Gossip or glory

Oxymoron?

I worked in a children’s psychiatric hospital full time, while I finished my undergrad degree in anthropology.  I picked anthropology because I had accumulated the most credits in that area, as I only took anthro electives in an early stint at Maryland, as there was a human dissection class (Comparative primate anatomy) only open to juniors or better in anthropology (or grad students).  Of course, the year I got to the class there were no cadavers, so had to dissect a macaque I named George.  Fast forward past a couple of years on the road, working off-shore oil and blood banking, and I am finishing an undergraduate degree working on a locked, co-ed adolescent psychiatry unit.  This passage is from my dissertation:

"I was a “milieu therapist” (the local job title for the more ubiquitous “clinical child care worker”.  In that environment it was universally shortened to “MT”, a homophone which figured in many puns), on a locked co-ed 17-bed inpatient unit.  I took care of patients, trained staff, did computer programming work, co-authored a social skills program, conducted in-service training and ran workshops at regional conferences and eventually worked as a research assistant, on a project focused on suicide attempters.  I found myself in an odd place, between the professional staff and the line staff,  affectively (1) more connected to the line staff but intellectually involved with the clinical staff.  My experience as a clinical child care worker drove home the schism between them in a singular fashion, with the issue underscored by my participation in research projects.   As part of that project, for example, I reviewed, at the morgue, the medical examiner’s records on any adolescent committing suicide; some whom had been previously hospitalized our facility.  I had been involved in the clinical care of several of the adolescents and had known them quite well.  I reviewed their records, saw pictures of the “suicide scene,” followed by pictures of their naked mottled bodies on the steel autopsy tables.  I read suicide notes, interviews with family, case histories, and in some cases remembered  things I’d said to them while they were hospitalized.  I’d then carve out of this “data”, using statistical programs, correlations, trends, and connections, between their final act and the clinical residue of their short lives.  No matter how I worked the data, no matter how I interpolated, ANOVA’d or regressed (2) it, every time I looked at the pictures, Johnny was still hanging bugged-eyed from his chin-up bar, belt thickly around his neck creating the illusion of muscular tension in his otherwise limp body.  No matter how persistently I translated all their sadness, fear and self-doubt into Risk/Rescue scores (3), BDI totals (4), or SIQ (5) percentages, Mary’s urine-soaked jeans belied her repose as the permanent Desipramine induced sleep that it really was.  And so it hit me, like Col. Kurtz’s (6)  diamond bullet in the forehead, that much of my activity in this professional research was the conversion of the experiences of these adolescents into homogenized, “useful” data that became the tokens (7) of professionalism in the various associated disciplines." 

What I came to understand was that these apparently competing and even adversarial ‘economies’ were differentiated by the nature of the ‘tokens’ that were considered of value (where value is defined as the indicator of status).

A simple example.  A nuclear physicist is often seen as someone who is breathtakingly intelligent and of very high status in the community. That is evidenced by the very complex mathematics that she uses to communicate and explain her world.  Of course, there are only a small group of people who understand this kind of math and are seen as competent to discuss it.   In the same community, there is someone who is relatively uneducated and engages in menial labor.  His discussions are mostly about the people around him and he may know quite a bit about them and freely passes on anything he thinks interesting, provocative, embarrassing, etc.  Gossip.  This man has relatively low status.  But, if you are new to a community, gossip is a much more useful source of information and nuclear physics completely useless.  But status is almost inversely proportional to utility?  Why?  Because anyone can produce gossip but only a few can enter the formal conversation in the mathematics described.  The latter is a club only open to a select few, so high status, and the former open to all comers, so of no status.  So it is in medicine.  The more complex the analysis, the more sophisticated and high-status the people engaged in it, whereas the actual lives of the children involved are of low status, because they are only slightly different from ordinary.  It is the transformation of the ordinary suffering into high-value tokens of scientific medicine that drives and helps explain much of that activity. 

1: In the sense of outward emotion

2. Statistical methods of data analysis

3: Risk/Rescue: rates lethality by risk of death by chance of rescue

4. Beck Depression Inventory

5. Suicidal Ideation Questionnaire

6. Apocalypse Now, 1981

7. Such psychological testing translates real human experience into numbers, percentages, scales, diagnoses that represent these experiences in such a way that the professional can compare them (the numbers) with other cases and make generalizations.  How this alchemy works is mostly a matter of faith to those outside of it.  Telling a patient that their BDI is normal does not somehow relieve them of, say, a history of sexual abuse.  But it does help generate things like papers which can be exchanged with others in the professional economy of association meetings and journals.