In the ER psychiatric ward in San Francisco’s busiest hospital, murder threats aren’t quite as rare as you might think. Every day, mental health specialists make decisions to keep us safe from ourselves and others, but sometime the tables get turned ……Dr. Paul Linde, author of “Danger to Self: On the Front Line with an ER Psychiatrist,
Section 5150 is a section of the California Welfare and Institutions Code the (Lanterman–Petris–Short Act or “LPS”) which authorizes a qualified officer or clinician to involuntarily confine a person suspected to have a mental disorder that makes them a danger to themselves, a danger to others, and/or gravely disabled. A qualified officer, which includes any California peace officer, as well.
In informal usage, 5150 (pronounced “fifty-one-fifty”) can refer to the person being confined ,the declaration, or the act of committing someone. It is also used as police slang for individuals who are negligent.
Once a 5150 is established , the dr’s assess whether to make a Tarasoff warning, meaning a duty to warn others if the patient makes a threat towards someone. The Tarasoff warning is named after Tatiana Tarasoff.
The woman, Tarasoff, was an 18-year-old student at college in California. The daughter of Russian immigrants who moved first to Brazil and then the U.S., Tatiana had lived in the States since she was 14.
Her parents were protective, even forbidding her from wearing makeup, and she struggled against their rules, sometimes lying in order to do what she wanted, or waiting until she was out of the house to apply her mascara. But she was permitted to go to folk dances at the “I-House,” where she tutored Portuguese-speaking students in her free time, as long as her brother Alex drove her there and back.
By the time Titania Tarasoff lay bleeding to death on her family’s lawn, at least one person had been told repeatedly that she was in danger: her murderer’s therapist. And yet, neither the 20-year-old woman nor her family had been warned of the looming threat.
Today, if a therapist has reason to believe a patient intends to commit a crime that will harm another person, they have an obligation to report it to authorities and protect that person — it’s actually a crime not to.
That’s now a standard feature of psychiatric care, but it hasn’t always been. In fact, the “duty to warn” was the direct outcome of Tarasoff’s savage murder in Berkeley, California in 1968. The landmark decision by the California Supreme Court to allow therapists to disclose threats constituted a major change to the doctor-patient confidentiality agreement.
Tatiana Tarasoff is a prime example of a stalking victim who did not have the proper laws in place to protect her.
In 1968, Tatiana became friends with Prosenjit Poddar, a University of California-Berkeley student from India. They shared a dance and possibly a friendly kiss at a New Year’s Eve party, which gave Prosenjit the impression that Tatiana was attracted to him, but Tatiana soon clarified that she was not interested in a romantic relationship. Prosenjit could not handle the rejection and developed an unhealthy obsession with Tatiana.
From their first meeting, at a folk dance at Berkeley’s International House in the fall of 1968, to their last angry encounters in the fall of 1969, these two innocents play an increasingly dangerous cat-and-mouse game.
”Prosenjit, a brilliant but painfully shy mechanical engineering student, one of only a literally few Indian Untouchables to ever earn the right to study abroad, had “never so much as shared an intimate moment with a girl, let alone a romance,” He was born in India as a member of the Dalit, or “Untouchable” class, a group so low that they are considered beneath the four castes that make up the Hindu system. Poddar had fought incredible odds to leave home, let alone end up in a graduate program at Berkeley. But Poddar struggled with the incredible culture shock of landing in the Bay Area during the “Summer of Love”. Everywhere around him, young people were throwing off cultural expectations in favor of radical experimentation with music, fashion, sex, and drugs.
Poodar dealt with his shock of his new surroundings, by occasionally withdrawing into his room for days to work on his own projects, tuning out the chaos of student life outside his door. Prosenjit Poddar, a graduate student in naval architecture who lived at the I-house, worked as an inspector of marine structures, and built miniature model ships in his spare time. Poddar seemed to Tarasoff like a kind, intense, young man, but in fact he was unlike most every other UC Berkeley student.
It’s noted when he first sighted Tatiana’s “raven-haired, green-eyed lissomeness.” The first symptoms of his delusions surface immediately.
Though he’d been entranced by Tarasoff’s dancing the first time he laid eyes on her, Poddar didn’t work up the nerve to talk to her until a subsequent folk dance. Tarasoff, was curious about Poddar, though she was breezy and non-committal in her early dealings with Poddar. For his part , Poddar had written to his parents back in their Bengal village, telling them details about the Tarasoff family, and especially about the accordion-playing young Tatiana , who had “won a seat to the university.”Within weeks of meeting her.
“Quite naturally,” he wrote, “the family looks to me to express my intentions.” In truth, the Tarasoffs knew nothing of Poddar’s existence. Blind to everything but his own intoxication, Prosenjit began massaging his fantasies early.
But Tanya, who “felt an enormous vacancy at the center of her life that only the right man could fill,” did little to disabuse the Indian of his wild dreams. While “wishing he’d disappear off the face of the earth,” Tanya would feed Prosenjit’s obsession with occasional “wet kisses.” “There was something about taunting him that she seemed to enjoy,” A biographer writes writes, “She toyed with the meek and reclusive Prosenjit to the very end.”
The two began to see each other here and there, going out for pizza and to the movies. But Poddar, who came from a family where casual sex was unheard of and arranged marriage was the norm, had never dated or really interacted with women. In part because of his inexperience, and in part because of what would prove to be his profound mental instability, he misread almost all of the signs Tarasoff was sending.
Sadly, however, they soon would. As Tanya’s interest in Poddar waned, his affection for her only ramped up. He couldn’t believe that the girl who had once seemed to like him now wouldn’t commit to hanging out, and didn’t even really seem to look him in the eye. He continued to try to change her mind, showing up at her house, standing with her at her bus stop, and calling incessantly.
Tarasoff eventually began spending time with Poddar again, but by all accounts did not think of him as a boyfriend. Rather, she liked the attention he gave her. She was freaked out occasionally — as when he showed her a detailed journal in which he recorded details of their every interaction, with headings like “Taking My Girlfriend to The King of Hearts” —but she had little sense that he was truly dangerous.
The tragic irony was that he also knew what she was doing. Rather than fleeing, however, with the steel-trap logic of madness, Prosenjit built a sophisticated taping system in his dorm room. He decided to record their conversations in order to have “concrete and indisputable proof that she loved him.” Instead, as was Prosenjit’s fate, in the first conversation, Tanya tells him about “this guy I really cared about.”
But it was known to more than them. Tanya’s best friend, Cindy, warned her not to make light of the “marriage sari” Prosenjit had given her. (Instead, Tanya tells him she will burn it.)
And two months before she was killed, Prosenjit’s therapist at the University’s psychiatric clinic warned a colleague that Tanya “may be setting up her own execution.” (The psychiatrist tried, unsuccessfully, to commit him to a hospital and was put on probation for his efforts.)
In the summer of 1969, Tatiana left on a trip to Brazil. Desperate, he befriended Tarasoff’s brother, Alex, who became his roommate not knowing Poddar knew his sister because he had used a different name and he had never met Poddar up to then. Poddar felt toyed with by Tarasoff. In the subsequent months, he sank into a deep depression, often skipping work and school and rarely leaving his room.
Eventually, at the insistence of a friend, Poddar sought help at a campus mental health clinic, where he was treated by Dr. Larry Moore, then a rising star in psychiatry. Moore was instantly concerned by the way Poddar spoke about Tarasoff, and wondered a number of times whether he ought to breach doctor-patient confidentiality and tell someone about the increasingly deranged threats Poddar made in his office. He’d said he planned to buy a gun. He said he would like to murder Tanya. But Moore thought “the best predictor of future violence was a history of past violence,” and Poddar didn’t have one. So he simply asked Poddar for his word that he would cease all communication with the girl. Poddar agreed. Soon after, he stopped going to therapy.
Dr. Moore informed the campus police, but after police interviewed Prosenjit, they determined that he was not dangerous and decided to let him go. When Tatiana returned from Brazil, she was not informed about Prosenjit’s threats against her.
Twice, Poddar angrily told co-workers he would like to blow up Tarasoff’s home. According to some accounts. Poddar audio taped his conversations with Tarasoff, playing them back later for clues to her capriciousness.,
On October 27, Poddar showed up at Tarasoff’s house. When she asked him to leave, he said he needed to speak with her. She shrieked, and Poddar pulled out a gun, which he promptly unloaded into her torso. He walked back out onto the family’s front lawn. Tarasoff, screaming, lunged toward him. Poddar then pulled out a 13-inch butcher knife and stabbed her 8 times, to quiet her, as he would later tell police. He walked into the house, called the police, and said “I just stabbed my girlfriend.” When police arrived, he said calmly, “Handcuff me. I killed her.”
Tarasoff was pronounced dead on arrival at the hospital. Poddar was found guilty of second-degree murder and sentenced to five years. But following an appeal, a new judge agreed to release Poddar on the condition that he be deported to India. He returned to Calcutta, married, and had a child.
Tarasoff’s parents were still furious that university mental health professionals, especially Larry Moore, had known about Poddar’s plans and had told campus police but not the family, so they brought a wrongful death suit against the Regents of the University of California. The case ultimately went to the California Supreme Court, which ruled in 1976 that it is a therapist’s moral and professional obligation to report threats like Poddar’s in order to protect threatened individuals. Some members of the medical establishment argued that the decision would chip away at the entire practice of psychotherapy, of which confidentiality is thought to be the cornerstone.
But the majority decision was clear, and has saved lives in the 40 or so states in which it is codified in law or upheld through precedent. As Justice Matthew O. Tobriner wrote in the decision, “The protective privilege ends where the public peril begins.”
Most states have laws that either require or permit mental health professionals to disclose information about patients who may become violent. Those laws are receiving increased attention following recent mass shootings., Conn. A New York law enacted Jan. 15, 2013, moves that state’s law from a permissive to a mandatory duty for mental health professionals to report when they believe patients may pose a danger to themselves or others but protects therapists from both civil and criminal liability for failure to report if they act “in good faith.” New York’s new law also allows law enforcement to remove firearms owned by patients reported to be likely to be dangerous. (Note: Please see chart below for update.)
Under ethical standards tracing back to the Roman Hippocratic Oath, doctors and mental health professionals usually must maintain the confidentiality of information disclosed to them by patients in the course of the doctor-patient relationship. With some exceptions codified in state and federal law, health professionals can be legally liable for breaching confidentiality. This case triggered passage of “duty to warn” or “duty to protect” laws in almost every state as summarized in the map and, in more detail, in the url below.