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Rape and sexual assault by psychiatrists

    “In every house where I come, I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women and men.”

    Excerpt – Hippocratic Oath 1

    A mostly hidden disgrace

    Despite being part of the Hippocratic Oath that was up until the 1990s sworn by all doctors and psychiatrists and for the most part, labelled as unethical by professional associations, sexual contact between psychiatrists and patients regularly occurs and rape too.

    As Hippocrates included it in the code, he was obviously addressing this as a situation right back in the days of ancient Greece and undoubtedly this has been occurring as long as there have been asylums and psychiatrists.

    We have little data on this area for most of the 19th and 20th centuries other than reports of sexual assault by psychiatrists were often said to be patient delusions.

    Astonishing bias against females

    “Charges of sex abuse were thus generally attributed to an assumed innate female tendency to make false allegations of a sexual nature against innocent men.”

    Kenneth S. Pope

    Any reports from female patients of sexual assault by psychiatrists would run up against considerable bias against women and girls in Western society.

    “Charges of sex abuse were thus generally attributed to an assumed innate female tendency to make false allegations of a sexual nature against innocent men. It is possible that this attribution gained popularity from Freud’s renunciation of his “seduction theory”. “When girls who bring forward this event [incest] in the story of their childhood fairly regularly introduce the father as the seducer, neither the phantastic character of this accusation nor the motive actuating it can be doubted” (Freud, 1924/1952, p. 379)”

    Kenneth S. Pope Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation. 2

    The following quote from the United States legal scholar J H Wigmore from 1934 shows how this bias also extended into the legal sphere.

    “…when a woman or young girl testifies as complainant against a man charged with a sexual crime-rape, rape under age, seduction, assault. Modern psychiatrists have amply studied … girls and women coming before the courts in all sorts of cases. Their psychic complexes are multifarious, distorted partly by inherent defects, partly by diseased derangements or abnormal instincts, partly by bad social environment, partly by temporary physiological or emotional conditions…. The unchaste (let us call it) mentality finds incidental but direct expression in the narration of imaginary sex incidents of which the narrator is the heroine or the victim… . No judge should ever let a sex offense go to the jury unless the female complainant’s social history and mental makeup have been examined and testified to by a qualified physician…. The reason I think that rape in particular belongs in this category is one well known to psychologists, namely, that fantasies of being raped are exceedingly common in women, indeed one may almost say that they are probably universal.”

    Kenneth S. Pope Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation. 3

    Thus the tremendous difficulty of ever getting any response in terms of justice for women who were the victims of psychiatric sexual abuse. The victim might immediately find herself interned without any rights in a psychiatric facility operated by the same psychiatrist responsible for the initial abuse.

    And so, against this backdrop psychiatry itself ignored the subject and it took until the mid-1970s for the first study on the subject of sexual abuse of patients to be published.

    While these quotes are from the 19th and 20th centuries, there is little evidence to suggest these biases do not remain in place, although better hidden.

    Far more common than generally thought

    …one should know the data being provided has been admitted anonymously or where the victims have made a criminal complaint and no one knows the actual full extent of the abuse.

    The following are statistics that have been collected from studies on the subject of psychiatrist sexual abuse of patients. Other data is available through the website PsychSearch where media reports of psychiatrist sexual abuse are collected. When using these or other data sets, one should know the data being provided has been admitted anonymously or where the victims have made a criminal complaint and no one knows the actual full extent of the abuse.

    While these statistics cover four countries there is no reason to believe they do not validly represent the broader international scene – they may in fact under-represent it as at least in these countries some statistics are being reported.

    • A 1973 US survey of physicians including psychiatrists, found: “Five to 13 percent of the respondents indicated that they engaged in erotic behavior with patients and 5 to 7.2 percent engaged in sexual intercourse specifically. ” 4
    • A 1977 survey of 1000 (with a 70% response rate) US psychologists found: “Results show that 5.5% of the male and .6% of the females reported having had sexual intercourse with patients; an additional 2.6% of the males and .3% of the females reported having had sexual intercourse with these patients within 3 months after the termination of therapy. Of those who had had intercourse with patients, 80% repeated it.” 5
    • A 1986 nationwide survey of 1,423 psychiatrists in the US found that 7.1% of the males and 3.1% of the females had sexual contact with their patients. Of the psychiatrists offending, 33% had sexual contact with more than one patient. Some psychiatrists even suggested that sexual contact was a ‘therapeutic intervention’ between therapy sessions. 6
    • A 1994 survey of 1000 Clinical Psychologists in the United Kingdom found that while 3.6% of those admitted sexual contact with a patient however 22.7% had treated a patient who had previously been sexually abused by a mental health professional such as a psychiatrist, nurse or social worker. 7
    • A 2004 paper from Australia found that 7.6% of all psychiatrists in that country had erotic contact with their patients during or after treatment. Using data from the New South Wales Health Care Complaints Commission, the paper also found that 4% of all psychiatrists in that state had been reported for sexual abuse of patients. 8
    • in 2005, the Kerr/Haslam Inquiry was completed in the United Kingdom which found that two consulting psychiatrists (Wiliam Kerr and Michael Haslam) had sexually abused some 77 patients over a period of more than two decades. Kerr, the worst offender, was found in the 1960s to have sexually abused a teenage patient on the basis of having sex with him as part of therapy. When this was discovered, the local authorities told him that if he wanted to continue practicing he would have to leave the area which he did, but the details of his offending were never passed on leaving him free to offend over decades. 9
    • A 2006 Australian study of sexual misconduct complaints found that psychiatry had the worst record of all health practitioners. 10
    • A 2012 study found that psychiatrists in Canada were more likely to be disciplined for sexual misconduct with patients than any other practitioners. 11

    Eroticized transference

    This phenomenon provides an opportunity for the predatory or weak-minded psychiatrist who, seeing this in his patient, would despicably take advantage of it.

    There is a phenomenon that occurs between a patient, often under considerable stress and mental trauma, and a therapist (either psychology or psychiatry) where the patient may initiate sexual contact. The phenomena can then evaporate as the patient recovers.

    “Eroticized transference is an intense, vivid, irrational erotic preoccupation with the therapist characterized by overt, seemingly egosyntonic demands for love and sexual fulfillment. The patient is unable to focus on developing appropriate insights and attends the sessions for the opportunity to be close to the therapist, with the hope that the therapist will reciprocate love.”

    Darnell Ladson and Randon Welton. Recognizing and Managing Erotic and Eroticized Transferences. 12

    This phenomenon provides an opportunity for the predatory or weak-minded psychiatrist who, seeing this in his patient, would despicably take advantage of it. And when this is done, how is this different from rape?

    So prevalent as to need special handling

    “Patients who have experienced sexual exploitation by a previous therapist constitute an increasingly recognized clinical population.”

    R P Kluft.

    The abuse of patients by psychiatrists has been found to be so prevalent that studies are now being done proposing ways to assist these type of victims.

    “Patients who have experienced sexual exploitation by a previous therapist constitute an increasingly recognized clinical population. Although some of these patients were transiently overwhelmed or mildly disturbed when exploited, the majority were severely symptomatic and the victims of incest or other previous abuse.”

    R P Kluft. Treating the patient who has been sexually exploited by a previous therapist. 13 14

    Targeting the earlier abused

    And studies repeatedly bring up data that patients abused have earlier sexual abuse histories – this can only suggest the scenario of a heinous psychiatrist choosing such a patient as the special target of his attention.

    “Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented with depression, 68% had a history of childhood abuse, and one half were themselves helping professionals.”

    Quadrio, C Sexual Abuse in Therapy: Gender Issues. 15

    Damaging patients

    “A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.”

    Laura P. Chen, et al. Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis.

    There is a great deal of evidence that sexual contact by psychiatrists, let alone rape, and the betrayal involved is extremely damaging to the patients who are subjected to it.

    A 2010 study involving data on over 3,000,000 persons who had been subjected to sexual abuse found there was a distinct correlation between this abuse and later psychiatric diagnosis.

    “A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.”

    Laura P. Chen, et al. Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis. 16

    Further data on the consequences of sexual abuse is given here:

    “A review of the literature suggests that a sexual relationship between a mental health provider and a patient brings significant risks to the patient. In one study, treating psychologists estimated that harm occurred in up to 95 percent of victims of psychotherapist sexual exploitation. In this study, 11 percent of victims required hospitalization due to the intimate relationship, 14 percent attempted suicide, and 1 percent completed suicide. Only 17 percent of patients eventually achieved complete recovery. In another study of psychiatrists who had treated such patients, 87 percent of respondents felt prior sexual exploitation had been harmful.”

    Michael R. MacIntyre and Jacob M. Appel. Legal and Ethics Considerations in Reporting Sexual Exploitation by Previous Providers. 17
    Female patient in straight jacket

    Rape and sexual assault in UK mental health

    More than 26,000 sexual abuse incidents over 5 years found in UK mental health facilities. 2,500 alleged incidents of sexual violence and misconduct AGAINST PATIENTS …
    1. Free Dictionary The Hippocratic Oath
    2. Kenneth S. Pope Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation.
    3. Kenneth S. Pope Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation.
    4. S Kardener, M Fuller, and I. N. Mensh. A Survey of Physicians’ Attitudes and Practices Regarding Erotic and Nonerotic Contact with Patients. Am Journal of Psychiatry. 1973.
    5. J C Holroyd, A M Brodsky Psychologists’ attitudes and practices regarding erotic and nonerotic physical contact with patients. 1977. American Psychologist, 32(10), 843–849
    6. Gartrell, N., Herman, J., Olarte, S., Feldstein, M., & Localio, R. (1986). Psychiatrist-patient sexual contact: results of a national survey. I: Prevalence
    7. Janet Melville-Wiseman. Professional sexual abuse in mental health services: Capturing practitioner views of a contemporary corruption of care. Social Work & Social Sciences Review., 2012.
    8. Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation. Med J Aust 2004; 181 (7): 380-383.
    9. P Kennedy. Kerr/Haslam Inquiry into sexual abuse of patients by psychiatrists. Cambridge University Press: 2018
    10. Marie M Bismark, David M Studdert, Katinka Morton, Ron Paterson, Matthew J Spittal and Yamna Taouk. Sexual misconduct by health professionals in Australia, 2011–2016: a retrospective analysis of notifications to health regulators Med J Aust. 2020.
    11. Alam A, Kurdyak P, Klemensberg J, Griesman J, Bell CM. The characteristics of psychiatrists disciplined by professional colleges in Canada. PLoS One. 2012
    12. Darnell Ladson and Randon Welton. Recognizing and Managing Erotic and Eroticized Transferences. Psychiatry (Edgmont). 2007 
    13. R P Kluft. Treating the patient who has been sexually exploited by a previous therapist. Psychiatr Clin North Am. 1989
    14. Rivka Yahav, Sheri Oz The relevance of psychodynamic psychotherapy to understanding therapist-patient sexual abuse and treatment of survivors J Am Acad Psychoanal Dyn Psychiatry. 2006.
    15. Quadrio, C Sexual Abuse in Therapy: Gender Issues Aust. and NZ Journal of Psychiatry. 1996.
    16. Laura P. Chen, M. Hassan Murad, Molly L. Paras, Kristina M. Colbenson, Amelia L. Sattler, Erin N. Goranson, Mohamed B. Elamin, Richard J. Seime, Gen Shinozaki, Larry J. Prokop and Ali Zirakzadeh. Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis
    17. Michael R. MacIntyre and Jacob M. Appel. Legal and Ethics Considerations in Reporting Sexual Exploitation by Previous Providers Journal of the American Academy of Psychiatry and the Law Online February 2020,
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