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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