Wednesday, March 30, 2016

How to Create a Sociopath: Part 4

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 have come across a recent news article that makes the case that students learning procedures on students is a far superior way to learn versus on real patients. It quotes the (in)famous Dr. John Henry Hagmann He retired from the U.S. Army in 2000, and is considered a pioneer in trauma (specifically combat trauma). Source: Reuters via Yahoo News

In the Army, Hagmann practiced emergency medicine for two decades. He rose to the rank of lieutenant colonel and co-authored an influential combat treatment manual.

After retiring, Hagmann founded DMI – also known as Deployment Medicine Consultants. It is based in Gig Harbor, Washington. Following the Sept. 11, 2001 terrorist attacks, demand for his courses grew and DMI emerged as a preeminent trauma-response trainer. The majority of DMI’s government contracts are with the U.S. military – in particular, Army and Navy special operation units.

“The mission of DMI is to train you to save lives in the combat environment, no one matches our ability to do this,” the company says on its website. “We are the single largest trainer of US military forces in operational medicine throughout world, and our record for excellence stands unchallenged.”

The allegations have lead to an investigation by the Virginia Board of Medicine and Defense Criminal Investigative Service. The allegations against against the good Dr. Hagmann (scientist and saint) are described as:

...During instructional sessions in 2012 and 2013 for military personnel, Hagmann gave trainees drugs and liquor, and directed them to perform macabre medical procedures on one another, according to a report issued by the Virginia Board of Medicine, the state agency that oversees the conduct of doctors.

Hagmann, 59, is accused of inappropriately providing at least 10 students with the hypnotic drug ketamine. The report alleges Hagmann told students to insert catheters into the genitals of other trainees and that two intoxicated student were subjected to penile nerve block procedures. Hagmann also is accused of conducting “shock labs,” a process in which he withdrew blood from the students, monitored them for shock, and then transfused the blood back into their systems.

...In one case detailed by investigators, Virginia authorities allege that Hagmann boasted to a student “about his proficiency with rectal exams” and took the student to a warehouse on his property. There, the report claims, the two “continued to consume beer” and Hagmann asked the student “about the effect (the student’s) uncircumcised penis had on masturbation and sexual intercourse.” The student told investigators “that he was inebriated and felt that he could not refuse Dr. Hagmann’s request … to examine, manipulate and photograph his penis...

In his defense, Dr. Hagmann said, "...the Virginia board is applying the wrong standard in assessing his conduct: He said that his trainees are "students," not "patients" as the board calls them, and therefore he may have them perform procedures on one another as part of the educational process.

...the courses and procedures in question were all reviewed and approved” by officials at the Uniformed Services University of the Health Sciences (the government-run medical school that trains and prepares health professionals to support the military)."

The dirty little secret is that the double standard to discriminate (and abuse) males is taught in the formal medical curriculum....

"Genitalia: Boys always; girls when indicated (e.g. all sexually active girls and those with any symptomatology) should have an external inspection and an internal pelvic examination. Desirably, all adolescent girls should have pelvic examination at some time as a matter of routine." Hofmann, A and Greydanus, DE; Adolescent Medicine, 2nd Edition, 1989.

...and everyone wonders why men avoid healthcare.

Previously I have focused on (basically) how physicians and other providers objectify and harm (psychologically) patients while being unaware that they are doing so. There is another part to my research that The Stanford Prison Experiment bridges into. That addresses the issues such self-policing and, AND why they have guidelines based on ritual and not science (annual pelvic exam) and are designed to subjugate patients to a subservient role (PPC).

I am referring to a real incident at an American high school in 1967 that shows the horror of mob psychology and group pressure. I am referring to "The Third Wave;" in 1981 it was made in to an ABC after school special titled "The Wave," and remade in 2008, titled "Die Welle" (the original German title).

The Third Wave was an experimental social movement created by high school history teacher Ron Jones to explain how the German populace could accept the actions of the Nazi regime during the Second World War. While he taught his students about Nazi Germany during his "Contemporary World History" class, Jones found it difficult to explain how the German people could accept the actions of the Nazis, and decided to create a social movement as a demonstration of the appeal of fascism. Over the course of five days, Jones conducted a series of exercises in his classroom emphasizing discipline and community, intended to model certain characteristics of the Nazi movement. As the movement grew outside his class and began to number in the hundreds, Jones began to feel that the movement had spiraled out of control. He convinced the students to attend a rally where he claimed the announcement of a Third Wave presidential candidate would be televised. Upon their arrival, the students were presented with a blank channel and told his students of the true nature of the movement as an experiment in fascism, presenting the students with a short film discussing the actions of Nazi Germany.

...The experiment took place at Cubberley High School in Palo Alto, California, during the first week of April 1967. Jones, finding himself unable to explain to his students how the German population could have claimed ignorance of the extermination of the Jewish people, decided to demonstrate it to them instead. Jones started a movement called "The Third Wave" and told his students that the movement aimed to eliminate democracy. The idea that democracy emphasizes individuality was considered as a drawback of democracy, and Jones emphasized this main point of the movement in its motto: "Strength through discipline, strength through community, strength through action, strength through pride.

Healthcare has proven again and again that they can not be trusted.

A new report finds that the American Psychological Association gave federal officials what they wanted when it came to torture: an ethical policy that aligned with government interrogation techniques. The APA has issued an apology and said it will ban psychologists from participating directly in interrogations.

Washington (AFP) - The US's top psychology association colluded with the Pentagon and the CIA to devise ethical guidelines to support post-9/11 interrogation techniques that have since been labeled as torture, a report said Friday.

Some members of the American Psychological Association (APA), including senior staff, sought to "curry favor" with defense officials, according to the 542-page probe commissioned by APA's board.

These individuals issued an ethics policy that aligned with government interrogation techniques after the September 11 2001 terror attacks, such as waterboarding and sleep deprivation.

The association colluded with several government agencies, including the Pentagon and the Central Intelligence Agency (CIA), to devise ethical guidelines for the interrogation program under former president George W. Bush, according to the review.

The government agencies "purportedly wanted permissive ethical guidelines so that their psychologists could continue to participate in harsh and abusive interrogation techniques being used by these agencies after the September 11 attacks," the report said.

"APA's principal motive in doing so was to align APA and curry favor with DoD (Department of Defense). There were two other important motives: to create a good public-relations response, and to keep the growth of psychology unrestrained in this area."

The findings come after Democrats on the US Senate Intelligence Committee in December released a damning report detailing brutal and previously unknown interrogation techniques, including beatings and rectal rehydration, used by the CIA on Al-Qaeda suspects post 9/11.

The APA board apologizes, recommends: participate in human rights activities, create committees, and maybe sing Kumbaya...

I mentioned (above) the 1967 social experiment "The Third Wave." Where Milligram's experiments were with individuals, The Stanford Prison Experiment was a bridge encompassing both individuals and organizations.

I linked to the ABC After School Special that was made about it. I believe that this shows how an organization adopts an "us and them" view and creates policies that consolidate and protect the organization's power while subjugating the "them."

This is where healthcare has come up with beliefs, customs, norms, mores, etc. that are abusive to patients, scientifically unfounded, and defy common sense. One such example is [sic.] the AAP's statements of "normalizing" and showing the "routine" nature of the genital exam despite the fact that research (which I referenced previously) concludes that a genital exam is "never routine" (for the patient at least).

Perhaps the biggest fallacy that healthcare promotes is that just because one becomes a provider (and has a magic white coat), then they have the RIGHT to see ANY patient's (person's) body (naked), AND the patient (person) should have NO objections and comply. This is seen in the statement, "I am a professional."

***WARNING*** This may seem "pornographic," but it is actually [more] ABSURD. It is an extreme example to show the absurdity of the statement "I am a professional."

Let us extrapolate this to another profession. I am a porn star. I have been trained in all the safe sex practices of the CDC, California Department of Health, and Cal/OSH. I have had sex wit so many people so many times, that I do not experience sexual pleasure, it is just a JOB. "I am a professional."

So no healthcare provider should object to me touching their genitals...

Let's take this down a notch. I am a camera man in the porn film/video industry... "I am a professional." So no healthcare provider or any member of society should object to me looking at their genitals.

Let's extrapolate some more. Theoretically most (almost all) members of society can be educated, trained, and become a healthcare provider (not just physicians and nurses). Do you think that most people (if not everybody) would accept the notion that potentially any member of society if given a magical white coat can see their (naked) body and touch their genitals AND they should be comfortable with this?

Disclaimer: I know that there are other factors that come in to play with the above examples such as "being therapeutic" versus sexual pleasure. But I argue that these are the same, there is a benefit to both parties. Again, it is more to illustrate the absurdity of the "I am a professional" statement.

Just look at how people date/choose a mate. First there is a preference or perhaps NO preference (bisexual) in gender. There are other factors as well. Think of the "creepy" person would NEVER date due to that (perceived) "ick" factor. What about the patient's perception of some providers being "creepy?" What about the cultural sensitivity papers put out by provider groups about female Muslim and Hmong patients? Just as religion dictates gender norms in healthcare, so it dictates in marriage (sexual relations), thus validating my examples.

The policy should be, "I am a professional, may I have your permission to participate in YOUR healthcare?" "If not, we will find someone that you are comfortable with." But as "The Third Wave" illustrates, organizations are self-serving and protect their status and existence with power, control, and convenience (PCC).

However, even in optimal operational contexts, some combat and operational experiences can inevitably transgress deeply held beliefs that undergird a service member’s humanity. Transgressions can arise from individual acts of commission or omission, the behavior of others, or by bearing witness to intense human suffering or the grotesque aftermath of battle. An act of serious transgression that leads to serious inner conflict because the experience is at odds with core ethical and moral beliefs is called moral injury.
More specifically, moral injury has been defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009).

Then again, healthcare is in denial about what they do to patients being traumatic, so "moral injury" could never be the cause of physician suicide...

It is not uncommon for (dysfunctional) professions, systems, families, etc., to deny the internal abuses (reference; The Third Wave), this is very common in the dynamics of dysfunctional families. This is very often seen in families where sexual abuse and/or alcoholism is/are problems.

Experience “reality shifting” in which what is said contradicts what is actually happening (e.g., a parent may deny something happened that the child actually observed, for example, when a parent describes a disastrous holiday dinner as a “good time”). Source: Brown University

This may be due to (psychological) projection as a defense mechanism. In order to hide one’s own sociopathic characteristics (the lack of empathy that prevents some providers to validate patients’ modesty issues), they project mental illness upon patients. Why should anyone have a problem letting all the doctors, nurses, and students examine their genitals, you are getting hundreds of second opinions...

Another cause is burnout. Burnout in healthcare has long been considered "a state of chronic stress” that can lead to illnesses both physical and psychological, most notably depression, substance abuse, and suicide. (source: Psychology Today, The Tell Tale Signs of Burnout ... Do You Have Them?) There is a question does burnout describe a set of symptoms describing an illness OR is it one of the symptoms describing an illness:

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no such diagnosis as “burnout”, unlike depression, which is a widely accepted and well-studied illness. That is not the case with burnout. Some experts think that there might be other symptoms behind being "burned out" – depression or an anxiety disorder, for instance. Physical illnesses may also cause burnout-like symptoms. Diagnosing "burnout" too quickly could then mean that the actual problems are not identified and treated properly.(source: Depression: What is burnout syndrome?) There is growing support that burnout is an illness with comorbidities. (reference: Oxford Journal, Burnout as a clinical entity--its importance in health care workers.

Burnout has also been causes of patient neglect frequently relate to organizational factors (e.g. high workloads that constrain the behaviors of healthcare staff, burnout) (source: Patient neglect in healthcare institutions: a systematic review and conceptual model). It has lead to "an unfeeling and impersonal response toward recipients of one’s service, care treatment or instruction,” "treat patients as objects" (source: Society of Critical Care Medicine: Physician Burnout - A Threat to Quality and Integrity).

This is significant because providers who did not learn disregard for patient dignity and modesty as part of the formal or hidden curriculum of their training are at risk to become offenders due to burnout.

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