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      in Music

      Testing Britney Spears: Restoring Rights Can Be Rare and Difficult

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      To get out of conservatorship, the pop star will likely have to undergo a psychiatric evaluation, an uneasy melding of legal standards and mental health criteria.Her voice quaking with anger and despair, the pop star Britney Spears has asked repeatedly in court to be freed from the conservatorship that has controlled her money and personal life for 13 years. What’s more, she asked the judge to sever the arrangement without making her undergo a psychological evaluation.It’s a demand that legal experts say is unlikely to be granted. The mental health assessment is usually the pole star in a constellation of evidence that a judge considers in deciding whether to restore independence.Its underlying purpose is to determine whether the conditions that led to the imposition of the conservatorship have stabilized or been resolved.The evaluation process, which uneasily melds mental health criteria with legal standards, illustrates why the exit from strict oversight is difficult and rare. State laws are often ambiguous. And their application can vary from county to county, judge to judge, case to case.Isn’t Ms. Spears’s artistic and financial success proof she is self-sufficient?Yes and no. A judge looks for what, in law, is called “capacity.” The term generally refers to benchmarks in a person’s functional and cognitive ability as well as their vulnerability to harm or coercion.Under California law, which governs Ms. Spears’s case, a person deemed to have capacity can articulate risks and benefits in making decisions about medical care, wills, marriage and contracts (such as hiring a lawyer), and can feed, clothe and shelter themselves.Annette Swain, a Los Angeles psychologist who does neuropsychological assessments, said that because someone doesn’t always show good judgment, it doesn’t mean they lack capacity. “We all can make bad decisions at many points in our lives,” she said. “But that doesn’t mean that we should have our rights taken away.”Even so, Ms. Spears’s professional and financial successes do not directly speak to whether she has regained “legal mental capacity,” which she was found to lack in 2008, after a series of public breakdowns, breathlessly captured by the media. At that time, a judge ruled that Ms. Spears, who did not appear in court, was so fragile that a conservatorship was warranted.Judges authorize conservatorships usually for one of three broad categories: a severe psychiatric breakdown; a chronic, worsening condition like dementia; or an intellectual or physical disability that critically impairs function.Markers indicating a person has regained capacity appear to set a low bar. But in practice, the bar can be quite high.“‘Restored to capacity’ before the psychotic break? Or the age the person is now? That expression is fraught with importing value judgment,” said Robert Dinerstein, a disability rights law professor at American University.Records detailing grounds for the petition from Ms. Spears’s father, Jamie Spears, to become his daughter’s conservator are sealed. A few factors suggest the judge at the outset regarded the situation as serious. She appointed conservators to oversee Ms. Spears’s personal life as well as finances. She also ruled that Ms. Spears could not hire her own lawyer, though a lawyer the singer consulted at the time said he thought she was capable of that.Earlier this month, Los Angeles Superior Court Judge Brenda Penny said Ms. Spears could retain her own counsel.Does “capacity” differ among states?Yes. Some states, like California, detail basic functional abilities. Others do not. Colorado acknowledges modern advances like “appropriate and reasonably available technological assistance.” Illinois looks for “mental deterioration, physical incapacity, mental illness, developmental disability, gambling, idleness, debauchery, excessive use of intoxicants or drugs.”Sally Hurme of the National Guardianship Association noted: “You could be found to be incapacitated in one state but not in another.”Who performs the psychological assessment?Ideally, a forensic psychiatrist or a psychologist with expertise in neuropsychological assessments. But some states just specify “physician.” Psychiatrists tend to place greater weight on diagnoses; psychologists emphasize tests that measure cognitive abilities. Each reviews medical records and interviews family, friends and others.Assessments can extend over several days. They range widely in depth and duration.Eric Freitag, who conducts neuropsychological assessments in the Bay Area, said he prefers interviewing people at home where they are often more at ease, and where he can evaluate the environment. He asks about financial literacy: bill-paying, health insurance, even counting out change.Assessing safety is key. Dr. Freitag will ask what the person would do if a fire broke out. “I’d call my daughter,” one of his subjects replied.Who chooses the evaluator?Ms. Spears has not been able to choose her evaluators in the past because the conservator has the power to make those decisions. However, if she moves to dissolve the conservatorship, she can select the evaluator, to help build her case. If the conservator, her father, opposes her petition and objects to her selection, he could nominate a candidate to perform an additional assessment. Ms. Spears would likely pick up both tabs as costs of the conservatorship.To avoid a bitter battle of experts and the appearance that an assessor hired by either camp would be inherently biased — plus the strain of two evaluations on Ms. Spears — the judge could try to get both sides to agree to an independent, court-appointed doctor.What impact does a mental health diagnosis have on an evaluation?Many states explicitly say that a diagnosis of a severe mental health disorder is not, on its own, evidence that a person should remain in conservatorship.Stuart Zimring, an attorney in Los Angeles County who specializes in elderlaw and special needs trusts, noted that he once represented a physician with schizophrenia and bipolar disorder who was under a conservatorship. The doctor’s rights were eventually restored after he proved he was attending counseling sessions and taking medication.“It was a joyous day when the conservatorship was terminated,” said Mr. Zimring. “He got to practice medicine again, under supervision.”The association between the diagnosis of a severe mental disorder and a determination of incapacity troubles Dr. Swain, the Los Angeles psychologist.“Whatever they ended up diagnosing Britney Spears with, was it of such severity that she did not understand the decisions that she had to make, that she could not provide adequate self-care?” she asked. “Where do you draw that line? It’s a moving target.”Does the judge have to accept an evaluator’s findings?No, but judges usually do.What standard does a probate judge apply to reach a decision?In most states, when a judge approves a conservatorship, which constrains a person’s autonomy, the evidence has to be “clear and convincing,” a rigorous standard just below the standard of “beyond a reasonable doubt.”But when a conservatee wants those rights restored, many experts believe the standard should be more lenient.Some states indeed apply a lower standard to end a conservatorship. In California, a judge can do so by finding it is more likely than not (“preponderance of evidence”) that the conservatee has capacity. But some states say that the evidence to earn a ticket out still has to be “clear and convincing.”Most states do not even set a standard.“There’s an underlying assumption that if you can get the process right, everything would be fine and we wouldn’t be depriving people of rights,” said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. “Our take is that the process is fundamentally broken and that we shouldn’t be using guardianship in so many cases.”If someone is doing well, isn’t the conservatorship no longer necessary?Yes and no. “Judges are haunted by people they have had in front of them who have been released and disaster happens,” said Victoria Haneman, a trusts and estates law professor at Creighton University. “So they take a conservative approach to freedom.”Describing the Kafkaesque conundrum of conservatorship, Zoe Brennan-Krohn, a disabilities rights lawyer with the American Civil Liberties Union, said: “If she’s doing great, the system is working and should continue. If she is making choices others disagree with, then she’s unreliable and she needs the system.”Or, as Kristin Booth Glen, a former New York State judge who oversaw such cases and now works to reform the system, put it, “Conservatorship and guardianship are like roach motels: you can check in but you can’t check out.”Can an evaluator recommend a less restrictive approach than a conservatorship?At times. Judge Glen once approved the termination of a guardianship of a young woman originally deemed to have the mental acuity of a 7-year-old. After three years of thoughtful interventions, the woman, since married and raising two children, had become able to participate fully in her life. She relied on a team for “supported decision making,” which Judge Glen called “a less restrictive alternate to the Draconian loss of liberty” of guardianship.A supported decision-making approach has been hailed by the Uniform Law Commission, which drafts model statutes. It has said judges should seek “the least restrictive alternative” to conservatorship.To date, only Washington and Maine have fully adopted the commission’s recommended model. More

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      in Movies

      Dr. Aaron Stern, Who Enforced the Movie Ratings Code, Dies at 96

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      He was a New York psychiatrist who went to Hollywood to help lay down guidelines for sex and violence in films. Not everyone was pleased.Dr. Aaron Stern, a psychiatrist who as head of Hollywood’s movie rating board in the early 1970s established himself as filmgoers’ sentry against carnal imagery and violence, died on April 13 in Manhattan. He was 96.His death, in a hospital, was confirmed by his stepdaughter Jennifer Klein.An author, professor and management consultant who had always been intrigued by corporate ladder-climbing, he jousted with egocentric studio executives, producers, directors and actors — providing ample grist for his 1979 book, “Me: The Narcissistic American.”From 1971 to 1974, Dr. Stern was the director of the self-policing Classification and Rating Administration of the Motion Picture Association of America, which had been founded only a few years earlier. It replaced the rigidly moralistic Production Code imposed in the early 1930s and censoriously administered by Will H. Hays, a Presbyterian deacon and former national Republican Party chairman.The new ratings board, which was struggling to gain credibility when it began, graded films by letter to let moviegoers know in advance how much violence, sexuality and foul language to expect on the screen.The board’s decision that a film merited a rating of R, or restricted, might lure more adults, but would immediately eliminate the pool of unchaperoned moviegoers under 17; an X rating would bar anyone under 17 altogether.Dr. Stern recast the PG (parental guidance) category to include a warning that “some material might not be suitable for pre-teenagers.” He also tried, but failed, to abolish the X rating — on the grounds, he told The Los Angeles Times in 1972, that it wasn’t the job of the Motion Picture Association to keep people out of theaters. (The X rating was changed to NC-17 in 1990, but its meaning remained unchanged.)Not until last year, with the release of “Three Christs,” a movie about hospitalized patients who believed they were Jesus, did Dr. Stern receive a screen credit (he was one of the film’s 17 producers). But the lack of onscreen recognition belied the power he wielded as director of the board, which privately screened films and then voted on which letter rating to impose.Even some critics gave the new letter-coded classification the benefit of the doubt in the early 1970s, agreeing that its decisions, in contrast to those of the old Production Code, were becoming more grounded in sociology than theology. Still, two young members of the rating board, appointed under a one-year fellowship, wrote a scathing critique of its methodology that was published in The New York Times in 1972.They accused Dr. Stern of megalomaniacal meddling, editing scripts before filming and cropping scenes afterward, and of tolerating gratuitous violence but being puritanical about sex. They claimed, among other things, that he had warned Ernest Lehman, the director of “Portnoy’s Complaint” (1972), that focusing on masturbation in the film version of Philip Roth’s novel risked an X rating.“You can have a love scene, but as soon as you start to unbutton or unzip you must cut,” Dr. Stern was quoted as saying in The Hollywood Reporter about sex in movies.The Times article prompted letters praising Dr. Stern from several directors, including Mr. Lehman, who said that Dr. Stern’s advice had actually improved his final cut of “Portnoy’s Complaint.” To which The Times film critic Vincent Canby sniffed, “If Mr. Lehman was really influenced by Dr. Stern’s advice two years ago, then he should sue the doctor for malpractice.”Dr. Stern argued that the rating system, while imperfect, served several goals. Among other things, he said, it fended off even more restrictive definitions of obscenity by Congress, the courts and localities; and it warned people away from what they might find intrusive as mores evolved and society became more accepting.“Social growth should make the rating system more and more obsolete,” he told The Los Angeles Times.Members of the movie rating board privately screened films and then voted on which letter rating to impose. An R rating might lure more adults, but would immediately eliminate the pool of unchaperoned moviegoers under 17.Motion Picture Association of AmericaAaron Stern was born on March 26, 1925, in Brooklyn to Jewish immigrants from Eastern Europe. His father, Benjamin Israel Stern, was a carpenter, and his mother, Anna (Fishader) Stern, was a homemaker. Raised in Bensonhurst and Sheepshead Bay, he was the youngest of three children and the only one born in the United States.After graduating from Brooklyn College in 1947, he earned a master’s degree in psychological services and a doctorate in child development from Columbia University, and a medical degree from the State University of New York’s Downstate Health Sciences University.In addition to his stepdaughter Ms. Klein, he is survived by his wife, Betty Lee (Baum) Stern; two children, Debra Marrone and Scott Stern, from his first marriage, which ended in divorce; two other stepchildren, Lauren Rosenkranz and Jonathan Otto; and 13 grandchildren.Dr. Stern was introduced to Jack Valenti, the president of the Motion Picture Association, by a neighbor in Great Neck, N.Y., Robert Benjamin, an executive at United Artists. He initially began reviewing films for the association and was recruited by Mr. Valenti to run the ratings administration in mid-1971.He left there early in 1974 to join Columbia Pictures Industries and eventually returned from Los Angeles to New York, where he revived his private practice. He also taught at Yale, Columbia, New York University and the University of California, Los Angeles, and he served as chief operating officer of Tiger Management, a hedge fund, and a trustee of the Robertson Foundation.A veteran educator at NewYork-Presbyterian/Columbia University Irving Medical Center, Dr. Stern, with his wife, donated $5 million in 2019 to endow a professorship and fellowship at Weill Cornell Medicine to treat patients with pathological personality disorders. The gift was in gratitude for the care he had received during a medical emergency.Dr. Stern had been interested in narcissism even before he went to Hollywood, but his experience there proved inspirational.In “Me: The Narcissistic American,” he wrote that babies are born narcissistic, unconcerned about whom they awaken in the middle of the night, and need to be disciplined as they mature to take others into account.“When narcissism is for survival, as with the infant and the founding of a country,” he wrote, “it is not as destructive as when one is established, successful and affluent.”In 1981, Mr. Valenti told The Times that he had “made a mistake of putting a psychiatrist in charge” of the ratings system. Dr. Stern replied, “I am at a loss to respond to that.”But he had acknowledged, when he still held the job, “There’s no way to sit in this chair and be loved.” He was constantly second-guessed.Why give “The Exorcist” (1973) an R rating? (“I think it’s a great film,” he told the director, William Friedkin. “I’m not going to ask you to cut a frame.”) Why originally give Stanley Kubrick’s “A Clockwork Orange” (1971) an X for a ménage à trois filmed in high speed? (“If we did that, any hard-core pornographer could speed up his scenes and legitimately ask for an R on the same basis.”) Later, as a private $1,000-a-day consultant, he helped edit Mr. Friedkin’s “Cruising” (1980), about a serial killer of gay men, to gain an R instead of an X.“You can only rate the explicit elements on the screen — never the morality or the thought issues behind it,” Dr. Stern said in 1972. “That is the province of religion, leaders, critics and each individual.” More

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      in Television

      ‘In Treatment’ Is Back. How Does That Make You Feel?

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      Pandemic tensions led HBO to make a new version of the therapy drama, which stars Uzo Aduba and aims to reduce stigmas about mental health care.The writer Jennifer Schuur (“My Brilliant Friend,” “Unbelievable”) has seen the same therapist every week for 17 years. “It is one of the most significant relationships of my life,” she said. Sometimes friends and family question that longevity. More