A surgeon on those who understand murderers, rapists and child molesters

(Editor’s note: reader discretion advised)

Recently I was involved in a discussion with a guy that was explaining how we should understand criminals. The emphasis was on farm murders but we touched on murderers in general, rapists and child molesters. My point of view was that I did not understand them and felt that he was justifying their actions. In the end I was informed that I was smug. Apparently that is the word for people that couldn’t see the point of view of the poor misunderstood murderers and rapists and molesters.

So smug is what I am, it seems. You see the fact is I can’t understand his beloved murderers. I just can’t. I also in my smugness wonder how he can, but I think I know.

It has to do with not being in the trenches. It has to do with not being faced with the blood and the tears and the guts and the screams … mostly the screams. It is probably easy to be nice and philosophical sitting snugly (not smugly apparently) in a nice air-conditioned office, philosophizing on the reasons people point a gun at people and pull the trigger. or worse…

The thing is I can’t forget. I am scarred. I remember the patient lying in a pool of his own blood, looking up at me and asking, beseeching even to tell him he is going to be ok. I remember wanting to tell him that it would all turn out just fine. I even remember wanting to hold his hand because his mother wasn’t there to take care of the emotional side of things. In the end I remember not telling him he would be ok because I wasn’t sure he would. I also remember not being the mother he needed in the last moments of his life because that is what it turned out to be.

After we had plowed through the blood and feces floating around in his abdomen, violated by the bullet fired from the gun of someone my friend feels I must understand, the patient died. He did not die well with his mother or wife holding his hand in love. He died alone in some ICU ward with adrenaline being pumped into his veins and oxygen being pumped into his lungs with a scarred doctor who felt that his time may have been better spent holding the patient’s hand rather than pouring time and energy into a futile attempt to save his life. You see the reason I can’t see the side of the killer is that the killer is still alive and has the sentiments of my learned friend to feel for him. My patient is dead and there was no one next to his bed when he died. There is no one to state his case now.

I remember the baby violated by her uncle. I was just a house doctor, but I had to examine her. The pediatrician couldn’t face it. It is quite a thing to see the perineum of a four month old after it has been ripped apart by the penis of one of the people my friend understands so well. Feces runs out of the vagina. It leaves a mark on the soul. But worse than that is the cry. The child did not scream anymore. I think it used up all its scream for its entire life during the deed. All that was left was a quiet constant moan. It is the ghostly moan of someone who has learned in her four month existence that there is no one who will come to her aid. There is no one to understand her. It will never leave me. My friend who is quick to understand the violator will call me smug, but may I suggest I might just be jaded?

The women raped is difficult to examine. Somehow you feel you are violating her again. You feel you are making the whole ordeal worse. They don’t resist. They are already broken. Anyway, rape in our country is so commonplace, it may be the one area where I understand that my friend may have sympathy with the perpetrator, but, sorry, I cannot. For me to examine those women tears me apart. It leaves me with a feeling that my own soul has been violated. That I am forced to do something because someone else destroyed a life. I refuse to see the point of that someone else. If that makes me smug, then smug I must be, but again I suspect I might be jaded.

A bullet can do a lot of damage. Physically I think I might have been a witness to pretty much all of it, but there is another side to the story. I remember an old man, shot in his home when he tried to defend his wife from the killers that broke into their house in the early hours, people that my friend chooses to understand. We did pull him through, but not without a massive operation and the obligatory ICU time. I remember when he came to me for follow up some time later. I was so proud that he had made it. But somehow he was the shell of the man he used to be. He was alive, but broken. His confidence was gone. He lived in fear. He felt helpless because he knew he could do nothing against the lead of the people who I hear from my friend I must understand and sympathize with. But who sympathizes with my patient whose peace has been stolen from him? The smug or the jaded?

Recently I enjoyed my Christmas Eve over the open abdomen of a woman shot in her bed by strangers, strangers whom my friend has endless sympathy for. I did not enjoy my holiday period, but more than that, my patients didn’t either. Hopefully my friend, while maybe enjoying a beer with the killers he understands so well had a really festive time. I do not understand him.

“bongi” is a general surgeon in South Africa who blogs at
other things amanzi.


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  • Charles Zhang

    Thanks for sharing this. I am disgusted and very angered by these acts you describe and from what I’ve seen, but I still agree with your surgeon friend. I’m not sure on the smug part and what that means, but I try to understand the point of view of all others I encounter (importantly I don’t necessarily empathize or agree with these other points of view). One example I can bring up is the holocaust, which so many people try to understand. If we do not try to figure out the mindsets and world changes that led to these horrifying murders and experiments we will not learn from the mistakes and do our best to prevent its reoccurrence. For me I want to understand these terrible behaviors because I want to try to change them for the better. I don’t believe I can do much if I do not try to understand their influences and motivations.

    MD/MPH student, Tulane

    • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

      I’m not sure why I’ve attracted men into my life who have offended their siblings, their children. I was born into a family with generations of sexual offenders.
      I’ve dated men who have offended others. I have no memory of having been assaulted, molested, but I wonder why I always attract such wounded souls.

      Maybe because I’m a healer?

      Last year, I spent a few months (at my own request) attending weekly rehab with male sexual offenders.

      In order to stop the cycle of abuse I must understand where it starts. From a lifetime of knowing these men and in witness to strangers at a court-mandated offender program I have discovered a triad that often leads (male) offenders to offend:

      high sex drive
      low self-esteem
      unemployment/lots of “free” time

      Many of these men were emotionally detached due to
      dysfunctional childhoods. Many were victims of sexual abuse. A subset of men who are mentally ill, mentally retarded (and are rejected by appropriate-age adults, yet still have high libido) end up pursuing younger girls who are more their emotional peers.

      I sat next to a 65-year old man who had molested twenty-five girls under age three.

      I sat next to a man who was accused of molesting his toddler.

      I felt sick, but I sat in the room and listened for as many weeks as I could.

      . . . and then I stopped showing up for sessions when my car broke down.

      I never could bring myself back.


      Pamela Wible, MD
      Blog with me:) http://www.idealmedicalcare.org/blog/

  • H

    Totally understand where you’re coming from. As I read this article, I cried for all the horrifically abused children I have cared for, the women that I have seen beaten and killed by the person that is supposed to love them, the victims of random and senseless acts of violence. I too have seen horrible, unspeakable things like you mention above – often spending my whole 12 hour shift as a nurse with those patients. It hurts deep in your soul – but if not us, who?

  • heath

    I call bullshit on your friend who thinks to understand the twisted minds that kill, torture and maim others. We have no obligation to understand them, we have no responsibility to see their point of view. We put ourselves at risk if we do. The toxic swaps of the world are better off not visited, not stepped in, not embraced. I would suggest the smugness is his to enjoy the luxury of such a belief, he has obviously never expereinced the soul destroying trauma of another’s cruelty

  • Marc Gorayeb, MD

    It is the height of pacifist, elitist arrogance to believe that depravity can be studied, analyzed, understood and ultimately eliminated from the human condition.

  • http://obesefromtheheart.com Sara Stein MD

    As someone who transitioned from surgery to psychiatry, I’ve had the experience of being on both sides of the perpetrator. I asked my chief resident in surgery, and years later my attending in psychiatry, how can you handle this?
    Interestingly, the answer was the same both times, and ultimately very comforting.

    Veterinary care.

    You do what you are trained to do without error or hesitation and you don’t deviate no matter what you feel.

    Thanks for posting such a difficult post.

    • DVM

      I like my patients. They’re innocent.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Though we may never rid the world of depravity, we must commit to healing which is our chosen profession. By ignoring “deviant” personalities we are blind to the red flags that perpetuate the cycle of abuse.

    Pamela Wible MD

  • Finn

    You’ve made the fundamental errors of mistaking correlation for causality (“I have discovered a triad that often leads (male) offenders to offend”) AND of studying only men who have been caught sexually offending and participated in a program. You have no idea how many men who do not offend, or who offend but have not been caught, who also have high sex drive, low self-esteem, and
    unemployment/lots of “free” time.

    This is similar to the cognitive error that assumes child victims of sexual abuse grow up to be abusers themselves, an error caused by only studying imprisoned child rapists and not surveying the general population of adults sexually abused as children. Once this was undertaken, it was discovered the majority of victims of child sexual abuse do NOT become abusers themselves.

  • horseshrink

    I believe “explanation” and “excuse” have too often been confused by well intentioned people.

    Almost all behavior is explainable … even the most horrific examples.

    Only a small fragment is excusable.

    Unfortunately there are many … especially in my profession … who believe “explainable” = “excusable.” In trumpeting this, these “experts” smugly fly in the face of basic societal common sense/wisdom, tainting my profession in the process.

    Re: caring for criminals … been there. I practiced correctional psychiatry for several years (jails and prisons.) Perpetrators of horrific crimes sometimes attempted to evoke sympathy from me for misdeeds, or for how they’ve been treated by other inmates as a result of their crimes (especially child molesters.)

    My reaction? Side step that without comment or judgment. Focus instead on the reality of the here-and-now situation, basic safety, how he’ll cope, and whether there’s really a severe mental illness for which medication needs to be given.

    Forgiveness? Punishment? Not my job.

    And it’s not fair to the other inmate patients to drain my ability to serve them by diving into the torrid details of crimes committed by some of their peers.

  • http://www.talktoyourunconscious.wordpress.com BobBapaso

    I once worked in a forensic prison. I started reading this post with the assumption that this was a discussion with an inmate.

    It seems the word understand is being confused with the word condone. It is easy to understand that violence and selfishness are inborn characteristics of human nature. Civilization is the struggle to resolve these with another human characteristic, compassion.

  • http://www.liz4cps.com liz4cps

    As someone who talks to victims a lot, it is important to understand and even help abusers, though it is more important to stop them. Understanding them will help us to recognize abusers sooner and so stop them sooner.

    Victims of childhood abuse do miss out on the positive things they need to grow up emotionally as well as having to deal with the damage — PTSD, triggering, anxiety, loss of autonomy. They can harm others from fear and desperation, even though they often do not want to — not always harming them abusively, though. They do need help to be safe and to heal. They need giving love, not “love” that takes.

    As a Christian, I see lives changed and healed by God’s love and by them seeing love in people around them who can show them God’s love. However, I am also concerned with attitudes about sex in culture that make it sound normal for youngsters to engage in sex.

  • Molly Ciliberti, RN

    Horseshrink said it best: forgiveness? punishment? not my job. As people who care for the victims and the perpetrators our job is take care of whatever the acute problem is without judgement.

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