Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior

by Robert I. Simon

  In the treatment situation, M PD patients receive an average of 3.6 erroneous diagnoses before they obtain the correct diagnosis. It takes, again on average, 6.8 years between the time of their first mental health assessment of symptoms that might be attributable to M PD and the accurate diagnosis of the problem. In the courtroom, there is no luxury of time or leeway for wrong diagnoses. But because the process of correct diagnosis requires time and sufficient latitude for exploration, limitations imposed by litigation may lead to either an erroneous overdiagnosis or an underdiagnosis of MPD among litigants and criminal defendants. It is known, however, that M PD has a disproportionately high representation in the forensic population. This situation is further complicated by those persons available (or unavailable) to submit corroborating or controverting evidence. Lack of corroboration of a patient’s M PD symptoms, for instance by family members, may be evidence that M PD does not exist in that patient. But it may also result from the patient’s family having been involved in the childhood abuse that provoked the M PD into existence. Ultimately, the forensic examiner must rely on an intimate knowledge of the clinical presentations of MPD to make an evaluation for the court.

  Hypnosis, the Legal Process, and Multiple Personality Disorder

  The medical uses of hypnosis are well established and no longer controversial. Hypnosis (hypnoanalysis) can be used in psychiatric treatment to uncover painful feelings or buried experiences. Dramatic results have also been obtained through hypnosis in the treatment of allergies, warts, asthma, insomnia, burns, and pain. However, the use of hypnosis in questioning witnesses to enhance their memories and thereby solve crimes remains highly controversial. Advocates of the use of hypnosis in criminal cases point out that the nation’s largest mass kidnapping case was solved in this way. In 1976, in Chowchilla, California, 26 children were abducted from a school bus and were buried in a pit. Under hypnosis, the bus driver recalled the license number of the van in which the children were whisked away, and this led to the solution of the case.

  Laypersons, including some policemen, have a common misconception about hypnosis: they believe that hypnotized people must tell the truth. This belief is false. Even some people who are deeply hypnotized are capable of resisting suggestions to be truthful and can continue to lie. Others are able to fake being in a hypnotized state, and their fakery is good enough that it is only detectable through special tests. In general, memories obtained under hypnosis, even when vivid, are less reliable than those elicited through normal recall. The reason for this is complex, but in part has been traced to the fact that the hypnotized individual is highly responsive to suggestions and may therefore translate his or her own beliefs, or even those of the hypnotist, into pseudo-memories. Studies show that hypnotized persons can readily accept, with total conviction, suggestions of happenings that contradict their actual experiences.

  For this reason, the Council on Scientific Affairs of the American Medical Association (AMA) questions the usefulness of hypnosis to enhance memories in criminal and civil cases. Many state supreme courts have declared that hypnotically induced testimony is inherently unreliable and should not be admitted as evidence in criminal trials. The AMA council affirms that although subjects generally reveal more information under hypnosis, the recollections may contain many inaccurate details. The council has recommended that the use of hypnosis in the judicial process be limited only to the investigative stage. Other groups have pointed out that if the practice is relied on in court to provide validity to the testimony of witnesses, the use of hypnosis can lead to miscarriages of justice. Some forensic experts feel that hypnotic examination may be necessary in criminal cases because of the limited time available to question witnesses. The gain in finding important details, such as the van license number in the Chowchilla incident, must be balanced against the potential loss of credibility that can result when evidence has been obtained through hypnosis.

  The people who are more responsive to hypnosis are usually those who are more adept than others at becoming totally absorbed in a fantasy. Approximately 15% of the population are highly hypnotizable, whereas 25% are thought not to be hypnotizable at all. The hypnotic state is merely an altered state of consciousness in which the mind’s attention is sharply focused. People are considered to be in a hypnotic state when daydreaming. One common experience in self-hypnosis that most of us have experienced is becoming lost in thought while driving. After many miles, we awaken from reverie and cannot remember the drive. None of us can be hypnotized against our will, nor will we perform acts under hypnosis that we really do not want to carry out.

  In the treatment of MPD, hypnosis can summon personality alternates in a way that is controlled and is not frightening. In the context of litigation, however, hypnosis—especially when it involves dealing with suspected personality alternates—is highly problematic. Particularly when leading questions are asked, hypnosis can cue the defendant to produce a false alternative personality for the purpose of avoiding criminal responsibility. Because we distinctly experience various aspects of ourselves, defendants who are in the “highly suggestible” category and are undergoing hypnosis may be able to personify these various aspects as independent personalities. To the untrained eyes of juries, these hypnotically induced personified states seem like M PD alternate personalities, even when they are actually artifacts produced by hypnosis and would not exist if the subject was not under hypnosis.

  I do not mean to suggest that the forensic examiner who elicits these personified states through hypnosis does so maliciously. Experts are often fooled when using hypnosis, not realizing the extent to which suggestive questions can stimulate fantasy, distortion, falsification, and sometimes outright fabrication of memories. Clinicians who use hypnosis and then make a false diagnosis of M PD in the litigation context do so because 1) they lack clinical experience with dissociative disorders like MPD, 2) they are unfamiliar with hypnosis and its sometimes false artifacts, 3) their examination has been too brief, 4) they ask leading questions to the hypnotized subject, 5) they have not obtained enough collateral data about the existence or nonexistence of M PD in the subject, or 6) they have confused their own roles of therapist and of forensic examiner.

  If hypnotically induced memories are untrustworthy, what about the trustworthiness of those memories that are only recovered and brought to light many years after events have occurred? This is a problem in therapy, and an even more difficult conundrum in the litigation process, because previously buried memories of childhood sexual and physical abuse have been at the center of high-stakes, hotly contested court cases. In all of them, the more general concern is the accuracy of memory—a subject critical to the understanding of child abuse and its long-lasting effects on people, and to the line that separates what bad men do from what good men dream.

  8

  The Ultimate Betrayal

  Sexual Misconduct in the Helping Professions

  I swear by Apollo the physician…never do harm to anyone.

  —Hippocratic oath

  Singer and songwriter Barbara Noël wakened slowly from sleep induced by the sodium amobarbital administered by her psychiatrist, Dr. Jules Masserman, former president of the American Psychiatric Association. Many times before, during the course of her 18 years of office treatments with Dr. Masserman, she had returned from deep sleep, but this time the awakening was shockingly different. A man was over her, and he was breathing deeply. As her consciousness brightened, she could feel his breath on her shoulder. Still under the influence of the amobarbital, she stirred and moaned. The breathing stopped and the man lifted his body carefully away. Fearing that the man might turn violent if he were discovered, Noël pretended to be asleep. Moments later, she opened her eyes a bit and saw a man standing at the sink, with his back to her. He was bald and tanned except for his white buttocks. To her horror, she recognized that it was Dr. Masserman. She could even hear the coins jingling in his pockets as he put on his trousers. Then she heard him walk over to her,
pull up her underpants, and then carefully tuck the sheets around her and leave the room, closing the door behind him. She fell back to sleep. Some time

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  later, the lights in the room flipped on and off. This was the customary way that Dr. Masserman had always awakened her from her amobarbital-induced deep sleeps.

  In her book Yo u M u s t B e D r e a m i n g, Noël describes this scene and alleges that Dr. Masserman behaved toward her in other ways that were questionable and inappropriate to the doctor-patient relationship. Upon return from his travels, he would bring her coins, trinkets, Bach records, and other gifts. He gave her copies of his articles, poems, and music. He invited her to go sailing on his yacht and to fly in his airplane. Noël says she was uncomfortable but flattered by his attention. She accepted only one of his invitations while she was his patient, and that was to accompany him to Paris. There, as president-elect of the World Congress of Social Psychiatry, he was the host of an evening reception. She acted as his hostess.

  Noël had no idea that Dr. Masserman, as president of the American Psychiatric Association, had condemned sexual relationships between psychiatrists and their patients. When she finally understood what had been happening to her, Noël had to overcome the disbelief of detectives, lawyers, and therapists, who dismissed her story as the erotic dream of an unstable woman infatuated with her psychiatrist. She finally managed to find attorneys who would bring suit on her behalf, and when she did, there was a firestorm because of Dr. Masserman’s standing and prominence. He had written 16 books and 410 articles, had been president of the American Psychiatric Association and had previously been president of the American Academy of Psychoanalysis, the American Society for Group Therapy, the Illinois Psychiatric Society, the Chicago Psychoanalytic Society, the American Association for Social Psychiatry, and was an Honorary Life President of the World Association for Social Psychiatry.

  Dr. Masserman denied all charges of sexual misconduct brought against him by Noël and three other former patients, all of whom described a similar pattern of having been sexually abused while they were under the influence of sodium amobarbital. Noël’s attorneys later stated that 10 other women had also come forward with similar allegations against Dr. Masserman but had not wanted to join the suits. They did not want to undergo the further traumas that would be associated with litigation. Barbara Noël thought that her own childhood sexual abuse at the hands of her parents had set her up as a perfect, compliant victim for a powerful authority figure like Dr. Masserman. The four cases were all settled out of court. Noël received a $200,000 settlement. Dr. Masserman voluntarily surrendered his medical license and signed an agreement never to practice therapy in the United States again. He was censured and given 5-year suspensions from such organizations as the Illinois Psychiatric Society and the American Psychiatric Association.

  Lozano v. Bean-Bayog

  The case of Lozano v. Bean-Bayog received sensational, nationwide media coverage. It was alleged by the late Paul Lozano’s family, in a malpractice and wrongful death suit, that Harvard psychiatrist Margaret Bean-Bayog had used an unorthodox method of therapy that fostered severe regression. They alleged that Dr. Bean-Bayog’s treatment reduced their son—a medical student at Harvard—to the emotional stage of a toddler. The plaintiffs further claimed that she systematically manipulated and sexually abused him to the point that, 10 months after termination of his treatment, Paul Lozano committed suicide.

  Unfortunately, the case was tried in the media before it ever got near the courts. Media reports, for instance, described items that had been retrieved from Paul Lozano’s Boston apartment. These included children’s books such as Goodnight, Moon, inscribed in Dr. BeanBayog’s handwriting to “the baby”; tapes of the therapist instructing Lozano to repeat 10 times, “I’m your Mom, and I love you, and you love me very, very much”; and flash cards made by Dr. Bean-Bayog, one of which referred to missing “the phenomenal sex.” The media displayed photographs, taken by Lozano, which showed the therapist snuggling a stuffed bear. Also revealed were a series of letters and stories that the psychiatrist allegedly wrote to Lozano in which fantasies of maternal love and devotion are played out. Dozens of pages of records in Dr. Bean-Bayog’s handwriting described her sadomasochistic sexual fantasies in response to Lozano’s bombardment of her with hideous fantasies of sexually torturing women. These pages also revealed that Dr. Bean-Bayog had consulted other psychiatrists about her treatment of Lozano.

  The psychiatrist had explanations for all of these seemingly damaging items. For instance, she said that the flash cards had been dictated by the patient. She also said that the fantasies in her handwriting were transcriptions of her dreams and had never been intended for the patient to see. She alleged that without her knowledge, he had broken into her office and had stolen them.

  Lozano’s sister claimed that her brother had said that he and the psychiatrist had had an affair. Dr. Bean-Bayog categorically denied it. She claimed that treatment had been ended after Lozano allegedly refused to follow her recommendations that he be supervised by the Massachusetts Medical Society, which monitors impaired physicians. These services were also available to medical students. Her explanation for his death was that he had felt so rejected and angry after his therapy ended that he had taken revenge on her. She thought he had not committed suicide, but had died of an accidental overdose of cocaine. Dr. Bean-Bayog said that her treatment approach with Lozano had been unconventional but had also been necessary to treat a very disturbed patient with a history of severe childhood abuse. He had required at least 10 hospitalizations for suicide attempts, some before his treatment began with Dr. Bean-Bayog. Without such treatment, she said, the patient could not have functioned at all in the 4 years prior to his death.

  From an outsider’s point of view, what was most interesting about the pending court case was that the plaintiff and the defendant both cited the same documents in support of their opposing allegations. This was an extraordinary cache of 3,000 pages of documents filed by a lawyer for the Lozano family with the court. The key issue raised by the case was whether the psychiatrist had used an unconventional approach that was justified, given the nature of the patient, or whether she had gone beyond the pale of acceptable forms of care. Investigating the matter, the Massachusetts Board of Registration in Medicine found that there was not sufficient evidence to prove sexual misconduct. However, the board decided that Dr. Bean-Bayog’s treatment “did not conform to accepted standards of medical practice,” and that her failure “to terminate or otherwise address” her sexual fantasies that had been evoked in the treatment of Lozano was not acceptable.

  Dr. Bean-Bayog had a choice. If she insisted on having a trial, and lost the case, she would be responsible for the enormous costs. Her insurance carrier advised her to settle. To avoid what she termed a “media circus,” Dr. Bean-Bayog surrendered her medical license and settled the case out of court for $1 million. Decrying the storm of publicity, Dr. Bean-Bayog declared, “No male therapist has ever been the subject of such an assault.” She will be able to continue to practice as a psychotherapist, a profession that does not require the therapist to have a license to practice medicine.

  Critics who were close to the events of this case feel that Dr. BeanBayog’s career was ruined by a combination of inaccurate, biased reporting by the news media, inept proceedings held by the Massachusetts Board of Registration in Medicine, and the threat of ruinous legal fees, which deprived her of having a fair day in court. A number of her colleagues stood by her. They cited the great difficulty in treating this very disturbed patient, Dr. Bean-Bayog’s consultation with other psychiatrists, the need for an innovative treatment approach to her patient’s unique problems, and the fact that the suicide took place 10 months after treatment ended, while Lozano was under the care of another psychiatrist, showing that he was unable to survive without the treatment provided by Dr. Bean-Bayog.

  Sexual Misconduct by “Helping” Professionals

  C
rossing of sexual boundaries by those in the helping professions is probably the clearest example of how fine the line is between “good men” and “bad men.” Abuses of professional power and authority occur across all of the helping professions. None are immune. Lawyers, clergy, teachers, physicians, psychotherapists, and other helpers have been censured, defrocked, and sued for committing a particular form of power abuse—sexual misconduct. Certain sensational cases that are reported in the media, particularly those that involve the abuse of children by such professionals, have fueled national scandals. Public trust has been undermined and the helping professions damaged by persons in prominent positions, usually men, who have betrayed the trust placed in them. The greatest harm has been felt by the victims of professional sexual misconduct. Their suffering is incalculable.

  The vast majority of men and women in the helping professions are competent and trustworthy. And if they have sexual thoughts and feelings toward their patients and clients, it must be recognized that, as I demonstrate later in this chapter, such feelings and thoughts are quite common, and most of the time they are not acted out. In fact, the competent therapist is able to turn personal feelings to account for the benefit of the patient’s therapy. It would compound the tragedy caused by abuse of power and authority to damn all professions and professionals because of the transgressions of the few. This said, the nature of sexual abuse and sexual harassment needs to be understood by both professionals and consumers to lower the incidence of sexual misconduct.