Time - Man of the Year/Time_Man_of_the_Year_Compact_Publishing_3YX-Disc-1_Compact_Publishing_1993.iso/moy/041392/0413350.000

Text File | 1992-08-28 | 8KB | 170 lines

                                                                                MEDICINE, Page 61

Did His Doctor Love Him to Death?


A dispute over a Harvard psychiatrist's unconventional role-
playing highlights troubling medical issues involving intimacy
with patients

By ANASTASIA TOUFEXIS -- Reported by Hannah Bloch/New York, with
other bureaus


    To his Mexican immigrant family, Paul Lozano was a star.
A brilliant and shy student from El Paso, he had gained entry to
one of the nation's most elite institutions: Harvard Medical
School. His future seemed assured. But during his third year of
studies, Lozano became homesick and depressed. He got a list of
Harvard-recommended therapists and called the first name on the
alphabetical roster: psychiatrist Margaret Bean-Bayog. A
clinical assistant professor at the medical school, she had a
reputation as a gifted lecturer and dedicated researcher into
substance abuse.

    But what followed for Lozano, his grieving family claims,
was a death spiral into infantilism and madness. On April 2,
1991, just a few months before he was to receive his M.D.,
Lozano, 28, injected himself with a lethal dose of cocaine. Last
week Dr. Bean-Bayog, 48, found herself before the Massachusetts
medical licensing board refuting charges by Lozano's family that
she had driven him to suicide by seducing him into a lurid
affair, brainwashing him into thinking that she was his loving
"Mom" and he her baby boy, and then dumping him when he could
no longer pay for treatment.

    Lozano's family, which is suing the psychiatrist for
malpractice and "wrongful death," offers some extraordinary
evidence. Among the items they retrieved from his Boston
apartment were children's books such as Goodnight, Moon,
inscribed in Bean-Bayog's hand to "the baby"; tapes in which the
therapist instructs Lozano to repeat 10 times, "I'm your Mom,
and I love you, and you love me very, very much"; flash cards
made by the psychiatrist, one of which refers to missing "the
phenomenal sex"; photographs taken by Lozano that show
Bean-Bayog snuggling a stuffed bear; and a series of letters and
stories she wrote to him playing out fantasies about maternal
love and devotion. More perplexing still are dozens of pages in
her handwriting that describe her sadomasochistic sexual
fantasies. Lozano's sister claims her brother said he and the
psychiatrist had an affair.

    Despite such evidence, the case against Bean-Bayog is by
no means airtight. In testimony before the state board, the
psychiatrist denied ever having sex with Lozano and maintained
that he was far more disturbed than his family is letting on.
She described him as "chronically suicidal," the victim of
"horrendous childhood abuse," a drug user, and a liar subject
to delusions of sexual abuse involving both her and another
female psychiatrist. Though a social worker who had worked with
Lozano challenges this depiction, other therapists familiar with
the case support Bean-Bayog's account.

    The psychiatrist concedes that her treatment of Lozano was
"somewhat unconventional" but says she turned to it only after
routine therapy failed and after Lozano suggested that he found
the notion of a loving, nonabusive mother comforting.
Role-playing mother and son, she says, was a useful method of
calming his behavior and helping him confront traumatic
childhood memories. As for the flash card mentioning "phenomenal
sex," the psychiatrist says it was a statement dictated by
Lozano referring to his relationship with a girlfriend. She
admits the sexual fantasies are her own dreams but says they
were never meant to be shown to Lozano: he broke into her office
and stole them, she contends. Far from cutting his life short,
Bean-Bayog says she helped sustain him for four years. She
believes his death was accidental.

    Wherever the truth may rest, the Lozano case illustrates
the tangle of emotions and desires that wind through many
doctor-patient relationships. Surveys indicate that between 7%
and 13% of healers within an array of specialties -- including
psychologists, gynecologists, surgeons and family practitioners
-- have had some erotic contact with their patients. Public
outrage over such cases has led eight states to pass legislation
in recent years making sexual abuse of patients a crime.

    Medical organizations have been revising their ethical
codes. Last year a Canadian task force recommended that doctors
wait two years between treating a patient and becoming sexually
involved. For psychotherapists, the prohibition is much
stronger: intimacy with a former patient is never acceptable.
While U.S. doctors are fairly unanimous in opposing sex with a
current patient, they are divided over guidelines concerning
former patients. In the view of the American Medical
Association, a relationship with a former patient is unethical,
no matter how much time has elapsed since treatment, if it
exploits the "trust, knowledge, emotion or influence derived
from the previous professional relationship."

    The greatest potential for such exploitation arises in the
field of mental health, because of the intimate and emotional
nature of psychotherapy. According to one study, 86% of
therapists acknowledge sometimes feeling attracted to their
patients. Another study showed that half of psychologists have
seen at least one patient who has been sexually intimate with
a prior therapist. (In about 90% of those cases, a male
therapist was involved with a female patient.)

    On the other hand, mental-health professionals are
supposedly better trained than other doctors to deal with the
sexual feelings that arise during treatment. A patient's
emotions toward the therapist are in fact a major tool in
therapy. In a process known as transference, patients shift to
the counselor the myriad feelings -- love, lust, anger, hate,
admiration, envy -- that they harbor for significant people in
their lives, including parents, siblings, lovers. By discussing
those feelings in the safe shelter of a therapist's office,
clients can confront troubling issues from their past.

    Of course, therapists are not automatons; their feelings
can be stirred in sessions every bit as much as are those of
patients. Sometimes those emotions shift onto the client, a
process called countertransference. When a woman counselor takes
up with a male patient, the impulse is often a "fantasy that
love will cure the patient," says psychiatrist Glen Gabbard of
the Menninger Clinic, who points to the romance between the
therapist played by Barbra Streisand and Nick Nolte's character
in The Prince of Tides. "The movie would have you believe that
what was helpful to him was her love for him, not her
professional expertise."

    When therapists feel themselves drawn into an emotional or
sexual relationship with a patient, they are supposed to consult
colleagues for guidance. Bean-Bayog seems to have done just
this. Last week a clinical social worker in Boston said that
Bean-Bayog had discussed her sexual attraction toward a
Mexican-American patient in a teaching session. Bean-Bayog also
repeatedly sought advice on the Lozano case from senior
psychiatrists. Said one of her colleagues: "She had
consultations at every stage of the game." He points out that
a therapist who is abusing a patient is unlikely to be so open.

    Last week the Massachusetts licensing board criticized
Bean-Bayog for "departing from accepted standards of medical
practice" in her treatment of Lozano, but it came to no
conclusion about the charge of sexual misconduct. Pending
further hearings, the board decided to allow the doctor to
continue to see patients under the supervision of another
psychiatrist. The plight of this respected therapist caught up
in one of the great hazards of her profession has stirred
sympathy within the Boston psychiatric community. "There is a
strong tension within us that we should be able to heal, comfort
and cure terribly troubled people -- particularly gifted, young
people," says one therapist who is familiar with the case. "I
am inclined to think this has all the hallmarks of a real
tragedy of good intentions to cure and heal, and something went
awry."