Does Genocidal Ideation Warrant a Breach of Doctor-Patient Confidentiality?
A Therapist’s 10-Step Treatment Guide for Totalitarian Clients
1. Listen without judgment. If your client wishes to discuss their fervent desire to commit genocide(s), they need to feel safe. Receive their malignant nationalism as a courageous expression of vulnerability. Allow them to speak freely on their undying passion for eugenics. This is their time.
2. Validate their feelings. This one can be tricky. At times, you may find your client’s opinions to be objectionable, or terrifying. But it’s important not to react emotionally. You could say, “I understand that it must be challenging to wake up every morning obsessed with annihilating x nationality. Let’s work on that together.”
3. Explore your client’s childhood. Is there any trauma in their past? Do they have early memories playing the board game Risk? Was Pol Pot a family friend? Or perhaps they were the middle child.
4. Assess the threat. Have they previously committed or attempted to commit genocide? Do they have access to nuclear weapons? Did they give a specific date and time for their crime against humanity, or was it more vague (e.g., “Sometimes I get so stressed that I don’t know if it’s worth allowing certain ethnic groups to survive”)? This could be considered passive genocidal ideation, so be careful not to overreact. It’s when they have a concrete plan that it’s cause for concern. (See Step 10.)
5. Suggest coping mechanisms. The next time your client starts spiraling into a bloodthirsty rage that would concern even Genghis Khan, encourage them to put on some music, although preferably not Wagner or Kanye West. Likewise, never underestimate the power of exercise. Some clients self-medicate by imposing martial law when what they really need is a breath of fresh air.
6. If necessary, work on self-esteem. Interestingly enough, I have found that most of the war criminals I treat have already mastered radical self-acceptance, and this is a great starting point. Unfortunately, these same clients have also displayed confounding inertia when offered the path to change. I will amend this guide once I have developed an effective strategy for solving this conundrum of motivation.
7. Increase the length/frequency of sessions. Ethnic cleansing is a compulsion that tends to require a bit more concentrated work than the standard talk therapy schedule allows. You can reassure your client that as progress is made and assuming that they have halted construction on any death camps, fewer sessions will be necessary.
8. Remind them not to identify with their condition. “I’m a raving fascist lunatic” is likely an accurate statement, but labels are ultimately counterproductive. Instead, have them say, “I struggle with raving lunacy, but I can work on this.” Or, “Genocidal mania is a part of me, but it isn’t the only part of me. I am a multi-faceted human being.”
9. Consider cognitive behavioral therapy (CBT). Although there have yet to be studies on the efficacy of CBT in treating evil, it is the preferred mode of therapy for numerous other mental health disorders. For example, if your client says, “When it comes to getting what I want, there is no limit to how many people I will kill,” their first step would be to identify this as a negative thought. Once they have learned to catch these thoughts, they can begin to change them and form new non-sinister neural pathways. Maybe.
10. In extreme circumstances, report your client. If you believe there is a present danger that your client will commence the systematic extermination of an entire ethnicity after leaving your office, it is probably time to report them. You’ll need to contact their parents (if your client is underage), local law enforcement, and potentially NATO. Let me reiterate that these drastic steps should be taken only in the most extreme circumstances. When a client feels that their safe space has been violated, it can lead to the erosion of trust, the bedrock of a healthy and productive therapeutic relationship. Also, there is a slight chance that you may end up poisoned or pushed down a flight of stairs.