Wednesday, March 29, 2006

Trained incapacity and untrained capacity

Erin Wais, who studies rhetoric at the University of Minnesota, wrote a fascinating paper last year on trained incapacity. Thorstein Veblen coined the term, applying it to business models, and Kenneth Burke expanded its applications beyond that. The term itself is not complicated, although some of its implications are. Erin explains that "Burke defines the phrase as 'that state of affairs whereby one’s very abilities can function as blindnesses.'" People who are trained to do one thing are trained not to do something else; sometimes, however, that "something else" might have been a better approach.

Like many good papers, that one got me to thinking, and I shared some of these thoughts with my literature students when I discussed "The Yellow Wallpaper" with them a couple of weeks ago. This story, written in 1899, deals with a woman's mental illness. The woman's husband, John, is a physician. He approaches the problem by insisting that his wife get complete rest, not even allowing her to write. His training makes him sure that his approach is correct: "I am a doctor, dear, and I know," he insists. His wife is not so sure: "John is a physician, and perhaps--(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind)--perhaps that is one reason I do not get well faster." If it weren't for his training, he wouldn't know to take such a silly approach as he does.

This story takes place over a hundred years ago. Is trained incapacity less of a problem in healthcare now? I'd like to make the argument that it is. Not because physicians know more than they did then--their higher level of training, if anything, probably leads to a higher level of trained incapacity--but because their patients are taking more control than they once did.

One remedy for trained incapacity may be untrained capacity. When patients, who tend to be rather ignorant about advanced medicine, insist on having things explained in simple terms before making their own decisions, that limits the risks of situations like the one in "The Yellow Wallpaper." (The woman in the story had little choice, but most patients in real life have more.)

This may sound strange coming from a teacher, but I think we sometimes underestimate the value of ignorance. The best example I can think of involves racism. Racism is not ignorant behavior. It's learned behavior. Watch toddlers of different races playing in the sandbox. They haven't yet been taught to be racist, so they aren't. If they were never to be trained that way, they would never develop this trained incapacity.

Having said that, I don't mean to imply that training is necessarily a bad thing. Part of the problem might relate to Pope's observation in "An Essay on Criticism": "A little Learning is a dang'rous Thing." The learned behavior of racism can be fought with more learning. The mistakes made by nineteenth-century physicians can be fought with twenty-first century medicine.

So how do we know how much training we should have, or of what kind? I don't know. I'm still training myself in that.


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