Schaler, J.A. (1989, March 15). AIDS and the psychiatrist's dilemma.
The Washington Post, Letters to the Editor, p. A22

Psychiatrist Lise Van Susteren's plea for help is a clear statement of contemporary psychiatric confusion ["Doctors' Horror: Death on the Loose," Outlook, Feb. 26]. Contrary to her assertions, this does not seem to be the case with her AIDS patient who is intent on "conquering the world."

Dr. Susteren says that her patient is "sick," a "deeply disturbed bisexual AIDS victim," who is deliberately trying to infect other people with his disease. She is convinced that her patient knows what he is doing, namely that his behavior could kill people.

She says that she treated this person for "multiple-personality disorder" and "encountered two of his alternate personalities -- a sexually promiscuous one, an evil one." In fact, if anyone is suffering from multiple personalities I believe it is the poor doctor. She describes herself as in "fear," "a nightmare," "a personal dilemma," "agony," "reluctant," "stunned," "full of dread," "unbelieving," "confused," "helpless," "surprised," "conflicted," suffering from "cold feet," "incredulous," "devastated" and "sweaty." She further admits to having lied in her diagnosis to have her patient admitted to a hospital.

This is quite a contrast to her patient's presentation of himself. He does not seem confused in the least. She admits that he tells her the truth. Both agree that he is quite clear regarding his intentions and that he knows the consequences of his actions. He wants to give people AIDS. Simple enough.

Dr. Susteren, unlike her patient, claims she is in an ethical dilemma and asks for help. I have two suggestions: 1) Make a statement at the beginning of your psychiatric work with a person that you will not work with people nor protect the confidentiality of your relationships if you discover that a client deliberately gives people AIDS. Either the client agrees to these terms or does not. 2) Devote time, energy and expertise to educating the public about awful people like the person you wrote about.

Dr. Susteren states that her "story must not become an excuse for intolerance." I disagree. We must not tolerate, as psychiatrist Thomas Szasz has written, the myth of mental illness and its consequences. As long as society views the psychiatric relationship as a form of medical treatment for mental illness instead of as a contractual agreement between people that is educational in nature, the dilemma presented by Dr. Susteren will continue, as well it should.

JEFFREY A. SCHALER
Silver Spring