09/08/04

Diagnosis For A Victim 

Christie Blatchford

Globe and Mail

It was at 1:10 p.m. on Sunday, Nov. 30, last year that I got a lengthy e-mail from a woman who told a horrific story of sexual abuse at the hands of her family doctor, and begged me to attend his approaching disciplinary hearing at the Ontario College of Physicians and Surgeons, where he was facing charges of professional misconduct and incompetence.

"I would really like you to cover the hearing," she wrote. "Only two per cent of women who have been abused come forward to complain to the College . . . I feel if more women knew how to report, and trusted the process, they would complain . . . If you or someone from The Globe came to the hearing, I would be very co-operative with sharing documents, such as my medical chart, his letter of response to my letter of complaint, and so forth."

She sounded literate, rational and intelligent, and so, the following day, the hearing began, and I was there, and for the first time, clamped eyes upon the woman, who can't be identified because of a publication ban, and on Dr. Alan Abelsohn.

I mention this to establish a couple of things -- first, that the woman, in my view anticipating sisterly sympathy, had invited my scrutiny, and second, that as lawyers are wont to say, I held no brief for Dr. Abelsohn.

The tale that unfolded over the course of the next weeks and months was considerably more nuanced and less one-sided than the woman had presented it.

In short, she was a ruinously tricky patient who admitted she had initiated, suggested and demanded (and, more important from the doctor's end, appeared to need) the physical contact, he a gentle general practitioner who did some counselling on the side, as many GPs do, but was woefully ill-equipped to help a woman like this. What happened between them was nothing less than a train wreck, with her grabbing the therapeutic reins and him allowing her to dictate the course of her own treatment until it grew so bizarre that on a half-dozen occasions, with his consent, she was masturbating on the floor of his office.

This week, it all culminated with a decision from the discipline committee, whose members unanimously found Dr. Abelsohn guilty of professional misconduct, via sexual abuse, and of incompetence, but who were sharply divided over what role the doctor had played in it all.

Because of that -- because two of the four committee members ruled that he had not encouraged the sexual acting out and was a "caring, compassionate and empathetic physician" who had got in far over his head and far beyond his expertise with an astonishingly difficult patient -- Dr. Abelsohn will not be subject to the automatic revocation of his licence to practice.

He will be sentenced this fall, and though he could still be stripped of his licence -- that is the most severe potential penalty, with a range of less punitive options available -- I hope it doesn't happen.

While the story is instructive on a number of levels for Canadian doctors, it is no less so for the rest of us, insofar as it deals with the always-shifting rules governing what is acceptable conduct between adult men and women.

Broadly speaking, this woman was presumed from the get-go to be a truth-teller and a victim -- so much so that seven months before Dr. Abelsohn's hearing even began, another committee of the college cheerfully and quietly paid out $10,000 for her to get counselling.

The corollary, of course, is that Dr. Abelsohn was presumed guilty from the start.

In this case, because he had carefully documented the sexually charged sessions on the woman's chart -- compelling exculpatory evidence, in my view, of his benign if misguided intentions -- he was guilty.

But the presumption of guilt, and the victim status immediately accorded his accuser, are not confined to this case, or even to the college and the medical profession.

All over Canada, in quasi-judicial proceedings like this one, at similar inquiries held by the self-regulating professions, at labour dispute tribunals, in family court and even to some degree in the criminal courts, the same general presumptions exist: Women are in need of protection from men; women rarely lie ("Why would she make it up?" is always the implicit question, as though women are not subject to the normal unpleasant human characteristics of viciousness, get-even bitterness, or even the raw exercise of power for its own satisfying sake), while men lie and are predatory.

If this case was governed by the physician's obligations to the patient -- Dr. Abelsohn was the one, at least in theory, who was in charge, and who ought to have called a halt -- I believe it was also clouded by them.

The woman, it turns out, is a "borderline," short for a person diagnosed with a borderline personality disorder, one of the most difficult psychiatric disorders to treat and usually accompanied by personal and social chaos. Predominantly women, borderlines in other times used to be called hysterics, in large measure because of their insatiable neediness and chronic manipulation.

Is a borderline's behaviour a function of her illness, the way that a schizophrenic's is? Does the illness, if that's what it is, get the borderline wholly off the hook for her conduct? Is the former the sole explanation for the latter? The experts say yes, but to the layman or the cynic -- and, I confess, to me -- it seems just as plausible that what psychiatry has done is formally package up as a disorder what many of us would intuitively recognize and know as ordinary, if ugly, human behaviour.

I found the lady to be frankly scary, and even the panel, while on the one hand pronouncing Dr. Abelsohn guilty, accorded her testimony no weight, and deemed it unreliable. If they could have been stripped of their labels -- the patient and the doctor -- there would have been little doubt that she was the schemer, the dissembler, the sexual aggressor and the manipulator of the two.

I have exchanged not a word with either one of them, but I can tell you who I would trust, and who would send me scrambling for the nearest exit. And I resent, beyond bearing, that I can't tell you the name of the one who would have me running for cover.