Was It Illness Or Immorality?

From the time he admitted making a series of obscene phone calls last March to the home of a Virginia police officer and his wife, former American University president Richard Berendzen has been at the center of an intriguing psychiatric debate. Berendzen resigned his presidency and underwent intensive therapy at The Johns Hopkins Hospital, which helped him win a suspended sentence from the court. But some commentators felt he had been let off the moral hook too easily. Not least of the doubters was Susan Allen, the object of most of the bizarre phone calls. Appearing on ABC's "Nightline," she listened stonily as Berendzen and Dr. Paul McHugh, chief psychiatrist at Johns Hopkins Medical School, told how he recalled being sexually abused as a child--a memory "triggered" at the funeral of his father, who died in the very room where the abuse occurred. That, Allen snorted, was no excuse. Berendzen may well have been sick, but he should have controlled himself. "Each time they [obscene callers] make that choice, they know that what they're doing is wrong. They can choose to continue their illness, or they can choose to say, 'That's it, I stop and I'm going to get help'."

In her direct, unpsychiatric way, Allen put her finger on the nub of the argument. Essentially it is a question of responsibility: are individuals accountable for their actions at times when they are emotionally disturbed? Not long ago, Mayor Marion Barry had provoked sharp skepticsm among Washingtonians by claiming that when he denied his addiction to alcohol, it was "the disease talking." Many took a similarly dour view of Berendzen's apologia. Noting a rash of letters to The Washington Post urging compassion for Berendzen because of the pressures he had been under as a university president, Baltimore Evening Sun writer Jim Fain summarized: "Anyway, Freud made him do it." Indeed, despite expressions of sympathy, there has been an uncharitable undertone in much of the reaction to the Berendzen affair. Partly, that may be due to his reputation as a publicity seeker. But it may also stem from the popular tendency to view emotional disorders as failures of character rather than manifestations of mental illness, especially when they result in harm to others. Psychiatrists, says Hopkins's McHugh, are in constant collision with a society that believes people who can't deal with such problems as addiction or sexual compulsions suffer "a lack of moral fiber."

Psychiatry's official diagnostic manual inevitably has its own name for obscene phone calls: telephone scatologia. The scatologists, almost invariably men, are often in the grip of a compulsion. Some are exhibitionists, who use the calls as a safer verbal alternative to exposing themselves on a street corner--or having normal sex. Most obscene callers have trouble maintaining normal sexual relationships. The call is clearly an act of aggression. But what is being acted out, says Dr. Richard Carroll, director of the sex and marital therapy program at the University of Chicago medical school, "is the desire to have a sexual partner." A high percentage were sexually abused as children. By making the calls, in a sense they are trying to re-create the childhood situation, hoping somehow to repair it. (Freud called the phenomenon the "repetition compulsion.") McHugh insists Berendzen was doing that more than operating from "prurient interest."

Like most of his colleagues, Chicago's Carroll agrees that the behavior can burst without warning into an otherwise unexceptionable life. It often has a "dissociative" quality, he says, stemming from early sexual trauma. "They may be completely unaware of the trauma, and it's triggered at some point in their lives." In his "Nightline" appearance, Berendzen described having just such feelings of unreality when he completed conversations with Allen (who kept the talks going while her husband arranged phone taps), and then turned back to the business of being a university president. "They have split off this behavior so thoroughly, they don't apply the usual logic or reasoning," says Carroll. "That accounts for why someone who you think would be so smart would be so dumb as to risk it. I've seen it time and again-- high-level corporate execs go out to expose themselves in the company car. If they saw someone else doing it they would have righteous indignation and go over and collar the guy."

One frequent approach to treating obscene callers is a behavioral technique called "overt sensitization." The patient is pushed to imagine, over and over again, a scenario in which he is caught in the act of a call dragged offby police in full view of his neighbors and thrown into a dank jail cell. Then he is told to think about reading the account in the newspapers and facing his children. "It's a matter of supplying that missing piece of impulse control, which is being aware of all the consequences," Carroll says. But without long-term talk therapy aimed at underlying causes, "most of these behaviors return."

Good prognosis: For those who do get the right course of therapy, the prognosis is generally good--though hardly as rosy as the Hopkins report on Berendzen, which termed him "physically and psychologically sound" again after only three weeks of therapy. ("Find me that miracle worker," says one dubious psychiatrist.) The court did order him to continue as an outpatient, and report regularly on his progress for a year. For most obscene callers, until the compulsion diminishes, the real issue may be the one Susan Allen poses: whether or not they can make the right behavioral choice. That is no simple matter, especially in the trancelike condition under which the calls are often made. But to say so is not to let anyone off the hook, psychiatrists insist. Rather, says Washington-based psychoanalyst Stephen M. Sonnenberg, "It's a matter of pointing to the complexity of the human condition."