Analysis Of My Doctor My Lover English Literature Essay

Can the American Psychiatric Association (APA) govern itself within its ethical guidelines or does it have conflicts of interest where laws are required to protect its patients? Although the Hippocratic Oath taken by psychiatrists includes “doing no harm” and maintaining a professional and ethical relationship with their patients and the community, some chose to place their personal desires above the ethical code they swore to uphold. Within the Frontline episode, “My Doctor, My Lover,” the ethical behavior of a psychiatrist and the APA were challenged. The tale is told from opposing viewpoints and leaves the viewer wondering about the ethical and legal protection of patients and their advocates.

Analysis of Opposing Viewpoints

On November 12, 1991, “Frontline” aired a 90-minute episode entitled “My Doctor, My Lover.” This television show recounted a 1989 sexual abuse case filed by Melissa Roberts-Henry against psychiatrist Dr. Jason Richter (Zaritsky, 1991). Richter admitted to engaging in a sexual relationship with Roberts-Henry, however the re-telling of the events of the relationship differ greatly. Both viewpoints will be presented in the analysis.

Psychiatrist

Jason Richter graduated from Columbia Medical School as a psychiatrist where he took the Hippocratic Oath, which included doing no harm to his patients. He had been practicing psychiatry for ten years and was married with one child when he met his patient Melissa Roberts-Henry. He treated her for eleven months and diagnosed her as having a primitive superego and that she looked to people outside of her for validation. According to Richter, Roberts-Henry questioned him persistently about how he felt about her and that she pursued a sexual relationship with him. Although Richter had written in her case notes that a sexual relationship would be detrimental to Roberts-Henry, he called her to end their doctor – patient relationship so he could pursue a relationship with her. Richter recalled receiving a letter from Roberts-Henry requesting the professional relationship be dissolved. He felt that he was not exploiting her because he wanted to help her by getting into a relationship. He also felt that they had gotten close enough over their eighteen-month sexual affair to consider divorcing his wife. He stated on many occasions that he loved her and the ending of their relationship left him hurting.

Patient

Melissa Roberts-Henry, a married geologist, went to seek therapy because of the depression and guilt she felt after having an extramarital affair she had recently ended. She stated that her husband was away a lot and was fearful of her marriage falling apart. In contrast to Richter, Roberts-Henry remembers Richter asking her what she thought of him on multiple occasions. This led her to think that he was thinking about her and although she stated that she did not have feelings for him, she began to think about him. According to Roberts-Henry and her husband, they felt that Richter was isolating her from her family and friends. He kept telling her he would treat her better than everyone else would. Her marriage became a rollercoaster and began falling apart. Her symptoms became worse and she became more dependent on her psychiatrist. Richter told her to stop taking her medication and she became suicidal. She began thinking that since he really helped her and cared about her that a physical relationship would be good. She stated that he could be “my doctor and my lover.” At this point, she asked Richter if there could be something between them. She confirmed that she had sent him a letter to end their professional relationship so they could pursue an intimate relationship.

Melissa’s recollection of the sexual relationship is very different from Richter’s version. She stated that the first sexual contact occurred two months after the professional relationship ended. She went to his office where he pulled her pants off and had intercourse without her consent pushing a tampon up inside of her. She remembers crying and hearing him say, “Isn’t this what you wanted?” Thereafter, the majority of their sexual encounters occurred in Richter’s office and would be timed as if she was an appointment. He set appointments for their sexual encounters at once per month. Melissa remembers not being able to make much sense out of what was happening to her and felt she needed additional therapy. Richter saw her reach for help as a threat to his career and subsequently threatened her. The Richter – Roberts-Henry relationship had reached its breaking point and Melissa told her husband about what had occurred. Melissa’s husband confronted Richter regarding his unethical and illegal behavior and promised to stand by her. Melissa Roberts-Henry filed a lawsuit against Dr. Jason Richter that went to trial in February of 1989.

Legal Proceedings

Dr. Richter was provided a top lawyer through his APA insurance. The defense strategy was to probe into Melissa’s sexual past to show that she was promiscuous. Mrs. Roberts-Henry was questioned repeatedly and for long periods. Her family and friends were tracked down and asked questions about her sexual past. Her father, knowing nothing of Melissa’s past sexual history, was brought in and questioned for 24 hours. Richter brought in sexual fantasy letters that he had received from Roberts-Henry and brought forth intimate details from his psychiatric sessions with her to enhance his defense.

Melissa Roberts-Henry claimed that because of the episode with Dr. Richter, she suffered from posttraumatic stress disorder (PTSD). Dr. Richter’s attorney, a woman, countered that it was only “secondary gain syndrome, which means, symptoms seem to increase when you want money for the symptoms.” However, Roberts-Henry’s attending psychiatrist, Dr. Gay, testified that she suffered from PTSD and was supported in the diagnosis by three other psychiatrists as well as the defense psychiatrist. Even with the support provided, Dr. Gay was placed under scrutiny and accused of causing Roberts-Henry’s symptoms. Dr. Gay was not able to provide any session notes because Roberts-Henry did not give permission for her private sessions to become part of the court proceedings. Dr. Gay’s personal life began to be questioned and brought into court.

The three men and three women jury found Dr. Richter guilty of one misdemeanor of substandard care. The jury attributed 82% of the responsibility to Richter and 18% to Roberts-Henry, showing that Richter’s defense worked. Melissa Roberts-Henry was awarded $180,000, a much smaller amount than was sought and that barely covered her psychotherapy expenses.

Impact

Richter retained his medical license, divorced his wife, remarried and continued a flourishing practice. Dr. Gay, on the other hand, was forced to resign her position as vice-president of the ethical society because of the allegations and her referrals dropped 75%. She closed her practice in 1990 and was unable to get anyone to take over Melissa’s care. Dr. Gay requested that the APA review their strategies in future cases.

Melissa Roberts-Henry became an advocate for patient rights and was able to push through legislation that made it a crime for psychiatrists to have sex with their patients in Colorado. This 1991 legislation also placed a limit on the investigation of a patient’s sexual history. She continues to speak out and hosts a group for women who have been sexually assaulted by their doctors, many of whom never report it.

Dr. Cynthia Rose, former APA president of Colorado, spoke out against Dr. Richter and stated that she would never refer a patient to him. Dr. Fleming also believed that Richter was not safe to be around and that the laws were inadequate in protecting patients.

Synthesis

This video report not only exposes the violation of the rule that a psychiatrist should not have sex with a patient, but adds in the way in which such cases are dealt with by the law and the American Psychiatric Association. It points out that although the APA is supposed to govern its members and keep them up to the ethical mark that it actually has a financial stake in ensuring malpractice cases are won. The conflict of interest in the APA becomes very evident within the video. The defense tactics used in this case leave the impression that the APA invested insurance company will place undue pressure on anyone bringing charges to discourage future malpractice suits. The patient is no longer considered or protected by the very governance that was put in place to protect them.

Roberts-Henry was compelled to answer many questions about her sexual past, but Richter was not required to divulge any information regarding his sexual history. Richter also used confidential information gathered during his sessions to provide his defense team with information, violating doctor-patient confidentiality. The defense used this information to place doubt in the jurors’ minds when allotting responsibility.

Roberts-Henry attending psychiatrist, Dr. Martha Gay, came under attack by the APA defense team simply because she had taken Roberts-Henry as a patient. They charged that Dr. Gay aggravated her condition instead of helping. Dr. Gay requested help from her insurance company, the same APA backed insurance company that represented Dr. Richter, and she was told that the insurance company had approved the attacks on her. Dr. Gay was left fighting for her reputation without the backing of her insurance carrier. Richter’s defense hoped to lessen the damages against him by putting doubts about Dr. Gay’s competence in the jurors’ minds. Dr. Nanette Gartrell resigned from the Psychiatric Association’s Committee on Women in protest of the issues surrounding this case. She said, “In this case, I think the psychiatric association put its resources behind the defense in order to make an example of Dr. Gay and intimidate and harass other women psychiatrists who might consider supporting their patients who have been victimized by psychiatrists (Zaritsky, 1991).”

Evaluation

Dual relationships with patients have been a topic of discussion even prior to the events that took place within the Richter case. Although it was not a crime to have sex with a patient, Richter ignored the ethical principal of nonmaleficence (American Psychiatric Association, 2009). Professionals have a responsibility to act in a manner that will not cause harm to their patients. Richter’s notes included a statement that he felt that a sexual relationship would cause harm to Roberts-Henry, yet he pursued it anyways.

Sex with a patient reveals the psychiatrists disregard for the therapeutic relationship in favor of the sexual one (Moleski & Kiselica, 2005). “It is clear from survey research, and from case study reports, that therapist sexual contact has almost universally negative consequences for the client” (Stake & Oliver, 1991, Introduction section, ¶ 1, as cited by Moleski & Kiselica, 2005). Once the sexual relationship becomes primary, the psychiatrist fails in his obligation to promote autonomy and nonmaleficence. Richter took advantage of Melissa’s need for help, her willingness to share her deepest thoughts, and her eventual reliance on him. This made her especially susceptible to his influence and authority. Because of this power imbalance, Melissa may have felt that she did not have the freedom to choose to enter or not to enter into the sexual relationship with Richter, nor the freedom to leave it (Moleski & Kiselica, 2005). Moleski and Kiselica wrote of the tragedy of sexual relationships:

The tragic cost for the patient of such a relationship may include cognitive dysfunction, sexual confusion, ambivalence, suppressed rage, guilt, depression, psychosomatic disorders, and risk of suicide (Kagle & Giebelhausen, 1994; Smith & Fitzpatrick, 1995; Stake & Oliver, 1991). Furthermore, Stake and Oliver cited the destruction of the integrity of the therapeutic relationship, the client’s diminished trust in future caregivers, and the exacerbation of the very symptoms for which the client had sought help as further negative results of sexual contact.

Melissa appeared to suffer many of the issues cited in this journal article from the sexual relationship with Richter. Interestingly, during the trial and while under the care of Dr. Gay, Melissa also had an exacerbation of the symptoms she sought help with from Dr. Richter.

The unethical conduct of Richter towards Melissa led her to file a complaint. This complaint opened Melissa’s private life to the public. Richter abused confidentiality and her right to privilege by his disclosure of therapy information to his defense attorneys (American Psychiatric Association, 2009). The therapeutic relationship was subverted and used for Richter’s personal needs.

The unethical conduct of the APA was also very apparent within the video. Based on the information provided in the video, Dr. Gay was not provided the protection she paid for because her insurance carrier decided to support Dr. Richter’s case. She was left unprotected and her career suffered irreparable damage. The payout for the insurance claim became the top priority of the APA backed insurance company. No sense of justice entered into the decisions made by the APA. The patient and her supporting doctor were left without protection from the very organization that was put in place to protect them. How can the APA govern its members if its only focus is on its financial protection? It cannot. The APA ethical principles were completely ignored in this case.

Because of the persistence of Melissa Roberts-Henry, law was put into place to step in where the APA failed. The video leaves all who watch it doubting the ethical principles of the APA and whether they will adhere to them. This doubt has already spilt over into laws that now provide criminal sanctions against psychological professionals who enter into sexual relationships with patients in many states besides Colorado.

American Psychiatric Association. (2009). Principles with annotations. In The principles of medical ethics: With annotations especially applicable to psychiatry (2009 Edition Revised ed., pp. 3-10). (Original work published 1973) Retrieved from http://www.psych.org/mainmenu/psychiatricpractice/ethics/resourcesstandards/principlesofmedicalethics.aspx

Moleski, S. M., & Kiselica, M. S. (2005, Winter). Dual relationships: A continuum ranging from the destructive to the therapeutic. Journal of Counseling & Development, 83, 3-11.

Zaritsky, J. (Director). (1991). My doctor, my lover [Television series episode]. In D. Fanning & V. Storring (Producer), Frontline. New York, New York: Public Broadcasting Service.