Getting caught

I do not remember when I started writing about people getting “caught by” when putting into words what I would have written earlier as “participating in.” When anthropologists observe some people in some setting (family dinner, school classroom, hospital recovery room), they do observe people “participating”–to the extent that all the people are somehow responding to what others are doing there and then. In many cases, anthropologists add that that to which people are responding is “their” culture often without considering whether the possessive form is appropriate. It is clear to me to no “culture” is the possession of anyone and that it is taking a huge step to say that the nice lady one is observing swaddling her baby is responsible for the manner in which she is swaddling the baby (or the color of the blanket, the style of folding, the song she may be singing, etc.)—whether this lady lives on the island once known as manaháhtaan in 1400 or 2000. I once wrote a paper (1984) to counter the misleading tendency of many anthropologists of my generation, following Geertz, to write “the Manhattanites, ‘they’…” and that “they are like [that interpretation].” I was particularly sensitive to this as I was critiqued for writing about “Americans” when it was getting clearer to me everyday (and was mostly reflected in my writing) that I was writing about people “in” America—that is, as I put it later people who participate in American institutions to the extent that they have no choice but to respond to what the institution requires (for example, teachers must give tests and grades to “students,” many of whom may be “foreign,” if not “aliens”).

I do not recall exactly when I started writing about people being “caught by” America as a preliminary step to “participating.” In my current autobiographical memory, I’d say that it happened when I started to ponder systematically Jean Lave’s version of the “community of practice.” I take it to be a model (in Lévi-Strauss’s sense) of social structuring that is a major transformation of the always static earlier modeling of “social structures” (or “systems”). Lave’s models a field within which people move between two positions (from “peripheral” to “full”). Leaving aside what all this implies for “learning” (as she, and McDermott, were mostly concerned with), this must make one think about movement through (rather than “participating in” or “socializing to”), what is important to me now is that the model implies that we also pay attention to other movements. When teaching Lave, I always start with the movement from [outside] into the “peripheral” position.In an early paper ([1947] 1953) David Schneider tells the story of some drafted men, assembled from many backgrounds for “basic training,” transforming themselves into an army unit a process that included reclassifying some of them as “not for the army.” This movement is essential for any “community” (“congregation” would be better) must recruit people from those who are not yet peripheral, but may have been seeking entry (or are conscripted into it). I thus imagine an “accretion” disk of potential peripheral members who might get attracted until, in some case, they pass what astronomers call the “event horizon” after which they can no longer escape the gravity well of the constituted community (though some may not make it to the “legitimate” “periphery” for their will always be illegitimate ones).

When teaching this I tell the story of my circling America, and then falling into it. I remember playing cowboys and Indians as a 6 year old in a small Southern French village. I remember being awed by 1960 Buicks. I remember trying to transcribe Blowing in the Wind. Like all Europeans after the end of WWII, I was experiencing the gravitational pull of America though most did not take the step that eventually caught me. I like to say that I crossed this event horizon the day I entered the American consulate in Marseille (as everyone called it though its official name was “United States Consulate”). There, I was told what I needed to do to get the student visa which would allow me to attend the University of Chicago. Arguably, entering the consulate was the moment when America morphed, in my life, from fantasy to actuality. I had to respond to local agents of something huge and shadowy that, like millions before and after me, I could no longer escape. Many have attempted such an escape after being caught. The Mormons tried moving to Utah. People from from China, or Jewish enclaves in Europe, attempted to build neighborhood institutions that might partially protect one’s children from America. In all cases, the very attempt to escape constituted what America is becoming—and all the more so when their attempts at escape were noticed by others also caught.

I thought about all this again as I entered, literally, a massive hospital in the above mentioned island for complex tests “prescribed” by fully authorized agents of this institution. Actually, “getting tested” is a step well into the gravity well of medical institutionalization. I got caught earlier, when symptoms (some peculiarities on a routine test) were transformed into a particularity (the “diagnosis” that determines treatment).After decades of adulthood, I certainly “know” what was going to happen but this knowledge does not actually say much about what I actually had to respond to as I went through the door, got my temperature taken by a guard, was directly by another guard to an office where I was “registered” before being taken to another part of the hospital where I was, after being handed over to people who took me to a bed, told me to undress, hooked me to various machine, and told me to wait. At that moment nothing strictly “medical” had yet happened but a second major boundaries had been crossed when I moved from being allowed to seek an office by myself to having to be accompanied to the next. This boundary marked entry into another “community” of some practice that systematically removed the signs of my various statues as I became the pure body on which some authorized person(s) would operate after the body ha been anesthetized and thus stripped of its last status–consciousness. Much has been written about this loss of status but much less about what is actually a movement through more and more specialized statuses (“what kind of health insurance do you have?” as the first agent asked me) as others fell by the way size (university professor)—as well as the movement back until one eventually walks out the door of the building.

Detailing, step by step, the various interactional patterns (who can talk about what how; how a body is decorated by whom; who can touch which part of a body how; who has authority to alter this or that procedure; etc.) is a task for future ethnographers who eschew the tendency to jump too fast to “interpretation.” For another take on the multiplicity of “communities” in a large hospital see an earlier post.And the first thing to accept is that at no moment is participation in a particular status-setting interaction are the patterns either one’s own or escapable. They are what they are for all involved at the moment and even small improvisations on the pattern (for example, joking about a detail) constitute the setting as patterned. Take what may be the “least interesting” moment in the movement through hospital testing: registration. It is a 5 minutes event between patient-in-process and institutional agent during which “verification” is performed culminating with the printing of labels and the transition to the first medical setting. The labels are actually an essential event as they become an extension of the verified body as various parts (for example blood) gets moved into various distant settings in parallel (and for inscription in the body/patient/person’s history with future institutions including not only hospitals but also insurance companies, etc.).

And so “being caught” is the best metaphor I can currently come up with for the whole thing.

References

Schneider, David   [1947] 1953     “Social dynamics of physical disability in Army basic training.” in Personality in nature, society and culture. Edited by C. Kluckhohn and H. Murray. New York: Alfred A. Knopf. pp. 386-397.

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On the (mis-)use of anthropology

Sherente Village
(Nimuendajû 1942: 17)

Last week, I heard a most interesting paper by Oren Pizmony-Levy and Gita Steiner-Khamsi about, of all things, school reform in Denmark! It may seem strange that I resonated to such a topic.[Ftn 1] But it should not appear so: in graduate school, I also resonated to reading ethnographies of Ge people of Central Brazil! People over all the world do amazing things and “school reform” is one of them.

network represenation
an example of the representation of a network
using UCINET (White 1997)

Last week, I particularly resonated to the methodology. Nimuendajû, the great ethnographer of the Ge, in his time, modeled Šerente villages on the basis of his local observations. Pizmony-Levy and Steiner-Khamsi have found a way to make visible networks involved in the production of “school reform,”[Ftn 2] on the way I suspect to modeling how such reforms proceed. Their work is part of a broad movement in the social sciences, and anthropology in particular (at least in the networks who attempt to build on Jean Lave’s work as transforming social structural analyses). The goal is to trace movement and change (or return to the old normal) in position, and perhaps even in the field of positions within which people move (including school organization). The current consensus, backed by much ethnography, is that these changes do not “just happen” as effect following some cause. It proceeds through deliberate action by emergent polities. Nimuendajû did not have the tools needed to trace how the Šerente came to do something that could be modeled as he did. But these tools are now available.

More on this another time.

What surprised in me most Oren Pizmony-Levy and Gita Steiner-Khamsi’s paper was that the most quoted document in the network of people and institutions who performed “school reform” in Denmark was …. an ethnography, of a school, by Danish anthropologists!

Anthropology of education, actually applied for what appears positive change!
Continue reading “On the (mis-)use of anthropology”

Instruction, uncertainty, and meta-pragmatic repairing in medical education

At some point in their career, people who are moving towards being acknowledged as Mds enter what is known there as a “clerkship” where they will be, for the first time, authorized to care for a patient, under the gaze of doctors and nurses with various experiences and authority. So what happens during various stages within this clerkship?

When I teach Lave and Wenger’s (1991) altogether brief introduction to “legitimate peripheral participation,” I do not teach it as a theory of learning but as a model for social structuring in Lévi-Strauss’s sense (1962 [1952]).  But Lévi-Strauss was seeking to model a moment in the organization of a people while Lave, in a major development, seeks to model movement through social structurings when everyone and everything involved in the movement constitute this structuring as it will be available for the future.  By an implication that remains to be developed, Lave also opened the way for a modeling of culture change.

In brief, for those who do not know the background to this approach, Lave asks us to move from imagining participation in any position as dependent on earlier learning to imagining this participation itself as producing some personal learning.  Thereby she argues that a personal movement into a position is dependent on mechanisms other than learning (or socialization/enculturation).  These are the mechanisms that make the initial positioning “legitimate” and authorize the acknowledgment of movement.  Wondering about legitimacy and authorization leads to searches for the interactional, political forces that establish legitimate participation, authorize certain forms of leaning, and thus of course, refuse participation, does not acknowledge learning, etc.

Much of this formulation sprung from an interest in apprenticeships and it has been found to be a very useful way of approaching traditional problems generally phrased as matters of socialization into positions—for example the movement that transforms a medical student into a physician.  But there is still a need for more exact accounts of movements that might help us develop further properties of the model.

Given all this, I am thankful to Dr. Yan-Di Chang and her dissertation about a moment in the education of physicians in Taiwan.  At some point in their career, people who are moving towards being acknowledged as Mds enter what is known there as a “clerkship” where they will be, for the first time, authorized to care for a patient, under the gaze of doctors and nurses with various experiences and authority.  So what happens during various stages within this clerkship?

Dr. Chang has a good sense of what makes ethnography worthwhile and also infuriating: there is a long chapter in the dissertation about orientation day when the new clerks are told, among many, many, many things … where the bathrooms are!  Do we really need this level of detail?  Yes, if we are not going to gloss over the difficulties involved in movement across the virtual spaces of social structure.  Yes, if we are going to highlight how much work it is not only to be a “peripheral” participant but also to be the fuller participants who have the responsibility to teach what they can never be quite sure the students do not know.  The people who plan the orientation, and those who actually perform it, are faced with the “instruction manual” problem discussed by Garfinkel (2002: Chapter 6): we, the instructors, know that they, the inductees, will need instruction, we can imagine what they will need, but we cannot be sure.  So the actual moment of interaction is difficult for all, and open for much deliberation, including self-reflective deliberation by the instructors about how to do it the next time.

Dr. Chang then proceeds through several other moments when all these matters become salient.  There is the encounter with one’s first patient and how to balance his care with one’s personal life while knowing that one might make mistakes, while knowing that one should ask for advice but not necessarily from whom, while being told that one has made a mistake one had not noticed, and all the while knowing that a person well-being, if not life, is at stake.  Moving into the position of “physician” re-arranges a small crowd!

Dr. Chang then takes us into a more detailed, almost conversational analytic, look at another salient moment in the life of the whole polity: the senior doctor’s rounds when a few students (including both beginners and some more advanced) have to present a case to the doctor, in the presence of fellow students, as well as other more seasoned personnel.  Everyone is participating legitimately.  The hierarchies are multiply indexed discursively and practically, particularly by the balance between questioning, proposing answers, redirecting and sometimes actual instructing.  But the detail of the conversation reveal again and again that noone is following a script.  Everyone has to handle multiple uncertainties that cannot be resolved simply by following rules or applying knowledge.

Everyone is indeed in movement, re-constituting hierarchies which, as Dr. Chang illustrates in a later chapter are themselves subject to meta-pragmatic deliberation among the most legitimate and fullest of participants.  There the questions keep arising: how do we best prepare future doctors? Could we produce “happy doctors”?  These are the conversations that must have guided medical education as it shifted though various models in the history of Taiwan.  And they are the conversations that will participate in transforming it.

The detail in Dr. Chang’s dissertation made me think in a somewhat inchoate fashion about the interactional consequences of the instruction manual problem.  At any moment in an asymmetrical interaction (and perhaps all interactions are) one must wonder what it is that the other person does (not) know.  But, of course, this wonder cannot be settled in any definite fashion.  In any event there would be no time.  Conversational analysis has clearly demonstrated the extent of “repairs” in face to face interaction.  It is as if all conversation occurred in what, to play on Vigotsky, one might call a zone of “proximal ignorance” where all participants have to play with first, what they can make each other pass as knowing (that is they authorize each other’s participation), and, second, what some must instruct others who have exhibited allowable ignorance at this moment and about this (that is, at other moments, a display of ignorance about this might lead to status degradation).

What Dr. Chang, building on other work, illustrates again is that this is not simply a moment to moment matter that must proceed under meta-pragmatic discursive awareness (as classical theories of cultural learning have assumed).  It is also a process taking place in longer sequences where meta-pragmatic discursive awareness is very much involved.  In the day to day matter of moving students into the position of physicians experiential difficulties abound: a future doctor must find out where the bathroom are, must face her first patient along with experienced nurses, must explain her actions to other doctors.  At every moment further deliberations must occur to develop, repair, redirect what has happened before.  And these deliberations may, or may not, make moving medical students into physicians a smoother process for all involved.

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