Working in private practice people sometimes make the assumption I only treat the “worried well”. Every prospective employee I interview I tell them- while there are serious perks to private practice including total control of your schedule and fully remote work…we still treat sick people. You may get an easy straightforward anxiety…but you likely will have some serious cases that will push you.

For me, I’ve treated…a lot. I’ve treated sexual abuse victims, incest victims, victims of DV, and many other incredibly intense cases over the years.

What has been surprising for me, and what no one ever discussed when I attended school and training- were treating patients who committed murder. Working both inpatient and outpatient I’ve treated roughly 40-50 patients who have committed murder in some capacity.

There are many different kinds- negligent homicide is something like a drunk driver who hits a car and some one in the other car dies- basically an unintentional homicide but caused by the person’s negligence. There are homicides that are intentional, or perhaps just witnessed but the witness is held responsible for not stopping it or for contributing to it, and the saddest are probably the murders committed by people in a psychotic state such as with postpartum psychosis- those are probably the most publicized in the media.

We learn a lot about transference and counter-transference in school- and we do talk about how it would feel to treat a perpetrator of a sex crime but for some reason we never touched on treating some one who commits a murder.

But it’s an important conversation to have.

Working in mental health has caused me to take stock of my values, ethics, and core belief systems…and made me re-evaluate all of those things repeatedly at a very visceral level.

I remember working in the pediatric emergency department. There was a certain coldness projected toward the parents that overtook all of our demeanors when we realized the child we were treating was the victim of abuse- whether sexual or physical. At some point the truth always comes out. And I did treat some children who died of their injuries. And if you could have bottled the rage in the room from the healthcare providers…well that would be some potent nuclear energy.

So I had that background going into mental healthcare.

Then I sat across from my first patient who committed a homicide. I did not have that rage encompass me though. I still do not. I think they expect it. But as the mental health provider treating the perpetrator of a crime, well they are still my patient, and I treat all my patient’s the same. With respect and I try to come from a place of empathy and understanding.

In reflecting on murderers I’ve thought of my Dad. Was he a murderer? Not by my our standards I suppose. But he did kill people when he fought in Vietnam. He was a gunner on a helicopter- one of the big ones where the sides are open…hopefully you’ve seen enough war movies you know what I mean. I asked him one day when I was old enough to realize what a “gunner” meant “Dad does that mean you killed people” and in typical Dad fashion he said, “Well I killed more cows than people hon,” and that was that. My Dad was excellent at non-answers. Especially about Vietnam.

So I suppose the first “murderer” I sat across from at a table was my Dad.

So you can see why I have a stronger response to pedophiles than to murderers? Murder I’ve had to assimilate and rationalize because I grew up the daughter of a combat veteran. There ain’t no assimilating or rationalizing pedophilia though. That’s never okay. Not even in war.

I am speaking somewhat facetiously because the double standard is absurd. Murder is never okay. Pedophilia is never okay. But we live in a society that is more okay with murder than any other type of crime. As evidenced by the lack of gun legislation in America after the first mass school shooting. We receive the message from the highest level of politicians and courts that murder is justified as long as it’s with a gun that you should be free to carry.

We also live in a society with combat veterans who have committed legal murders. And we praise them, respect them, salute them. I am not saying we shouldn’t do all of that. I am grateful for all the people who have served and continue to serve our country because I see the sacrifices they’ve made in my work every day in the veterans I treat who carry such shame, guilt, and trauma.

I used to be very black and white in my thinking. Back when I was 22 and thought I could be part of the solution in saving the world. I’m 37 now. I’ve seen children die at the hands of their parents- intentionally and unintentionally. I’ve treated men and women who have been raped and who have killed.

I also grew up with a Dad who was a Vietnam veteran and deeply committed to the love of his country.

Through all of this I’ve come to realize there cannot be a black and white version of myself or of mental health treatment. I’ve treated rapists who I did trauma work with who were deeply wounded humans perpetrating in the cycle of their own traumas. I’ve treated incredibly brave and resilient victims and supported them through court proceedings to bring their perpetrator to justice. I’ve treated murderers who carried the deep wound of taking a life. And I’ve treated murderers whose murders were legal in the face of battle but who have to make the decision to live every day because the incredible wounds they feel internally drive them so close to suicide.

There is no black and white and there is no right or wrong. What I’ve discovered in myself is that I have to present myself with empathy, understanding, and I have to listen to my gut and bodies responses. If my body is telling me that there is no remorse here, and potentially sociopathy, our consultation appointment is just that. A consult. And I will not be following up with them.

But those are rare. More common is the person who is just a person. Trying to survive. Who was thrust or who put themselves into unthinkable circumstances and who are spending the rest of their lives trying to not be defined by that one moment. There is grief for the person they once were, compassion for who they are in this moment- vulnerable and seeking a non-judgmental space- and hope for the person they can become.

Fifteen years in and I still love being a nurse. I love this field, I love that it pushes me to see beyond society’s expectations and norms. I love that it makes me examine my own weaknesses and prejudices and challenges me to do better and be better. In these cases it’s pushed me to examine my beliefs about “murderers” and what I found is they are just people with a story. Stories that deserve to be told and to be heard.

p.s. #banguns #fucktheNRA

p.p.s. For all those asshats saying you should have the choice to not treat people who are LGBTQ…you are assholes. If you continue in that vein for your “religious freedom” shouldn’t you also not treat adulterers, murderers, pedophiles…etc? How come you can decide to not treat one population of people but not all the rest? How come you are more comfortable treating a heterosexual murderer than a law abiding non-rapist and non-murdering lesbian? Y’all need to have a Come to Jesus moment. Cuz you make no sense. Just own it and say you are homophobic and transphobic.