A Way Out of Burnout: Cultivating Differentiated Leadership Through Lament

Some interesting (and provocative) thoughts from the world of church leadership. “Lament” is not prominent in our culture anymore, at least not in our official culture… and one could wonder how to translate these ideas into a secular setting. Nevertheless, there is much to ponder here and I would feel that all in leadership positions – or roles susceptible to burnout – could benefit from reading this, whether they have religious faith or not.

I found the following paragraphs (of what is a long paper) especially resonated:

Leaders who are most likely to function poorly physically or emotionally are those who have failed to maintain a well-differentiated position. Either they have accepted the blame owing to irresponsibility and constant criticism of others, or they have gotten themselves into an overfunctioning position (that is, they tried too hard) and rushed in where angels and fools both fear to tread.[12]

Many programs often aim to cure clergy burnout by offering retreats that focus on rest and relaxation. However, Friedman asserts, “Resting and refreshment do not change triangles. Furthermore, because these programs focus on the burned-out ‘family’ member, they can actually add to his or her burden if such individuals are inclined to be soul searchers to begin with.”[13] These same soul-searching and empathetic clergy are vulnerable to seeing the overwhelming burdens that they carry for others as crosses that they ought to bear. Friedman calls this way of thinking “sheer theological camouflage for an ineffective immune system.”[14] When clergy bear other people’s burdens, they are encouraging others not to take personal responsibility. And often in bearing other people’s burdens, clergy easily tend to ignore their own “burdens” (ie. marriage issues, financial problems, etc.) and thus fail to be personally responsible for themselves.

London also discusses how “lament” and in some ways “passing the buck onto God” has Biblical roots:

God responds with sympathy to Jesus’ ad deum accusation and lament. Furthermore, one may easily interpret the empty tomb at the end of the Gospel as a sign of God’s ultimate response to Jesus’ lament: the resurrection (Mark 16:4-7). In the psalms of lament and in the cry of dereliction, we see that God does not respond with hostility but with a sympathetic openness to our struggle, our need for someone to blame and, in the words of Walter Brueggemann, our “genuine covenant interaction.”[34] God responds with sympathetic openness to Jesus’ ad duem accusation and then dispels the blame and emotional burden that no human could ever bear. Jesus receives the blame that humans cast upon him and then gives it to God who receives it, absorbs it and dispels it. Jesus let go of the blame by giving it to God. His cry of dereliction became his cry for differentiation. In this way, Jesus serves as a role model for leaders who receive blame from others and then need to differentiate in order to not take accusations personally. By practicing lament, leaders can turn the ad hominem accusations against themselves into ad deum accusations against God, who responds with sympathetic openness while receiving and dispelling the blame. Moreover, leaders can respond with empathy to the suffering of others, knowing that they will not have to bear the emotional burden that they have taken on, indefinitely. They can let go of the emotional burden by passing it on to God through the practice of lament.

This “passing of the buck” to God does not encourage irresponsibility. Rather, it gives the emotional baggage away to the only One who can truly bear it, thus freeing the other to take personal responsibility, without feeling weighed down by unbearable burdens. With this practice, a pastor can therefore receive blame and emotional baggage from parishioners in a pastoral setting because they can differentiate through lament. They can take the blame like Jesus because they, like Jesus, can also pass the buck to God through ad deum accusation. Eventually, the pastor will want to teach the parishioners to redirect their human need to blame onto God as well so as to occlude the cycle of scapegoating in the community.[

DeForest London

This is the final paper I wrote for the class “Leading Through Lament” with Dr. Donn Morgan at the Church Divinity School of the Pacific.

INTRODUCTION

On August 1, 2010, New York Times published an article titled “Taking a Break From the Lord’s Work,” which began with the following statements:  “Members of the clergy now suffer from obesity, hypertension and depression at rates higher than most Americans. In the last decade, their use of antidepressants has risen, while their life expectancy has fallen. Many would change jobs if they could.”[1] Although these are troubling reports, some of the statistics that came out of a study conducted by Fuller Theological Seminary in the late 1980s prove more disturbing: “80 percent [of pastors] believe that pastoral ministry is affecting their families negatively, 90 percent felt they were not adequately trained to cope with the ministry demands placed upon them, 70 percent…

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Marcus Aurelius: reflection good enough for an emperor but is it good enough for medicine?

Sati Heer-Stavert very kindly asked my permission to link to the paper I wrote a while back on Marcus Aurelius, stoicism and reflective practice – here is the post that has resulted which I am very impressed by! Certainly Sati has provided an excellent framework to prompt students and learners to reflect on what reflection means and what the obstacles to it are….

UNEXAMINED MEDICINE

Reflection is an important part of training, appraisal and revalidation for doctors based in the UK. However, for many doctors the very thought of reflection can cause feelings of frustration, non-engagement or even rejection. Where did we go wrong?

Learning objectives

1. Consider the definition of reflection used in medicine

2. Understand how reflection can be assessed

3. Encourage you to read Meditations by Marcus Aurelius

Oh no! A patient has complained about your refusal to supply antibiotics for a cold. Wow! This would make a really good entry in your learning portfolio:

“That men of a certain type should behave as they do is inevitable. To wish it otherwise were to wish the fig-tree would not yield its juice. In any case, remember that in a very little while both you and he will be dead, and your very names will quickly be forgotten.”

You have to respond to…

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Can fMRI solve the mind-body problem? Tim Crane, “How We Can Be”, TLS, 24/05/17

In the current TLS, an excellent article by Tim Crane on neuroimaging, consciousness, and the mind-body problem. Many of my previous posts here related to this have endorsed a kind of mild neuro-scepticism, Crane begins his article by describing an experiment which should the literally expansive nature of neuroscience:

In 2006, Science published a remarkable piece of research by neuroscientists from Addenbrooke’s Hospital in Cambridge. By scanning the brain of a patient in a vegetative state, Adrian Owen and his colleagues found evidence of conscious awareness. Unlike a coma, the vegetative state is usually defined as one in which patients are awake – they can open their eyes and exhibit sleep-wake cycles – but lack any consciousness or awareness. To discover consciousness in the vegetative state would challenge, therefore, the basic understanding of the phenomenon.

The Addenbrooke’s patient was a twenty-three-year-old woman who had suffered traumatic brain injury in a traffic accident. Owen and his team set her various mental imagery tasks while she was in an MRI scanner. They asked her to imagine playing a game of tennis, and to imagine moving through her house, starting from the front door. When she was given the first task, significant neural activity was observed in one of the motor areas of the brain. When she was given the second, there was significant activity in the parahippocampal gyrus (a brain area responsible for scene recognition), the posterior parietal cortex (which represents planned movements and spatial reasoning) and the lateral premotor cortex (another area responsible for bodily motion). Amazingly, these patterns of neural responses were indistinguishable from those observed in healthy volunteers asked to perform exactly the same tasks in the scanner. Owen considered this to be strong evidence that the patient was, in some way, conscious. More specifically, he concluded that the patient’s “decision to cooperate with the authors by imagining particular tasks when asked to do so represents a clear act of intention, which confirmed beyond any doubt that she was consciously aware of herself and her surroundings”.

Owen’s discovery has an emotional force that one rarely finds in scientific research. The patients in the vegetative state resemble those with locked-in syndrome, a result of total (or near-total) paralysis. But locked-in patients can sometimes demonstrate their consciousness by moving (say) their eyelids to communicate (as described in Jean-Dominique Bauby’s harrowing and lyrical memoir, The Diving Bell and the Butterfly, 1997). But the vegetative state was considered, by contrast, to be a condition of complete unconsciousness. So to discover that someone in such a terrible condition might actually be consciously aware of what is going on around them, thinking and imagining things, is staggering. I have been at academic conferences where these results were described and the audience was visibly moved. One can only imagine the effect of the discovery on the families and loved ones of the patient.

Crane’s article is very far from a piece of messianic neurohype, but he also acknowledges the sheer power of this technology to expand our awareness of what it means to be conscious and human, and the clinical benefit that is not something to be sniffed at. But, it doesn’t solve the mind-body problem – it actually accentuates it:

Does the knowledge given by fMRI help us to answer Julie Powell’s question [essentially a restatement of the mind-body problem by a food writer]? The answer is clearly no. There is a piece of your brain that lights up when you talk and a piece that lights up when you walk: that is something we already knew, in broad outline. Of course it is of great theoretical significance for cognitive neuroscience to find out which bits do what; and as Owen’s work illustrates, it is also of massive clinical importance. But it doesn’t tell us anything about “how we can be”. The fact that different parts of your brain are responsible for different mental functions is something that scientists have known for decades, using evidence from lesions and other forms of brain damage, and in any case the very idea should not be surprising. FMRI technology does not solve the mind–body problem; if anything, it only brings it more clearly into relief.

Read the whole thing, as they say. It is a highly stimulating read, and also one which, while it points out the limits of neuroimaging as a way of solving the difficult problems of philosophy, gives the technology and the discipline behind it its due.

Leandro Herrero – “The best contribution that Neurosciences can make to Management and Leadership is to leave the room”

A while back I reviewed I Know What You’re Thinking: Brain Imaging and Mental Privacy in the Irish Journal of Psychological Medicine, and discussed a couple of studies which illustrate the dangers of what could best be called neuro-fetishism:

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

I am becoming quite addicted to Leandro Herrero’s Daily Thoughts and here is another. One could not accuse Herrero of pulling his punches here:

I have talked a lot in the past about the Neurobabble Fallacy. I know this makes many people uncomfortable. I have friends and family in the Neuro-something business. There is neuro-marketing, neuro-leadership and neuro-lots-of-things. Some of that stuff is legitimate. For example, understanding how cognitive systems react to signals and applying this to advertising. If you want to call that neuro-marketing, so be it. But beyond those prosaic aims, there is a whole industry of neuro-anything that aggressively attempts to legitimize itself by bringing in pop-neurosciences to dinner every day.

In case anyone doubts his credentials:

Do I have any qualifications to have an opinion on these bridges too far? In my previous professional life I was a clinical psychiatrist with special interest in psychopharmacology. I used to teach that stuff in the University. I then did a few years in R&D in pharmaceuticals. I then left those territories to run our Organizational Architecture company, The Chalfont Project. I have some ideas about brains, and some about leadership and organizations. I insist, let both sides have a good cup of tea together, but when the cup of tea is done, go back to work to your separate offices.

It is ironic that otherwise hard-headed sceptics tend to be transfixed by anything “neuro-” – and Leandro Herrero’s trenchant words are just what the world of neurobabble needs. In these days of occasionally blind celebration of trans-, multi- and poly- disciplinary approaches, the “separate offices” one is bracingly counter-cultural…

Sophistry, the Sophists and modern medical education. Medical Teacher Volume 32, Issue 1, 2010. Part 2.

THE SOPHISTS AND THE PROFESSIONALISATION OF MEDICAL EDUCATION

One of the direct ways in which the Sophists are relevant to today is that they were the first to put a monetary value on education; they were the first professional educators. In Plato’s Hippias Major Socrates remarks that Gorgias ‘by giving exhibitions and associating with the young, he earned and received a great deal of money from the city’ and that Prodicus ‘in his private capacity, by giving exhibitions and associating with the young … received a marvellous sum of money.’
The Sophists’ innovation of seeking payment for tuition is the first appearance of an idea now all pervasive. Today it is taken almost entirely for granted that teachers require payment, and with it in the modern age come sick leave, maternity leave, pensions and other payments.
The professionalisation of education in general is therefore a legacy of the Sophists. The whole apparatus of modern university teaching, for good and ill, has its root in this idea. Despite a long gestation, it is only in recent years that a professionalisation of medical education has taken root, and it still faces cynicism and opposition today even in recent times (Peterson 1999). There has been concern at the standard of clinical teaching in medicine internationally for a number of years (Wall and McAleer 2000). In the United Kingdom, partly under the influence of the National Committee of Inquiry into Higher Education (Dearing 1997), in the number of departments of medical education attached to medical schools has grown, and a proliferation of masters level programmes and postgraduate certificates in medical education (Pugsley et al. 2008). The whole apparatus of modern academic discourse — peer-reviewed journals, associations, national and international conferences and other scholarly paraphernalia — has grown up around the subject. The subtitle of Peterson’s article cited above — Tomorrow’s doctors need informed educators not amateur tutors — gives a flavour of this new emphasis on professionalisation in medical education.

THE SOPHISTS AND TEACHING VIRTUE

The second great sense in which the Sophists are still relevant is their case that virtue was not inborn or innate, but could be taught. Their ‘most revolutionary innovation was, precisely, that, faced with nature, they set up teaching to counteract it and considered that virtue could be learned by attending their classes’ (de Romilly 2002), and the problem of nature versus nurture, as it is invariably dubbed today, is a very old one that troubled the Athenians with a peculiar intensity. We see it in Thucydides, in the comparison between the courage of the Athenians — described by the historian as deriving from reason, from expertise and from experience — and that of the Spartans, portrayed as ‘natural’ and traditional. We see it in Euripides’ play, Hecabe, when Hecabe (wife of King Priam of Troy) learns of the slaughter of her daughter. After a few rather perfunctory expressions of grief she launches into a meditation on this very question:
How strange, that bad soil, if the gods send rain and sun,
Bear a rich crop, while good soil, starved of what it needs,
Is barren, but man’s nature is ingrained—the bad
Is never anything but bad, and the good man
Is good: misfortune cannot warp his character,
His goodness will endure.
          Where lies the difference?
In heredity or upbringing? Being nobly bred
At least instructs a child in goodness; and this lesson,
If well learnt, shows him by that measure what evil is.
(Vellacott 1963, lines 593–603)

Plato’s dialogue Protagoras is devoted to the dispute between Socrates and Protagoras on this particular issue, the teaching of virtue. Although both agree that virtue can be taught, Socrates doubts Protagoras’ self-confidence on the issue. This is an issue that has huge implications not only for education but also for wider political economy. Improved knowledge of genetics in the last hundred years has given the problem a new acuity. Nevertheless, in this as in many fields one can get the impression from contemporary media coverage that all this is a new problem, which only our time has had to face. Nothing could be further from the truth, as the example of the Sophists illustrates.

Whatever ones own beliefs on the issue of nature-nurture, and whatever science may or may not tell us about it, one must concede that the Sophists have, from a practical point of view, won the argument. That education should be available for all is such a commonplace in Western society that to suggest otherwise would be social and (for an elected official) political suicide. Prior to the Sophists, the idea that arete was inborn and therefore unteachable was widely held. Therefore aristocratic birth alone qualified one for rule. If Protagoras’ self-confidence in his ability to teach virtue seemed dubious to Socrates, who was after all sympathetic to the essential point, imagine how shocking it must have been to Athenians more in thrall to notions of aristocratic virtue.
This parallels the reaction medical educators often receive from colleagues. While it is often not directly articulated, the claim that communication skills, for instance, or attitudinal aspects of medical practice, cannot be taught but are innate is frequently encountered. With the exception of ethics teaching (discussed below), medical educators may not consider themselves as teaching ‘virtue’, per se, but overall professionalism and attitudinal aspects of medical practice are explicitly incorporated into curricular design and structure. For instance Harden et al. (1999) describe a concentric circle model of learning outcomes, with an inner core of task focused outcomes defining the technical competency of a doctor, a middle section of ‘approach to practice’ outcomes defining understanding of the context of illness and evidence-based and ethics-based approaches to clinical work, and finally an outer circle of outcomes focused on the overall role of the doctor and ongoing personal development. The term ‘personal development’ itself implies that character can be changed by training.
This debate is particularly relevant to ethics training. A tension has been described (Eckles et al. 2005) between proponents of the view that ethics training should be aimed at the formation of virtuous physicians (for instance, Pellegrino and Thomasina,1993) while others have argued that the moral character of medical students is formed at arrival in medical school (Glick1994). This latter viewpoint is expressed as a belief that the goal of ethics training is to impart of body of ethical knowledge and provide a set of skills for application by medical graduates, whose underlying virtue has been established prior to admission to medical school. Eckles et al. identify this dichotomy as making it ‘difficult to find a consensus regarding the goals of medical ethics education’ and suggest that further theoretical work is needed to delineate the core content, processes and skills relevant to the ethical practice of medicine. The antiquity of this debate is not acknowledged.

INTERLUDE – PROTAGORAS AND EDUCATION

A theme of this article is that what the Sophists really thought, and what their influence on Western thought really was, is very different from the broad caricature often presented. Before discussing the final trend in medical education which is prefigured in Sophist thought, I wish to examine the thought of a specific Sophist figure and link with modern medical education theory. The thought of Protagoras (circa 490-420 BC) described as ‘the first and greatest of the Sophists’ (Waterfield2000) is known from a seven fragments and the reports of others, especially his appearance in the Platonic dialogue Protagoras. Both Socrates and Protagoras believe that virtue can be taught, although to differing degrees (and Plato will later have Socrates definitively oppose this view in the dialogue Meno), but Socrates is sceptical of Protagoras’ confidence on this issue.
The surviving fragments of Protagoras’ thought indicates the seriousness with which he thought about education (Lavery2008). The most famous, ‘man is the measure of all things’, is often cited as a key motif of relativist thought. Debate continues as to whether this was an example of ‘strong’ or ‘weak’ relativism – in other words whether this is a general statement about humanity or is about the individual human being’s ability to accurate perceive the world. However the underlying relativist thrust of this aphorism is not in doubt. Constructivist theories of learning, which are influential in medical education today, are clearly influenced by this approach.
Other Protagorian mottos directly related to education are ‘teaching needs endowment and practice. Learning must begin in youth’ (cited as Fragment 2 in Lavery, 2008). ‘Art without practice, and practice without art, are nothing’ (Fragment in Lavery,2008) and ‘education does not take root in the soul unless one goes deep’ (Fragment 8 in Lavery, 2008). All of these are relevant to medical education – the emphasis on practice and on deep learning, and on lasting attitudinal and behavioural change particularly so. As can be seen, these aphorisms are far in spirit from the caricature of the Sophists as promoting a superficial, purely rhetorical education.

THE SOPHISTS AND BEST EVIDENCE MEDICAL EDUCATION

Another characteristic of contemporary medical education theory prefigured in the thought of the Sophists is an evidence-based approach. The Sophists championed empirical knowledge and direct enquiry, which as well as marking them out as early pioneers of the scientific method, also suggests their place as exemplars of evidence-based practice.
The pre-Socratic philosophers of the centuries before both Socrates and the Sophists are often called both the first philosophers and the first scientists. This, of course, is due to their inquiring minds, and readiness to challenge explanations that depended solely on divine action — thus we have the atomic theory of Democritus, or the postulate of Thales that all matter is water (Waterfield 2000). Nevertheless, a modern reader often finds the Sophists more familiarly ‘scientific’ than the pre-Socratics. This is due to the pre-Socratics’ tendency to expand speculation into explanation, and to engage in metaphysics. The Sophists are more recognisable ancestors of modern scientific method because of their scepticism, their refusal to accept simple explanations, and their pragmatic bent. Defining the scientific method is a hugely problematic enterprise, but an attempt at the unprejudiced search for alternative explanations for any given event or observation is one of its cardinal features.
‘Making the weaker argument the stronger’, a taunt of Aristophanes in The Clouds, is one of the phrases with which the Sophists were most often abused. At first glance, it suggests a sort of confidence trick, a justification for wrongdoing. Yet on reflection, ‘the weaker argument’ may conceal the best answer. The querying approach of the Sophists forces one to examine apparently sound arguments and justifications, and thereby perhaps discover their soundness to be illusory. Richard Feynman described the scientific method as ‘a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty–a kind of leaning over backwards. For example, if you’re doing an experiment, you should report everything that you think might make it invalid—not only what you think is right about it: other causes that could possibly explain your results; and things you thought of that you’ve eliminated by some other experiment, and how they worked—to make sure the other fellow can tell they have been eliminated’ (Feynman 1974). So openness to alternative explanations, and a willingness to accept that the ‘weaker argument’ (or initially less persuasive or attractive hypothesis) may be closer to the truth, is a characteristic not of rhetorical chicanery, but of any empirical approach to knowledge and practice.
Best evidence medical education enshrines this empirical approach. Mirroring definitions of evidence-based medical practice, it is defined by Harden and Lilly (2000) as the implementation, by teachers in their practice, of methods and approaches to education based on the best evidence available. This means integrating individual educational expertise with the best available external and internal evidence from systematic research. Best evidence medical education approaches mean that the assumptions of medical educationalists are themselves open to question. Our fondness for a particular innovative means of teaching should be as suspect as the stubborn retention of every aspect of traditional teaching. In Western thought, the Sophists were the great intellectual gadflies, the questioners – pointing out social assumptions and prejudices for what they were. Medical educators owe a debt to these intellectual precursors.
Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

REFERENCES

  • 1. Boyles, DR. 1996. Sophistry, Dialectic, and Teacher Education: A Reinterpretation of Plato’s Meno. Philosophy of Education. [Published 1996]. Available from: http://www.ed.uiuc.edu/EPS/PES-Yearbook/96_docs/boyles.html, pp. 102–109.
  • 2. Dearing R. Higher education in the learning society: National Committee of Inquiry into Higher Education. HMSO, London1997
  • 3. de Romilly J. The Great Sophists in Periclean Athens. Translated by Janet Lloyd. Clarendon Press, Oxford 2002
  • 4. Eckles RE, Meslin EM, Gaffney M, Helft PR. Medical ethics education: Where are we? Where should we be going? A review. Acad Med 2005; 80(12)1143–1152
  • 5. Feynman R. Cargo Cult Science. Surely you’re joking, Mr. Feynman: Adventures of a curious character, E Hutchings. W W Norton, New York 1974
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  • 8. Glick SM. The teaching of medical ethics to medical students. J Med Ethics 1994; 29: 239–243
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  • 10. Harden RM, Crosby JR, Davis MH. AMEE Guide No.14 Outcome-based education: Part 1. An introduction to outcome-based education. Med Teach 1999; 21: 7–14
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Sophistry, the Sophists and modern medical education. Medical Teacher Volume 32, Issue 1, 2010. Part 1.

I’m sure on a Friday evening what the world is waiting for is the reposting of a paper on  (possibly) unfairly maligned Ancient Greek philosophers and the parallels between their thought and modern medical education theory. I fully expect this one to go viral. Re-reading it I am quietly happy with my discussion of the (mis)use of the term “sophistry” in the educational literature…. less admirably, I barely mention any of the Sophists themselves. Original is here

Sophistry, the Sophists and modern medical education

Abstract

The term ‘sophist’ has become a term of intellectual abuse in both general discourse and that of educational theory. However the actual thought of the fifth century BC Athenian-based philosophers who were the original Sophists was very different from the caricature. In this essay, I draw parallels between trends in modern medical educational practice and the thought of the Sophists. Specific areas discussed are the professionalisation of medical education, the teaching of higher-order characterological attributes such as personal development skills, and evidence-based medical education. Using the specific example of the Sophist Protagoras, it is argued that the Sophists were precursors of philosophical approaches and practices of enquiry underlying modern medical education.

Abstract

The term ‘sophist’ has become a term of intellectual abuse in both general discourse and that of educational theory. However the actual thought of the fifth century BC Athenian-based philosophers who were the original Sophists was very different from the caricature. In this essay, I draw parallels between trends in modern medical educational practice and the thought of the Sophists. Specific areas discussed are the professionalisation of medical education, the teaching of higher-order characterological attributes such as personal development skills, and evidence-based medical education. Using the specific example of the Sophist Protagoras, it is argued that the Sophists were precursors of philosophical approaches and practices of enquiry underlying modern medical education.

The Sophists and Medical Education

J

The Sophists

The Sophists were among the earliest philosophers of the Western world. Their name is now generally used as a term of intellectual abuse. ‘Sophist’ means a clever cheat, a casuist, a spin doctor, an insincere practitioner of misleading rhetoric. This is because what little we know about the Sophists comes from their opponents, especially Plato. Plato portrayed Socrates as a man of truth, seeking wisdom, as opposed to the quick-witted but superficial Sophists. They were also accused of being mercenary as they took payment for their teaching. Modern perceptions of the Sophists derive mostly from Plato’s depiction and Aristophanes’ comedy The Clouds. In this play, an Athenian father sends his son to a parodic academy of unworldly philosophers so he can learn how to win law cases. However ultimately his son questions and overthrows (literally) paternal authority using the rhetorical skills he has learnt. It suggests that young men would be distracted from dutiful, honest dreams of martial glory by a world of, at best, useless speculation and, at worst, logical hair-splitting that would allow them, literally and figuratively, to beat their betters (Sommerstein, 1973). This negative image of the Sophists has passed into both general discourse and educational philosophy. In this article I wish to discuss what the Sophists actually thought, insofar as we can elucidate it, and draw parallels with modern medical education theory and practice. Some of the most fundamental principles of medical education theory have their origins in the work of the Sophists.
There are three main strands of Sophistic thought which find parallels in the modern discourse of medical educationalists. Firstly, the whole idea of education as a professional enterprise requiring structured attention and of monetary recognition. Secondly, the idea that what are often seen as innate qualities can in fact be taught. Thirdly, an empirical, evidence-based approach to receive opinion and practice.

Who were the Sophists? The word is derived from the Ancient Greek sophos meaning ‘wise’, ‘skilful’, ‘clever’. In early Greek literature, a Sophist was a teacher, poet and wise man. This is how ‘Sophist’ is used by Homer and Hesiod in the seventh centuries BC (O’Grady 2008). A laudatory meaning was attached to the word when used by Homer. In the works of Herodotus (c. 490–420 BC), ‘Sophist’ is employed neutrally to mean ‘teacher’. The ‘Sophists’, as a term, now generally refers to philosophers of the fifth and fourth century BC. They were freelancers, mostly non-Athenian, independent teachers who travelled from city to city throughout Ancient Greece, charging for their services and making their living from a demand for education (O’Grady 2008). Kerferd (1981) identified distinguishing attributes of Sophists – they were paid for teaching, they were patronised by the wealthy, were mainly non-Athenian as well as itinerant, claimed to teach political arête (excellence) and how to be a good citizen, and emphasized the art of speaking. It was this focus on the art of speaking, and a delight in rhetorical innovation and, above all, a constantly questioning stance, which earned the Sophists their reputation. Although a later group of philosophers in the second century A.D. were also dubbed Sophists, ‘the Sophists’ generally refers to these fifth century B.C. intellectuals.
The Sophists brought tremendous intellectual excitement to Athens. This excitement brought with it anxiety, as is evident in The Clouds. All was up for grabs for the Sophists, from the nature of reality itself to the nature of the good to the existence of gods. For traditionally minded Athenians, this was a threatening stance.
The history of ideas is sometimes seen as a series of reactions and counter reactions — Reformation and Counter-Reformation, Romanticism and Neo Classicism, Postmodernism versus modernism. In educational theory, we see parallel dichotomies of behaviourist and constructivist paradigms. The Socratic movement and the Sophists can be seen as being in a similar opposition. Of course, all these developments derive from the other and each depends upon the other. Socrates and the Sophists were not mutually exclusive camps. Aristophanes’ portrayal of Socrates in The Clouds, for instance, is very clearly of a Sophist. And the intellectual excitement which the Sophists kindled in Athens surely had much to do with Socrates setting himself up as a philosopher, and with Plato, at later date, writing his dialogues.
Later generations have been harsh to the Sophists. They were described by the classicist Henry Sidgwick in 1872 as ‘a set of charlatans who appeared in Greece in the fifth century, and earned an ample livelihood by imposing on public credulity; professing to teach virtue, they really taught the art of fallacious discourse, and meanwhile propagated immoral practical doctrines’ (Sidgwick 1872). Right up to the present day, ‘Sophist’ carries this meaning, as can be seen in the words of the contemporary Catholic apologist Peter Kreeft: ‘Socrates made a point that he never took a fee for his teaching. (Neither did Jesus.) This proved that he was not one of the Sophists, who sold their minds as a prostitute sells her body’ (Kreeft 2002).

‘Sophistry’ in modern educational theory

In educational theory and philosophy, similar views prevail – Socratic and Sophistic approaches to education are often contrasted, usually unfavourably to Sophistic ones. For instance Furedy and Furedy (1982) propose a Socratic-Sophistic continuum, positing that Socratic approaches are characterised by enquiry while the Sophistic approach is characterised by persuasion and a focus on rhetoric. Elsewhere, the same authors (1986) argue that Socratic approaches are conterminous with critical enquiry and that Sophistic influences have been mainly implicit and manifested in tendency towards instrumentalism and affective learning as well as in the choice of curricula and curricula development. The title of this latter paper — On Strengthening the Socratic Strain in Higher Education — strongly suggests where the authors’ sympathies lie. As Furedy and Furedy acknowledge, the Sophistic–Socratic dichotomy, like all dichotomies, is overly simplistic, and in this ariticle I will argue that when we look at what the Sophists themselves thought and taught, we find a strong commitment to critical enquiry and the questioning of assumptions.
Boyles (1996), writing from the perspective of teacher training, collapses the Socratic–Sophistic dichotomy in his analysis of the Socratic dialogue Meno – but in a way unfavourable to both schools. He argues that Socratic dialogue is an example of coercive Sophistic rhetoric rather than disinterested enquiry. Hall (1996) in his commentary on Boyles’ paper takes the view that ‘sophistry is deficient insofar as it panders to the desire of the unwise, untutored, and unreflective for quick acquisition of knowledge. If one had enough money, one could with great speed acquire knowledge about, for example, political affairs together with the ability to speak persuasively on virtually any subject’ (Hall 1996) This statement, coming as it does within a sophisticated discussion of a Socratic dialogue, summarises the dominant view of the Sophists within educational philosophy. Stabile (2007), in his analysis of the clash between ‘virtue’ and ‘Sophist’ trends in education, depicts Sophist approaches as synonymous with utilitarian ones. In educational discourse, ‘Sophist’ has become a pejorative term in a more specific way then the general pejorative usage. These negative views are counterbalanced by a modern awareness of the importance of the Sophists, and awareness that their thought was more subtle and less focused on persuasion by any means necessary than their critics wrote.

What makes “a new mental illness”?: The cases of solastalgia and hubris syndrome. Cosmos and History, 2009. Part 3

Solastalgia and hubris syndrome considered through the prism of the contesting definitions of mental illness

Analogies can be drawn between solastalgia and post-traumatic stress disorder. Post traumatic stress disorder is a contested diagnosis within psychiatry. Many argue that it is simply a new name for a condition described by Homer (Shay 1995) and recognised by military physicians and psychiatrists under a variety of names (Shepherd 1994). Others argue that is has been “invented” for political reasons (Summerfield 1999) and reflects the subjugation of psychiatry to socio-political imperatives. Uniquely among conditions described in both DSM-IV and ICD, in its definition the cause is specified.Solastalgia would share this quality. Indeed, online commentators from the environmental movement have criticised Albrecht for the perceived narrowness of the focus and his adoption of a medical model of harm induced by environmental change.

It is of course invidious to try and predict what individual thinkers might “make of” solastalgia and Albrecht’s contention that it is a “new mental illness, ” or of Owen’s identification of hubris syndrome as potentially causing more death and disability than any other illness worldwide. However, it seems reasonable to assume that Thomas Szasz would dismiss the idea of both being “new mental illnesses” because he views mental illness itself as a myth. The problem of adjusting to an environment made strange around one is a “problem of living”, and the problem of leaders growing out of control is a political one. The use of the concept of disease in these two settings is simply an error.

Using Boorse’s framework to analyse these entities also leads to interesting considerations. One of Boorse’s initial arguments in his 1975 paper is that what gives rise to ambiguity and difficulty with mental illness is the “territorial ambitions” it has. Psychiatry is laying claim to more of life’s problems, leading to a “medicalisation of morals.” This,rather than basic definitional issues of what is a mental illness, leads to problems. In a sense Boorse partly agrees with Szasz about “problems of living” being the root of at least some “mental illnesses”—the difference being that Szasz would deem all mental mental illnesses so. This would suggest that Boorse would be sympathetic to the view that the concept of solastalgia and hubris syndrome represents medicalisation of the moral fault of man-made environmental change and of overweening power. Boorse’s 1975 argument came in two parts—by positing disease as dysfunction, it preserved a value-free status for medical and psychiatric practice and decision making, while by describing the social components of illness, it acknowledged the degree to which social practices and behaviours within a social context define illness. In the case of solastalgia, what “dysfunction” may be said to underlie the “disease process?” It is not clear, although perhaps the development of psychological assessments of Environmental Distress may aim at identifying specific thought processes. It is noteworthy that Albrecht and colleagues do not propose a “treatment” for solastalgia, but propose further research. It is not suggested that the interviewees reactions are in any way pathological, or that other reactions and emotions are more appropriate or more “functional.”

Canguilhemian notions of illness as a loss of normativity, a loss of the ability to adapt, are consonant with solastalgia’s emphasis on the distress caused by change. Canguilhem’s other emphasis on an understanding of disease that must move beyond the laboratory and detached “scientific” considerations to the setting where distress is experienced is also echoed in the solastalgia literature. Yet the use of a rating scale, with the inevitable emphasis on scores and purported norms, suggests an approach ultimately very different from that of Canguilhem.

Using Fulford’s “full field” model of mental illness, which incorporates both a “value-laden” pole of failure-of-action/illness and a “value free” or “factual” failure-of-function/disease pole, we again hit the difficulty of which, if any, failure of function is being described.There is a similarity between the approaches of Locker and Albrecht in terms of their use of interviews to discover themes in subjective experience. Using the four features identified by Locker, clearly the experiences described by Albrecht’s interviewees are negatively evaluated. They have an ongoing duration and intensity. The experience is not “done by the person experiencing it.” The “sense of injustice and powerlessness” described by Albrecht et al in their paper as characteristic of solastalgia reinforces this. However, one could observe that that the experience could be said to be due to the actions of another—for instance the mining companies. Using this approach, solastalgia describes distress rather than disease.

As for hubris syndrome, Owen suggests neurochemical imbalances that may underly the phenomenon. These are very much suggestions, however, without any definite suggestions as to what neurological circuitry is involved, for instance. Owen also writes that

Hubris syndrome is not yet a diagnostic category of accepted mental illness but it probably stems from a set of genetically codetermined predisposed personality traits. To the psychiatrist any potential new syndrome is likely to be an interaction between genes and environment or nature and nurture. Early biology and upbringing provide the basis of personality which can then be expressed, or not, depends on constraints or opportunities. (Owen, 2008b, p. 431)

While this statement is accurate, it is also extremely generalised and does not point to which aspects of “early biology and upbringing” might contribute to later hubris syndrome.

Owen locates hubris syndrome as stemming from personality traits. The implications of Canguilhem’s thinking on the normal and the pathological for the diagnosis of personality disorders has been discussed by Buchanan (2007), in particular intolerance of “the inconsistencies of the environment.” Buchanan suggests that “one testable hypothesis arising from Canguilhem’s work is that a failure actively to adapt to one’s surroundings represents the final common pathway by which narcissistic, borderline, schizoid, or other traits prevent someone from achieving his or her potential in a range of social and occupational spheres.” Owen describes a rigidity and unwillingness to reverse decisions as being among the criteria for hubris syndrome.

The distress experienced by Albrecht’s interview subjects is real. Is what they are having a “new mental illness”? While there is clearly some journalistic hyperbole at play here, and in their published papers Albrecht and his co-authors are careful to emphasise the preliminary nature of their work, solastalgia serves as a good example of how the concept of “mental illness” is discussed in the public domain. Albrecht is describing a psychological phenomenon and making a link with environmental change.

From the philosophical point of view, solastalgia is extremely broadly defined and seems synonymous with distress due to environmental changes. Albrecht et al powerfully illustrate the distress of their interviewees, but have not shown this is distress to be a mental illness. The weakness of Robins and Guze’s model of defining mental illness is illustrated by this. Essentially it depends on consensus and the acceptance of a phenomenon as an illness by the body of psychiatrists. Solastalgia, especially since the creation of a relevant and reliable rating scale, may in fact suit this definition more readily that any definition rooted in more philosophical rigour.

Similarly Owen provides a checklist of “symptoms” of hubris syndrome. Unlike what is the case with solastalgia, there is no evidence that the individuals purportedly “suffering from” hubris syndrome are experiencing any distress. The threat is more to society in general. Using Locker’s framework, the experience is not negatively evaluated by the person, or experienced as necessarily inflicted from outside on the person. Furthermore there a sense of powerlessness is not (though possibly one of injustice is) associated with the experience. Overall, then, what Owen is described is not pathological for individual but for wider society.

Conclusions

One could surmise that one of the motivations for developing the concept of solastalgia is to try and quantify the immediate health costs due to environmental change and further influence the arguments about environmental policy (a particular issue in Australia, which has a strong mining lobby) in the context of often rancorous debate, rather than to identify a new mental illness per se. Similarly, Owen’s identification of hubris syndrome can be seen as a plea for rule by cabinet and parliament rather than individuals, for oversight over leaders and for mechanisms to avoid the isolation and insularity that can accompany great power.

The language of psychiatry, as seen with Robins and Guze’s approach to defining schizophrenia as an entity, tends to circularity. Mental illness is treated by psychiatrists, and who are psychiatrists? They treat mental illness. This allows the language of psychiatry to be adopted as a form of rhetoric. What both Albrecht and Owen have identified are serious social problems, ones which in different ways can affect the continuance of human life on this planet. Both raise issues that are worthy of consideration by any thinking person. The rhetoric of mental illness, which of course is related to the rhetoric of illness and disease overall, is a powerful tool to raise awareness and to agitate for change. However we should be cautious of identifying new mental illnesses based purely on the laudable motivations of those who expound them.

Special Lecturer and Senior Registrar in Psychiatry
at the Department of Psychiatry and Mental Health Research,
St Vincent’s University Hospital/University College Dublin,
Elm Park, Dublin 4, Ireland.
Email: seamus.macsuibhne@ucd.ie

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