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Wrong diagnosis, wrong medicine won’t cure bullying
Why medical school anti-bullying policies are failing.
It may not be perfect, but the New York Times is the model of what a newspaper should be. The writers are smart and adhere to a high level of journalistic integrity. Nevertheless, it misunderstands the issue of bullying just like the rest of society. As a result, it recommended that all medical schools adopt policies scientifically proven to have failed.
The August 9th edition carried a fascinating article by Dr. Pauline Chen about the failure of anti-bullying policies in medical school. In “The Bullying Culture of Medical School,” she described the abuse senior physicians often unleash against those beneath them. The article came on the tracks of a recent scientific study reporting the disappointing results of the intensive efforts of the David Geffen School of Medicine at UCLA to eliminate abusive behaviour.
In 1995, the medical school began a multi-faceted program to improve the way staff treat students. As the NY Times reports:
“They adopted policies to reduce abuse and promote prevention; established a Gender and Power Abuse Committee, mandated lectures, workshops and training sessions for students, residents and faculty members; and created an office to accept confidential reports, investigate and then address allegations of mistreatment.”
What were the results of thirteen years of surveys conducted at the school?
“While there appears to have been a slight drop in the numbers of students who report experiencing mistreatment, more than half of all medical students still said that they had been intimidated or physically or verbally harassed.”
The article also reports that the results for the school were typical of medical schools in general. Joyce Fried, the lead author of the paper, said, “We were really crushed when we saw the results. We were disappointed that [the abusive school culture] was so difficult to change.”
The only explanation offered for the dismal results is that the culture of bullying is extremely hard to change. In the concluding paragraphs, the article states:
“’We’re talking about the really hard task of changing a culture, and that has to be done on a national level,’ Ms. Fried said. Such an effort would include shared training programs, common policies regarding mistreatment and greater transparency about the mistreatment that currently exists in medical schools.”
In other words, the way to reduce abuse is for the entire country to unite in implementing the very same policies that failed for the David Geffen School of Medicine! This is the same conclusion that is inevitably drawn whenever anti-bullying policies are found to fail in schools and the workplace: We need to implement the policies more intensively and consistently. Albert Einstein said, “The definition of insanity is doing the same thing over and over again and expecting different results.”
In theory, researchers are supposed to be impartial regarding their studies and emotionally indifferent to the results. In reality, such neutrality is almost nonexistent. Researchers usually have a strong interest in the interventions they study and are desperately hoping to prove their effectiveness. It is understandable that Ms. Fried, who is chairwoman of the Gender and Power Abuse Committee at the medical school, was devastated by the failure of the school’s policies. We can’t fault her for continuing to believe in the policies’ effectiveness and for insisting that all medical schools need to do what she believes they should despite the contrary indications of her own research.
But the NY Times is supposed to be free of bias and to seek to uncover objective truth. The correct conclusion from the study would be that we should probably get rid of these policies because they are a waste of time and money. Why is the article’s author, who is a doctor and therefore a scientist, willing to unquestioningly promote Ms. Fried’s invalid conclusion in “the newspaper of record”? And why would the Times’ editors allow it to be printed in their paper?
The reason is that they are human beings like the rest of us. Antibullyism is the most popular social movement in world history because everyone likes the idea that other people are the bad guys and society should eliminate them for us. The idea of anti-bullying policies sounds so obviously right that not even diligent NY Times reporters consider the possibility that it may be wrong.
Ms Fried and the NY Times, like the rest of us, want to see bullying reduced. But we can’t do this through bad science. What is the point of doing research if we are going to ignore the results? We need to accept unpleasant findings and apply an accurate understanding of human psychology if we wish to solve problems.
There are two basic mistakes the NY Times and everyone else is making about bullying. Those mistakes are preventing society from reducing it.
Mistake Number One
The first mistake is assuming that bullying is cultural and that the solution, therefore, is to change the culture. Because of this mistake, whenever efforts to change the culture fail, we conclude that we need to beef up our efforts to change it.
But it is not culture that is hard to change. Culture is relatively easy to change. Culture is constantly changing, and it is changing more rapidly then ever thanks to modern technology. Anyone old enough to be a grandparent can attest to the massive changes our culture has undergone in less than one lifetime.
The thing that’s hard to change is not culture. It’s nature that’s hard to change. No matter how hard we try, we cannot eliminate the human drives for sex, food, water, air, sleep and companionship. They have been part of our makeup from the beginning of life and any attempts to get rid of them are bound to fail and cause misery. And another drive that cannot be eliminated is dominance. The drive for power is as basic and necessary for life as any of those other more “obviously biological” drives.
Bullying goes on in the entire animal kingdom. Not only doesn’t this surprise scientists, we understand that it is necessary and inevitable in nature.
Have human beings ceased being animals? Have we evolved into pure spirit like angels from Heaven that can only do good deeds? Or have we, perhaps, become like our computers and robots that can do whatever their human programmers decided? Is there any logical reason to believe that official policies have the power to create a social organization whose members are always nice to each other and treat each other like absolute equals?
The most important social psychology experiment ever conducted was, in my opinion, the Stanford Prison Experiment by Prof. Philip Zimbardo in 1971. A group of college students, screened to make sure they don’t have any obvious psychological problems, were randomly assigned to play guards and prisoners for two weeks in a mock prison set up in a university basement. The experiment was discontinued after six days because the situation became so incredibly realistic. The “guards” became extraordinarily sadistic to the “prisoners” who simultaneously became horribly tormented, even to the point of nervous breakdown.
There is a wealth of knowledge that can be obtained from the Stanford Prison Experiment. One thing it reveals is the well-known psychological principle that people take on the roles that are assigned to them. The students who were randomly assigned to be guards developed the mentality and behaviour of guards. Those assigned to be prisoners developed the mentality and behaviour of prisoners.
Another important lesson is that when people are in a position of power, they tend to abuse that power. This is not cultural. It is natural.
The Stanford experiment helps us understand phenomena such as the Holocaust, in which the most cultured people in the world became the most systematically murderous. As much as we may hate to acknowledge it, the Nazis are not them. They are us.
When we witness doctors abusing their power, we are not seeing culture in action. We are seeing nature. The abuse is not because of culture but despite it.
The "culture of bullying" myth
The purported “culture of bullying” is a myth. The truth is the precise opposite. We are now living in the most anti-bullying culture in history. The number of anti-bullying laws is constantly growing. New York State has passed a Dignity for All Act. Abuse in all its various forms is being exposed and condemned by the media, including TV news programs, magazines and movies. Politicians and celebrities have been coming out against abuse. Children are taught the evils of abuse from the moment they enter pre-school. All parenting materials teach people to raise their children with kindness, respect and understanding. Teachers are instructed to avoid doing anything that might hurt their students’ feelings. Citizens are taught to celebrate everyone else’s differences. People respond with horror and pity to a video of students humiliating a bus monitor and send her hundreds of thousands of dollars.
Anti-abuse is also the culture of medical schools. I challenge you to find one medical school or textbook that encourages doctors to scream at their students, intimidate them, belittle them and take unfair advantage of them. You can be sure that if they teach doctors anything at all, it is to treat their students with respect. But all of society’s anti-bullying education and policies cannot undo the nature of people to abuse their power.
It’s because bullying is nature, and nature trumps culture.
Mistake Number Two
The second mistake made by the NY Times article, and a fundamental mistake underlying the entire field of bullying, is that abusive behaviour is bullying. It’s not. Most abuse is victim behaviour.
In the modern academic paradigm of bullying, society is comprised of bad guys–bullies, good guys–victims, and bystanders who either actively or passively encourage the bullies to abuse their victims. This is a legal view of life: guilty perpetrators violating innocent victims.
But that is not psychology. Psychology understands that we are all good and bad in varying degrees at different times and depending upon the circumstance. Leon Festinger explained in his theory of cognitive dissonance what philosophers have known forever, that we are experts at rationalizing our bad behaviour to ourselves. We are the animal kingdom’s masters of hypocrisy. We have a remarkable ability to convince ourselves that we are the good guys and they are the bad guys. Even Hitler was certain he was the good guy.
Sometimes we do, in fact, intentionally abuse others for the sheer pleasure of it. Some people do it a lot. But they are relatively rare. Almost every instance in which we are truly abusive to others is when we feel victimized by them. We feel they are abusing us, so we respond aggressively. We get angry with them. We blame them. We insult them. We desire revenge.
However, the recipients of our anger don’t experience themselves as our abusers. They experience themselves as our victims, while we experience ourselves as their victims.
And both sides are right. In each one’s subjective experience, they are the victim and the other is the abuser.
Pay attention to your own lives. When you scream at your child, parent or spouse is it because you are thinking, “I am so happy that I have someone to torment with my superior power! It gives me so much pleasure to cause my family members pain?” If your answer is yes, please stay far away from me. And from everyone else.
Why do you scream at you family members? It’s because they are disrespecting you, criticizing you, defying you, ignoring you, wasting your money, denying you sex, behaving contrary to the values you’ve been trying to instil in them. You feel you are their victim.
Read the NY Times article’s descriptions of the abusive doctors' behaviour. Did they take advantage of their power to abuse their patients, who are in an even weaker position than their students? No. They treated their patients with respect and caring. Did the doctors sport looks of smug satisfaction while calmly abusing their medical students? No. They were mad at them. They screamed at them. They lost self-control.
The reason they screamed at, humiliated and abused their students is because they felt victimized by them. Students are not the only ones under pressure. Teaching doctors have more objective stressors than their students. Not only do they work long hours, they have sick patients to heal, bills to pay from their meagre salaries, spouses who complain to them of lack of attention and assistance, malpractice lawyers to fear, and tough supervisors to answer to. On top of that, they have students they are responsible for teaching.
Yes, teaching doctors are only human beings, and they too, get angry when they feel victimized by their jobs and students. If they fly off the handle it is not because they seek the sadistic pleasure of causing their students pain but because they feel victimized by their students and the system. Their experiences are:
“How dare a student challenge my authority in front of the entire class?"
“I am trying to move on. Why is this student wasting our time with foolish questions?”
“Why is this student partying all night and coming to the hospital with a hangover?”
“How did these imbeciles ever get accepted to medical school? And why is it my rotten luck to be assigned as their teacher?”
“I want to be a doctor. I don’t like teaching. Why am I being forced to do this?”
Pay attention. You will notice that people behave worst when they feel like victims. Random shootings are all committed by people who feel like victims. Hitler got Europeans to exterminate Jews in World War II by convincing them they were the victims of the Jews. Our own leaders get us to go to war with other countries by convincing us that we are the victims–or potential victims–of those countries. Then we are happy to blow them to pieces.
But the field of bullying doesn’t understand this because it is defines all bad behaviour as bullying. So we think that abusive doctors are bullies. No. They are victims.
Furthermore, the bullying field teaches us how horribly destructive bullying is and that we mustn’t tolerate it. It teaches us that if we feel victimized, it is has nothing to do with us; that our misery is only because of them; that we are the good ones and they are the bad ones; that they are the ones who need to change, not us.
And that’s why all of our anti-bullying policies are failing: we believe they refer to them, not to us.
It is natural for us to think we are the good guys and they are the bad guys, and the supposedly scientific field of bullying is confirming these subjective, counterproductive views. So when our organizations adopt anti-bullying policies we think, "That's right! They need to change. They must stop bullying me." And when they don’t stop, we become even angrier with them.
Anti-Bullying Policies Turn Us into Abusers
The intention of anti-bullying policies is to get us to treat each other better. But they can’t do that because they require us to treat each other worse. One of the nastiest things we can do to people, without actually committing a crime against them, is to inform on them to the authorities.
Let’s say you are a teaching doctor and I am your student. I didn't like the way you treated me, and now I report you to the school authorities who proceed to conduct an investigation against you. Are you going to admit guilt? Will you like me better? No. You will defend yourself and try to prove that I am the bad one. You will hate me for getting you investigated by the authorities. You will try to get revenge against me. And you certainly won’t want to help me succeed in my medical studies.
Or vice-versa. You are the student and I am the teacher. If I complain about you to the school authorities, are you going to like me and want to learn from me?
It is logically impossible to get rid of abusive behaviour via anti-abuse policies because implementing the policies is highly abusive.
As the end of the NY Times article states in a hopeful note, abuse can be reduced in medical schools. This is definitely true.
However, contrary to the assertion of the article, it can never happen by getting all medical schools to adopt the very policies that have been scientifically proven to fail. Reducing abuse requires a different approach – a scientific, psychological approach that understands that we are most dangerous not when we feel like bullies – because we don’t – but when we feel like victims. And, unfortunately, our anti-abuse and anti-bullying policies are unintentionally encouraging us to see ourselves as victims. That’s why bullying is becoming an epidemic in our anti-bully culture: we are mandating by law a pro-victim culture.
Life is not Heaven – certainly not in medical school. It is inevitable that we will occasionally be treated in ways we don’t like, whether we are teachers or students, bosses or employees. External human authorities cannot change this reality for us. And getting angry at people is also not likely to stop them from abusing us. The only reliable way to reduce abuse (I am not referring to true criminal behaviour) in medical school or any other organization is to teach all members, at all power levels, how to handle being victimized. And the best way to handle it is to treat others like friends even when they treat us like enemies. Talk to them directly with respect, without getting angry or defensive, without threatening legal action. People deserve this education, just as they deserve to be taught to read, write, calculate math and practice medicine. The required social skills are not hard to learn. Just take a visit to the Self-Help section of your local bookstore. The solutions are all there.
Israel “Izzy” Kalman is Director of Bullies to Buddies, a program that teaches the practical application of the Golden Rule to reduce bullying and aggression and solve relationship problems.
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