University of North Carolina, where he was a law student. Williamson was tried and acquitted on the grounds of insanity.

Following this verdict, Williamson sued psychiatrist Dr. Myron Liptzin, with whom he had had only six meetings, the last of which had been eight months prior to the shootings. Williamson asserted that Liptzin had made an incorrect diagnosis of his condition, had not conveyed the gravity of his illness, and had not followed up after their sessions ended. Last month the jury granted Williamson $500,000.

Liptzin plans to appeal the verdict contending that psychiatrists should not have to "police their patients." "How can I be responsible," he asked, "for something that is unpredictable?" Still, as Williamson told the jurors, he believes that "Liptzin had more control over the situation than I did."

The verdicts of both of these cases are deeply troubling--both demand too much response from psychiatrists. In the De Masi case, it is truly unjust and incorrect to hold Ingram responsible for his patient's actions. It is not uncommon for a patient to tell his analyst his sexual fantasies.

Acting on a sexual fantasy that is destructive to someone else is a crime, but merely having such a fantasy is not. Ingram did what he could to ensure that these fantasies would not be pursued. He asked the right questions and received reassuring answers. What else could he have done? A fundamental element of Ingram's job is to maintain the privacy of his patient, even if that means giving him the benefit of the doubt.

Of course a psychiatrist is an important figure in a patient's life. However, he may be in contact with his patient for as little as 45 minutes each week. The psychiatrist can offer insightful perceptions from his outside viewpoint. He can also provide valuable guidance. But the psychiatrist is not psychic and, in fact, has little control over his patient beyond the counseling the patient willingly accepts.

If psychiatrists are held legally and financially responsible for every action and decision of their patients, fewer medical students will go into the field. It would just seem too risky to have one's whole career based on the assumption that a doctor will never ever work with an unpredictable patient.

Equally distressing is the notion that as psychiatrists become more wary of lawsuits, they will more readily break their oath of doctor-patient confidentiality. Patients will become less trusting, talk less freely, and consequentially benefit less from treatment.

Psychiatrry is a crucial field of medicine. Whether treating the mentally ill or helping a 13-year old maintain sanity in junior high, psychiatrists are indispensable. Currently, we are in a cultural stage in which we are obsessed with excessive "quick-fixes." If you're feeling blue, take Prozac. If you have a headache, take Demerol. It is essential that we recognize and show due respect to an area of medicine that forces the patient to thoroughly contemplate and understand his problems in order to get well. The success of psychiatry, furthermore, is based on its unique doctor-patient relationship. To allow that relationship to function properly, we must not contaminating it with over-zealous legal scrutiny.

Emily Liebert is a sophomore in Saybrook.

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