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Being Stalked: a Psychiatrist's Perspective

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Being Stalked: a Psychiatrist's Perspective Jefferson Journal of Psychiatry Volume 12 Issue 1 Article 8 January 1994 Being Stalked: A Psychiatrist's Perspective Kalpana I. Nathan, MD Stanford University Medical Center, Stanford California Tina T. Lee, MD Stanford University Medical Center James Missett, MD, PhD Menlo Park, California Follow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatry Part of the Psychiatry Commons Let us know how access to this document benefits ouy Recommended Citation Nathan, MD, Kalpana I.; Lee, MD, Tina T.; and Missett, MD, PhD, James (1994) "Being Stalked: A Psychiatrist's Perspective," Jefferson Journal of Psychiatry: Vol. 12 : Iss. 1 , Article 8. DOI: https://doi.org/10.29046/JJP.012.1.005 Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol12/iss1/8 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Jefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Being Stalked: A Psychiatrist's Perspective Kalpana I. Nathan, M.D. Tina T. Lee, M.D. James Missett, M.D.,Ph.D. Abstract It is only recently that stalking has been criminalized afler some highly publicizedfo rensic cases. Psychiatricfocus has been on erotomania, and in this article we primarily highlight stalking as a separate entity with psychiatric and legal implications. The case reports reveal our vulnerability as therapists, and we hope will raise our awareness qf stalking as a potentially dangerous situation. The legal statutes vary in different states, but our recommendations may provideguidelines totoardsformulating policies and proceduresfor the sofety ofhealthcareproviders. INTRODUCTION The traditional do ct or-patient rel ationship has been scrutinized intensely in recent ye a rs . Several instances have been brought to ligh t wh ere the physician has abuse d his /her power in th e ro le of ca re -g ive r to patients, and this has been add resse d exte ns ive ly in th e lit erature (I). The exploitation of pa tient s has always been d eemed ethica lly wr ong, and more recently has been exam ine d from th e legal perspective. Yet, th e reve rse situati on, wh ere the ph ysician ca n becom e a victim of haras sment a nd as sa ult, has rarely been addressed in th e lit era ture.T he re is oft en reluctance to di sclose, on the part of ph ysicians, possibl y from fea r of revea ling vulnerability. There has been an incr eas e in th e number of report ed incid ents of assault against nursing st aff, but most cases remain unreported (2). The recent sh ooting of emergency ro om staff in the U nivers ity of So ut h California H ospita l, Los An gel es, shatters the assu m ption of personal safe ty within ou r profession. In psychi atry, we are exposed to viole nt and threatening patients ea rly in ou r training, a nd very quickl y we learn st rategies in m anagement of patients in th ese situations. Results from data collec te d fr om psych iatric residents wh o were m embers of the Canadia n Psychi atric Associa tion re vealed that 40 .2% of resident s have been assa ulte d at least once. In ge ne ral, as sau lts on residents a nd sta ff tend to be under-reported (3) . There are routin e security m easures in psychi a tric facilit ies a nd e merge ncy rooms to protect th e st aff a nd patien ts fro m vio lenc e, however, these Kalpana I. Nathan, M.D. is currently a resear ch fellow in mood disorders and psychoph ar ma­ cology in th e Department or Psychiatry at Stanford University, wher e Ti na T. Lee, M.D. is the Associat e Program Director for Residency.J am es Missett, M.D., Ph.D. is a cert ified forensic psychiatrist in privat e practice in Menlo Park , Ca liforn ia. BEING STALKED: A PSYCH IATRIST S PERSPECTIVE m easures may need to be re-ex amined a nd up grad ed fro m time to time, as ne w situations evolve. EROTOMANIA There is very little mention of stalking, as such, in th e litera ture. St alking has been largely described in th e conte xt of erotomania. T here have been reports of delu sion al eroto mania, a nd Segal (4) reviews th e historical evolution of this disorder. Kr aeplin was th e first to describe e ro tomania, which has also been ca lled de C lera mba ult's syndro me, afte r th e Fren ch psychi atrist who described it in det ail in 1921. The esse ntial feature of th e ero to manic delusional disorder, as described in th e Di agn osti c Statistica l Manual-III-R evised (DSM-III- R) (5), is that th e patient be­ lieves th at he or she is loved by a no the r. The person about whom thi s conviction is held is usu all y of high er status, suc h as a famous pe rson or a superior at work, a nd may even be a comple te stranger. Efforts to contact the object of th e delusion, through telephone calls, letters, gifts, visits, a nd eve n surve illa nc e and stalking a re common, th ou gh occasiona lly th e pe rson keeps th e delu sion secr et. C linical case reports have been pr ed ominantly of wome n, wh ereas for ensic cas es mostly involve men (6). FOR ENSIC/LEGAL PERSPECTIVE Two fore nsic cases have ca pture d wid espread pu blic attention. First was th e assassina tion a ttem pt of Ron ald Rea gan on March 30, 1981 byj ohn H inckley,jr., who was obsessed with th e ac tre ss j odi e Fost er. The second involved Richa rd Fa rley, who had stalked a co-worker Laura Black, and eventua lly wounded her a nd two others, as well as killed seven people on February 16, 1988 in t he silicon vall ey firm in California th at had recently fired him. Califo rn ia, in 1990, became t he first state to enac t a crim ina l law tha t proscribed "stalking," and since then 47 additional states have passed a nti-stalking legislation. California enacte d its a nt i-stalking law in response to seve ral highl y publicized stalking incid ents, including th e murder of actress Rebecca Sch aeffer by a n obsess ed fan ; th e brutal stabbing of ac tress Theresa Sa ldana; and murders of four wome n in Oran ge County, each of who m had been stalked, had a te mpo ra ry restraining order agains t th e assailant, and had told th ei r family a nd friends th ey thought th ey were go ing to be killed. Morville (7) points out th at Hollywood sta rs are not th e only victims of sta lking, a nd th at this problem most oft en occurs in connection with ac ts of domest ic violen ce. Often, a spur ne d lover or es tra nged spouse, who is usu ally a male, follows a nd ha rasses th e former partner. Simi la rly, a battere d woman who leaves her abusive partner may become a victim of stalking . Approximat ely ni nety percent of wom en killed by th eir hu sbands or boyfriends a re stalked pr ior to th eir deaths (8) . Prior to th e enactme nt of anti-stalking legislation, th e offender usu ally had to comm it a n ove r t a ttack before he could be a rrested or pr osecuted . A civil prote ction order such as a restraining orde r ofte n offered inadequa te protect ion; moreover most vict ims 46 JEFFERSON J O URNAL OF PSYCHIATRY lacked the ability to obtain on e. Criminalizing st alking m ay help d et er more violent acts su ch as deaths, and has be en supported by National Organization for Vict im Assistance, the National Victims C enter, and th e National Battered Wom en's Law Project. In O ctober 1993, the U.S. D epartment of Justice 's National In stitu te ofJ ustice (NIJ) (9) developed a model anti-stalking code to encourage states to adopt a nti­ sta lking measures and to provide them with direction in formulating such laws. Stalking is typically defined as willful, malicious, and repeated foll owing a nd ha rass­ ing of another person. Many stalking statutes prohibit non-con sen sual co m munica­ tion. Provisions often require that the victim have a reasonable fear for his or her safety, or a fear of death or bodily injury. The two chief ele me nts of most stalking sta tu te s are threatening behavior and crim inal intent of th e defendant.
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