crazy week

This has been a crazy week.  First full draft of the dissertation is due today.  At the start of the week I hadn't had an intro or conclusion yet.  Still don't have a full conclusions.  Sara has been on service.  Oliver got his first stomach bug, complete with puking, and was home from daycare for a day and a half.  But here is a pic for the week...

Also, here is a funny video of Oliver standing up on his own (with some help balancing). I love his little grunts.

Not who, but what are you?

By popular request (as in 1 person...) here is a post about some of the work I have been doing lately.

Life is often busy.  Because of that I, like probably all of us, resort to quick, impersonal interactions with people.  When waiting in line at the grocery store I look at magazine covers and stuff like that, rarely acknowledging and even more rarely interacting with others in line.  When I get to the front of the line, I engage the clerk in a friendly, and largely meaningless conversation.

I struggle with this, however, because if you think about it none of these interactions mean anything.  None of them actually need another person.  For this reason for some time now I make the attempt to force their humanity upon those I interact with.  By that I mean that when I resort to depersonalized interactions with other people, they are doing the same thing.  In other words, both of us treat the other as an object of necessity and not a person, thereby also reducing our self to an object and not a human being.  So, when I interact with others, I try to avoid allowing them to reduce their self and force more than a mindless, automatic exchange with them.  When I say hello back to them and ask how their day is I always try to mean it.  I try to use their name.  I try to do something to pull them out of their automatic interaction, thereby also trying to pull them out of their automatic self objectification.

This same process happens in medicine.  It is not uncommon for a physician to interact with a patient and focus only on the symptoms of an illness that they have with a complete disregard for the patient's understanding of or experiences of those symptoms.  The patient is often reduced to a biological machine that is broken and needs to be tweaked in some way.  Patients also tend to learn this and so they will supply the information they think the Dr wants and act how they think the Dr wants them to - which often means they at that point see their self as a laundry list of broken biological processes and veil their self, their humanity.

Religious beliefs are very common in the United States, and as such, religious beliefs often undergird people's understanding of the world.  Those beliefs provide the meaning and color for their reality.  If a physician were to try and connect with a patient on a more personal level, beliefs and values may be one such personal dimension.  I have been finding, however, that how religious the patient population is actually has nothing to do with how often the physician talks about religion with patients or prays with them.  We could be talking about a physician who is in the middle of the Bible Belt and a majority of their patients are strongly religious or a physician on the west coast with a patient population who is largely non-religious.  It won't matter - neither impacts how often the Dr talks about religion and in some cases the more often a physician reports that their patient population speaks to them about religion the less often they reciprocate.  In other words, some dimensions of the patient's personal identity may not matter at all in clinical interactions and in some cases may be actively avoided by the Dr.  It is hard to avoid habitual, automatic, time saving interactions with others, but this may be costly on a personal level for both the patient and the physician in the long term.

gmail metadata

Meta data is a popular phrase these days with political institutions snooping and all.  Some people think that knowing 'meta data' isn't really a big deal and you can't know too much from that anyways.  This isn't really that true.  If you know meta data you can know a lot about a person, the groups they are a part of and whether there are any connections between them.  For example, here is an article by a sociologist showing that with simple 'meta data' the British could have found and isolated revolutionaries like Paul Revere (it is awkwardly told as if it was a British person during the Revolution...).

Anyways, using only meta data (to, from, time stamps...), here is a network cloud of my own gmail account (make your own!!).  Kind of interesting.

Sara is that grey node in the middle right that connects the blue network (our Bible study) and the rest of the grey one (mostly her family).  The massive blue one at the bottom is my brother... apparently we email/text/chat a lot.  Seems I have a fair number of disconnected networks and a ton of isolated nodes.  This means I have interacted with a lot of people that are not connected to one another.  

Is being 'spiritual' enough?

This just became available online today.  Pretty excited about it.  It was a fun study to work on and it got placed in a really good journal.  Always nice to move on from projects...

If you are in need of some self-flagellation, let me know and I can send you the article.  (There was a page break on the abstract, so the screen shot wouldn't get it all...)

Re-integrative medial interactions

The dream of reason did not take power into account.     - Paul Starr

Something I have been thinking a lot about lately (besides the fact that we are about to have a kid) in working on the dissertation is the place that power and authority plays in our interactions with other people.  We all have what Peter Berger call 'typification schemes' that allow us to quickly process, make sense of, and project our experiences of reality.  We get used to understanding certain actions of others as meaning something always - hugs show affection, yelling communicates heightened emotions, etc.  We use these cognitive tools to make sense of everything we experience and 'assign' meaning to it; we make sense of it.  We then assume that other people generally assign the same meaning to shared experiences, and on this basis are we able to have generally predictable interactions with other people. 

Sometimes, however, we are unable to make sense of some experiences.  When this happens we seek the help of someone we think can help.  This is what a physician is, essentially - a professional whose job it is to make sense of the experiences of others and ameliorate those experiences, assuming they are adverse ("so what do I have doc...").  Another dude, Talcott Parsons, once wrote about how illness is essentially the result of any given person shifting their self-perception to that of an 'ill' person.  This makes sense if you think about it - two people could both have a cold, and one asserts that they are 'fine' and goes to work while the other asserts that they are 'sick' and stays home from work.  One has shifted their identity while the other did not. 

Parsons asserted that one of the jobs of a physician is to re-integrate 'ill' people back into society as 'normal' people. 

What happens when a patient does not listen to their doctor though?  For example, someone may have trouble breathing but refuse the advise of their physician to stop smoking.  Starr, the dude who said the quote at the start, would say this is an instance where the physician has not successfully asserted their authority over the patient.  He thinks that one of the jobs of the doctor is to asses the nature of reality, which in this instance is the patient's experiences and needs.  The physician needs to interpret those experiences and the needs of the patient and literally create the conditions under which the patient thinks their advice is appropriate. 

This is where the interaction between a patient and a physician gets interesting though.  What if the patient is religious and makes sense of their world and experiences through a lens tinted by an engaged God?  The patient has a 'broken' identity when they are ill, and they are in need of being brought back to a state of 'normalcy'.  This requires that their physician successfully interprets and assigns meaning to their reality, but very often in a medical setting this meaning invoked by the physician does not include religious beliefs.  So we have a professional whose job it is to bring a state of normalcy back to a religious patient, but that 'normalcy' and meaning introduced by the physician is devoid of religious beliefs and meaning. 

Is it really possible for a religious person to be 're-integrated' with who they are in a setting that implicitly rejects religion?  Often this just leaves a bit more work for the patient to do on their own time, but recent changes in medical practice have gravitated more towards understanding patients in a wider sense than just a broken machine that needs to be oiled.  This is likely a good thing, but just as before, the interpretive work of the physician is a big challenge.  Cheers to you doctors who fully dive into the work you do.  Short cuts are easier, but they don't always get you to the same place or even where you wanted to go. 

Professional socialization, status and service

I thought about making this more than one post, but figured few might read this anyways so length probably doesn't matter, ha.  Also thought it was about time a post like this gets put up.  Cheers. 

I think that one of the biggest challenges in life is figuring out how we can pull ourselves out of our own insular daily lives that have very little, if any, impact on those outside of our direct circles of interaction.  How do we make our 'mark'?  This problem (maybe) is more challenging with professions that require a lot of training that is then repaid with more money and prestige   Like de Botton says, we will always struggle with status anxiety, and those with more status both have more to gain (a bigger continuum) and more to lose (higher ledge from which to fall).

One way to avoid the preoccupation with status attainment is to pair life with service - to intentionally and regularly expand our circle of interaction to include those different than ourselves and in need of something.  I used to (may still... jury is out) think that some professions have a much easier time solving this status/service issue than others.  Physicians are an easy example.  The work that they do is directly tied to serving other people.  Academics are also an easy example for the opposite reason - there is almost no connection at all between the work we do and serving other people, typically.  So the solution to insular status anxiety for academics makes it much harder to bridge passions, training and knowledge with helping others.  It almost forces academics to bifurcate their lives into profession and service which does not really fix the problem of connecting with other people because how can one connect with others when they are in that very attempt disconnecting with their self?

But it occurred to me over this past week as I have been thinking through part of the dissertation that this may be overly simplistic.  All professions have beliefs and values that are socialized into the professionals to different degrees.  For physicians, one of the strongest beliefs/values in that socialization process is that of valuing scientific thought and processes which naturally is linked with detaching people from the diseases and health problems that they have.  This detachment is at odds, in a sense, to empathetic and compassionate care for the person coming to see the physician.  It also tends to be at odds with the religious beliefs of the physician because the one puts compassion and empathy at the front and the other devalues and at times even ignores compassion because machines and science have no need for empathy -  even getting in the way at times.

So, like the academic struggling to connect their skills and passions with service to others, the physician in serving others struggles to connect two different socializations, two different modes of thinking and feeling, that contribute to how they think and feel - professional detachment and religious compassion.  Some feel the tension more than others.  Some ignore the tension and bifurcate their lives.  Others uncritically (I don't mean this in a negative sense) accept both professional and religious socializations as they are and the tension never comes to the surface - similar to Gould's non-overlapping magisteria.  

I think that many people struggle with some of this stuff when they think about what they want to do and accomplish in life.  How can my life make a difference?  How can I help people best?  Pretty much any profession has processes of socialization in place and these will also relate to these struggles in different ways.  At what point will one's religious beliefs overpower their professional socialization (if we can think of them in those terms)?  How can they happily work with one another?  Should they?

pic

Doctors, culture and patient compliance

My first year at Baylor I wrote a theory paper about what happens within a patient/physician interaction when there is a larger and smaller spread between the two people's cultural background.  So if the patient is very poor and is struggling in life, the world that they know and how it works has a very different feel and nature to it that the physician, whom we would assume is not struggling - at least in the same sense.  I got to thinking about these issues again today at the eye doctor.

Our eye doctor (or mine - Sara doesn't need to go... yet) clearly has a different cultural background that I do.  It is in a very nice neighborhood, in a building whose rent cannot be cheap, and I am betting serves a certain kind of client that is from the upper end of the socio-economic ladder.  Much of this makes me feel uneasy being there - not because I am intimidated by them or something like that, but I feel as though I am merely a dollar sign and has a feel to it like I would imagine a used car lot would.  The conversation they have with me, the words they use, the seemingly memorized lines that are 'answers' to my questions and the assumption that I am more than willing to pay out of pocket for additional and seemingly unnecessary stuff.  The highly visible diplomas of the doc on the wall, despite the fact that she has an office.  The clothing they all wear - stilettos (yes, literally designers super high heels) and matching everything that I guarantee is not at Old Navy.  All of it are symbols that communicate a cultural background foreign to me.

As such, I am on high alert for things that it seems that they are trying to 'get' me on (it happened no less than 4 times today).  Because I am on high alert, I am halfway listening to what they have to say about my eye care (which is only a notch above nothing) and halfway defending my wallet.  This naturally makes the conversation borderline adversarial most of the time, which spurs them to try and reassert their position as the expert in the room.  I am sitting there trying to not elevate their defensiveness because I am aware of the fact that this will not help either of us, but can't shake the feeling of a disconnect between myself and them.

All of this leads me back to the patient/doctor interaction and patient compliance.  We know that rapport with a patient increases the information the patient will supply to help the physician solve and problems or figure out a diagnosis, but past interactions also play in.  If they know the patient from past interactions, it only helps - unless the interaction is breaking down.  This is why continuity is such a big deal when it comes to medical care, but also why attempts to reduce the cultural gulf between patient and physician is crucial.  All of this leads up to the point at which the patient leaves the office or the hospital.  Are they going to follow the advice?  Will they do it willingly or begrudgingly - both of which will impact outcomes for either the better or the worse.  Are they able to follow the advice?  Did they understand the advice given, and relatedly, did the physician know whether or not they communicated successfully?  Medicine is a pretty hard job - because it really is almost never just medicine.

writing

So I don't think I will ever take people's writing for granted anymore - especially more professional or academic writing.  Each sentence has likely been written and re-written many, many times before it ever reaches the reader.  I have a paper that has been through a few reviews by now and I have been writing and re-writing for over a year now.  Each sentence has been read literally like a hundred or more times and most every sentence has been inserted, changed, removed, moved or any other combination so many times by now. It is interesting to think about whether or not the paper is still the same paper as it was when it started or not.

I can now see why people say that papers and books are never really finished, but are abandoned.  There comes a certain point when you just get tired or reading, working on, or changing the thing and you just want to give up on it and move on.  That is the point at which it is considered 'finished.'  I think this one was 'finished' long ago but it still plagues me, ha....

build it. they may come.

People's health is an interesting beast.  We often think of health as between one person and their immune system, or some variation of this.  There has also long been a correlation between lower income individuals and poor health and, often, shorter lifespans.  There are many ideas and studies showing why this latter relationship may exist, but so often it can be oversimplified.  This becomes a real struggle when we try to make structural changes to fix things (think healthcare reform) - we know something is broken, but if we are not sure why how can we really fix it?  (Before I go on, you should keep in mind that there is neither an explicit nor implicit political point/argument in this blog.  Carry on.)

Here are some thoughts from some recent research in the sociology of health and illness.  Policy makers and people in general often place a high degree of emphasis on the individual.  This usually translates over to things such as focusing on health care and insurance coverage, or even the availability of (affordable) health care.  But, even if these problems were fixed, people still may not use the health care available to them because it is not clear that this is the problem (obviously it is a big problem, but it could be subsequent to other issues).

Going back to the 'poor people' and their healthcare.  We assume that poor communities have poor health because there is no insurance or the care is hard to access.  While this may in part be true, recent research shows that within poor communities, it is not the poor people that are most affected by barriers to health, but middle-class and upper-class individuals living in that location.  In other words, the poor health in poor communities is actually not attributed to the poor people within that community, but the middle and upper class individuals within that lower income community.  This is usually because poor individuals have social networks in place that allow them to deal with their issues apart from the structural solutions in place - they talk to their friends and family to get help with health and not a doctor.  The middle and upper class individuals living within those poorer communities, on the other hand, do not have access to these social networks for solutions and 'suffer' the consequences.  Thus, it is possible that if we provided all of these poor people with health care that it may not change community level health outcomes anyways.  After all, they are not even the ones pulling down the average level of health.

Additionally, poorer individuals are less trusting of those in positions of authority like a physician and also expect worse outcomes from their interactions with doctors.  So, if they did have access and insurance as well as actually use that access, they may still have worse health outcomes than others.  This, again, is not so much a structurally caused health problem, but more cultural.  They have other ways to deal with health issues in their community and have different expectations when they do seek formal help.  Neither of these will be fixed by a shift in the structure of our health care system, but may require something else.  Some think a possible road forward is for all doctors to be more engaged with the communities they serve so that when/if people do have access, they will use it and expect something from it.  Others find it hard to differentiate solutions to these problems from political activism, and as such think no requirement for 'health advocacy' should be imposed as the activism would necessarily alter the substance of the medicine itself.  Either way, it is clear that health requires much more than a mere individual focus and that a structural change is needed in the delivery of health care.  It is significantly less clear, however, what that actually means.

Pretty interesting.  Sorry if that was a bore.  Mostly because there will probably be more.

Erroneous and Skewed

We like categories.  Boxes.  Organization.  I get that and it is clearly necessary for social interactions to work because it lays a bedrock of working assumptions upon which a non-dysfunctional society is based. But it is also very hard to avoid dismissing things you do not like by automatically (miss)categorizing.  I have always tried to avoid labeling people/thoughts/ideas quickly without really thinking about the content.  Doesn't always work, but I try.

This is even more true now, I would like to think.  Since people have read about some research I have done, many avoid really thinking about the content of the research or the content of their own assumptions of how things work by quickly putting a 'yes' or 'no' label on both me and the work.  Me and the research have been put in every camp possible it seems.  An article I wrote for Christianity Today came out recently and I really started to think more about this after those comments.  There are probably a few things going on.  Many quickly react to the title and don't even read the article it seems.  Other read it but what they already think literally drives what they read, and read some of what is written in literally opposite of what is written.  This could be a clarity issue on my part, but still.  There are some really good comments, too, but they are less fun to post.  Here are a few comment-morsels for you:

• [this is a partial - the person goes on and on, but I have no idea why this is talked about - maybe they think I am a universalist?]  Jesus' parable of the wheat and the tares entirely contradicts the universalism of the liberals. So does his injunction not to throw pearls before swine, and his description of the Pharisees as 'offspring of vipers', in other words genetically cursed, and his parable of the 'wicked tenants' or 'wicked husbandmen', describing those who were attempting to usurp the kingdom.- the Edomites, descendants of Esau, described as a people God hates (Malachi 1:2,3), who had been converted to become 'Jews' in about 120BC.
• [I like this one, ha]  Wait wait wait... So you're upset that the author uses statistics to form conclusions? What else would you suggest? And nothing is "proven" in science. What the author is doing is using the facts to support her argument, explaining what they INDICATE. Your discernment is clearly hindered. Might I suggest some Bible reading to boost it? :)
• What an erroneous conclusion from what sounds like a skewed poll.
• [maybe my favorit one]  What a load of baloney. Liberalism is simply encouraging the Government to wrongly assume the role of the church. Keep Jesus out of your socialism.
• [again a partial, but even I am not sure what political viewpoint would be 'evident' and I wrote the thing]  Besides the likely problems inherent in the poll and thus the interpretation that others have pointed out, the political orientation of the author is evident. His criticism of Beck is misplaced, for instance....