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Psychiatric Treatment of the VIP: Some Paradoxical Risks

Silverman, Benjamin C. MD*†; Asby, Alice MD*†; Brendel, David H. MD; Choras, Peter MD*†; Chu, James A. MD*†; Holman, Julieta MD*†; Pope, Harrison G. Jr MD*†; Radden, Jennifer Dphil§; Samson, Jacqueline A. PhD*†; Smith, George W. LICSW*†; Tsimprea, Gail PhD*†; Bodkin, J. Alexander MD*†

The Journal of Nervous and Mental Disease: June 2012 - Volume 200 - Issue 6 - p 545–548
doi: 10.1097/NMD.0b013e318257c805
Brief Report

One might expect that VIPs—individuals with wealth, fame, or power—would typically receive excellent care when treated for psychiatric disorders. Often, this is the case, but paradoxically, VIP status may compromise the quality of psychiatric treatment. In this article, we present four case examples, representing disguised amalgamations of actual cases from our experience, demonstrating how VIP patients may sometimes receive suboptimal psychiatric care. These cases show certain similarities; typically, there was no serious doubt about the general nature of the treatment that should be undertaken, but the treatment team was unable to deliver that treatment in the usual manner because of various outside pressures created by the VIP status of the patient and by the patient’s entourage. One possible solution to this problem, when feasible, is to assign treatment to a team specifically experienced with VIP patients. A strong and united treatment team, accustomed to the unusual difficulties and pressures often encountered with VIP patients, can be prepared to act promptly, firmly, and unanimously to devise an appropriate treatment plan and then maintain this plan true to its course despite these pressures.

*Department of Psychiatry, Harvard Medical School, Boston, MA; †McLean Hospital, Belmont, MA; ‡Private Practice, Belmont, MA; and §Department of Philosophy, University of Massachusetts-Boston, Boston, MA.

Send reprint requests to Harrison G. Pope Jr, MD, McLean Hospital, 115 Mill St, Belmont, MA 02478. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.