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No, I’m not talking about the health-care bureaucracy. That’s clearly dangerous to our health, as we will soon discover. I’m describing how all bureaucracies, both governmental and private, tend to foster a mind-set that is risk-averse and incapable of dealing with serious problems.
If possible, the problem is scheduled for discussion at a future committee meeting. If the problem seems pressing, it is fobbed off on a subordinate. If this can’t be done, it is passed up the bureaucracy. But in any case, the person concerned acts not as a responsible individual, but merely as a cog in an impersonal and indifferent machine – whose key objective is to maintain and increase its own power.
Captain Hassan gets promoted.
In 2009 Major Nidal Hassan shot up Fort Hood, murdering 14 and wounding 29 others, while shouting “Allahu akbar!” The media described him as murdering 13. No, it was 14 – one of his victims was pregnant. And I use the word “wounded” rather than “injured.” When soldiers are hurt by an armed enemy, they are wounded, and eligible for a Purple Heart Medal. Or at least they should be.
Major Hassan used to be Captain Hassan. He went through a psychiatry residency and fellowship while in the Army. He was observed daily by his colleagues and superiors. They were treated to his anti-American rants, which he presented instead of the psychiatric case discussions he was assigned. He tried to convert patients to Islam, a gross breach of professional ethics.
Meanwhile, Hassan was in e-mail contact with Imam Al-Awlaki, who advised him that it was his Islamic duty to kill “infidel” soldiers. Reportedly the FBI knew about these e-mails and told the Army, but did nothing else. Apparently they too did not want to seem “Islamophobic.” Al-Awlaki was killed in 2011 by, appropriately enough, a Hellfire missile. He will advise no more American soldiers on their duty.
Hassan was given mediocre evaluations, and the staff reportedly discussed whether he was a security risk. But nothing was done. No one wanted to be accused of being “Islamophobic” or of opposing “diversity.”
So Captain Hassan was promoted to major and assigned to Fort Hood, with the duty of caring for those about to go into combat, and those returning from combat. We see how faithfully he performed his duty, and how well he earned his promotion.
Afterward, Army Chief of Staff General Casey declared, “And as horrific as this tragedy was, if our diversity becomes a casualty, I think that’s worse.” Diversity of what? Race, religion, ethnic origin, or gender? Fine. But diversity of loyalty? Can we tolerate some troops who are loyal to the United States, and some who are loyal to our enemies? That leads to the ultimate diversity – some troops who are above ground, and some who are in it. There, is that diverse enough for you, sir?
Jerry Sandusky counsels more youths.
Sandusky was a long-time assistant football coach at Penn State, under legendary head coach Joe Paterno. In addition, Sandusky headed a charitable organization for troubled boys. Both activities served the ulterior motive of attracting boys.
One day Mike McQueary, a former football star and at the time a Penn State assistant, entered the shower room and found Sandusky apparently having anal sex with a 10-year-old boy. McQueary’s response was to slam his locker door to announce his presence, then leave. The next day he notified Paterno, who in turn notified university officials. Those interested in details can read reports of Sandusky’s trial, at which he was convicted on almost all counts and given what amounts to a life sentence.
But McQueary was a large, strong, young man. He could have beaten up Sandusky and warned him never to do it again. He could have taken the boy home and informed his parents. He could have called the police. But he was so much a part of the football culture, and so enmeshed in the quasi-military hierarchy, that he felt he had done his duty if he informed Paterno, his superior, just as Paterno felt he had done his duty when he informed his superiors.
Their loyalty was to the organization, not to the boys, and not to any moral principles. The investigation by former FBI director Louis Freeh concluded that most senior officials at Penn State showed a “total disregard for the safety and welfare of Sandusky’s child victims” for 14 years and empowered Sandusky to continue his abuse.
If there is a more disturbing example of the bureaucratic mind-set, I hope never to hear of it.
James Holmes generates a report.
James Holmes murdered 13 and injured 58 in the Aurora, Colorado movie theater. Media reports claim he murdered 12, but one of the injured women miscarried. Holmes was an honor graduate of California State University Riverside and was in the PhD program in neuroscience at the University of Colorado-Denver. But he was not doing well in his studies and was seeing a university psychiatrist.
His condition worried his psychiatrist enough that she reported him to the threat-assessment team. But by that time, Holmes was in the process of dropping out of the university and had lost access to secure areas. The threat-assessment team decided that Holmes was no longer their problem – and did nothing.
But Holmes still had access to non-secure areas of the campus. Instead of using three firearms and multiple tear-gas grenades to attack the showing of “The Dark Knight Rises,” he could have attacked a lecture hall filled with Psychology 1A students, and perhaps murdered even more. But the threat-assessment team didn’t assess that threat. Nor did they assess the threat that he might attack an off-campus target. Perhaps they were too busy assessing the threat that if they did anything, they might be sued, or accused of being politically incorrect – the only unforgivable crime at a university.
So nobody notified the police. After the theater attack, a package addressed to the psychiatrist was found in the campus mail room. Reportedly it contained detailed plans and drawings of a mass murder. Accounts differ as to whether the package was reported to the police immediately, or whether it sat in the mail room for some time.
Here we run into serious problems with doctor-patient confidentiality. Under California law, and I believe Colorado law, short of a judge’s subpoena, physicians (including psychiatrists), psychologists, and other mental-health professionals must keep patient records confidential. But they are obligated to call the police immediately if a patient is a danger to himself or others.
In addition, health-care professionals have a duty to warn. Under the Tarasoff decision, they must warn an intended victim if one can be identified. And under the Hedlund decision, they have a duty to warn people around the intended victim. For example, if I disclose a plan to murder my professor, my therapist must warn him and also warn other people in that office.
All this becomes clear only in hindsight. At the time, the patient may be unclear as to what he intends. Mentally disturbed people often speak obliquely, in ways subject to various interpretations. It would be unfair to affix blame at this early stage.
Nevertheless, it seems likely that Holmes was descending into schizophrenia, which often becomes evident in the late teens or twenties. Only a small fraction of schizophrenics become violent, but those who do present a serious problem. If we are too proactive, we may involuntarily hospitalize people who could have done well as outpatients. But if we are too inactive, we may wind up at the midnight showing of “The Dark Knight Rises.”
There are no easy answers to complex problems. But if we hope to find answers, a bureaucracy is not the best place to look. In the end, the risk-averse paper-shuffler may pose the greatest risk of all.
There is an experiment in social psychology in which a person falls down on the sidewalk. If only a few people are there, someone will usually stop to help. But if there are several people, often no one will stop. The responsibility is so divided that each one feels only a negligible amount. Surely, they think, someone else will do it. No one feels personal responsibility to do anything – except conform to the group, which is doing nothing.
The bigger the group, the smaller the individual’s responsibility to do anything. If the group includes all 314 million Americans, the individual’s responsibility will vanish entirely. Those who favor big government should remember this experiment.
Dr. Stolinsky writes on political and social issues. Contact: dstol@prodigy.net. You are welcome to publish or post these articles, provided that you cite the author and website.
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