Bava Kamma 105b ~ Teaching By Humiliation

בבא קמא קה, ב

אמר ליה תדורא...

Rabbah said to Rav Amram : "Scatterbrain" 

As a medical student in London, humiliation came with the territory. There I was, on rounds on General Surgery Firm. At its head, the consultant surgeon.  Followed (in their correct pecking order) by two senior registrars, three or four registrars, several senior house officers and house officers, nurses, physiotherapists, and a couple of medical students.  We gathered around the bed of some poor patient who had recently undergone surgery. The consultant surgeon turned to me: "Mr. Brown" he said, looking at me atop of his professorial reading glasses, "how long is the anal canal?" Everyone else smiled, relieved to know they had not been asked this, rather challenging question. I had no idea, despite having once known this useful fact to pass my anatomy exams. "Thirty centimeters, sir" I replied, hopefully.  "Correct," said the surgeon, as he surveyed the menagerie of staff trailing him.  "If you are an elephant." And so ended my surgical career.

Teaching By Humiliation in the Talmud

The rabbis of the Talmud were not shy to call out those they felt were slow-witted or annoying. After Rabbi Yehudah HaNasi was asked a relatively innocent question by Levi, the great editor of the Mishnah replied כמדומה לי שאין לו מוח בקדקדו - "it appears to me that Levi has no brains in his head," an insult he repeated on at least one other occasion. Rabbi Tarfon had enough of  Rabbi Elazar when he told him "How long will you pile up meaningless  words and bring them against us." He even used the same insult against Rabbi Akivah. Rabbi Akivah! (See ילקוט שמעוני תורה פרשת בהעלותך רמז תשכה.) Rabbi Yishmael was called "a date palm" (and not in a good way) by Rabbi Eliezer (see ספרא תזריע פרשה ה).  One of my favorites, though, came from Rabbi Dosa who called his  younger brother "the first-born of Satan" (and you thought your kids had issues).  I could go on, but you get the point. These guys could be really insulting.

Pimping in the Medical Literature

For the reader who is not medically trained, here's a new word: pimping. It's a real word that is OK to use in polite company (maybe).  According to the esteemed Journal of the American Medical Association, pimping is

a series of difficult and often intentionally unanswerable questions posed to a medical student or house staff in quick succession. The objective of pimping is to teach, motivate, and involve the learner in clinical rounds while maintaining a dominant hierarchy and cultivating humility by ridding the learner of egotism.

There is an art to pimping, according to Fredrick Brancati, the man generally thought to have invented the term in its medical content. Here is an excerpt from his classic 1989 paper, called, what else, The Art of Pimping:

Pimp questions should come in rapid succession and should be essentially unanswerable. They may be grouped into five categories:
1. Arcane points of history.These facts are not taught in medical school and are irrelevant to patient care—perfect for pimping. For example, who performed the first lumbar puncture? Or, how was syphilis named?
2. Teleology and metaphysics.These questions lie outside the realm of conventional scientific inquiry and have traditionally been addressed only by medieval philosophers and the  editors of the National Enquirer. For instance, why are some organs paired?
3. Exceedingly broad questions. For example, what role do prostaglandins play in homeostasis? Or, what is the differential diagnosis of a fever of unknown origin? Even if the intern begins making good points, after 4 or 5 minutes he can be cut off and criticized for missing points he was about to mention. These questions are ideally posed in the final minutes of rounds while the team is charging down a noisy stairwell.
4. Eponyms. These questions are favored by many old-timers who have assiduously avoided learning any new developments in medicine since the germ theory. For instance, where does one find the semilunar space of Traube? 
5. Technical points of laboratory research. Even when general medical practice has become a dim and distant memory, the attending physician-investigator still knows the details of his research inside and out. For instance, how active are leukocyte-activated killer cells with or without interleukin 2 against sarcoma in the mouse model? Or, what base sequence does the restriction endonuclease EcoRI recognize?
....pimping can create a hostile environment among the team members, suppress creativity or intellectual curiosity because of fear of embarrassment, and dehumanize students at the expense of maintaining medical hegemony.
— McCarthy, CP. McEvoy, JW. Pimping Medical Education. JAMA 2015; 314 (22). 2347-2348.

 Last year an Australian team published a paper titled "Teaching by humiliation” and mistreatment of medical students in clinical rotations. They found that 74% had experienced and 83% had witnessed teaching by humiliation during their adult clinical rotations; smaller proportions had experienced (29%) or witnessed (45%) it during their pediatric rotations, which just proves what everyone already knows.  Pediatricians are all nice. All this pimping comes with a down side. "Students’ responses to these practices" wrote the Australian researchers, "ranged from disgust and regret about entering the medical profession to endorsement of teachers’ public exposure of a student’s poor knowledge. Reported victims and perpetrators included junior medical staff, who were subjected to the practices as much as students and were equally likely to be the perpetrators, alongside senior medical and nursing staff."

As a deeply ingrained cultural, institutionalised practice, mistreatment requires focused action to replace the existing culture with one of compassion, tolerance and respect.
— Scott, KM. et al. “Teaching by humiliation” and mistreatment of medical students in clinical rotations: a pilot study. Medical Journal of Australia 2015; 203(4): 1-6

Talmudic Insults and Respect for the talmid

In today's page of Talmud, Rabbah called Rav Amram תדורא, a scatterbrain. In fact he called him a scatterbrain again (in the next tractate we will learn), so I guess he really meant it.  This epithet seems to have been the "moron' of its day. Rabbi Hiyya bar Abba called Rebbi Zeira a scatterbrain, and  even the great Abayye must have felt a little miffed when he was called a scatterbrain by Rava bar Hannan.  

It seems demeaning to use language like this, and out of place given the words of the Mishnah (Avot 2:10) יהי כבוד חבירך חביב עליך כשלך - "let your friend's honor be as important to you as your own." Rabbi Yair Chaim Bachrach (Germany, 1638-1732) addressed talmudic insults in his book of responsa called Chavvot Yair, first published in 1699. Apparently things were getting out of hand in Germany, where the talmudic art of humiliating had evolved. Yeshivah students now also yelled and gesticulated rather enthusiastically as they sparred with their learning partners:

 מש"כ קפיצה וסיפוק וריקוד תוך הפלפול איש נגד רעהו שזה גורם בלי ספק שחבירו ימהר לעשות כמעשהו וירקוד ג"כ כנגדו וירים קולו בצעקה גדולה ומרה יותר ולא ישמע איש שפת חבירו ואין זה רק מנהג יהוא וכל המרבה בה ה"ז משוגע 

Students jump and dance around each other in the middle of expounding a subject, and this will cause, without doubt, that other students will do the same and will leap and raise their voices in a louder and more bitter cry. No one will be able to listen to the voice of his partner. This is nothing other than a ridiculous custom, and anyone who does this often is a mesgugah...  

Rabbi Bachrach then rose to the defense of those who used talmudic insults, claiming that they did so with only good intentions. They did it, he said, in order to bring out the very best they could in those they insulted. Hmmm. I'm not convinced.

Insults don't work, not for medial students and not for any students.  Ad hominem attacks are also unlikely to elevate the quality of an argument. In this final run up to the US presidential elections we are likely to see more of both forms of  disrespect, though they usually say more about the person uttering them than the person against whom they are directed.  

תנו רבנן: שלשה שונאין זה את זה, אלו הן: הכלבים, והתרנגולין, והחברין. ויש אומרים: אף הזונות. ויש אומרים: אף תלמידי חכמים שבבבל
The rabbis taught: three groups hate each other: Dogs, roosters, and sorcerers. Some say: so do prostitutes. And others say: so do the sages in Babylon...
— פסחים דף קיג עמוד ב
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