Psychiatry & Psychotherapy Podcast - Britney Spears - Discussion with a Conservatorship Lawyer and Several Psychiatrists

Episode Date: July 18, 2021

Interview regarding the recent court case of Britney Spears and unique aspects of conservatorship law and treating people with large amounts of fame or money. Conservatorship Lawyer: Mark McGuire Psychiatrist: Herndon Harding M.D. Psychiatry Resident: Serena Weber, M.D. Psychiatrist Host: David Puder, M.D. No conflicts of interest to report. Contact me on IG: here By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com. Sign up, sign in, take the test, and the certification is emailed to you in seconds.

All right, welcome back to the podcast. I am joined today with Serena Mammon Weber. She was on some previous book episodes with us. Most recently, Marcus Aurelius. Herden and Harding, related to President Harding, also related to another Dr. Harding, which was a mentor of mine. And he is a psychiatrist who has been seeing patients for 40 years. And Mark McGuire, different than the famous baseball player. He is, I would like to call you a conservative, conservator expert lawyer. That's what he's done for the last, like, how many years, 12 years? 14. 14 years, yeah. So you've been in the trenches, and today we will be discussing Britney Spears.

There's kind of two things that I think we'll be able to add to this conversation that's going on right now. our perspective from the legal aspects of the case, specifically kind of getting Mark McGuire's expertise and what is going on and how to make sense of that. Also, our expertise is psychiatrists because I've had patients who have had a conservator and Dr. Harding is nodding. He has to. So kind of discuss some of those aspects of psychiatry, and specifically this case, I think it's a good way to learn about it. And then also talk about how people with a lot of money, people with a lot of fame, fortune, are sometimes uniquely, um, are unique population to treat and how maybe we should think about those complications

and, um, and how that might apply for Britney Spears in particular. So, Dr. Harding used to treat baseball players at the highest level, still does. And you can speak, you can speak up. Yeah, I didn't want to speak over you there. So he's had a lot of experience with that. Due to the podcast, I've had a lot of people reach out who, you know, can't talk about the specifics of who they are, but some unique clients. And so kind of some of the reflections of treating that population and some of the unique aspects I think of Brittany case is that you know if you were to describe one one just general thought I'll just throw out there if you were to me a common psychotic patient they would say something like I have people following me at all

times taking pictures of me at all times of the day people are out to get me people are trying to manipulate me and with Brittany I mean she had paparazzi around her literally literally 24-7. I mean, there were people literally making all of their wages off of her, taking pictures. And she had just this intense scrutiny, absolutely intense. And for those of us who maybe aspire for fame, I don't think we would really aspire for that kind of pressure. And we wouldn't know what that's like unless we were there. So, okay. Serena, I had you kind of dive into some of the details of this case. Yeah.

I did a deep dive, as you'd say. A deep dive, yeah. And we kind of created a timeline comparing different articles and such. What would you say is the general gist or surprise that you've had as you've kind of started to dig deeper and deeper into this? Well, I don't know. I guess I've been living on a rock because I didn't know anything about free Brittany or anything until she testified in court. And my first thought was she must be mistaken with a lot of what she's saying or that can't be true. I think the most shocking thing was a lot, just how much control a conservator can have on a conservate.

Yeah. And yeah, there's so much room for abuse in the system. Dr. Harding, you said one line over the phone to me that perhaps someone has the right to screw up their life or to risk screwing up their life. We all do. I mean, one of the principles of medical ethics is self-determinacy, that you're allowed to make choices for yourself. There are exceptions to that that have to do with imminent danger to self or others

or an inability, a gross inability to take care of oneself. But just because you want to make a bad decision that others consider to be poor judgment isn't necessarily so. And I think it's particularly true in the context. text that you were alluding to, people with a lot of notoriety and money, they live differently than us mortals. And so some of their decisions may seem crazy to us, but to them may be perfectly sane. Yeah, and I would say further, we're not in this podcast insinuating culpability. We're going to try to stay in our lane. We haven't examined Brittany. She's not been our patient. If she was,

we couldn't say anything. Without a full examination, we would never give a diagnosis. We weren't there when she was hospitalized twice initially. So there's a lot of places that we don't want to overstep our bounds as professionals. That being said, usually when someone's hospitalized twice, how often is it that we have someone go straight into a conservator? And maybe, Mark, you could say, how often, like, how quickly does it usually happen?

Like, what's the normal story that someone arrives at your office? And you're like, yes, I need to put that one. That one needs a conservator. Well, remember, you're dealing with the full spectrum of society and full spectrum of ages. So a conservator is kind of an odd beast in terms of California because we have two separate areas of law. Most states just have guardianships and they just call them either an adult or a minor guardianship and because California understood, I think rightly, that there's substantial differences between guardianships and conservatorships. We created a whole separate area of law. So I point that out

to say, you have to ask me, you have to give me some specific facts because you could have a conservorship that could be at inception at 17, 17 and a half when a parent understands that their child is going to turn 18 and they're development of disabled or a child going in for a conservorship over their 97-year-old parent. And those are all completely different factual scenarios. That's why I mean you have the whole spectrum. And it's a vastly complicated area of law that I would say is more like sociology than it is law. Okay, maybe just to get us all on the same page, you described four different types. Yeah. And different severities with those types. Yeah. So the best thing that the best way to understand

conservorship is to start with what's the standard, meaning how am I going to get appointed? And this is like one of the first things I point out to people is the standard that it has to be necessary for their care and the least restrictive means. So if you think about constitutional law, that's essentially strict scrutiny, right? So you're not going to take away someone's First Amendment rights or the right to marry or the right to vote unless it meets strict scrutiny. So it's got to be necessary and it's got to be the least restrictive means to provide for their care. That means if they have a power of attorney, you're not going to be in conservorship court because someone can manage their care under power of attorney. So that being said, if it's necessary,

then you have sort of like four things that are in an order of hierarchy of being restrictive. And I say that because you have to keep in mind that it's got to be the least restrictive means. And the least restrictive conservorship is what's called a limited conservorship. And you have to be development and disabled. And the developmental disability has to have arrived. before the person turned 18. And that's kind of like a list of different powers that can be granted or not granted. Power to control social sexual behavior, power to control where they go to school or if they have a job, power to control medical information.

Then above that is what's called a general probate conservorship, and that includes sort of all the powers of a limited conservorship, all rolled into one. Then above that would be a dementia conservorship or a neurocognital. conservatorship that would allow someone to put someone in a secured facility and force them to take medications. And then above that, in a whole separate area of court, is an LPS or what some states call mental health conservorship, and that allows someone to put someone in a secured facility and force them to take psychotropic medications. So from your understanding of Britney Spears' court case, which one was she under? Well, I think it's very interesting. I've had these kinds of

cases. From what I understand, she started off after a 5150 hold, which is a temporary hold when someone has a mental break and they're a danger to themselves or others and they're gravely disabled, was put into a LPS or a mental health conservorship. And then in fairly short order, my understanding is she was put into a guardianship or sorry, a probate conservatorship. And I think that's kind of what allowed it to be secret. And I say secret, I mean confidential. and private because everything you file in court is a public document, except for certain things like restraining orders, unlawful detainers, and mental health court. So a mental health court for obvious reasons because of stigma is a whole separate court that's private and confidential. So you can do lots of things. Some people may critique that because things could be done without people noticing it, but it's probably pretty good because you don't want to have a lot of stigma to people.

So my understanding is she was put under an LPS conservorship and then it was transferred to a probate conservorship. And that's probably what allowed it to be kind of like under the radar for such a long time. And some of the things that she complained of, some of the rights that were taken away that to me seemed more egregious, was like she wanted to get the IUD removed from her. She wasn't allowed to have a cell phone. She wasn't allowed to retain her own counsel. can you speak to that at all about how that fit into how the law is currently? Yeah.

She, unfortunately, probably got caught in a time period where, I mean, we're a common law system, right? So we pass statutes and we have appellate courts and we have trial courts and appellate courts and we have superior courts and Supreme Courts that review all those decisions. So they change the law. It's what I mean by common law system. It evolves and changes all the time. So this law is changing. It's changed substantially.

There's some substantial cases from the 1990s that put in lots of restrictions. Maybe there's more restrictions that need to be put in and protections for conservatives. But there's been some recent case law that have interpreted the statutes that said, even under a conservatorship, a person has a right to say who they want to see, who they don't, want to see medical care that they want, medical care that they don't want. So if you want to force someone to see someone or force someone not to see someone, or force someone to get medical care, or force someone not to get medical care, you have to get specific legal orders from courts to do that. So unfortunately, all of this appears like it to come about before those cases

came down and before attorneys really got educated. Now, should her attorney have advocated strongly or for her, probably. I don't know. I don't want to like critique the other attorney unless I know everything about it, but just from what I know, it sounds like she probably was kind of abandoned a little bit. My understanding was number one,

she had to pay for him, which seemed. Like half a million dollars. Like a lot of money. And then number two, he never filed to drop the conservator, which seems. odd. Yes, very odd. I've filed completely useless petitions to terminate conservatorships as court appointed counsel knowing that I was going to lose, but also knowing that's what my client wanted to the complete frustration of the court and to the complete frustration of the family members,

but guess what? As court-appointed attorney, you have to do what your client says, unless it's illegal or immoral. As court-appointed counsel, you are not what's called a guardian ad litem. So often the court will appoint will appoint two attorneys. One is the court appointed counsel whose job it is to do what the client wants, and then also appoint a guardian ad litem, and their job is to report to the court and do what they think is in the client's best interest. Those are two, could be two completely different things. And in this case, it doesn't look like, at least to me, doesn't look like the court-appointed attorney went and tilted the windmills as they were supposed to for their client. Mark Hernden Harding here. As a psychiatrist, we're much more familiar with guardianship

because of the medical nature that most guardianship includes. It sounds like most of the conservator relationships you're talking about are for people who are not expected to at some point regain their capacity so that the assumption must have been that this person, and again, we can't diagnose someone that we've not seen, but just by the description, it seems unusual that someone that young unless they had some clear organic brain or some kind of louis body dementia or some kind of dementing process,

it would be odd that they would be expected to not at some point be able to have capacity. This actually, before Mark McGuire jumps in here, this was the one thing that kind of struck me as I continued to read further and further. As a psychiatrist, so I imagine people are going to be listening to this curious what a psychiatrist, a couple of psychiatrists would think about this and a lawyer, who's a conservative lawyer, usually the person who gets put on a conservator in my mind is

someone who's like homeless, using drugs, not taking their medication, and if they continue to be without very, very restrictive controls, like they will continue to decompensate. like these are people who are, it's often like the fifth time to the 20th time, they're in the hospital, and the team has seen them so many times, and it's the same pattern. They're in the hospital for a couple weeks. They get discharged. They come back. They're, you know, again and again and again.

And this type of person, if you put them on, you know, a conservator, they have this kind of restrictive set of things that they can do and can't do. when they take the medications for a prolonged period of time, it's like, ah, the sun comes out, and they can go on with their life. So these are the people that I've seen over my career. And so when I hear about Britney Spears, like literally running her shows, choreography, making millions and millions of dollars, wow, she's under this very restrictive... She was a judge. Concern. The X factor.

Like she she obviously had her cognitive capacities, despite the Instagrams that kind of made her seem a little bit loofy, which were by the way, not posted by her, which is, you know, she had a social media company. So, yeah, I don't know. Anyone else have any thoughts on this? Dr. Harding, you're kind of nodding your head. Well, yeah, I mean, were she someone that inevitably would have a massive failure in her life not being able to. be successful or be dangerous to herself or somebody else, then perhaps a longer-term conservatorship would make sense. But I don't know that there's any evidence to that, that she may have had a meltdown here. I'm not sure what that means. But if it's more likely a temporary phenomena

and not an ongoing cognitive impairment, then not checking to find out whether or not the conservatorship should be dropped at some point to just keep perpetuating it, just doesn't make sense. So, for example, some people have said, oh, Brittany is bipolar. Now, I have no idea if that's the case or not. But I can tell you that a manic episode does not last for 13 years. So, you know, if they're wanting to be able to acutely take care of her because she's having a dire disease flare up, that's one thing. But it doesn't seem to be consistent with the history. Okay. So just for, oh, this is what I wanted to say.

For those of you who are not aware of psychiatry, this is a totally new, fringe world to you. If a person came into the psychiatric hospital with depression or with a manic episode, first of all, with a manic episode, usually they're in the hospital for weeks if it's their first manic episode. Secondly, usually they're not sleeping until like seven days of pretty strong antipsychotics, sleeping meds, mood stabilizers, all at the same time. Like manic people, hearing voices, seeing things, connecting the mind calendar with quantum physics, leaving their children to go find the physicist to solve the world's crisis, right? This is what mania looks like, okay?

Normally, when that person goes into a psychiatric hospital, they'll be treated, and then they'll go to like a partial hospital, especially if they have money. A partial hospital or like someplace where you would live for like a couple months, you'd get treatment, you'd get therapy, and then you'd be stabilized. It's very, very rare, like Dr. Harding said, for someone with bipolar to not be able to be stabilized, especially with all of the types of treatment that we have. Right. So it's very, it's like when I was reading this case, I was like, wait a minute.

Why didn't she get just standard level of care? Like I would have immediately thought partial hospitalization, psychotherapy. You know, Dr. Harding, you're shaking my head. And that's because I agree with you. Absolutely. That's how it should last. And even if she never got treatment, you're not going to have a manic episode last 13 years. It will correct itself at some point, maybe 18 months.

But you're not going to have a prolonged single manic episode without some bipolar phasality. So that wouldn't be a good argument that that's what's happening, even if that is a diagnosis that's being put forth. And again, we're not putting that forth. The reason I was shaking my head, though, is that when you're talking about people of notoriety and who have money, everything changes. The way that people have investments in that person, what they want to get out of that person's life and success now becomes a big factor. It's not just the patient or the person who's experiencing the symptoms that is the sole focus. It's the whole retinue that's dependent upon that person. And the more money, the more it happens.

And I would say to add to that, some people do it consciously, some people, it's very unconscious. Like some people don't even know that they're behaving differently, that they're making decisions. It's not like they've gone through the psychoanalysis to understand, like, oh, I may be acting a little bit differently towards this person. It's like, so there are people who are more, you know, the Machiavellian, psychopathic. they're the ones that are like how do I con this person? And then there's the people who are like just unconsciously driven to act very different. And they may have all sorts of psychological defenses thinking that they're doing the best thing. Mark McGuire, you were thinking something there? Yeah. So I just, I don't know much, but I just wanted to point out that an LPS conservorship

under the statute in California is only for one year. So it's built-in temporary. So, you know, I don't know. I'm not trying to accuse anybody of anything, but if she was under an LPS conservorship, that automatically by law comes up for review within a 12-month period. And if it's not granted, meaning it's a hard and fast rule, if you don't have a trial and you don't have it approved by a court within one year, the court terminates it in your free bird.

Now, we stopped using the word permanent conservorship some years ago, they call it general conservorship now because conservations can be terminated. So transferring the matter from an LPS conservorship to a general probate conservorship means it's not really up for termination. It's up for review on an annual or biannual basis, but it doesn't have an automatic trigger of a termination point. So that might be their motivation for changing it? Because it is like a forever, it's just in place until someone says they want to terminate it. And from what I understand, you know, correct me if I'm wrong, but it's very unusual for a general probate or a probate conservatorship to be like primary mental illness like this.

You would, those people generally get LPSs. Yeah, generally the referrals go the other way. So one of the problems, I don't know, gaps in the law you want to say, any, you know, any private citizen can file for a probate conservorship. only the government can file for an LPS conservorship. So it has to originate from the government entity and has to originate only from the county agency on the county under which the person is under a temporary hold.

So that creates a little bit of a problem, right? If you have a child or a parent who's on a mental break and you want to secure them in a facility and make them take psychotropic medications, you can't do it. There's actually no options available for you. A lot of us is tried to lobby to get these laws change. It runs up against constitutionality. It runs up against different lobbying efforts.

I don't know if you guys have ever read the book One Flew of the Cuckoo's Nest, but that's essentially where this problem comes from is we have an unholy alliance in the late 1970s between conservatives and liberals who wanted to set my people free and open up all the mental institutions and also cut the budget and not pay for mental institutions anymore. So welcome to the problem of the gap in the law between probate conserverships and LPS conservatorships. I'm just coming back to, like, the patients that I've had who have had conservators, they're so sick when they're put on this thing. And they're sick for months.

And often they, like, we've had patients in the hospital for almost half a year. And if you saw this person, you would immediately, like, if you were just a random, normal person and you walked into the hospital and talked to this person, you would know something that's very, very wrong. Like without any psychiatric background, you know, they're responding to internal stimuli. They're looking up at the wall, like with spiders coming down, or like they're running into their room screaming or, you know,

hitting people without sort of provocation because they have some paranoia. So I'm thinking, like, in my mind, when I'm thinking, like, oh, this person needs to be on a conservator, I'm thinking like that level of severity. And I've had a patient who, after being in a very controlled setting, went on to get a graduate degree. And somewhere one year into the graduate studies, this person was taken off the conservator. Because at that point, there was no argument that was strong enough to keep them on it. Yeah, I guess that was part of what I was driving at before is if there is a likelihood that someone will be able to be able to,

able to get back capacity to make reasonable decisions for themselves, then the idea of the conservatorship should be that let's get rid of it as soon as we can get that person to that place. The only persons who should not be brought to that place are persons who can never get back that capability to make decision. And that's why such a prolonged conservatorship and someone this young who is doing all those things that you described, it seems. seems rather odd that it would be an ongoing conservatorship and somebody hasn't said, wait a minute, we ought to take a look at this. I think the one thought that I was, or one thought that I was having, I was having a lot of

thoughts. I woke up at like three in the morning thinking about this. Kind of obsessively thinking about it, you know, reading all this stuff. And I was thinking, how difficult is it for someone to be this famous, this quix? quickly. And I was thinking about some of the other really young stars that are out there right now. And just the unique pressures that they have, like, you can't leave to go on a run without, like, pictures being taken. Like, if you watch video footage of Brittany and her, in her early 20s, it was almost like, like, a seizure invoking, like, flashes, like just nonstop flashes of cameras whenever she would get out of a car, whenever she would be in a store.

It was like the flashes just never stopped. And it only gets worse when you're sick or something horrible is already happening in your life. People have this intense curiosity. People really want to know, like, well, what's going on? Well, it's not only those kinds of pressure is think about the different mentality someone has about money. So someone might say, well, you know, what if Britney Spears, and again, or anybody of that, fame and fortune said, well, I'm going to go blow $50 million on something. And everyone in the family or the surrounding entourage goes, oh, but there's all that money, you're going to be

wasting this, that, the other. If in her mind she can make a million dollars doing two shows, for her it doesn't matter. So the sense of proportionality is different. The experience is different. And for us to pathologize it, I think, is a problem, unless there's clear diagrams. diagnostic kinds of criteria met for a diagnosis. So just to say it's aberrant behavior without being able to define it as a DSM-5 diagnosis, that's where I think we get into trouble because we're not talking about mortal humans as we tend to be. Mark, you raise your hands.

Yeah, so I thought about this today. And, you know, my brain is odd to say the least. but I was thinking right on your point about, you know, bad behavior or destructive behavior or wrong decisions that people might be allowed to make. Question, would Amy Winehouse have preferred to have her father be more aggressive and gotten a conservorship over her for her alcoholism and still be alive today? Or would she rather burned out the way she did? I don't even know the specifics of that story, but I think in general, like, I think it, I think it bakes the deeper question of should people be allowed to make mistakes.

Right. And like, what is the cost of not having that, right? If, like, every time... You're not allowed to learn. You get locked up. It's like you're... It's like exercise, okay? I would desire all my patients and all the professionals listening.

to this podcast, you should exercise. Strength training, cardio, do both. But if I were to force you to exercise, you would actually be more stressed out and you would actually be more miserable and more unhappy. So that's what they found this in rats. If rats spontaneously exercise, it's really good for them. If they're forced to exercise, it's really bad for them. And so now you're, if you, so if you create a society where there's so much control, it actually is like very stressful. So the fact that Brittany, in the midst of the conservator, in the midst of all these pressures,

is still performing for multiple years. She wanted to quit. It's still doing tours. I think just because she wants this thing to stop. Yeah. And she knows like she has to almost go broke before it stops. Or that's what she said, allegedly. In some way, it's almost like she's been living a Kafka novel, right?

I mean, when you're talking about stress of being forced to do stuff, when you listen to her testimony, one way of looking at that is like, oh, she's crazy. And then another way of looking at that is listening to that going, this woman's been made crazy. She's been pressured and controlled and gaslighted and convinced that she's crazy and not been giving any sort of place to flourish. I mean, I'm not a Rousseauian that I want to like open up the mental institutions. and let everybody be free, but I agree with your point on more freedom is better than less freedom. And it's a difficult, it is a difficult, difficult, difficult dance to deal with family members because I have family members calling me all the time screaming at me about, you know, we should stop the person from doing that.

But people are allowed to make bad decisions. That's the definition and cost of freedom. Yeah. If one has capacity, one should be allowed to make bad decisions. If one doesn't have capacity, then there's a reason to have a parental kind of oversight and care. Well, let's talk about that. What do you mean by capacity? Because I, you know, doctors and lawyers are often like cats and dogs, right?

We don't get along. Doctors drive me crazy because they're like the only profession that feels that they're exempt from the law. And doctors have this idea that capacity is like this one thing that's either on or off. But from the legal perspective, it's a full spectrum. Way at the top is contract capacity and way at the bottom, the last thing the court will take away from you is your right to vote. And in between there is a whole rainbow myriad of different levels of capacity. And that's only one dimensional. The four dimensional part of it is it happens over time.

So someone could have capacity on one day or one moment to do something. not on the next. That's my understanding. And I'd agree with you. It's not only that, but it's also contextually capacity, that someone might have capacity standing next to their father or mother, someone who's supportive and yet standing next to a physician that they think might be out to get them might not have capacity. So I agree with you.

It's not a global kind of concept. And in fact, hopefully conservatorship would be focused on limiting those things to where someone doesn't have capacity. What I'm referring to is the capacity to make, in general, a kind of choice. And that would, when we talk about capacity and psychiatry, again, we're not talking about competency. That's a legal term. But capacity is where someone can communicate having made a choice, where they evince

understanding of the consequence of that choice and can discuss or at least give some demonstration of risk-benefit reasoning analysis, and then also be able to appreciate for themselves what those kinds of consequences might be. So there's a whole realm of cognitive processing that needs to be demonstrated, not just, it's the difference between consent, informed consent, versus assent, just saying, yes, go ahead and do what you need to do. That's not consent. That's assenting to something. And so the, the, the point. process that usually would lead, at least in Florida, to the idea of guardianship is that someone would have to lack that distinct processing capacity that I was describing. And I don't know,

you know, I don't know Brittany from Boo, but I would suspect that that kind of processing evaluation would be very important for them to be able to have a conservatorship. Mark? Yeah, it's a, it is a difficult area. I think a lot of doctors just want to see it as an on-off switch. That's certainly, and maybe law sees it that way too, because the Judicial Council form for the capacity declaration just has one thing that says capacity or not. And that's just not really the way. Well, I appreciate your nuance, Mark. I really do. And I also, I think we're, where, what you said is most interesting probably for those who are very curious about the Brittany thing is that they just gave

her the right to hire her own lawyer. So this was a recent hearing. It was the second hearing that's kind of public. And that, you're saying, is the highest level of capacity evaluation. Correct. So that's very hopeful for those of you who want to free Britney. That the highest level. Also, Brittany, if you're listening to this, Mark, you know, he's just in San Bernardino. I'm looking at his desk right now and it looks pretty empty. So, oh, bad. You didn't ask me the most important question. What's the most important question?

What am I drinking? Does that change your capacity, Mark? Well, I want to know what you're drinking, Mark. It's after 4 o'clock and I'm an Irish attorney. so you're going to have to deduce it. Okay. It's going to be red breast 12. Oh, I did have a bottle of red breast from a really good client, but I finished it.

No, unfortunately, well, fortunately or unfortunately, which everyone didn't want to look at it, it's just that Jameson, which is probably too cliche, but if you double down in a cliche, does it become not a cliche anymore? No, it's still very pedestrian. All right. Okay, so I wanted to talk a little bit about treating people. who are influencers who maybe have a lot of money. Dr. Harding,

anything that kind of is coming to the top of your mind of unique things that providers should be aware of? Yeah, and as a psychiatrist, you're very well aware that the relationship is the key thing in providing any kind of help to someone in psychiatry. And the nature of the relationship with folks of power, stature, and money is often very skewed. I was working with a professional basketball player

who was referred to me because he was getting into trouble because he was hanging around with people who were clearly just wanting pieces of him, things that he could bring to the table for them. And we had a long discussion, and his final conclusion was it might be wise to stick with the friends

that were always his friends because he knows and they know him and they're not wanting a piece of him just to have a piece of him. Another example that it's just different. I was counseling with a player, this was a baseball player who wanted to go to lunch and talk over lunch, and I said, sure, we can do that. And so we went to his favorite restaurant, which was Sizzler. And that was fine.

We went through the cafeteria style line. And when I got my salad and he got whatever. he was getting, he turned to me and he said, Doc, this one's on me. And I said, no. And he said, why not? Because my salad came to like $3. And he knew full well that I knew that in today's money, he was making at that time about $50,000 a day. So totally different realm than where I live. And when he said, you know, it's really no skin off my nose to buy your lunch for $4. I knew what he meant. And what I told him was, look, I know that doesn't mean something to you, but it means something to me.

I don't want you to give me anything. I want you to know that I'm here for you and I want nothing in return. And that was something that was important to him. The money didn't matter because money didn't matter to him. But to have someone say, no, there's a principle here that I'm here for you really meant something to him. And it opened up our discussions thereafter. Yeah. I would say kind of one of the things in that is the frame. You know, these are the rules of engagement for doing psychiatry, doing psychotherapy, don't have sex with your patients, don't enter into business ventures, which, by the way, Dr. Harding wants to do an episode on that. So we've priorly talked about doing a deep dive into that topic for the benefit of mental health professionals. because there will be solicitations, right, from patients.

So, number one, don't sleep with your clients. Number two, don't enter into any business ventures. And then number three, what I would say is don't change the way you treat patients, the cost of treating, just because they're famous. And specifically, like, for myself, I have, you know, a cash pay price. It doesn't change above. a certain rate, that's my high rate, for anyone, right, irrespective of how wealthy or how powerful or how influential there. And, you know, I've had people who have wanted to give me large sums

of money in a paper bag to do different things, one to hire his son to do something. He didn't want his son to know where he was getting his money. He wanted, you know, the son was fairly independent. So I said, hey, can you take this bag of money and hire my son to do a website for you? And I looked at him and I was, there was a moment of temptation. I needed a website. And then there was a this is going to, this is going to get messy really quickly. And luckily I didn't do it. But, you know, like as a psychiatrist and as a therapist, you will be asked to transgress the frame which you have set up professionally, right? And so the frame is, this is the cost of sessions, this is how long the sessions are, you know, this is the type of relationship we have. And so I think with treating

very wealthy people, I think they appreciate that actually. Well, I think it's more than appreciate it. I think it's of paramount importance because boundaries are so often pushed for these people. As an example, I don't, again, I don't know Brittany's case particularly, but I have heard that her father is not only the conservator, but is also the business manager. Well, that's a de facto conflict of interest, especially if he derives his living from making money as her business manager. It's those conflicted relationships that by definition mean that the boundaries have been blurred at best and destroyed at worst. Well, that's also why I was actually going to bring up, does anyone have a good argument or explanation for why he would be the conservator when she explicitly, like said,

she didn't in the very beginning? You know, I was just wondering, are there rules of conservators? Yeah, it's a priority of appointment. There's a statute, and the statute reads you know what I often tell people when I'm talking to young people who are going to law school or law sense I'm like you don't necessarily need to look up the law just think how should the law work so what would a statute look like for who would have priority of appointment and that's essentially what it is right so it's parents siblings children it just goes in order of family relations so he has priority of appointment so I understand that but I guess because he's involved in other ways, because just from what I understand,

he maybe did not have the closest relationship, you know, compared to her and her mother, the fact that supposedly he has a serious drinking problem. Like, you know, like, is that supposed to be the conservator? And he's involved with the business. Yeah, she probably should have had a private fiduciary. A private fiduciary would have jumped all over it. It would have cost a lot more money.

The father wouldn't have made as much money. And that was my understanding, like, she asked for that. My interesting, I don't know enough about the case, but the thing that's questionable to me is why wasn't her attorney involved in all of these contracts? I mean, if I was court-appointed counsel, I would have been like, there's no contracts being signed without her counsel looking at them. Like, I would have required counsel to sign off on everything. So he may have signed off on everything, in which case he's got some major problems. That's going to come out in discovery when the inevitable lawsuit comes. Yeah. And, you know, for those of you who have started to be more curious about this case, there's a lot out there. And there's stuff that it seems to be like the mainstream media is putting out there. And then there's some really good podcasts. You could do a deep dive. I'm hesitant to express all of my thoughts on all the particulars just because it sounds like a very nice conspiracy theory. It's like a very nice season of,

I totally buy it now. I totally buy it all. I've been following these podcasts. I was telling one of my therapist friends I was going to record this and I was telling him all the details that I'm not expressing here. And he's like, you're, dude, that is so different than your normal podcast. Because, you know, I'm used to like, here's this study and here's what it says, right? And so a lot of this stuff is, what's nice is if you listen to other people who are firsthand

witnesses talk about their experiences. That seems, there seems to be a very big trail of information. There is, so many years. I do think, though, that it's, we should always maintain a note of caution with the salaciousness of something like this, because there are so many perspectives. There's so many people weighing in on this that, you know, unless I as a psychiatrist actually got to examine her, I would be staying away from any pathologizing, and I would instead be talking about the principles of conservatorship and the principles of guardianship and capacity. Because there's so much that is out there that's even contradicting that I can't weigh in as an expert on this case. All I can do is talk about some of the peripheral principles on which it hangs.

Yep. And that being said, like, I think my sort of preaching to our profession would be if you have a high-profile person like this, the normal things that would give you a diagnosis don't apply necessarily. For example, spending lots of money. Okay. Our definition of money is very different. You know, working really hard. Like people in high professions sometimes work 16 hours a day.

you know talking fast people who are highly intelligent always talk fast well wait a minute I mean not not every person who is highly intelligent will be talking fast I'm not always the fastest talker so that doesn't say if I'm intelligent or not but what I'm saying is that like the normal criteria like I've met one person who my attending thought was manic oh and I'm there with her friend who is a surgeon, and he says, this is how she always is. She always talks like this. She's always thinking a little bit paranoid. That's just who she is. This isn't any different than her baseline. And she actually, like, as I got to know her, as a patient, she had a long history of being who she was. It was, like, very baseline. But to a normal person,

that person was really off. This is why in the DSM-5, our diagnostic manual, you can have all kinds of weird presentations, but if you do not have a dysfunctional aspect connected to those things, you don't meet the criteria. So you could talk fast all you want, you could have spending behavior, but if it's not leading to some kind of clear dysfunction,

you don't even meet the criteria for a diagnosis. And that's why what you're saying is so important. If your lifestyle is so different, but it's not leading to dysfunction, welcome to a different lifestyle. And the DSM says that, right? Like, is it clinically significant? And is it culturally, I don't know, I forget the exact word, but culturally irrelevant? Or like, you know, if you take it in the context of that person's culture, where they come from. Yep.

And I've treated different groups of people, which historically have been fighters. Like they come from a long line of. fighters, they're more likely to, they look a little bit hypomanic all the time because they are just built to fight and they're built to conquer and they're built like they're just wired differently, you know? And a lot of the professional athletes, you know, and people who are in these high levels are like, they're just, they're wired a little bit differently, you know? They're willing to work 16 hours a day for 30 years, nonstop. and they're still hungry for more.

Just a hypothymic person. Hyperthymia, right? Yeah. It's a positive trait a lot of times, right? Dr. Hardini. Well, as long as it doesn't lead to dysfunction. Yeah. You know, there are people who are fast, high-energy people.

There are people who are slower energy. Intelligence, yeah, some people who are smart talk fast, but there are some people who just talk fast because their brain works fast and they're not necessarily smart. There's a real diversity in who we are as the human race. And that makes it wonderful and beautiful. The only time it's pathological is if it's leading to poor function. And the real question, I think, again, coming back to this particular case, what was the evidence of prolonged dysfunction?

That someone might have a meltdown and shave their head or get pissed off at something. Again, like you were saying, David, you know, if you've been hounded by the paparazzi, is paranoia a normal response? It very well could be. she's not the only one who's had a response like that. Or like it's, I mean, I watched some of the videos and it was like, it wasn't just the paparazzi like just taking pictures from afar. It was like literally invading her space over and over again. It's like, what's a normal response to someone invading your space? Yeah.

No, I. It's like pushing them away. You know, like, give me some space. That framing. Go ahead, Mark. Yeah, on the issue of the DSM and abnormal psych and. and diagnoses. Specifically, if people, you know, this has been litigated and the law is kind of shifting a little bit,

but there's been some big cases in the last couple of years that have come down, if someone has delusions or hallucinations or, you know, mental breaks where they are believing stuff that is absolutely not true, you can't determine that they don't have capacity to do something unless there is a connection between that delusion and the capacity to do the other thing. Right? So, for instance, if someone still understands who their kids are and if they're married or not and what their property is, if they believe their Barack Obama and the emperor of quantum Zeno and the known universe, they can still do a will. Right? They still meet the criteria. There has to be a connection between their delusion and their capacity to do the thing that you're asking them to do. Yeah, there has to be dysfunction specific to the claimed. pathology because you're right. You could have you could be crazier than or as professor

Alan Stone used to say you have to be bonkers. But even if you're bonkers, if you're able to do the math to be financially responsible, you're financially responsible. Amen. And thus is the incredible frustration of the vast majority of my clients. I mean, this is this is good to point out that conservatorships are in probate court. There's essentially two kinds of courts in any common law system. There's courts of law and there's courts of equity. And probate court is a court of equity. And a court of equity simply means that it's going to take all perspectives

and everyone's vested interests into consideration. So you're down Alice in Wonderland and the rabbit hole, which is frustrating to some parties and exciting to some parties. Talk to me a little bit about how the courts are different. Sure. So courts of law are like civil courts and criminal courts, right? If you're suing some money for money, you're in a court of law. And the hard and fast sort of razor's edge rules of procedures of the law apply. Same's with the criminal court, right? There's some very strict rules that apply that are very frustrating, but cut off people's rights. Courts of equity are completely different. You know, Charles Dickens, his father pressured him to be a lawyer. He went to law school. the first book you wrote was Bleak House, which is a probate case about the court of equity and a will contest that goes on for like 50 years. It's incredibly frustrating to people because it takes forever because in a simple case, you're like,

okay, dad's crazy, we need to get a conservorship. Well, dad can object. Dad has a right to an attorney. Dad has a right to a jury trial. Dad still has a right to decide things even after the conservorship is granted because it's a court of equity and we don't just make decisions based on the law. we make decisions based on the equitable interest of all parties involved for the duration of the life of all the people.

So it's just completely different than it's straightforward. It's more like sociology than it is law. Okay. But then that's interesting how, I don't know, how much she has taken away from her. Right. Right. And some of that, what you were saying to me, Mark, earlier was maybe she didn't quite know that she had more rights than her.

she actually has. Absolutely. Maybe the people are being told that she doesn't have these rights where, like, they don't really know the law. So if you were advising her, you would say, for example, does she have the right to take her IUD out at this point? Yeah, absolutely. Does she have the right to have her own cell phone?

Absolutely. Does she have the right? So what does she not have the right to at this point? It's kind of a, I mean, this is why conservorship law is so frustrating, right? You know, unless you get specific orders, the example I use is, is do not, do not resuscitate, right? So if you want to kill grandma to turn off the machine, you have to get a specific order. Your general conservorship letters and orders don't give you the right to kill grandma and turn off the machine. that law is effectively being applied now to all medical decisions, who you want to see and not see.

So the example I use is if someone was financially abusing grandma and grandma still wants to see the grandchild who was taking money from them, grandma gets to see the grandchild who was abusing them, period. Okay, but what about the money, though? Because if she doesn't have control over her money, how can she control over her money? How can she control over who she hires, who's your therapist, who's your psychiatrist? It seems like she doesn't have that control because she doesn't have the control of money. Right. So the cases that have come down have been on refusing medical decisions and right to see people.

Right. So you can't force, and usually it's a lot of it is dental care. You can't because dental care is fairly intrusive to people. So you can't force people to get certain procedures done unless you get a specific order, like getting an operation, or you can't bar someone from seeing somebody without a specific order. So if someone's in a facility, they get a cell phone and they get to call whoever they want to call. So one of the things that I heard allegedly was that there was a threat, like if you don't do these things, then you won't be able to see your kids. And it seems to me

that that was the most powerful tool to get her to do whatever they wanted her to do. Yeah, we We have a name for that in law. It's called undue influence. Okay. So your understanding, do they have any right to keep her from seeing her kids? If they get a court order. But it would need to be a court order. It wouldn't be a part of the conservatorship automatically. No, and it's no fault of, I mean, I shouldn't say no fault. I don't know if it's a fault of any of attorneys or not, but it's a changing area of law. People think that the general power to control who someone sees comes with the general power of a conservorship. And we know now that it doesn't.

Conservatives are not minors. They get to see whoever they want. I mean, you have to make the analogy to guardianships. Do I get to block the drug addicted dad who just got out of jail from seeing his child when I have a guardianship? Absolutely. Why? Because it's a minor. Do I get to control the grandchild?

child from seeing grandma who stole money. No, why? Because grandma's an adult. Grandma gets to see whoever she wants to see. We can talk about Britney Spears a lot, but maybe for the people listening to this, let's take it to an example that they will probably come across in their life. One of their parents is going to die

after a long marriage. The other parent is probably going to meet someone, enter into a relationship. They're probably going to start spending money on that person. And guess what the kids hate? The kids hate that. Now, did they hate it because the money is being spent? Maybe. Do they hate it because the existential reality that their mother or father has now been replaced? Probably more so, I would say, from a psychological standpoint. What if they're

surviving parent now is making bad decisions and buying cars or spending money or going on trips, but they're having a really good time doing it? They're having fun. They have a girlfriend. They have a boyfriend. They're having some fun at the end of their life, but they're making poor decisions doing it. do the kids have a right to stop them from that happiness at the end of their life because they're spending money on someone that the family doesn't want them to spend money on? Well, define poor decision because that may be a poor decision from the kids' perspective and may be an ideal decision from the surviving spouse. So, again, if it's the spouse's money, unless they don't have capacity to make those kinds of decisions, they should be able to do whatever the heck they want with their money. as I hear that I think to myself how many of my clients have tons of pain due to end of life arguments over money with their you know dying parents or you know some court case that happens afterwards lawsuits or you know forging of the will I mean this stuff is just like, it's insidious.

Well, now multiply it by 60 million. Yeah. It was like 500, I think, when she started. Her state currently is 60 million. Yeah. But see, that might be what you mentioned about people coming in and, you know, not trustworthy people coming in. That seems to be the parents' like argument.

Yeah, okay. We don't want to, I don't know if we want to get into the details of that. Yeah, I don't know the details of that. But I'm not sure anyone really does until these court cases happen. And I imagine they will. I imagine we'll be watching this for some years to come. That was one thing I was thinking about. The other huge psychological burden is child custody battles.

I have never seen men weep in the way that they've wept in my office. and Dr. Harding's nodding his head in absolute affinity with me with this over not being able to see their kids or the battle and there's lies that are brought out. I can't tell you. I think I've heard from in these cases that lawyers are telling one of the parties to lie, like your dad abused you, you know, stuff like that. And it just tears the men and women apart. not being able to see their kids, brutal, absolutely brutal.

So talking about a stress Brittany had early on after the divorce, just brutal. So painful. So if you're listening to this and you've had a taste of that, I mean, my heart just goes out to you. That is so painful. I can't think of anything more gut-wrenching. No. Being the doting father of two lovely daughters, there is nothing that would get to me. so much as any possible threat to them or my separation from them.

Yeah. And I could even amplify it even more. It's like when they know that the step parent is abusive. Like that just amplifies it like even more. It is so painful. And it's ongoing. And you have to turn your kid to them. As a therapist, like I am sitting with them not one time to help them processes.

It's ongoing. for decades. It's, oh gosh. Mark, what do you thinking, man? What I'll say about your connection to the custody thing is, just this, given my bias, coming from a philosophy standpoint, is I think that that's why that's so emotional

is the same issue as to why the emotionality on the back end of life, meaning kids dealing with their parents dying is the same. You know, Shakespeare said all's well, but ends well. And so if you're a parent and you feel like you're never going to get to see your child again, you feel like the end is going to be bad. And when you're a child and you're watching your parent go off the cliff with these different mental problems, you feel like the end is going to be bad. And so a lot of times people just need to hope that the end is going to be good, all as well that ends well.

So if you can give people hope that there's going to be some goodness to come out of things, to find some goodness in things, then there's, perspective changes and people are remarkably, have a remarkable ability to flourish once they feel like there's some hope. You know, to that point, I was thinking about Britney Spears, and I think her best years are ahead of her. I could see her acting in some like movies where she maybe gets to manifest some of these like, you know, voices that she hasn't been able to have in the midst of these dynamics, you know? I can see her having an acting career. I want to put that on record right now. We'll refer back to this in 10 years. I'm thinking some action films to

Brittany, if you're listening to this. I could see that. Couldn't you see her? She's done kind of action in some of those music videos. Couldn't you see her kind of like taking like? Yeah. Okay. Hey, any final words? Let's just wrap it up right now. Dr. Harding. Yep. Any final words? Any final thoughts? No, look, I, I, the only final thought is that I think that this is the kind of thing that is important for society to get clarification on because this is a very painful area and this is just writ large but like you were talking about some of your clients you know these are very painful parts of life and if we can get clarification so people have a good idea of what they can and can't do what a conservatorship does lead to and what it doesn't necessarily lead to how you can challenge it

I think if those things can be clarified, then some of the pain that some people are experiencing with these may be mitigated. Serena, last thoughts? Yeah, I mean, I guess just the long same thing. These kind of conservatorships are put in place to help people, right? To help people with disabilities, and we don't want to see them used to hurt people further. So kind of just that clarification or if things need to be added to the law or, you know, Yeah. I think we need more whistleblowers when the obvious, if abuse is happening, I think we need more whistleblowers in our profession. Yeah. I don't know if you guys have seen the movie. I care a lot. No. No. Yeah, talk about conservatorship gone crazy. Mark, you've seen that?

Yeah, it's about a very famous case in San Bernardino, actually, that I worked with attorneys who worked with that attorney for years. even it's it's so specific even down to the strange involvement of the russian mafia really i thought that was fabricated but that's fast i thought it was too and then i asked one of the attorneys who knew that attorney very well and she was like oh no no she was involved with the russian mob okay only in san bernadino only in san vernonino who mark any final thoughts yeah don't blame the legal profession there's good for people and bad people in all professions doctors lawyers police officers officers there's good lawyers, bad lawyers. If lawyers simply followed the rules and their oath that they were given,

a lot of these problems wouldn't exist. Hey, Mark, do you think we were blaming the legal profession today? Me? No, but I think people want, the problem is bad law comes out of bad cases, right? So we don't need to change the laws. We just need better people in the law doing their damn job. Mark, I'm going to jump in because I don't think it's all an attorney issue. still have questions as to how a 5150 could have been parlayed into the conservatorship

without a good diagnostic workup from an impartial clinician. So I think physicians need to take some responsibility here as well. Oh, and it was renewed by multi, you know, there's so many players involved. Yeah. And we could go on, you know, like how we do the 5150 being very articulate, very accurate writing only the truth into those, I think is very important. Last note, I'll say this. From what I read and from what I listened to, Brittany has the best thing going for right now. She has a fantastic judge, and that judge is starting to make decisions in her favor, and she's got a really good judge for her case. Is it a new judge, or is this judge she's always had? No, it's a new judge for her case. I think it's a really, she's really good. I've been reading me up on her,

and she's very well respected and listening to her make decisions, it's a good thing. Oh, okay. Well, I think there's two things going with her. Being able to choose her own counsel, a good judge, and also a good fan base. Because honestly, like, I think the fan base is so powerful, the Free Brittany Warriors, right, out there who might be listening to this, they're so powerful. And I think they've put, they've moved things forward. Yeah, the irony is that a fan base like that may have been able to see more of the clear truth and reason than some of the players that have been too close. Yeah. And I think that's like that there are thousands of investigative journalists.

And that's kind of like what me and Serena were like digging it to. New careers here. Oh, man. All right, man. All right. We'll sign off. It's very nice to see you. Take care.

All right. Well, I hope that you have enjoyed this episode. It's a little bit different. If you have any thoughts, please reach out to me on Instagram. We'd love to hear your DMs if this was an interesting episode for you. If you have any other ideas on future episodes, I would love to hear from you. And if you would like to ask Dr. Harding, any other questions, we'll have them back in the future. He's a new neighbor of mine.

a new colleague and a rower as well. I got to get back on the water. All right. Take care.