Customer Reviews

Breakdown: Sex, Suicide, and the Harvard Psychiatrist

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Alarming story of how a noted psychiatrist (who was obviously very sick herself, read the notes she kept on the case) was able to turn her own demons lose on an already disturbed patient. The psychiatrist was obviously baby obsessed and serverly neurotic after nine miscarriages in four years. Her treatment of the patient reads like something from the journal of a madwoman, in my opinion. the only complaint i have (i took this book out of the library) is the pacing is way too slow, the author painstakingly goes over the patients childhood and his sister's conversations etc etc, and the final outcome is only dealt with in the last few chapters or so. i think the writer could have written a much more engrossing story if she had paced it better and gotten to the heart of the matter quicker, after all the doctors' notes are the basis of the treatment. anyway i think the story itself worked well, and i enjoyed reading it.

A Boston psychiatrist in her 40's, Dr. Margaret Bean-Bayog begins treating Paul Lozano, an intelligent and driven but also mentally ill Harvard medical student who's in his early 20's. She decides that he displays all the symptoms of an abused child, though he has no memories of being abused, never told her was abused, and by all accounts (Except Dr. Bean's) was not abused. Bean then proceeds to subject this guy to four years of deranged therapy. She regresses him back to being a three year old during appointments which occur up to 5 times a week, and tells him she's his "Mom", and she'll keep him safe. She reads baby books to him (Goodnight Moon, etc.) and gives him stuffed toys. She refuses to meet with any of his family to the point that once when Paul's sister, Pilar, saw Bean in a hospital lobby and called out to her, Bean refused to acknowledge her and simply kept on walking. The Lozanos are presented as good people who are just sick about what's happening to their son and brother, but Bean tells Lozano that since his family is responsible for his condition, he should not contact them. However, Bean is not only his "Mom", she is also a sexual presence in his life, writing him EXTREMELY graphic letters, with highly sado-masochistic overtones, about her fantasized encounters with him. Fifty-five of those letters were found among Paul's possessons. And Bean openly masturbates during their sessions.
Paul Lozano, the patient knows she isn't really his Mom, but, due in large part to Bean's "therapy", he deteriorates to the point that he fades in and out between fantasy and reality and comes to "love" her, though what it actually is is just total dependence and sexual desire. There are basically no boundaries between Doc and patient. Dr. Bean keeps telling him that - as his mother - she loves him and will keep him safe. And she says he can call her any time day or night, she'll be there for him. So naturally, as she's encouraging his decompensation and total dependence on her, he does so, becoming increasingly needier and more demanding. Eventually, 4 years down the road, Bean decides she doesn't want to deal with his neediness and craziness any more, that it's too demanding, and she terminates their sessions. This is of course the beginning of an end toward which Lozano's been heading for a while.
He eventually commits suicide. His family, having heard Paul repeatedly expressing his complete love for "Margaret" and wavering between love and anger towards them, decides to investigate.
The book is BREAKDOWN by Boston newspaper reporter, Eileen McNamara. The story has almost everything a true crime reader could want: a Harvard educated and affiliated psychiatrist treating a young Hispanic man, extensive background on Paul Lozano, excellent writing, and extensive research. I wish there had been considerably more information on Dr. Bean's background, but she would not agree to be interviewed.
BREAKDOWN is not unbiased - it is clearly sympathetic to the Lozanos while the entrenched Boston community of analytic psychiatrists is presented as arrogant and in many ways dishonest.

Two quotes:
"...Dr. Larry H. Strasburger reviewed the materials (pertaining to Bean's treatment of Lozano) and was firm in his rejection of Margaret Bean-Bayog's methods. `Dr. Bean-Bayog engaged in a consistent pattern of inducing a dependent, infantile state in Paul Lozano...to the degree that he required her support, companionship, approval and love. This deviant course of "therapy" erased appropriate boundaries of the psychotherapist-patient relationship and violated acceptable standards of psychiatric practice."

And, reporting on the opinions of Dr. Paul McHugh, chairman of the Department of Psychiatry at the Johns Hopkins School of Medicine, McNamara writes, "It was a generic, and unsubstantiated, victim story that Dr. McHugh read in Dr. Bean-Bayog's records of Paul Lozano. A story written by the doctor, not the patient, a story that distracted Paul Lozano from identifying and coping with his real troubles."

Mine is the first positive review of BREAKDOWN on this site, but I found it fascinating and McNamara's writing intelligent. If the subject matter appeals, I highly recommend this book.

This is an important book, not simply in its illustration of a respected doctor who seemingly became unmoored, but in some of her colleagues' hustling to spin the embarrassing news.

It is the tragic story of psychiatry gone-haywire, a depressed Mexican-American Harvard medical student, Paul Lozano, unfortunately drawn into an infantilizing, eroticized treatment at the hands Dr. Margaret Bean-Bayog in the late 80s and early 90s. Author Eileen McNamara carefully traces the tragic path toward Lozano's suicide and its highly publicized aftermath.

Many questions will never be answered: did patient and psychiatrist actually have sex? Could this depressed patient have been saved under more ethical, skilled care? Was the treatment the cure, or did it provoke the disease? There was large evidence of an out-of-control therapist who damaged her patient through a distorted and sexually-provocative Mom-Boy relationship and mutual over-dependence.

Beyond this specific case are the larger issues. Aspects of harmful therapy are offered at its source: a depiction of a doctor's rescue complex, her bunker mentality and her fantasy universe. This book also is a cautionary tale about the irresponsible side of mental health profession. For not only did this doctor rationalize her bizarre methodology and its mountains of artifacts, but many in her community rushed to defend her, hailing Bean-Bayog their victimized hero.

Therapists sometimes can be so strangled by their own theory that they're myopic to the common sense. Study the photo of Bean-Bayog in semi-recline, slipped hips low on her chair, tenderly holding Dr. Bean Bear teddy to her breast. Her defenders even have a rationalization for that one.

For one of the first times, I am forced to absolutely agree with the review atop this one. Although this book could have been an excellent engrossing story, the author, Boston Globe reporter Eileen McNamara tries too hard to make it into a scholarly book and a cautionary tale- and does not truly make either characters come alive, or the reader understand the true nature of the relationship between Paul Lozando and his psychiatrist. The first chapters are almost exclusively based on excerpts from the court documents- and are quite boring. She doesn't know which is the relevant information to include and which could be left out- and the book is not even that long. So in other words, she does not get to the heart of the matter quick enough before the reader loses interest- I have read hundreds of true crime books- and for the first time, I lost interest enough to skim over boring section discussing the psychiatric profession at large. I did not want detailed descriptions of the medical board and its procedure- only the basic information so that I Could understand what was happening- and the truth was, that (maybe out of boredom) I couldn't figure it all out, because all of the information on the aftermath of the tragedy, in other words, everything that happened after Paul's death, is condensed into the last chapters. In short, not a particularly fulfilling read. I wonder if "Obsession", the other book on this case is better.

The McNamara book is so biased that it verges on the fraudulent. The Chafetz book was the honest attempt at the truth. Both authors were reporters for the Boston Globe. Below is the book review that the Globe ran on these two books on March 25, 1994.

Boston Globe

Author: By Geoffrey Stokes, Special to the Globe
Date: 03/25/1994 Page: 50
Section: LIVING
BOOK REVIEW
BREAKDOWN
Sex, Suicide, and the Harvard Psychiatrist
By Eileen McNamara
Pocket, 289 pp., illustrated, $22

OBSESSION
The Bizarre Relationship Between a Prominent Harvard
Psychiatrist and Her Suicidal Patient
By Gary S. Chafetz and Morris E. Chafetz
Crown, 365 pp., $25

Geoffrey Stokes, who has written extensively on the media,
writes the My Back Pages column for the Sunday Globe book
section.
By now, of course, everybody knows the saga of Paul Lozano and Margaret Bean-Bayog: After a youth that was both troubled and sunny, with loving parents who sexually abused him, Lozano entered Harvard Medical School in the autumn of 1983. At the end of his second year, at which point he was both close to suicide and a strong, well-adjusted student, he began a course of therapy with Dr. Bean-Bayog. Over the next four years, she simultaneously kept him alive through heroic and innovative therapy and so badly mistreated him -- perhaps having an affair with him or at the very least, masturbating in his presence -- that her therapy caused him to regress dramatically. Finally, nine months after their therapy terminated, he killed himself, proving both that she'd done wonders to keep him alive for as long as she had and that her infantalizing treatment had left him incapable of coping with the world.
The malpractice suit and licensure hearing that grew from these events -- and the attendant media coverage -- were influenced by Harvard's disdain for ordinary folk, by bigotry against Mexican-Americans, by working-class distrust of intellectuals and by bigotry against uppity female doctors and were thus both a replay of the Salem witch trials and a long overdue tightening of lax supervision of the medical profession. Such wildly contradictory accounts are what one would have to believe if one somehow managed to accept the different facts, opinions and tones of these two books -- one by a Globe reporter, the other by a Globe contributor -- as true. But blanket acceptance of this sort being impossible, a reader has to choose -- and though it might theoretically be possible to select a factoid here, a judgment there, the two present such radically different views that the choice is necessarily all-or-nothing.
This is not easy; though I am somewhat more sympathetic toward Bean-Bayog as a result of these books, I'm not that much more certain about what ''really" happened during Lozano's therapy and life than I was when his vexed case was playing itself out on the front pages. But I am sure of this: One of these books -- McNamara's -- is pervaded by a bias that fatally cripples its argument.
It took me a while to realize this, partly because I've admired McNamara's journalism in the past and was therefore inclined to cut her some slack, but more because her confident, no-nonsense tone and just-the-facts demeanor make her book seem far the more objective of the two. Gary Chafetz's, by contrast (and I'm going to refer to the book as his because its first- person voice and its preface make clear that while his psychiatrist-father, Morris, was an active consultant throughout this project, Gary Chafetz did the writing), offers such a personal take that it at times seems self-indulgent. Is it really necessary for us to know, for instance, that Chafetz was nervous about interviewing an Andover/Harvard/ Harvard Law prosecutor because the lawyer had "grown up on the tough streets of Somerville, a blue-collar suburb"? Or that Chafetz's own reporting had been honored by Boston Magazine?
The answer, somewhat surprisingly, is more yes than no; though any particular detail might seem silly, their cumulative effect turns out to be reassuring. It took a while -- perhaps two-thirds of the book -- for the strategy to kick in, but I found myself convinced that his was an honest quest for a slippery and difficult truth.
Initially, however, Chafetz seems merely to be dithering, while McNamara -- who as storyteller exhibits a stronger narrative grip on the material -- marches through the case with the unambivalent zest of Sherman cutting a swath through Georgia. Choosing to play a prosecutor's role (Bean-Bayog did not grant her requests for an interview), McNamara makes the Lozanos' malpractice case with all the force she can muster. Hers -- she rather too obviously believes -- is the terrible swift sword of righteousness. And when she deals with such topics as the Commonwealth's shameful indulgence of dangerous doctors, it may well be.
Just as often, though, she's out there with a tire iron. Here, for instance, McNamara tries to twist a sympathetic phone call to Bean-Bayog from Dr. Thomas Gutheil, who would have been one of her expert witnesses, into an act of insensitivity: "When this case began leading the evening newscasts, Dr. Gutheil was one of the first to telephone Dr. Bean-Bayog to express his condolences. 'The initial stuff was, I would say, critical to the point of being abusive, and I feel sorry if anybody gets that,' he said, in explaining his call. He placed no similar call to the Lozanos."
Well, no, of course he didn't. He knew and had worked with Bean-Bayog; the Lozanos were strangers. If my friend and a stranger get into an automobile accident, it's to my friend's hospital bed that I go. And McNamara deducts no moral points from the Lozanos -- whose lawyer, after all, had chosen to make the case as public as possible -- because their friends in El Paso didn't commiserate with Bean-Bayog.
The tire iron is actually preferable, however, to the tear-stained hanky McNamara sometimes wields. Dismissing feminist criticism that Bean-Bayog was treated more harshly than similarly situated male therapists, McNamara writes: ''Where were the feminist complaints about the rush to judgment against Epifania Lozano? Where was the righteous indignation about the smearing media that circulated unproven claims against this woman of impeccable reputation? Or did the good name of a Mexican-American housewife carry less weight than that of a Harvard psychiatrist?"
There is so much wrong with this typically (alas) sentimental ''argument" that one hardly knows where to begin. For openers, anyone who believes Margaret Bean-Bayog was treated better by the media than Epifania Lozano was spending those months of 1992 on Mars (Quick quiz: Whose first name did you remember before reading this review, Dr. Bean-Bayog's or Mrs. Lozano's?). Second, the charge that Mrs. Lozano had abused her son was made privately, in therapy, and the source for the "unproven claims" against both women -- though not of the carefully crafted arguments against Bean-Bayog -- were one and the same: those words of the late Paul Lozano that the family of Epifania Lozano had chosen to make public.
Indeed, the most honest element of this passage is its venom. Throughout, in ways that inform and ultimately undermine her book, McNamara is furious with "Harvard" and all its metaphorical and political power. For reasons that doubtless seem to her worthy, McNamara has used poor, sad Paul Lozano and his story to smite her enemies.
Against this, Chafetz's confusions and ambivalence come almost as a relief. In a number of instances, his reporting seems more thorough than McNamara's, and he is good at explaining difficult psychological notions. By the time I'd finished reading his explanation of "countertransference," for instance, I'd understood that Bean-Bayog's much-discussed sexual fantasies might have had some genuine therapeutic purpose (that is to say, to the extent Lozano transferred to her some of the feelings he'd had for other important women in his life, Bean-Bayog's writing down her own reaction to that transference -- so it could be restudied and sifted for clues -- is intellectually defensible). That didn't make reading them any easier -- and I can't shake the visceral feeling that she got into deeper waters than she should have -- but Chafetz's tolerance for ambiguity is more convincing than cruder arguments would have been.
Additionally, he is careful rather than argumentative when trying to explain the overlaps and differences -- and the hostilities -- between psychiatrists who believe that mental illnesses can be managed primarily or exclusively with medication and those who believe more traditional therapy is required. This high-stakes debate is both the battlefield on which the case of Bean-Bayog's license would have been fought and the crossfire in which she got caught. And it was, as he says, much more a matter of "Harvard vs. Harvard" than the crowd-pleasing, tabloid version McNamara offers.

Being something of an "insider" (my treating psychiatrist was also one of Dr. Bean's consultants, and we discussed the case at length) I feel that Dr. Bean was guilty primarily of the sin of hubris. She tried to do it all, she tried to do too much, and she tried to do it all alone. She should have reached out far sooner than she did for second opinions.
That said, she was working at cross-purposes with her patient, Paul lozano, whom even by Mcamara's lights was a difficult patient--maniulating, dependent, demanding, substance-abusing. There's blame aplentry in thhis tale. and not just for the doctor and patient. Why on earth did Harvard allow paul to go on his clinical rotations when he was oced uo in a psychiatric lockup getting ECT? Why was the Lozano family so smothering as to run up to Boston every time paul had a meltdown??? Clearly there was a certain amount of manipulation and passive-aggressoveness going on, and neither the doctor, nor the family,nor paul seemed motivated to discuss them.
Reparenting therapy, as MacNamanara is careful to point out, predates Freud. It has been known to work for certain patients--I underwent such therapy before entering analysis, and it helped immeasurably. But it has to be finite--after two years we acknowledged that we had taken it as far as we could, and I needed a "stricter" form of therapy. Dr. Bean-Bayog apparently didn't think in these terms (she certainly wasn't thinking when she wrote down her fantasies!) or Paul Lozano was so difficult to treat that she couldn't put borders on him.
As for the Lozano family,I find it a little hard to believe that the Lozano family was as saintly and close-knit as described. A lot of manipulation was going on, and I find it difficult to think that he wasn't abused in some ways--maybe not the ways he specifically related to Dr. Bean-Bayog, but I think they were simultaneously trying to keep him their "baby" and demanding he do well at Harvard at the same time. This guy was obviously grossly psychotic toward the end of his life (saying he heard "Margaret's voice" over the El Paso hospital intercom)
and i don't think it can all be blamed on Dr. Bean-Bayog.