Wednesday, March 30, 2016

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.

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