Ten years of trial, and Greenspan walks

I just finished reading Natalie Robins’ book on the Libby Zion malpractice “case” and lengthy trials that went on and on for the next ten years after her death.

I can tell you that there was one key element of the whole ordeal that was entirely missed. This was mentioned in Chapter One of the book and then, forgotten. Interestingly, the doctors at New York Hospital attempted to bring up the question multiple times but from what I can tell, no one could answer this question. Later in the book, and even in the trial, it appears that during a rather poignant moment, no one could answer the following question:

What was Libby Zion being treated for? Or was she being treated for anything at all?

This question was unanswered. Because there was no answer.

I can tell you why. Dr. Kenneth Greenspan (I hope I have his name right this time) committed perjury in the very beginning of the trial, which is why there was so much inconsistency in this case. I can tell you that the hands of New York Hospital were tied. Were the doctors at New York Hospital as negligent as Sidney Zion claimed? I don’t think so, and the court ultimately didn’t think so, either.

I think the doctors at New York Hospital should have apologized to the Zion family. They didn’t, apparently. We also know Sidney Zion was not exactly approachable after his daughter’s death. How can anyone expect to act in a reasonable manner after being told your 18 year old kid just died? People act in all kinds of ways, usually completely irrational and out of their minds, often for a long time. They usually cannot be expected to be reasoned with, either. So all that ended up in a very bad tangled mess.

What about Greenspan? Looks like he weaseled his way out nicely. He was interviewed in the court deposition briefly and that was all. In this interview, apparently, he lied. He claimed that he had diagnosed Libby with “atypical depression.” Okay…..

And he claimed he had TESTED HER FOR A CHEMICAL IMBALANCE.

Now this he stated in court. He also told this, in an interview to Natalie Robins, according to the Appendix of her book. I am wondering if he produced this “test” in court. I am asking this because

There is no test.

Period. There’s no test. What on earth did he test? Did he claim that he took out part of her BRAIN and test it? Or did a spinal tap?

Perhaps Greenspan did the ole inkblot test. This test, by law, has to be done by psychologists, not psychiatrists, and it does NOT indicate CHEMICAL imbalances of any sort. Perhaps he handed her a questionnaire. This, too, has no relevance to CHEMICALS in the body. He may have ordered a blood test. If so, did he submit the blood test to the court, and what were the results? At the time, and even now, there’s NO BLOOD TEST for depression, not atypical not typical not any type of depression. There’s no brain test, no test of body fluids whatsoever.

What year did all this take place? Greenspan saw Libby Zion in 1984, perhaps the end of 1983 to start. Actually, Greenspan did the following: He started her on biofeedback. He didn’t even do regular therapy, apparently. She had seen a school counselor once or twice but not in any official way. We know this since she had been pretty much absentee at college (due to her “dating” situation, there were many such students….). So Greenspan was her first official mental health “treatment.”

Back in 1984, “medication” ‘was never the first course of action. Almost never. It was never used if the patient was working at a job and functioning okay. Back then, psychiatry was not practiced the way it is now. Times were different. By all means, a teenager would have a hard time getting antidepressants from most doctors. These were given to extreme hard-core cases, people who literally could not get out of bed, who had tried all other means.

In general, psychiatrists didn’t give out these pills to people who saw them in outpatient treatment settings, not if these patients otherwise functioned and had jobs or went to school. I’m not saying there weren’t exceptions. But this was 1984, not 2010. By 2010, times had changed, and these drugs were given out like coupons at the grocery store.

Also, back in 1984, a patient and her therapist (and even psychiatrist, who did therapy) generally developed a close relationship. You got to know your psychiatrist. By all means, NO psychiatrist would prescribe pills without getting to know the patient first. Back then, psychiatrists met with patients for a full hour at least. NOT for the ten-minute “med check.” These did not exist back then. Plus it looks like Greenspan was kooky enough to keep Libby overtime.

Many of the doctors involved with the case, and those consulted around the lawsuit questioned why on earth Greenspan, of all people, never knew that Libby was a recreational drug user, most likely a fairly heavy cocaine user.

It does make sense that her parents wouldn’t know. What kid tells her parents? Come on, folks……. Look back on your own childhood. Back then, what did we tell our parents? Some kids are more private than others. This doesn’t mean a pathological family relationship. It might mean kids need independence to grow and learn on their own. And kids need the freedom to make mistakes. They usually do learn, even if it ends up being the hard way.

When we college students saw therapists, we developed close relationships with them. Many of the doctors were quite surprised that Greenspan, Libby’s therapist and psychiatrist, was totally clueless about Libby’s drug use. Not only that, but get this: He diagnosed her with “ATYPICAL DEPRESSION” based on a BOGUS TEST and then, testified UNDER OATH that he had administered this test! This is PERJURY. It was never caught, apparently. Why? Because Greenspan wasn’t being sued. He wasn’t one of the inpatient hospital doctors, one of the ones on call the night Libby died.

Greenspan walked. The others were blamed. Greenspan quickly invented a lie, lied to the courts, and got off. Then, they argued it out for the next ten years, and turned cocaine into the main issue.

It wasn’t.

Where is Greenspan now?

Listen: In any responsible medical practice, NARDIL should not have been prescribed to an 18-year-old college student. Libby was working at the time. She was not lying in bed all day. She was not inpatient on the psych unit. She was not crying all day or unable to move her body due to depression. There was NO BLOOD TEST, not then, not now, indicating “atypical depression.”

What is NARDIL? Nardil is an unusual antidepressant. Even back then, it was rarely given. It was not supposed to be given unless others had been given a fair trial, and had failed. That is, as follows:

Greenspan never even did regular therapy with Libby. He only did this dubious biofeedback! Biofeedback has never been proven to be effective, though for a while they hoped it might work (it doesn’t). He tried it a few weeks, then, he threw his hands in the air.

Apparently Greenspan never even asked her about recreational drug use, although it seems he suspected it. He was never direct with her about it. You’d think a psychiatrist would have the skills and training to ask such a question directly and openly.

In my heart I am guessing this is the one thing Libby wanted, a direct and honest conversation. But from what Natalie Robins writes in her book, Greenspan never asked Libby this one very important question. They never had that conversation.

Isn’t it funny how we humans manage to avoid such topics?

Now, after a few weeks of failed biofeedback, or with mixed results, and much conversation about “atypical depression,” which is bogus, as there was never any test, and no chemical imbalance, he then tried Nardil.

“Atypical” suited her fine, didn’t it? I think it suited everyone involved just fine. It excused away everything, and sustained the status quo.

It keeps you crazy, excuses your genius behavior while you go to college to learn more of it.

Nardil shouldn’t be given unless other antidepressants have been tried, and have been ineffective. In conventional psychiatry of the day, they usually tried Imipramine and the like, and gave these at least six weeks each, if not several months.  All this would have taken a lengthy period that Greenspan didn’t even have.

Greenspan wanted to do a rush job, clearly. After all, he only had a couple of months with Libby. She was returning to school March 5. He put her on Nardil. This was so irresponsible of him. An 18-year-old shouldn’t be put on that drug.

The reason is as follows. Back then, and any time, someone 18 years old isn’t responsible enough. The risks are high. Apparently he had “educated” her in what foods she had to avoid. There was a list. There were also lots of medications, including a list of antihistimines. Red wine, cheddar cheese, and many fermented foods had to be avoided.

This is just my opinion, but wouldn’t a responsible MD request that anyone that young or less responsible patient or if there’s any question about the level of responsibility or ability to inform emergency personnel wear a Medic Alert bracelet? I know a college student might not be willing to do so, but if she’s not, then the prescriber could have withheld the prescription. I mean, c’mon……

A Medic Alert bracelet would have saved Libby’s life. Or could have.

Libby was not responsible for informing the New York Hospital doctors that she was on Nardil. She had a fever to the extent that she was “out of it.” I believe Greenspan made a terrible mistake here prescribing it in the first place. Well before she ended up in the ER on March 4, 1984.

But Greenspan walked.

Let’s imagine a very private moment here, a moment no one ever saw, a moment Greenspan doesn’t want us to know about. Why? Because two people are alone in a room here. One is dead now.

Let’s all imagine we’re a college girl, and I know that’s hard for some of you, but that’s not so hard for me. I went to Bennington, too. So I know what it was like there.

Atypical would have suited me fine. In fact, if I, as a young Bennington student were offered a choice of diagnoses, all pretty ones in a basket, and among them was “Atypical,” for sure, I would have chosen that one.

So that’s what Libby did. I know, she sounded like that kind of kid. Creative and artsy. So Atypical it was.

How are diagnoses REALLY given? Are they really given by a blood test? Now let’s get to the nitty gritty truth of the matter. Did Greenspan really give Libby a test?

I can assure you he lied under oath.

She liked Atypical. I would, too. I’ll bet she milked it for all it was worth. If you show the same patient to ten psychiatrists, you will get ten diagnoses. This is because there’s no test, nor any science behind diagnosis. So she was called atypical, and given that atypical drug. That drug ultimately killed her.

Greenspan lied about the why she ended up with the diagnosis, and why she was so hastily given this hard-core antidepressant. Over the years, times changed, and drugs became more commonly given. So the everyday person didn’t realize that Nardil was so rarely a first choice of action that Greenspan was in fact far more responsible for Libby’s death than anyone realized. It looks like his little lie never got caught. Where is Greenspan now? Dang, I hope he isn’t practicing biofeedback anymore, or practicing any more irresponsible medicine! I am saddened that this lawsuit could have been directed at him, and the Zions could have won a few more bucks.

Tired hospital doctors? This doesn’t have much to do with that. What was Libby supposed to do? It was a toss-up that night. Tell them, or not tell them? I think Libby was very, very tired herself.

Feedback and comments welcome!