I almost became a psychiatrist instead of family medicine doctor. It was after experiencing a near-epiphany during a Grand Rounds presentation that I almost crystallized my decision to specialize. It occurred while satisfying a mandatory one month rotation as a senior medical student at the state mental hospital, Mississippi State Hospital, at Whitfield.
This particular Grand Rounds case was in forensic psychiatry and involved a patient being brought before the class for interview. In this particular case the class asked the patient questions without the benefit of given the history or any test results. Then by deductive reasoning, a consensus would be arrived at and the correct psychiatric diagnosis declared. We were given an advantage compared to that in real life in that our patient was required to answer all questions truthfully. After a 30 minute barrage of questions, it was apparent our patient was normal in every respect. He seemed, acted, and talked like a normal guy. He seemed like ‘one of us.’ His body language was normal; his facial responses, everything about him was, or appeared to be, normal in every respect. The opinion of the class was that he was normal. Many of us thought it was a ‘trick’ case to ‘get us to think’ about a lot of things. After he had been ushered out of the room, in ankle cuffs which up till then were not visible behind the desk, by the two undercover armed guards dressed in civilian clothes quietly attending the session on the side, the correct diagnosis was then revealed. He was a killer and had murdered four people: his wife, his son, his pastor, and his neighbor. After the session we thought we had asked an all encompassing range of revealing questions. But we asked ourselves what other kind of questions should we have asked that would’ve revealed his heinous acts, like… Did you ever kill more than one cat when you were a kid? Were you an only lonely child? What pisses you off easily? Do you enjoy being a parent? Does your wife give you sex when you want it? Do you enjoy your pastor’s sermons? Does your neighbor keep up his yard? Does your neighbor play loud music and if so does it bother you? Seriously though the cases’ overarching lesson, aside from being aware of the difficulty in obtaining correct information from some who are mentally disturbed, was that things that drive people to do bad things are not always apparent to anyone, more so a trained person or inquiring physician. It was a lesson in abnormal psychology. Sometimes there are deranged thought processes, or mental rot if you will, that runs deep and well beneath the appearance of normal – or such was the point being taught. We’ve all heard the stories. With respect to the Penn State story, why a normal looking and normal acting man, talented and productive, would want to act on the desire to have a sexual encounter with a young boy is beyond the comprehension of most, assuming the allegations are true. Everyone is allowed his day in court but 40 criminal charges of sexual deviancy makes for a long day in court. As they say, you struggle to get your mind wrapped around it. Moreover, why other learned men, even more productive and in leadership positions, upon learning of such happenings, if the allegations are true, would reduce it to an “out of sight” status is also beyond understanding. But then again, not being in someone’s shoes at decision-making time is another thing. While there are different understandings and explanations for the actions of a few, as of this date, of what has transpired in this story, for me, there are two main observations. One is that at its root it can be reduced to Big taking advantage of Little -- Big advancing at the expense of Little. The predisposition that power has over the powerless takes on a variety of forms and patterns, and has prevailed over many years, perhaps not as much as it once did, but probably more than we would like to admit. For “Big” you can substitute: institution, organization, corporation, government, business, employer, political party, church, majority, strong. For “Little” you can substitute: person, individual, elderly, children, consumer, employee, minority, weak. The second observation is to not run to judgment to paint everyone at Penn State with the same moral brush. While there could be more than a few more people involved in a cover-up, I would think and hope the faculty, most of the administration, and of course students, would not be so inclined to sweep such a matter under the rug, in spite of the university‘s reputation and money-making ways. Don’t blame all for the sins of a few. I’m thinking that at some point the accused will be interviewed by a psychiatrist. I thought about what kind of questions I might ask in an effort to understand the workings of such a mind, assuming the allegations are true. Did you have sex with a boy? Have you ever had the desire to have sex with a boy? When did you begin to have thoughts of showering with a boy?Have you seen other men shower with boys? Do you believe showering with boys is considered by most men to be a normal thing? Has, and is, your sex with your wife satisfying? If your sex life with your wife changed when did it change? Have you ever been molested as a child? Have you ever had sex outside of marriage? Have you ever had sex as a child with an older man? Do you relate better with children and teens or adults? Have you ever harbored or suppressed homosexual tendencies? Do you feel more comfortable socializing with children or adults?Did your affection and desire to help vulnerable children arise before you considered it normal to horse around in the shower with boys? Have you ever taken photographs of children? Have you ever provided alcohol or recreational drugs to children?You are on tape remorsefully apologizing to a mother about an encounter with her son. About what are you remorseful? Even then, it’s possible every answer would be one that would point to a normal kind of guy. I suppose DNA, polygraph tests, and/or the cumulative weight of witness(es), and perhaps circumstantial evidence in the end would be the determinants of guilt or innocence. Everyone has an opinion about this story and will take away from it lessons on different levels. But when witnessing or being made aware of Big taking advantage of Little, or a man raping a woman or child, our options boil down to a few: we can either point it out and move for change or justice, accept it, or walk away. Then prepare our conscience to live with the choice we’ve made. The test of the morality of a society is what it does for its children. ~Dietrich Bonhoeffer "...the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped. " ~ Last Speech of Hubert H. Humphrey "A nation's greatness is measured by how it treats its weakest members." ~ Mahatma Ghandi
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