Why do people do bad things? Because they can get away with it.

One of the timeless eternal questions is: why do people do bad things? in the extreme, there simply are individuals who are psychopaths who derive pleasure in torturing and killing other creatures, including other humans. Although fascination of these monsters captures the public attention, they are relatively rare, maybe no more than 1 in 100,000 individuals are true psychopaths. Still 1 in 100,000 still means there are 3,000 psychopaths wandering the streets of the USA. I will delve into psychopaths in health care in a separate blog.

There are however many individuals who do a fair amount of bad things, and perhaps many of them have the common personality disorder of narcissism, but a number do not, and they are subclinical narcissists. The simple core explanation is: because they can get away with it. There are numerous co-factors that apply generally to individuals of lower social stature, which could occupy an entire book, many of these focused on the senses of isolation, being disrespected, taken advantage of, and at some level although not justifying bad behavior but at least explaining it... But most people simply do bad things because they perceive some advantage to them in doing so (unfortunately generally they are right), and they can get away with it. A greed-to-success based societal structure certainly fosters this behavior. This has always existed, but there are times throughout history where this has been the accepted, even expected behavior. Now is such a time.

What to do about it? Most of American society has used as the Mantra "thoughts and prayers" for the ills and tragedies that have befallen individuals and groups. But these are worthless, meaningless, comfort words, a false salve for the great majority of people. In modern western society, since Elizabethan justice is no longer acceptable (I am referring to Elizabeth the I... but scaled back a bit), we are left with transparency and accountability - if this is actually sought. A brief segue to a related topic that will be addressed later: many mass murderers are already under psychologic/ psychiatric care, so even if there was 1 psychologist assigned to live with each disturbed individual, there would be not much impact. Mental health as a cure for mass murder is also a worthless, meaningless talking point distraction.

So we are left with transparency and accountability as the only legally available tool to limit excess bad behavior. Transparency and accountability are however elusive especially when dealing with people in power, generally the worst perpetrators of bad behavior..... until they are no longer in favor. The story of Larry Nassar is such an example, but it is rare for these individuals to experience justice, because most of the time the cover-up is sufficiently complete that the truth remains concealed. At the present time it seems only with individuals who are physicians who commit sexual molestation acts, is there any chance of receiving justice, and then generally only when this is happening in states run by liberal democrats and not when they are run by conservative Republicans: the prime examples: the fates of George Tyndall, MD vs that of David Broadbent, MD. Uneven delivery of justice across states also needs to be addressed. None-the-less sexual molestation is atleast now getting much deserved recognition.

So, people do bad things because they can get away with it. In some areas, such as sexual molestation by physicians, there finally is some attention drawn to it, and sporadic accountability and justice served. The critical missing component is that the supervisors in charge need to experience accountability and justice, not only the ground level miscreants. The actual supervisors themselves must be named and held to account, not the broad cover of the institution being held responsible. Real change will only occur when the supervisors face the full force of justice served upon them.

Richard Semelka, MD