MEDICINE

Sex and psychiatry

A suicide sparks debate about treatment techniques

DIANE BRADY April 13 1992
MEDICINE

Sex and psychiatry

A suicide sparks debate about treatment techniques

DIANE BRADY April 13 1992

Sex and psychiatry

MEDICINE

A suicide sparks debate about treatment techniques

In 1986, a troubled 23-year-old student, Paul Lozano, went to Dr. Margaret Bean-Bayog for psychiatric counselling during his third year at Harvard Medical School in Cambridge, Mass. Bean-Bayog, then 43, says that she gave Lozano children’s books to read in an effort to stabilize his behavior and instructed him to call her “Mom” as part of an attempt to deal with the aftereffects of childhood abuse. But Lozano’s family claims that Bean-Bayog, an assistant professor of psychiatry at Harvard, convinced her patient that he was her three-year-old son, wrote pornographic fantasies involving him and forced him to engage her in sadomasochistic fantasies and sexual intercourse.

They add that BeanBayog stopped treating Lozano in June, 1990, when he could no longer afford to pay her. Nine months later, he killed himself.

In November, his family launched a lawsuit against Bean-Bayog in Boston’s Middlesex Superior Court, claiming that she engaged in malpractice by fostering a dangerous psychological dependence that led to Lozano’s death from a cocaine overdose. Meanwhile, officials at the Massachusetts Board of Registration in Medicine last week cleared the psychiatrist of charges that she had sexual relations with Lozano, but called for a further inquiry into the ethics of her techniques and practices.

The allegations against Bean-Bayog shook the Boston medical establishment and sparked an anxious debate about what many reputable psychiatrists say are thoroughly well-established therapeutic techniques. Boston lawyer Andrew Meyer, who is representing Lozano’s family in the wrongful-death and malpractice suit, late last month filed in court several thousand letters and index cards allegedly written by Bean-Bayog. One card states that “I’m your mom and I love you and you love me

very, very much. Say that 10 times,” while another refers to “phenomenal sex.” In an affidavit filed last week in connection with the lawsuit, Amy Stromsten, a clinical social worker who treated Lozano, stated that BeanBayog “talked about her erotic sexual feelings and sexual attraction towards a MexicanAmerican medical student” in a teaching seminar. In a statement to the press released by her lawyer, Bean-Bayog rejected Stromsten’s claim.

In her statement to the board of registration, Bean-Bayog said that the index cards were intended to help Lozano “contradict his depressive and suicidal thoughts.” She added that the reference to “phenomenal sex” was a phrase that Lozano wanted to hear from his girlfriend.

Still, some mentalhealth experts criticized Bean-Bayog’s approach as potentially damaging to a patient. “This deviant course of ‘therapy’ erased appropriate boundaries of the psychotherapist-patient relationship and violated acceptable standards of psychiatric practice,” wrote Dr. Larry Strasburger, who is expected to be called as a witness for the Lozano family, in 2 a statement on file in I the court records. Othlt; ers said that the most crippling blow may be to the profession itself. Said Dr. Elizabeth Reid, president of the Boston Psychoanalytic Society and Institute: “The real tragedy is that people will be frightened of therapy that could be very helpful.” Bean-Bayog told the board of registration that she developed a “unique” form of treatment for Lozano after conventional methods failed. She said that Lozano claimed to be a “victim of horrendous childhood abuse” and said that he suffered from “homicidal, violent and delusional thoughts” as well as “overwhelming feelings of anxiety and rage.” She added: “Many psychiatrists would not have even attempted to treat him.” Bean-Bayog

said that the student admitted in November, 1987, that he broke into her apartment and stole dozens of pages of notes in which BeanBayog had described her own sexual fantasies. According to a report by the board of registration, some of the fantasies may have involved Lozano.

Lozano’s family members claim that he only developed symptoms of abuse after he entered treatment with the prominent psychiatrist. Lozano’s sister, Pilar Williams, a critical-care nurse in El Paso, Texas, said that her brother was a bright student who had no record of childhood abuse or previous mental illness. After he started therapy to combat loneliness and depression, Williams sáys that she immediately sensed a change in his behavior. By 1987, Williams said that Lozano was seeing Bean-Bayog five days a week and constantly sought her permission for doing things, as though she were his mother. “He was speaking like a six-year-old,” said Williams. “He even walked like a little boy.”

The sensational accusations intensified debate about the psychiatric practice of helping patients regress to earlier stages of their life, to confront traumatic events of childhood or infancy. Some psychiatrists contend that many people block out unpleasant events and remain unaware of their impact until they are forced to face them. “Controlled regression is part of almost every therapy,” said Reid. “In a safe environment, it can be enormously helpful.” Other specialists in the field claim that the technique is outmoded and potentially harmful. “You should help patients to master the feelings, not relive them,” said Dr. Stanley Greben, a professor of psychiatry at the University of Toronto. “One should not revert to the state of a three-year-old.” Last week, Bean-Bayog dismissed the charges against her as “outlandish and false” and argued that she provided Lozano with “life-sustaining treatment for four years.”

Bean-Bayog’s defenders say that the nature of psychiatry often leaves therapists open to allegations of exploitation. Experts contend that the trust and intimacy needed to help disturbed patients deal with emotional issues can also allow the patient to distort the relationship. “It is tricky at the best of times and easy to get hurt,” said Dr. James O’Brien, a Baddeck, N.S.-based psychiatrist.

Since the investigation began last spring, Bean-Bayog has been on leave from Harvard and engaged in private practice in the Boston area. She has refused to discuss the case with journalists. Meanwhile, the board of registration asked the Division of Administrative Law Appeals, which conducts hearings on medical board issues, to rule on the propriety of her psychiatric methods. For Bean-Bayog, a wellknown specialist in alcohol addiction, the accusations could be a crippling blow to her career. “I feel sorry for her,” said Reid. “But I feel more sorry for the people who may now be scared to seek help” as a result of reports of the bizarre case.

DIANE BRADY