When Doctors Know Better

September 28, 1990|By Douglas Peddicord

AN ARTICLE in the current Baltimore magazine (''Johns Hopkins Hospital Has A Sex Problem'') points up the dismaying tendency of the popular press to reduce complicated medical-legal controversies to simple good guys-bad guys morality plays. Or perhaps it merely illustrates that a powerful local institution can practice spin control in a way that would make any White House press secretary proud.

In either case, the one-sided presentation of the misunderstood healers of the Sexual Disorders Clinic valiantly endeavoring to treat deviancies which misinformed sexual ''phobics'' would only punish slights a genuine responsibility borne by those in the mental-health professions: When working with patients whose very illness may represent a significant potential for harm to innocent others it is essential that a reasonable and considered balance between treatment and community safety be maintained. The public has a right to expect that. And they, and their elected representatives, rightfully express grave concerns when they think that such may not be the case.

That this is the central issue has been amply demonstrated by the controversy over the obligation of Hopkins' Sexual Disorders Clinic to report offenders under that state's child-abuse reporting law.

In 1987, when the measure was first passed, Fred Berlin, the clinic's director, offered a convincing rationale that those who specialize in treating pedophiles (individuals whose sexual orientation is toward children) should be exempted from reporting offenses which occurred prior to treatment, on the grounds that abusers would simply not seek help if they knew that legal prosecution would likely result. But during the next session of the General Assembly other points of view carried the day and the voice of the community was expressed in a repeal of the reporting exception.

For a time, then, the Sexual Disorders Clinic adopted a policy of advising prospective patients that offenses against children would not be reported if their cases were referred to the clinic by an attorney, since such information could be protected by the attorney-client privilege.

When medical professionals try to hide behind lawyers to shield knowledge that the legislature has specifically refused to exempt, it is not their clinical judgment, but the willingness to operate responsibly within the political process, to act in good faith, that must be questioned.

The position that doctors ''know better'' than the public has been an excuse for too many tragic errors. And it is sad that it took an opinion from the attorney general disallowing the attorney-client dodge to make clear that even the best motivated healers should not try to place their work beyond the law.

Public trust in the efficacy of treatment for sexual disorders is hard to win, but easy to lose. Too often, the medical community is its own worst enemy. Take the case of Richard Berendzen, the American University president who was discovered making obscene phone calls.

As quoted in Baltimore, Dr. Berlin's assessment of that behavior goes as follows: ''This man had been sexually abused as a kid. Recently his father died, and he went back to the room where he had been abused by this older woman, which brought back a lot of memories. He read about the same time about the McMartin [California child-abuse] case, which gave him the idea that women who take care of babies in child-care centers may be abusing kids. Then, as he began reading ads in the newspaper from women doing day care, he got the confused idea that if he could find someone who's abusing kids, he could discover why in God's name a woman would be do something like that, and why it happened to him.''

However accurate this explanation in terms of Dr. Berendzen's psychological state, the description seems to understate considerably the actual events. To make it sound as if this man was conducting some benign telephone survey when, as far as can be surmised from media reports, he was venting, on an innocent victim he'd never even met, extremely disturbed and disturbing fantasies, seems the kind of ex post facto reasoning which may explain, but does not fully illuminate.

Not to deal with the complications, not to acknowledge the unknowns -- why in the world did the behavior take the form it did? under what circumstances might there be a recurrence, and can that be prevented? what about the impact on the victim? -- may make for good copy but provides little reassurance that the central tensions which are part and parcel of such treatment efforts, between the needs of offenders and the legitimate concerns of victims, between justifying behavior and understanding it, have been fully appreciated.

Having painted a picture of a treatment program beset by unrelenting and misinformed public opinion, the Baltimore reporter concludes that the Sexual Disorders Clinic may be forced to close, and if so ''the only loser may be the community.'' But, save for offenders in other countries who have actually been castrated, the scientific literature regarding treatment of sexual deviancies ranges from equivocal to unconvincing. Certainly no study has suggested that a city with such a program is somehow safer or even more humane than one without.

That those associated with Hopkins' Sexual Disorders Clinic must apply their specialized expertise and genuine commitment to helping under difficult, often thankless, circumstances is undoubted. But, even in the current contentious environment, to portray them as misunderstood victims seems a ''correction'' of the record gone a bit too far.

Dr. Peddicord is a clinical psychologist.

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