UPDATE 2020-12-30: My research has been validated by Anthony J Mazzarelli, MD, JD, MBE, co-president and C.E.O. of Cooper University Health Care and by Stephen W Trzeciak, MD, MPH.
Cooper University Health Care brought in consultants to suggested ways for the hospital to strengthen its bottom line. One idea: the hospital should focus on improving patient experience and physician engagement. Some of these recommendations had to do with the relationship between doctors and patients.
Mazzarelli, realized that most of what he was being asked to do was to get doctors to show more compassion. Now, you might assume that most people who choose medicine as a profession do so in part because they are compassionate (at least that they’re taught compassion during medical school).
If that’s the case, where does it go? Does compassion somehow evaporate over time? If so, was there a viable way to increase it? And can compassion even be measured? Before doing anything, what Mazzarelli needed was some research.
Mazzarelli turned to Cooper's #1 N.I.H.-funded researcher, the person with the most publications, the most N.I.H. dollars: Stephen W Trzeciak, MD, MPH.
TRZECIAK: So, I never doubted that compassion was essential. And I don’t know anyone in healthcare that feels otherwise, or at least no one that would admit to it. It’s what we ought to do. The way that we ought to treat patients. But does it actually move the needle on outcomes in a measurable way? That’s what I was skeptical about.
Trzeciak and Mazzarelli began to focus on the science of compassion, they started a program at Cooper Health System to mentor physicians on how to connect and communicate with patients. Mazzarelli, true to what he’s learned during his compassionomics journey, was careful to note that, "Of course we can only report association rather than definitive causation from these data."
Trzeciak and Mazzarelli wound up writing a book that tries to answer these questions. It’s called Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference.
While the compassionomics research does not look at the causes or the loss of compassion and empathy, it validates that there is a deficit of compassion and empathy by healthcare providers. My research looks at the beginnings (causes) of the loss of compassion and empathy during the medical education. Much of the research that I rely upon came from the Nuremberg Trials, specifically the Physicians' Trials and wondering how such apparently compassionate people could commit such atrocities.
*End of the Update*
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.
