Dr. Death : The Curious Case of Turning Antisocial Tendencies Into Surgery… or Not
Let’s dive into one of the most disturbing, yet absolutely fascinating, cases in modern medicine: Dr. Christopher Duntsch, aka Dr. Death. This guy left a trail of ruined lives, crippled patients, and stunned medical professionals. Now, as much as we therapists (obviously me) love a good head-scratcher of a case, Duntsch’s story also gives us an opportunity to talk about something a bit less criminal, not so well-known, but a little something I learned in grad school, — the psychological concept of sublimation
But first…who Is Dr. Death?
Dr. Christopher Duntsch was a neurosurgeon who left an unusual legacy—one of horrifying malpractice. Over the course of his career, he injured over 30 patients and caused the deaths of two others. His colleagues were astounded by his shocking incompetence, and many believed he acted deliberately. Duntsch was eventually convicted of gross malpractice and sentenced to life in prison. (You can find multiple docuseries, movies, and documentaries about him on Netflix, Peacock, and the podcast channel Wondery. I may or may not have watched and listened to them all.)
But here’s where things get interesting from a psychological perspective: many believe (me included) that Duntsch might have had Antisocial Personality Disorder (ASPD), characterized by a lack of empathy, manipulative behavior, and a blatant disregard for others' well-being (APA, 2013). Obviously, I would NEVER diagnose a real - live human, someone who I did not see in my office, with my own eyes. But say.. in a make believe world of this man only being a television star, a fable, and urban legend, I WOULD ABSOLUTELY DIAGNOSE with ASPD. While most people with ASPD aren’t out there botching spinal surgeries, Dr. Creepy’s actions fit the bill for someone who thrives on control, dominance, and, in his case, wielding a scalpel as a tool for disaster.
Sublimation: Your Brain’s Fancy Recycling Program
Sublimation is all about taking the "bad" stuff inside and transforming it into something useful. Sigmund Freud—the king of "let's talk about your weird dreams"—coined the term. He believed that humans could redirect impulses like aggression or even sexual urges into productive avenues like art, science, or, you guessed it, surgery. So, instead of causing chaos, you might just save lives. You know, normal people stuff.
Sublimation, when done right, is a win-win for everyone. You take those less savory urges and funnel them into something productive.
Sublimation in Everyday Life Examples
Athletes and aggression: Many athletes thrive by channeling their aggressive or competitive nature into their sport. Their high-energy impulses become focused on winning games rather than creating chaos.
Artists and trauma: Many artists, from musicians to painters, turn personal struggles into masterpieces. The pain gets funneled into creative expression, providing both catharsis and cultural value.
Professionals and perfectionism: In high-stakes careers, like law, medicine, or engineering, people often sublimate perfectionist or controlling tendencies into their work, creating solutions for others while finding fulfillment in their precision.
These examples show how sublimation can turn potentially negative traits into positive contributions, benefiting both the individual and society. But the key here is empathy—a critical ingredient that was missing in the case of Dr. Duntsch.
That’s where Duntsch’s story takes a left turn. Instead of sublimating his need for control into a healthy outlet, he seemed to let his impulses drive him toward something darker. The scalpel, instead of being an instrument of healing, became a tool for chaos. In therapy, we’d say he failed to properly channel those antisocial tendencies—leading to, well, everything that went wrong.
How Could Surgery Be an Attempt at Sublimation?
Let’s break this down. Individuals with Antisocial Personality Disorder (aka sociopaths) are often drawn to high-stakes careers where they can exercise control, feel powerful, and operate in a setting that requires decision-making under pressure. Surgery, especially neurosurgery, could seem like the perfect fit. You get to hold someone’s life in your hands (literally), make snap decisions, and be hailed as a hero when it goes right.
For someone like Duntsch, instead of channeling these traits into something positive, his need for power and control wasn’t tempered by the usual checks—like competence or, you know, caring about his patients. His failed sublimation turned the operating room into a personal evil play-place, where he seemed more interested in asserting dominance than actually helping people.
In therapy, we often work with clients to help them channel their emotions, impulses, and drives in ways that benefit both themselves and those around them. But what happens when someone lacks the empathy and insight to make sublimation work? Well, in Duntsch’s case, you end up with a disaster in the OR.
So, what’s the lesson here?
Duntsch is a case study in what happens when someone can’t properly manage their impulses. While most people with control issues or aggressive tendencies can successfully channel those through careers or hobbies, without empathy, even the best outlets—like surgery—can lead to disaster. The lesson? Channel your impulses into something productive, but also, maybe get a therapist (not me) to check in on that empathy thing.
Sources:
Freud, S. (1923). The Ego and the Id.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Hare, R.D. (1991). The Hare Psychopathy Checklist-Revised.
