Why the despicable deserve the best care possible

I received a very intriguing question the other day.

“What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?”

I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having raised three daughters of my own and now having two grandchildren and another on the way, these things brought forth such a visceral reaction from me that it was all I could do sometime to continue the interview and not just scream, “Enough!”

I have sat three feet away, close enough for the toe of our shoes to touch, from a murderer in little interview rooms in a county jail. The feeling is almost surreal when a murderer tells you about his family, spending holidays with his wife, his love for his Chevy truck, and the day he got his first job. You listen and you piece the story together and you do your job, but somewhere in the deep recesses of your brain that little protective, self-preserving blinking red light warns you. This man shot another person at point blank range with a twelve gauge shotgun. He could kill you too.

I have interviewed husbands who beat their wives so badly that they sent them to the hospital, jaws broken, ribs cracked, bleeding, faces blue and puffy and swollen. I have heard them blame their wives for the beatings, explaining to me in plaintive, sincere, pleading tones about how she asked for it, she provoked it, she wanted it, she needed it. Again, stomach-turning stuff, my friends.

The question made me think about these people I’ve interviewed over the years in hospitals and emergency rooms and county jails and clinics and courthouses. What is the common denominator here?

This will not surprise those of you have have been reading my musings for any length of time.

All of these people, the child molesters, the murderers, the wife beaters and all the rest, are people just like you and me. They are people who, for whatever reason, are in great distress.

Some of them feel great pain and remorse; some do not. Some feel guilt. Some have no conscience. Some, oddly enough, are trying desperately to connect with another human being, but have such a skewed view of what that looks like that they hurt the very person they are trying to connect with.

They all deserve the best care possible. The wounded assassin gets the same trauma protocol as the man he just shot.

I guess it’s the training we get that protects us. The hours of grilling by supervisors. The case presentations that get picked apart by professors and peers. The thousands of patients we see. The gut checks that we ignore at our peril. The things we’ve read. The stories we’ve heard and the patterns they make that give us a heads up when one more patient walks in fitting the mold.

I don’t judge people. I will leave that up to God. I think He’s up to the task.

I ask questions.

I listen for answers.

I try to understand.

I do my job.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

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  • Frank Lehman

    You said: ” I have heard them blame their wives for the beatings, explaining to me in plaintive, sincere, pleading tones about how she asked for it, she provoked it, she wanted it, she needed it.”

    Why did you sit there and listen to that?

  • Ron Smith

    I think you are confusing your willingness to give care with what you think is that patient’s ‘right’ to receive care. That’s just idiocy. To deserve something implies that you have done something out of merit. These creeps don’t ‘merit’ anything.

    Look there are certain things that we ascribe as rights. Things like the right to life, liberty, and the pursuit of happiness. We have the right to free speech, bear arms, vote, etc which have been enumerated.

    We can forfeit those rights. That’s what happens when someone murders. The result of a guilty verdict is that that person has certain rights removed.

    People should be treated as human beings, but to ascribe health care as a right in the same vein that we talk about the right to life, liberty, etc., is just poor reasoning at best. We have the pretty darn good health care in this country overall. We don’t deserve any of it. That’s part of the nature of our American heritage to give the best of ourselves.

    As I said, we should try give good care even to undeservings. But you don’t live in some oblivious medical bubble. I bet you wouldn’t feel the same, for example, if you were the mother of the 18 month old little girl who’s father raped her and who suffocated under him in the process. (That’s a true story from when I was a Pediatric resident 30 years ago.)

    There are lines which once crossed, are forever barriers to any return.


    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • SarahJ89

      Dr. Smith,
      I totally understand your feelings, but would like to point out another point of view. My mother was a sociopath who sold her very young daughters for a sandwich and a bottle of beer. She perpetrated abuse so severe that I have had trauma specialists burst into tears upon hearing about it. (I’ve learned to be very careful in doling out this information, in deference to the professionals who are, after all, human.)

      She died of metastatic breast cancer. I had not seen her in 14 years before her final illness. My sisters had had no contact in 6 years and a year, respectively. We simply couldn’t have a relationship because her abusiveness and manipulation never stopped.

      In the end we were there, helping to take care of her. On the wall outside her hospital room was a plaque with her name on it–she was the “volunteer of the year.” In her home was a framed letter from the governor of our state, extolling her many virtues. She was a con artist and a very gifted one.

      Why were we there at the end, providing what care we could? Because we are better than she was. We didn’t do it for her, we did it because it was the right thing to do. We were not stupid about it–we waited until she was unconscious, to protect ourselves from further harm.

      But caring for one’s dying mother is the normal thing for humans to do. We waited until it was safe and then we did the right thing because it was the right thing. It had nothing to do with her–if there’s any accountability to be had it hasn’t been with us for a very long time.

      • SarahJ89

        Du-uh. I miss the fact the author is a psychiatrist. Therapy is actually wasted on a sociopath, a whole different ball game from the physical care you give your patients. I was talking physical care. I can tell you our mother enjoyed psychotherapy. It gave her the chance to play the con game and she usually “won” when it came to mental health practitioners. Or thought she did.

        My friends’ father referred to his court-ordered sexual offenders’ therapy group as “perp class.” The members would meet after therapy for coffee and exchange names of victims who’d outgrown their particular age fixation.

        So yeah, I’m of another opinion when it comes to psychotherapy.

      • Ron Smith

        Hi, Sarah.

        i understand entirely. But what I’m trying to say is that what care these people receive is not because of them…they didn’t deserve it in the sense of it was owed to them or they had a right to it. There is no quality that warrants the ‘deserving.’

        What care your mother received was because of the person that you are.

        If I may philosophize for a moment, I realize that all of humankind individuals have to struggle with the degeneracy within. Some do battle poorly with that and then end up victimizing other individuals. The value of being an individual in humankind is the basest of our value.

        Its when you, who aspire to be a ‘better person’ and can provide that care based on that and not on the other persons lack of character that is important. But again, to say that the other person deserves that from you though is wrongheaded.

        That is what I’m trying point out, though maybe not as clearly as I could have.

        Warmest regards,

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

        • SarahJ89

          Yes, totally agree. I still have a really hard time with the games sociopaths play with the mental health profession–especially when I see so many of their victims unable to receive help.

          Fortunately, no one’s put me in charge of things yet. I’m still awaiting my crown, sceptre and Queen of Everything card.

  • meyati

    The doctor does not pick the patient. We need to think-what would happen to us, patients-if the doctor decided that we had some moral-mental flaw-that could lead to mistreating a patient for any reason. We are not Nazis and medical personnel are not the judge, jury or executioner. As a society, we have to protect the weak. Unfortunately these people are weak and damaged. A psychiatrist is a vital part of the legal system in bringing justice for the victim.

    My state has seen horrific actions. A vet caught a man viciously raping a 3 year-old boy. The vet picked up a 2×4 and did major damage to the rapist. Unfortunately the rapist already did major damage to the toddler. The first responders took the toddler. When the rapist finally arrived at the hospital much later-perhaps the cops kicked in a few more ribs and hoped the rapist would die enroute- the nurses, residents, and on up-did not want to touch that man. The head doctors had to personally come out to remind them of the hippocratic oath and that the medical staff are not part of the judicial system. They told them to do their jobs or quit.

    We had another horrendous crime that made people throw up. The police arrested the group of sadists. No lawyer would represent these disgusting monsters. If a lawyer did not represent these monsters, the authorities would have to let them go free. The State Attorney General called up lawyers, who refused to represent these monsters. Governor Bruce King called up his best friend, and pleaded for him to vigorously defend these men to the best of his ability, so justice could be served for the poor victim. The lawyer agreed. He lost many clients, so the governor released the news of why this lawyer did represent the monsters.

    If you want to see depravity, do a search on Johnny Zinn -Albuquerque

    A Crime That Shocked Us All – ABQJournal Online | Albuquerque …www.abqjournal.com/161355/news/a-crime-that-shocked-us… Cached
    … Johnny Zinn, ringleader in the crime, is serving more than 100 years in prison.

    It was important for the monster to have a mental examination, to make sure that justice was served for everybody. Today, you say-that poor girl Linda-and people that were around, even as children know who did it.

    Dr. Greg, thank you for doing your job; for protecting everyone, and most of all-for not losing your humanity.

    • SarahJ89

      But legal questions aside, we know that psychotherapy is a total waste of resources for sociopaths. There are plenty of analogies in physical medicine in which you do not treat because the treatment will just plain not work. This has nothing to do with repulsion or hate, just a recognition of the facts.

  • Rob Burnside

    I can’t help but recall the old saw, “Hate the sin, not the sinner.” There’s nothing helpful in hating someone else. It doesn’t change anything, and often damages the hater more than the object of his/her hate.

    Revulsion is something else entirely. A few months after I left EMS for an engine company assignment, my former long-time partner was first on-scene at a gruesome mass murder. A short time later he left the job, in the middle of what should have been an outstanding career. This was before Critical Incident Stress Debriefing existed, though I don’t know how much of a difference it would have made. Maybe it would have given him another year or two. He’d earned that much and more.

    Revulsion, I think, is cumulative no matter what. And that’s my greatest concern for all who labor in mental health, or any other extra stressful health care occupation such as long-term burn care and ED work.

  • Frank Lehman

    You do not get it, MedJ. He should provide medical care, but just refuse to continue if the patient goes into those pleadings. Tell him that if he wants to say such things, he needs to find another doctor.

  • EmilyAnon

    How many here have silently rooted for Dexter when he metes out his version of ‘justice’ to such lowlifes?

  • Tammy

    I understand the point you are making, but…

    I assume that we’re spending taxpayers’ money to provide this care. That’s all well and good if we have an unlimited bucket of taxpayer dollars, but we don’t.

    And you only have to look at how our vets who need mental help are (under)-treated, to understand why this sort of thing gets some peoples’ goats.

    What does a law-abiding Vet have to do to get the kind of mental health care we’re paying you to provide for convicted child sex fiends and wife-bashers?

    (ETA: I guess the Navy Yard shooter provided one answer to that…)

  • guest

    That’s a great video. Thanks for sharing it.

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