This controversial psychiatrist in Sussex County
not only did a profoundly offensive disservice to me 30 years ago, but has been
the most-complained-about p-doc in the county, with aggrieved patients cutting
across varying lines of age, profession, and level of sophistication
About 13 or so other people, patients or advocates, with negative views of Nielsen will be noted below (identified or not as is suitable)
Subsections below:
[introduction]
A quick history of
his involvement with the Newton
hospital, during my high school years
If Dr. Nielsen
arrived at the CMH in 1980, this was amid my college period, when I was away
from the county
A CMH social worker’s
verbal inroads and presumption were inflammatory, to say the least; Dr. N
stonewalled a complaint
In the 1990s, I only
dealt with Nielsen in a sort of default way of having him be a normal-consultation
doc
Dr. N’s shortcomings
would prove prodigiously numerous, and often sensational, among other patients
Other measures
My becoming a
“critical-of-practiced-psychiatry” activist
[Edits 8/23/17. Edit 8/29/17. Edit 8/31/17. Edit 10/13/17.
Editorial note 1/26/18: About two weeks ago, someone I'll refer to as Barbara L. e-mailed me and said Dr. Nielsen had gotten established as a doctor in the county in 1976, in Sparta Township. If this is so, it makes sense, because it helps explain how "Joan," whom I mention well below, could have seen him about 1980 and been egregiously snubbed by him--she must have seen him at his private practice. And I have no memory of him being at the version of the Center for Mental Health that existed from 1977 to 1979 (even though a Dr. Ira Kramer, a talking therapist I last saw in 1979, said on the phone from his New York location in 1987 that he had some memory of him); the only p-doc I knew from the CMH in 1977-79 was a consulting doc from Mendham. So it's quite plausible Dr. Nielsen was a private practitioner in Sparta from 1976 until whenever, and only started helming the CMH in about the early-to-mid 1980s.
Edit 1/23/19: Here is a scan of an April 1989 letter from Rev. Ernest Kosa, and a later June 1989 letter from me to him, showing our dealing with improprieties at the CMH in 1987, which I started addressing with Rev. Kosa in 1989. My obituary on Rev. Kosa, at a later date on this blog has a link to a 1987 letter from Rev. Kosa.
Edits 4/22/19.]
I do not salivate at the prospect of writing about Dr.
Nielsen, as if I can “take revenge,” as that would be too cheap to do, and
anyway my obituaries are meant to be balanced, at least to some degree. I also
wrote an obit on Dr. Ivan Goldberg in 2013, when he died that November. I wrote
it as soon as I found out the news of his death, and I left the obit
essentially as I wrote it off the cuff, as I felt was the best way. I
especially have left the obit standing—and it is among my most linked-to blog
entries—because, strangely, The New York
Times or its ilk never did an obituary on him. Why, I don’t know,
especially as he was a long-time fixture among Manhattan practicing
psychiatrists, as well as an author.
I also felt I personally owed Dr. Goldberg the
memorialization, since he had accepted the minor “burden” of driving to Sussex
County no fewer than three times to give lectures I was arranging in those
days. And at least one of the times, he drove himself (in his car that had the customized
license plate with the inscription “SSRI”; he was in his seventies when he
drove, and worked in Manhattan and had a home in Westchester or Rockland County,
N.Y., I believe).
Dr. Nielsen is a far more ambiguous prospect (for a standard, positive representation, see an online
memorial site on him
here). I didn’t want to
post a dark obit that held forth while his family was dealing with his
immediate memorial services, etc., and I felt that for my own news purposes I need not post this immediately.
Reasons for delay aren’t hard to come by; when a woman died in the county
several months ago (last winter) who had been a several-year exponent of the
local NAMI group, I considered writing a blog entry on her, and ended up
declining. I had moderately strong feelings about her, as there were
ambiguities about her to address, but they can be kept in reserve. Dr. Nielsen
is a far different matter, due to his standing in
Sussex County
going back to about 1980, and due to his profoundly negative effect on me in
1987 and after.
Incidentally, a line in his obituary in The New Jersey Herald (August 11, p. A9) is, I feel, tendentious at
best, and can be put into some question by even just half of what I have to say
in this blog obit: “Nicolai was recruited to develop the Newton Memorial
Hospital[’s] Center for Mental Health, which became a nationally acclaimed mental
health center due to its quality care.”
While his family, as is their right, can represent that he
had a role in setting up a mental health center in the county, I feel it must
be said that (from anecdotal information I developed a rich trove of when with
support groups here 10-15 years ago) he was, hands down, the most complained
about (informally) psychiatrist in Sussex County in the past 37 years. His main
faults, to the extent they can be safely generalized from a host of reports and
remarks, were in his being not empathetic enough and relying too much on
medication.
I would add to these two points the important quality he
maintained of his aiming to build, shore up, defend, etc., a health practice as
a business as if its business
prerogatives were PARAMOUNT, while he felt empathetic service to patients was
of secondary importance at very best. He might not have articulated this
“principle,” but it was demonstrated in his behavior time and time again.
A quick history of
his involvement with the Newton
hospital, during my high school years
Dr. Nielsen apparently came to the Center for Mental Health
at what was called Newton
Memorial Hospital
in about 1980. The MH center was very rudimentary at that point. When I first
attended talking-type psychological counseling in Newton on a regular basis in
1976, there was a small set of professionals at what was called the “Family
Counseling Center” on Trinity Street in Newton, N.J., and there were a few
social workers there; I don’t recall if there was a psychiatrist there. In
1977, the Family Counseling Center basically moved to the hospital, in the old (original)
part of the hospital complex (it was a forbidding old building, to me as a
mid-teen, with high ceilings and some of the doors big; an old-time smoke stack
loomed over the old building, in the back), and I saw my talking counselor (a
social worker) there, after starting with him at the Trinity Street location.
(This was Daniel Yurwit, who left the social work field many years ago. Prior
to him at the Family
Counseling Center,
I saw a Robert Young, I think his name was, whom I have very few memories of. I saw him through December 1976.)
When I had to start seeing a psychiatrist for prescription
of medication in winter 1978, who I saw was a consulting psychiatrist, Dr.
Laurence Mundy, a Brit immigrated into the U.S., who was domiciled in Mendham,
N.J., and had consulting status at the new Center for Mental Health. (Dr. Mundy
died in 1997.) I don’t remember a Dr. Nielsen being there at that time.
From February 1978 to April 1979, after the Center
transferred me from being seen by Mr. Yurwit, my talking counselor was Ira
Kramer, a Ph.D., far and away the best talking counselor I had there, though when
seeing him, I felt a bit alienated from him at times. It was one of the true
cold learning experiences of my life. For medication I saw Dr. Mundy on a
periodic basis. It was a straitened, sad time. As a function of progress I made
(at least in part), I stopped seeing Dr. Kramer on a regular basis in April
1979, and from then on for close to a year at first, I only saw Dr. Mundy for occasional med checks. I would
see a talking counselor again only in 1980, from March through August, about nine times. This was when I saw Bill Towle, another social worker (I believe he
had been at the Family Counseling Center when I went there in 1976-77). This
period of intermittent visits was in the wake of my grandmother, Gertrude
Ludwig, dying by suicide in December 1979, though I don’t recall speaking to
Bill Towle about this particular event.
(When I saw Towle's session notes from those days—I was in
senior year of high school—they were remarkably banal, all the more so in light of his
criticism in late 1986 of Dr. Kramer’s session notes of 1978-79, which were overall much more astute and ground-covering
than Towle’s, if on the abbreviated side. I can interpret them based on my
knowledge of what went on then. Mr. Towle’s notes could include something like,
laboriously written out, “He has a new T-shirt from the college he’ll be
attending. He doesn’t seem too excited about going there”—one of the great zero-foresight
comments of all time by a counselor in my session notes.)
All this shows the humble situation I was in, related to
dark struggles of my life. I don’t recall seeing Dr. Nielsen (passing in the
halls, or otherwise present) at the CMH in 1980, either.
In sum, I saw a succession of talking therapists from about June 1976 through April 1979; a saw a "p-doc" from February 1978 on; and the only other talking counseling I had in the normal way was a few times from March through August 1980. After that, I never saw a talking counselor in the normal way again. I did, however, see a "p-doc" for periodic medication-check visits, from 1978 onward. [
Added 8/31/17: This meant seeing a long series of different doctors, often for no other reason than a kind of doc turnover at the CMH. For details, see
this Word document.] This was a routine established in my college years, when my competence as a person, both attending college full-time and working at paid jobs, was clear and was ongoing. For people not to understand how this limited regimen got started shows their lack of imagination and education on how psychological assistance can go, rather than anything about my being "perverse" in my use of such help.
If Dr. Nielsen
arrived at the CMH in 1980, this was amid my college period, when I was away
from the county
If you wonder why I shape this history according to my
school career, the reason will become crystal-clear before long.
If Dr. Nielsen came to the CMH at any point in 1980, in any
event this seems to have been within the first year that I was in college, when I was standing on my own feet (with limited use of psych
professionals), forging my professional identity in school.
I would attend college from 1980 through 1984, and would
live in the Washington, D.C. area (in Arlington, Virginia) until February 1986,
working in D.C. Though I stopped at the Newton CMH a couple times in 1983 and 1984
on visits home (this was so routine and almost unimportant related to my med
use that I barely remember these CMH visits), I saw a psychiatrist (again for
routine med checks) at a strange facility in D.C. (the "D.C. Institute of Mental Hygiene," I think it was called) across from the entrance to
the national zoo. From 1980 until 1986, I very deliberately did not see a
talking counselor. In this period, I only saw psychiatrists for routine med-maintenance
consultations. (This whole non-crisis situation ranged over many years, and should
define my status as a patient like nothing else, though over the years since
then, and among doctors not least, various people with not the best of
motivations have interpreted quite other, usually ludicrously so.)
The limitations of what service I got, within my college years
(two majors, awards for work in both, while I worked at a part-time job
throughout, including 80 hours a week a couple weeks in summer 1983), should
speak for itself. And it certainly puts the lie to the idea, which you hear
floated at times and in various contexts, that if you get psych medication, you
also must see a talking therapist, and that once you start down this route,
you’re in the same “regimen” forever.
##
In November 1986, after I had been living back home in the
Highland Lakes, N.J., area since February, I was preparing to do VISTA service
in Somerset County, N.J. I went to see Bill Towle (basically for the first time
since 1980) in an intended one-off visit for a talking-counseling “consult.” As
a premise for this, I thought he remembered, indeed had met, my family (my
mother and my sister). In 1986, I consulted him about my mother (this objective
was predominant and express; Towle even commented on my efficient manner in
coming in [I had an appointment to keep to try to sell some record albums], as
if there were something remarkable about it); I’d had concerns about my mother
since returning home in February. This was an unavailing visit, to say the
least. He had a litany of banal and expectations-limiting things to say (which
I ended up detailing in a narrative that also included later, and much richer,
developments). I expected never to see him again, and wrote him a letter
expressing disappointment. I was off to VISTA
service.
He eventually wrote back (my mother forwarded to me the
letter when I was living in Somerset
County), with his expressing being
miffed. He suggested curtly that we should meet to “clarify matters.”
I wondered whether to respond to him. I did, and this led to
the most conflagration-like experience I ever had with the mental health
system.
(Its personal affront to me regarding a family issue was the essential problem;
though its insulting me as an honored psychology student would also seem
relevant, this was not the key
problem in 1986-87.)
I had no idea that the CMH had changed its philosophy of
operating since 1980. I was looking at how things unfolded (in 1986) purely
from what my needs were (and based on my knowledge of it in its small-scale way
in the late 1970s). And I just assumed Mr. Towle remembered me from 1980
(though I was mistaken about whom in my family he’d actually met then).
It could be said, in long retrospect, that the CMH went from—in
the late 1970s, when it was very rudimentary—“passive mediocrity” to, in 1986, “aggressive
mediocrity.”
A CMH social worker’s
verbal inroads and presumption were inflammatory, to say the least; Dr. N
stonewalled a complaint
Bill Towle’s contentions about my family were so outrageous;
in the series of exchanges we had, both on the phone and in person, he alleged
things about my father that not only were untrue, but were not supported by anything in my psych records (though he made a less-than-sincere attempt to back himself up
with the same records). He had never met my father, who had died in 1970; and
as a psychological professional, for him to allege what he did about my father (on
no factual basis) broke some boundaries of professionally acceptable standards.
Let me not seem cagey: Over a few meetings in November and December 1986, Mr. Towle claimed, and I worked diligently within my own areas of proof (such as a frank discussion with my mother--all while I was working in VISTA [added: I drove home for the conversation with her, from Somerset County in the project van]) to verify (and debunk), (1) the idea that my father had been schizophrenic (
false as to facts; and in counselor-ethics terms, a bad move to claim in Towle's absence of never having met him); (2) Towle's trying to back himself up via a written remark by Dr. Kramer (in 1978) in my files suggesting this "diagnosis" of my father, while the written record had Kramer's own qualifier "probably," and there is the 1970s-type looseness about the conception of "schizophrenia"; this "diagnosis" was on the reckless side on Kramer's part, and Towle's trying to use this in 1986, while hiding the records from me in our personal get-together, to justify himself, omitting the word "probably," was ridiculous (I have a copy of the relevant 1978 record). Accordingly, (3) also to be fought was the concomitant argument, just how Towle implied it, that I should accede in X treatment "because" my father didn't want treatment for
his schizophrenia, a juvenile kind of argument in any event, and all the weaker for the lack of factual basis mentioned in (1) and (2). This was the worst aspect of many features of Towle's dealings with me in late 1986, and it helps explain the months of a complaint process that followed in 1987, which overall frustrating situation has haunted me, though increasingly faintly, in the decades since.
[
Added 10/13/17: Towle's preposterous claims about my father included that my father didn't want to take antipsychotic medication he was allegedly prescribed, and not only was this false because my father was never prescribed this medication (nor was he ever diagnosed with something that would condition it), but there was not anything in my records at the CMH that could be construed to even remotely support this notion (I have copies, both hard-copy and electronic, of my CMH records that are relevant to this). My father was a type 1 diabetic, as led in part to his early death, a sort of issue that has haunted me for many years, in a way I won't go into here. Towle was reckless in how, in 1986, he showed a mixture of pulling false notions out of thin air and a willingness to fight me almost out of spite. This all might have been forgiven if the CMH didn't, when I complained about Towle, fight me for months in relation to what started with Towle's claims, with Nielsen capping the mess with weeks of stonewalling. I would find many years later that Towle was apt more generally to resort at times to false claims in dealing with a client/patient, as I heard in the support-group context from a patient that Towle had lied to him about something that was equal in importance to the father/medication issue, too.]
A memorial card for my father can be seen
here (406 KB, color), in case you think I can't be respectful about old doctors on their demise. (My father died April 17, not April 18, 1970.)
Roughly ditto regarding my mother, whom he’d also never met
before (to my surprise; yet he seemed to think he knew where things stood with
my mother, especially as our consultations went on, even though he had no
first-hand acquaintance with her [until one short phone call in winter 1987]).
About my sister, he tossed off the glib notion that she’d had a “drug problem,” and that was it; this despite her having engaged in three years of mayhem,
including her running away from home in 1978; the police being involved in some
issues at least twice; my having to pick her up at a ski resort when she was so drunk that she couldn't stand up; her having (in 1980) a house party at our home that led
to damage and stories between my mother and me for years; etc. And it all amounted
to a two-word “drug problem.” With some hyperbole on my part here, it’s like someone
attempting to be encyclopedic about Nixon by saying he had a “politics
problem.”
(Among Towle’s presumptuous responses in [probably] my first
visit with him in early November, he said I should work out my problem with Dr.
Pfeiffer, the megavitamin huckster [which I’ve written about in my blog series
on the Brain Bio Center]. As if I merely had a transient problem with Dr.
Pfeiffer and NOT as if [as I was starting to come to terms with in great
anguish in summer 1986] Pfeiffer was perpetrating a fraud that would be solidly
regarded as such years later [as could be seen on the Internet today--see references to Stephen Barrett in
this entry], and
about the invalidity of whose therapy there was scholarly literature in a book
in 1979 [which I got ahold of by early 1987], and even similar material going
back to 1973 [which I never saw until many years later].)
Well, after my numerous exchanges with him through February
1987, as I first thought was quite worthwhile, I complained about Bill Towle to
a series of workers at the CMH, which by then (1986-87) was hugely beefed up
from the rudimentary, almost sad thing it was in 1978-79. (Its workers numbered
in the dozens by 1986, including support staffers, after it had been a scant
handful of people in 1978-79.)
As I was duly referred to during my complaint process, I spoke to Richard Finkelstein,
Ph.D. (the immediate supervisor of Mr. Towle), who made an effort to be helpful
(while hewing to the CMH’s prerogatives in some way), but ultimately wasn’t good enough
(eventually, many years later, relations between him and me became patched
enough that, after it happened that he hadn’t been working at the CMH for years
but was in an independent group practice, I arranged for him to give no fewer
than three educational lectures in my lecture-arranging period in the county of
2002-07, and he showed me no hard feelings from the 1986-87 complaint period).
Above Dr. Finkelstein in the chain of command, I spoke to a
John McNaught (this was in April 1987, I believe), who to all appearances had
never done counseling work and who had, I believe, a master’s in health-care
administration [correction 4/22/19: he had an M.A., I don't know in what, and he had certification in health-care administration]. He was a stuffed shirt and, compared to Dr. F, he was distinctly less
helpful (even was obscurantistic, such as to suggest in a letter in a baldly gratuitous way that it was unclear what I sought when consulted Towle the previous fall; not only do I have a 1987 letter from him,
but I have a transcript of a conversation or two I had with him that year, one
of which I taped, with his permission, in his office).
One thing McNaught was especially piqued by was my claim
that Bill Towle had taken the “line of least resistance” with me. This has remained
a good way to put what my beef was (though I would certainly stop looking for
satisfaction from them regarding this, after I achingly and quixotically did this in 1986-87).
His questioning this went right along with the CMH’s new philosophy of “aggressive
mediocrity,” I think.
This whole situation I ended up (by 1988 or so) writing a collected,
detailed narrative of, which was quite worthwhile; part was based on rigorously-taken
notes of phone conversations, and part was actually transcripts of taped
conversations. The whole thing remains a fascinating set of human exchanges
that I would classify, if it were released in book form, as “lapsing-professional
noir.” Adding to the shadowy oddness of it was the depressed condition I was
in, following a demanding 1986 and with me serving in VISTA (
here is a scan of the first page of a newsletter I
made for the service I was helping set up, with the VISTA ID card superimposed
in the lower-left corner of the scan).
(Not only was I interested in doing a sort of "nonfiction-novel" narrative, but I did research, over a number of slow-progress years, into issues of psychiatric practice for nonfiction purposes [a lot of this research was done at the medical library at what I believe was called the Robert Wood Johnson facility of UMDNJ at Piscataway, N.J.]. See
here for a passage from a doctor who outlined the ethics of psychiatric diagnosis. In the sideways scan, the paragraph noted with the arrow--and see especially where I put brackets--speaks eloquently in contradiction of just the mishandling [regarding diagnosis] within the issues I presented at the CMH in 1986-87; that is, the article outlines how psychiatric diagnosis, and this in the context of inpatient settings [while I always operated in the outpatient setting], is handled in a systematizing way that runs against indicating respect for the dignity of the patient and his viewpoint. This is the sort of thing that I think Nielsen didn't recognize, and certainly did *not* act thoroughly on, at all. [
8/23/17: This paragraph was written during tricky editing. The main point is that Nielsen clearly enough did not seem to recognize that psychiatric diagnosis, at least in an inpatient setting (not relevant to me and others in outpatient), involves an abstract way of regarding the patient, which a truly ethical person would realize was a paradoxical disposition to be in.] Reference: Walter Reich, "Psychiatric diagnosis as an ethical problem," in Psychiatric Ethics, Sidney Bloch and Paul Chodoff, eds. [Oxford Univ. Press, 1981], p. 79.)
##
Intrepid in spring 1987 (but in what would be in a sort of
“tragic” way), finally, I tried to appeal to Dr. Nielsen, who was next above
McNaught. As it would turn out, the trouble really began.
Let’s recall again the line in Dr. Nielsen’s obituary:
“Nicolai was recruited to develop
the Newton Memorial Hospital[’s]
Center for Mental Health, which became a nationally acclaimed mental health
center due to its quality care.”
And let’s also recall my assessment:
[He aimed] to build, shore up,
defend, etc., a health practice as a business as if its business prerogatives were PARAMOUNT, while he felt
empathetic service to patients was of secondary importance at very best.
For his part in what had become my long complaint process
(five months total), he stonewalled. And stonewalled. By about July 1987, he
claimed through a secretary to be unavailable due to vacation schedules, etc.
This went on for weeks. When my patience had run out, I appealed above Nielsen
to the Rev. Ernest Kosa, who was the drug-and-alcohol and mental health
administrator for the county (and he wasn't located at the hospital, but had an office in a county government building, I believe). Rev. Kosa kindly wrote back that Dr. Nielsen was
busy and it would take some time to review the case, etc. He acted as if I only
need wait on Dr. Nielsen (as if Nielsen would have interacted with me in good
faith when he had the time), and Rev. Kosa’s tone seemed promising, unlike
Nielsen’s frosty aloofness.
I had to leave the area (for St. Louis) in August 1987 for
graduate school, and Nielsen—after requesting I give proof I was going away to
grad school, and out of indignation, I refused—remained in his own role in the
complaint process as one of stonewalling/nonaction until I left the county.
(Interestingly, when I phoned Dr. Ira Kramer in April 1987,
among other things—he remarked as soon as I greeted him with my name, “I
remember that family!” as if he was a bit daunted by us Ludwigs—he said he
remembered Dr. Nielsen [which would mean Nielsen was there in 1979, the last
year Kramer was there, which I find surprising], and I should be able to find
him reasonable.)
##
When I was back in the county in 1988, I dealt with Dr.
Finkelstein at the CMH to get copies of records, etc. I was in a humbler
process of gathering information, partly for my own purposes, not necessarily
for a complaint. I don’t remember trying to deal with Nielsen in 1988.
In 1989, I tried to pursue a subordinate issue with Nielsen,
including (as I found) a counselor’s having violated (in the process of my 1987
complaint) the hospital’s own policy about access to records in dealing with my
complaint in 1987. Still no answer from Nielsen.
In about May 1989, I appealed to Rev. Kosa, who met with me
in his office at the hospital. He was cordial and even quite nice. He spoke of
being vexed by Dr. Nielsen’s stonewalling even
him about my complaint when Rev. Kosa duly inquired. (Rev. Kosa mentioned
to me, as a World War II vet [4/22/19: I'm not sure about the WW II connection, though I had a memory he mentioned this to me; but a report shows he was a chaplain in two later U.S. wars], how in the old days you carried your medical
records around, as if things were vastly different then from 1989 days where
bureaucratic prerogatives could trample on your rights regarding medical
records.)
(By the way,
here from
early 1987 [1 MB file!] is a color scan of a letter I received from the Sussex
County Office of Aging when I was quixotically looking into helping run a
center in Sussex County like the one I was working within in Somerset County,
the “PeopleCare Center.” Also,
here (975 KB file!), when I was domiciled again in Sussex County and way back in 1988-89, is a scan of letters to editors that I wrote in those plodding-editorial days. The last page has a big letter on "Prime Care...," which was a corporate entity, emanating out of the Newton hospital's Center for Mental Health, that was trying to set up a group home in Andover Township, and apparently ran into serious flak from the public there, because Prime Care--consider that Nielsen probably was a big motivator behind it--was too high-handed in opting for that group-home location. An earlier letter in this scan-set, on the first page and small and to the left and from 1988, touches on this discussion.)
In the 1990s, I only
dealt with Nielsen in a sort of default way of having him be a
normal-consultation doc
I was done dealing with Nielsen until the early 1990s. While
I was going to the CMH as the main psych facility in the county, following a med-check
stint with Dr. Steven Sarner in 1988-91, for medication follow-up I was seeing
Nancy Grossman, a D.O., from 1991 through 1995, while working at the first
phase of my editorial career (All American Crafts; AB Bookman; CPG; then freelance
in 1995). Eventually I found that, as Dr. Grossman found objectionable, there
seemed to be some issue of Dr. Nielsen second-guessing other doctors’ work at
the CMH. He seemed to want to change or modify diagnoses of patients, such as
what she did with me. (The standards-related unacceptability of this move of
his should be obvious.)
This second-guessing stuff he was doing was one reason Dr.
Grossman was leaving the CMH. (I would be in touch with Dr. Grossman again,
cordially, in an informal e-mail exchange sometime after about 2002.)
In 1995, just before many workers of the CMH (with Dr.
Nielsen as their head) would leave the CMH en
masse and set up InHealth, a group practice first located in Sparta
Township, N.J., I started seeing Dr. Nielsen (when he was still at the CMH) as
my “p-doc” for med follow-up. [Added 8/29/17: InHealth, as a separate corporation operating within the CMH, was formed in 1992, I believe.]
A risky proposition, you say? I had little other choice (as
there was no other psychiatrist to see, with Dr. Grossman gone, other than Dr.
Sarner, whom I’d left in 1991 and didn’t want to see again), and I thought I would
be optimistic and try to be constructive with him.
I moved with him when his new practice InHealth went to Sparta (the CMH at the
hospital became a shrunken pile of leavings as a result). Before long, he
saddled me with an unacceptable diagnosis I fought against. In 1995, when (1) I
was at a temporary editorial job at Reed Reference Publishing and I had
lightheadedness phenomena related to my medication, and when (2) a company HR
person wanted me to supply emergency info tied to this, Dr. N expressed (in
this case, proper) hesitation at conforming with their demand. But the
information he ended up providing in a signed letter did not acknowledge the
actual phenomenon I was experiencing, but talked only in hypothetical terms
regarding possibly lightheadedness tied to my med, and concomitantly gave a
banal possible treatment for it (my lying down), which any idiot could have
thought of. I.e., he was being evasive about my specific health issue.
(Incidentally, it was shortly before this that I’d had
published, among other medical items I’d written when working for CPG, an article
on medication, related to side effects, that involved my working from a
conference tape and even consulting with the author doc by fax or the like. See
here. As it happened, for my writing-related purposes, I shared this article with various professionals, communicating by mail, whom I located in various ways. I forget the context of this, but I got
this response from a Dr. Lee Tempel in 1994 to a letter I sent him that was accompanied by a copy of the vitamin E article.)
This conforms with how, in addition to (by 1986) the CMH’s
engaging in “aggressive mediocrity,” it also followed this much more plausible
(if not entirely respectable), and I think fairly universal, model for a
health-care facility: among the doctors,
minimize the sense of personal responsibility (to the patient) and heighten
vigilance to guard against legal liability. (This sort of practice could be
seen in a New York Times article some
years back [in 2013?] looking in close detail at a young man who misused ADHD medication,
with his feverishly getting prescriptions for it, and ending up dying. Session
notes were quoted, and they had the same old thing I saw in latter-year CMH
notes, sketching what a doctor did and minimizing close attention to the
patient’s picture, while guarding against liability.)
##
Finally, in 1998, when I fought with Dr. N one more time
about a diagnosis he had for me (which no one has seriously given me since, nor
had anyone before), he changed the record “in accord with what I contended” and
threw me out of his office. This was a distinction to be proud of (a “Nixon’s
enemies-list honor”).
(For a sense of how I was faring in work, compare
this scan
[279 KB] of a page from a reference book
from 1998 that shows information on me—look for my name in about the middle—and
shows how I was doggedly pursuing my career interests, no thanks to the CMH
docs.)
In 1998, nervous in the wake of Nielsen's sudden shove-off, I went back to the, by then, erratic CMH (which was
under new management) for use of p-docs for medication follow-up, and would do
so until about 2007.
(Dr. N could have taken credit and solace in that the
erratic nature of the CMH after he had left it with InHealth in 1995 only
became worse thereafter, as I would find firsthand starting in 1998. But also his own separate group practice would shrink over years, to the point that, apparently, in his last years, it was basically just himself, with his wife [a nurse and a key worker there], an office manager, and maybe one or two others, from what I can gather from a Google review posting.)
##
I did not have dealings regarding Dr. N again until 2002,
when I was starting to arrange lectures for a DBSA group in Sussex County.
He had been suing a former colleague, Dr. Sandra Squires, for her leaving
InHealth in 2001 to start her own private practice in Sussex County; he sued
her for violating a contract provision of InHealth that a doctor in the group
shouldn’t set up a competing practice within a five-mile radius of InHealth’s
location (within a certain period). The suit went on for months (there was an article about it in The New Jersey Herald in January or February 2002, possibly in December 2001); at one point I
spoke with Dr. Squires’ attorney to offer help (some details of what he said
will be conveyed below). Finally, as Dr. Squires had changed her situation to
be the in-house psychiatrist within the psych-inpatient unit of the CMH, the
suit was dropped.
As may seem ironic, in about February 2002, I sent a letter
or fax to Dr. N asking if he would do one of our (DBSA’s) first lectures, but
with a catch, which I knew would effectively give him cause not to do it (as I
really didn’t want him to do our first lecture anyway): our lectures would
implicitly (and necessarily) affirm
patient dignity. No surprise, he opted not to lecture (though he had
lectured for the DBSA group in about 1992).
Dr. N’s shortcomings
would prove prodigiously numerous, and often sensational, among other patients
If it was just based on my own experience with Dr. Nielsen,
I would have affirmed (with all good faith and no small amount of solid
emotion) that he was a psychiatrist in the county who stood out above all
others for leaving much to be desired (in not just a precious, too-idealistic
way you assessed psychiatrists). As I’ve said, he placed administration of a
group practice, with himself as president, above all other considerations as a
psychiatrist. For whenever it mattered, I had no problem (in terms of factual
basis) with being apt to speak highly critically of him from my own experience,
but I would find from being richly involved with the DBSA and NAMI chapters in
the county that many other patients (or advocates) had such negative things to
say about him that they cemented his status as the most complained-about
psychiatrist in the county, beyond question and by a long shot.
The following is from an updated version of my manuscript The Temps (some of this repeats some of
what I said above):
After 1998, a year in which he essentially
threw me out of his office (by then he ran his own MH facility separate from
the hospital’s) (this throwing-out was over an issue I persistently raised
regarding his diagnosing me) and our three-year association as doctor/patient
was effectively (and relievingly, for me) at an end, I would find the
following: (a) numerous patients in a support group nexus in the county (two
groups, actually, of the DBSA network [Depression and Bipolar Support Alliance]
and the NAMI network [National Alliance on Mental Illness]) had complaints
about him, essentially, and in a most-common-issue fashion, these complaints
conveyed that he medicated too much and wasn’t empathetic enough. Among
patients with testimony about this were a (former?) stewardess (roughly middle-aged),
another woman who was in her twenties (as I pretty much recall), and (as
someone who had seen him in about 1987) pseudonymous Betty (who is a major
focus of my unpublished memoir A College
Try that Courted Trouble); she is the age-about-43 woman I helped (as a
support-group leader) extensively, including in a domestic-abuse issue she was
mired in, in 2002-03. I know there were two or so other patients from that time
with other, distinct-enough complaints about Dr. N, but I can’t offhand recall
their reports or who they were (even blurrily remembered).
(b) The most atrocious story came
from the longtime leader (1993-2002) of the county chapter of the national
network DBSA, “Joan,” who reported that in about 1980, she tried to make an
appointment with Dr. N (presumably when he was at the hospital’s CMH) and he
essentially declined, on the basis of that she couldn’t afford him (or such; this was curious of her to say, because I knew
the CMH, which I’d been going to in about those years, had a sliding-scale
capacity for payment); and in the wake of this, she almost committed suicide,
as she said.
(c) Another remark strongly
critical of Dr. N came from a woman, who was a social worker or such (I
believe), who helped run the NAMI group in about 2002; she claimed Dr. N was an
alcoholic (that I’m not sure I
believe).
(d) Another woman who judiciously
helped run the NAMI group for several years, Rita Wright (who has since died),
said her son, who saw Dr. N as a long-term patient, hated Dr. N. [Added for this blog, to show family responsibility: Wright's daughter Peggy had been a news reporter for The New Jersey Herald and, for many years more recently, a reporter for the Daily Record in Morris County. She has written occasionally on mental illness.]
(e) Another issue with Dr. N that
actually was reported on in the county newspaper [the New Jersey Herald] was that he had a lawsuit, lasting quite a few
months, against Dr. Sandra Squires, when she left the group practice he formed
in about 1995 when he left the hospital and took numerous of the CMH’s workers
with him. After a few years in the group practice, Dr. Squires wanted to work
in the county independently of Dr. N’s practice, and then he sued for what
amounted to something like violation of a non-compete clause in their
contractual arrangement (she counter-sued him). The lawsuit was reported on in
the county newspaper in early 2002. Eventually the two doctors dropped the suit
against one another, as Dr. Squires started working at the psych-inpatient unit
at the county hospital (where the CMH was).
(f) In early 2002, when the lawsuit
was still pending, I spoke to the attorney representing Dr. Squires, generally
in order to see if I could offer her side some support in terms of anecdotal
information. Amid our relatively brief phone discussion, the attorney remarked
that Dr. Nielsen was regarded, implicitly fairly widely, as a “big jerk”—this
comment was what the attorney was acknowledging in the process of pointing out
to me the issue (related to a forward-looking strategy to the case) that he
really wanted to focus on, which was (I think) the need for Dr. Squires to
serve a certain segment of the psychiatric-needs population in the county, the
pediatric. Anyway, the attorney’s “big jerk” phrase sounded as if he’d had a
fairly good whiff of what general wisdom circulated about Dr. N.
Then, (g) as one last patient-based
droll particular in my “case” against Dr. N, “Anneka,” a fellow support-group
attendee with whom I went to educational meetings in Morristown for years, had seen Dr. N as her
doctor for years until about 2013. I spoke casually with about the negatives
about him and she seemed oddly impervious to my stories. Finally, she (who at first seemed so apt to “look
past” the many anecdotal negatives I could relate about Dr. N) stopped seeing
him, and started seeing another psychiatrist in another county; her issue with
Dr. N was essentially (and not super-specifically speaking) what many others’
was, that he overmedicated and wasn’t empathetic enough.
[end of Temps stuff]
Interestingly, I found some Google-hosted ratings of Dr. Nielsen (a scan of the printout is
here). You can add these to the set above; I don't know any of these people. These three were the total available at the page that this scan is from. Note that the woman who with her autistic son was dismissed from Dr. N's servicing them means that I had the somewhat-grim honor of being among several who were "shunned" by him: the three-or-four of us include "Joan," whom I mentioned above, in about 1980; and this woman and her son. Another person, Amy Munoz, who wrote a long review
not accessed by me when I printed this page, reflects having been cast off by Nielsen's practice via his wife, in a practical sense set in motion by the office manager.
The number of patients and advocates from my
Temps accounting, combined with the Google review people just mentioned, total about 13 or more. You can guess as to whether there are more.
Other measures
Dr. Nielsen’s way of being widely criticized, if not
condemned, was not something you would think likely on meeting him. He seemed
intelligent and level-headed, cordial. That he had played classical guitar was
evident from a poster on his office wall in the 1990s. But that he could stick
to his guns with some narrow way of interpreting you didn’t take long to be
appreciated and objected to (and I’m sure he had some resentment toward me,
since 1986-87, that was a driver of how he handled me in the 1990s).
He even was the only Sussex County psychiatrist listed in a
legal-services booklet (my evidence is from, as I have a copy of a page from [not related to Nielsen], the 2009 edition of the reference book The Legal Pages, published by a firm apparently called the Law Diary, located in Newark, N.J.; you can find it in a public library in this state) as doing forensic psychiatry for the local area. Which
could be called “another way he could be a prick.”
All this does not sound lovely, and my tone here is about as
“nice” as can be managed given the many complaints about him.
One wonders why, if he so consistently failed to exercise
empathy toward patients as numerous such people, from varied backgrounds, have
felt compelled to remark on—why did he opt to be a doctor, or at least a psychiatrist? As someone from a family
of health-care professionals—my father was a dentist, my mother was a hospital
technician, and I have a degree in psychology (though I never worked as a
practicing counselor)—I know empathy is a key factor in being a health-care
professional (even though for specific practitioners, this ability may decline
at times, or over time). With Dr. Nielsen, he seemed consistently to have
missed this point about empathy.
In character for him, when I talked to him about borderline
personality disorder in 1995, he remarked that this essentially meant the
patient was a “pain in the neck.” Dr. Goldberg’s generalization about BPD (see
extracted quote within
this entry) shows some generosity (based on Dr. G’s elastic attempts to help the patients)
amid the humor. Dr. N’s remark, however off-the-cuff and meant to show humor,
has more of the cheapness that seems to have characterized him over a range of
his dealings with patients.
My becoming a
“critical-of-practiced-psychiatry” activist
In one way, Dr. Nielsen opened up a new vista to me. In
1986-87, when I was grossly insulted by the CMH’s handling of my complaint
process as if I was a “nothing-but-trouble” patient, and after my glorious
years majoring in psychology in Washington, D.C. (going to show one example,
and the very best, of how my biggest steps of progress in my career and life
have been outside of the
cesspool-of-pettiness that is New Jersey), I began to learn about, and
promulgate views and helpful technical information in, the patient-centered
movements that were available in the late 1980s.
Dr. Peter Breggin, in his own controversial way, inveighed
against the excesses of practiced psychiatry in books and media presentations
that were starting to make waves by 1987. (I wrote to him and got a response in
early 1987.) I got in touch with David Oaks by 1989; located in Oregon, he ran the
journal Dendron, as well as the group
that first was called Support Coalition International and eventually was called
MindFreedom. I have tons of material at home (amid other tons of material on
other subjects) related to such patients’ rights activity and publications.
This was all before I got involved with the more “establishment”-type DBSA and
NAMI from 2001 through 2007.
As I came to feel in no uncertain terms (on rich experience
and deep emotions), the Center for Mental Health under Dr. Nielsen was an
exemplar of how not to run an honest
mental health facility. From 1988 to 1995, that facility seemed to be about
nothing so much as doctors’ denying medication side effects and (within
med-check visits, anyway) their being stubborn about how to talk to you about
what issues you brought up and address issues of diagnosis. This was especially
painful when I was going through the grind of publishing jobs with their own
weird pressures from 1990 through 1994.
Accordingly, in my private (speculative) writing efforts
(and occasional letters to editors), and even with some paid editorial work for
a medical publisher, I often based some of my positions (or my clues for
further research) on certain psychiatric issues on how, if the CMH seemed to
follow X policy with talking to the patient about certain meds, the real,
academically-based way to do it (or the way top-notch doctors outside the
county would do it) was
the opposite,
or certainly different. It was amazing how consistent this practice of mine
could soundly be. The series of lectures I helped set up (see a blog entry
listing them
here, most of which were
well attended and which even involved some artistic touches, were good not only
for their content but because in their philosophy they tacked
away from how the CMH seemed to think,
which was of patients as sacks of unfortunate chemicals.
The notion at large that gets bandied about so much—“We want
to return patients to the community where they can get community
support”—really depends on what you have available “in the community.” And if
the community MH center is a disingenuous SHITHOLE, this doesn’t do much for
the patient.
Dr. Nielsen’s heading InHealth lasted a long time (from 1995
to the 2010s, I guess), but that facility shrank over lengthy time, and various
doctors (as suggested by Dr. Squires’ example, and Dr. Finkelstein’s some years
earlier) left working with him, suggesting that Nielsen wasn’t an endless fount of having
all local professionals cleave to him. His last practice in Lafayette, N.J.,
seemed to rely in part on Suboxone treatment of patients (which strikes me it
can be done in ratcheted-through fashion) for its routine bread and butter.
I am not allowing blog comments, in accord with my usual blog practice. But if you have comments to forward to me, use the e-mail address grludwig@warwick.net. Expect a delay before a reply.
