Psychopathy and the Medical Profession

IMG_9598Psychopathy is present in all professions. In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths.   Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors  (in general) are listed among the lowest.

Although by no means a scientific study, Psycopaths, by their very nature, seek power and it would make sense that a psychopath among us might pick surgery over pediatrics or pathology as they are drawn to power, prestige, and control. Be this as it may the incidence of psycopathy or psychopathic traits in doctors of any specialty is low. Statistics indicate that no more than 1% of men in general exhibit psychopathic traits. In Women these characteristics are far less.

Due to irresponsible behavior and a tendency to ignore or violate social conventions and rules,  psychopaths frequently find themselves engaged in conduct involving the criminal justice system or involved in other disciplinary action. Juvenile delinquency, arrests, school suspensions and misconduct related issues are barriers that preclude professional careers for many and, with around 15% of the prison population estimated to be psychopathic, incarceration and recidivism are common final pathways. Because of this tendency it would be highly unlikely for most sociopaths to follow a standard professional career pathway involving academic rigor and normal professional and societal expectations,  because impulsive irresponsible actions commonly blocks it. This would predict a probably much lower prevalence of psycopathy in physicians compared to the general population.

That being said, such self imposed removal from a potential  career is the sole product of getting caught for misconduct and being held accountable for it.   Psychopaths possess several traits that make this difficult.    With a talent for “reading people” and identifying their weak spots and vulnerabilities they are able to get people to see what they want them to see.  Psychopaths often exude charm, confidence and charisma.  They can lie effortlessly and are very convincing..

The natural history of psychopathy involves risky behavior and the ability to get away with it or out of it. The consequences of this depend on if and when it occurs. It is entirely conceivable that some may live their entire lives undetected. With a need for stimulation and a proneness to boredom the psychopath is particularly prone to drug abuse and addiction and twice as likely as the general population to be diagnosed.

 Psycopathy involves a path of risky behavior as well as the potential for being held accountable for it. At any age the behavior that brings they psychopath to the attention of the criminal justice system is often drug or alcohol related. The natural history of the average psychopath reveals an overrepresentation in prison with a 15x greater risk in general. Any statistics on psycopathy in a population is based on psychometric evaluations retrospectively in specific populations. Being arrested or getting caught for something does not reveal the pathology or the correlation. You have to look for it.

And nothing is known of subpopulations of psychopaths and the impact of intelligence, education, profession and other factors and how they relate to outcomes and consequences over time. Egocentricity and a sense of entitlement drives they do not adapt to the environment but try to make the environment adapt to them. Without empathy and lacking remorse the goal is always self-serving and a question of what they can get out of it.

 Many judges, as an alternative to incarceration, have been requiring people arrested for drug and alcohol related offenses to attend AA meetings and provide proof of participation. As misguided as this is on other levels it is also dangerous. Given a choice between incarceration and attending AA the majority of any population, including those with psychopathic traits, would choose the latter. And as in any situation they would use it to see what they could get out of it. Masters of manipulation and impression management in a room full of potential victims. The reports of rape and theft coming out is no surprise. It is in all likelihood much worse.

And in reality psychopaths exist in every profession, including medicine.

What is the natural history and final common pathway of M.D. psychopaths?  Where do these shape-shifters end up?

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In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the Federation of State Physician Health Programs (FSPHP) and those in charge of state physician health programs that is exactly what you will find.     Less than 1/% of the population are psychopaths but they represent more that 10% of those in prisons.  What is the natural history of the physician psychopath? You do the math.


7 thoughts on “Psychopathy and the Medical Profession

  1. Hi, Dr. Langan,

    Fascinating read. I noticed that you were following my blog and I have a tendency to be curious about who my followers are. I’m thankful that you ‘stopped by’ and more so that I’ve found your blog!

    I actively educate about psychopathy. I have a love-hate relationship with politics and see so much psychopathy in all levels of government, in particular, pathological politician’s. While people are becoming more aware, what I find most common is that people are very good at describing the behaviors, but they can’t label it so as to do further research.

    I’m convinced, without a doubt, that psychopaths tend to professions where power is a priority. Given that the psychopath is power addicted, and without empathy, can ruthlessly climb corporate, justice system, police force (Ugh! A lot to say about this), BIG PHARMA, and within the medical and mental health professions.

    I’ve listened to hundreds of stories from survivors of not only romantic pathological relationships, but also those that were abused by therapists, Pastors, and medical doctors. I too, have experienced this personally and it is quite traumatic.

    I have chronic pain/chronic illness (two serious autoimmune), and severe PTSD and major depression as a consequence of a lifetime of exposure to psychopaths. I believe the disorders are genetic, although there isn’t any ‘real’ science to back this up yet. YET. I’m often stigmatized and receive substandard care. I can count on one hand, the doctors I’ve had (specialists seem to have an extraordinary God complex), that were abusive and clearly lacking in empathy. Knowing what to look for in behavior and action that suggests psychopathy makes my relationship with doctors difficult at best, impossible at worst. I’m an empath and I often feel targeted by these personalities, whether by doctors or others in society that I must deal with. I’m grateful to have a healthy minded therapist who understands the disorders as she has had them in her care through court ordered anger management, more so than drug/alcohol issues. Psychopaths are quite good at hiding these issues and, I believe, function quite ‘normally’ at their highly successful careers. My father was/is a psychopath and a massive alcoholic, yet he’d get out of bed immediately in the morning, shower, shave, shit and all was good. It was as if he hadn’t had one drink the night before. I’ve often wondered if they do not ‘feel’ the effects of alcohol/drug addiction like an empathic person might. Does this make sense to you?

    I’m rattling, and I apologize. It’s rare for me to discover anyone from a field of success, particularly medical or mental health that would bother to speak openly about what I believe is a monumental problem in medicine and mental health. I plan to read many more articles on your blog and I thank you for having the courage to write.

    Liked by 1 person

    • Thank you- I have found that most
      Doctors are people of good conscience who care about their patients. Most doctors I know at MGH wrestle with their medical decisions to do what is best
      And carefully consider their decisions. I believe it was John Nash who spoke of the Psycopath equilibrium and how a small number of sociopaths exist
      In any society and when that starts to cause problems the non sociopath majority react by taking counter measures such that
      The percentage of psychopaths stays low at 1-2% or something like that. The “impaired physician movement ” that began with good intent
      To “rehabilitate” rather than “discipline” due to a confluence of factors has become a haven for psychopathy. First of all it is a final common pathway for a sociopathic doctor who gets caught -once caught that doctor would choose the Physician Wellness path and over time the percentage has increased and they have taken it over. By blaming whatever behavior got them into trouble on their “disease” and saying they are in recovery doctors who have done terrible things have it only gotten their licenses back but given power. They have also removed themselves from all accountability with no regulation, oversight or answerability. An academic analysis from experts in the corporate psychopathy field is needed.

      Liked by 1 person

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