We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over another. I next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of "physician arrogance" as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of "killing suffering"; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer.

中文翻译：

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医学中的“暴力”：必要和不必要，有意和无意。

我们更习惯于将药物与减轻暴力影响的方式联系起来。然而，学术文献中的一条重要线索承认，医学也可能造成暴力侵害，尽管这是无意的，但针对打算帮助的个人的暴力行为也是如此。在本文中，我讨论了暴力的定义，强调了理解该术语的重要性，不仅要理解为暴力，而且还应理解为一个人对另一个人的权力行为。接下来，我将探讨一种医务行业的悖论，这种矛盾有时充满了暴力，有时是必要的，通常是无意的，并且几乎总是未被认可。确定“医师傲慢”的构造是造成暴力的原因，我继续在医学背景下确定暴力的不同表现形式，包括对身体的暴力；结构性暴力；隐喻暴力；以及与患者（或医疗保健系统中的其他人）进行交谈或与之交谈的方式（以最小化或不尊重他们全人类的方式）。我进一步建议对医生中这类暴力行为的起因进行可能的解释，包括害怕遭受痛苦和死亡最后，我提出了一些简短的建议，着眼于社会和机构结构内的暴力根源，并提出了一些建议，以解决与创伤性外伤有关的问题以及随之而来的“消灭痛苦”的概念；以及为什么患者可能愿意接受针对他们的暴力。并在我们自己内部，提供受伤的治疗师的模型。包括对与替代性创伤有关的痛苦和死亡的恐惧，以及随之而来的“消灭痛苦”的概念；以及为什么患者可能愿意接受针对他们的暴力行为。最后，我提出了一些简短的建议，以解决社会和机构结构内以及我们内部的暴力根源，并提供了受伤的治疗者的榜样。包括对与替代性创伤有关的痛苦和死亡的恐惧，以及随之而来的“消灭痛苦”的概念；以及为什么患者可能愿意接受针对他们的暴力行为。最后，我提出了一些简短的建议，以解决社会和机构结构内以及我们内部的暴力根源，并提供了受伤的治疗者的榜样。