|INSPIRATION FROM HISTORY
|Year : 2016 | Volume
| Issue : 2 | Page : 138-140
The story of Prosenjit Poddar
Tamonud Modak, Siddharth Sarkar, Rajesh Sagar
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||4-Nov-2016|
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
The concept of "Tarasoff duty" is familiar to mental health professionals. Entwined with the name of Tarasoff, is that of Prosenjit Poddar, the other important character in the story which led to the courts giving directions for mental health professionals with regard to their duty of warn. Prosenjit Poddar killed Tatiana Tarasoff when his advances toward her were rebuffed. However, the court ruled that the mental health professional who was treating Poddar and was in knowledge of his intentions to harm Tarasoff, did not take adequate measures to warn the potential victim. This led to courts laying statutes for warning the potential victims by mental health professionals when their clients disclose such threats. However, the ruling has been a matter of debate about when to take any threat seriously and how to tread cautiously given the therapist-client privilege. The case of Prosenjit Poddar throws light on complex issues related to balancing confidentiality and potential harm to others.
Keywords: Confidentiality, duty to warn, Poddar, Tarasoff
|How to cite this article:|
Modak T, Sarkar S, Sagar R. The story of Prosenjit Poddar. J Mental Health Hum Behav 2016;21:138-40
The concept of "Tarasoff duty" is familiar to mental health professionals.  Entwined with the name of Tarasoff, is that of Prosenjit Poddar, the other important character in the story which led to the courts giving directions for mental health professionals with regard to their duty of warn. A native of Bengal, India, Poddar entered the University of California, Berkeley, as a graduate student in 1967. In the United States, he met and became romantically attached to Tatiana Tarasoff who, however, did not reciprocate his feelings. Poddar did not take the rebuff lightly and plotted to kill her, feelings that he confided to his treating psychologist Dr. Lawrence Moore. Dr. Moore informed the police who interviewed him and found him rational. Subsequently, Prosenjit acted on his threat and killed Tatiana in October 1969. He was subsequently convicted of the second-degree murder, but it was appealed, and the conviction overturned on the ground that the jury was inadequately instructed. Prosenjit Poddar was released on the condition that he would return to India.
Tarasoff's parents subsequently sued the campus police and the Regents of the University of California for failing to warn their daughter. In its first judgment (known popularly as Tarasoff I), the California Supreme Court stated that therapists have a duty to warn people who are in foreseeable danger from their patients.  This first ruling enunciated "The duty to warn" also known as the "Tarasoff duty." The court later explained the first ruling in a rehearing of the case. In this ruling (often referred to as Tarasoff II), the court stated that the therapist has a duty to "use reasonable care to protect the intended victim against such danger." 
The Tarasoff ruling has been a controversial and divisive one. The media frenzy over mass shootings by supposedly "mentally unstable" persons have brought into spotlight the role mental health professionals might play in preventing such atrocities. However, the Tarasoff rulings posed a number of difficult questions and continue to remain controversial even today. At the same time, it has profoundly affected the practice of psychiatry and psychotherapy in the United States. It has been argued as "bad law, bad social science, and bad social policy."  The APA's Council on Psychiatry drafted a model duty-to-protect statute which of the Tarasoff ruling.  In a sample of nearly 3000 randomly selected psychiatrists, psychologists, and social workers found clinicians who were aware of the Tarasoff case and acted according to the judgment. At the same time, nearly four-fifths expressed the belief that a personal or professional ethical duty to protect existed before the Tarasoff decision. 
In the aftermath of the Tarasoff decision, a number of US states promulgated laws mandating a duty to warn. Subsequently, multiple rulings have interpreted the boundaries of the therapists "duty to warn." There has however been a lack of consistency across the judgments, and most cases have been decided on their individual merits rather than a broad policy framework. 
Closer home, in India, there has been no legal statute or precedent which guides a practitioner of his duties when encountered with a Tarasoff-like situation. The laws limit a medical practitioner from committing a criminal act. On the question of civil negligence, there has been no precedence. Indeed, patient-therapist confidentiality is less of an issue with most Indian patients, and violent homicides are considerably less common. Yet in the rarest of rare cases, a practitioner might be confronted with a similar situation.
It has been argued that the Tarasoff rulings were a step backward in the evolution of the therapist-patient privilege. Anyone can divulge violent thoughts to acquaintances who are not duty bound to preserve confidentiality. Yet it is only in a relationship that implies trust, confidentiality, and full disclosure (i.e., a therapist-client one), the rulings mandate a breach of confidentiality. As a result, patients might not be as fully forthcoming, may not engage, and possibly drift away from the treatment if informed that their secrets might be divulged to law enforcement agency without their will.
The other major flaw with the judgments has been imposing upon the clinician to judge for himself/herself the severity, and the magnitude of threat implied by the patient's words. Does the client intend to carry out his/her threats of violence? The therapist has to judge what might take place in the future and while that it be predicted with a certain amount of accuracy, and it is quite impossible to be correct always.
The next problem is when therapists over-predict or under-predict violence what would be the implications? A few suits have been brought against clinicians by patients who believed that their confidentiality should not have been breached. A judgment passed against a psychiatrist for breach of confidentiality was a 1981 Pennsylvania case of Hopewell v. Adebimpe. Here, the psychiatrist had informed the patient's employer (who was not the intended victim) without discussion with the patient. The court judged the psychiatrist had not made a proper assessment of the risk posed by the patient, and it constituted breach of privilege. 
Another persisting problem therapists have to grapple with is "identifiability." If a patient express violent urges without directing it at anyone in particular who does the therapist warn? Is warning an authority constitute a breach of privilege or failure to warn a dereliction of duty? In the case of Thompson v. County of Alameda, the court refused to rule against the therapist and stated that the victim must be describable rather than member of a "large, indeterminate group." 
When to announce to the client the existence of the ruling constitutes another matter of debate. Most practitioners tend to accept the client and announce their terms only when the client announces some violent thought toward others. This issue has never been settled and remains a bone of contention and is best left to individual practices. It has been further argued that communicating candidly with the patient about the need for and purpose of the duty to warn might actually strengthen the sense of trust between the psychotherapist and patient. 
The Tarasoff rulings have had far reaching effects even beyond the realm of psychotherapy. The HIV epidemic generated controversy in determining whether a physician has the duty to warn the third party who may be exposed via the physician's infected patient. There have been no rulings on the subject. However, the APA has taken the position that notifying a potential victim and/or the public health authority is ethically permissible if it places others at risk.  The American Medical Association states, in the absence of contrary regulations, clinicians must notify potential victims. 
While the Tarasoff rulings were handed out with the best of intentions and with the aim of protecting the life of potential innocent victims, it remains a matter of debate as to how successful they have been in their original intent. Whether codified in a statute of law or not, it has always been an unwritten rule of ethics to save a potential victim. Although the Tarasoff rulings made it compulsory on the part of the therapist to act, it is quite possible that the judgments have turned away many a needing client from an effective catharsis of his troubles.
In India, there have been no legal statute guiding clinicians what to do in a similar situation. The various judgments in the United States serve to educate us that to protect himself and his client from unnecessary legal hassles; the physician must do his utmost for both the protection of both the client and the society. This guiding principle will serve well in most situations. However, a policy framework on the topic is desirable.
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Conflicts of interest
There are no conflicts of interest.
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