Humiliation

Zevachim 25b ~ Teaching By Humiliation

זבחים כה, ב

 אמר ליה תרדא...

R. Chiya bar Abba said to R. Zeira: "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 insult hurled by R. Chiya bar Abba said to R. Zeira in today's Daf Yomi תרדא –  is variously translated as "lunatic" (Schottenstein) "imbecile" (Koren) and "fool"(Soncino). 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).  

The rabbis of the Talmud did not just insult individuals. The were not averse to humiliating swaths of Jewry.  Big swaths.  After hearing a teaching that came from Babylonia,  Rav Yirmiyah, who lived in Israel, couldn't control himself: "Stupid Babylonians; because they live in the dark, they state teachings that are dim." 

בבלאי טפשאי אמטול דיתבי בארעא חשוכא אמרי שמעתא דמחשכא
Stupid Babylonians; because they live in the dark, they state teachings that are dim.” 

— מאמר בשם ר׳ ירמיה, תלמוד בבלי זבחים נ, ב

 

One of my favorites though, came from Rabbi Dosa, who called his  younger brother "the first-born of Satan" which raised name calling among siblings to a whole new level.  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, R. Chiya bar Abba called R. Zeira a "scatterbrain." Rabba called R. Amram the same thing back in Bava Kamma (105b.) In fact he called him a scatterbrain again in Bava Metziah, so he must really have meant it.  This epithet seems to have been the "moron" of its day. 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. (כלם י"ל שהיו חבריהם וגודלים מהם ולא קפדי כלל). Hmmm. I'm not convinced.

Insults don't work, not for medial students and not for any students.  Ad hominem attacks are now, alas, the currency of many public or political (especially political) debates, though they usually say more about the person uttering them than the person against whom they are directed. It seems that the rabbis of the Talmud were just as susceptible as the rest of us to this all-too-common failing. We can all do better. 

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

[Mostly a repost from here.]

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Sanhedrin 107a ~ Blushing, Shame, and Humiliation

סנהדרין קז, א

דוד הבא על אשת איש מיתתו במה אמרתי להם הבא על אשת איש מיתתו בחנק ויש לו חלק לעוה"ב אבל המלבין פני חבירו ברבים אין לו חלק לעולם הבא

The enemies of King David would taunt him. "David! What is the form of execution for a man who committed adultery?" I [David] replied: "He is executed by strangulation, but he still has a share in the world to come.  One who embarrasses another in public, causing his face to turn white [as you are doing to me] has no share in the world to come."

Embarrassing  another is considered a grievous transgression.  Elsewhere, the Talmud suggests a person must commit suicide rather than shame another: 

 תלמוד בבלי כתובות סז ב 

נוח לו לאדם שימסור עצמו לכבשן האש ואל ילבין פני חבירו ברבים

It is better for a person to jump into a fiery furnace, rather than embarrass his friend in public
Humiliation photo.jpg

The phrase used to denote embarrassment in the Talmud is להלבין פני חבירו – to whiten the face of another. At first, embarrassment causes the face to redden as the blood pools; then, as it drains away the victim is left "white with shame."  As a child, I blushed easily. This did not rise to the level of an illness (I think) but I was most certainly aware of of how easily I blushed, and so were some of my high school teachers, who would only need to call my name and my face would turn red. (I now know this is not that uncommon. The easy blushing that is. Actually, nor is the cruelty of teachers, now I come to think of it.)  Darwin called blushing "the most peculiar and the most human of all expressions." It occurs when the face, ears, neck and upper chest redden on darken in response to perceived social scrutiny or evaluation. 

Shame is, in one sense, nothing more than the loss of honor. Shame depends of the failure to measure up to the external standard imposed by the honor group
— William Ian Miller. Humiliation: And Other Essays on Honor, Social Discomfort, and Violence. Cornell University Press 1993. 114

When Do We Blush?

There appear to be four social triggers that result in blushing: a) a threat to public identity; 2) praise or public attention 3) scrutiny, and oddly enough, 4) accusations of blushing. This last trigger is especially fascinating: just telling a person that they are blushing - even when they are not - can trigger a blush. 

Blushing is not only triggered by certain social situations; it also triggers other responses in those who blush. The most commonly associated behaviors are averting the gaze and smiling. Although gaze aversion is a universal feature of embarrassment, its frequency differs across cultures: in the United kingdom 41% report averting their eyes when they are embarrassed, whereas only 8% of Italians report doing so. Smiling is also a common response. Up to a third of those who are embarrassed display a "nervous" or "silly grin." 

Why Do We Blush?

We blush when we are embarrassed, but why should this physiological response occur? The blood vessels in the face (and the other areas that blush) seem to differ structurally from other vessels, and so respond in a unique way. But just how they do so, and why, remains a physiological mystery.  Here's the surgeon Atul Gawande's explanation, from the pages of The New Yorker.

Why we have such a reflex is perplexing. One theory is that the blush exists to show embarrassment, just as the smile exists to show happiness. This would explain why the reaction appears only in the visible regions of the body (the face, the neck, and the upper chest). But then why do dark-skinned people blush? Surveys find that nearly everyone blushes, regardless of skin color, despite the fact that in many people it is nearly invisible. And you don’t need to turn red in order for people to recognize that you’re embarrassed. Studies show that people detect embarrassment before you blush. Apparently, blushing takes between fifteen and twenty seconds to reach its peak, yet most people need less than five seconds to recognize that someone is embarrassed—they pick it up from the almost immediate shift in gaze, usually down and to the left, or from the sheepish, self-conscious grin that follows a half second to a second later. So there’s reason to doubt that the purpose of blushing is entirely expressive.
There is, however, an alternative view held by a growing number of scientists. The effect of intensifying embarrassment may not be incidental; perhaps that is what blushing is for. The notion isn’t as absurd as it sounds. People may hate being embarrassed and strive not to show it when they are, but embarrassment serves an important good. For, unlike sadness or anger or even love, it is fundamentally a moral emotion. Arising from sensitivity to what others think, embarrassment provides painful notice that one has crossed certain bounds while at the same time providing others with a kind of apology. It keeps us in good standing in the world. And if blushing serves to heighten such sensitivity this may be to one’s ultimate advantage.

Blushing and Crossing Boundaries

So blushing may confer an advantage. It keeps us in good social standing, insuring that we do not step outside of the bounds of accepted behavior. This notion is supported by some recent work (published more than a decade after Gawande's 2001 article) that supports this notion of blushing having a social utility.  Those who blush frequently showed a positive association between blushing and shame. These frequent blushers generally behaved less dominantly and more submissively. Writing in the journal Emotion in 2011 (yes, that really is the name of this academic journal), three Dutch psychologists demonstrated that blushing after a social transgression serves a remedial function. In their (highly experimental lab) work on human volunteers, blushers were judged more positively and were perceived as more trustworthy than their non-blushing counterparts.  

Still, helpful as it may be to regain the trust of others, social embarrassment can come at a huge cost - including the suicide of those who have been embarrassed. As we have seen, in the Talmud embarrassing another person is called הלבנת פני חבר - literally translated as "making the face of another turn white." This is of course quite the opposite of what actually occurs when a person blushes, and seems to suggest another, deeper level of embarrassment, (though it's not something discussed in the scientific literature). According to the Talmud, the person is so embarrassed that the blood drains from his face, causing him to turn pale.  This raises an interesting question: if  blushing serves an important social function - reminding a person that he has violated rules which should be held sacred - why does the Talmud tell us to to avoid causing embarrassment? Haven't they been caught in the act of  violating our rules?  King David transgressed religious boundaries and committed a capital offense. When called out on this, he felt deeply ashamed and embarrassed. But isn't that precisely how he should have felt? As Gawande wrote: "...embarrassment provides painful notice that one has crossed certain bounds while at the same time providing others with a kind of apology. It keeps us in good standing in the world."

Nuanced Translations

In our discourse we have three words that have nuanced but important differences. Here is what the Oxford English Dictionary has to say:

Embarrass The archaic use of this word meant to hamper or impede. Today we use it to mean to cause someone to feel awkward, self-conscious, or ashamed.

Shame The painful emotion arising from the consciousness of something dishonoring, ridiculous or indecorous in one's own conduct. Or of being in a situation which offends one's sense of modesty or decency.

Humiliate To make low or humble in position, condition or feeling. 

To describe each of these emotions, the Talmud uses only a single term, להלבין פני חבר.  It is translated into English in various ways. The Artscroll and Soncino translations use the term shame whereas the Koren Talmud translates it as humiliation.   In modern Hebrew each of these three emotions has its own word. Embarrassment is מבוכה; shame is בושה, and humiliation is השפלה. 

The three terms are often used interchangeably, but humiliation is perhaps the harshest of them.  To feel embarrassed in public seems to be less of a big deal than to feel humiliated in public, although both are surely unpleasant. The best way to translate what King David felt is humiliation. And it is to avoid humiliating others the Talmud takes its extreme position: "It is better to jump into a fiery  furnace than to humiliate another in public."

DO MONKEYS FEEL SHAME?

In a 2006 paper, a group of researchers demonstrated that primate color vision has been selected to discriminate changes in skin color - those changes (like blushing) that give useful information about the emotional state of another.  But does this mean that non-human primates feel shame? That's a harder question.

Frans De Waal directs the Living Links Center at the Yerkes National Primate Research Center at Emory University in Atlanta. In his wonderful book The Bonobo and the Atheist (guess which of these he is), De Waal discusses emotional control among primates - and in particular, the role of shame. When a human feels shame after a transgression, "we lower our face, avoid the gaze of others, slump our shoulders, bend our knees, and generally look diminished in stature...We feel ashamed and hide our face behind our hands or "want to sink into the ground." This is rather like the submissive displays made by other primates: "Chimpanzees crawl in the dust for their leader, lower their body so as to look up at him or turn their rump towards tim to appear unthreatening...shame reflects awareness that one has upset others, who need to be appeased."

Only humans blush, De Waal writes, and he doesn't know of "any instant face reddening in other primates."

Blushing is an evolutionary mystery... The only advantage of blushing that I can imagine is that it tells others that you are aware of how your actions affect them.  This fosters trust.  We prefer people whose emotions we can read from their faces over those who never show the slightest hint of shame or guilt. That we evolved an honest signal to communicate unease about rule violations says something profound about our species. (The Bonobo and the Atheist, 155.)

And then De Wall makes a remarkable observation: 

Blushing is part of the same evolutionary package that gave us morality.

So it turns out that evolutionary biologists, psychologists, and social scientists, while they may disagree on some details, agree on one feature of the emotion of shame. It is a vital emotion for any ethically sound society. This is echoed in Nedarim, the tractate we learned a couple of years ago: 

נדרים כ, א

תניא "בעבור תהיה יראתו על פניכם" זו בושה "לבלתי תחטאו" מלמד שהבושה מביאה לידי יראת חטא מיכן אמרו סימן יפה באדם שהוא ביישן. אחרים אומרים כל אדם המתבייש לא במהרה הוא חוטא, ומי שאין לו בושת פנים בידוע שלא עמדו אבותיו על הר סיני

It was taught in a Baraisa: "So that the awe of Him will be on your faces" (Ex. 20:17). This refers to the characteristic of being susceptible to shame [since bushing is that which is noted "on your faces". The verse continues] "So that you will not sin". This teaches that shame leads to the fear of sin.  From this [teaching] they said it is a good sign for a person to be [easily] embarrassed. Others said that any person who feels embarrassed will not quickly sin. And if a person is not [the kind of person who is] embarrassed - it is known that his ancestors did not stand and Mount Sinai. 

 

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