Hannibal Lecter and Philosophy (Popular Culture and Philosophy)

by Joseph Westfall

  The question of what constitutes a profession is complex, in part because a definitive list of professions seems impossible to come by. For a long time, to be a professional meant simply to be a doctor or a lawyer. However, with increasing specialization and the necessity of accessing ever more esoteric kinds of knowledge and skills, professions have proliferated—or, rather, jobs and careers that used to be non-professions have been professionalized. Joining the clergy, for instance, was once considered not a profession, but a vocation, a calling. There’s some element of that remaining in how people think of the clergy, but it has been increasingly professionalized in the course of the last couple of centuries. So, rather than attempt to define a profession precisely, I will simply set forward some common traits that many professions have.

  First, each profession involves some sort of expertise. A professional, typically, has some knowledge or skill that non-professionals lack. We hire lawyers because they know about the law and doctors because they know about medicine. But that is true of almost everyone. I know things you don’t, and you know things I don’t. Dr. Lecter is an expert at preparing human flesh for consumption, but that isn’t his profession. So it is not just any expertise that makes one a professional. The expertise of a professional must be useful and important to others.

  But it takes more than just expertise to make a professional. Someone may, for instance, be very knowledgeable about the law or medicine without being a lawyer or a doctor. To be a professional generally also means to be licensed or recognized as such by either a government or other members of the same profession. Such recognition is generally based on proof of expertise and adherence to the ethical code of the profession.

  Now, revoking a license does not deprive a professional of her expertise—nothing can do that. It deprives her of recognition and the right to practice. This last aspect is, I think, a further condition for what makes a person a professional. One may be a professional even if one does not practice, but one must at least have the ability, the right to practice if given the opportunity. That opportunity often but not always comes in the form of having clients or patients. The clients make the professional a professional by placing their concerns in her hands. This exemplifies an extraordinary amount of trust, especially in situations in which the professional in question is a virtual stranger. To protect the client, we say that there is a contract between the two parties. The client gives the professional her trust, and in exchange the professional uses that trust to help the client achieve her goals.

  The Private Exit

  Right up to the point when he snapped his neck, Dr. Lecter was actually a good and ethical therapist for Franklyn Froideveaux. Admittedly, intentionally killing one’s patient is a serious violation of the Hippocratic Oath, but until that moment every action we see Dr. Lecter take regarding Franklyn is that of an ethical psychiatrist. So, we begin our discussion of psychiatric (and professional) ethics not with Will Graham, but with Franklyn.

  We first met Franklyn leaving Dr. Lecter’s office after a session. Franklyn left the office via the private exit for patients, which is significant in itself. At the core of most professional codes of ethics—and most especially the psychiatric code—is a concern for the client’s privacy. The client must trust the professional. In the case of the psychiatrist and her patient, the client must trust the professional with the most intimate details of her life. Anything less than complete trust would undermine the attempts at therapy. One of the ways of ensuring that trust is through rules of confidentiality. Whatever Franklyn tells Dr. Lecter, indeed the very fact of their relationship, must remain between them. The secrets are Franklyn’s, not Dr. Lecter’s.

  This is why Dr. Lecter tells Franklyn when they meet at the opera that “It would be unethical to approach a patient” (Hannibal, Season 1, “Sorbet”). It is unethical for a doctor to approach a patient in public, particularly if by doing so he would identify the patient as a patient. Dr. Lecter, attempting to be an ethical psychiatrist, fumbles a bit when Franklyn approaches him at the event—he doesn’t know how to introduce Franklyn to his friend. He can’t possibly admit that Franklyn is a patient, because it would violate confidentiality. At the same time, to introduce him as an acquaintance or a friend would send the wrong message to Franklyn, and possibly hinder the progress of his therapy. Thankfully (perhaps), Franklyn relieves Dr. Lecter of the burden by identifying himself as a patient—something he has every right to do.

  Contrast this interaction with Dr. Lecter’s interactions with Will. In the first season, Dr. Lecter is reluctant to identify himself as Will’s therapist, but this reluctance extends beyond the public realm and into the privacy of his office and his home. “Office hours,” he tells Will, “are for patients. My kitchen is always open to friends” (Hannibal, Season 1, “Coquilles”). While Franklyn desperately wants to be Dr. Lecter’s friend rather than his patient, Dr. Lecter wants Will to be his friend rather than his patient. In a telling exchange, Dr. Lecter asks Will, “Am I your psychiatrist, or are we simply having conversations?” to which Will responds, “Yes, I think, is the answer to that” (Hannibal, Season 1, “Sorbet”).

  It is the less formal relationship with Will, the “friendship” (if we can call it that), that allows Dr. Lecter to discuss Will with Jack Crawford, not only acknowledging that he and Will know each other and interact (which of course Crawford knows, having introduced them), but the content of their conversations and his own reflections on them. Will, presumably, knows that Dr. Lecter shares this information. He nonetheless feels the need to extract a promise, of sorts, from Dr. Lecter that he will not publish anything that he learns from his relationship with Will. Will Graham is, after all, quite the topic of conversation among psychiatrists. It is one thing for Dr. Lecter to share with Jack Crawford, and another entirely for him to share with the psychiatric community at large.

  On the other hand, when Will explicitly engages Dr. Lecter as his psychiatrist, he is just as scrupulous about protecting confidentiality as he was with Franklyn. When Jack Crawford asks Dr. Lecter his opinions about Will after this point, Lecter is blunt about telling Crawford that since Will is now officially his patient, he cannot share any information regarding him.

  What, then, should we say about Dr. Lecter’s willingness to share the contents of his conversations with both Franklyn and Will with Dr. Du Maurier? If Dr. Lecter and Dr. Du Maurier were simply friends or even colleagues, he would be in ethical hot water for discussing the details of Franklyn’s therapy without first receiving Franklyn’s permission. The confidentiality surrounding their sessions is entirely Franklyn’s and so cannot be breached without his explicit permission. However, because his relationship with Will is less formal, more of a friendship than a professional-client relationship, the secrets they share belong to both of them. As it is, Dr. Lecter is ethically in the clear in sharing details with Dr. Du Maurier because of her status as his therapist. The same confidentiality that protects Franklyn’s sessions with Dr. Lecter protects Dr. Lecter’s sessions with Dr. Du Maurier.

  In fact, of the various psychiatrists in Hannibal, Dr. Du Maurier has the murkiest track record when it comes to confidentiality. (Dr. Chilton’s utter disregard for confidentiality rules is a problem unto itself, given his status as administrator at a publically-funded state hospital with intimate ties to the penal system.) Dr. Du Maurier acknowledges that she is on the very edge of the precipice, ethically speaking, in discussing Dr. Lecter with Jack Crawford. Even after Dr. Lecter signs a waiver freeing her to speak with Crawford (a questionable waiver, given the disclosures in his sessions about some of his patients), there is still a line that must be drawn.

  If we could, perhaps, argue that Du Maurier was ethically covered by that waiver in her brief discussions with Jack, there is still no way to justify her interaction with Will. Simply acknowledging that she’s heard of Will through her interactions with Dr. Lecter constitutes a breach of her patient’s confidentiality—a trust that is in no way renounced when
she stops being Dr. Lecter’s psychiatrist. Again, the contents of the sessions still belong to Dr. Lecter, not to Dr. Du Maurier.

  It should not, perhaps, surprise us that Dr. Lecter is so scrupulous about confidentiality. If there is anything that his sideline requires, it is an ability to keep secrets. But also, divulging others’ secrets is rude. Hence Dr. Lecter’s distaste for Freddie Lounds—as an investigative reporter, violating privacy and revealing secrets is basically her job description. Further, protecting his patient’s confidentiality is one of the ways that Dr. Lecter protects himself. In his sessions with Will and Margot Verger, as well as his interactions with Randall Tier, it becomes clear that Dr. Lecter’s therapeutic techniques are not always the most ethical, after all.

  The confidentiality rules that govern many professional relationships are there to ensure the kind of trust that we have with friends. In the case of friends, explicit confidentiality rules are rarely necessary, because the organic nature of the relationship means that in coming to trust a friend, one also comes to trust their discretion. Because the professional-client relationship is artificial, explicit confidentiality rules are a necessary part of the groundwork for the trust that has to exist between them—specifically, the trust the client must place in the professional.

  First, Do No Harm

  It is one thing for a professional to keep a client’s secrets; it is quite another for a professional to keep secrets from a client. Again, this is sometimes ethically required—Dr. Lecter can no more tell one patient about another than he can anyone else. But it is sometimes entirely unethical: as, for instance, when Dr. Lecter and Dr. Sutcliffe decide not to tell Will about his encephalitis.

  I will present the case for the unethical nature of this conduct in a moment, but first I will attempt to show why it is not as black-and-white as it may appear. It is a topic of much interest in professional ethics how much information the professional is required to divulge to the client. The client, after all, has gone to the professional in part because the professional has information and expertise that the client lacks. The professional knows the goal that the client has in engaging her and, presumably, the best way to achieve that goal. As it turns out, there are some cases where the best way for the professional to help the client achieve her goal is to conceal information from her—sometimes even to the point of lying to her.

  For instance, imagine a patient goes to a doctor complaining of a number of symptoms. The doctor runs a battery of tests and can find nothing wrong with the patient. After more rounds of tests and consultations with other doctors (with the patient’s permission, of course), the doctor concludes that there is nothing physically wrong with the patient at all. Medically speaking, she is in perfect health. So, the doctor concludes that the symptoms are psychosomatic—they are a manifestation of the patient’s belief that she is sick. Rather than confront her with the diagnosis, which will in all likelihood only lead to her going to another doctor and wasting even more time and resources, the doctor tells the patient that she is in fact ill with some fictional disease. The doctor then prescribes a placebo, and refers her to a psychiatrist under false pretenses—the particular illness, says the doctor, can also manifest in psychic disturbances, so the patient needs to be monitored by a psychiatrist.

  Contemporary codes of professional ethics, including contemporary versions of the Hippocratic Oath, have largely been written with a view toward preserving and defending client autonomy. So, contemporary codes of medical ethics discourage the use of such placebo treatments and deceptions to help a patient. The professional is expected to adequately inform her client, even if having all of the relevant information may hinder the client’s ability to pursue her goal.

  But such emphasis is not without controversy. In the case above and cases like it there is a conflict between the professional’s duty to treat the client with respect and the professional’s duty to help the client achieve her goals. It is a basic question in professional ethics whether a professional has a right—or perhaps even a duty—to mislead a client in order to help the client achieve her goals. There is an inherent danger of abuse in any asymmetric relationship, like the professionalclient relationship. If we grant that the professional has a right to deceive a client, then the client is robbed of the ability to ensure that the professional is actually acting in the client’s best interests.

  This brings us back, once again, to Dr. Lecter. Late in the first season, Dr. Lecter consults with Dr. Sutcliffe, a neurologist, about Will’s condition. An MRI reveals that Will has encephalitis, which is causing his hallucinations and lost time. Dr. Lecter then convinces Dr. Sutcliffe to keep the results of the MRI from Will so that they can observe the effects of the disease. They will, he assures Sutcliffe, treat it before it’s too late, but in the meantime they may gain some valuable insight into this rare condition and its effects.

  Between them, and without consulting their patient, Dr. Lecter and Dr. Sutcliffe come to two decisions, only one of which is a clear violation of professional ethics. First, they decide not to inform Will of the diagnosis. Under the right conditions, this can be a justifiable decision by a professional—if such knowledge would hinder the client in the pursuit of her goals, then we can even make the case that a professional may be required to withhold it. Their second decision, however, is not only unjustified, it violates the oath they both took as doctors: the decision not to treat Will. Leaving a condition like Will’s untreated doubtless does him some harm.

  Again, these rules are in place to foster the kind of trust that grows organically in friendships. We generally do not lie to our friends and expect our friends not to lie to us. But few people would get upset at a friend who, for example, kept a surprise party secret from them. Our trust in our friends includes a trust that they will tell us the truth, or, at the very least, that when they conceal the truth from us, it is for a good reason. We have grown to trust our friends’ discretion and judgment. With professionals, however, we expect their judgment to be bound by the rules of professional conduct.

  This Is Your Hour

  One of the reasons the professional/client relationship does not parallel a friendship, indeed one of the core reasons, is because the relationship of a professional to a client is always asymmetrical. Friendships may be more or less symmetrical, but at their core they are relationships between equals. Many, if not most, of the guidelines set out in professional codes of ethics are designed to protect the client, because in trusting the professional with whatever she has, she has made herself vulnerable. In a very real sense, patients are at the mercy of their doctors, clients of their lawyers, etc.

  One of the common safeguards in professional codes of ethics is the requirement of informed consent. This is the requirement that Dr. Lecter and Dr. Sutcliffe violated by keeping Will’s diagnosis from him and their refusal to treat him. Had Will been informed of his condition, it is reasonable to conjecture that he would have insisted on being treated for it. However, it was also his right to insist on not being treated. What matters is that he knows his options.

  Informed consent is not, however, as cut-and-dried as it may at first seem. Arguably, for instance, the doctor who prescribes a placebo has not violated the requirement. The patient wishes to be treated for whatever malady she has, and the doctor prescribes the best treatment she knows of for that illness. It happens to be the case that in order for that treatment to work effectively, certain things have to be kept from the patient. The patient does not have all of the relevant information, but she does know that the doctor knows more than she does and that the doctor thinks this treatment will make her better. She consents to the treatment in light of the information she has, which the doctor deems to be all the information that is relevant to the decision.

  The interesting problem for us, though, is not the question of how much and what kind of information a client needs to have to give informed consent to a course of action. What is interesting, because of Dr. Lecter’s particular profession,
is what exactly constitutes consent. Why this is interesting is because among the responsibilities that psychiatrists and psychologists are tasked with is the burden of determining whether a particular client is capable of making decisions for herself. Where lawyers may declare a person incompetent to practice law, and other doctors may declare a person incompetent to practice medicine, psychiatrists and psychologists have the authority to declare a person incompetent to exercise autonomy at all. In effect, psychiatrists can declare their clients non-persons.

  So, how can professional ethics deal with a situation that seems to undermine one of the foundations of ethics as such—namely, individual autonomy? If Will’s encephalitis was having a negative impact on his judgment and rationality (and it seems to have been, though not quite so severely as Dr. Lecter led him to believe), that shifts the power even more in the psychiatrist’s favor. Now we have a situation of paternalism (or parentalism): a case where the professional takes it upon herself to make decisions about what is in the client’s best interests without consulting the client, or even necessarily informing her. For one person to do this to another is at least rude, at worst downright evil; but in the case of the psychiatrist, it is not only allowable but in some cases positively condoned. If, for example, Dr. Lecter diagnosed that Will posed a danger to himself or others, it would be not just his right, but his professional duty to prevent that danger from manifesting itself—even to the point of effectively incarcerating Will against his will.

  This authority may seem extreme, and it is, but in a way it parallels the kinds of duties and responsibilities that non-professionals have in their everyday lives. Think, for example, of Franklyn’s dilemma regarding Tobias Budge. Tobias made some rather dark comments, and subsequently a man was murdered in a way very similar to what Tobias proposed. Should Franklyn go to the police with this information? There was no reason for him to report Tobias before the murder—he just made a rather off-color comment, which is not sufficient evidence to believe that Tobias posed any danger to anyone. However, after a murder is discovered that closely matches Tobias’s comment, Franklyn has a reason to think Tobias may be dangerous.