Abuse and shame in Homer and medicine

Abstract

ABSTRACTLearning through ritual humiliation used to be standard in work-based medical education as a rite of passage, a militaristic hardening. More enlightened pedagogies have emerged, but such abusive and shaming practices still linger, especially in surgery. Humiliation now includes harassment of women trainees through overt and covert sexism. We explore the resilience of such “compulsory mis-education” through “thinking with Homer.” Returning to Homer’s Iliad and Odyssey as Ur-texts for shaping the human imagination, we re-read shame and abuse in medical contexts, suggesting that these are products of historical shaping by metaphors of violence and conflict. It is only when such primary metaphors shift and more liberal metaphors emerge that a more collaborative and feminine medical culture will be shaped. We draw on distinctions between “honor–shame”/“tradition-directed” and “guilt”/“inner-directed” behaviors to explore medicine’s lingering authoritarianism. The former rely on gaining respect from peers or being ostracized (losing face), where as the latter depend upon an internalized moral code expressed as pride or guilt (conscience). While structural changes will enable a more democratic medical culture to emerge, medical education can facilitate such change through promoting learner-centered techniques such as supportive and constructive feedback.