April 13, 2003
Mob boss Gigante Outwitted 34 Psychiatrists Professional Diagnostic Standards?
The New York Times asks: "How did some of the most respected
minds in forensic psychiatry and neuropsychology--including a prominent Harvard
psychiatrist, five past presidents of the American Academy of Psychiatry and
Law, and the man who invented the standard test for malingering, get it wrong?
Over the years, former Mafia boss, Vincent (the Chin) Gigante--who acknowledged
in court that he had eluded justice for years by feigning mental illness--had
been diagnosed with "schizophrenia" "severe dementia" "impairments of memory"
"attention deficit" "thought disorder."
Indeed, 34 psychiatrists declared Gigante "mentally incompetent" due to mental
illness. But a transcript of Gigante's telephone conversation with his wife,
Olympia, reveals a perfectly sane, rational conversation between husband and
wife.
This case demonstrates that psychiatric diagnoses are loosely issued impressions
that are not arrived at by solid professional diagnostic criteria.
Gigante's personal psychiatrist of 17 years declared him suffering from
schizophrenia...his diagnosis may be viewed like a lawyer's declaration of his
client's innocence...
However, how to explain the unambiguous "professional" declarations by 34
psychiatrists who made that diagnosis as well? Is there an effort to increase
the number of clients?
Among the experts who declared Gigante mentally incompetent are: Dr. Wilfred G
van Gorp, director of neuropsychology at Columbia University Medical Center is
quoted in The Times: "Mr. Gigante currently has moderate to severe dementia
which reflects significant underlying central nervous system dysfunction." Dr.
Gorp heads the division of Neuropsychological Assessment Service at Columbia
that conducts "Complete testing for ADHD, learning disabilities, memory
disorders and other cognitive problems" (212) 543-6940 e-mail: vangorp@pi.cpmc.columbia.edu
Dr. Thomas G. Gutheil, co-director of the Law and Psychiatry Resource
Health Center at Harvard Medical School; Dr. William Reid, professor of Forensic
Psychiatry, Univ. of Texas medical school and past president of the American
Acad of Psych and Law.
The Times reports that "All the doctors who examined Mr. Gigante were asked if
there was any chance he was malingering. Most of them said no, noting that in
addition to his behavior, scans of his brain showed abnormalities in blood flow
consistent with vascular dimensia."
But claims about brain abnormalities on the basis of brain scans have so far not
proven credible because the people whose brains were scanned have been exposed
to psychiatric drugs which do cause physical changes in the normal brain.
Only Dr. Jonathan D. Brodie, a professor of psychiatry at New York University
School of Medicine, called on his colleagues to admit that they had blown the
call.
After hearing excerpts from the Gigante taped conversations, the psychiatrists
denied they had erred, some rationalizing: "Mr. Gigante might be both mentally
ill and a malingerer."
ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)
http://www.ahrp.org
Contact: Vera Hassner Sharav
212-595-8974
e-mail: veracare@ahrp.org
April 13, 2003
Analyze This: Vincent Gigante, Not Crazy After All Those Years
By ANDY NEWMAN
An enduring urban mystery was solved last week when Vincent (The Chin) Gigante,
the Mafia leader who spent decades slobbering, muttering and wandering
Manhattan in his bedclothes, admitted in a Brooklyn federal court that he had
deceived the teams of psychiatrists who had evaluated his mental competency
from 1990 to 1997 and found him to be suffering from various forms of
dementia.
Mr. Gigante, 75, was sentenced to three years in prison, to be served, if he
lives, after he completes his current racketeering sentence in 2007. He
pleaded guilty on the eve of a trial at which prosecutors were prepared to
play audiotapes of numerous phone calls he has made to family and friends
since being imprisoned in 1997.
Another mystery remains: How did some of the most respected minds in forensic
psychiatry and neuropsychology — including a prominent Harvard psychiatrist,
five past presidents of the American Academy of Psychiatry and Law, and the
man who invented the standard test for malingering, get it wrong? For Mr.
Gigante's 1997 trial and sentencing, at least six doctors declared him
mentally incompetent.
A juxtaposition of some of their 1997 findings and excerpts from a phone call
Mr. Gigante made to his wife, Olympia, in December 2000, shows how far apart
diagnosis can be from behavior.
Mr. Gigante currently has moderate to severe dementia which reflects
significant underlying central nervous system dysfunction.
Dr. Wilfred G. van Gorp, director of neuropsychology at Columbia University
Medical School
He is suffering from schizophrenia. Schizophrenia is a disease of the mind
which is manifested by delusions, hallucinations, a thought disorder, and what
we call negative symptoms. Negative symptoms include a flattening of affect or
a constriction of emotional tone, psychomotor retardation, a slowing down of
his thinking processes and of his muscular motor coordinate movements.
Dr. Louis D'Adamo, who had been Mr. Gigante's personal psychiatrist for 17
years.
I do not believe that Mr. Gigante's overall level of dementia can reasonably
be attributed to the type or dose of his current medications.... None of the
likely causes will change in the future, with or without treatment, and thus
the dementia will either continue at about its present level or, more likely,
worsen over time.
• • •
Dr. William H. Reid, professor of Forensic Psychiatry at the University of
Texas medical school and past president of the American Academy of Psychiatry
and Law
During the recorded conversation with his wife, Olympia, Mr. Gigante
reconstructs both sides of a lengthy discussion with a prison doctor.
GIGANTE I went to the doctor today.
OLYMPIA You did? What'd he say?
GIGANTE He says, "You haven't got a rupture." He says, "What's this about
ruptures?" I says, "You were supposed to call me." He says, "Well, how long
you got the pain?" I says, "It's about 2 months" Ain't it about two months?
OLYMPIA Maybe.
GIGANTE On and off. He says, "six months?" I says, "Doc," I says, "[tssk],
almost two months." He says, "All right, I'm gonna give you the same medicine
you're taking."
I don't think he has a sense of time passing in the sense of knowing when
things occur, or at least I didn't see that in the interview. But he might
have some idea of, you know, past versus present.
Dr. Thomas G. Gutheil, co-director of the Law and Psychiatry Resource Health
Center at Harvard Medical School
GIGANTE Then he put a glove on and he went and he examined me down there and
he said, well, he says "You ain't got a rupture. Cough." I coughed. You know
something? It didn't hurt. Every time I sneeze or cough, it hurts. Today it
didn't hurt. "Does that hurt?" I says, "No here's the pain." I showed him
where the pain is and I showed him where the scar is. I said, "That scar hurts
too."
OLYMPIA So if it's not a rupture, what did he say it is?
GIGANTE He says it could be a torn ligament. What do I know? He's a D.O.
[doctor of osteopathy.] He ain't a doctor. You understand?
The subject shifts from Mr. Gigante's possible hernia to his heart condition:
GIGANTE Then he told me that the heart doctor is a fine doctor. I says, "I
didn't say he ain't."
He does not speak in sentences. He just speaks in words. Very often I would
ask him a question and he would give a short answer which is not related to my
question at all . . . . In all the years I've known him I have never been able
to have a cogent conversation with him . . . . If I would say to him,
"Vincent, how are you feeling, are you feeling better than last time?" He
would say, "My mother cooks."
"Did you sleep last night?" "I ain't sick no more."
Dr. D'Adamo
GIGANTE He says, "Well, I'm going to give you all, all the same medicines and
this and that. You pick it up today." I says, "Doctor, I can't pick up the
medicine today because I still got all that medicine, I gotta finish that
first."
Mr. Gigante revealed impairments of memory (recalling only one out of three
objects in five minutes), orientation (knew only the year), fund of
information (impoverished) . . . He was unable to discuss meaningfully any
aspect of his case . . . This examination is consistent with other data and
with substantial incapacity to understand sentencing . . . In anything that
requires organized thought or thinking at any level of abstraction, his basic
deficit is revealed by his inability to really do that and, in fact, there is
no clinical evidence in the entire database that affirmatively indicates that
he can manipulate abstract information.
Dr. Gutheil
GIGANTE He says, "You know, your ejection — when we done the echocardiogram,
your ejection fraction is down to 35." Normal is 60.
OLYMPIA So?
GIGANTE So I says, "What do you want me to do?" He says, "Well, I'm just
telling you." I says, "Then I'm in trouble." "Oh no," he says, "don't worry,"
He says, `You'll be all right. You're doing fine." I says, "Thank you." I
says, "but the pains in the chest don't mean nothing, doc?" "All right, take
your Nitro." I says, "I do but it gives me headaches." He, he was nice. I
ain't saying he wasn't bad, but he does the best he could.
He manifests organic brain damage by his inability to, for example, subtract 7
from 100. His memory is impaired. He sometimes is very confused and doesn't
know where he is or the time of day, the year. His recall is very poor. If you
would give him two or three objects to recall, he would have difficulty doing
it immediately after you tell him and certainly after a period of three or
four minutes. Dr. D'Adamo
All the doctors who examined Mr. Gigante were asked if there was any chance he
was malingering. Most of them said no, noting that in addition to his
behavior, scans of his brain showed abnormalities in blood flow consistent
with vascular dementia.
Mr. Gigante's responses appeared to reflect cognitive processing difficulties
and were very atypical of malingering.
Richard Rogers, a malingering expert and professor of psychology at the
University of North Texas in Denton.
The reports of the psychiatric experts are broadly in agreement as to Mr.
Gigante's assessment as not competent or unfit to proceed with sentencing.
Note that these individuals are senior people in the profession of forensic
psychiatry and very familiar with the issue of real versus malingered mental
illness. All raised or addressed the question of malingering; all found the
evidence not supportive of that diagnosis. Beside dementia, additional
diagnoses offered included various forms of schizophrenia (Dr. Portnow notes
that 34 different doctors made this diagnosis over the years), personality
disorders and serious medical conditions . . . . Although he could have
certainly fooled me, and I will readily concede that possibility, and some of
the other doctors recently, the evidence in all of the database, the clinical
evidence in all of the database, comes down the other way. Dr. Gutheil
Many of the doctors were played brief excerpts from the tapes by the
prosecutors.
[Mr. Gigante] sounded like a guy talking to his family — the technical term in
forensic psychiatry is schmoozing,
Dr. Gutheil said that nothing he heard established that Mr. Gigante was
legally competent.
The guy on the tapes is not the one I examined. I hear the tapes and I hear a
quasi-normal person talking. The question is how do you explain it.
Dr. van Gorp said Mr. Gigante might be both mentally ill and a malingerer.
It should make all of us humble that we can indeed be had, because we don't
get inside somebody's brain.
Jonathan D. Brodie, a psychiatry professor at New York University School of
Medicine who testified for the prosecution in 1997, called on his colleagues
to admit that they had blown the call.
http://www.nytimes.com/2003/04/13/weekinreview/13WORD.html?pagewanted=print&position=top
Last Updated on
04/14/04
webmaster@namiscc.org
