The Boston Globe
Written records cover case notes, letters, fantasy
By Don Aucoin
April 6, 1992
The case of a Lexington psychiatrist and the patient she is accused of driving to suicide has unfolded publicly to an unusual extent because of a voluminous written record that includes three major groups: case notes, sexual fantasies, and correspondence between the pair.
While such records are not uncommon in psychiatric cases, they are not usually available at this early stage of a case.
This documentary evidence was attached on March 26 to a civil lawsuit filed late last year at Middlesex Superior Court by the family of Paul Lozano, who accuses Lexington psychiatrist Dr. Margaret Bean-Bayog of sexual misconduct, psychiatric malpractice and wrongful death.
The family has accused Bean-Bayog, 48, of seducing and exploiting Lozano and causing him to commit suicide at age 28 one year ago.
A key factor in the case are dozens of letters and cards Bean-Bayog and Lozano exchanged with each other that the family had contended are indications of an improper relationship between the two. The letters from Bean-Bayog, most of which are signed “Love, Dr. B,” offer constant reassurance, praise and expressions of affection and solicitude to the patient, along with warnings to Lozano not to let his family “trigger you off.”
A source who advocates Bean-Bayog’s side of the case said last week that the letters were drafted by Bean-Bayog and Lozano during a therapy session immediately before the psychiatrist went to the Philippines on a two-week vacation.
The letters were designed to alleviate Lozano’s anxiety at being separated from his therapist, the source said.
Most of the cards from Lozano to Bean-Bayog express gratitude for her treatment. One reads: “I can’t begin to thank you for the kindness you have shown me, although there were times I couldn’t perceive it.” However, in another letter that was apparently written after Bean-Bayog had him admitted to a psychiatric hospital, Lozano lashes out angrily at his psychiatrist: “I think you are a bitch for taking me there . . . This vacation showed me I don’t need you daily, although you foster that . . . You can be very kind, but also tragically stupid and incompetent. The size of your ego almost rivals mine.”
Before one visit home by Lozano, Bean-Bayog wrote to him: “Remember I love you. If you start to loathe yourself remember it’s a reaction to something they’re doing which we haven’t understood yet. When we do it won’t hurt like that anymore.” A day later, she wrote: “If your interactions with your family get hard remember my opinion of you. I think you’re terrific. If they set off other feelings we have work to do. . . . ”
Several days after that, Bean-Bayog wrote to Lozano that “I worry about you getting into a spiral and hating yourself. In fact I worry a lot, not because I think you will but because I want to protect you and comfort you and keep you safe. You’re probably doing fine. I’m the one who’s having trouble.”
One letter displays the motherly play-acting Bean-Bayog has acknowledged was part of her therapy with Lozano. The letter portrays Lozano as a young boy agog with excitement on Christmas Eve, hoping to get a puppy as a Christmas present, while Bean-Bayog reads him children’s stories and reassures him that Santa Claus can enter the house despite its lack of a chimney.
Another letter reassures Lozano that “You are sick, not bad. . . . I am not angry with you. You need treatment and will get better. You can finish medical school.”
In a letter that apparently alludes to the sexual feelings Lozano expressed for Bean-Bayog during therapy sessions, the psychiatrist wrote: “What we talked about today will seem increasingly manageable the more we talk about it. Your sexual feeling is not your fault and is not bad. It does not mean the end of the relationship.”
Another key element of the case is 987 pages of notes handwritten by Bean-Bayog on hundreds of psychiatric sessions with Lozano.
The notes detail Lozano’s four years of treatment, and recount Lozano’s sadomasochistic fantasies about his psychiatrist. In some passages of her notes that deal with a therapy technique in which Bean-Bayog apparently cast herself as Lozano’s mother, Bean-Bayog indicates also her belief that Lozano had been sexually abused as a child by his mother. The family has denied any sexual abuse.
Much of the notes detail the patient’s feelings. In April 1987, for example, she describes Lozano as feeling “overwhelming shame and pain. Discussed intensity of experience, needs for support and structure. . . .Repeated panicky experiences in two more sessions.”
Others directly recount the patient’s sexual fantasies:
On Jan. 3, 1988, Bean-Bayog noted a sexual fantasy recounted by Lozano in which he becomes the doctor and she, the patient. “You are helpless and I can’t move,” he allegedly said to her. “You are submissive and vulnerable. Detailed descr(iption) of lovemaking. No real coercion or torture.” The following day, Bean-Bayog transcribes again, “. . . another sexual fantasy, not violent. Wanted me to hold perfectly still or he would put me in restraints.”
After his death, the family discovered in Lozano’s apartment explicit sexual fantasies written by Bean-Bayog that have been entered into the court record. The Massachusetts Board of Registration in Medicine said last week that the fantasies, which include sadomasochistic scenarios, “may have related to Paul Lozano.”
The psychiatrist has contended that the fantasies were written accounts of her dreams that were not intended for Lozano’s eyes, and that Lozano broke into her office in 1987 and stole them. The family asserts that she gave Lozano copies of the fantasies and that they are proof that Bean-Bayog had a sexual relationship with Lozano, a charge the psychiatrist denies.
Several psychiatrists say the fantasies neither confirm nor deny the charges of sexual abuse in the Lozano case. They say that recording fantasies can help a therapist avoid acting on sexual feelings for a patient.
Bean-Bayog’s fantasies are written as though she is speaking to another person. For instance, the first one begins: “There was something about what I did Thursday that left me uncomfortable. One of me was left out, and she’s important. You actually ought to have met her first before her older sister found you. I want you to meet this chaste girl. “When I was 21 I couldn’t have made love to you like that. I didn’t know how. . . .”
The fantasies written by Bean-Bayog equate helplessness with arousal, portraying a woman struggling vainly against a dominant, violent sex partner. In the fantasies, the partner slaps the woman, beats her with a belt, and verbally abuses her.
“I adore you. I am your slave,” the fantasy reads. “I am your sexual toy. I do not exist except to serve you and give you pleasure.”
After the sex partner has slapped the woman, one passage reads: “I wonder if I had wanted you to hurt me. It occurs to me it would be fun to provoke it, make you punish me. We’d both love it. You wouldn’t show it, but I’d know. I also feel oddly concerned and protective around you. This is your pain I’m in.”
In addition to the case notes and the sexual fantasies, sets of flash cards Bean-Bayog gave to Lozano have become an issue. The medical board said her use of these cards did not conform to standard practice.
Many of them offer directions and advice on how he should act. One appears to compliment Lozano on the “phenomenal sex” she allegedly enjoyed with him. The psychiatrist contends Lozano dictated the contents of that card and that the sex statement referred to his girlfriend.
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