Did His Doctor Love Him to Death?

To his Mexican immigrant family, Paul Lozano was a star. A brilliant and shy student from El Paso, he had gained entry to one of the nation’s most elite institutions: Harvard Medical School. His future seemed assured. But during his third year of studies, Lozano became homesick and depressed. He got a list of Harvard-recommended therapists and called the first name on the alphabetical roster: psychiatrist Margaret Bean-Bayog. A clinical assistant professor at the medical school, she had a reputation as a gifted lecturer and dedicated researcher into substance abuse.

But what followed for Lozano, his grieving family claims, was a death spiral into infantilism and madness. On April 2, 1991, just a few months before he was to receive his M.D., Lozano, 28, injected himself with a lethal dose of cocaine. Last week Dr. Bean-Bayog, 48, found herself before the Massachusetts medical licensing board refuting charges by Lozano’s family that she had driven him to suicide by seducing him into a lurid affair, brainwashing him into thinking that she was his loving “Mom” and he her baby boy, and then dumping him when he could no longer pay for treatment.

Lozano’s family, which is suing the psychiatrist for malpractice and “wrongful death,” offers some extraordinary evidence. Among the items they retrieved from his Boston apartment were children’s books such as Goodnight, Moon, inscribed in Bean-Bayog’s hand to “the baby”; tapes in which the therapist instructs Lozano to repeat 10 times, “I’m your Mom, and I love you, and you love me very, very much”; flash cards made by the psychiatrist, one of which refers to missing “the phenomenal sex”; photographs taken by Lozano that show Bean-Bayog snuggling a stuffed bear; and a series of letters and stories she wrote to him playing out fantasies about maternal love and devotion. More perplexing still are dozens of pages in her handwriting that describe her sadomasochistic sexual fantasies. Lozano’s sister claims her brother said he and the psychiatrist had an affair.

Despite such evidence, the case against Bean-Bayog is by no means airtight. In testimony before the state board, the psychiatrist denied ever having sex with Lozano and maintained that he was far more disturbed than his family is letting on. She described him as “chronically suicidal,” the victim of “horrendous childhood abuse,” a drug user, and a liar subject to delusions of sexual abuse involving both her and another female psychiatrist. Though a social worker who had worked with Lozano challenges this depiction, other therapists familiar with the case support Bean-Bayog’s account.

The psychiatrist concedes that her treatment of Lozano was “somewhat unconventional” but says she turned to it only after routine therapy failed and after Lozano suggested that he found the notion of a loving, nonabusive mother comforting. Role-playing mother and son, she says, was a useful method of calming his behavior and helping him confront traumatic childhood memories. As for the flash card mentioning “phenomenal sex,” the psychiatrist says it was a statement dictated by Lozano referring to his relationship with a girlfriend. She admits the sexual fantasies are her own dreams but says they were never meant to be shown to Lozano: he broke into her office and stole them, she contends. Far from cutting his life short, Bean-Bayog says she helped sustain him for four years. She believes his death was accidental.

Wherever the truth may rest, the Lozano case illustrates the tangle of emotions and desires that wind through many doctor-patient relationships. Surveys indicate that between 7% and 13% of healers within an array of specialties — including psychologists, gynecologists, surgeons and family practitioners — have had some erotic contact with their patients. Public outrage over such cases has led eight states to pass legislation in recent years making sexual abuse of patients a crime.

Medical organizations have been revising their ethical codes. Last year a Canadian task force recommended that doctors wait two years between treating a patient and becoming sexually involved. For psychotherapists, the prohibition is much stronger: intimacy with a former patient is never acceptable. While U.S. doctors are fairly unanimous in opposing sex with a current patient, they are divided over guidelines concerning former patients. In the view of the American Medical Association, a relationship with a former patient is unethical, no matter how much time has elapsed since treatment, if it exploits the “trust, knowledge, emotion or influence derived from the previous professional relationship.”

The greatest potential for such exploitation arises in the field of mental health, because of the intimate and emotional nature of psychotherapy. According to one study, 86% of therapists acknowledge sometimes feeling attracted to their patients. Another study showed that half of psychologists have seen at least one patient who has been sexually intimate with a prior therapist. (In about 90% of those cases, a male therapist was involved with a female patient.)

On the other hand, mental-health professionals are supposedly better trained than other doctors to deal with the sexual feelings that arise during treatment. A patient’s emotions toward the therapist are in fact a major tool in therapy. In a process known as transference, patients shift to the counselor the myriad feelings — love, lust, anger, hate, admiration, envy — that they harbor for significant people in their lives, including parents, siblings, lovers. By discussing those feelings in the safe shelter of a therapist’s office, clients can confront troubling issues from their past.

Of course, therapists are not automatons; their feelings can be stirred in sessions every bit as much as are those of patients. Sometimes those emotions shift onto the client, a process called countertransference. When a woman counselor takes up with a male patient, the impulse is often a “fantasy that love will cure the patient,” says psychiatrist Glen Gabbard of the Menninger Clinic, who points to the romance between the therapist played by Barbra Streisand and Nick Nolte’s character in The Prince of Tides. “The movie would have you believe that what was helpful to him was her love for him, not her professional expertise.”

When therapists feel themselves drawn into an emotional or sexual relationship with a patient, they are supposed to consult colleagues for guidance. Bean-Bayog seems to have done just this. Last week a clinical social worker in Boston said that Bean-Bayog had discussed her sexual attraction toward a Mexican-American patient in a teaching session. Bean-Bayog also repeatedly sought advice on the Lozano case from senior psychiatrists. Said one of her colleagues: “She had consultations at every stage of the game.” He points out that a therapist who is abusing a patient is unlikely to be so open.

Last week the Massachusetts licensing board criticized Bean-Bayog for “departing from accepted standards of medical practice” in her treatment of Lozano, but it came to no conclusion about the charge of sexual misconduct. Pending further hearings, the board decided to allow the doctor to continue to see patients under the supervision of another psychiatrist. The plight of this respected therapist caught up in one of the great hazards of her profession has stirred sympathy within the Boston psychiatric community. “There is a strong tension within us that we should be able to heal, comfort and cure terribly troubled people — particularly gifted, young people,” says one therapist who is familiar with the case. “I am inclined to think this has all the hallmarks of a real tragedy of good intentions to cure and heal, and something went awry.”