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A psychoanalyst who found himself caught in the conflict between confidentiality and duty to warn was held partly responsible by a federal jury last month in the case of a 10-year-old boy who was sexually abused by one of his former analysands. Douglas Ingram, M.D., a clinical professor of psychiatry at New York Medical College, was found culpable in not having sounded a warning about the analysand, who had told Ingram of his sexual fantasies about children but did not say he would act on them. Ingram and his lawyer settled with the plaintiff on damages on October 9.
A September 4 article in Psychiatric News examined the complex issues raised by Ingram's experience with patient Joseph DeMasi. DeMasi was in training at New York Medical College to become a child psychiatrist, and he also was undergoing training to become a psychoanalyst. As part of his training, he underwent psychoanalysis with Ingram, who was a training supervisor at the Psychoanalytic Institute of the department of psychiatry and behavioral sciences at New York Medical College. Ingram discontinued the analysis when he learned of DeMasi's sexual fantasies and instead saw him for psychotherapy. He consulted with colleagues and lawyers about the legal and ethical aspects of revealing DeMasi's sexual fantasies and after considering them, decided to maintain confidentiality and the ability to treat DeMasi.
DeMasi was later charged with molesting three boys. One boy's family sued Ingram and the New York Medical College. The jury did not find the college at fault.
In response to the verdict, Thomas Gutheil, a professor of psychiatry at Harvard Medical School and codirector of the program in Psychiatry and the Law at Massachusetts Mental Health Center and Harvard Medical School, said, "The public has persistently been ambivalent about confidentiality and psychiatric treatment.
"Beginning with the Tarasoff case in California, in which judges had spoken against the necessity of tolerating additional risk in a 'risk infested society,' the public has been torn between wishing to keep material confidential and feeling that after a disaster has occurred, it should have been broadcasted and 'something should have been done.'
"The jury award in the Ingram case almost certainly reflects the notion that something should have been done even if it would have been ill advised, and to some degree unethical and illegal, to do so. Such paradoxes really bother the public."