Violation of civil rights, forced treatment and commitment under the guise of psychiatric care are depicted in two cases involving female physicians who became “patients” in non-medical situations in different States, They were each violently victimized and at some point in their cases acted in pro per.
In both cases the victims were denounced in court as malingerers after a misdiagnosis of psychosis and dangerousness was used to justify police action, incarceration, restraint and forced injections of psychotropic drugs to incapacitate these women.
In addition, this author’s role as a forensic psychiatrist and expert witness in each of these cases was markedly handicapped by the court’s prosecutorial favoritism and prejudicial attitude against such “mentally ill” persons.
The specific effect of the many injustices in these two very similar cases was to negate the freedom of these women and the overall effect was to discredit psychiatry while justifying the court’s and the police powers.
The current level of anti-psychiatric bias and the role of a psychiatrist in the legal system are shown to be as great as ever.
Case # 1
AB at the time of my psychiatric evaluation was a 46 year old foreign born divorced mother of two children who is a physician. She lived with her husband and twin sister after migrating to the United States from Russia. Upon her arrival here she took additional residency training. On one of her clerkships, in psychiatry, she was lured into a “treatment” relationship with her supervisor who then seduced her into an inappropriate and unwanted sexual relationship.
After extracting herself from this relationship AB confided in another psychiatrist about this event, because she felt guilty and frightened. However, this psychiatrist, ostensibly out of concern for her, passed on the confidential information to her husband, who then divorced her but remained in their home.
AB moved to another city and consulted with a number of other psychiatrists, continuously trying to deal with the embarrassment and humiliation from the affair. She also sought legal counsel when she considered suing both the seductive supervisor and her psychiatric confidant. The offending psychiatrists’ attorneys then began a campaign of phone calls to AB which were aggressive, intimidating and threatening to counter sue her in an attempt to have her drop her case.
The patient then sought psychiatric advice at a university out-patient clinic where she was very cautious because of her prior experience with the psychiatric confidant. She requested that the resident who evaluated her assure her of complete confidentiality and that no harm would come to her. When the female resident acted in a superior manner, AB refused to sign any form with her address or permission to receive medication.
AB explained that she was against medication because of her knowledge about the side effects, the use of neuroleptics in Nazi experiments on the Jews (where she had previously lived) as well as her religious beliefs. She also told the resident about the attorneys that were threatening to counter sue her.
The psychiatric resident wrote a note in her chart about the visit with AB which included a diagnosis of Psychosis NOS and prescribed Zyprexa. AB did not go to the next appointment which had been scheduled but did speak on the phone to the resident a few more times about the attorneys threatening her.
The resident then assumed that AB was not taking her medicine, was paranoid about the sexual abuse claims and the psychiatrists’ and attorneys’ behavior and assumed that the woman, who spoke with a pronounced accent, was not feeding her infant child, when she spoke about her concern for her child.
The resident faxed a statement to Child Protective Services (CPS) reporting that AB was psychotic and not feeding her child. No address was provided because AB had refused to disclose this on her initial clinic visit.
Several weeks later when the resident learned that CPS had not made a home visit to AB, the resident inappropriately called 911 and reported to the police that her patient was psychotic and not providing food for her child. The police were able to find AB’s address and 6-7 uniformed police and one nurse from the Police Emergency Response Team (PERT) rushed to the home to do a “welfare check”, although the resident related to the dispatcher that the uniformed police appearance would “drive her crazy”.
Several police cars drove to the patient’s home and the police overwhelmed and overpowered AB who was holding her baby when they arrived. Despite AB’s protests, her ability to answer factual questions and the fact that the baby was not in pain (although crying) they took the baby from her and sent the infant to a child shelter.
The police wrestled the patient to the ground, put her in handcuffs and then forcefully held her outside of her house and told her not to move and to “shut up”. One policeman put his hand on his weapon while another searched through personal papers in her home. She had had no warning that they were coming, no Miranda rights given to her and no notice of why she was being arrested.
The patient was taken to the emergency room of the county medical hospital where she was interviewed for 10 minutes during which she gave a coherent history and answers to the admission questions. She was then taken from her chair and “thrown on to a gurney by five people”. Her pants were pulled down and she was held down and injected with Haldol and Ativan despite her protestations. The patient informed the nurses that she was pregnant and was afraid of the effect of the drugs on her fetus as well as herself. One nurse said; in a nasty way, “Who would make you pregnant?”
The next day AB was transferred while on the gurney and in restraints to the university hospital where they did not properly re-evaluate her but “just rubber stamped” the police and county hospital records. They forced her to take medication by threatening to inject her again. Each time her protests against the medication were seen as evidence that she was violent, dangerous or uncooperative and thus appropriate for restraints and she was injected with medications, which did have adverse side effects.
And yet, the patient was discharged only two days later, but with the recorded forever defamatory diagnosis of Psychosis NOS.
AB was obviously not psychotic, had no true delusions, hallucinations or disorganized thinking and was not dangerous to her self or others and did not meet the requirements for involuntary commitment. There had been no lack of food at home to justify concern for the baby’s welfare although the PERT officer never actually went in to the house to look for food but reported that she had. The question of a concurrent pregnancy was not verified.
The patient sought legal help but found she could not afford her attorney’s fees and eventually began filing malpractice and civil right suits (5 separate cases) and prepared all the briefs on her own.
After almost two years of various denials by the court she found an attorney who would represent her (the plaintiff) on contingency and he brought the case to trial suing everyone involved in her detention, care and treatment, including the County and the police department for violation of her civil rights and malpractice.
At trial the judge appeared to be sympathetic to the defense which represented the county hospital and the police department when he repeatedly ruled in their favor each time the plaintiff’s psychiatric expert witness (this author) attempted to define and discuss the standard of care issue and how it was breached. The opportunity to present this issue was crucial to proving maltreatment by the psychiatric resident, the clinic psychiatrist, subsequent medical personnel and the police. It was sabotaged by the defense’s objections which were supported by the Court.
Case #2
CD was at the time of my psychiatric examination a 50 year old divorced pediatrician who had become a child advocate for those not properly cared for by the County and Child Protective Services. She is a very bright woman who has suffered from a number of medical illnesses since childhood so she was particularly empathic with her patients.
CD’s motivation in her medical life was combined with a strong identification with the injustices experienced by the poor, the Blacks and especially the children with illnesses which no other doctors wanted to treat. Thus, she took on the task of challenging the “system” which consisted of hospitals and the political bureaucracy at the county and state level. Not only did CD gain attention for her treatment of those with unusual or exotic disorders that others would not accept as patients, she also made house calls, often went without payment and was available for parental concerns at all hours of the day and night. She drew a lot of attention for these reasons alone. Then, when she proceeded to act on her desire to emergently treat some of her patients in a hospital setting without going through the proper, but intolerable administrative admission procedures, the hospital balked at allowing her to function outside of their prescribed structure and suspended her from practicing there.
CD’s unconventional though very admirable medical practice style, wherein she also enabled her staff to provide psychotherapy for her impoverished clinic children which was not covered by insurance, led to her being regarded unfavorably by her own hospital administration.
There was also an occasion in which she treated a sexually abused child who was in some way related to a city governmental official, who apparently felt threatened by the matter. This official later became a member of a notorious law firm and it is believed he sparked a broader legal community antipathy toward her.
Later, because of a medical problem of her own, while in a hospital emergency room she was deemed delusional because she spoke of issues concerning a case which involved a political figure. She was then inappropriately forced into restraints and despite her protestations was injected with Haldol and Ativan, which was so stressful for her that she developed a posttraumatic stress disorder.
CD then began a series of administrative attempts to gain reprimands toward the ER doctor. She was then required to seek psychiatric treatment.
After several months of treatment the ER doctor episode led to her hospital demanding that she be evaluated by a forensic psychiatrist to determine her competency to practice medicine and regain her hospital privileges. The report authored by this supposedly renowned psychiatrist was written as if it were a legal brief to be used to indict CD.
This was a very pejorative report and used convoluted logic, denial of factual and documented information and characterized CD’s complaints and allegations of defamation and reports of attacks upon her person as “histrionic descriptions”. The forensic psychiatrist was apparently politically motivated by his first opportunity to gain a referral connected to the notorious law firm as evidenced by his conclusions that CD was “Psychotic NOS” and had a “Personality Disorder, NOS (with histrionic features). This was a misdiagnosis, not supported by the real facts and evidence,
The report, however, was then the kiss of death for CD and thereafter she could gain no credibility in court, subsequent emergency room visits or with law office security officers or the police department. Political ramifications developed into a personal antagonism toward her by some major political figures. This all required CD to repeatedly defend herself in court.
The patient felt forced by bias and finances to represent herself pro per. Not only did she provide her own defense in a very professional manner but she also felt it necessary to initiate actions against those who she saw as adversaries in her campaign to practice better medicine. What started as actions on behalf of those patients who were the primary victims of a dysfunctional medical system then became a protracted defense of her mental state and an attack on those whom she saw as guilty of malpractice or violation of her civil rights.
CD ‘s life throughout this period has been marked by a dozen legal cases being filed against her, a half a dozen suits filed by her and numerous arrests and incarcerations. She has been handled roughly, beaten, deprived of water and food, molested and threatened with rape. Her medical conditions have invariably been compromised, exacerbated and at times brought her near death.
She wrote, “Senior jail personnel surrounded me from the time I was taken into custody (three sergeants in the courtroom, when they announced “no bail” arrest warrant). They purposely confined me to the psychiatric tier which limited my writing to using a pen 30 minutes per week on Tuesdays, one envelope and stamp and two pieces of paper. I was otherwise held incommunicado, not allowed to use the law library, contact an attorney or contact courts or opposing counsel. Nevertheless, I was able to write an emergency motion to review bail to the State Court of Appeals and I was successful in gaining my release today. It was a highly illegal act for that judge to order me to jail, as verified by the court of appeals.”
The courts see CD as an irritant and treat her as if she were an escapee from a psychiatric unit despite her logical, coherent and accurate legal arguments. They try to avoid her political charges by referring to her as delusional when in fact she has never had any true symptoms of a psychosis.
The fact that CD has suffered emotional reactions of anxiety and depression to her medical illnesses as well as the abuse by the ER doctor, her hospital administration, the police who arrest her, the jail guards who watch over her and the court personnel who reject her is used to relegate her to the “not-to-be-taken-seriously” psychiatric patient category.
Civil rights seem to be non-existent for psychiatrically labeled victims especially when they become resistant to the abuse.
CD was also victimized by the police action and incarceration which at times did not allow for her to receive emergency medical treatment. Her medication was at times withheld and at times they did not recognize her right to refuse treatment when she asserted that certain drugs were contraindicated by her medical condition and/or her other medications.
Finally, when this author was requested to be a witness for CD, to testify about her mental competency, the Court would not allow her to have such a witness. This was the ultimate censure and denial of her legal as well as civil rights.
Discussion
“Psychiatry has been criticized for ethical abuses in every sphere of its activity.”** This is especially so with its ability summarily to cancel a person’s freedom through its power to commit that person against his or her will. At the base of this power is the psychiatric act of diagnosing which may have immediate as well as lifelong consequences. **
The two women physicians described above, each in somewhat different initial circumstances but both asking for help in some form were incorrectly diagnosed as psychotic and thereafter mistreated. They were each abused physically and rendered helpless by use of neuroleptic medications. Then when they complained about their maltreatment they were regarded as psychotic or malingering and not acknowledged as having valid complaints.
Neither was psychotic, malingering about the abusive consequences or otherwise not entitled to the right to refuse treatment or the right to resist abuse.
This psychotic labeling led them to be apprehended by the police who treated each of them as if they were criminals, rather than patients, as those in charge assumed their protestations were evidence that they needed to be restrained and tranquilized. The courts in turn disregarded their complaints because of the “Psychotic” diagnosis and thus the abuse continued in one venue or another.
In each case these women sought restitution of their good names, their rights and compensation for the abuse suffered. Both attempted to do so pro per and, although one did eventually have representation, the pro per status brought additional resentment from the Court. The Court does not like dealing with outsiders and showed obvious bias and inappropriate incarceration with severe maltreatment of the one woman who persisted and bias at trial against both.
In AB’s case she was a foreign born woman with a pronounced accent that had grown up where psychiatry was used as a tool to incarcerate or experiment on such persons. “The ill are excluded from the main-stream of social life: they are deprived of jobs, marriage is prohibited. and there is a ban on sexual contacts”*
Consequently, AB’s suspiciousness was not unreasonable when she was victimized sexually by a psychiatric supervisor/therapist, when a confidential inquiry about that event was inappropriately exposed, and when she was consulting with another psychiatrist who considered her “affair” and its exposure as a delusion and thus evidence of her “psychosis nos”, even though her husband believed it enough to divorce her as a result.
That psychiatric resident who diagnosed a psychosis most likely was influenced by the foreign accent, the frenzied state of her patient when resisting the police handcuffing her and the emergency room nurses restraining and injecting her. She also obviously disregarded AB’s clear and logical presentation of her vital data and cultural background when brought to the ER, prior to being restrained and injected there.
The resident abused her power over her patient by calling the police for a non-dangerous situation and misdiagnosed the patient leaving her with a stigma which caused her to lose credibility in the judicial arena as well as a receive a life-long blot on her record.
CD’s victimization was similar to AB’s in that she was considered psychotic because she fought a system which was undermined by politics and politicians who needed to deter all those who purport to upset their areas of influence and power. This power was vested in CD’s hospital board of directors as well as city and state officials. It is thus not surprising that the courts in turn were influenced adversely against her.
Compounding CD’s initial intent of gaining more favorable medical treatment for the children, which was not a high priority of the local government, was her forcefully made vocal protestations and those made in her own legal briefs which denounced all those oppressors as misleading, deceptive, and dishonest. She was also relentless and unforgiving, never giving an inch and repeatedly correcting every iota of error she could find.
She thus irritated and alienated all those whom she was asking to correct the system. There was no give on her part and she was not tolerated, her message went unanswered and she was repeatedly sent to jail, made miserable while there and suffered numerous exacerbations of her many medical conditions.
However, she was not psychotic! Yet, it was this labeling which started the antipathy toward her and continuously prevented her from being appreciated for her very good intentions and her creative thinking and intelligence, evidenced in the legal field as a pro per but most importantly in her medical practice.
Psychiatry should not be taken lightly as a critical specialty in the medical field nor should it be used as a weapon by physicians or the legal or political system against individuals who are different, sound strange or are non-conforming. Accurate diagnosis with thoughtfulness as to the many consequences coming from each label is a requirement of all physicians and must represent the standard of care.
The ethical standards we need to operate a reliable and safe society depend on rectifying the kinds of abuses to which these two physicians were subjected.
REFERENCES
- * Rutkowshi R, Gordon T: The crisis in psychiatry and the protection of the civil rights of mentally ill patients, Psychiatr Pol. 1994 May-June:28(3): 301-12
- ** Reich W: Psychiatric diagnosis as an ethical problem, in Psychiatric ethics edited by Bloch S, Chodoff P, Green SA. New York, Oxford University Press, 3rd ed.1999, pp 193-224