IPT Book Reviews

Title: Breakdown: Sex, Suicide, and the Harvard Psychiatrist  Neutral Review
Author: Eileen McNamara
Publisher: Pocket Books

Pocket Books
1230 Avenue of the Americas
New York, NY 10020


This account of sexual impropriety and the psychiatrist's assumption that her client had repressed childhood sexual abuse was written by a reporter for the Boston Globe Magazine.  The book is mainly historical and well prepared, and describes a black page in the history of psychoanalysis.  The book provides a detailed account of Dr. Margaret Bean-Bayag masturbating in front of her client, having sexual intercourse twice with her client, and prematurely diagnosing child sexual abuse by the client's mother while he was in his crib.  McNamara describes her book as a "cautionary tale about the fragility of the human mind, the imprecision of psychiatry, the cavalier diagnosis of childhood abuse and use of unorthodox therapeutic techniques" (p.273).  Dr. Bean-Bayag took, as gospel truth, the literature she had read on childhood sexual abuse, recycling myths as if they were facts.  The book closes with a good set of references, no index, and an informal guide to the book's research methods.


The client committed suicide and his family sued Dr. Bean-Bayag for $1 million and won.  Bean-Bayag resigned from the Harvard Medical School and surrendered her medical license.

Among the malpractice issues were:

(1)    She did not report her suspicions of sexual abuse to the Welfare Department as required by Massachusetts law.
(2) She never attempted to validate her suspicions of sexual abuse by talking to the mother even though she had the chance to do so.
(3) She did not truly comprehend Mexican culture and child-rearing practices.
(4) She ordered her client not to talk to his family.
(5) She did not manage erotic transference well and ended up having intercourse with her client in her home along with taking photographs.
(6) She used a new unorthodox form of treatment called reparenting.

 The client stole Bean-Bayag's written account of her sexual fantasies (55 handwritten pages) from an unlocked desk.  After his 4th hospitalization for depression, she terminated him from therapy.  The client spoke to a hospital social worker who contacted the Massachusetts Board of Medicine.  The social worker got no more referrals from the establishment as she was identified as a whistle blower.  She was later accused of violating the client's confidentiality by the local chapter of the National Association of Social Workers.

Bean-Bayag's treatment records were criticized for their lack of empirical supporting data.  The author also raises interesting but unanswered questions about her sexual abuse claim and inappropriate (reparenting) treatment.  Bean-Bayag maintained that her sexual activity with the client was part of the transference process and was scientifically supported.

The Social Service Department of Wyandot County, Ohio (where the client was raised) claimed they had no record of child abuse and felt Bean-Bayag's theory of sex abuse was "ludicrous" (p. 215).  The family received grief therapy after the suicide and eventually returned to Mexico, claiming that American life was hazardous to Mexican children.  Bean-Bayag, without a license, opened a private practice in her home with a big caseload of women well-wishers.

Reviewed by LeRoy G. Schultz, Professor Emeritus of Social Work, West Virginia University, Morganstown, West Virginia.

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