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In one month, I’ll be 47. I’ve had 6 recent surgeries. I’ve gone through breast cancer. I’m in menopause. I have schizoaffective disorder. This is what I look like. No cosmetic surgery. No fillers. No makeup. No photo touch-ups.

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Confession of a Doctor

Jennifer Lee Lawson

Chapter 1: The Incision

Elena loved the resistance of human skin.

To the rest of the surgical team at St. Jude’s, her steady hand was a product of elite training and a profound dedication to saving lives. They saw a brilliant cardiothoracic surgeon. They didn’t see the truth: Elena didn’t care if the patient lived or died.

Well, that wasn’t entirely true. She preferred them to live, because a living body kept coming back, and a living body meant she could keep her license. But the thrill—the quiet, electric hum in her veins—came strictly from the blade.

She was, by definition, a serial killer who had found a loophole. Every week, she drugged people, sliced them open, rearranged their interiors, and sewed them back up. The hospital paid her a half-million dollars a year to indulge her deepest, darkest obsession.

“Bipolar forceps,” Elena murmured, her voice a calm anchor in the sterile, bright operating room.

She made a clean, deep incision into the patient’s mediastinum. The smell of cauterized flesh filled the room. To anyone else, it was metallic and unpleasant. To Elena, it was home. She was entirely, brilliantly camouflage.

Chapter 2: The Confession

“I just think it’s beautiful how much you care,” David said, reaching across the candlelit table to squeeze her hand.

David was an architect, gentle and structured. They had been engaged for exactly three days. The ring on Elena’s finger was a flawless two-carat emerald cut.

Elena looked at him, feeling a sudden, strange swell of confidence. She loved David, or at least, she loved the idea of him. He was a good man. If they were going to spend their lives together, shouldn’t he know the brilliant efficiency of her mind?

“I don’t care, David,” she said softly, taking a sip of her Pinot Noir.

“What do you mean? You spend fourteen hours a day saving people.”

“No,” Elena corrected, her tone conversational, as if explaining a medical billing code. “I spend fourteen hours a day cutting people open. The healing part is just a byproduct. If I could legally dissect healthy, conscious people without them dying or complaining, I’d probably do that instead. Medicine is just the only legal avenue for my… appetites.”

David laughed, a nervous, fleeting sound. “That’s a dark joke, El.”

She didn’t laugh back. She just stared at him with her wide, unblinking, intelligent eyes.

The color slowly drained from David’s face. He pulled his hand back across the white tablecloth as if he had just touched a hot stove. “You’re serious.”

“I’ve never been more serious,” she said. “I am a monster, David. But I’m a highly productive, socially acceptable one. You don’t have to be afraid. I’ve sublimated it entirely.”

David stared at her, horrified, realizing that the woman he loved looked at a scalpel the way a wolf looks at a fawn.

Chapter 3: The Diagnosis

The breakup was quiet, but devastating. David left the ring on the kitchen counter. He couldn’t look at her without seeing a butcher in a white coat.

A year passed. Elena grew jaded, cynical, and deeply lonely. She bought a Great Dane named Barnaby, convinced that a massive, silent animal was the only companion she would ever be allowed to keep. Humans were too fragile, too easily spooked by the truth. She resigned herself to a life of cold steel, empty sheets, and dog food.

But the isolation began to bleed into her work. Her hands were still steady, but her mind was restless. Under pressure from the hospital board to “address burnout,” she reluctantly booked an appointment with Dr. Julian Vance, a renowned psychiatrist.

Julian’s office smelled of old books and leather. He was a man of quiet observation, with sharp gray eyes that seemed to read the fine print of her soul.

For the first four sessions, Elena played the part of the overworked doctor. But by the fifth session, bored of the platitudes, she decided to break him. She told him everything. She told him about the urge, the euphoria of the first cut, the calculated choice to go to medical school instead of prison, and the absolute lack of remorse for her nature.

She expected horror. She expected him to call the police, or at least the medical board.

Instead, Julian just leaned forward, his hands clasped, analyzing her face.

“And how does it feel,” Julian asked, his voice low and entirely devoid of judgment, “to be the only apex predator in a room full of sheep?”

Elena caught her breath. For the first time in her life, she felt completely seen.

Chapter 4: Ethical Violations

By the eighth session, Elena realized she was looking forward to Tuesdays more than she looked forward to her surgeries. Julian didn’t look at her like a monster. He looked at her like a masterpiece of psychological adaptation.

Today, she sat on his leather couch, Barnaby’s massive head resting on her knee.

Julian was pacing slightly, an unusual break in his rigid, professional demeanor. He stopped and looked out the window, his back to her.

“Elena,” he said, using her first name for the first time. “I have to refer you to a colleague. I cannot treat you anymore.”

Elena felt a cold spike of panic. “Why? Because I’m too high-risk? Because of what I am?”

Julian turned around. His tie was slightly loosened, his gray eyes burning with an intensity that made her breath hitch.

“No,” Julian said, taking a step toward her. “Because I am a psychiatrist, Elena, and I have spent my entire career studying the human mind. I know exactly how dangerous you are. I know what lives behind your ribs.”

He paused, standing right in front of her.

“And I am entirely, hopelessly in love with you. I can no longer be objective. I can no longer be your doctor.”

Elena stared up at him. For the first time in her life, the brilliant, calculated surgeon had absolutely nothing to say. Her heart, that stubborn muscle she so casually exposed in others, was beating erratically all on its own.

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Author’s Note: I wrote the 1st Edition of this short paper prior to the Trump Presidency of 2026. I lost the work while sick with breast cancer. I revised it today. 8/20/2026

Jennifer Lee Lawson, MA

Second Edition, 2026.

As an undergraduate at Stetson University in the early 2000’s, I majored in philosophy and psychology. In my psychology classes, we glossed over Sigmund Freud. At the time, too, feminists were criticizing his works for being sexist. I read Freud on my own, out of interest in the ideas of a man who was a pinnacle in my field of study. In this work, I will argue that Freud’s psychoanalysis is perhaps the best analysis of Nazism. Along the way, I will discuss how these dynamics mirror and contrast with the actual practices of BDSM. 

Freud was born Jewish and lived in Vienna. As the Nazis rose to power, he was forced into exile in the United Kingdom, where he died in 1939. Not to psychoanalyze Freud himself, but his ideas are an excellent critique of the Third Reich.  

When one studies Freud, it is important to be aware of literary devices like metaphor. For example, contra many feminists who dismissed Freud’s discussion of penis envy as inherently sexist, I believe Freud’s concept can be reinterpreted through a feminist lens. Suppose, as is common today, some women work closely with men against other women to secure power within a patriarchal structure. This alignment, I argue, is the true modern manifestation of “penis envy”—a metaphorical desire to possess the societal power and autonomy exclusively granted to men, rather than a literal anatomical longing. These women choose to assimilate into the dominant masculine power structure because they recognize that, under patriarchy, being a woman is a position of subjugation. 

During the Third Reich, Nazis were not exclusively men; women played integral roles in perpetuating the regime. While Hannah Arendt famously analyzed the “banality of evil” through the lens of bureaucratic compliance, Freud offers a deeper psychological post-mortem of the fascist mind. 

In psychology, Freud taught us that human beings possess an urgent, primal sexual drive—the libido—alongside its darker counterpart, the death drive (Thanatos), which together motivate human behavior. While dismissed by modern empirical psychology as “unscientific,” Freud’s structural model of the psyche provides an unmatched framework for understanding the mass psychology of fascism. 

Fascism operates by weaponizing the collective Superego. In a healthy psyche, the Superego acts as the moral conscience. Under a totalitarian regime, the charismatic dictator—Adolf Hitler—steps into the vacuum of the collective Ego Ideal. The masses completely project their ideal selves onto the Führer, handing over their moral autonomy. This mass psychological surrender results in an eroticized submission to authority, where the individual experiences a profound, subconscious pleasure in yielding to total control. 

This brings us to the modern, consensual practices of BDSM. To understand Hitler’s Germany through Freud, we must look at the psychological mechanics of submission and dominance. In consensual BDSM, which is practiced in a Safe, Sane, and Consensual way, the submissive partner intentionally relinquishes control to the dominant partner, often experiencing a psychological release from the burdens of the Ego—a phenomenon known as “sub space.” The submissive or masochist chooses the dominant or sadist–never the other way around. Practicing healthy BDSM in this way gives enormous pleasure for practitioners.

Consensual BDSM relies entirely on strict boundaries, mutual consent, and a baseline of absolute trust, maximizing personal agency through a controlled sexual script–and a safe word. Conversely, Nazism represents a non-consensual, sociopolitical sadomasochism. Hitler acted as the ultimate societal sadist, projecting his own deep-seated castration anxieties and fractured Ego onto a submissive populace, demanding total destruction of the individual self. By examining Nazism through the lens of Freudian drives, patriarchal power assimilation, and sadomasochistic dynamics, we can see that the horrors of the Third Reich were not just political failures, but a catastrophic manifestation of the repressed human psyche. BDSM practiced in this pathological way gives no one–including (especially?) Hitler–pleasure. Nazi Germany was bleak for everyone: void of happiness and even primal sexual pleasure. Those who idolize fascism are taking the worst model to act out their sex drives. While Hannah Ardent wrote about a bleak bureaucracy, I assert there was very little happiness or pleasure for absolutely anyone in Nazi Germany, as well. Hitler’s sexual hang-ups are already a known topic in political science and political philosophy. This deformed psyche–that of Adolf Hitler–gave the world an ironic model, where Hitler was impotent and sexually boring– even to himself.

By contrast, in healthy BDSM, partners can experience the height of Nirvana–even enlightenment–all while, if I may be blunt, “getting off.”