The uproar over Phillip McGraw's intrusive interaction with Britney Spears raises a number of interesting issues about clinical psychology and the privacy rights of hospital patients.
As most of you know by now, McGraw barged into Spears' hospital room January 5, apparently without an invitation from the beleaguered pop star. After soliciting her appearance on his TV advice show, he issued a public statement about her condition.
In the wake of this incident, some have accused McGraw of violating doctor-patient confidentiality. But McGraw is not a doctor, nor was Spears his patient.
Much of the public confusion on this point is due to the TV personality's use of the title "Doctor." Like Laura Schlessinger, the conservative radio pundit with a Ph.D. in physiology who calls herself "Dr. Laura," anyone with a doctoral degree is technically a doctor (of philosophy). But to engage in therapy as a clinical psychologist, a person must also be licensed in the appropriate state. While McGraw holds a doctoral degree in psychology, he is not licensed as a psychologist or a mental health practitioner in any state.
Once upon a time, McGraw really was licensed as a clinical psychologist. In 1989, the Texas board that licenses psychologists disciplined him for an inappropriate "dual relationship" with a 19-year-old patient. (McGraw denies the young woman's claim that the relationship was sexual.) The Texas Board of Examiners of Psychologists ordered him to take an ethics class and have his practice supervised for a year. He subsequently stopped practicing therapy and started a jury consultation firm, Courtroom Sciences Inc. (CSI). It was in this capacity that he met Oprah Winfrey, then fighting a lawsuit by the beef industry, who boosted him into the world of show biz.
His haranguing style of voyeuristic quasi-therapy has proved enormously popular. Last year, he netted 6.7 million viewers and earned a whopping $45 million.
What’s the attraction? Some scholars have compared it to a religious conversion narrative, involving a confession, a testimonial, a moral authority (Dr. Phil), and an instant cure.
"It's the quintessential cultural product," said media consultant Ellen McGrath, also a psychologist. "Get some quick advice and change your life. You, too, can hit the psychological jackpot…. It's a spectator sport to watch someone be humiliated. It's the psychological version of Who Wants to Be a Millionaire."
Bottom line: Since McGraw (much like Britney Spears) is a celebrity icon rather than a licensed professional, he is not governed by any code of medical ethics or by the state and federal rules and regulations that apply to licensed clinical psychologists.
What about the hospital? Some have suggested that Cedars-Sinai Medical Center may have violated Spears' privacy rights when they allowed McGraw into her hospital room with her permission. But even that claim is somewhat tenuous, since her parents invited him into the hospital.
Ironically, amidst all of the fury over whether McGraw or the hospital violated any legal or ethical rules, other professionals who are exploiting Britney Spears' problems have escaped reproach. For example, three clinical psychologists and psychiatrists are quoted in an online gossip magazine as publicly diagnosing Spears with everything from mania to borderline personality disorder to a "genetic predisposition" to depression.
The Ethics Code of the American Psychological Association has several sections addressing drive-by assessments conducted without benefit of personal evaluation.
Ethical Standard 9.01 states that, in general, psychologists should only provide opinions about someone's psychological characteristics after having conducted an examination adequate to support their statements or conclusions. More broadly, Principle E, "Respect for People's Rights and Dignity," states that psychologists respect "the rights of individuals to privacy, confidentiality, and self-determination."
These self-same spokespersons for psychology and psychiatry call themselves by their first names, a la "Dr. Phil," and one is even premiering his own online TV show tonight - a live celebrity rehab show.
Between "Doctor" Phillip McGraw and the rest of these spokespeople, it's no wonder some members of the the public are confused, not to mention a bit leery of the mental health profession.
For more information:
"Do the rules apply to Dr. Phil?" New York Times, Jan. 10, 2008
"Analyze This," Dallas Observer, April 13, 2000 (background on McGraw’s career; information on legal cases involving Dr. Phil can be found here and here).
"Patient in the spotlight," Newsweek, Jan. 8, 2008
"Spears clan calls foul on Dr. Phil's blabbermouth," E! Online, Jan. 9, 2008
Photo credit r5d4 (Creative Commons license)