November 2, 2007

The Problem With One Specific Female Doctor

This is a true story that's going to offend you, I'm telling you that up front. 

This is how it goes: the pediatrics attending was attractive, no two ways about it.  That's probably not what she wanted you to notice about her but that's the way things go, you have no control over first impressions and even less over second and third impressions.  Hold tight to your identity, I sometimes say, because no one else is buying it.

In her defense, if defense is actually needed, she tried to downplay her looks. Hair in a ponytail; glasses on, long dress, white labcoat, modest shoes, little makeup, but as is the problem with some women who don't know the game, all this had the opposite effect.  You may get to choose an identity, but you can't pretend to be someone else.

She's talking to the parents of a 4 year old girl.  The kid needed an MRI because an ultrasound maybe showed something... "I'm pretty sure it is nothing, but just in case."

Well, just in case isn't just just in case, since it involves sedating to unconsciousness a four year old while her parents look on, visibly anxious, invisibly terrified.  The little girl blinks, shakes her head, eyes drift simultaneously north and southwest before she jerks herself alert-- she looks at her parents who gave her the juice and for a devastating, guilty moment the parents think that she thinks that they are trying to kill her.  And then she's down.  All this, for "nothing."

Sometimes, when a pediatrics attending at a major university hospital says "nothing," what she actually means is "partial anomalous pulmonary venous connection" which, I'll admit, to the untrained ear sounds like two different things, but praise God they are exactly the same.

"Even if that's it," she reassures them before the MRI, "it's one of the more common congenital heart defects, and it's usually associated with another, also pretty common, heart defect, called an atrial septal defect.  That's a hole in the septum between the left and right atria."  Again, reassuringly.

The father looks at her blankly.  "You're saying she could have two heart defects?"

"Well, no, they're both part of the same syndrome. "

"You're really going to have to dumb this down for me, I'm sorry."

She repeats herself.   Just slower.

"The surgery will attempt to patch the defect in the septum and redirect the pulmonary vein to the left atrium." 

"I don't follow you."

She tries to use simpler words, but in an attempt to maintain the formalism of medicine, she dumbs down the easy words.  "Defect-- it's the hole in the septum."  Obviously, this isn't what he needed clarified, because she then adds,  "redirect-- reattach."

"I still don't understand.  There's a hole in her heart?"

"Let me draw it for you."  And there, look, she draws for him an excellent drawing of the heart and vessels, with arrows showing blood flow; then scratches out part and redraws, showing what is normal and what she is worried it could be.  It's obvious it's different, anyone could see the pathology.

"But this artery is smaller--?"

"No, that's a vein, but it's ok because after the repair..."  She is frustrated, it couldn't be any clearer, what the hell is wrong with these people? 

Meanwhile I am watching in amazement.  She won't tell them what they need to know.   She wants to tell them facts, not realities.  I see her, she is pretty, really beautiful.  Distractingly pretty.   What does she look like without glasses?  Without clothes?   And then I think, why am I thinking this?  I'm a dog, I know it, but this is different, the thought "she is pretty" appears like a puzzle, a code, it means something else...

I gently lean over and say, "but what's the relevance to the girl?  What does that anomaly actually do to her?" 

The father nods, yeah, yeah, exactly-- but the attending looks at me in hostile shock.  Then her expression softens, I actually see her create and discharge the thought, "oh, he's just a psychiatrist."  She thinks I'm retarded, I know, she thinks I don't know any cardiology at all because I'm a psychiatrist, it never even occurs to her that I may be asking on behalf of the parents, because it never even occurs to her that she's not explaining herself well.   So she tells all of us, in pretend surprise relief, "oh, it just means a left to right shunt, sometimes they're asymptomatic, maybe sometimes pulmonary infections..."  Pause, staring.  "Shunt. Blood gets diverted."

After the surgery, can she run, play, swim? Hold her breath?  "Oh, sure, there's normal oxygenation."  What if she gets into a car accident, is she any more likely to rupture a reattached vessel?   Is she more prone to heart attacks in later years?  "No, no, she'll have the same risk factors for heart disease as anyone else."  She can't say it, she can't say, "no the kid will be normal" because it's not technically exactly accurate, she's a doctor, and she's careful, she's precise.  

And there are the lawyers, of course.  She always thought it was nothing, that there was no chance it was PAPVC, but the risks of sedating an otherwise asymptomatic 4 year old girl through an expensive test and putting the parents through a week of anxious hell certainly are outweighed by the risk of lawyers, right?

I notice how pretty she is again:  a secret message.  And I realize that I am seeing her as particularly attractive because she is trying not to be defined that way.   She is overcompensating with words, and since no one can understand her they are left only with what they see-- the very thing she was trying to mask.   The result is she is incomprehensible except as attractive: "...and you can tell she's really hot underneath all that..."  Take a highly technical paper and black magic marker out one sentence, people will spend more time trying to look through the magic marker than they will trying to understand the technical paper.  And if they manage to figure out the redacted sentence, it will be assume to be a proxy for the entire paper, even if it isn't.

You can't judge a book by its cover.  But if no one understands the book, they will judge it by the cover, if they bother to at all.  And if the cover is confusing also, well, forget it.

These parents need her to be real, but she can't be real, her whole professional demeanor is based on the suppression of real.

And that's the problem with this one, single, particular female doctor.  I'm not saying this is something that I've observed in other female doctors or that it doesn't happen to male doctors.  If you want to make generalizations based on this story, well, that's your own lookout.


When my son when in for his... (Below threshold)

November 2, 2007 5:55 PM | Posted by cerebralmum: | Reply

When my son when in for his cleft palate repair a few months ago his resident was hot. Absolutely and totally hot. And it was not downplayed in any way. She wore fishnets and a stylish black trench. There was an initial strangeness about this (even about my noticing this) because usually medical practitioners tend toward the nondescript.

Her communication skills were excellent (for a surgeon, at least) so I saw her as "knowledgeable and in control". She answered most of my questions before I even asked them and clarified whatever I was unclear on. I did trust her to "think creatively and aggressively" if it was needed.

But perhaps I was just dazzled?

Alone's response: without making a generalization about women in fishnets, the point of my story was that the doc wasn't in control of her sexuality-- she saw it as a liability. She thought her sexuality would interfere with her work; in fact, it was her attempts at concealing her sexuality through formality that interfered with her work. Your surgeon, however, seemed comfortable in her own body and life, which seems to have lead to her being the opposite kind of doctor to mine. And before anyone flames me, I'm not saying the solution is to dress in fishnets. The solution is to pick your identity, and stick to it. Be who you want to be, not someone else.

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I guess my parents were jus... (Below threshold)

November 2, 2007 6:26 PM | Posted by Anonymous: | Reply

I guess my parents were just a tad brighter than the couple in your story. They understood what "shunt" meant without it having to be explained. In fact they probably know more about endocardial cushion defect than...most psychiatrists. Of course, the pediatric cardiologist was a male, and not cute so maybe that's the reason.

Alone's response: umm... you do realize that these parents in the story did know what shunt meant?

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Why would people be mad at ... (Below threshold)

November 2, 2007 9:09 PM | Posted by Demodenise: | Reply

Why would people be mad at your post? It's not *really* saying that being pretty makes her any less of a capable clinician.

What does impact her capability is how insecure she is about her looks influencing patients' (and in this case patient's parents')beliefs about her competence in her field, because that insecurity is what drives her need to be super-professional and rigid in her interactions with patients.

Alone's response: Thanks for getting the post. I'm always very nervous before each post, this one especially, and it helps to know I could communicate a point to at least one person.

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"the problem with some w... (Below threshold)

November 2, 2007 9:29 PM | Posted by Stephany: | Reply

"the problem with some women who don't know the game, all this had the opposite effect. You get to choose an identity, but you can't pretend to be someone else."

Women know the game. The main theme is that the same women know the facts, and want those to stand first before anything else.The distraction from fact, happens all of the time. [How many times do we hear words, see mouths move and talk, but hear nothing? "How tall is he? What did he say? what color were her eyes? what?]
-this happens in ER's, hospitals and doc offices.It's a wonder anyone can think.

That being said, I've been known as "the mom in tennis shoes" as I helped hold my daughter's legs and arms with 4 male techs--as she was knocked out for an MRI--"because there's probably nothing there". When she woke up I wiped the blood off of her blanket, as it spurted across the fleece when the tech ripped out the IV."She has a Chiari malformation.".
The next day or maybe the next year, I started to wear make up again.

Yeah, women and men play it down, and the thing is, that's the real person there. That's what counts.

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The first thought that came... (Below threshold)

November 3, 2007 2:32 AM | Posted by Randall Sexton: | Reply

The first thought that came into my head was "wonder if this doctor and do any Latin dancing?"

Maybe I'm sick.

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Sorry, I think I must have ... (Below threshold)

November 3, 2007 8:27 AM | Posted by Anonymous: | Reply

Sorry, I think I must have been so blinded by the doctor's beauty that I missed the point about the shunt. Carry on.

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I am confused here. You say... (Below threshold)

November 3, 2007 12:29 PM | Posted by mo: | Reply

I am confused here. You say "pick your identity and stick with it". This doc did that and she is sticking with it.
Maybe you're right maybe the identity she picked wasn't the best choice for you but she chose it.
Everyone in health care picks an identity. The person we want other people to believe we are. Usually it's an extension of who we are in our real lives.
I have a "role" and an identity at work. If I didn't my brain would explode and I would be in hospital for intractable sadness and PTSD from seeing too many dead children.My role is to be empathetic not sympathetic.My identity is compassionate but business like.
Insecurity is what you saw. This resident is unsure of her role. The "identity" isn't truly hers yet. Wait two years and all you will see is a doctor.
Insecurity shows up everywhere in medicine. Our surgical residents use hostility and aggression. Our ortho guys are all testosterone filled dudes.
We choose our identity in hospital by observing our successful peers, we react to comments from them to perfect this identity.
If this doc had jerks for staff who made comments about appearance she reacted by modifying her appearance. Identities are chosen for success with peers not for patients.
She explained the procedure in the same way she presents to her senior on rounds. It is the fault of her seniors that she is still using this language with patients.Of course she was frustrated, her peers have never asked her to describe how it feels to be the patient. On rounds no one talks about how this condition impacts patients..that is a"nursing" function according to the ones I work with. It is the fault of medical education that holds "presenting" as the standard. Train new docs in thinking about impact and not always about treatment.
I see no gender issue here. I have seen the same identity misfits in lots of new male residents. I have seen easy going, lovable, laid back guys change into short tempered, impatient, aggressive people after a few meetings with their staff advisor. They become what their peers demand.
Sucks don't it?

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Sorry for my assumption tha... (Below threshold)

November 3, 2007 12:33 PM | Posted by mo: | Reply

Sorry for my assumption that the doc was a junior but I still think her training and her peers molded her chosen work identity.

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So what were we supposed to... (Below threshold)

November 3, 2007 7:42 PM | Posted by keepitreal: | Reply

So what were we supposed to be offended about? Have you become so bloody emasculated by that you are not "allowed" to be distracted by some smart doctor's physical beauty? That WAS the part that was supposed to offend/shock us, right? Or was it the fact that you gave voice to it in a semi-serious forum such as this? Honestly I get right pissed off about this "political correctness" bullshit. And frankly, I'm surprised that someone as (usually) outspoken as yourself would write so timidly about this experience.
Grow yourself a pair, LP!
Yellow card!

I just got served!

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The biggest failing of femi... (Below threshold)

November 3, 2007 9:35 PM | Posted by Demodenise: | Reply

The biggest failing of feminism is society has normalized the idea that talking about gender (especially when a man talks about a woman or something specific to gender)must be somehow tied to sexism or a power differential of some sort. So we've become socially "primed," so to speak, to see as sexist things that aren't really sexist. My (completely unsolicited, of course)guess is that's what Alone was worried about when writing this post.

Oh, and on an unrelated note: Alone, do you have an RSS feed for comments? 'Cause I'm really lazy and would like to follow the discussions through my RSS reader.

Alone's response: it may even be more basic than that. It's not just that men have difficulty looking past a woman's appearance. It's that women themselves can't get past it. You'll be happy/horrified to learn that it's now happening to men. Thanks, porn, now we can all be neurotic.

As for RSS feeder, I'll be honest and say I don't even know how to get one. And while we're on the subject, does anyone have a "email to friend" script for MT4?

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I didn't find it offensive ... (Below threshold)

November 4, 2007 5:50 PM | Posted by wetnurse: | Reply

I didn't find it offensive at all. I hope it would be enlightening for other women in medicine that have the brains to match the beauty, many of whom are struggling with the very real problem of how to be regarded as intelligent and capable while being strikingly beautiful. For many women, age is a key factor. It takes us a long time to be comfortable in our own skin, with how we feel about our bodies. Our comfort, or lack thereof, is reflected in the style of clothing we choose. Women from every walk of life struggle with this, most of us until our mid-thirties. A good barometer of a woman's self-confidence is when she has a style of dressing that just looks and feels right, but doesn't look like she's trying to hide something. She'll finally stop being tormented by agonizing decisions about whether a particular outfit or accessory is "really me". I don't think this doc has evolved enough comfort with her beauty in this setting to not be so self-conscious. As she gets a little older, her self-confidence will gradually increase, and her look and style will evolve on its own to where it probably belongs. And her comfort with that style will be apparent.

Piggish comments (NOT YOURS) anywhere along the way tend to have a profound effect on this process, and that may be a part of what you have observed here.

And my beat (at the risk of being flamed to the point of incineration):I'm a knock-out with a brain. My style reflects both my confidence in my ability and my awareness of my sexuality. And my comfort with both.

You'll recognize me at my workplace. I'm the 40-something that looks like a hot 30-something in a stylish suit or skirt...and I'll probably be wearing fishnets.

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I think you're assuming a l... (Below threshold)

November 5, 2007 2:10 AM | Posted by Anonymous: | Reply

I think you're assuming a lot about this woman. Believe it or not, not all women are interested in shoes, clothes, and accessories. My mom is strikingly beautiful. She rarely dresses up and couldn't care less about fashion. It's just not an interest of hers, and I doubt there is some deep hidden meaning behind it.

That being said I cannot help but notice appearance, myself. I saw a PA (once) who dressed like a slut. Her skirt barely covered her butt and she wore tall white heels. Apparently she didn't get the memo that that sort of attire is trashy.

You may be right, theoretically. But the impression that I got from her is that she is, absolutely, interested in appearances, and is very conscious of her own looks, and specifically tried to hide it. Let me be clear: I'm not saying she should flaunt it, Ior that people in general should dress up or down; 'm saying her (failed) attempts at hiding a part of herself only emphasized what she was hiding (anyone ever try to pretend they're not drunk?) And the reason it was so noticeable, so prominent to me, was that the artificiality of her looks (in this case the hiding of them) was equivalent to her artificial style of communicating. Some people may be like that, but she wasn't, and so everything-- her looks, her language-- came off wrong.

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Alone, I did get your point... (Below threshold)

November 5, 2007 7:57 AM | Posted by cerebralmum: | Reply

Alone, I did get your point. The example I added was intended to support it. I guess I didn't communicate that well.

The comments here have been interesting. I find the idea of getting to choose your identity, but not being able to be someone else a little grey, though. Beauty may be a fait accompli when it comes to who we are physically, but who we are psychologically may just not take note of that. I'm not arguing with your reading in this woman's case - your description and conclusions were very coherent - but I do think different personalities have different levels of physical awareness. It seems very plausible to me that there are people who appear to be making the same mistake but, in reality, just do not notice physical beauty as much as others do, not even their own.

I know that I still find myself a little bit shocked occasionally when strangers respond to what I look like. I know that I am for the most part oblivious to the attractiveness of men around me and find I have nothing to contribute to the conversation when my friends are sizing them all up. This doesn't make me any less susceptible to forming first impressions. It's just that my (subconscious) criteria are different.

Isn't there always going to be some mismatch between self-perception, and other people's perceptions when we look at each other through such different lenses?

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I didn't find any plug-ins ... (Below threshold)

November 5, 2007 3:33 PM | Posted by Demodenise: | Reply

I didn't find any plug-ins or add-ons for a "mail to friend" feature for MT, it seems like they discontinued the one they had because it was a .cgi script and had some real serious vulnerabilities for spam.

You can always put a java script in your individual post template (like this one), but java is moody and doesn't play well with others sometimes. And it's not terribly invested in the whole W3C compatibility/web 2.0 thing. Antisocial little language, if you ask me.

Oh, and how to put comments feeds on a MT template

Happy coding :)

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You know what's interesting... (Below threshold)

November 5, 2007 9:55 PM | Posted by Stephany: | Reply

You know what's interesting here, is this is like reading a Grey's Anatomy script. Anyone can create an image, but seriously, when it counts ppl want a doctor to take the time with the person, and be compassionate. The worst docs ive dealt with are rigid and have no feelings show. It is important to maintain professionalism, yet the best doc I saw was a neurosurgeon who sincerely looked me in the eye, told my daughter she was okay, and then shook my hand and said, "it was a pleasure to meet you." now I wasnt looking at appearance-- i saw what counted, the knowledge that was there, and the sincere expression, and words of compassion. The absolute bitch and rigid doc ive encountered myself was the OB/GYN who sucked at compassion, but she save all 3 of my kids lives when they were born blue. I've also just been on site where EMT's were training and all of the men looked like Ken dolls on crack. Hopefully that image won't matter when they need to do CPR.

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haha stephany, i'm wonderin... (Below threshold)

November 8, 2007 7:50 AM | Posted by anonymous mom: | Reply

haha stephany, i'm wondering what ken dolls on crack look like!

hopefully the doc in question will grow to be comfortable in her own skin, as well as develop a seemingly compassionate bedside manner. but if not, who the hell cares as long as she is a competent doc. that's all i'd really want for my son.

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That was a good one.... (Below threshold)

November 9, 2007 4:17 AM | Posted by Fargo: | Reply

That was a good one.
I've worked with some people like that, where they'll tell someone exactly what they're doing without relating the why or the consequences of not going through a procedure. This, to me, seemed to stem from some mix of concepts they held-
1)This is so simple, only an amoeba would fail to grasp it.
1a)Duh, of course they get WHY, I mean, everyone knows what tcp.sys does.
2)Some snide satisfaction in bewildering someone with jargon.
2b)Pretend snide satisfaction in reading a jargon laden procedure to someone.

I imagine the doctor fell into something like 1a, where an obvious failure to understand is assumed to mean you aren't explaining the system correctly, and the frustration turns into them eventually treating everyone as though they're at least mildly retarded.

As for RSS, you have an atom feed already, which is at least supported by my RSS reader of choice.

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I've termed this behavior "... (Below threshold)

November 9, 2007 10:05 AM | Posted by KWL: | Reply

I've termed this behavior "Privileged Perspective" for lack of finding any other suitable tag for it. I run into it all the time. It's described well here. She, and anyone else practicing it, are using the simplest words they can to describe to others what their Perspective allows them to convey but as they have some Privilege in that perspective they can't, or as Alone adds motivation very nicely to this, won't do is make sincere efforts to step out of the privilege and add broader perspective. Ironically, their core reasoning, competency, would benefit but they disallow the means to gain in order to preserve the privilege.

It's why I like this blog so much, I rarely get to actually think. These posts always exercise the little grey cells for varying reasons and that's another good thing.

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The Problem with One Specif... (Below threshold)

January 4, 2008 12:40 AM | Posted by blw: | Reply

The Problem with One Specific Male Psychiatrist: Instead of attending solely to the patient's needs, he was making unfounded interpretations about the female doc's style of dress and "chosen identity." (And doesn't this just prove what laypeople fear about psych-professionals? That we're all judging them with premature analysis). He presumes to judge her mode of dress as some kind of disguise. (Do male colleagues get similarly judged by their unstylish attire?) Maybe she doesn't want the hassle of applying makeup or the dark smudges under her eyes late in the day. Maybe she likes to dress for comfort, not for fashion or to show off her gams (has psychiatrist ever tried working all day in a short skirt?), likes her hair to stay neatly out of the way. Maybe she puts about one-tenth the thought into her appearance as the psychiatrist's judgement of her appearance. Not all women relish in adorning themselves in feminine-enhancing attire, like wetnurse says. I'm saddened that a male colleague is so quick to make such long winded judgements grounded in appearances. I recommend a womens studies course or Feminism 101. The female doc may lack warm, humanist bedside manner. But we've all met our share of male physicians with the same problem and it isn't about "chosen identity." Its often about under developed social skills or a profession that requires so much physio-know-how that the psychological factors are lost.

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I not only get this post, b... (Below threshold)

February 6, 2008 1:22 PM | Posted by Anonymous: | Reply

I not only get this post, buy why you put the disclaimer on it indicating that it could offend.

People get so worked up about "empowerment" and being SEEN to be empowered that they try to choke off who they really are. All it does is confuse people because trying to shove your expression regarding one aspect of life into tight constraints will likely carry over to every other way you express yourself. But because this attempt was likely made so this doc could "empower herself" and be taken seriously, I can see how you might think you would offend the "empowerment police" who basically argue that it's a personal choice how we express ourselves "and who are you to criticize?"

I think the behavioral line between self-actualization and repressed ego elements is often characterized by the difference between radiating who you intrinsically feel and think yourself to be and simply trying to control the perceptions of others according to the restrictions you place on your own radiations (expressions).

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I had a desire to begin my ... (Below threshold)

August 11, 2011 6:07 PM | Posted by LELIA24Bell: | Reply

I had a desire to begin my firm, however I did not have got enough of cash to do it. Thank goodness my dude advised to take the credit loans. So I used the credit loan and realized my old dream.

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Once and for all: javascrip... (Below threshold)

November 11, 2014 8:34 PM | Posted, in reply to Demodenise's comment, by Anonymous: | Reply

Once and for all: javascript is not java

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Sure, but there are importa... (Below threshold)

November 12, 2014 9:06 AM | Posted, in reply to Anonymous's comment, by : | Reply

Sure, but there are important commonalities. Both use their own brand of "language" to execute a series of operations, instructions.

Think of it as an advanced flow-chart.

Do you feel parents should allow their children to learn about programming?

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Since people try to "progra... (Below threshold)

November 12, 2014 11:56 AM | Posted, in reply to 's comment, by johnnycoconut: | Reply

Since people try to "program" each other anyway, and sometimes this is good, bad, or neutral and sometimes it's in the best interest to defend yourself from it, I think it is inevitable that people learn something about the nature of "programming" from somewhere. Might as well try to empower people to have some choice in the matter and hope that helps things.

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Good, bad, neutral you say.... (Below threshold)

November 12, 2014 2:46 PM | Posted by : | Reply

Good, bad, neutral you say.

I appreciate being influenced. Nothing wrong about that. Love is patient, doesn't present fixed choices and won't press a choice.

There is a choice between he who says a choice has to be made, and he who doesn't?

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For fun, I mentally replace... (Below threshold)

November 12, 2014 3:41 PM | Posted, in reply to 's comment, by johnnycoconut: | Reply

For fun, I mentally replaced "he who" with "an ego that."

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The approach felt scientifi... (Below threshold)

November 12, 2014 4:20 PM | Posted by : | Reply

The approach felt scientific, cold, calculating. Not barbaric, but "civilized". It was omnipresent. It was: - "good thing will happen if you do good, bad things if you do bad."

I now realize that I could have handled it better, but for me, destructive behavior became crucial for my psyches integrity, independence.

The approach was clearly based on a flawed understanding of humans. I never dived into it, but I strongly suspect a misunderstood understanding of positive reinforcement. It felt like being trained as an animal.

It may be that man in itself is an animal, but in practice, positive reinforcement works differently on humans and animals. It's common knowledge: on animals you reinforce measurable behavior, on humans mentality, not result. No surprise, after all humans are more complicated: meta-understanding of the process may cause the subject to manipulate it, which effectively undermine the approach. In fact, you may end up with producing the opposite of what you attempted to reinforce.

You get what you reinforce, not what you think you reinforce.

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It's hard to pinpoint it pr... (Below threshold)

November 12, 2014 4:29 PM | Posted by : | Reply

It's hard to pinpoint it precisely, but it doesn't take much fantasy to imagine that superficial positive reinforcement promotes narcissism.

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superficial positi... (Below threshold)

November 12, 2014 6:48 PM | Posted, in reply to 's comment, by johnnycoconut: | Reply

superficial positive reinforcement

Something you take to have an underlying threat?

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I mean, not necessarily tha... (Below threshold)

November 12, 2014 6:49 PM | Posted, in reply to johnnycoconut's comment, by johnnycoconut: | Reply

I mean, not necessarily that you think the person is threatening you, but that you perceive there is a threat coming from somewhere that informs those words, whether the speaker realizes it or not?

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