Wednesday, March 9, 2011

Is democratic discourse even possible when healthcare professionals behave like this?

Faith in democracy rarely survives a scroll through a blog's public comments section.

To wit: Yale psychologist Rebecca Puhl, PhD wrote a blog entry on Medscape (a site for health professionals) entitled, "Harsh Comments During the Holiday Season" in response to Alastair Macaulay's New York Times review of the NYC Ballet's new production of The Nutcracker. Macaulay had criticized a male and female dancer for their lackluster performance. Here is the offending paragraph, which was, by the way, embedded within an otherwise glowing review of the opening night performance:

"This didn’t feel, however, like an opening night. Jenifer Ringer, as the Sugar Plum Fairy, looked as if she’d eaten one sugar plum too many; and Jared Angle, as the Cavalier, seems to have been sampling half the Sweet realm. They’re among the few City Ballet principals who dance like adults, but without adult depth or complexity. Ashley Bouder (Dewdrop) has the brilliance they lack, but also a greater and more tough-grained hardness."

Because Medscape requires a subscription, here is Dr. Puhl’s response to the Macaulay review:
Many people enjoy the holiday ritual of attending the Nutcracker ballet this time of year, and a couple of weeks ago a review of George Balanchine’s “The Nutcracker” at the New York City Ballet appeared in the New York Times. In part of his review, the writer Alastair Macaulay criticized the body weight of Jenifer Ringer, cast as the Sugar Plum Fairy, who according to Macaulay, “looked as if she’d eaten one sugarplum too many.”

These comments spurred considerable media attention, including a televised interview with the ballet dancer Ms. Ringer herself, who has battled with anorexia and overeating.

If a dancer doesn’t conform to the strict (and often unhealthy) ideals of thinness expected in ballet, does it reduce the quality of the performance? Are these expectations appropriate, or just reinforcing stigma? Ms. Ringer is a talented ballerina performing in a prestigious ballet production – her high profile role and the quality of her dancing speak to those talents.

This criticism sends yet another concerning message to young girls, who may face terrible pressures, negative body image, eating disorders, and other potential health problems in order to conform to excessively thin body types that have become the norm in the ballet world. Is this really necessary? Instead of instilling shame, stigma and harmful health messages on girls and women who love to dance, let's embrace and applaud them regardless of what size of tutu they wear.
Dr. Puhl, whose research specialty is weight bias, seems to have been overly sensitized by her occupation. She grand jet├ęd to the conclusion that Macaulay was insulting the female dancer's weight (she was apparently unconcerned about the male dancer), launched an attack on the "strict and unhealthy ideals of thinness" expected in ballet (forgetting that professional dancers have to be healthy enough to jump, twirl and kick most of their waking hours), and conflated “girls and women who love to dance” with NYC Ballet prima ballerinas who are called to somewhat higher standards.

Dr. Puhl seems to not understand ballet or criticism; the issue is not whether Ms. Ringer is talented, but how she performed on a particular night in a particular role. The real surprise of the blog, though, was the harshness, vindictiveness, simple-mindedness, and ignorance displayed by so many of the blog’s commenters—healthcare professionals, no less!—who leapt onto the eating disorders bandwagon without having bothered to check the original review. Some suggested ballet should be forced to change its standards and be boycotted until it does; many commenters searched for still photos of the female dancer in question and concluded that she was perfectly lovely and thin (it never occurred to them that one cannot evaluate a dancer or dance performance by looking at still shots). There were numerous ad hominem attacks on the critic, and some gratuitous gay-bashing. (A few comments, one of which suggested torture and death for the critic, were so inflammatory they were later removed by the blog’s editor.) The solid majority of commenters were able to see the issue only through the restricted lens of eating disorders, and a startling number evinced no understanding of the role of a critic.

What concerns me most, however, is not the clear ignorance of the healthcare-blogging public in matters of art. It is the ignorance of how to read critically, to analyze an argument. It is the fact that the people entrusted with our care (doctors, nurses, pharmacists, psychotherapists) seem so disinclined to question assumptions or check their sources or even control their hostility. This does not bode well for democracy. Eating disorders are evidently a hot-button issue, but are they any more volatile than, say, taxes? education? the environment? social security? Democracy works only if the citizenry is educated and committed to acting responsibly and honestly. There are many ways to cheat the system, as we have seen over and over again. But when the system is so weakened from within, what recourse do we have?

Lest my gentle readers think that I am over-reacting, I will now provide a glimpse of the comments.

The Data

I spent a considerable amount of time reading through all 195 comments and categorizing them to get a clearer picture of the state of this particular hive mind. Five comments were so off-topic or hard to decipher that I had to discard them. Otherwise, the breakdown was as follows.

Agree with Dr. Puhl’s post (“supporters”): 157. (= 80.5% of total comments) Of the 157, there were 59 calm supporters who wrote nothing harsher than “I looked at Ms. Ringer’s photos and she’s not fat” or “The reviewer’s comments are probably fair within the ballet workday, but are appalling in the healthy context. Maybe ballet should die a lovely death.” (Well, ok, that last comment isn’t terribly calm, but wait until we get to the hostile categories.) There were 8 autobiographical supporters who relayed personal or familial experience with eating disorders. 9 supporters were markedly ignorant about ballet (e.g., “the name Sugar Plum Fairy suggests a full-figured woman anyway”), 16 were markedly ignorant about the nature and purpose of reviews (“I doubt if the critic could have performed the piece as well as she did.”). The comments in this category were striking for their reliance on homilies: there seems to be something about adopting the position of criticizing someone else for their criticism that pushes one toward banality. Below are excerpts from comments in this category:
“ ...people who criticize others are trying to compensate for their own shortcomings...”

“... Abe Lincoln once said it is better to remain silent and thought a fool than to speak up and remove all doubt.”

“... I hope her parents taught her the old saying, ‘I'm made of rubber, You're made of glue, Whatever you say bounces off me and sticks on you!’”

“ not judge and be kind to one another”

“...let him who is without sin cast the first stone”

“...As for the critic I would offer Proverb 14:23 All hard work (ballet dancer) bring a profit but mere talk (critic) leads only to poverty.”

“ the old saying goes ‘no one has ever erected a statue or named a hospital in honor of a critic.’"

“...The Bible has great wisdom – ‘Be slow to anger.’ Let me add Be very slow to criticize.”

“...the most critical are those who have nothing to write home about themselves”

Seven commenters (the objectifers) seemed to be trying to use science to tamp down the emotional quotient: they wanted to make the question about whether the dancer had a “normal” BMI (body mass index) or not. Early on, one poster rightfully pointed out that normal BMI ranges are not applicable to professional athletes, but that didn’t stop four subsequent commenters from continuing to speculate about Ringer's BMI based on her photographs (!).

Now we get to the hostile categories (63 total, or 32% of total comments): 10 were angry toward the critic (e.g., “I’m seeing red!” “shame on this chauvinistic creep”), 12 were nasty toward the critic (from “he’s insane, he should have his nuts cracked” to calls for him to be fired, physically punished, or assassinated), 23 employed ad hominem attacks and speculations (he must have eating issues; he is sadistic and misogynistic, jealous, envious, soul-sick; “This old fool needs a new hairdo. When I did a Google search and saw his photo I thought what a jerk!”), and 3 homophobic comments assumed any dance critic must be gay and proceeded to conflate homosexual with pedophilic, sometimes with unintended self-contradiction: “...Since most skinny formless women are under age 13, the men/women attracted to that look are closet child abusers. In fact, it is my understanding that unwanted sexual advances is one of the risks for young women who go into ballet and female gymnastics.” (If the problem is pedophilic homosexuality, one wonders where all the sexual advances toward women come from.) 11 posts were angry-dismissive toward other commenters, and 2 were angry-oppositional (e.g., “Maybe Jenifer Ringer and all the other whiners should take a trip over to namby pamby land and get a dose of self-confidence. They should also realize no one wants to watch a Sugar Plum Fairy shake like a bowl-full of jelly...” Um, wouldn't that require a trip away from namby-pamby land?).

One post from a hospice nurse was in a category of its own: an over-reaction that was both wierdly morose and poignant:

This article and your message have upset me. My dream has always been to go to the ballet in a big city instead of watching on TV. But now in this terrible recession, I have started to walk and talk with my money. Too many in my family are unemployed or underemployed. From now on I will not watch ballet on TV and I will put aside my dream. Anyway, there are better things in my life now, like our first grand daughter and first grand son. I will give them my time, bake cookies, buy books published here in the USA. I did not go shopping after Christmas this year. I think we all need to use our assets to change what is so wrong in this world. We do not need goods made in foreign countries. We do not need to see dancers kill themselves in order to be accepted into dance companies. I do not approve of the way girls and women are treated in the fine arts and entertainment world. Never have. Now I have a good reason to not even watch The Nutcracker on TV ever again.

Among the mere 22 (11%) who voiced non-hostile disagreement were 6 who accepted Dr. Puhl’s premise but thought that obesity is a bigger problem to worry about than anorexic dancers. One of these thought we should be just as concerned about males with eating disorders.

Out of all 195 posts, only 16 (8%) expressed polite, thoughtful disagreement with Dr. Puhl’s premise. Comment #93 summed up the situation nicely: “it seems many commenting here are not fans of ballet and don’t understand critics...” Some urged an attitude of respect toward professional critics (“Ballet is art...those who spend a lifetime studying an art form are likely to have opinions based on some substance....”). Comment #49 (mine) took a step back and referred to the original review, which I was prompted to read only after finding flaw with Dr. Puhl’s reasoning:

Before we all form a cavalry on our high horses, let's look at the quote in context, near the end of an overall glowing review of this new production of the Nutcracker: 

"This didn’t feel, however, like an opening night. Jenifer Ringer, as the Sugar Plum Fairy, looked as if she’d eaten one sugar plum too many; and Jared Angle, as the Cavalier, seems to have been sampling half the Sweet realm. They’re among the few City Ballet principals who dance like adults, but without adult depth or complexity. Ashley Bouder (Dewdrop) has the brilliance they lack, but also a greater and more tough-grained hardness." 

The core criticism—about both Ringer AND a male dancer (which no one seems to be comparably up in arms about)—is about their dancing. The critic thinks they lack depth, complexity, brilliance, lapidary hardness.

To me, the reference to sampling sweets is not a veiled reference to corpulence but to a sense of a post-prandial somnolence, a soporific or even lazy quality in their dancing that he felt did not equal the technique and artistic imagination of the other dancers in that particular production, on that particular evening. It is akin to saying a few dancers in a ballet about a bacchanal looked like they'd had one too many glasses of wine. You wouldn't interpret that as a comment on their personal alcoholism—you would assume, rightly, that it was a reflection on how they danced.

Four comments applauded this “rational viewpoint” (thank you, #51, 123, 174 and 175), but the vast majority of the subsequent 146 kept riding their high horses. #186 expressed the same wonderment I felt when returning to the blog a couple days later and seeing how little influence my “rational viewpoint” had exerted:

Wow, I have to say that as a veterinarian, I am truly amazed (appalled) at the level of professionalism (what professionalism???) demonstrated by my human doctor counterparts on this particular blog. Amongst professionals in my chosen field, there is a level of respect, tolerance, and courtesy when engaged in professional blogs, even when opinions differ. Perhaps this is why so many of my clients tell me that they wish I could be their personal physician instead of their MD.

I hope to examine, in future posts, other situations in which respectful discourse seems compromised and to understand why this happens. Perhaps by understanding the categories we might fall into, we’ll be better able to recognize the pitfalls and avoid them ourselves.

* * * * *

P.S. Macaulay himself responded to general media brouhaha here. ("Judging the bodies in ballet.") His account of the whole kerfluffle, as well as the requirements of ballet and of reviewing, is worth reading; some of the NYT reader comments, apparently, were also "obscene and abusive."

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