A Psychoanalytic Perspective on Ethics, Self‐deception and the Corrupt Physician

Abstract

In this paper the authors use a psychoanalytic perspective to understand observations about the modes of self-deception that operate in physicians who have been dishonest or have engaged in other transgressions of ethics guidelines. They emphasize that it is inaccurate to categorize physicians as simply honest or dishonest, ethical or unethical. Physicians who have been ethical practitioners may rationalize sexual relations with patients, stealing from professional treasuries, lying, or other transgressions while convincing themselves that they have acted in an honourable manner. The authors share their experience of evaluating these phenomena in over 300 physicians who were referred to a specialized treatment centre by licensing boards, hospitals, physician health organizations or ethics committees. They note the high prevalence of defensive compartmentalization, temporal splitting and projective disavowal as means of tolerating behaviours they would generally regard as unethical. They also examine the implications of these modes of self-deception for psychotherapy.

Moments of Meeting: The Relational Challenges of Sexuality in the Consulting Room

“…Although it may be argued that this was implicit in my ‘romantic weekend’ intervention, I would caution against drawing too literal or concrete a conclusion from this playful comment. That said, and particularly in the light of Gabbard and Hobday's () findings, as discussed above, I think we have to accept that, at times, we are all vulnerable to self‐deception and attempts to defeat and triumph over our superego. In recognition of this, I would emphasize the importance of regular, ongoing supervision as I note in drawing this paper to a conclusion.…”

“…Typically, self‐deception is maintained by defensive compartmentalization, splitting and projective disavowal and used as a means of tolerating behaviours that would otherwise be regarded as unethical. For example, in projective disavowal, the patient ‘may be regarded as a ‘bad object’ who is persecuting the doctor and demanding sex’ (Gabbard & Hobday, , p. 242). Modes of self‐deception, then, are used to protect oneself from the darker side of the psyche that allowed the boundary transgression, and reflect the fact that: ‘The superego is a fluid structure that involves a variety of identifications from multiple developmental levels’ (p. 238).…”

“…Needless to say, these various clinical and ethical issues were discussed in supervision as they arose in the therapeutic relationship. Again, given Gabbard and Hobday's () findings from their work with professionals who have transgressed an ethical boundary, I would stress the importance both of the supervisory relationship and of not becoming isolated in our clinical work, particularly when engaging in a more direct, relational way with a patient's sexuality. As a supervisor myself, I am only too well aware of how intensely unsettling at times a supervisee can find the relational challenges of sexuality in the consulting room.…”

The Intricate Process of Psychoanalytic Research: Encountering the Intersubjective Experience of the Researcher–Participant Relationship

“…() describe a ‘role‐reversing interaction’ as participants ‘seduce’ researchers into certain roles. Gabbard and Hobday () describe patients as unconsciously recreating their internal object relations in the transference–countertransference relationship with their psychotherapist. I suggest that the same occurs in the nature of the research relationship using the psychoanalytic method I employed and thus researchers need to be very mindful of this blurring in order to manage it successfully.…”

Reflections on knowledge and experience

“…Nevertheless, those occasions when analysts depart too far from standard analytic boundaries and commit ethical boundary violations offer salutary warnings to us all. Nor is it surprising to learn that it is senior male analysts who are most at risk of transgressing in this way since the additional freedom and confidence that come with experience can easily tip into the omnipotent belief of those who believe the rules do not apply to them (Gabbard & Hobday ).…”