A court-appointed psychiatrist believed that Dr. Susan Diamond was perpetrating a bizarre and controversial kind of deception called Munchausen Syndrome by Proxy.
A court-appointed psychiatrist believed that Dr. Susan Diamond was perpetrating a bizarre and controversial kind of deception called Munchausen Syndrome by Proxy.
Mark Graham

An Irritating Woman

Dr. Susan Diamond is delicate as a wren, with large dark eyes and hair swept back in a no-nonsense shoulder-length bob. She's an expert on treating HIV/AIDS, with a thriving practice near Presbyterian Hospital, and her patients describe her as warm and compassionate, a rare doctor who makes house calls and gives out her cell phone number. Colleagues say Diamond is extremely intelligent, a good physician who works hard to stay on the cutting edge of research and treatment of a difficult disease.

She's also a mother of five children. Friends within the Orthodox Jewish community of North Dallas see Diamond as devout, dedicated to raising her children in accordance with God's laws. She keeps a kosher house and doesn't drive on the Sabbath. She lives in the "eruv" area of North Dallas where many Orthodox Jews own homes within walking distance of their synagogues. From 18 minutes before sundown every Friday until sunset the next day, they don't work, drive or do household chores. Only within the eruv are they allowed to push baby strollers and carry prayer books on their way to services.

Most of those patients, friends and colleagues don't understand why, after a bitter divorce battle, Diamond not only lost custody of her children but for months saw them just a few hours in tightly controlled visits at a place designed to host meetings between kids and parents accused of domestic violence, child abuse or neglect. She was allowed to speak to them only about what they were doing at the moment--playing bingo or cards--not how they were doing in school or soccer or Cub Scouts or basketball.

Diamond's life was turned inside out in 1999 when her husband, Rick San Soucie, abruptly announced he wanted a divorce. When he walked out, Diamond, then 44, was five months pregnant with their fifth child.

Raising five children and managing a busy practice was hard enough, but bizarre behavior by her second child, Daniel, created much more stress. Always a difficult child, by age 8, Daniel was acting out in dangerous ways--grabbing knives and chasing family members, threatening to kill himself by jumping in front of a car or over a stair banister, and biting or choking his siblings and other children. (The names of the children have been changed.)

Diamond believed her son was bipolar. But a court-appointed psychiatrist examined Daniel and declared that the problem wasn't the boy; it was his mother.

The doctor believed that Diamond was perpetrating a rare and bizarre kind of deception called Munchausen Syndrome by Proxy (MSBP), in which an adult, almost always a mother, manufactures symptoms in a child in order to get attention or her own way. The psychiatrist concluded that Diamond was lying about what her son was doing and manipulating him to win the custody fight. Several nannies testified that Diamond was some kind of "Mommie Dearest."

A second psychiatrist, Dr. Mark Blotcky, initially rejected that judgment and diagnosed Daniel with bipolar disorder. But after months of wrangling with Diamond over medication and custody issues, Blotcky told a family court judge that Diamond was manifesting Munchausen Syndrome by Proxy and was indeed dangerous to her children's mental and physical health.

Then recently, an independent court-appointed forensic psychiatrist released a report saying that Blotcky's diagnosis was wrong, that Diamond is not perpetrating MSBP.

Her story illustrates the controversy over the MSBP diagnosis, usually seen in cases where a child has physical symptoms that disappear when the mother is removed. More physicians, confronted with problematic cases, are concluding that these women are fabricating or aggravating their children's disorders.

But critics contend that the warning signs of MSBP are so broad they are worthless, based on anecdotal descriptions of the disorder, not rigorous study. One expert in such factitious disorders says that women who are diagnosed with MSBP are often intractable or irritating people who don't fall in line with psychiatrists and other authority figures when it comes to the treatment of their children. "As a result, mothers who are inappropriately concerned about the health of their children or are problematic in other ways have become entangled in legal battles that should have been resolved clinically," says Dr. Loren Pankratz, a clinical professor in the Department of Psychiatry at Oregon Health Sciences University.

There's no doubt that Diamond--furious at her husband for leaving her, frightened by her son's dangerous behavior, frustrated by the family court system--can be a maddening, controlling person. She's made serious errors in judgment and behavior. Some Diamond admits; some she denies.

Once labeled, all of Diamond's actions were seen through the prism of MSBP. The court battle has cost Diamond and her former husband hundreds of thousands of dollars. But a close look at the case shows that in punishing Diamond, the court system also penalized her five children, sentencing them to awkward snatches of time with a mother they all profess to love. That's formative time they'll never get back. And there's plenty of blame to go around.

One judge called their divorce the most acrimonious she'd seen in 34 years on the bench. And as far as Diamond is concerned, it came out of the blue.

On February 9, 1999, Diamond, after attending an HIV/AIDS conference, was met at the airport by her husband, Rick San Soucie, who announced he wanted a divorce.

Diamond felt blind-sided. That night, after Diamond announced the news to their four children--then ages 2 through 10--San Soucie left the house and has rarely spoken to her since. (San Soucie and his attorney Robert Sullivan declined to speak to the Dallas Observer. Their point of view is represented through extensive court filings.)

They'd been together 16 years, married for nearly 10. San Soucie's unhappiness had been building for a while. In 1998, San Soucie had told his wife he and the kids needed more attention from her; though she made a few adjustments in her schedule, little changed.

San Soucie also was unhappy with his wife's desire to have a fifth baby. When Diamond learned she was pregnant in 1998, San Soucie was furious, feeling she'd tricked him by taking a fertility drug. Diamond admits she'd taken Clomid earlier in the year but says she'd stopped.

Despite the warning signs, Diamond says she was devastated when her husband walked out. Asked if she wished they were still married, Diamond, in a rare moment of unguarded emotion, seems unable to speak for several moments, as if fighting to maintain control. Her eyes flicker in pain, but she answers in an even tone, "yes."

Diamond tells her story in a lawyer's conference room. She dresses in simple knits, a thick gold chain around her neck and matching bracelet on one wrist. Though her explanations of events are sometimes convoluted, Diamond speaks of wrenching events in analytical terms, seldom showing emotion.

Diamond and San Soucie met in high school in New Jersey but went their separate ways in pursuit of Ivy League educations. Diamond attended the University of Pennsylvania undergraduate and medical schools; San Soucie went to Dartmouth, then Wharton business school to get an MBA. They reconnected periodically. Diamond moved to Dallas in 1980 to train at Southwestern Medical School; San Soucie followed her here in 1983.

The couple married in 1989, and their first child, Stephen, was born a year later. Stephen was followed by Daniel, Justin, Rebecca and Mark.

"They were the perfect intellectual couple," Candy Evans says. Her husband, Dr. Walter Evans, knew San Soucie from Dartmouth and delivered all five of their children. "He was devoted to her."

By the late '90s, the family seemed to be doing well. Diamond had sold her ownership in a home health-care business for $5 million and was working 45 to 50 hours a week in a small but demanding practice. San Soucie managed their finances. Though they had full-time help at home, San Soucie was a hands-on father, spending lots of time at Akiba Academy, where the children were enrolled as soon as they hit preschool.

San Soucie, who was raised Catholic, and Diamond, a conservative Jew, agreed to give their kids a Jewish education. Akiba devotes half the academic day to Orthodox Jewish religious studies beginning in first grade.

The Dallas Orthodox Jewish community consists of about 300 families. Most live in one of the two eruvs in North Dallas, and until Torah Day School opened two years ago, they sent their children to Akiba. As their kids grew and brought home questions, San Soucie made a huge effort to learn more about Judaism, even studying Hebrew and learning to conduct the Passover Seder.

After losing so many young patients to AIDS in the early '90s, Diamond found increasing solace in her faith and moved toward being an observant Jew, at first through simple things such as buying kosher food. San Soucie, who felt subtle discrimination against non-Jews at Akiba, was increasingly uneasy about her immersion into Orthodox Jewish culture. But he said nothing to his wife.

Their children were delightful and well-mannered. But both parents were worried about their second son, Daniel.

From the day he was born in 1991, Daniel had been a difficult child--irritable, hard to console, impulsive--but the real problems began when he started at Akiba, Diamond says. "We used to say to him in the morning before school: no hitting, no biting, no kicking, no fighting." At age 4, he punched another child and knocked out a tooth. Though usually affectionate, another Daniel would emerge to terrorize his siblings or choke a playmate. By first grade, Diamond suspected he was bipolar.

In 1998, Daniel began telling his parents and his nanny, "You don't love me; you hate me. I want to die; I'm going to kill myself." At one point, Daniel threatened to throw himself over the banister. Diamond, thinking he was just seeking attention, tried to ignore the behavior.

San Soucie suspected that his son was depressed. In December, without his wife's knowledge, San Soucie took Daniel to Dr. Judith Samson, a clinical psychologist. "He feels the upset talk and threats are a cry for Dr. Diamond's attention and that he himself [San Soucie] feels much the same way about her lack of time and attention," Samson wrote in her report.

Samson saw Daniel three times: Cute and very bright, the boy was a whirlwind of activity, clowning, interrupting and ignoring instructions. "He was strikingly oppositional and willful," Samson wrote.

Her diagnosis of Daniel was generalized anxiety disorder, "with a very high level of chronic anxiety and agitation, many fears of near-phobic proportion, intense insecurity and emotional neediness, and at times, bizarre phobic and morbid fantasy production...He displayed frightening thoughts with violent content of various kinds, including human violence and natural disasters, all ending in death.

"He was quite clear...that he threatens suicide and other self-destructive action when he is angry and frustrated about his wishes being thwarted...He indicated that his parents are easy to manipulate with this kind of intense emotionality...[Daniel] is a seriously emotionally disturbed boy whose cognitive and behavioral functioning are quite disrupted by his underlying emotional distress."

Samson recommended psychotherapy with a child psychiatrist who could prescribe medication. "Daniel's parents should engage...in counseling together to explore the conflicts between them and any other family dynamics contributing to Daniel's difficulties."

San Soucie received the report in January 1999--apparently around the same time he learned that a company to which he'd loaned $1.3 million was in trouble, something he hid from Diamond.

Unwilling to go into counseling with his wife, several weeks later he filed for divorce. And the battle royal began.

Three bizarre events would lead to Diamond's losing her children. The first occurred in the summer of 1999.

Diamond told friends her husband had to be mentally ill to leave her and the kids; if he would just get treatment, he'd come to his senses and return. Her initial disbelief turned to immense anger when San Soucie refused all contact with her, rarely picking up his children for visitation.

Baby Mark was born in June. San Soucie was not present at the delivery.

Dr. Donald Lammers was appointed by a family court judge to do a psychological evaluation of each member of the family. Dr. Glen Pearson was appointed to evaluate and treat Daniel. They were the first in a raft of therapists.

Daniel's behavior got worse after his father left. Caregivers later described how he grabbed his sister around the throat and tried to choke her. He threw his little brother Justin onto the floor and sat on his chest. He'd pretend to kiss the baby and would try to bite him.

He seemed obsessed with death and knives. Stephen would later tell a psychiatrist that his younger brother had grabbed a knife, put it to his neck and threatened to kill himself--in separate incidents at each parent's house.

One night, Daniel grabbed a kitchen knife and chased a baby sitter around, prompting Stephen to lock himself and the baby in a bathroom.

Samson's report, along with Daniel's bizarre behavior and manic episodes, convinced Diamond that her son was bipolar, or manic-depressive. Pearson began seeing Daniel on May 24. At that first meeting, Diamond informed Pearson that a colleague didn't consider him an expert on bipolar disorders in children. Things went downhill from there.

Pearson found Diamond's reports of Daniel's bizarre actions "incredible." A 7-year-old running around with knives? And her own behavior made Pearson suspicious. Heavily pregnant, Diamond lay down on the couch in his office while Pearson talked to Daniel. She insisted that her soon-to-be ex-husband was bipolar, too. When he suggested that San Soucie be involved in Daniel's treatment, Diamond questioned whether he was the right person to evaluate Daniel. And Daniel's interaction with his mother seemed lacking in warmth and emotion--and vice versa.

In Diamond's defense, she was physically and emotionally exhausted, about to give birth to her fifth child.

San Soucie brought Daniel to his next appointment with Pearson. The father "stringently denied that [Daniel] had displayed any behavioral symptoms of agitation, sleep disturbance, mania, irritability, that would suggest the boy were bipolar." Daniel seemed warmer, more interactive with San Soucie.

The parents' accounts were opposite, but Pearson thought San Soucie more believable. Daniel seemed convinced that he was bipolar and his father was, too, and that as soon as Dad admitted it, he'd come home.

Pearson's opinion of Diamond didn't improve over the remaining visits. For one thing, she repeatedly canceled appointments. And Diamond, overwhelmed by Daniel's behavior, had taken him to a colleague at the medical school who prescribed Depakote, a mood-stabilizing drug she was familiar with from her own practice. San Soucie disapproved, but Pearson agreed to continue the medication, even though he was irritated that she claimed "medical emergencies" and contacted other physicians to consult about Daniel.

When Diamond's "house manager" Michael Lamberti brought Daniel to several later appointments, Pearson began hearing of other unusual behavior. Lamberti contended that Diamond encouraged her son to act up more to convince everyone that he had a bipolar disorder. Diamond says Lamberti was lying and had a record as a felon, which she had not yet discovered. (The Observer confirmed that Lamberti did have a conviction for theft and is now in prison on a fraud charge.)

At their final interview, Pearson informed Diamond that while Daniel needed therapy, he wasn't bipolar and didn't need Depakote. The psychiatric problem, Pearson told Diamond, was hers, not Daniel's. "Susan's behavior reflects a serious emotional disturbance in which she is consciously or unconsciously using allegations of Daniel's having a psychiatric disorder for purposes of her own," he wrote in an affidavit. Pearson reported Diamond to Child Protective Services for inappropriately medicating her child, refusing to follow competent recommendations for medical treatment and encouraging Daniel to misrepresent both facts and his own behaviors. "It is my recommendation that the children be placed with their father on an emergency basis until these issues can be addressed."

In an emergency hearing in September 1999, Pearson testified that Diamond was a liar and manifested MSBP. Asked if it was possible his diagnosis of Daniel was wrong, Pearson replied: "Anything is possible, but I'd give that one 100 percent."

The specter of MSBP--in which mothers have been known to injure or kill their children--was too great to ignore. The judge ordered Diamond to have 24-hour supervision at home when the children were with her. That was in effect until April 2000, when an agreement on shared custody was signed.

Diamond had now been labeled. Her prickly personality and obstreperous attitude would do the rest.

A person with Munchausen Syndrome--named after Baron Karl von Munchhausen, an 18th-century teller of tall tales--fakes physical illness for psychological gratification.

Munchausen Syndrome by Proxy, first described in 1977 by British pediatrician Dr. Roy Meadow, is a form of child abuse applied to someone who simulates or triggers illness in a child to assume the sick role through a surrogate.

MSBP is included in the DSM-IV, the "bible" of the psychiatric profession, only in an appendix, because not enough empirical studies have been done to warrant inclusion as an official diagnosis. But it has received a lot of attention because of the shock value of "monster moms" willing to hurt their own children for sympathy.

In the American Journal of Forensic Psychology, Dr. Eric G. Mart describes the many problems with the MSBP diagnosis, especially the "vague, general, and possibly false profile data" relied on by doctors.

The typical perpetrator is described as a mother, often with medical or nursing experience, who describes symptoms that are extremely unusual. The victim is usually a young child. Chronic family dysfunction can be present. The mother grows defensive if the information she provides is questioned. If her belief about her child's disorder is not supported by one doctor, she will seek out another one.

More than 100 "red flags" of MSBP were identified by 1996, even though some of these warning signs are contradictory. Despite the imprecision, MSBP has gained wide acceptance. In England, Dr. Meadow testified in thousands of trials. Hundreds of children were removed from their parents, and 250 women were convicted of abusing or murdering their children. "He is so personally powerful, so sincere, so correct, he convinced judges," Oregon psychologist Pankratz says. "An inarticulate mother had no chance against him."

Meadow was discredited in the late 1990s after research showed his knowledge of genetic defects in children deficient and his methodology seriously flawed. Reviews were ordered of 5,000 cases in which he had testified. Next month, Meadow faces a hearing on charges of serious professional misconduct by the General Medical Council for his testimony against three women wrongly convicted.

But Meadow's discrediting hasn't slowed the MSBP diagnosis in America. Pankratz has evaluated 37 MSBP cases for U.S. courts, verifying the diagnosis in only two of the cases. The consequences of a false diagnosis are "devastating, especially as they unfold in courtrooms," Pankratz says. "The exotic label entangled them in a destructive web with no apparent escape. Some of these are simply conviction by profiling."

Dr. Mark Blotcky, appointed by the family court, became Daniel's treating psychiatrist in the fall of 1999. Described by colleagues as brilliant, acerbic and arrogant, Blotcky has been a mainstay of the Dallas psychiatric community since the 1980s heyday of Timberlawn Hospital, before managed care killed the long-term psychiatric inpatient business.

Daniel's condition had deteriorated. While walking from services one Sabbath with friends, he announced he wanted to kill himself and ran into Preston Road. A caregiver described how a "sudden rage" would come over Daniel and he would lash out, kicking, hitting and biting both children and adults. "It is as if he is in his own world when he does this because it is not a playful act, but malicious," the caregiver wrote.

In September, Blotcky saw a boy torn between two parents, angry at his father for leaving and parroting his mother's line that San Soucie was "sick" and didn't really want a divorce. He denied having suicidal thoughts. Asked about previous threats to kill himself, Daniel said "it was when Dad wasn't around."

"Seems coached," Blotcky wrote. "Demanding, bossy, poor S[elf] E[steem], almost a bitter tone to this boy."

After a handful of sessions, Blotcky diagnosed Daniel as suffering from a "mixed bipolar disorder" and prescribed Depakote, Prozac and Risperdal, an antipsychotic. He disagreed with Pearson's evaluation of Diamond for the time being.

Diamond was relieved that her son's disorder had finally been correctly identified. With medication, Daniel seemed calmer.

Handling such a disturbed child is difficult even in the best of circumstances. But the Diamond-San Soucie divorce had devolved into unrelenting animosity. Diamond and her estranged husband fought over everything, including who got to spend Jewish holidays with the children and when the Sabbath began. Diamond refused to drive on the Sabbath or on certain holidays and wanted the children to attend a Jewish school through 12th grade.

San Soucie felt she was retreating further into the world of Orthodox Judaism and taking the children with her. He wanted them to go to a less religious school.

Each was accused of withholding visitation and bad-mouthing the other parent. "My dad says that she does not care about us," one child told a therapist. After hearing Diamond repeatedly say negative things about San Soucie in front of the children, a friend pulled her aside and pointed out that her comments were inappropriate.

Diamond initially approved of Blotcky's treatment. San Soucie complained that "Susan was just getting her way again," but Blotcky got him to accept the diagnosis and Daniel's need for medication. Blotcky, however, couldn't persuade him to talk to his ex-wife. San Soucie insisted on communicating with her only by fax. "He isn't focused on Daniel but instead on mo[ther] & his anger and resentment of mo[ther]," Blotcky wrote.

Blotcky recommended that Diamond be the children's sole managing conservator with standard visitation by San Soucie. "She has been responsible in all our many contacts, though she was initially very overwrought by the loss of her marriage, the divorce, litigation, and ongoing fight for what she felt was appropriate medical care for [Daniel]...She has made considerable progress in decreasing her anxiety...

"It is critical that Rick San Soucie and Susan Diamond learn to communicate without hostile criticism, threats, and a complete deflection of the issues away from their children's needs."

But the two seemed locked in acrimony. Diamond was blasted for relatively minor infractions, like returning Stephen 30 minutes late from visitation. San Soucie got a pass for his, like the time he withheld the children from their mother on Mother's Day, took them to the movies and sat in a different theater to see a movie by himself.

And their anger was picked up by the children, especially Daniel and Stephen, who felt like "the messenger boy."

Even on medication, Daniel continued to act out. On September 30, Blotcky received a note from Gloria Mosley, one of Diamond's caregivers. "[Daniel]'s dangerous and threatening behavior--a knife on 9/29, forcing her to run into the bathroom & lock the door. Incident began w/ Daniel biting [Rebecca]. Also talked of killing himself."

By October, Daniel was calmer, less impulsive and less angry. But his disorder proved very difficult to treat. In the spring of 2000, Daniel's behavior was so disruptive he was in danger of being expelled from school.

"Even as this letter is being typed I am returning your phone call Susan about Akiba's recommendation that he needs hospitalization, so the seriousness of his illness is pressing us to gain control," Blotcky wrote to each parent. San Soucie was alarmed, believing Daniel didn't need to be hospitalized.

Their assets were divided, and the divorce was finalized on August 29, 2000. Their mediated agreement gave Diamond primary custody of the kids. Almost immediately, San Soucie filed a motion to challenge the custody arrangement.

On November 7, 2000, the second major incident occurred.

When Diamond's housekeeper Margarita Aljasar picked up the kids from school, Daniel kept chanting, "I have a special job to do today. I know what I have to do." When Aljasar asked what he meant, Daniel said, "Well, I can't tell you."

According to Aljasar's later testimony, when they got home, the rest of the kids got ready to go to their father's home for visitation. But Daniel went into the kitchen and got two big knives from a knife block in a cabinet. Holding one in each hand, Daniel began running around the house, ignoring Aljasar's demand that he put down the knives.

When Diamond arrived home, Aljasar said, Daniel raced to her. "Look, Mom, I got the two biggest knives. You told me I could use these." Eyes wide, Diamond said, "I never told you any such thing. Put those knives back."

"No, I'm going to kill my dad," Daniel yelled. "I want to kill my dad. I'm going to kill my dad. He destroyed our lives and he needs to go away."

Aljasar said that Diamond went after him, saying, "[Daniel], come here, come here." But the boy ran out the front door behind his siblings, who were walking out to meet San Soucie. A screaming, out-of-control Daniel charged out of his mother's house wielding a carving knife in each hand and began slashing at his father's car and nearby bushes. After a few scary minutes, San Soucie was able to get the knives away. Daniel returned to the house, grabbed another knife and again charged his dad. San Soucie again took the knife and left with the other kids, leaving Daniel, who'd finally calmed down, at home.

The housekeeper described Diamond as a good mother and said she'd never seen any problems with the other children. But Diamond did say negative things about San Soucie to the children, Aljasar said.

Most damaging, the housekeeper said that Diamond "pointed at" the cabinet that held the knife block when Daniel ran back in the house, as if encouraging him to attack his father. Diamond denied that, saying she ran into the back yard, "afraid for my life." She points out that soon after giving her testimony, Aljasar went to work for San Soucie.

The knife incident alarmed Blotcky, who was already annoyed by Diamond second-guessing him about the boy's medications, according to Blotcky's notes. Concerned about the side effects, Diamond pestered him about blood tests, about dosage, about Daniel's weight loss.

She didn't believe Daniel was being medicated properly at his father's house.

"I thought he required hospitalization," Diamond says. San Soucie opposed that. In self-defense, he began videotaping Daniel as he took his meds.

Feeling that the Depakote wasn't working, Diamond suggested they try lithium. When Blotcky didn't agree, the relationship between the mother and psychiatrist further deteriorated.

After a dispute over her refusal to pay his fees, Diamond filed a complaint against Blotcky with the Texas State Board of Medical Examiners, accusing him of fraudulent billing. (He used that as proof she was vengeful, but Humana Insurance later issued a statement that some of Blotcky's bills included "multiple dates of service directly rendered to [Daniel] that are not supported in the medical records as being rendered." The complaint against Blotcky was dismissed.)

Diamond says she just wanted the best treatment for her son. The physician in her collided with the mother, and she couldn't step back and trust Blotcky, whom she blamed for not persuading San Soucie to agree to joint counseling. She turned to Dr. James Bennett for a second opinion about Daniel's treatment.

In May 2001, Diamond wrote a prescription for lithium in Daniel's Hebrew name and began administering it to him. When the switch was discovered by San Soucie, Diamond faxed Blotcky a letter thanking him for letting her do a therapeutic trial of lithium. Blotcky was furious at the ploy. Though it wasn't illegal or unethical for her to prescribe a drug for her child, it usurped his role as treating physician. Diamond later admitted her action was deceptive.

Blotcky wrote a blistering letter to Diamond and San Soucie, accusing Diamond of "doctor shopping," deceit and manipulation resulting in Pearson's testifying she "was perpetrating a Munchausen-by-Proxy, and I understand why [Pearson] came to believe that." He predicted that if she didn't comply with visitation, she would end up in jail. To Diamond, Blotcky seemed like an advocate for her husband.

The lithium, which Diamond thought had helped, was discontinued. A judge ordered that Daniel could be treated only by Blotcky and his pediatrician. Diamond was ordered to submit to psychological testing. Her foot was on the slippery slope.

So she filed a motion to remove Blotcky as the treating physician, citing "inappropriate behavior as a psychiatrist" and that "Mark Blotcky, M.D. has ceased being an independent observer of the court process and has chosen sides, to the detriment of his ability to work with either party or child."

Blotcky fired back: "[Dr. Diamond] is pathologically driven by her needs to be in control, to express her rage, to get her dependency gratified and to be right in what she perceives to be a competitive disagreement." She speaks "in smoke and mirrors," was driven by her internal conflicts and "draws attention to herself--a Munchausen-by-proxy dynamic."

Blotcky described her as immersed in the supportive Orthodox Jewish community, "a very tight, exclusive, firmly boundaried group, which for many persons promotes healthy living and adaptation with a good deal of structure, support, a strong moral and religious foundation. However, Dr. Diamond uses it almost as if it were a cult."

He recommended that Daniel and his siblings live with San Soucie and that visitation with Diamond be limited and supervised in order to limit her "psychonoxious" influence on the children and her "demeaning and villainizing [of their] father."

The judge ordered the parents to attend joint counseling to work out ways to communicate. It ended miserably after six sessions. Sharp words were exchanged over money, and while Diamond was willing to continue, San Soucie wasn't. From now on, he insisted, all their communications would be via fax.

In April 2002, they went to trial. One therapist, Dr. Linda Threats, testified that Diamond had made a lot of progress in therapy dealing with her anger. She described a visit to Diamond's home to observe her with the children. She called it "full of energy" and "quite a lively home." The children were gracious and open. They played freely, laughed and smiled. "She's very attentive, very nurturing," Threats testified. "She listened to them. She played, she cuddled." When Daniel clamored for attention or acted up, she was able to set limits.

But most of the testimony by Blotcky and others was unrelentingly negative about Diamond. The judge ordered that San Soucie get custody of all the children. She was prohibited from making any medical decisions except in an emergency. Instead of receiving child support each month, she was now paying San Soucie child support.

That summer, Diamond filed a lawsuit against her ex-husband. She alleged that during divorce proceedings, San Soucie had not adequately disclosed a $1.24 million loan he'd made to a company called Crudgington Machine Tools while they were married and another loan after he filed for divorce. Temporary orders in the divorce case forbade either spouse from taking on assets or liabilities, except for personal expenses.

She also filed a legal malpractice lawsuit against her divorce lawyer at the time, Kevin Fuller, for failing to do sufficient discovery. Both cases were settled out of court. The lawsuits added to the perception that whenever Diamond didn't get her way, she either sued or filed a complaint. It didn't matter if her beefs were legitimate. Diamond had thoroughly alienated not only Blotcky but Pat Keane, the attorney ad litem for the children, who Diamond felt consistently sided with San Soucie. (Keane declined to comment on the case.)

The third bizarre event occurred on July 20, 2003.

On a weekend visit with Diamond, Daniel, now 11, got angry at his brother, went out to the patio and set some leaves on fire. That evening, Diamond took her son to Timberlawn, where he was diagnosed as suicidal and admitted for treatment.

At 2:45 a.m. on July 21, 2003, Diamond faxed San Soucie, saying that Daniel had been admitted to the hospital. San Soucie was furious--and suspicious when he learned what happened. Daniel had started the fire in the afternoon. Diamond had waited to drive him to the hospital until the end of the Sabbath that Saturday. Earlier that week, worried that Daniel's condition was deteriorating, Diamond had talked to a rabbi and a friend about accompanying her to the hospital if necessary. To San Soucie, that proved she planned it.

But psychiatrists at Timberlawn agreed that Daniel was depressed and psychotic. "I just want to hurt people...I think about cutting an X on my body and then sticking the knife in it or walking in front of a car," Daniel told Dr. Kishore Sunkara. He reported hearing voices saying "remember, time to kill" and "kill 'the loved ones.'"

Denying that his son had any of those symptoms, San Soucie, with Blotcky's help, tried to get Daniel out of the hospital. Blotcky had seen Daniel earlier in the week; the boy looked better than he'd seen him in years. He called the hospital and told a social worker that Daniel didn't need inpatient care and that "you better be nice to [Daniel's] father or he will sue you."

Sunkara refused to release the boy, saying he was still suicidal. After talking to Blotcky and both parents, Sunkara wrote: "All these 3 are so entangled in the legal battle over Daniel's custody and decision making issues they lost their objectivity. I am unable to treat Daniel the best possible way with medications due to these legal wranglings." Sunkara released Daniel on July 24 after determining he was no longer suicidal.

He would later testify that he "absolutely agreed" with Diamond's decision to take Daniel to Timberlawn. Blotcky alleged Diamond had brainwashed her son into believing he was suicidal. The judge ordered that Diamond could have only supervised visits with Daniel.

Several months after that crisis, Stephen wrote a letter to Judge Frances Harris, saying that he and his siblings wanted to live with their mother.

"She pays more attention to us and is almost always a better parent," Stephen wrote. He urged the judge not to listen to Pat Keane. "From my own personal experiences and from the way she has dealt with us, the children, I believe that she will misrepresent us as our attorney ad litem."

The parental conflict was taking a terrible toll on Stephen, now 14. He was becoming more angry and depressed. A month later, he left a note on his dad's desk saying, "I'm tired of waiting for Pat Keane to do the opposite of what I want," and disappeared for a few hours.

Stephen e-mailed Mayor Laura Miller's daughter, whom he knew at Akiba, asking for help. At Miller's suggestion, he wrote her a "gut-wrenching" letter saying he wanted to live with his mother. "His whole thing was nobody will listen to me," says Miller, who as a child experienced a terrible divorce. Miller met with Stephen. "He said, 'I've got an ad litem attorney who doesn't talk to me,'" Miller says. Feeling compelled to help, Miller called the judge and Keane to pose a hypothetical question regarding the situation.

"The ad litem said, 'I don't need to talk to the kids; I listen to the doctors,'" Miller says. "I asked, 'Is she burning him with cigarettes? Beating him? Starving him?' On what basis do you take a child from his mother? I think the family courts are messed up, and the last thing they think about is the welfare of the child."

Her "ex parte" communication created a ruckus, with the judge calling Miller's conduct "sinister" and "malicious."

Diamond was accused of manipulating Stephen into writing the letter and contacting Miller. Several of her e-mails to Stephen seemed to support that. Or maybe the kid was just fed up, torn between two people he loved.

In an emergency hearing, psychologist Malcolm Bonnheim, Stephen's therapist, proposed that Diamond's visitation with all her children be supervised, as Keane insisted, to "tease out" whether she was the cause of his recent outbursts and anger. Blotcky took the stand and diagnosed Diamond as MSBP; now that she had little access to Daniel, she had shifted the proxy role to Stephen. If not stopped, she'd continue on down the line with each child.

In December 2003, the judge added Stephen to the supervised-visitation order. A few months later, the judge extended that to all five children, though there was no evidence of Diamond causing any harm to the other three kids. She got to see them three times a month at Hannah's House. Finally, the judge appointed Dr. Jaye Crowder, a forensic psychiatrist, to evaluate Diamond's mental condition and report back to the court.

Diamond waited nine agonizing months for Crowder to finish his report, rarely seeing her children, rarely able even to talk to them on the phone. In June, Diamond learned she won her appeal of the ruling in 2002 that resulted in her losing custody. The case was remanded for a new trial. But that didn't mean she was any closer to getting her kids back. San Soucie filed a request for a rehearing. The court proceedings could go on forever.

At last, on November 1, 2004, after talking to all the parties and reading psychiatric reports and court records, Crowder issued a stinging report, criticizing Blotcky, Keane and the passel of lawyers.

His conclusion: Diamond was not perpetrating MSBP. And what was good for the children had gotten lost in the vitriol.

Crowder's report started with the kids. Stephen told Crowder that he would prefer to live with his mother and visit his father. "He added that his mother is a more patient parent than his father." Stephen denied that his mother pushed him to contact Mayor Miller but admitted she suggested he try again after his first attempt failed. "Dr. Diamond did advise [Stephen] he could sign an affidavit expressing his preference to live with her, but he stated he wanted to do so," Crowder wrote. "He retracted the affidavit under pressure from Mr. San Soucie and Ms. Keane."

Daniel denied that his mother encouraged him to attack his father with the knives. Crowder attributed Daniel's knife attack on his father not to Diamond but to "a command hallucination."

"Susan can be difficult," Crowder said in an interview, "but that doesn't mean she's a danger to her kids...She had the best intentions. She didn't foresee the consequences."

He suggested that "unconscious counter-transference" may have played a role in what happened to Diamond "because early on people got angry with her." (Counter-transference can happen when a therapist develops positive or negative feelings about a patient; the feelings are normal, but to act on them can, in extreme cases, be considered unethical.)

"It shows the need for diagnostic humility," Crowder said. "The risk of harm is so great with certain diagnoses," and MSBP is one of them. "It prejudices proceedings. It shifts the burden to the person to prove they are not."

For accusations with such serious consequences, Crowder said, extensive investigation should be done instead of the court relying on a court-appointed expert or even several experts.

Crowder pointed out that Daniel's illness was not fabricated. And finally, MSBP is rare, "while acting out based on personality disorder"--as he believed Diamond was doing--"is very common, especially in custody/visitation disputes."

His diagnosis: Diamond had a personality disorder, with some histrionic, narcissistic and obsessive-compulsive features. "She tends to see issues in intellectual terms to the relative exclusion of emotional considerations and has difficulty being flexible, especially concerning moral matters...The combination of these problems with her narcissistic egocentricity leads her to push her own agenda without giving adequate thought to how others will respond." San Soucie was not evaluated, however, so Crowder cautioned against drawing any conclusions about who was the better parent.

Crowder added that Diamond had significant strengths: intelligence, decisiveness, personal resolve, a willingness to sacrifice career for attention to her children and a desire for close involvement with them. "I cannot see that Dr. Diamond poses any undue risk to her children." In fact, taking her away from them could hurt the kids developmentally.

He recommended integrated psychotherapy with her and the children, a trial of unsupervised access and for everyone to stop running to the court to litigate relatively minor misbehaviors committed by Diamond.

"Finally, I am concerned that treatment for [Daniel] and relations between Dr. Blotcky, Ms. Keane, and Dr. Diamond have become so negatively polarized that allowing or denying Dr. Diamond access to them is the only intervention that can be employed to modify her behavior...it virtually guarantees perpetual litigation and does not help her change what she needs to. Worst, I have the clear impression that supervised visitation has led Stephen and Daniel to distrust Dr. Blotcky, Ms. Keane, and the legal system as a whole.

"I recommend that all parties reconcile to the extent necessary to work together again...I sense a great deal of anger at her from the professionals involved in this case...Some professionals may need to be replaced if this is not possible."

Last month, Diamond was in court and pissed off again. As the lawyers negotiated in the hall with Dr. Joseph Hernandez on a plan for unsupervised visitation, she demanded a hearing on the record. After the last five years of feeling ambushed by emergency hearings, Diamond wanted everything out in the open. And she wanted Hernandez's positive report submitted into the record.

"Let's go," she said loudly. "I want it on the witness stand."

Hernandez had been appointed to meet with Diamond and her five children to develop a stair-step plan for the future. Diamond had behaved well on three unsupervised home visitations, and the kids seemed overjoyed to spend time with their mother.

"Each of them was explicit in their preference for not only a continuation of the unsupervised visits but an increase in their frequency and duration," Hernandez wrote in his report. "Dr. Diamond's actions during these visits demonstrate an understanding of the need to focus on parenting her children and moving past interpersonal conflicts."

Hernandez took the stand and recommended that Diamond have two extra hours every other Sunday, giving her a total of eight hours, and two hours each Wednesday night. After two months, assuming therapy goes well, the visits will be stepped up.

When it was her turn, Pat Keane made a point of mentioning Diamond's outburst to the judge.

Afterward, Diamond expressed her disgust. "I wanted the hearing," she said, "so I'm impulsive. It's more name-calling.

"By the time I get more time with the children," she said, "I'll be 90."

And whatever the lawyers and dueling psychiatrists think of Dr. Susan Diamond, the kids just miss Mom.


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