Wednesday, March 30, 2016

How to Create a Sociopath: Part 1

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3

Let us to have to look at the healthcare system from a forensic psychosocial and an organizational psychological perspective. At what point do these standards become the universally accepted standard of care (the hundredth monkey effect)?

To a certain extent it is group dynamics where individuals with similar characteristics band together to strengthen and protect the group. The group develops an "us-and-them" mindset to protect the group from outsiders. This is hardwired into our brains after millions of years of evolution stemming from when the first humans huddled together in a cave. A very good illustration of this is The Third Wave (a social experiment undertaken by history teacher Ron Jones with sophomore high school students Cubberley High School in Palo Alto, California, during the first week of April 1967).

I believe that the answer can be gleamed if we can simply answer one of the largest ethical dilemmas faced recently by healthcare: the justification of pelvic exams on anesthetized female patients.

Dr. Peter Ubel writes, "I felt a woman’s uterus without her permission." We all know that the research he did in to the subject changed laws. What about all the other physicians who graduated medical school more than 20 years ago?

What is more disturbing is that beyond losing their license or criminal charges, no physician that I know of (other than Ubel... maybe), that has stood up, admitted what they did, and apologized. Whether it be eugenics, the Holocaust, Tuskegee, or the CIA use of physicians for torture after 9/11. So what do they really believe? Physicians are entitled to a patient's body but don't get caught? I know (what I think to be) many good, ethical physicians who are truly empathetic to patients.

This begs a serious question about the ability of healthcare providers ethical decision making, just by the nature that there has be no apologies. It seems that the outliers in respect to the pelvic exams are Dr. Peter Ubel, Dr. Michael Greger, and Hilary Gerber are the outliers.

The 1847, the inaugural Code of Ethics of the American Medical Association (AMA) stated, “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them.

Let me also address "Great men are almost always bad men". That is the complete quote of John Emerich Edward Dalberg-Acton. I think the better quote is "Power tends to corrupt, and absolute power corrupts absolutely."

Another issue that these theories of "The Lucifer Effect" that we are exploring here fails to address the issue of "great men." The reason for this is that there are 2 groups that dehumanize patients in the healthcare setting; those born sociopaths and those suffering "The Lucifer Effect" (out-group sociopathy, situational sociopathy, or learned sociopathy, perhaps...).

The first group, those who are sociopaths before entering the medical profession also tend to be megalomaniacs. Healthcare is just a way that they can disguise their deviant behavior and avoid being caught. There is a certain amount of truth in the portrayal of Hannibal Lecter and other modern sociopaths having a connection to the medical/psychological professions. Even Jack the Ripper was thought to be a surgeon.

The second group are just ordinary people. I think they are best described by Admiral William (Bull) Frederick Halsey Jr.; 
“There are no great men. Just great challenges which ordinary men,out of necessity, are forced by circumstance to meet.” These are the people that we call "great." Many such Mahatma Gandhi and Mother Theresa would describe themselves as very ordinary people. Perhaps that is the problem, coming from ordinary, that newfound power is like an addictive drug or an aphrodisiac.

Let me illustrate with Shakespeare's "The Tempest," transformed in this landmark science-fiction film; Forbidden Planet (1956).

Space men travel to a planet ruled by expatriate Pidgeon who has built a kingdom with his daughter and obedient robot Robby. There the good doctor is plagued by his mad quest for knowledge through his "brain booster" machine. Ostrow explains to Adams that the Great Machine was built to materialize anything the Krell ( the original alien inhabitants) could imagine, projecting matter anywhere on the planet. However, with his dying breath, he also says the Krell forgot one thing: (Freudian) "Monsters from the id!" Adams asserts that Morbius' subconscious mind, enhanced by the "plastic educator", can utilize the Great Machine, recreating the Id monster that killed the original expedition and attacked the C-57D crew.

Note: this is a possible explanation of the evolution of "The Lucifer Effect." I will further simplify my example: A physician/resident/clerk, acts ethically in treatment of patients, one day encounters a patient who does not need an intimate exam. The provider pushes for the exam and justifies it to the patient and perhaps to himself as medically necessary. Think Dr. Stanley Bo-Shui Chung (accused of dozens of unnecessary intimate exams on female patients) If for no other reason, then just out human curiosity, he uses the inherent power and achieves the intimate exam. He may not be aware that his motives are non-medical, he may ascribe it to "medical curiosity" or "being thorough." Subsequently, it becomes easier to "push" these exams when the curiosity arises. He feels a sense of satisfaction when these are completed, again he may ascribe the satisfaction not as "sexual" but as "medical."

Eventually there becomes a desensitization to seeing women, to satisfy that nagging curiosity, he progresses to doing this to men too and eventually children. Having been taught to put emotion on the side and rely on logic, he justifies this. The definition of a sociopath is a person who lacks a sense of empathy, moral responsibility, or social conscience, and devoid of emotion. Lacking emotion and conscience, logic is the only tool used to make decisions. The goal that logic is direct to is determined solely by our pleasure drives (the id).

(Reference: Id, Ego and Superego .)

That is because a medical education conditions the Superego out of decision making because the Superego makes mistakes. It makes choices that counter logic (the Ego). Logical thinking is encouraged. The Ego grows and the Superego is reduced. The medical education takes no account for the ID. Saying that medical students are taught ethics does nothing, that would be the ID, which is repressed by the medical education.

The pattern of escalation follows that of a serial killer to the point where the devient behavior has become normative. (See: John E. Robinson, Sr.: The first Internet Serial Killer and Serial Killers: The Method and Madness of Monsters.) This endless line of patients satisfies the massive amounts of desire that the Id produces. A few remain unsatisfied and need to progress beyond the professional boundaries. That is where we get our Dr. Melvin D. Levine's (via NY Times), Dr. Nikita Levy's (via CBS), and Dr. William Ayres' (via Mercury News).

Perhaps this can shed light (or vice-versa) on the contemporary and controversial topic of "Radical Islam" I have very good friends who practice Islam, and they, like most Muslims, are good people who condemn these terror acts for what they are. Yet how can some, even Americans, be swayed? Let us look at that culture and see parallels with a medical education. Replace "Islam" with "medical education" and "America/the west" with "patients demanding dignity" and you will see the similiarities.

...While many Muslims adapted to the fast-paced changes common to Western industrialization and modernization, some Muslims rejected them. Instead, they created a rigid ideology imbedded in the traditional values and laws of the Koran. This is the phenomenon known today as Islamic fundamentalism, or Islamism...Islamism came to be seen as a struggle to return to the glorious days when Islam reigned supreme. It represents a yearning for the "pure" Islam as practiced by the prophet. Not unlike the American Amish, the movement rejects much that is innovative. Islamists, however, take the rejection of modernity a step further. They perceive those who have introduced these innovations (the West) as its enemy...Source:

...In some cases, Islamic extremists even describe sharia as a superior form of “democracy” ...Acts of Islamic extremism includes terrorism, human rights abuses, the advancement of sharia-based governance, bigotry towards non-Muslims and rival Muslims and overall hostility to the West and, in particular, Western democracy. ...Islamic extremism is the primary national security and human rights concern of the world today... It is firstly the primary motivator of acts of terrorism worldwide. Secondly, as Islamic extremists gain power and rule, human rights abuses – including oppression of women, homosexuals and religious minorities as well as governmental tyranny, sectarian warfare and bigotry inherent in sharia law – come to the fore...Not all Islamic extremists carry out violent acts. Islamic extremists can advance their goals using non-violent tactics such as activism, developing interfaith coalitions with unsuspecting non-Muslims, fundraising, building political influence and the overall spreading of the ideology. These extremists follow a doctrine called gradualism. The largest Islamic extremist group to use this method is the Muslim Brotherhood.>Source:

Perhaps like paternalism, radical Islam is what we get when when the group refuses to relinquish the archaic rules that solidified their power and status and the subservience of those to whom they were suppose to serve. Just as many radical Muslims were educated in western schools and had western values, they were replaced by a sociopathic ideology that they justify.

I respectfully submit this for critical debate.

Note: I will use the term "pathy" now until I comment on the difference between sociopath and psychopath. This is the article Ray referenced, "How to Tell a Sociopath from a Psychopath" that I will be referencing.

I differentiated between the learned in medical school "pathy" and the born-that-way (psycho)path. The latter being very few in number and more of an anomaly. This will also explain why I used the term "sociopath."

Edwin Sutherland’s Differential Association Theory is one of my favorites. It is where we get the axiom "Prisons don't reform, they make professional criminals." I always finish that with "I went to Catholic School for 12 years, what does that make me?

In regards to psychopath and sociopath i like the differentiation that psychopathy is biological and sociopathy is result of socialization. I think that when "normal" people are socialized, psychopaths are socialized too, but instead of growing empathy for others, they learn how not to get caught. The article that you referenced also stated:

...sychopaths are often well educated... psychopaths carefully plan out every detail in advance and often have contingency plans in place. Unlike their sociopathic counterparts, psychopathic criminals are cool, calm, and meticulous. Their crimes, whether violent or non-violent, will be highly organized and generally offer few clues for authorities to pursue... Psychopathy is related to a physiological defect that results in the underdevelopment of the part of the brain responsible for impulse control and emotions.

That fits perfectly with the Banterings' Theory of Superego Repression (Nullification).

Theories of socialization such as Charles Horton Cooley's Looking-glass Self, George Herbert Mead's Social Behaviorism, Sigmund Freud's Id, Ego, and Super-ego, James Henslin's Gender Socialization and others (Klaus Hurrelmann, Lawrence Kohlberg, Carol Gilligan, Erik H. Erikson, George Herbert Mead, Judith R. Harris) are important for two reasons: First looking at how psychopaths socialize (this is when they learn to mimic emotions among other things) validates the second. The second is we look at how providers are re-socialized to a learned sociopathy (if you will).

Two of these socialization theories stand out in relationship to this thread. Sigmund Freud's Id, Ego, and Super-ego which Banterings' Theory of Superego Repression is based upon. This also takes Freud's theory one step further in that the Ego is attributed as the logic center (the brain) and is separate from the "self." The "self" is a combination of the consciousness, Id, Ego, Super-ego, memories, experiences, and other components.

This being said, logic needs to be taught as well. Teaching a child 2+2=4 does nothing for the Superego or Id. Perhaps teaching addition is "adding" is a better statement and 2+2=4 is a truth (Superego). Banterings' Theory of Superego Repression acknowledges that the Ego can be grown. This then leaves us with providers who have a repressed Superego, a strong Ego, and the Id =we all have. With the repressed Superego, the Id is not balance hence the dehumanization of patients.

The second is James Henslin's Gender Socialization. This has bearing because of the issue of gender choice in healthcare, or better yet the lack of gender choice in healthcare. This implies that there is a de-socialization then re-socialization of providers. I do not believe that you can unlearn the morals that we were socialized with as children, we can learn more and grow the Superego, we can't erase it and rewrite it. We can repress it though.

This can be seen in children whose mothers were abused growing up to be abusers. This was what was put in their Superego at that critical time when it was empty and needed to be filled. We can also explain that children who reject the premise of abuse have grown their Ego to reason that this part of their Superego is corrupted. Although they may not abuse ever, they have a tendency or predisposition to.

I do not like the description of the sociopath as being a trailer park dweller. I think that this is an incorrect assumption because sociopathy is attributed usually to a childhood trauma. Therefore they have had their socialization interrupted. They never learn empathy or how to fake (mimic) it.

Sociopaths tend to be nervous and easily agitated. They are volatile and prone to emotional outbursts, including fits of rage. They are likely to be uneducated and live on the fringes of society, unable to hold down a steady job or stay in one place for very long.

So what about healthcare providers? Most were normally socialized but they are taught to repress their Superego, hence Sociopathy being learned. Sociopaths tend to be nervous and easily agitated. They are volatile and prone to emotional outbursts, including fits of rage. How many surgeons does this describe?

In 2008, The Joint Commission became so concerned about “behaviors that undermine a culture of safety” that it issued a Sentinel Event Alert on the topic and developed a Leadership standard requiring all hospitals to have a code of conduct as well as a process for managing disruptive and inappropriate behaviors. Now there is compelling evidence that some behaviors contribute directly to medical errors. This was a prominent finding in Rosenstein and O’Daniel’s work,1 in which respondents commonly indicated a reluctance to call or interact with certain doctors to clarify or question orders for fear of provoking a hostile response...

In its Sentinel Event Alert, The Joint Commission describes disruptive and intimidating behavior as including “overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities,” and it goes on to say that “intimidating and disruptive behaviors are often manifested by health care professionals in positions of power... Source:

I think that taking the 2 definitions (sociopath and psychopath) we can put together a good definition of providers that dehumanize patients:

Provideropaths tend to be nervous and easily agitated. They are volatile and prone to emotional outbursts, including fits of rage. It is difficult but not impossible for them to form attachments with others. Many are able to form an attachment to a particular individual or group, although they have no regard for society in general or its rules. In the eyes of others, they will appear to be very disturbed. 

Provideropaths are unable to form emotional attachments or feel real empathy with others [outside their group, i.e. patients), although they often have disarming or even charming personalities. They are very manipulative and can easily gain people’s trust. They learn to mimic emotions, despite their [repressed ability] to actually feel them, and will appear normal to unsuspecting people. They are often well educated and hold steady jobs. 

When committing [infractions to patient dignity], Provideropaths [are following] carefully planned out in advance [protocols/guidelines] and often have contingency plans in place. They are cool, calm, and meticulous. Their [infractions to patient dignity], will be highly organized and generally offer few clues for authorities to pursue [as a crime]. Intelligent Provideropaths [are] excellent white-collar criminals and "con artists" due to their calm and charismatic natures.

There are providers that reject the suppression of the Superego. I present Dr. Peter Ubel and the Harvard Medical School students refusing to do pelvic exams on anesthetized female patients. Perhaps in the growth of their Ego, they realized the consequences of repressing their Superego. More simply that it was wrong to do pelvic exams on anesthetized female patients because the Ego (logic) showed that there was no medical necessity and that contradicted "First, do no harm."

Using Banterings' Theory illustrates the mechanics of the Lucifer Effect, the Stamford Prison Experiment, Milgram Experiment, Pavlov's Dogs, the Asch Conformity Experiments, etc. are the tools used in the mechanics of the repression of the Superego. "Power tends to corrupt, and absolute power corrupts absolutely." This shows the predisposition that human beings have to making the situation favorable to themselves (the Id) when they can make the rules. " Great men are almost always bad men." This is the time when human beings ARE able to make the rules.

Philosophies like Machiavelli's "The Prince," Karl Marx's "Communist Manifesto" are just reinforcements of the Ego to justify atrocities done. Along with being the logic that chooses what to do (balancing the Superego and the Id), the Ego also logically evaluates the logic that it (the Ego) uses in decision making. Atheists (or more appropriately agnostics) see no physical proof (pure logic) of God, therefore they do not believe in God. That is not good or bad at face value, it is just their logic. Believers tend to reason that statistically (also pure logic), the chances of life have had to be guided by at the very least "Intelligent Design."

Banterings' Theory thus explains the Holocaust. Germany after WWI, with the economy and whole social structure in ruins called people to question traditional logic. The Reichstag fire of 1933 satisfied the Superego in saying this was wrong and the Id this was wrong as an attack on the Id and not morally wrong). When, in the rare instances, the Id and Superego are in concert, there is a tendency NOT to regulate the Id [as much] because it seems to be in check by nature of agreeing with the Superego. That is how (and when) "An eye for an eye" is justified.

This can explain medical students in "you are saving lives." The Superego says saving lives is morally right. The Id says "saving lives makes me feel like God." Repression of the Superego (how else can one justify cutting off all the clothes of a person) along with the Id not regulated as much (Superego and Id agree on saving lives), the patient's requests to be covered with a sheet for dignity are ignored by the provider's Id because it is an attack on the provider's power (the Id) and on their altruism (Superego) of saving the patient's life.

This is a lot to digest and follow, I realize that. My theory does explain many situations of abuse.

How to Create a Sociopath: Part 2

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3
The whole healthcare model is an aberration to social norms and mores. The only reason that society was forced to accept it was that it held the ultimate bargaining chip, our lives. When healthcare told us that their sacred and forbidden knowledge required us to be totally naked under a gown for wisdom teeth surgery as a means of infection control, we accepted it. There has been a change in thinking where we see quality of life issues (particularly mental health) just as important as preserving live. After all, who wants to live their life in a prison cell of depression and PTSD from a healthcare encounter? The internet has shared the sacred knowledge where we see that much of what is practiced is ritual and tradition rather than hard science. (Think the secrecy and traditions of the Free Masons.) Healthcare is losing its bargaining power.

Two prime examples are the "trauma log roll and rectal exam," and "DRE in constipated children."

It’s a well known scenario: The blunt trauma patient is decided to have a mechanism of trauma that warrants a trauma CT. The primary survey is nearly done. Everyone is ready to move – but, oh no!, we nearly forgot the two final steps of ATLS: the log roll and the digital rectal exam!...

For blunt trauma, there isn’t really any good evidence or theory behind the log roll. For penetrating or suspected penetrating trauma, a log roll is necessary for excluding wounds on the back of the patient...the log roll seems to be the least stable way of moving a patient – both for the spine and for pelvic injuries.

The digital rectal examination (DRE) is useless as a general screening tool in trauma, and only seems to be there for getting back at patients for waking you at 3:30 in the morning. Still, most surgeons are really anal about the digital rectal exam... in the latest version of ATLS, DRE is not mandatory anymore. So, engage brain and include the stats below in your decision making...(Source: )

US replaces x-ray for diagnosing childhood constipation: British pediatricians at a London children's hospital are using ultrasound to assess the severity of constipation in children. They have found that ultrasound is a good substitute for abdominal x-ray, with its radiation exposure, or a digital rectal examination, a procedure that children find unpleasant and disturbing. 

Dr. Bhanumathi Lakshminarayanan, a pediatric gastrointestinal specialist, and colleagues from Evelina Children's describe a system they developed for scoring ultrasound exams of constipated children in an article published in Pediatric Surgery International (December 2008, Vol. 24, pp. 1379-1384).

According to the study, the scoring system enables pediatricians to accurately measure fecal loading in a consistent manner. It also provides a tool to assess the long-term improvement of patients undergoing treatment for chronic constipation.(Source: )

Here are links that recognize that healthcare can retraumatize or be traumatic, and "trauma informed healthcare" can reduce the chance this:

Making Hospitals Less Traumatizing I like this resource because it advocates "Provide a Post Discharge Safety Net".

RETRAUMATIZING RAPE VICTIMS This is a great article!

Secondary Victimization of Rape Victims: Insights from Mental Health Professionals Who Treat Survivors of Violence This is an excellent research piece, and is something that I noticed in survivors of abuse from in, out, and both in and out of the healthcare system.

One of the most disturbing texts I have ever read was "Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations." It provides the following insight: "A more drastic form of solidifying the definition by excluding recalcitrant participants is to cast the patient into the role of an "emotionally disturbed person." Whatever an "emotionally disturbed person" may think or do does not count against the reality the rest of us acknowledge."

I even explored past and present abuses committed by providers and explored the reasons that they can cognitively have occurred in "Patient Dignity 16: From Mother Theresa to Dr. Mengele."

I illustrated that "medically necessary" and "being thorough" are not always necessary, AND there are limits to "medically acceptable," namely in what is "socially acceptable" in the case of Dr. Stanley Bo-Shui Chung.

Part of what adds to the trauma is that we are (basically) told that it is in our head, it is not true (so me must be delusional), and so on. We hear that even more so when we reply with "You first." That response is because we can not believe that people who are so educated lack such basic common sense and empathy.

I also have stated, and most of you agree with me, that it is not all providers that traumatize and the traumatizations may not always be intentional.

What is even worse that we have all been missing is that we are told what happens to patients and how exams are performed IS ACCEPTABLE because healthcare says IT IS ACCEPTABLE. When we question this, we are pointed to guidelines. Even when forced to reevaluate guidelines, which only happens from multiple law suits (DREs, Brian Persaud) or legislation (pelvic exams, ACA), most providers resist and ignore the guidelines because "That is the way we have always done it."

Then physicians wonder why they have lost credibility, trust, prestige and face such high rates of burnout. It is paternalistic thinking like that that has relied on oligopolies, "sacred knowledge," and limiting access to resources that put the healthcare system where it is today. That is why physicians are becoming employees and hospitals are turning into WalMarts. It is not healthcare any more, it is the healthcare industrial complex run by bean counters and guided by patient satisfaction surveys.

“Anyone who has been admitted into a hospital or undergone a procedure, even if cared for in the most appropriate way, can feel as though they were treated like an animal or object,” says Harvard University psychologist and physician Omar Sultan Haque. Health care workers enter their professions to help people; research shows that empathic, humane care improves outcomes. Yet dehumanization is endemic.

I have stated that it is a physician's training that causes these things to happen, but the training causes a physical change in the brain of physicians. I am not making this up. This also fits in with Ray's question of making changes.

Doctors also show less empathy to patients’ pain than non-doctors do, suggesting they are not thinking of patients as having fully human feelings. A recent neuroimaging study found that, when watching a patient get pricked with a needle, physicians showed far less activation in brain areas linked to empathy. This lessening of empathy, Waytz and Haque say, likely comes from medical training. (Source: "Kellogg Insight," publication of the Kellogg School of Management at Northwestern University"A Patient, Not a Person")

So I ask, how do you fix that???

Here are the big 4 most egregious violations of children by healthcare:

The most disturbing thing about this incident is:Dr. Ramlah Vahanvaty, who performed the exams... She said, "Even a parent doesn't have the right to say what's appropriate for a physician to do when they're doing an exam."

The most disturbing thing about this incident is:They forcibly removed the clothes from numerous children between the ages of three and five--over their cries of fear and desperate attempts to resist--and proceeded to probe the genitals of the now-nude children.

Here is a story about modesty. It is the reverse of what we talk about here: High-Schooler Told to Cover Up for Exposing Her Shoulder.

There is a picture of the dress, see what you think. Lone Peak High School is in a suburb of Salt Lake City which has higher standards of modesty due to the prevalence of the Mormon culture there.

I think that the relevance of this story is in relationship to another story I referenced: LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal

Could one possibly infer that higher modesty standards of the providers led to more patient protections in 1998!

From The NY Times, "In the Hospital, a Degrading Shift From Person to Patient": The psychological dynamics of this identity change have evolved little since the 1950's, when the sociologist Erving Goffman detailed the depredations of life inside a mental institution in his classic book, "Asylums."

In normal life, people can keep intimate things like ailments, thoughts and their bodies to themselves. In an institution like a hospital, "these territories of the self are violated," he wrote. "The boundary that the individual places between his being and the environment is invaded and the embodiments of the self profaned."

Here is a great article on KevinMD, "The patient experience can be dehumanizing". Too bad the article finishes just as it begins to expose the dehumanizing practices.

... humanizing a patient's suffering positively predicted symptoms of burnout especially for those participants that had higher levels of direct contact with patients. Source:NIH PubMed, "Defensive dehumanization in the medical practice: a cross-sectional study from a health care worker's perspective."

Eight coping mechanisms were identified, including medicalization, dehumanizing the patient, anger directed at the patient, use of euphemisms, use of humor, denial of the lack of skill, going numb, and talking to others. Source:APA PsychNet, "Coping mechanisms of physicians who routinely work with dying patients."

A June 2014 study found, Nurses who viewed their patients as less human reported experiencing less stress. This was especially true for nurses who were more emotionally attached to their employer, the hospital, and to their patients. Source:Research Digest, "Committed nurses cope with stress by dehumanising themselves and their patients - Italian study"

Here are 2 consistent accounts of what it’s like to be a patient in a US hospital. Both accounts were from minors, so these patients had even less power than adult (non-elderly) hospitalized patients. These patients’ accounts bring to my mind the Stanford Prison Experiment, and how psychologically vulnerable we are when stripped of our individuality, power, voice, and control over our environment and even our bodies. "This 15-Year-Old Absolutely Nails What 'Patient Centered' Is - And Isn't" (Forbes) and "Powerless"

Here is a solution (from October 2013, Feldman says that when he brings trainees into a patient room on rounds, he has everyone introduce themselves. Even if it's unlikely the patient will remember everyone, it creates a better relationship, he says, adding that modeling appropriate behavior for interns is a good place to start. Source:Johns Hopkins Medicine News Release, "'Common Courtesy' Lacking Among Doctors-in-Training"

How to Create a Sociopath: Part 3

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3

I feel this it providers are unable to make any sort of changes because by the nature of them perpetrating procedures and even abuses (PE on anesthetized women), they have demonstrated they are incapable of distinguishing what is socially acceptable or excessive. This is not all providers.

I also believe these abuses are more likely to occur where there is no relationship with the provider (such as ED, outpatient services, imaging, etc.) and where there is a strong corporate structure (hospitals). I think that even those good providers also contribute to the "white wall of silence."

Please do not insult me by defending the 2 following examples as "medically necessary."

I am talking about legislation requiring transvaginal ultrasounds for women seeking abortions and the rectal feedings at Guantanamo Bay. Why no outrage from the medical community?

There is no denial that TVAs are a ploy by conservatives to make access to abortions more difficult. Ref: "How Republicans Quietly Mandate Transvaginal Probes", "State Requirements for Ultrasound", "What We Are Missing in the Trans-vaginal Ultrasound Debate".

To protest a bill that would require women to undergo an ultrasound before having an abortion, Virginia State Sen. Janet Howell (D-Fairfax) on Monday attached an amendment that would require men to have a rectal exam and a cardiac stress test before obtaining a prescription for erectile dysfunction medication. Source: The Huffington Post

Our bodies are not political battlefields. The medical community has been largely silent on this issue. They have not spoken with a collective voice. Are they just willing to invade our bodies in another way when unnecessary???

When the CIA 'torture report' was finally declassified, waterboarding, sleep deprivation, abuse. But there was at least one newly-surfaced atrocity revealed in the report, too. Interrogators had subjected at least 5 detainees to 'rectal feeding' and 'rectal rehydration,' often against their will.

The CIA had administered rectal feedings and hydration both to counteract prisoner hunger strikes and to exercise "behavioral control". "Rectal Feeding: The Antiquated Medical Practice the CIA Used for Torture"

But leading human rights groups, including the United Nations Committee Against Torture, International Committee of the Red Cross and the World Medical Association, have accused the Obama administration of continuing a similar practice at the U.S. military prison at Guantanamo Bay. Note it is the WORLD Medical Association, NOT any US medical association. Source: ABC News "Former CIA Director Hayden: Rectal Feeding Not Torture, 'A Medical Procedure" See: "Is rectal feeding an actual modern medical practice?"

I guess just like the healthcare system, we can take SILENCE as CONSENT (approval)

Here is another problem that patients face against the healthcare system, and that is a few deviants can infect the whole industry in the same way the actions of a few led to the Holocaust. In healthcare the actions of a few led to the systematic victimization of patients.

Dr. James Marion Sims, considered the father of modern gynecology, carried out human experiments on female slaves and Irish women in the mid-1800s. (Note: the Irish were of the status as Africian-Americans and slaves. See: Irish need not apply) Read about his a human experimentation here: The medical ethics of the 'Father of Gynaecology', Dr J Marion Sims and Slaves, Experiments & Dr. Marion Sims's Statue: Should It Stay or Go?. His perversions led to what is know today as the "annual well woman exam" (which has been described as more of a ritual than science based).

Convicted pedophile psychiatrist Dr. William Ayres, was president of the American Academy of Child and Adolescent Psychiatry and co-author of "Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused" which is now an accepted guideline. Many of the egregious acts he used to groom the victims, give him access to their bodies, and allowed him to molest he had written into those guidelines. This has turned abuse into medical procedures.

The genital examinations of patients of William Ayres appeared to have "very specific” reasons and follow the general consensus of researchers who not only approve of but encourage such methods, a psychotherapist with a medical degree told jurors yesterday.
...Dr. Gilbert Kliman, who belongs to the American Academy of Child and Adolescent Psychiatry [Ayres once was president], differed from prosecution witness, Dr. Lynn Ponton, who told jurors there was little if any reason for the genital exams described by 10 former patients who testified.
…Kliman disagreed. He called one patient’s file a "delightful psychotherapeutic interaction” and praised Ayres’ methods. …the wider realm of psychiatry which allows — and sometimes proactively supports — the idea of physical and genital exams performed in conjunction with treatment.
Some researchers believe physical exams provide more comprehensive care and "increase rapport” between doctor and patient, Kliman said.
Kliman conceded he’d likely seek parental consent before performing a physical and genital exam on a minor patient but that it isn’t an industry standard. Source:Doctor defends physical exams in molestation trial

Ayres also said there is nothing inappropriate about a psychiatrist giving physical exams. He said every full pediatric exam should include an inspection of the genitals. Source:Dr. William Ayres defends practices in molestation trial testimony

Yet when common sense prevails, it is denounced because it goes against guidelines:

"My training was very strict on that," said Hugh Wilson Ridlehuber, a retired child psychiatrist who said he was present for Ayres' presentation and once worked out of the same group practice as Ayres. "Even if it's done innocently, there is a very high risk of a patient sexualizing it and affecting your relationship with the patient." Source: Doctor says boys were not molested

Here is something that I feel will be an obstacle to any reform and I want to comment on it. I also think this should be an issue for the AAMC as well.

Any physician who graduated their medical education prior to 1990 (this is a very early, arbitrary date, the issue has been discussed and occurred as late as 2012) has learned to do pelvic exams on anesthetized patients. When the story first broke, there were many physicians that defended the practice and stated that patients had an obligation to participate.

The failure by med schools to address these transgressions of the past only undermine all credibility moving forward and convey they do not care about human dignity but still believe in the paternalistic system.

I hear all too often that "this is how things were done then" as an excuse or "I was following orders."

Guess what?

Those arguments did not hold up at Nuremberg and they should not hold up here. Having to address such issues will also prevent future Tuskegee's and torture of prisoners at Guantanamo.

There was a backlash from physicians and students who felt that patients have an obligation to participate. Here are research papers examining that question, which shows that this was a commonly healed belief.

The first four links listed is a really frightening attitude:

Notice comment #22, the med student feels patients ARE OBLIGATED to participate:

The concept of deeming a patient mentally ill if they raise modesty concerns is nothing new, it is part of the "hidden curriculum." In Joan Emerson's

I, myself have been accused of having some mental illness in the position that I take in regards to my dignity.

I also want to touch on another issue that involves patient dignity. This may sound like a rant, but by now I am sure everyone knows that I back my assertions with evidence.

One of my tools for testing procedures, protocols, guidelines, beliefs, etc. is the extreme case scenario. When I say extreme, I mean to the point of absurd. The purpose is to show that these written procedures are faulty. One that I use is "How different would procedures be if the providers had to be in the same state of undress as the patient." 

Yes it is absurd, but answering that question seriously would demonstrate what "medically necessary" and "patient dignity" really is.

Some, for example, have been harmed through repetitive medical display, which they experienced as violating. Others have suffered from attributed shame.

As a result, one could reasonably envision a scenario where a disproportionately large number of medical students might want to gain exposure to these issues from a small number of patients. Protecting the individual patients’ right to respectful and confidential medical care should remain the priority. Alternative strategies should be employed to expose students to these issues so they can develop competency while protecting patients from overexposure. Such strategies might include the use of case discussions, videos, and case reports, which prevent patients from feeling “on display.” Source: Association of American Medical Colleges (2014) Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD.

Maurice started this volume with another document from the AAMC. This document addresses the extreme situation of children with DSD. The first problem that I have with this document I also have with the first: It fails to address abuses of the past.

“Those who cannot remember the past are condemned to repeat it.” Santayana, (1905), The Life of Reason.

Another issue is the failure of providers to NOT know that these practices are traumatic and abusive. I guess when you are the one with the clothes, YOU are comfortable with repeated genital exams.... This IMHO is borderline on mental illness, specifically sociopathy.

Sociopaths lack moral emotions, empathy, conscience, or remorse and guilt for their acts. Source: NIH, The Neurobiology of Moral Behavior: Review and Neuropsychiatric Implications.

Are physicians NOT trained to ignore emotions so as to make decisions scientifically and be able to preform painful procedures on patients?

Americans born with intersex conditions face a wide range of violations of their sexual and reproductive rights, as well as rights to bodily integrity and individual autonomy. In infancy and throughout childhood, children with intersex conditions are subject to irreversible sex assignment and involuntary genital normalizing surgery, sterilization, medical display and photography of the genitals, and medical experimentation. Intersex individuals suffer life-long physical and emotional injury as a result of such treatment.

...Various human rights bodies have recognized that the medical treatment of people with intersex conditions rises to the level of human rights violations.

…The United Nations Special Rapporteur on Torture (SRT) has also called for an end to the abuses against intersex people:

“Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, ‘in an attempt to fix their sex’, leaving them with permanent, irreversible infertility and causing severe mental suffering. . . The Special Rapporteur calls upon all States to repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery, involuntary sterilization, unethical experimentation, [or] medical display ... when enforced or administered without the free and informed consent of the person concerned. He also calls upon them to outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups” (SRT 2013)

…genital normalizing surgery risks psychological as well as physical harm, including
depression, poor body image, dissociation, social anxiety, suicidal ideation, shame, self- loathing, difficulty with trust and intimacy, and post-traumatic stress disorder. (SFHRC 2004)

Medical display, genital photography, and excessive genital exams
Many intersex individuals suffer lasting psychological effects as a result of repeated genital examinations and/or medical photography in childhood, which can be “experienced as deeply shaming” and may lead to symptoms of PTSD. (Hughes 2006) While some genital exams are necessary for medical diagnosis or monitoring, others are done without specific indication, sometimes to satisfy provider curiosity. A leading patient advocacy group has likened such procedures to child sexual abuse (CSA):

“[C]hildren with intersex conditions are subjected to repeated genital traumas which are kept secret both within the family and in the culture surrounding it. . . . These children experience their treatment as a form of sexual abuse, and view their parents as having betrayed them by colluding with the medical professionals who injured them. As in CSA, the psychological sequelae of these treatments include depression, suicidal attempts, failure to form intimate bonds, sexual dysfunction, body image disturbance and dissociative patterns.” (Alexander 1997)

….Accordingly, we make the following recommendations to address the plight of intersex individuals in the US:

That enforcement agencies investigate possible violations of, and take action to enforce, laws prohibiting FGM, involuntary sterilization, and unethical human subjects research to protect children with intersex conditions; and

That US courts recognize genital normalizing surgery and involuntary sterilization performed on intersex children as violations of their federal civil rights, and offer intersex plaintiffs comprehensive remedies for these harms.

The United Nations and other organizations feel that these medical procedures ant the training of medical students are criminal actes that rise to the level of Human Rights violations.

Note: These documents from BOTH the UN and AAMC do NOT address gender of the provider as the problem, it is simply the treatment of the patient.

But I ask, with the cases presented in these volumes, such as Kevin's, even though it is not as severe, is it no less egregious, immoral, unethical, and unprofessional?

True that participating in the murder of hundreds is worse than participating in the murder of a few, but it is still murder. Again, my example of murder is extreme, but how many abusive genital exams are acceptable? Just as murder, the answer is NONE!

This is paramount to the Holocaust when you take into consideration that most preventive health guidelines call for an annual physical (including a genital exam) for every person. Even in the face of evidence based guidelines that dispute the annual wellness exams, many organizations still recommend them and even state "despite lack of evidence..."

Failure to acknowledge abuses of the past only furthers the notion that providers and organizations STILL do NOT see that these procedures are traumatic and harmful.

This article, Visit!The medical gaze and children with DSD, is based on REAL cases. How could the students in the article not realize the trauma of the genital exams before this focus group?

Thankfully times and laws are changing, and these infractions will be treated as the crimes that they are. It is time to treat patients as human beings again.

Nurses and doctors entered training to help patients. Nearly 100 years ago, Peabody complained that new physicians relied too much on science and had lost “an interest in humanity”. It’s been said recently that medicine has become “far more interested in diseases than the people who suffer from them” (A. Miles, 2009).

Here is an example of ethics from 2009:

Klasko gives the example of a Georgetown University study in which medical students were asked to give a sleeping woman in a hospital bed a pelvic exam, with the attending physician telling them it was okay, even though the patient was asleep and hadn't given her consent. Ninety-five percent of the first-year students wouldn't do the exam, even though they were told it needed to be done. Only 33% of the fourth-year students refused to do the exam. Source: The Atlantic, (2009) Reprogramming the Ethics of Med Students

Finally this 2001 research paper concludes:

The review reveals that these arguments either cannot be verified or do not necessarily place any obligations on the patient. It is argued that, while a medical student may have a right to clinical education, the obligation to fulfil this right rests with the medical university and not on the patients of its teaching hospitals. Source: NIH (2001), Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical students.