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Chemical Restraint in Nursing Homes
and Other Forms of Social Control

Dr. Richard Kluft Treatise:  Précis

Dr. Richard P. Kluft, graduate of Harvard University, wrote the world's first treatise on abuse by physicians:

The Physician as Perpetrator of Abuse [PDF]

Exploiting patients is forbidden by every code of medical ethics from the Oath of Hippocrates to modern Medical Bylaws. Reality, though, falls short.

MDs are in a power position vis-a-vis their patients. This power can be misused. Kluft defines 7 ways, citing 26 (disguised) cases from his clinical practice.

When MDs abuse individuals or society, it is a form of Affinity Fraud. Kluft concludes with guidelines for management.

THE PHYSICIAN AS
PERPETRATOR OF ABUSE

Richard P. Kluft, MD

The Physician as an Abuser

Widespread media attention and a great amount of professional literature has addressed the specific problem of the sexual exploitation of patients by psychiatrists and other types of psychotherapists. Despite frequent unfavorable representations of physicians in television dramas and frequent news media attention to malpractice cases involving physician misconduct, a general literature on the abusive behaviors of physicians other than psychiatrists has been slow to develop. A computer search (in 1993) revealed a mere handful of references, mostly related to nursing journals' discussions of physicians abusing their power with nurses. [3, 9, 31]

This article explores the scope of physicians' abusive behaviors toward patients and selected others. It will note some of the consequences of these misadventures and offer some suggestions for management when a patient has experienced mistreatment in previous medical encounters. Space constraints preclude developing most areas in depth. Illustrations are drawn from situations that have come to my attention in the course of my clinical practice. Unless published accounts are cited or the author was given permission to publish a given incident, the vignettes below are highly disguised in the interests of confidentiality.

This discussion does not address the full range of human misbehavior by persons who happen to be physicians, most forms of fraud and fiscal misbehavior, nor malpractice that is unrelated to abusive activities. The topic headings are not always mutually exclusive, and the classifications offered should be understood as tentative and preliminary. Some readers may disagree vehemently as to whether certain of the behaviors listed should be considered abusive.

Physicians Acting as Agents of Social Control

Physicians have played important if inglorious roles in which their medical skills and authority have been placed in the service of institutions and agencies with other than healing intent. The former Soviet Union used psychiatry as a ruse to detain and disable dissidents and political prisoners. Physicians have played and continue to play clandestine roles in the management, control, interrogation, and torture of political prisoners in many parts of the world.

Perhaps the most large-scale, infamous misappropriation and misapplication of medical personnel and practices and widespread perversion of medical research occurred in the Holocaust. As Lifton [24] recounts in his monumental study, The Nazi Doctors, the Nazi biomedical vision seized on the metaphor of healing the racially diseased body of the German nation.

In this context, killing those who constituted the disease was a therapeutic venture, much as the excision of a malignant growth. The Nazis based their justification for direct medical killing on the simple concept of life unworthy of life (lebensunwertes Leben) … Of the five identifiable steps by which the Nazis carried out the principle of life unworthy of life, coercive sterilization was the first. There followed the killing of impaired children in hospitals; and then the killing of impaired adults, mostly collected from mental hospitals, in centers especially equipped with carbon monoxide gas. This project was extended (in the same killing centers) to impaired inmates of concentration and extermination camps and finally, to mass killings, mostly of Jews, in the extermination camps. [24]

Lifton [24] quotes Martin Borman, The Fuhrer holds the cleansing of the medical profession far more important than, for example, that of the bureaucracy, since in his opinion the duty of the physician is or should be one of racial leadership. In the camps, Jewish doctors among the inmates on occasion were forced into assuming various roles in the Nazis' projects.

Lifton [24] found that many of the Nazi doctors coped with the tension between their usual selves and values and the roles that they had in the camps by doubling, i.e., by forming a self that could tolerate and adapt to the total perversion of traditional medical values. In sum, doubling is the psychological means by which one invokes the evil potential of the self. That evil is neither inherent in the self nor foreign to it. To live out the doubling and call forth the evil is a moral choice for which one is responsible, whatever the level of consciousness involved. [24]

The participation of physicians in programs of social control that may not be consistent with a healing function takes many milder forms as well. Currently there is much concern over the abuse of nursing-home patients. It is not unusual to find that the complicated and often counterproductive medication regimens administered to them have developed because a physician is prescribing (usually in response to requests made by nursing-home personnel) in a manner that controls rather than assists the patient.

The reader may be shocked and offended by my drawing this analogy, but it is crucial to appreciate that the use of medicine in a manner that addresses the needs of parties other than the patient has a profound potential for abuse. When children are sedated to suit the needs of a parent, a similar process may be at work.

For the citizen of a democracy, it is crucial to remain aware that the misuse of medical skills is not something that is always happening somewhere else or in fictionalized accounts. Weinstein's Psychiatry and the CIA: Victims of Mind Control [43] offers poignant testimony that secret American projects have subverted and corrupted the physicians who were participants and that in the name of heaven knows what, perhaps patriotism, innocent people have been experimented on and severely damaged by North American doctors.

Furthermore, in interviewing persons who had been exploited in child pornography or child prostitution, it is not uncommon to hear of the involvement of a doctor in connection with handling injuries and pregnancies and with supplying drugs that were given to control them. In most of these accounts, however, it is not possible to determine whether the person identified as a doctor was in fact a physician.

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