Tuesday, July 03, 2007


Michael Ledeen at The Corner asks,
The FT says that there are even more MDs involved in the British terrorist attacks, once again showing what a great scholar Walter Laqueur is. He was the first, so far as I know, to notice this curious phenomenon. How does one explain the disproportionately high number of medical doctors in terrorist organizations? I'm trying to get Angleton on the ouija board...

Seven doctors are now held in the recent terror plots in the UK, so Ledeen asks a pertinent question.

In those who enter the medical profession there is almost always a curious mix of motivations. The motivation most often talked about (and believe me, I have read hundreds of prospective medical students' essays on why they want to become doctors, and after a while they all merge into one long, treacly sentimental tract) is the desire to do good, to help people, and to ease suffering.

This is good and essential, obviously. But have you ever considered the reality that in order to do good; or to help people in physical pain, that you must sometimes (actually often) cause them even greater pain for a time? That, if you are a surgeon, you must find some enjoyment (or at least be able not to get sick) slicig people open or debriding wounds and mucking around in them? Even those of us who are psychiatrists must often lead the unsuspecting patient to experience (and hopefully to resolve) all the unbearable psychological pain that his psychological defenses have been mobilized to ward off.

This aspect of medicine is not talked about much, but it is very real nonetheless. The physician's own cruel and sadistic impulses are never far below the surface. In the healthy person these impulses are generally sublimated and the instinctual energy derived from them can then be used to benefit society. Nevertheless, this is the dark side of altruism and the motivation to do good, and it is as human as the impulse to do good.

Personally, I find it truly an amazing thing that the worse and most base impulses of the human animal can be transformed into behavior that not only benefits society, but also gives pleasure to the individual who must cope with them if they want to be part of a civilized society. In the case of doctors, it is that side of human nature -- those cruel and often sadistic impulses existing within us all-- that gives them the ability to deal with other people's pain and suffering without diminishing their ability to do what needs to be done to remedy it.

It is a delicate balancing act to keep the two sides in some sort of positive equilibrium at the best of times; and things can get greatly out of balance by a variety of individual, cultural, and environmental factors that influence the the particular doctor.

I remember as a first year resident working the 24-hour shifts in the Surgical Emergency Room. There was a 4th year resident who used to supervise all the CPR and resucitative efforts; capably directing all of us as we tried to save lives. When it became clear that a patient was not going to respond to the CPR and was dead, this resident would move quietly away from the action and open a nearby drawer that contained a baseball umpire's hat; a protective mask and chest guard. He would don this outfit, then calmly wait until CPR was halted and the patient was pronounced dead; At that moment, in the best baseball tradition, he would yell, "He's outta there!", gesticulating just like an umpire making a close call. In an instant, the tension in the room would dissipate as we all broke into whoops of unrestrained laughter.

It sounds pretty awful, doesn't it? A group of doctors laughing uproariously over the body of a recently deceased individual. Not what you would imagine caring and compassionate healers would do, right? Certainly not in the tradition of all that sweetness and light we all wrote about in our medical school entrance essays, that's for sure.

Years later, when I ran into the surgeon who was then in private practice and jokingly reminded him of those days, he winced. "I was crazy then," he told me. "Not enough sleep, too many patients, so much death and mayhem--I just lost it sometimes."

But those are exactly the sort of factors that upset that delicately maintained balance from time to time. Medical humor is well-known for exploiting the latent sadism that is a component of the doctor's life.

Doctors are in a position to do both great good and great harm. Understanding a little of their own darker motivations can be helpful in keeping them from becoming monsters like Dr. Mengele or Dr. Zawahiri or Dr. Shipman (who has the distinction of being the most prolific serial killer of all time) --but that potential certainly lies within every physician--to a degree that is likely significantly greater than most other humans.

When those of our profession who have taken the Hippocratic Oath to "do no harm" are involved in incidents like the recently attempted terror bombings in England and Scotland, the horror experienced by all prospective patients who put their lives in our hands is palpable. When a terror plot is hatched in a hospital; and when some doctors who give into that dark side of themselves and find enjoyment, meaning or even religious awe by causing death instead of preventing it--it seems far more terrifying than any actions by your typical run-of-the-mill barbarian thug. After all, one expects a certain repellant style of behavior from barbarian thugs. It is extremely shocking to discover that the same repellant style can also exist in members of a profession that prides itself in saving human life.

But, in reality, it is not all that much different a dynamic from a supposed "relgion of peace" (a religion, for God's sake!) that has allowed itself to be taken over by elements exhibiting the most bestial aspects of human nature.

UPDATE: Welcome Instapundit readers! Sorry, but Haloscan comments seem to be down for the moment. They may be up a little later on....

UPDATE II: Well, the comments seem to be up and then down. Good luck if you want to leave a comment.

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