ECT used as punishment in Kolkata (India) psychiatric facility

The following is a transcript of an interview with a volunteer currently working inside Shanty Dan, a home for mentally challenged women in Kolkata, India. This particular volunteer has asked that her identity remain private as she is still working inside this home.  The following is a shocking and terrifying look at one of the medical institutions operated by Mother Teresa’s Missionaries of Charity and another primary example of the rampant negligence that is now far too common with this organization.

Interview by Hemley Gonzalez

Hemley Gonzalez: Please tell us about this home you are volunteering in:

Volunteer: This particular facility holds between 250-300 female patients at any given time; it consists of a large building with two stories, general dormitories packed with beds, a large interior hallway where the patients spend most of their time, bathrooms and a dining room.

HG: What exactly is the specialty of this medical facility?

V: Actually from what I understood initially, it’s not meant to be a medical facility, but rather a home that women with mental health problems go to, and once they get better they return to their homes.

HG: Would you then say it is a mental institution?

V: Yes, it seems like a psychiatry-unit type of place.

HG: When you say psychiatry unit, are there any certified psychiatrists permanently in the building who actually administer treatment? And could you please elaborate on the type of treatment these women receive while in this house?

V: There’s a doctor who comes in once a week, on Tuesdays, none of the volunteers are quite sure on his credentials and or qualifications in psychiatry, psychology or otherwise. In addition to this man’s visit, there is a nun who resides in the home and is in charge of handing pills to all the patients, again, not really sure what the pills are exactly as information is rarely shared with volunteers but the number of pills handed out is staggering.

HG: Do you think these are psychotropic medicines that are being given to ALL patients?

V: Definitely a mood altering drug and it is handed to both the upstairs and downstairs patients.

HG: And this broad regiment of pills for all the patients is prescribed by one doctor who comes in only once a week?

V: Yes, there is no proper diagnosis, but rather some ideas which they come up with while quickly observing the patients. I believe sedation is more of the goal rather than specific diagnosis.

HG: How many nuns are on staff and how many paid workers who operate this house?

V: Six paid workers and three nuns.

HG: Do they provide meals for these patients?

V: Yes, breakfast, lunch dinner and tea and biscuits as snacks.

HG: How many volunteers come to the house and for what length of time each day?

V: Usually ½ a dozen or less, we come in the morning about 8:00AM and leave by 12-1PM.

HG: What are volunteers asked to do?

V: We do practical chores, check and treat for lice, combing and cutting hair, nails, etc. Although I thought the focus was and should be rehabilitation programs with these patients.

HG: When you talk about lice, are these in patients who are just arriving or some of the ones who have been in the home for a while?

V: Well, it looks like the problem is always present, even when new patients come in without it; we seem to have the lice in our long term patients as well.

HG: Doesn’t it seem odd that a medical facility has an ongoing lice problem?

V: Well, the way I had been presented with information about this house, I thought I was coming to a home and not a medical place, but now after been here for over a month, I see how it completely is a medical facility, as all these women are constantly being given drugs and on Tuesdays there is additional treatment performed by the visiting doctor.

HG: What kind of treatment?

V: It’s actually been one of the most disturbing things I’ve ever seen; it is electroshock treatment, and something that now I’ve noticed is far too common. Many of the women who first come in are given it for six weeks, especially those who are physically unruly, and to the point where they only stop the treatment in some of them until they completely stop talking.

HG: So are you saying that patients who come in and aren’t properly diagnosed or as it seems to be the case, not diagnosed at all are receiving electroshock therapy so they can be subdued?

V: Yes. A lot of the women are suffering from incidents that have happened in the past, not necessarily being physically violent, suffering from internal trauma, perhaps some anger issues, asking for attention, and perhaps a range of other psychological ailments but the problem is that no one assesses the problem, how to treat the problem and actually treat the problem properly. They are just given electroshock therapy!

HG: So they are resorting to deliberately applying electroshock to these women without actually diagnosing their conditions as a way to try and calm them down?

V: Yes.

HG: How many instances of these electroshock therapies have you personally witnessed?

V: Usually on Tuesdays is when they do these treatments because that’s the only day the doctor comes, and the first time I witnessed 6 women going into the room.

HG: How different was the behavior prior and after receiving these treatments?

V: There is one patient for example who is very outspoken, likes to sing and engage in conversation with volunteers and other patients, when she came out of the room she was almost in a coma stage, foam coming out her mouth, unresponsive and was wheeled out in a stretcher. A few hours later she became somewhat conscious and was complaining of a massive headache and dizziness as well as being extremely confused. Clearly a horrible feeling for anyone who is submitted to this sort of procedure.

HG: So this goes on Tuesdays. Have you witnessed it take place on more than one week?

V: Yes I’ve seen it a number of weeks since I’ve been here and many women going through the same, but more recently since myself and other volunteers have been very worried and spoken about it they started to do it in hiding, so it’s hard to tell which women are being submitted to it and how many.

HG: How do they hide the treatments now?

V: One of the French volunteers who spoke up a week ago was kicked out by one of the nuns and was asked to never come back. Then I spoke up and went as far as writing a report which the nuns in charge refused to read, basically telling me I didn’t know anything about what was going on, and that I didn’t have any medical experience to question them.

HG: Do any of these nuns themselves have any medical experience and or certification in the psychiatry field?

V: No. The nun in charge used to be a dentist, and that is the extend of the medical knowledge from any of them in this house.

HG: So one volunteer has been kicked out and your concerns and report ignored?

V: The report I gave to the nun, was intended for the nun, and the interaction between her and the doctor who could care less about any of these women. He doesn’t diagnose them and seems to be more interested in just applying the electroshock when he does his weekly visit. If the women are kept sedated so they don’t create additional work for the nuns or the paid workers, then the doctor does his job “well”. There is a nun who is basically in charge of choosing which women are to receive the electroshock, and incidentally also has the power to stop it, so I figure I would research some information about electroshock therapy and show her the devastating effect this type of treatment could have on people who are not candidates for it in hopes of stopping this madness.

A lot of the information available in the web and medical sites all point to the same problematic side effects, such as memory loss, and in applying the findings to the patients directly I started to see how a lot of the cognitive functions were affecting their brains; particularly in women where there was some sort of normalcy days prior to them being placed under this barbaric therapy and after having essentially a mental meltdown.

What really unsettled me was the fact that a lot of these women came into Shanty Dan to get better and leave, but this isn’t happening because after electroshocks some of them have actually made them worse.

HG: Why aren’t the nuns at Shanty Dan hiring full time psychiatrists? For an institution holding nearly 300 patients with a wide range of mental illness, you would have to have several professionals on staff at all times. What’s happening here?

V: When I asked one of the nuns why weren’t any doctors she said the most ridiculous thing: “there are no counselors in India” “You find them and bring them here” “you wouldn’t be able to find any around.”

HG: Pardon the expression but that seems to be a crazy thing to say, wouldn’t doctors love the opportunity to accept a high paying job to look after 300 patients?

V: Agreed.

HG: So there is one nun who has some dentistry background, one doctor who comes in once a week who is supposedly a psychiatrist and prescribes a broad regiment of pills to about three hundred patients and about six medically untrained workers who look after the patients. What is your take of the actual state of this institution?

V: Is a big joke, they don’t care about any of the women there; they just have some workers to look after them and don’t seem to take seriously their conditions, certainly not a home for mentally challenged women where the goal would be to improve their lives. It’s basically a building filled with women with lots of mental issues who are vulnerable and in real need of help.

HG: Where you told or explained prior to volunteering that this was a place where women would be helped and or empowered to get better from certain mental illnesses?

V: Actually we weren’t actually told anything of value at the orientation/registration which was just two minutes long and they basically said the place was a home for mentally challenged women. And of course I assumed this was a place where women got treated properly so they could get on with their lives, I really didn’t think I would encounter what I have witnessed in my time here.

HG: Now that you have been forbidden to participate or witness the electroshock sessions of which you spoke against so strongly, what else are you asked to do with your time there?

V: We try to do some fun activities with the women, playing games, speaking to them kindly (unlike the forcefully and aggressive manner in which the nuns often speak to them).

HG: When you speak of aggressive behavior, is this something that happens frequently by the women and workers who operate the house?

V: Nuns and workers often treat the women angrily and harshly, they show signs of disgust and exhaustion in working there and understandingly so as some of the patients can be a handful, but for a place with three hundred patients and so little workers, it is expected that problems will arise. The patients are often beaten by workers who without any proper medical training often resort to violence in an effort to institute order.

HG: What kind of financial compensation do some of these workers get for their time in this home?

V: I know they are not getting a lot, especially since a lot of them live in slums.

HG: So these are women from the slum who are themselves in great financial need and even less likely to obtain medical training to deal with almost three hundred mentally ill patients?

V: The workers have their own issues, and they even have come to accept the idea that the shock therapy is actually a good thing because they hear it from the doctor and the nuns, in particular nun Benedicta and another who we’ve branded the evil nun, especially after personally seeing her torturing some of the older patients.

HG: One of the nuns tortures the women how?

V: Stupid stuff, emotional abuse for instance, demeaning them, I seen her doing that with some of the older patients, for example, one of the volunteers who comes in and does some of the dressing and cures for patients who need it, an old lady who has a wound in her back and the volunteer needed help moving the patient around  to get to the sore and the nun literally yanked her forcefully in front of the other patients, pulled up her dress and in degrading manner laid her down while asking the patient to stop being shy and exposing a private and serious wound to the rest of the floor, zero dignity, while telling her to stop crying in front of the volunteers and remind her that once the volunteers leave, she will still be here to deal with her. How sadistic and frightening is this?

HG: Basically this home becomes a house of horror for a lot of these patients once the volunteers leave?

V: Yes, especially with this nun who we now call the evil nun, she is middle aged, heavy.

HG: Are most of the nuns obese? I seem to find a large number of sedentary women who work for this organization. Why is that?

V: She’s actually quite big, a round face Bengali women, and she’s almost as big as the other two nuns in the house, Benedicta and Maria. The often just sit around and let the volunteers and workers do most of the work, of course, their diets are well proportioned with proteins and items which the patients don’t often get themselves.

Speaking of this “evil” nun, it’s actually evident that she has some mental issues of her own, the way she behaves with other patients, very sadistically, and even the workers agree there is something wrong with her, as they too allude to the fact that she is especially abusive with the patients.

HG: So even workers actually admit that there is something wrong with this particular nun who is also running this house?

V: Yes, all the workers feel very negatively about her and even volunteers no longer listen to her. In one instance she began to stab the feet of the old lady with the infected wound.

HG: Stabbing the patient’s feet?

V: Yes with a pair of scissors.

HG: For what reason?

V: It was very strange; it seemed like a personal thrill for her.

HG: And this is being done by a nun who is clearly disturbed?

V: Yes, clearly no sane person does some of the things this woman does.

HG: What would you say is required for this house to operate as the mental facility you thought you were coming to work in?

V: For starters, a must is a range of doctors, psychiatrists, psychologist and therapists and not these robotic tools such as the electroshock machine and this massive distribution of psychotropic medicines to all patients without diagnosis. There are no personal assessments of the ailments and or diagnosis for a cure and a long term plan to get these women to a somewhat normal life and in many cases to a full integration back to society.

HG: Is the broad application of medicines to all patients without understanding the specific issues of what each of them were brought to this house for in the first place creating more problems?

V: Exactly. And really to get any of these women to a path of improvement, there needs to be some consistent and professional counselling, they come in and many of them could truly be healed with the proper professional and consistent help.

HG: Would you say any of the nuns currently on staff are in any shape to adjust to any of the changes you would like to see for this particular house?

V: No. As it stands right now they refuse to listen to suggestions, apparently they’ve rejected ideas and or programs suggested by many volunteers.

HG: What did they do with your report when you suggested all these possible treatments?

V: The head nun, Benedicta basically laughed in my face and flat out said she “I wouldn’t have time to read any of this documents.”

HG: If they are too busy to read reports pertaining the work they are there to do, what exactly do they occupy their time with instead?

V: Looking after the women I suppose and not very efficiently obviously.

HG: As other houses operated by the Missionaries of Charity, does Shanty Dan also have hours of prayers where the nuns are absent from the facilities and neglect the patients?

V: Yes, and they  leave the women workers from the slums in charge the same group who are medically untrained and get paid very little money for all the work they do. What’s even more alarming is the fact that the “evil” nun as we have resorted to calling her has begun punishing unruly patients by administering electroshock therapy, regardless of their condition, she has been doing this as a way to subdue them physically which is disturbing and aggravating to say the least.

HG: Electroshock therapy is actually being applied as punishment?

V: Yes, unfortunately.

HG: Did you actually witness some of the electroshock procedures and how many?

V: Yes, I saw a line of women waiting for the application and after seeing the first one being applied, it horrified me. The women waiting in line were not told anything that was about to happen and became apprehensive as some of the other women who had been submitted to the electroshock were being wheeled out of the room in a stretcher while foaming at the mouth.

HG: After you spoke about this barbaric practice, what happened?

V: Almost immediately they banned volunteers from coming near the room where the electroshocks are performed. The glass window that looks into the room was covered with a curtain and on Tuesdays, the day they are performed, volunteers were being asked to perform other tasks away from the area where the treatments take place. What’s even worse now, the nuns are considering to close the doors to volunteers, so the horrors will continue without witnesses who can defend these patients.

HG: Do you believe these nuns are actually performing electroshock therapy themselves without the presence of the doctor who comes in once a week?

V: I wouldn’t put it pass them. And in any case, they line up the women they want to punish and makes the doctor apply the electroshock on Tuesdays. Some of them up to six weeks which basically render them useless for a long time after.

HG: Let’s talk about a bit more about the facility. Are there any outdoor areas or spaces where they could spend some time in the sun and receive natural light and other necessary sensory experiences?

V: There is actually a courtyard with some nice outdoor areas but unfortunately the nuns have closed off the area to the patients. Their main complaint is that some of the women were defecating in the grass and that became too much work for the paid janitors and nuns to handle, so now all the patients are confined to an inner corridor with some windows that look out to the exterior but basically all their time is spent indoors. They really get no natural light anymore and are essentially confined to these interior corridors, bathrooms and dining room.

HG: I think it is fair to say that the entire facility is wrongly and inefficiently staffed, given the fact that there are no permanent doctors, nuns with basically no medical training and workers who are at best cleaning and janitor women, wouldn’t you agree?

V: It would most certainly help to bring in professionals to asses all the cases of the women currently being kept in the house. While volunteers come in and try to help, their duties are usually limited to washing clothes, dishes and some grooming of the patients.

HG: Are there any washers and dryers in the house?

V: No. They’ve refused to accept them.

HG Do you think this house will change and or improve?

V: Not really. After several weeks of suggesting changes, researching, handing over helpful documents and speaking to the nuns and workers, I’ve come to realize they are not interested in altering their culture of abuse and neglect.

HG: One would also have to assume that the workers are trying to protect their income, however little it is and in essence are conspirators to the medical negligence perpetrated by these nuns on a daily basis.

V: Yes, they do pretty much whatever the nuns say including systematic beating of the patients at the request of the nuns themselves.

HG: It is my understanding that nuns within this organization are shuffled around the different houses they operate around the world, one of the reasons being is the mounting complaints and as a way to diffuse the public’s outrage or concern they continue to change some of them in charge and dispatch them to different places. How long before they resort to their malevolent practices in their new positions?

V: Well, we have already noticed some abusive behaviour by nun Benedicta who is recently new in Shanty Dan; we’ve seen her hitting patients sometimes and using forceful language, almost as if these patients are wild animals. I am afraid the behavior is chronic and symptomatic of these nuns. The same goes for the workers.

HG: Have there been any deaths during your time there?

V: Yes. Three. One was a new lady that had arrived; she was quite small and fragile. She seemed fine and had some difficulty walking, but other than that she was cognitive and responsive. After I returned two days later I found that she had passed and when I asked for the cause of death, I was told she had a stroke but there was a lot of ambiguity on the actual answer, especially when another volunteer felt that the medicine she had been given was the wrong kind and thus caused her to have a fatal and allergic reaction.

Another was a 40 something year old patient, her name Maduri, I remember her clearly because she was the very first patient I saw chained to the bed and now I see this more and more often. She was very active and always wanted to leave but one day I came to work and she also died.

And another patient who was ill was brought here which I thought was very strange, one who should have certainly been brought to a hospital.

HG: How many patients are chained to their beds?

V: At the moment from what I can tell probably half a dozen, perhaps more. And especially those who don’t want to remain in the facility.

HG: So patients who don’t want to stay are not allowed to leave?

V: No.

HG: Are there medical histories for each patient?

V: No. There are just these cards where they sometimes make notes about the medicines they give to the women, but nothing in detail and certainly no diagnosis; another thing I noticed is a slew of women who arrive from jail.

HG: From jail? Please explain:

V: There seems to be some sort of agreement between the Missionaries of Charity and some of the women jails where they bring some of the inmates who are being released but their families don’t want them home, so they end up here. Many if not all of them have absolutely no mental disabilities, so I find this whole arrangement quite strange.

HG: So perhaps for some sort of rehabilitation program? Except this is a mental institution which doesn’t even seem to rehabilitate their own mentally challenged patients in the first place!

V: Yes, very strange. There are no televisions or rehabilitation programs or visual or physical activities, they just sit there all day, almost rotting away. Also, all of the women who arrive from jail join the distribution of pills and almost immediately become subdued. And most of the women change their behaviour completely and overnight, as if becoming zombies. There is one in particular which is very troubling to me, it is a pregnant patient who is constantly given medicines, and her mood changes drastically.

HG: These type of pills are being administered to a woman who is pregnant?

V: Yes, even injections that basically knock her unconscious.

HG: Do we know if the one doctor who visits this home once a week has actually researched that the medicines he is administering to this pregnant woman won’t hurt the fetus?

V: No.

HG: You also mentioned another patient who had a baby recently and the baby was taken to an orphanage hours away from this facility, something quite strange considering the fact that the Missionaries of Charity operate another orphanage literally next door to the same place where the new mother is. Why would they do this?

V: When I asked the same question to the nun in charge her answered was: “God bless you and your compassion” and she laughed and walked off.

HG: Why aren’t other volunteers talking about the same things you have witnessed?

V: I just don’t think they care enough. They come here for a few days and don’t want to raise any issues. A lot of them are nice folks but they just feel helpless at the time or rely on the fact that someone else like you or me would speak up about it. Or worse, they think these nuns are actually doing a good job.

HG: I understand that a first rate health care facility, one that is typically found in develop countries such as the US, Britain, ect, is not something that is feasible or realistically possible to construct and execute in places like Kolkata, but for an organization that receives millions and millions of dollars in donations each year, is this the best they can do?

V: No, not at all, at best they are providing below minimum care. For an organization with European influence and the massive financial support they receive, this is shameful to say the least. There needs to be immediate and drastic changes. The electroshock therapy is running a lot of these women’s lives, they can never go back out into society and join a cycle of normalcy, their memories and even simple functions have been sucked out of them, almost if not all patients are treated like animals in a zoo.

HG: What happens when you leave?

V: Well, this is why I am talking about it. People like you who continue to raise awareness about these issues are a major source of hope for change and this why I couldn’t remain quiet any longer.

Source: “Another of Mother Teresa’s houses of horror: Electroshock therapy as punishment, women chained to beds and more… , as posted on blog The Web Presence of Anna Johnstone, URL: http://asystemofrandomtangents.wordpress.com, February 9, 2011.

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BC psychiatrist Mayer Nelken fined, disciplined over transcranial magnetic stimulation

(Transcranial magnetic stimulation [or TMS] is proposed as a non-invasive method of increasing brain activity by use of magnetic fields.  A variant of TMS, repetitive transcranial magnetic stimulation [rTMS], has been tested as a treatment tool for various neurological and psychiatric  disorders.)

On May 18, 2010, the British Columbia College of Physicians and Surgeon disciplined psychiatrist Mayer Nelken for violating the Medical Practice Act by failing to acquire the College’s consent.  The College fined him $15,000 and removed his license from the class of Full-Specialty registration and placed it in the class of Conditional-Disciplined.

According to the College’s press release, Nelken oversaw the treatment of a patient receiving repetitive transcranial magnetic stimulation (rTMS) treatment at the MindCare Centre in Toronto.  rTMS is an alleged treatment for depression which is non-invasive, using magnetic fields to induce electric currents in the brain.

The College’s release further states that Nelken failed to obtain College consent to practice in association with MindCare, contrary to the requirements of the Medical Practitioners Act; he had rental arrangements with MindCare which constituted a conflict of interest and were ethically inappropriate; he was represented as the rTMS psychiatrist and Medical Director of the MindCare clinics in both Vancouver and Toronto, when he had no experience or expertise in rTMS and was not registered to practice medicine in Ontario; he accepted the patient for rTMS treatment at MindCare without seeing the patient, obtaining appropriate consent or collateral data; he had no involvement in the patient’s treatment but co-signed the Patient Discharge Report without any knowledge of the treatment provided or the patient’s response to treatment, among other things.

Source: Dr. Nelken, Mayer, Richmond, B.C., Media release – May 17, 2010, College of Physicians and Surgeons of British Columbia.

Psychiatrist Nabil El Rafei surrenders license on various charges

On April 1, 2010, the New Jersey State Board of Medical Examiners issued a Consent Order, agreeing to accept the voluntary surrender of psychiatrist Nabil El Rafei’s license to practice medicine.

According to the Board’s document, this action was in response to the complaint filed against El Rafei by the Attorney General of New Jersey alleging, among other things, that El Rafei permitted and unlicensed person to perform an act for which a license is required, failed to supervise that employee during the period he was an Associate Counselor and maintained records and issued bills that failed to accurately reflect the treatment of services rendered.  Though El Rafei initially denied the allegations, he settled the matter without proceeding to hearing.

Source: Consent Order in the Matter of the Suspension or Revocation of the License of Nabil El Rafei, M.D., License No. MA02628400, OAL Docket No. BDS 07431-2009N.

State suspends California-Illinois psychiatrist Howard E. Wolin

On December 13, 2010, the Medical Board of California suspended the license of psychiatrist Howard E. Wolin.  This action was the result of disciplinary action taken against Wolin in the state of Illinois, where he lives and practices.

According to California Board’s Accusation document, Wolin was suspended indefinitely by the Illinois Division of Professional Regulation on September 23, 2010 for failure to comply with discovery requests: Wolin failed to produce documents to the Illinois board after being ordered to do by an administrative law judge; he failed to produce records pursuant to multiple signed releases from a patient he had treated using “crystals and secret methods.”

Source: Accusation and Notice of Out of State Suspension Order in the Matter of the Accusation Against Howard Evan Wolin, M.D., Physician’s and Surgeon’s Certificate No. C50320, Case Number 16-2010-210978, Medical Board of California.

State places psychiatrist Charles Huffine on probation; permissive “treatment” of teen’s drug abuse

The Washington State Department of Health (DoH) placed psychiatrist Charles Huffine on probation for at least five years with terms and conditions due to incompetence, negligence or malpractice constituting unprofessional conduct.

According to DoH documents, Huffine provided treatment to a teenage male with a known history of substance abuse and possible suicide attempt, as well as considerable present-time substance abuse, including alcohol, marijuana, methadone, OxyContin and LSD.

Among the allegations is that, despite an OxyContin overdose and the patient’s admissions of other substance use, escalating family turmoil instigated by the patient, increasing erratic and violent behavior, an auto accident and two citations (one for Minor in Possession), Huffine never pursued urinalysis or other laboratory tests to determine what exactly the patient was taking or how much; never suggested to the patient that he stop using; did nothing to monitor the patient’s use; did not adequately assess the impact of the patient’s substance abuse on his mental health; did not inform the patient’s parents regarding the serious nature of the patient’s substance abuse and did not significantly involve the family in the patient’s treatment.

He urged her to look beyond the drug issues and see the behavior as complex and affected by psychiatric issues.”  He told the mother that her son was “not ready” to stop using drugs.

Further, in response to the patient’s mother’s concerns about his behavior and obvious signs of drug abuse, Huffine did not inform the mother of the “serious level of danger to her son and others.  Instead, he reassured the mother…suggested that he mother should not be so sure about whether the drugs were producing the patient’s…behavior.  He urged her to look beyond the drug issues and see the behavior as complex and affected by psychiatric issues.”  He told the mother that her son was “not ready” to stop using drugs.

Lastly, despite known and very serious substance abuse, Huffine did not recommend more intense substance abuse treatment and on many occasions actually recommended against immediate inpatient treatment.  Ultimately, the boy was found un-arousable from sleep and was taken to the hospital where it was found he’d overdosed on 180 mg of methadone.  He soon after entered substance abuse treatment and did not return to Huffine’s treatment.

Source: Findings of Fact, Conclusions of Law, and Final Order and Statement of Charges in the Matter of Charles W. Huffine, M.D., License No. MD00013207, Case No. M2009-349, Washington Dept. of Health Medical Quality Assurance Commission.

Your Honor: Please base custody decisions on facts and evidence, not on the opinions of mental health custody evaluators

The recent dismissal of a court-appointed custody evaluator provides one more reason why our family courts need to get back to deciding custody based on facts and evidence—not the opinions of mental health “professionals” who back up their opinions with a diagnostic system which is both unreliable and admittedly irrelevant in legal matters.

On February 27^th, the Los Angeles Times published a story about psychiatrist Joseph Kenan, who was removed from a case as child custody evaluator by a family court commissioner after she had been presented with information about questionable content on his Facebook page and other internet postings.  On various sites (using the altered names “Joe Kegan” or “Joe Keegan”) Kenan was found publicly baring his buttocks to the camera and posing with a friend, holding a cake with frosting graphically depicting a sexual act.  Other material which was posted (but which has since been removed) is alleged to have promoted illegal drug use, unprotected sex and male prostitution.  This material was discovered by a client of whom Kenan requested $35,000 in fees to finish his report—well in excess of the $7,500 the client was required to pay.

Kenan, who is also current president of the American Society for Adolescent Psychiatry, has been involved in hundreds of custody evaluations in Los Angeles County in the last ten years.

He is reported to currently be under investigation by the state medical licensing board, relative to four complaints against him.

Mental health practitioners who work in the Los Angeles County family court system in particular are reportedly only required to submit a sworn declaration detailing their training and experience; it is acknowledged that the court does not verify practitioners’ credentials.  The same may or may not hold true for other states.

One could argue that the state should fund the salary for a background checker to verify practitioners’ reported credentials.  This would not be a solution because, as we see with the case of Joseph Kenan, one can have the appropriate degree and experience and still have a private (or public, in Kenan’s case) life that calls into question their fitness to be making decisions which affect the lives of others.

But even more importantly, mental health/psychiatric custody evaluators, “qualified” or not, leading questionable social lives or not, are an expensive and unnecessary complication to the already turbulent divorce/custody scenario.  Our family courts need to remove this complication, reclaim full authority in custody matters and base their decisions solely on evidence, free of psychiatric opinion.

What is a psychiatric/mental health opinion based on?  What is it worth?

It is based on the evaluator’s opinion and “legitimized” by use of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.  DSM is the book which mental health practitioners use to “diagnose” people.

With regard to legal matters and psychiatric diagnoses (such as rendering custody decisions based on one parent’s alleged psychological fitness/unfitness) its authors admit:

“The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments….”[i]

A later edition of the manual addresses “[The] imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis”[ii] (which is just another way of saying that law is far more scientific a discipline than psychiatry).

“…there is still not a single multi-site study showing that DSM is routinely used with high reliability by regular mental health clinicians.  Nor is there any credible evidence that any version…has greatly increased its reliability beyond the previous version.”

Why is our legal system relying on an admittedly flimsy “science” to influence decisions which could adversely impact the lives of innocent children and well-intentioned parents?

And what of the diagnoses themselves?  The DSM is candid about that, too:

“For most of the DSM-III-R disorders…the etiology [cause] is unknown.”[iii] (“Most” is actually about 99%.  The only mental disorders they claim to know the cause of are the “organic” disorders such as drug withdrawal or “paranoid delusions” such as that caused by amphetamine abuse.  However, an understanding of the cause leads to an immediate realization that they are not mental disorders but are reactions to physical conditions.)

So, to summarize, a DSM diagnosis is not entirely relevant to a legal decision and is not consistent with the concerns of legal procedure and psychiatrists don’t even know the cause of any mental disorders.

How reliable then could a psychiatric opinion or evaluation be?

Not very.

A 1994 study to determine the reliability of the DSM concluded that “…there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliability by regular mental health clinicians.  Nor is there any credible evidence that any version…has greatly increased its reliability beyond the previous version.”[iv]

The judge/commissioner/magistrate is without question more qualified to render a just decision by his/her own direct examination of the evidence (fact) than relying on the “results” of a mental health evaluation (opinion) which is based on a system which admittedly has no place in a court of law and which has been shown to be of low reliability.

As for Joseph Kenan, he is but the latest, albeit most flamboyant, example of a long and growing list of custody evaluators who have been called out or publicly disciplined for misconduct and/or negligence.  A few other recent examples:

In May 2010, the Arizona Board of Behavioral Health Examiners revoked the license of professional counselor Linda Bennardo for, among other things, recommending limiting a father’s access to his son based solely on information provided by the mother and daughters; in another case, Bennardo concluded that a three-year girl was highly traumatized by her visitation with her father—without having gathered any information on the matter from the father, parenting coordinator, best interest attorney or other entities.[v]

Texas psychologist Melody M. Potter, Ph.D., was fined $3,000 for providing testimony in a custody case which contained insufficiently substantiated opinions.[vi]

In July 2009, the Washington State Department of Health fined licensed mental health counselor-social worker Sara Ellingson $1,250 for, among other things, recommending a court-ordered psychological evaluation of a parent whom she had not observed in more than two years.  Ellingson was disciplined in 2006 for providing opinions on parenting and custody in a case in which she failed to include information provided by an in-law which was relevant to one parent’s fitness to parent.[vii]

Colorado clinical social worker Joanne Baum was placed on probation for one year for writing a letter that contained judgments concerning a person she had never met and publishing recommendations regarding child custody issues without having full knowledge of the facts necessary to make such recommendations.[viii]

It’s time our family courts operated free of the arbitrary and ultimately destructive psychiatric/mental health system.

Two NY psychiatrists named in whistleblower cop’s $50 million involuntary commitment lawsuit

Most of the news you will read about the lawsuit filed by New York police officer Adrian Schoolcraft is about how his superiors in Brooklyn’s 81st Precinct had him involuntarily committed to a psychiatric facility because he was going to blow the whistle on them for unlawful ticket quotas and manipulated crime statistics.

What is not so much publicized is that the defendants in his $50 million lawsuit include Jamaica Hospital Medical Center and two of its psychiatrists: Dr. Isak Isakov and Dr. Lilian Aldana-Bernier.

Among the allegations against Isakov and Aldana-Bernier in Schoolcraft’s civil suit:

• They failed to perform the proper and necessary tests to determine that plaintiff was either a “substantial risk of physical harm to himself…or to others….”

(In New York, as in most states, the criteria for being involuntarily committed to a psychiatric facility is that one must be shown to be a danger to himself or others by having made suicidal or homicidal threats or attempts or displayed such behavior.)

• They unlawfully detained and involuntarily confined Schoolcraft to Jamaica Hospital for treatment without any justification, in violation of his constitutional rights.

• They deprived Schoolcraft of his liberty, denied him his fundamental constitutional rights, publicly embarrassed and humiliated him and caused him to suffer severe emotional distress.

A psychiatrist can’t simply lock someone up in a psych ward just because another person—even an officer of the law—claims they’re “agitated” or “emotionally disturbed.”

Schoolcraft has since been vindicated in his whistleblower allegations:  The 81st Precinct came under investigation and its top commanders have all been given departmental charges and/or been transferred.

Which makes it look all the worse for psychiatrists Isakov and Aldana-Bernier.

Source: “Cop who made tapes accuses NYPD of false arrest,” Associated Press, October 9, 2010; Coleen Long, Tom Hays, “‘What is this, Russia?” Cop claims NYPD had him committed for being a whistleblower,” MSNBC.com, October 10, 2010; Len Levitt, “Adrian Schoolcraft: Now it’s getting serious,” Huffington Post, January 31, 2011 and Rocco Parascandola, “Brooklyn’s 81st Precinct probed by NYPD for fudging stats; felonies allegedly marked as misdemeanors,” New York Daily News, February 2, 2010.

Psychiatrist Mandeep Behniwal convicted, discplined by state for sexual incident with patient

On June 7, 2010, the California Medical Board placed psychiatrist Mandeep Behniwal on probation for seven years with terms and conditions.

According to the Board’s document, Behniwal was sentenced in Sacramento County Superior Court to three years informal probation following his no contest plea to a criminal charge of assault.

[Behniwal] pulled [the patient’s] breast out of her bra and blouse and sucked on it.  [The patient] observed that [Behniwal’s] penis was out of his fly and exposed.  He ejaculated on his hand and the hand of [the patient]. He told [the patient] she was beautiful and that he was attracted to her.”

The Board’s document reveals that on October 30, 2006, Behniwal had provided medication management to a patient whom he had been treating for one year and that, before she could exit his office, he “proceeded to put his hand down [the patient’s] blouse and under her bra.  He then firmly gripped her breast. [Behniwal] pulled [the patient’s] breast out of her bra and blouse and sucked on it.  [The patient] observed that [Behniwal’s] penis was out of his fly and exposed.  [Behniwal] put his hand down [the patient’s] pants and inserted his finger into her vagina.  He ejaculated on his hand and the hand of [the patient]. He told [the patient] she was beautiful and that he was attracted to her.”

The patient reported this incident to law enforcement.  An evidentiary examination showed positive for DNA fluid on the patient’s ring finger.

Source: Decision in the Matter of the Accusation Against Mandeep Behniwal, M.D., Physician and Surgeon Certificate No. A 79753, File No. 02-2006-179736, California Medical Board.