Teaching by Humiliation

Inspired by an epiphany from a friend and palliative doctor after watching this Ted Talk by Monica Lewinsky on the Price of Shame.

I keep leaving the house naked. I turn up to work, to lunch, to classes, parties, the gym, exams, weddings and funerals without a thread of clothing on. I'm no nudist. This is not by choice. I desperately want to be covered. I leave the house and it is not until I am already there and I can't go back that I realise my entire self is exposed and everyone is staring at me in shock, disgust and disappointment. They must see me as other to prevent them from seeing themselves and not just eliminate me, but make an example of me. Sometimes I am laughed at. Sometimes those I respect and love the most turn away from me. Sometimes I am raped. Duck and dodge as I might, lower my volume, do anything to distract attention from me - there's nowhere to hide. There is no hole to sink into. There is no one walking towards me with open arms and a pair of pants.

I'm vulnerable. I'm naked. I'm on a public stage with all of me bared. All of it ridiculed. In the minds of others, I am less than.

I'm humiliated.

It's a recurring dream. We've all had it. And that speaks volumes.

But if I coach my dream self to be more resilient, to be able to stand naked in front of a crowd and be proud will this solve the problem? No. I am still not safe. Someone else will have the same dream, maybe even on the same night.

Someone else will have their private stories, relationships, mistakes and conversations splashed across the internet; another politician will be laughed at and scorned not because of the values and intellect of their policy but because of a exhaustion-driven misnomer in their speech, their hair, their extramarital affairs, their human desires and flaws; another child will disengage from learning and skip class to avoid having their perceived stupidity exposed; another young man will have his self-esteem and self-respect further degraded in a court room and a news article; a medical intern will overdose after months or years of feelings of inadequacy; another woman will be raped; another genocide will occur.

A study by psychologists in Amsterdam recorded people reading scenarios that evoked humiliation, anger, or happiness and used electrophysiological measures of cognitive intensity to determine a level of perceived negative affect. Levels were markedly increased in humiliation scenarios. At most, it suggests humiliation as an emotion, is more powerful than happiness and anger. At least, it unveils the idea that humiliation is an intense experience, likely to have far-reaching consequences.

In 1994, Rwanda was the scene of massive genocide. At least 800,000 Tutsi and moderate Hutu were killed despite the presence of UN peacekeepers mandated to protect them. But it wasn't just a tragedy of elimination. It was more. Like all genocides and many cross-cultural conflicts, it is an agonising narrative of rape, torture, devaluing, dehumanisation, and - humiliation.

Would it have helped if Tutsi were more resilient? If they knew themselves better? That they contacted a mediator about being bullied and asked for support? They were. They are. They did.

We know that examining the behaviour and character of 'victims' of bullying and abuse only further portrays and reinforces their feelings of being a victim, of feeling weak and humiliated, of being powerless. Yet we continue to use this as a strategy for eliminating it. And so it continues. What is more, we often go as far as to investigate the behaviour of 'evil' people and contrast this with 'good' people.

"Oftentimes have I heard you speak of one who commits a wrong as though he were not one of you, but a stranger unto you and an intruder upon your world.
But I say that even as the holy and the righteous cannot rise beyond the highest which is in each one of you,
So the wicked and the weak cannot fall lower than the lowest which is in you also.
And as a single leaf turns not yellow but with the silent knowledge of the whole tree
So the wrong-doer cannot do wrong without the hidden will of you all....
You cannot separate the just from the unjust and the good from the wicked;
For they stand together before the face of the sun even as the black thread and the white are woven together.
And when the black thread breaks, the weaver shall look into the whole cloth, and he shall examine the loom also." - Kahlil Gibran, 'On Crime and Punishment'.

A pilot study published in the Medical Journal of Australia in 2015  set its sites firmly on a culture of "teaching by humiliation". Final-stage medical students from two Australian medical schools were surveyed anonymously about their adult and paediatric clinical rotations.

The development of professionalism is a huge topic of interest in medical education and most often an explicit goal in curriculums. Yet 81 per cent of students surveyed reported witnessing teaching by humiliation in their adult rotations and 74 per cent reported experiencing it. Researchers claim it confirms findings of decades of research with medical students, in which up to 95 per cent reported experiencing teaching by humiliation.

The research identified forms of abuse ranging from derogatory remarks and undermining students' abilities and motivation, to verbal attacks. Students reported public belittlement, having their reputation or career threatened, experiencing unjustified criticism, sarcasm and teasing. They experienced medical staff deliberately withholding necessary information, ignoring students and setting impossible deadlines. Teaching practises have included humiliation, contempt, harassment, discrimination, assault, mocking and demeaning behaviour. Other subtle forms of abuse included refusal to answer questions, return calls or answer pagers and use of condescending language. Reports also described a misuse of the Socratic form of teaching, known as "pimping", in which teachers ask questions aggressively, putting students on the spot and shaming them.

The report comes in the same year ABC's Four Corners program rocked the hierarchial foundations of Australia's medical fraternity with its report 'At Their Mercy: The bullying and bastardisation of young doctors in our hospitals'.

The Royal Australasian College of Surgeons then released a report which shocked even the doctor who first raised these allegations. If found nearly half of all surgeons across all specialities have experienced discrimination, bullying or sexual harassment. It included stories of surgeons being expected to provide sexual favours in return for tutorship, constant belittling, intimidation and public humiliation.

If we are to produce the best doctors, they must receive optimal education, and this requires an environment free of fear and anxiety. Previous research has found teaching by humiliation affects students' mental health, having an impact on their confidence, loyalty to the profession and the care of patients. A United States study found mistreated medical students were more likely to be stressed, depressed and suicidal, to binge drink and believe the faculty did not care about them.

But this is not a case of some particular doctors just being bullies. It is a medical and hospital hierarchy; a culture of competitive education; an acceptance of disrespectful behaviour towards patients, staff and students; a respect for teaching by humiliation as a right of passage. Senior and junior doctors do what was done to them as students in order to "toughen up" the young.

Those who are bullies, those who are moderately evil and those who are extraordinarily evil, who participate in, initiate and organise everything from teaching by humiliation, to scandalous 'news' articles to genocide, cannot be distinguished from those who we perceive to be good, just by their actions.

Character and behaviour complement each other. But it is not a purely evil character, an individual, who commits these atrocities against other humans. It is the character of our culture, of our bystanders, our encouragers, our collective insecurities, our religions and spiritual awakenings, our universal strive for purity of mind and of human race.

Whatever the bullying, whatever the collective humiliation, it is fostered by a system and society that fosters rational self-interest, a culture of cruelty. There is group conformity, a rejection of individual identity and thus reduction of personal responsibility, disengagement from self and others, and finally, the merger of a person's role and perceived duty to some 'greater good' with their personal character. It is rooted in the identification of the victim as the 'other', an impurity upon the higher human cause, who can subsequently be delegitimised, dehumanised and blamed.

Genocide is not a quest for wealth or power. It is a quest for a pure conscience, for freedom and happiness, recognition from a divine higher power, and a willingness to sacrifice the self and the other in this 'virtuous' pursuit. The right to an autonomous self and the need to preserve this as a human right, leads to the right to destroy an 'other' autonomous self in defence. That is why extinction of a race is not enough. To destroy them we must first detach from them, see them as less than human. The loss of individual identity and personal responsibility through conformity and virtuous loyalty to the cause, goes hand-in-hand with a need to make an example of the other, to prove their world view and autonomy illegitimate, their humanness inhuman. This dehumanisation and objectification is what leads to assaults against sexuality, rape, mistreatment of corpses and denial of civilised burials.

To prevent this from happening, it is not evil people we must examine. It is not evil behaviour. It is good people. Good, ordinary people who are capable of committing genocide. Who are capable of publishing stories that humiliate others. Capable of reading them with fascination absent of compassion. Of putting aside another human's emotions and wellbeing with a self consciousness that the ends will justify the means. Who are capable of defending and protecting themselves against shame by using humour to humiliate others, or even to self deprecate themselves before someone else does. We must examine ordinary people, good people, who are bystanders, who condone this in their obedience, their apathy and their silence.

The Aristotlean theories on virtue, that value honour, reason, self sufficiency, the pursuit of self-satisfaction must be counteracted with a new wave. It must wash away self-interest and self-sacrificing values, and make way for a tsunami of culture that promotes empathy and compassion for one another, that recognises the other in herself and understands the need for a collective movement against human destruction of each other and the world we live in.