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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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.

 Years ago 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 the run up to the US presidential elections later this year 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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Arachin 22a ~ The Psychological Impact of Corporal Punishment

ערכין כב, א

הכי אמר רב חסדא מאבימי קולפי טאבי בלעי עלה דהא שמעתא

Rav Chisda said “I was hit a lot by Avimi because of this halacha”

During a rather minor dispute (over how long before the sale of an orphan’s property must public notice be given,) the Babylonian sage Rav Chisda (died ~ 320CE) let slip a painful memory. His teacher Avimi had severely beaten him in a warped attempt to teach him the correct answer. (In case you are wondering, it is thirty consecutive days or sixty days if the announcement is made only on Mondays and Thursdays). Chisda the student was, in a way, lucky. His teacher might have killed him. In the tractate Makkot, a Mishna teaches that a parent or a teacher who kills a child in the process of administering corporal punishment is not liable to any punishment:

מכות ח,א

אבא שאול אומר מה חטבת עצים רשות אף כל רשות יצא האב המכה את בנו והרב הרודה את תלמידו

Abba Shaul taught…[there is no penalty for] a father who killed his son while hitting him or for a teacher who strikes his student…

Cartoon from 1888 depicting J.S.Kerr, an Australian proponent of corporal punishment.

Cartoon from 1888 depicting J.S.Kerr, an Australian proponent of corporal punishment.

Punishing by physical humiliation

In describing the procedure for administering corporal punishment, the Mishnah (Makkot 22b) teaches the following: 

If the criminal soiled himself [because of his fear of being lashed] with his own urine or feces, he is exempt from lashing. Rabbi Yehudah, a man is only exempted if he soils himself with his own excrement; and a woman is exempt even if she only soils herself with urine.

The Talmud makes it clear that in using corporal punishment, the goal is humiliation. That objective may be realized when the criminal is flogged; there the humiliation is the flogging itself. But it may also be realized if the criminal soils himself out of fear, immediately before being flogged.  That too is humiliating, and so no flogging is required. Humiliation is not something we usually associate with the goals of punishment: they are most commonly thought of as 

  1. Deterrence - the threat of punishment will deter people from committing the act.

  2. Retribution - the criminal inflicted harm on others. So we may now inflict harm on him.

  3. Rehabilitation - through punishment (typically, but not only prison,) the criminal learns how to become a better citizen

  4. Incapacitation - the criminal is removed from society, and which is made safer as a result.

  5. Restitution - the criminal repays the victim for his crime

Humiliation does not feature as a goal of punishment in any theory of justice I could find. Of course there is shame and humiliation that results from being caught and punishment, but this is a secondary outcome. The Talmud understands that the primary goal of corporal punishment is humiliation.  

where is the corporal punishment of children still legal?

Some believe that there is a distinction to be made between corporal punishment and child abuse. For example, Murray A. Straus, a professor of sociology at the University of New Hampshire, suggests that  corporal punishment is the use of physical force with the intention of causing a child to experience pain but not injury for the purposes of correction or control of the child’s behavior. In the US, most states have banned the corporal punishment of children. However it is still legal in 19 states including, Florida and Texas. Since 1998  corporal punishment of children has been  banned in England. In Israel, it has been banned since 2000.

Elizabeth Thompson Gershoff has studied how corporal punishment affects children. In a paper published in 2002, she identified all the articles that examined the associations between parental corporal punishment and child behaviors and experiences. This exhaustive review included over 300 relevant works, as well as 63 dissertations and 88 studies. She concluded that:

Parental corporal punishment is associated significantly with a range of child behaviors and experiences, including both short- and long-term, individual- and relationship-level, and direct (physical abuse) and indirect (e.g., delinquency and antisocial behavior) constructs...parental corporal punishment is associated with the following undesirable behaviors and experiences: decreased moral internalization, increased child aggression, increased child delinquent and antisocial behavior, decreased quality of relationship between parent and child, decreased child mental health, increased risk of being a victim of physical abuse, increased adult aggression, increased adult criminal and antisocial behavior, decreased adult mental health, and increased risk of abusing own child or spouse. Corporal punishment was associated with only one desirable behavior, namely, increased immediate compliance...

In another paper Gershoff notes that corporal punishment persists because it is a practice with strong ties to religion, particularly to Christianity.

Religious leaders and religiously inspired parenting experts in our twenty-first century, like their eighteenth-century compatriots, make connections between firm discipline and a child's spiritual well-being, and encourage parents to use corporal punishment as an important part of their discipline repertoire. Parents with conservative Protestant affiliations in particular are more supportive of corporal punishment and use it more frequently than do parents of other Christian and non-Christian religious affiliations.

Judicial corporal punishment is still legal in over thirty countries, including Afghanistan, Indonesia, Pakistan, Qatar and Saudi Arabia. Fortunately, most urban Israeli Jews do not endorse corporal punishment for children.

Whatever became of Rav Chisda?

As a child, Rav Chisda quite literally had Jewish law beaten into him. In some respects perhaps he managed to overcome this child abuse; he rose to become the head of the Yeshiva at Sura and lived to the ripe old age of 92. His many statements are found all over the Talmud. Despite this, it is clear that his abuse had a profound effect on his teachings, many of which address issues of the respect owed to a teacher. For example:

  • As a result of a dispute over precisely this issue, Rav Chisda and Rav Huna ignored each other for forty years.

  • In Kiddushin (32a) he taught that while a father may forgo the honor due to him from his son, a teacher may never do so (האב שמחל על כבודו כבודו מחול הרב שמחל על כבודו אין כבודו מחול).

  • And in Sanhedrin (110a) he made this startling comparison: “Anyone who disagrees with his teacher is like one who disagrees with the Divine Presence.” 

From today’s page of Talmud, it becomes clear why issues of authority were of such importance to Rav Chisda. How fortunate we are to be able to teach our children to respect their teachers without resorting to violence.

The results from these meta-analyses do not imply that all children who experience corporal punishment turn out to be aggressive or delinquent; a variety of parent, child, and situational factors not examined here have the potential to moderate the associations between corporal punishment and child behaviors. ... The presence of corporal punishment may make certain behaviors more likely but clearly not inevitable.
— Gershoff E.T. Corporal Punishment by Parents and Associated Child Behaviors and Experiences: A Meta-Analytic and Theoretical Review. Psychological Review 2002. 128 ( 4); 539–579.


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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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