Justina Pelletier is the 15-year-old girl who is at the center of a dispute between her parents and the Psychiatry Department at Boston Children's Hospital.
Justina, who lived with her parents in Connecticut, had been diagnosed with mitochondrial disease, a rare and debilitating illness, and had been receiving treatment for this from Mark Korson, MD, Chief of Metabolism Services at Tufts Medical Center in Boston.
In February of last year, Justina's parents took her to Boston Children's Hospital with flu-like symptoms. Dr. Korson had recommended an admission to Boston Children's so that Justina could be seen by Alex Flores, MD, a gastrointestinal specialist who had recently transferred from Tufts to BCH.
But instead, Justina's care was taken over by the psychiatry department. She was "diagnosed" with somatoform disorder ("it's-all-in-your-head"), and BCH reported the parents to the state of Massachusetts for medical child abuse. The complaint was taken by the Department of Children and Families (DCF), and within 24 hours Judge Joseph Johnston awarded custody of Justina to the Massachusetts DCF, and ruled that she had to stay at BCH.
The parents continued to press for Justina's release from BCH, but were hampered in these efforts by a gag order that Judge Johnston had imposed.
In January of 2014, having spent almost a year in psychiatric care at BCH (nine months of which were in a locked ward), Justina was transferred to the Wayside Youth and Family Support Network in Framingham, Massachusetts. She was still in the custody of the DCF, and still under the care of psychiatrists at Boston’s Children’s hospital. In February of 2014, Justina's father, Lou Pelletier, alarmed at the deterioration in his daughter's medical condition, decided to break the gag order, and go public, despite the risk of imprisonment. There was a huge outcry, and Massachusetts child protective services stated on February 28, 2014, that they are actively working to return Justina to Connecticut and the care of Tufts.
"The timetable for the shift of the teenager to her home state has not been set, and it is unclear just how much the Massachusetts Department of Children and Families is retreating from the girl’s case. But Loftus [DCF spokesperson] said child-protection officials from both states, the juvenile judge handling the case, and lawyers for the parents are actively working on identifying a new placement in Connecticut. He would not say what places are under consideration, but in cases like this, the child could be returned back to her home, or placed in a foster home or a residential treatment facility.
If she were to live at her family’s home in West Hartford, Conn., child-protection officials in that state, who would likely oversee the case, would likely demand that the girl receive services at home or that she attend a day program."
Because of the gag order, which was in place since November 17, 2013, and the official secrecy that normally attends these matters, it's difficult to establish all the facts. But the gist of the conflict seems to be that the psychiatrists at BCH disputed the diagnosis of mitochondrial disease. (In fact, there are indications that they may even have disputed whether such a disease even exists – an extraordinary accusation coming from psychiatry!) They also, apparently, formed the belief that the parents were dysfunctionally invested in the notion that Justina was gravely ill, and were subjecting her to needless medicines and treatments. During the eleven months she was at BCH, the psychiatrists placed very strict and stringent limits on how much contact the teenager could have with her family. There's a copy of a January 8, 2014, letter here from Kathleen Higgins, RN, a former BCH employee, to the DCF Commission. The letter provides a great deal of insightful background.
The parents protested vigorously that Justina had been taken off the medicines for mitochondrial disease, and they stated that her physical condition had deteriorated markedly during her stay at BCH.
Somatoform disorder is a DSM-IV term. It refers to a group of psychiatric "diagnoses," the common feature of which is "…the presence of physical symptoms that suggest a general medical condition…and are not fully explained by a general medical condition…" (DSM-IV, p 445). In addition, "…there is no diagnosable general medical condition to fully account for the physical symptoms." (ibid) Like all psychiatric "diagnoses," it has no explanatory value and is nothing more than a destructive and unreliably applied label.
So essentially what's happened here is that Dr. Korson, a pediatrician who is board-certified in Clinical Biochemical Genetics, an associate professor at Tufts University School of Medicine, and a specialist in mitochondrial diseases, has been treating Justina for about three years for mitochondrial disease. (According to the site MitoAction, "Dr. Korson is universally recognized as an expert in clinical practice for mitochondrial patients.") He sends her to BCH for a gastrointestinal consult with Dr. Flores. And within 24 hours, the psychiatry department hijacks her, rejects the mitochondrial disease diagnosis, substitutes a "diagnosis" of its own, files a medical abuse report with DCF, and supports a DCF petition to have Justina made a ward of the state. Prior to all this, Justina had no mental health history of any kind.
As soon as they realized what was happening, the parents sought to remove Justina from BCH – but when the teenager became a ward of the state, that door was closed, and the judge ordered that Justina be kept at BCH.
Justina's case has focused a great deal of attention on these matters generally. One of the points that has emerged fairly clearly is that BCH's procedure for pursuing a commitment of this kind is a well-oiled machine. The BCH physicians and staff on the one hand, and the DCF staff on the other, work closely to prepare their cases, and the courts are usually cooperative. Psychiatric evidence is afforded a high measure of credibility and deference, and, as in this case, the child is routinely ordered to remain at BCH.
The problem with all of this is that BCH stands to make a great deal of money on every child that is court-ordered to remain in their care. The conflict of interest is glaring. It's like a judge routinely sending convicted criminals to a private prison that he himself happens to own. The difference is that any judge who engaged in activity of this sort would be looking at criminal charges and disbarment. But in psychiatry, this sort of thing is common.
The matter is particularly compelling in that reports are emerging that BCH tends to pursue these kinds of court orders in cases where the family has "good insurance." Justina was kept at BCH for eleven months. I have seen no reports as to the size of the bill, but I'm sure it wasn't trivial.
BCH and Harvard
David R. DeMaso, MD, is the head of psychiatry at BCH. He is also a professor at Harvard, and is a member of Harvard's Psychiatry Department Executive Committee. He is evidently highly regarded at the University, and has his own Harvard Catalyst page. There's a tab on this page labeled "Similar People," and one of the people listed as "similar" to Dr. DeMaso is our old friend Joseph Biederman, MD, the eminent inventor of pediatric bipolar disorder. This is the bogus diagnosis that legitimized the prescribing of neuroleptic drugs to children as young as two years old for temper tantrums. Even some psychiatrists spoke out against this spurious and destructive activity, but the practice continues. The fact that Dr. DeMaso would allow Dr. Biederman's name to remain on his Similar People tab seems noteworthy. There is also a "connections" page on Harvard Catalyst, listing three publications co-authored by Dr. DeMaso and Dr. Biederman.
Dr. Biederman is on record as promising Johnson & Johnson a positive result for their drug Risperdal if they would fund his study. Why would any reputable physician allow someone like that to remain on his "Similar People" tab?
I did a PubMed search to see if there were other links between BCH psychiatrists and Joseph Biederman. In addition to the DeMaso publications, I discovered papers co-authored by Joseph Biederman and at least two other members of the BCH Department of Psychiatry "Leadership Team:" Joseph Gonzalez-Heydrich, MD (7 articles, as recent at 2012); and Deborah Waber, MD (3 articles, as recent at 2012).
None of Justina's story would have come to light had there not been an extensive and vigorous public outcry. This in turn would not have happened if Justina's father, Lou, had not breached the court's gag order. The fact that our courts can effectively prohibit a parent, on pain of imprisonment, from speaking out against his child's enforced psychiatric treatment ought to be a huge concern. Our legislative and legal systems have been hoodwinked by psychiatry for too long. The right to free speech is our most fundamental political freedom. The fact that a state court would so cavalierly suspend such a right to promote the agenda of BCH's psychiatry department suggests a measure of partiality on the part of the court in an area where the child's welfare ought to be the paramount consideration. There had never been the slightest indication that Justina's parents had been abusing or neglecting her. In fact, they brought her to BCH on the advice of the child's physician to get help for the flu-like symptoms. By any conventional standards, they were being dutiful and attendant. The gag order was clearly an attempt to prevent them from drawing adverse publicity to BCH's psychiatry department. Courts are supposed to be impartial. Why would the court in this case have assumed that the psychiatry department's motives were benign, that its "diagnoses" were valid and accurate, and that its practices were judicious and efficacious? Why did the court not recognize the financial conflict of interest when it ordered that Justina be kept involuntarily in the locked psychiatric ward at BCH?
BCH's psychiatrists kept Justina in a locked psychiatric ward for nine months. Apparently it never occurred to them that they might have made an error, or that they had acted too hastily. Psychiatry seldom engages in anything even remotely akin to critical self-scrutiny . They have resisted the parents' protests at every step of the way, and have been backed throughout by the court. It is only because of the public outrage that the facts are emerging. Massachusetts' Department of Public Health has called for a full investigation of the matter. One can readily imagine the kinds of pressures that will be brought to bear to whitewash the entire affair. Let us all, individually and collectively, do what we can to ensure that this does not happen.
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This blog first appeared on Philip Hickey's website, Behaviorism and Mental Health
Behaviorism and Mental Health: Philip Hickey is a retired psychologist. He has worked in prisons (UK and US), addiction units, community mental health centers, nursing homes, and in private practice. He and his wife, Nancy, live in Colorado, and have four grown children. His posts can also be seen on his website, Behaviorism and Mental Health.