At Second Sight

By Meera Reghunathan, MS4

As with all writing published on Stories in Medicine, locations and names in this piece have been changed.

Le Sommeil - Dali
Le Sommeil (Sleep) by Salvador Dali, 1939. Dali described this painting as “The act of sleeping was a monster sustained on the crutches of reality”

The first time I came face-to-face with a pedophile was nothing like I expected. At first sight, the gentleman was in jail uniform, a demented old man with disheveled hair and beady eyes. He leaned on his walker as he hobbled in, putting his bagged breakfast aside so he could comfortably sit. Through steel grey vertical bars, he looked up at me. As soon as I met his aged, sunken eyes, a shiver ran down my back. I saw him see me and recoiled, resisting the urge to run out of the room. The words from his victims’ statements flashed in front of my eyes. I felt an indescribable disgust, my stomach boiling thinking of this man’s wrongdoings.

I saw a predator. I saw a monster.

What I saw built a lens by which I perceived the rest of the encounter. Thoughts flashed through my head, thoughts that felt righteous in the moment.

“Why are we wasting our time with this guy? He deserves whatever he gets.”

“Mental illness? This guy is sick and twisted, and is making a choice.”

“Why does he deserve our compassion, when he doesn’t give compassion to his victims?”

“He donates to charities to cure cancer for kids? Does he realize how twisted that is?”

The interviewing psychologist continued to amaze me, an ocean of calm, methodically interviewing the pedophile before us. Before I knew it, the interview was over and I, the observer, was still caught in a storm of negative emotions towards the patient.

A sense of unrest lingered with me. Later that week in a morning meeting, an attending psychiatrist asked if I had any interesting cases to discuss. This was the first patient to come to mind, something about him still unresolved in my mind. The ensuing discussion was profound.

“You exhibited negative countertransference”.

I learned that the emotions I felt towards the patient have a label in psychiatry, although the concept applies across many fields: countertransference. This patient exerted an influence on my conscious and unconscious feelings, and without proper recognition and resolution of these feelings, optimal health care could not ensue. Before this man had even opened his mouth, I had formed an impression of who he was and what I expected him to say. My walls were up before he said hello.

“Aggressors were often the victims”

How easy to forget the vicious cycle that feeds the darkest parts of our society—poverty, abuse, and crime. A child’s sense of “right and wrong” is crafted by the social and physical experiences he or she attains throughout childhood. My attending elaborates, “this doesn’t make it okay to be a pedophile, but…”. But you can’t help but have your heart ache for someone when you see the flash of the helpless kid they used to be, the kid whose norm was abuse.  

“Pedophilia is a mental illness.”

Like most mental illness, pedophilia is not a choice. It represents a complicated intersection of genes, environment, and neurology. In fact, the despise that much of American society holds towards pedophilia contributes to the counterproductive ways that criminal justice and mental health systems address this mental disease.

“Mental illness is defined by our societal and cultural norms”

It was not easy to zoom out of my societal and cultural norms and see the diversity of experiences that exist in this world. My attending reminded me that there are entire societies where pedophilic behavior is considered a norm. This was not offered to justify such behaviors, but to imply something much bigger – that judgment does not play a role in compassion. It is not our burden to determine right and wrong, but it is our privilege to show humanity without discrimination.  

Reflecting on these lessons, I realized that my journey towards compassionate care has a long way to go. It was stunning to introspect and realize I had a mentality of “giving to those who deserve it”. I enforced an expectation that the recipient of my time and skills be “worthy”.

But compassion has no place for judgment. Humanism isn’t something we get to pick and choose and give to “deserving” people. I want to see the best in people and aid them in their darkest times. We are neither the judge nor the jury, we are the givers, and that is a beautiful thing.

Henry David Thoreau may not have been referring to medicine when he said “It’s not what you look at that matters, but what you see”, but I can think of no field in which this mindset is more important. I have the honor and privilege of being in a healthcare profession, where my duty will be to improve the lives of those I care for. I must learn to see with compassionate eyes and know that I am looking at a human who deserves excellence, empathy, and respect.

So, please allow me to start over again.

The first time I came face-to-face with a pedophile was nothing like I expected. At second sight, the gentleman was in jail uniform, an elderly man suffering from dementia, with disheveled hair and sad eyes. He was an aggressor and a victim. He was a man plagued by his own demons. He was a man who suffered from mental illness. He was a human.

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Meera Reghunathan is a fourth year medical student at UC San Diego School of Medicine. She is one of the two winners of the 2018 Gold Humanism Honor Society essay contest. 

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