Public Treatment, Private Anguish
I’ll send you the statistics on AIDS in New Jersey. Look at Newark and weep,” said Sylvia Woodaman Pollock ’63, a clinical psychologist from Madison, New Jersey, who works with children and families infected and affected by the AIDS virus.The municipality in which Newark lies, Essex County, reported 8,031 cases of AIDS as of June 30, 1995. Neighboring Morris County, home to suburban Madison, reported just 503 such cases. For Pollock, a member of the Task Force on AIDS for the New Jersey Psychological Association, the tremendous statistical disparity between these two very different communities does not diminish one essential truth: “People would really like it to go away, but AIDS is one of the major moral issues of our time: whether we will blame ortreat infected individuals.”
Until last October, Pollock served as supervising psychologist at Newark Beth Israel Medical Center’s Community Mental Health Center, where she worked with HIV-infected patients and established a clinic for children with Attention Deficit Disorder.
Recently, she became the psychologist in the hospital’s infectious disease department. The change allows Pollock to focus exclusively on AIDS and on teaching mental-health professionals how to treat the disease’s unique mental ravages. Nothing, said Pollock, prepares a therapist to understand the stigma endured by AIDS patients and their families. “You have to have a patient show up at your door to understand that this disease is in a class by itself,” said Pollock, who also maintains a private practice in Madison.
As a mental-health professional treating patients infected with the disease, Pollock understands the struggle between individual and societal rights: the individual’s need for confidentiality versus the public’s need for disclosure and safety. “If we don’t strike a balance, we’re in trouble.”
This becomes an especially contentious tug of war in the age of managed care, in which insurance companies are watchful parties to health-care decisions. At risk, according to Pollock, is confidentiality — how to keep a person’s HIV status between doctor and patient only. “I can’t tell you how much time I spend thinking about strategy. Whenever you involve another agency, you risk disclosure,” she said, referring to the written justification mental-health practitioners must provide insurers before they will pay for therapy. “Managed care and privacy don’t go together these days. It puts a tremendous pressure on those affected by the virus.”
The question of confidentiality rears its head again when Pollock must justify to an insurance company a patient’s continued visits beyond the usual six-to-ten limit. If the patient’s HIV/AIDS status is disclosed to the insurance company, said Pollock, he or she faces many potential risks, despite antidiscrimination laws. “That’s where I do my pro bono work,” she said. “How can you tell someone with AIDS that they’ve run out of sessions?”
Although Madison is a mere ten miles from Newark, “they are worlds apart,” said Pollock. Because AIDS affects so many inner-city families, it’s discussed more openly than in the suburbs. People in the inner city don’t fear the stigma or the loss of emotional support quite as much. “In the suburbs, people pretend it’s not here,” said Pollock. “Infected people here live with a different kind of fear. It’s a terrible secret.”
Often, patients will see her without mentioning their illness. She saw one man for a year before he found the courage to disclose his diagnosis. When she asked him why it took so long, he replied: “I was afraid you wouldn’t see me anymore.”
In the early 1970s, after earning her master of education degree from Tufts, Pollock met Sam Braun, a child psychiatrist who hired her to establish a therapeutic nursery school at the Somerville (Massachusetts) Guidance Center. Her alliance with Braun crystallized Pollock’s commitment to linking psychology with education. She returned to graduate school and in 1985 earned an education specialist degree in school and community psychology from Seton Hall University.
She then worked for five years as a school psychologist in New Jersey, pursuing her doctorate in clinical psychology at Seton Hall. “If I was going to work with kids, I needed to know what a powerful piece of the puzzle the school experience really is,” she said.
Indeed, it was a child who became one of the most important catalysts in her professional life. During a 1987 doctoral internship at the University of Medicine and Dentistry in New Jersey, Pollock was assigned to work with a seven-year-old girl with AIDS. She was suffering from depression after having already lost her mother, father, and sister to the disease. “She really changed my life,” Pollock said. The child died at age nine.