Competing psychological assessments raise questions about the therapists' ethics and motivations.
By Elizabeth Mehren, Times Staff Writer. Los Angeles Times. Tuesday, May 9, 2000
He's a normal 6-year-old who belongs with his sole surviving parent. He's a grieving child who loves his cousin like a mother. He misses his home environment. He loves his new environment. He has undergone unimaginable trauma. He's resilient; he'll get over it.
From a four-person panel assembled by the government to at least half a dozen specialists recruited by his Miami relatives, a profusion of professionals has weighed in on the mental health of Elian Gonzalez. Depending on which faction has the floor, almost any of the above can describe the
little boy who has come to symbolize the animosity between Cuba and the United States.
Political differences account for some of the divergent assessments, which will play an important role in the appellate court arguments over Elian set for Thursday in Atlanta. But so does the subjectivity that members of the profession concede is part of a standard evaluation process used
on children. Since Elian has undergone a series of these evaluations, some in the field fear he may become overanalyzed. Still others express concern that all the clamor puts their profession in a bad light.
"Dueling shrinks," said Dr. Eugenio Rothe, director of the child psychiatry clinic at Jackson Memorial Hospital in Miami. "It's very embarrassing."
For example, Dr. Paulina Kernberg, an eminent child psychiatrist who examined Elian while consulting for the government, reported that the boy drew a picture of a man on a mountain and told her the image was "Daddy looking around." Kernberg said the sketch revealed the child's "admiration
and pride" for his father.
Miami child psychiatrist Dr. Lydia Usategui, engaged to examine the boy by the lawyer for Elian's Miami relatives, was unimpressed.
"So he drew his father on a mountain," she said in an interview. "Big deal."
Kernberg's evaluation is included in the government's case. Spencer Eig, an attorney representing the Miami relatives, said that along with statements from specialists who have seen the boy, an affidavit from a psychologist who has worked with politically prominent children in Cuba will be "a
really key part of this case."
The appellate court is considering a request from Elian's father to dismiss the Miami relatives' appeal of the custody ruling in favor of Juan Miguel Gonzalez.
Starting with counselors at the Florida hospital where he was examined after his Thanksgiving Day rescue, the public and private psychological assessment of Elian Gonzalez has relentlessly continued. Only a handful of those who have voiced their opinions actually have seen the boy, but many
others have chimed in.
Lawyers from each side "are recruiting professionals who they know are going to sympathize with their view," said Rothe, who has not been involved in the case. "Many times, when the professional doesn't give the report they want, the report gets buried. Or they go through
several evaluations until they get the one they want to bring to court."
Is Analysis of the Boy or the Situation?
As executive director of the American Academy of Pediatrics, Dr. Joe M. Sanders Jr. cautioned that "psychological evaluations aren't hard science." The inherent subjectivity of the process, he said, means that some specialists may be analyzing the situation, not the individual.
Sanders also objected to remarks by professionals who have not examined Elian. "Unless you have the opportunity to get firsthand information, how can people make profound statements one way or the other?"
In a 62-page booklet put together by a group of mental health specialists in Cuba, for instance, psychologist Aurora Garcia Morey said she could tell from news footage that for Elian, "affective links are being lost and replaced by things."
About two weeks after Elian arrived in Florida, Eig asked Usategui to evaluate Elian. Her report, urging that the child remain with the Miami relatives, is included in court papers.
Usategui, who has since seen Elian several times, said the child's treating psychologist, Alina Lopez-Gottardi, "has been seeing him for months." (As a treating psychologist whose report on Elian is also included in the court report, Lopez-Gottardi declined to comment.) In all,
Usategui said, "six or seven" mental health professionals saw Elian in Miami--including Dr. H. Gunther Perdigao, a New Orleans psychiatrist who, with the family's consent, spent several hours with Elian while taping a "Good Morning America" segment.
"This was not a boy who was not attended to. He was seen. He was evaluated in every sense," said Usategui, who was not paid for her services. Numerous professionals arrived at the same opinion, she said: that Elian should not be abruptly removed from his relatives' home. "That's
why I'm so upset about this whole situation."
She reserved special ire for Kernberg, who on April 25 spent nearly three hours at Andrews Air Force Base evaluating Elian for the U.S. Justice Department. Kernberg, a specialist in child and adolescent psychiatry at Cornell University Medical College, concluded that far from maternal
affection, the boy's feelings for his cousin, Marisleysis Gonzalez, were "similar to the romantic feelings of a schoolboy for his teacher or a wished-for girlfriend."
Politely, Kernberg declined to discuss the case. But prominent Washington, D.C., child and adolescent psychiatrist Dr. Jerry M. Wiener explained that he and Kernberg were part of a team of mental health experts assembled by Immigration and Naturalization Service Commissioner Doris Meissner.
INS spokeswoman Maria Cardona said the as-yet-unpaid team was weeks in the making. Headed by pediatrician Dr. Irwin Redlener, director of the Children's Health Fund in New York, the panel also included Lourdes Rigual-Lynch, a psychologist for the Children's Health Fund. In large part
because he is bilingual, Dr. Gustavo Cadavid, a psychiatrist and mental health advisor for the U.S. Public Health Service, was selected to accompany Elian on his flight from Miami to Washington. On the plane, the boy was given Play-doh, which the government team thought would help relieve anxiety.
From the outset, Wiener said, the panel understood that the government had decided to return Elian to his father. The team's mission, he said, was to establish a set of principles to accomplish the ideal transfer.
First, the team said, the boy "should be transferred to his father as soon as possible and as unambiguously as possible." The panel also recommended that the transfer take place "in a neutral and secluded, private setting." Finally, the group told government officials to
be prepared to spend anywhere from one to three weeks in this process.
Though only Kernberg ultimately spent time with the boy, Wiener said the group was able to make its determination by focusing on the psychological development of any 6-year-old, "the range of understanding and cognitive and emotional development that he would be expected to have."
The fact that the boy had been through "an extremely traumatic experience" also was factored in.
Primary Attachment Was to His Father
Wiener said his group did not see evaluations made by the Miami family's mental health advisors. But family history was taken into account, Wiener said: "We knew that since the divorce between the father and mother, that this boy had lived with his father, grown up in his father's home
with a whole extended family. Basically he spent weekends with his mother. So we knew that his principal and primary attachment was with his father."
Yet before the transfer, Redlener, who did not meet with the boy, declared on television that "Elian Gonzalez is now in a state of imminent danger to his physical and emotional well-being in a home that I consider to be psychologically abusive. . . . This child needs to be rescued."
Mitch Spiro, one of the psychologists hired by the Miami relatives, rejoined by stating that the boy had post-traumatic stress syndrome. Removing him from the care of his relatives, he said, would likely produce "irreversible emotional damage."
An affidavit from child psychologist Marta Molina, who worked in a Cuban state mental-health facility before defecting to Florida, is a main point in his case, Eig said, because it describes "what happens to children who come to political prominence in Cuba in terms of brainwashing."
Dr. Paul Applebaum, vice president of the American Psychiatric Assn., said it was reasonable for people in his profession to serve as consultants to the government, the Gonzalez family or even the media. But Applebaum said he was concerned about comments from professionals with no
involvement in the case.
Almost 40 years ago, he said, his organization adopted an ethics rule barring psychiatrists from speaking about public figures or people in the public arena whom they have not directly evaluated. Public figures who have been evaluated must give consent for their cases to be discussed,
Applebaum said.
In this situation, Applebaum said, "I would have hoped that my colleagues would have taken a deep breath before entering the public discussion."
For the object of all this attention, said Dr. Donald Cohen, past president of the International Assn. for Child and Adolescent Psychiatry and Allied Professions, seeing "so many clinicians who try to engage him in the kind of inquiry that isn't normal for a child" could be very
stressful.
Psychological evaluations for children are standard procedures, Cohen noted. Basic questions are routinely asked. The child is observed, perhaps at play. Since the process is so consistent, Cohen said, after a while, when a child is asked once again to recount the same story, "he
doesn't know any more what he really thinks."
Mental health professionals are just as interested in world events as anyone else, and the almost mythic nature of this case--a child found floating at sea, separated from his dead mother--has only heightened the fascination. "It's like with Princess Diana, when she died, everyone
projected every kind of internal fantasy on her," Rothe said. "This is what this kid is, a million different things to a million different people."
Copyright 2000 Los Angeles Times |