Saturday, March 2, 2019

But What About The Elephant In The Room?

One of the most triumphal talks I went to during last October’s American Academy of Child and Adolescent Psychiatry (AACAP) Annual Meeting was the Noshpitz Cline History Lecture: "What Has Happened to Fifty Years of Child Abuse Reporting Laws? The One-Hundred-Forty Million Dollar Mistake.”

The talk was delivered by Dr. Lenore Terr, a San Francisco child psychiatrist famous for her work in the area of childhood trauma. As she reminded us during her lecture, she was one of the first to document the fact that victims of trauma can experience a foreshortened sense of the future, which eventually became one of the DSM criteria for PTSD. She also discussed the history of how child abuse reporting laws came into existence and emphasized the importance of these laws in protecting children from adults in positions of power, such as teachers and coaches. Notably, she left out medical professionals, despite all that's happened recently.

Dr. Terr delivered her talk old-school, using handwritten notes with no PowerPoint slides to distract from her narrative. She spoke in well formed paragraphs of cogent prose, and the incident that she described was truly stomach-churning. In 2010, a young woman who worked at a drugstore photo center developed a bunch of photos showing different children wearing blindfolds with tape over their mouths. There was no nudity or anything explicit, but the woman found the images unsettling, and her intuition told her that something was not right. Despite her manager saying that it was probably nothing, she contacted the authorities. This led to the investigation of Mark Berndt, a teacher at Miramonte Elementary School in the Los Angeles Unified School District (LAUSD), which was comprised of mostly low-income Hispanic students.

The investigation revealed horrifying details of what dozens of girls suffered at the hands of Berndt, including being fed cookies topped with his semen. Perhaps more dismaying is the fact that years earlier, LAUSD had received allegations of abuse against Berndt. But the district not only failed to report him to the police, it also destroyed records detailing these prior accusations. The families of the victims then sued LAUSD for its negligence.

Dr. Terr was eventually brought in by the plaintiffs’ attorneys to interview the victims, who were then in their teens. She showed that without a doubt, the abuse did lasting damage, and these teens had serious PTSD that affected their lives in ways wide-ranging and profound, even though at the time of their victimization they were too young to fully grasp what was happening. Eventually, LAUSD settled the lawsuit for $140 million, a record sum. Dr. Terr ended her talk by praising the courage of the drugstore employee, whose actions ultimately led to the humbling of the nation’s second largest school district for failing to protect the children in its charge. 

After Dr. Terr’s talk, I stood and applauded with everyone else. But something about her exultant tone seemed off to me. After all, here was a famous child psychiatrist who no doubt knew that one of AACAP’s former presidents, Dr. William Ayres, was convicted in 2013 of sexually abusing multiple boys while they were his patients. In fact, she seems to be friendly with Dr. Lynn Ponton, a child psychiatrist who reported Ayres to the authorities after hearing from one of his former patients about what he did. Yet there was no mention that our profession can harbor predators as well and that we all need to do the right thing if we suspect one of our colleagues of abusing children.

Even more surreal was the fact that the very first audience comment after the talk came from Dr. John Dunne, one of the distinguished elders of child psychiatry. He clearly knew Ayres, since they had co-chaired AACAP’s Work Group on Quality Issues in the 1990’s and worked together on multiple practice parameters (basically our version of professional guidelines), including one on the evaluation of children who may have been physically or sexually abused. When I saw him stand up with a microphone in his hand, I naively hoped that he would ask Dr. Terr something like, “what if a member of our own profession was a serial child molester?” Instead, he praised her for her wonderful talk and then went on to discuss his own experiences working with traumatized youth. I should not have been surprised, for I have never heard another child psychiatrist mention William Ayres in public. Almost six years ago, I wrote the following tweet:

Now that Ayres has died in prison, maybe this talk by Dr. Terr is finally some sort of attempt by AACAP at undoing? If so, it was not good enough. We’re the doctors who are supposed to be able to help others to not be afraid to go there and give voice to the unspeakable. Instead, I saw two preeminent child psychiatrists engage in a strangely self-satisfied dance around the dirty elephant in the room.