CNN on Mental Health - An Interview

The following appeared on CNN October 28, 1995

RHONDA ROWLAND, Anchor: How much can we expect from mental health professionals? Is it their responsibility to protect us from their potentially violent patients? Although very few mentally ill patients actually commit acts of violence, some do and that has psychiatrists who fail to predict their behavior heading to court. CNN's Larry LaMotte has this special report. PAUL SUGARMAN, Rotman Family Attorney: I would describe Dennis Gould as everyone's nightmare. He was a paranoid schizophrenic with fixed illusions. LARRY LaMOTTE, correspondent: But Gould's psychiatrist didn't have him locked up. PAUL SUGARMAN: He thought that he was the messiah or God or else- or that he was taking orders from God and that he had to kill a certain young woman whose name was Shelley Rotman, and indeed he did. LARRY LaMOTTE: Could Shelley Rotman have been saved? More and more states are saying yes, requiring psychotherapists to warn people specifically threatened by their patients. Dr. PARK DEITZ, American Academy of Psychiatry & Law: When the psychiatrist hears a threat, the therapist is on the horns of an ethical dilemma. Do I breach confidentiality and make a warning or do I keep this secret and take the chance that violence will occur and I could be held responsible for not warning? LARRY LaMOTTE: That dilemma underlies the Shelley Rotman story. A high school honor student in Milton, Massachusetts, Shelley met Dennis Gould at a dance and dated him. He later became mentally ill, even deliberately amputating his right arm under a Boston trolley car. And, he began hearing voices telling him to kill Shelley. Gould was hospitalized for psychiatric care. His doctor, Steve Mirren, released him, then saw Gould in therapy for three years. STEVE ROTMAN, Victim's Brother: He was somehow thinking that he could control this person who was fixed on killing my sister by having him come every two weeks or every three weeks to his office and, in between, be relied upon to take his pills every day. LARRY LaMOTTE: For the Rotmans, the biggest scare came when Gould showed up at their doorstep and explained his need to kill their daughter. The family went to court to get Gould committed but the judge refused, in part, because of a letter from Dr. Mirren. `Gould has a relatively normal social life' and `does not represent an eminent danger to himself or others,' he wrote. Six months later, that prediction proved wrong. One summer morning, as Shelley arrived to her nursing home job, the one armed ex-boyfriend attacked. In an alley behind the building he stabbed her 31 times. Gould was found not guilty, by reason of insanity, and sent to Bridgewater State Mental Institution in southern Massachusetts. The Rotmans sued Dr. Mirren for failing to protect Shelley from a violent patient like Gould. Mirren declined to be interviewed about this case but a colleague says it wasn't as simple as it sounds. Dr. TOM GUTHEIL, Psychiatrist: Violence by the mentally ill is a very rare phenomenon and, therefore, very hard to predict- it's kind of like earthquakes. STEVE ROTMAN: My sister was dead by somebody who was advertising that he was going to do it. He wasn't keeping it to himself, it wasn't a private thought. He was- it was like a neon flashing light. LARRY LaMOTTE: After two weeks of testimony, the jury found Dr. Mirren responsible and awarded the Rotmans $4.5 million. The ruling made some mental health professionals fearful of helping violent patients. Dr. TOM GUTHEIL: A lot of people read the case as a set of tea leaves saying, don't work with these patients and, unfortunately, that's always what can occur and that means, basically, that more of them are, I suppose, out running around that were the case before. LARRY LaMOTTE: Either way, psychiatrists say they cannot be bailiffs for their patients' behavior. Dr. Milton Burglass was sued for failing at his duty to protect in Florida. Dr. MILTON BURGLASS, Psychiatrist: I can't control any of my patients. I can't make them do anything. I can't make them stop doing anything. LARRY LaMOTTE: The patient he couldn't stop was Larry Blalock (sp), whom he had treated for five years for emotional problems and depression. Blalock struck in the parking lot of the family business, an oil distributorship in Homestead, Florida, the victim, Wayne Boynton had worked there. Both men were attracted to the same co-worker. As Boynton waited to drive her home, Blalock went into a jealous rage and killed Boynton with two bursts from a machine gun. Dr. MILTON BURGLASS: When I heard about this, I was as shocked as I have been by anything I've ever heard in my life. LARRY LaMOTTE: Yet, Boynton's family sued Dr. Burglass, claiming the doctor knew, or should have known, Blalock planned to kill their son and failed to warn them. Florida's courts dismissed the lawsuit. The appeals panel wrote, `To impose a duty to warn or protect third parties would require the psychiatrist to foresee harm, which may or may not be foreseeable, depending on the clarity of his crystal ball.' The attorney who won the case says a duty to protect discourages people from seeking help. ROGER SCHINDLER, Burglass' Attorney: Every patient who came to his therapist would find, sitting on the therapist's desk, a little card saying, be careful what you tell me because at some point in the stream of this therapy, I may have to violate the statutory, confidential relationship that we have and go out into the world and tell people about what you told me. LARRY LaMOTTE: The Boynton's lawyer says Florida's precedent is dangerous. GARY FRIEDMAN, Boynton Family Attorney: You will have to play the role of the psychiatrist. You will have to make the diagnosis. You will have to know that this patient is not simply making an idle threat, that he intends to come after you because you are going to be your only protection. Don't depend on the psychiatrist, don't depend on the courts. LARRY LaMOTTE: But psychiatrists insist they can't be depended on to predict violence. Dr. MILTON BURGLASS: Psychiatrists and psychologists perform no better than people picked at random off the street. Those studies are in the literature. Nonetheless, we are still held responsible for filtering out the trivial and casual remark from the one that is laden with deadly intent. LARRY LaMOTTE: Still, a majority of states now agree, psychotherapists must try to forecast deadly intent and stop it. That's no consolation for the families of Wayne Boynton or Shelley Rotman who believe their children could have been protected and were not. For Your Health, Larry LaMotte, CNN's special reports.