Is this Okay? The Power of Subculture

A subculture is a group of people within a cultural society that differentiates itself from the conservative and standard values to which it belongs. Policing is a subculture.

When I first read today’s guest essay in The New York Times by Dr. Carl Elliot I was immediately transformed back into my days of policing. For the kind of overwhelming power of medical professionalism, I also see and have experienced in policing. Perhaps you have, too.

Dr. Elliott teaches medical ethics at the University of Minnesota. He is the author of the forthcoming book “The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No,” from which, in part, the following are reprinted.

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“Here is the way I remember it: The year is 1985, and a few medical students are gathered around an operating table where an anesthetized woman has been prepared for surgery. The attending physician, a gynecologist, asks the group: ‘Has everyone felt a cervix? Here’s your chance.’ One after another, we take turns inserting two gloved fingers into the unconscious woman’s vagina.

“Had the woman consented to a pelvic exam? Did she understand that when the lights went dim she would be treated like a clinical practice dummy, her genitalia palpated by a succession of untrained hands? I don’t know. Like most medical students, I just did as I was told [my emphasis]…

“What is it that leads a rare individual to say no to practices that are deceptive, exploitative or harmful when everyone else thinks they are fine? For a long time I assumed that saying no was mainly an issue of moral courage. The relevant question was: If you are a witness to wrongdoing, will you be brave enough to speak out? [my emphasis]…

But, of course as well all have come to know, when one speaks out — challenges subcultural assumptions, all does not always end well. Dr. Elliot goes on.

“Before you decide to speak out about wrongdoing, you have to recognize it for what it is. This is not as simple as it seems. Part of what makes medical training so unsettling is how often you are thrust into situations in which you don’t really know how to behave… Your initial reaction is often a combination of revulsion, anxiety and self-consciousness.

“To embark on a career in medicine is like moving to a foreign country where you do not understand the customs, rituals, manners or language. Your main concern on arrival is how to fit in and avoid causing offense. This is true even if the local customs seem backward or cruel. What’s more, this particular country has an authoritarian government and a rigid status hierarchy where dissent is not just discouraged but also punished. Living happily in this country requires convincing yourself that whatever discomfort you feel comes from your own ignorance and lack of experience [my emphasis]. Over time, you learn how to assimilate. You may even come to laugh at how naïve you were when you first arrived.

“’You get with the program because that’s what you’re being hired to do.’

“One of the great mysteries of human behavior is how institutions create social worlds where unthinkable practices come to seem normal. This is as true of academic medical centers as it is of prisons and military units [my emphasis].

“To embark on a career in medicine is like moving to a foreign country where you do not understand the customs, rituals, manners or language. Your main concern on arrival is how to fit in and avoid causing offense [my emphasis]. This is true even if the local customs seem backward or cruel. What’s more, this particular country has an authoritarian government and a rigid status hierarchy where dissent is not just discouraged but also punished [my emphasis]. Living happily in this country requires convincing yourself that whatever discomfort you feel comes from your own ignorance and lack of experience. Over time, you learn how to assimilate. You may even come to laugh at how naïve you were when you first arrived…

“During the 1970s, it was thought that the solution to medical misconduct was formal education in ethics. Major academic medical centers began establishing bioethics centers and programs throughout the 1980s and ’90s, and today virtually every medical school in the country requires ethics training. Yet it is debatable whether that training has had any effect [my emphasis]…”

“You may find it hard to understand how pelvic exams on unconscious women without their consent could seem like anything but a terrible invasion. Yet a central aim of medical training is to transform your sensibility. You are taught to steel yourself against your natural emotional reactions to death and disfigurement; to set aside your customary views about privacy and shame; to see the human body as a thing to be examined, tested and studied.

“One danger of this transformation is that you will see your colleagues and superiors do horrible things and be afraid to speak up. But the more subtle danger is that you will no longer see what they are doing as horrible. You will just think: This is the way it is done [my emphasis].”

You can read the full article HERE.

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Some Questions

How is Dr. Elliot’s early training the same or different from what new police officers experience?
Are most police organizations also places “where a rigid status hierarchy where dissent is not just discouraged but also punished”?
Dr. Elliot is also suggesting that ethics training is not the answer to this problem. In light of that, how might the ethics of democratic policing be put into practice and not just a wall poster?
How might those who say “no” to a questionable practice be accommodated and not persecuted?
What are the current practices of policing a democracy that may offend you, but you say, “Sorry, but this is the way it is done?”
When you hear the statement, “Subculture eats policy for lunch!” what does it mean in your organization?
What practice in your organization do you question? What are you going to do about it?