11/19/2011· Psychiatry
Monroe was the kind of child from whom usually little is expected therapeutically. A member of a disadvantaged ethnic minority, he lived in the poverty of a big-city slum ghetto...
By: Dr. Gilbert Kliman
Tel: (415) 292-7119
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Website: www.expertchildpsychiatry.com.
Our child psychoanalytic consultation has resulted in most cases being considered won by the retaining side. Only five of over 200 cases have resulted in adverse decisions. Several of those adverse decisions were based not on the clinical merits of the case for damages but rather on liability matters concerning who was responsible.
The societal impact of the 52 OK Boys Ranch victims' cases in which I have been involved seems substantial. First, nothing else had closed the Ranch until the civil suits started to give promise of succeeding in a major and well-publicized way. Those suits depended heavily on my psychoanalytically informed testimony. I extensively interviewed each child concerning details of the assaults and psychological consequences, and videotaped the interviews. Earlier childhood histories (usually including many vulnerabilities due to prior traumatization and documented psychiatric disorders) were articulated in my written opinions and depositions. I carefully reviewed the facility's behavioral logs. Together with much of the assembled evidence assembled, the logs gave me a foundation for an opinion that the sexual assaults of the boys on each other were generally foreseeable, preventable, and harmful to the boys. In each child's case there had been a loss of much-needed residential therapeutic opportunity, linkage of therapeutic milieu with trauma, and accumulation of trauma through preventable victimization. Each child's personality development was harmed during the passage of several epochs. Because I am a child psychoanalyst factors involved in my testimony included extensive use of psychoanalytic literature, especially societal influences on personality formation, the superego and the ego ideal, and the opportunity for constructively reworking the Oedipus complex during adolescence (Bos 1979, Erikson, 1959). In one case a child who was allowed to be a frequent perpetrator was considered by his attorney, and by me, to be a victim of corrupt adult permission giving and turning a blind eye to his known assaultive behavior.
The litigation had several phases, spanned over seven years and involved 52 children. During the course of this widely publicized case, the State of Washington responded constructively by creating a more responsive and autonomous intermediary to protect the civil rights of children in state-licensed or stateconducted care. The Office of the Family and Children's Ombudsman is now required by state law to research child abuse in State controlled care. A booklet was created and distributed to all children over age 12 in state-licensed care, describing their rights and access to Ombudsman services. The OK Boys Ranch was finally closed, and several state officials chose or were required to leave employment. The children were compensated in every case, totaling over fifty million dollars. We thus believe there have been widespread favorable impacts on safety of children within Washington state institutions and agencies caring for children.
A secondary important issue was the failure of therapists who knew of the complaints of rapes and were treating some of the children, to call protective services to report and prevent further rapes of their clients and other children. This issue, also, resulted in favorable major (but confidential) settlements for the child victims.
Videotaping my interviews with each boy gave me the opportunity to return during later phases of the litigation to what I had seen earlier. The interval was as long as six years for some children. I used the old tapes in new phases of the litigation, re-interviewing and compare my later findings with previously noted conditions of the same children. Using Axis V of DSM-IV (American Psychiatric Association), we were able to form serial GAF (Global Assessment of Function) scores showing that many of the children were continuing to deteriorate, as well as having chronic PTSD. We used Khan's (1963) concept of cumulative trauma and relevant adult psychiatric literature concerning how chronicity is commonly found among traumatized veterans many years after the initial diagnosis of PTSD.
This case had other features of scientific and legal interest. One was quite unexpected, in that we learned that an attorney behaved in a wrongful fashion, mirroring his institutional client in a certain deceptive way. This discovery came about partly because of my psychoanalytic emphasis on attention to detail. Aiming for thoroughness, I had staff perform collateral interviews when I could not do so with parents and foster parents, perform standardized psychological testing, review and make timelines of literally tens of thousands of pages of documents about the earlier childhoods of the children ? many of whom were the subject of much narrative recording within social service logs. This resulting paperwork preoccupied one defense attorney strangely. He literally spent days deposing me about clerical matters. I noted a persistent tendency on the part of this attorney to projectively attribute unwarranted blame onto me concerning whether my own rather systematic records were in good order. At my first opportunity during the deposition, I offered an opinion that something was troubling the deposing attorney. I thought it concerned not my documents but rather a great concern about the adequacy of the submission to me of his own institution's behavioral documents. This psychoanalytically derived clue helped the already alert plaintiff's attorney, who was ultimately able to prove that 20,000 pages of institutional behavioral daily log documents had been wrongfully withheld during discovery by that same defense attorney. In addition the deposing attorney also had an ethical conflict as he was a former member of the defending institution's Board of Directors. He ultimately was penalized $160,000 as a disciplinary action by a court which reviewed the matter.
Dr. Gilbert Kliman, won the International Literary Prize for Best Book concerning the Well Being and Nurture of Children, "Responsible Parenthood" and is the recipient of grants from over 50 private foundations and The National Institute of Mental Health. His research interests include the Psychological Trauma and Treatment of Severely Disturbed Children and their families, in-classroom psychotherapy.
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11/19/2011· Psychiatry
Monroe was the kind of child from whom usually little is expected therapeutically. A member of a disadvantaged ethnic minority, he lived in the poverty of a big-city slum ghetto...
1/24/2017· Psychiatry
Objective: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. Methods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians (T = -3.56, P = .000).
12/14/2022· Psychiatry
Criteria For Diagnosing DSM-III Borderline Personality Disorders
By: Dr. James Reich
One hundred fifty-nine psychiatric outpatients were examined to determine which of the DSM-III Borderline Personality Disorder (BPD) criteria were most valid in terms of sensitivity, specificity, predictive power positive, and predictive power negative. Combinations of two criteria predicted