Doctor Evil: A study of caregiver as lifetaker

Toronto Star/July 7, 2007
By Francine Kopun

Bad medical professionals are a staple of both history and fiction. An expert helps explore the link between healing and killing

At least seven suspects in last week's failed bomb attacks in England and Scotland were members of the medical profession. They weren't the first physicians to be implicated in high-profile acts of violence - the list is as long and varied as the motives behind the aggression.

Nazi doctor Joseph Mengele carried out sadistic experiments on prisoners in Auschwitz during World War II; Britain's most prolific convicted serial killer was a GP named Harold Shipman who is believed to have murdered more than 200 people before he was sentenced to life in prison in 2000; a doctor brewed the cyanide, Valium, and grape-flavoured drink mix that 900 men, women and children drank at Jonestown, Guyana in a mass murder-suicide in 1978.

Jack the Ripper may have been a surgeon. Evil doctors abound in fiction - The Strange Case of Dr. Jekyll and Mr. Hyde haunts us still, more than 100 years after it was published, perhaps because it taps into our secret fears. We are rarely so vulnerable as when we're sitting in a doctor's office with our bare bums slipping out of a paper dress.

So what is it then that leads members of the profession we most need to trust to kill and maim instead of heal? It's a question Dr. Robert Jay Lifton, an American psychiatrist and author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, has pondered for decades. A lecturer in psychiatry at Harvard Medical School and Cambridge Health Alliance, Lifton has often addressed the susceptibility of physicians to engage in harmful behaviours, both historically and in recent times.

In an article called Doctors and Torture that appeared in the New England Journal of Medicine in 2004, Lifton described how and why U.S. doctors, nurses and medics became complicit in torture in Iraq, Afghanistan and Guantanamo Bay.

The Star asked him to comment on the participation of physicians in the recent British attacks.

Q Dr. Lifton, do you think it's more than coincidence the suspects in the recent bombing and attempted bombings in Glasgow and London are members of the medical profession?

A I'm sure it's more than coincidence and I've been much concerned with medical transgressions or things that doctors do that reverse healing and killing and violate the Hippocratic oath.

Q If it's more than coincidence, what is it that's at work here?

A In general, doctors are of special interest to despots because we are considered to be in possession of what might be called a shamanistic legacy ... And that shamanistic legacy invests doctors with powers over life and death. I think doctors can come to feel this about themselves, a kind of omnipotence. In this case, with Islamist fanaticism, I think there's a further element of doctors being in a kind of intellectual vanguard in these countries.

Q Is there something about the medical profession that attracts highly intelligent criminals or people perhaps with certain mental disorders or dispositions?

A I don't think these actions are best understood within the realm of traditional criminality and I don't think that mental disturbance is the reason for it. When people embrace fanaticism, they move into an extreme mental state, but not one that can be or should be diagnosed as a psychiatric disorder.

Most of the killing in the world is done by normal people, normal in the sense of not having a psychiatric diagnosis or disorder. They involve themselves in killing out of various motivations. We oversimplify and mislead if we attribute it to a psychiatric disorder. These people can be bright and functional, quite the opposite of psychiatrically ill.

Q Is there something about the medical profession itself that encourages behaviour that most people would consider out of bounds? Is there something about the practice of medicine?

A There's nothing about the ordinary practice of medicine that directly leads to extreme behaviour. But there can be elements of the physician's psyche that make him or her vulnerable to calls to extreme behaviour, and that has to do with the sense of omnipotence.

Q Do you want to elaborate on that?

A Well, these doctors didn't necessarily respond out of some individual aberration - of course, they have individual tendencies that enter into anything and some may be more susceptible than others - but they're responding to a vast international movement of Islamist fanaticism.

Q You've talked about something called "doubling," which posits that to participate in evil, doctors must possess the psychological mechanism that allows it and you propose the notion of doubling. Is that something that would apply in this case or not?

A What I called doubling is the formation of a functional second self and I describe this process as occurring in Nazi doctors, allowing them to function as killers in Auschwitz and then go back to their homes in Germany on weekends or on leave and be ordinary fathers and husbands.

And some such psychological process could well take place in these physician-terrorists.

. . . (I)t's possible that doctors are more susceptible than others to doubling because of their involvement with issues of life and death - and because of whatever elements of omnipotence they acquire. But I don't mean to say by any means that most doctors are prone to destructive or harmful behaviour; rather it's a potential.

A Does the potential among doctors exist to become inured to death and suffering?

Q There is the potential for steeling themselves to pain and suffering, part of which is necessary to the profession.

For instance, a surgeon who carries out an operation can't afford to experience the emotions of the family of the patient and needs elements of detachment, or what I call selective professional numbing. It's possible that the selective numbing of physicians can be exaggerated or intensified in actions like this.

Q You've also mentioned the role that the self-protective guild of the medical profession can play, can you talk about that?

A Their sense of medical identity could be a protective psychological element in enabling them to do their dirty work. It's as if as a physician, if one sees oneself as a healer, one may then engage in lethal acts to some degree.

Q Is this a problem that needs to be addressed or is it simply an inherent danger and there's nothing we can do about it?

A Of course it should be addressed . . . first in medical schools where it's raised now and then, but very inadequately in most places. Discussing it and understanding it would help members of the medical profession understand their own susceptibility.