DEFENDANT; A Psychiatrist on Trial For Malpractice. By Sara C. Charles and Eugene Kennedy. The Free Press. 230 pp. $17.95; THERAPIST. By Ellen Plasil. St. Martin's. 224 pp. 13.95.
THE RELATIONSHIP between psychotherapist and patient holds a peculiar fascination. It captures the essence of being human -- the effort to gain some degree of understanding and happiness -- yet at the same time all rules of normal human relationships are suspended; the normal emotional work of life is intensified and formalized, and while the relationship involves two human beings, only one is expected to change. This artificial imbalance has the potential to distort issues of personal responsibility and dependence, making the relationship ripe for exploitation. Two new books explore this delicate relationship, each through the lens of failed understanding. And although each is an intensely personal account with its own insurmountable bias, together they raise important questions about the helping professions and the legal issue of psychiatric malpractice.
The more interesting of the two cases, because it deals with grayer territory, is reported in Defendant, psychiatrist Sara Charles' account of her own successful defense against malpractice charges in 1980. This is what happened: In 1974, a patient (here referred to by the pseudonym Terry Walker) in therapy with Charles jumped from the roof of her Chicago apartment building. She survived, but was left crippled for life, and subsequently sued her therapist for $10 million.
As far as I can tell, these are the only undisputed facts in the case. The plaintiff's attorneys argued (among other things) that Charles should have recognized several warning signs of suicide and that she should have increased the frequency of therapy and prescribed anti-psychotic drugs. Charles, contended that Terry Walker was actually progressing well in therapy, and that it was the outside meddling of the patient's family and former therapist that interfered, perhaps triggering her suicidal panic.
These are murky issues, and I do not envy the jurors their task of having to weigh them. Indeed, that they were able to reach a decision is in itself remarkable, considering the conflicting expert testimony offered throughout the trial. Psychiatrists for both plaintiff and defendant offered various diagnoses for Walker and various suggestions for appropriate treatment. Even so, the jurors did ultimately conclude that Charles had not departed from the "usual and customary" standard of practice, and Defendant is more than anything a celebration of Charles' personal vindication. Unhappily, it tries to do more than that, and there the problems begin.
The authors (Charles' co-author is her husband, Eugene Kenney) want to convince us that it is not only Charles who has been wronged; it is all of organized medicine that's been wronged. They try to make the incredible case that doctors have been innocent pawns in a profitable scam rigged by lawyers and the insurance industry. This totally self- serving argument has no force, and unfortunately it detracts from what might be a valid and important point that Charles and Kennedy try to make. They claim that lawsuits involving medical negligence have increased dramatically in number recently, and they claim furthermore that this costly rise is the result of a legal misinterpretation of what medical care should accomplish. There has been a philosophical shift, the authors argue, so that today any undesirable medical outcome might be construed as the result of malpractice. The consequence of all this is that physicians are forced to practice "defensive" medicine or (as Charles has done) to get out of practice altogether.
To the extent that this is true, it is a serious problem, one that deserves more thoughtful consideration than it has gotten here. For one thing, a thorough analysis would dwell at length on an issue Charles and Kennedy choose to gloss over -- the medical profession's failure to police its own. This failure is shocking in Ellen Plasil's Therapist, a patient's account of sexual exploitation at the hands of her psychiatrist. Here the issues are to my mind black and white. A deeply troubled woman, riddled with self-doubts as the result of a childhood of psychological and sexual abuse, comes to therapist Lonnie Leonard (his real name) for help. Leonard practices an unusual brand of psychotherapy derived from the objectivist philosophy of Ayn Rand, and one particular of objectivism -- the belief that selfishness is a virtue -- is apparent in Leonard from the start: He first requires that Plasil masturbate him, then moves on to fellatio, and finally rapes her -- all in the name of therapy.
MOST OF PLASIL's book deals with the five years of sexual abuse she endured during her so-called therapy -- testimony to the extremes to which emotionally vulnerable people will go to rationalize the monstrous behavior of those they depend on. In the end, she discovers that Leonard has been requiring sex of his other female patients as well and, no longer able to rationalize his actions as signs of special affection for her, she sues, is successful in gaining an out-of-court settlement and in driving Leonard out of practice.
On an intellectual level, Therapist fails to engage, simply because such vulgar behavior requires no powers of discrimination on the part of the reader. But on a gut level, it works. It is written well and without self- pity, and witnessing Plasil's pathetic dependence turning into rage and resourcefulness is emotionally satisfying. I found myself imagining a much more fitting outcome for the despicable Leonard, but the fact that he got off easily reflects on the profession and should take nothing away from Plasil's personal triumph over his unconscionable aggression.