Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.
Our exchanges be marked by basic respect and civility-and by a willingness to take personal responsibility for what we say and how we say it. Physicians ought to be in the vanguard of such an Internet reformation.
I first read Saul Bellow’s masterpiece, Mr. Sammler’s Planet, back in my 1970s college days, but I recently began thumbing through my dog-eared copy again. I can only guess at what unconscious motive was working in me, but once I began reading, I became convinced that Mr. Sammler’s description of our planet, circa 1969, was remarkably prescient:
All this confused sex-excrement-militancy, explosiveness, abusiveness, tooth-showing, Barbary ape howling. Or like the spider monkeys in the trees, as Sammler once had read, defecating into their hands, and shrieking, pelting the explorers below . . .
I’m referring to the appalling incivility that seems endemic in our culture these days. Witness the recent bullying and abuse of 68-year-old bus monitor, Karen Klein, at the hands of a bunch of Satanic seventh graders. Or, consider the vilification and threats of violence directed at infectious disease expert, Dr Paul Offitt, following his debunking of the supposed vaccination-autism link. As for the anonymous, venomous bilge that clogs the Internet these days-as my New York relatives would say, fuhgeddaboudit!
Yes, I know: various forms of harassment and rudeness have always been with us. And yes, I’m aware of psychologist Steven Pinker’s argument that our modern times are actually less violent than, say, the Dark Ages. Perhaps-but as a child of the 50s and 60s, I can’t deny what my own senses and sensibility tell me: the world has grown crasser, crueler, ruder since I was a boy growing up in the late 50s and early 60s.
I’m far from alone in perceiving that rudeness has flourished apace in recent years. In a blog (6/15/12) titled, “Dearth of Civility in the Public Square,” commentator Gwen Ifill described an online survey by Weber Shandwick and Powell Tate. Sixty-three percent of the 1000 people surveyed said America has an incivility problem, and 72% believe things have gotten worse in the past few years.
What has spawned this general decline in courtesy, and its more uncouth brother, the rise of incivility? I suspect there are numerous causes, including the failure of many parents to set a good example for their children. (As the Talmud shrewdly observes, “The child’s talk in the marketplace is either of his father or his mother.”) But even the most diligent parents can’t control what their children are exposed to outside the home. Furthermore, there are forces at work in our society that seem to have increased narcissistic traits in young people-and where narcissism leads, discourtesy often follows.
In their book, The Narcissism Epidemic: Living in the Age of Entitlement, Jean M. Twenge, PhD, and W. Keith Campbell, PhD, point to “the relentless rise of narcissism in our culture.” Twenge and Campbell identify several social trends that have contributed to this problem, including what they term “the movement toward self-esteem” that began in the late 1960s, and the movement away from “community-oriented thinking” that began in the 1970s. Twenge and Campbell also point to “. . . the new parenting culture that has fueled the narcissism epidemic.” In effect, the authors argue that there has been a shift away from limit-setting toward letting the child get whatever he or she wants. Maybe so-but right or wrong, Twenge and Campbell have identified what I see as a growing trend.
Finally, there is the matter of the Internet-that double-edged sword that may be wielded against a brutal dictator, or aimed brutally against a lonely, marginalized classmate. As a psychiatrist who posts blogs on several Web sites, I have been appalled by the level of anonymous invective on many poorly monitored sites. I’m comfortable with constructive criticism, and I’ve sat with my share of verbally abusive (and often intoxicated) patients-but sometimes, the menacing comments I have read online have literally raised the hairs on the back of my neck. One colleague of mine-a humane and broad-minded soul who tried to “reach out” to online critics of psychiatry-found himself so vilified on one popular Web site that he decided to suspend his postings, at least until the site improves its screening policies. Christopher Wolf, an attorney who leads the Internet Task Force of the Anti-Defamation League, observes:
People who are able to post anonymously (or pseudonymously) are far more likely to say awful things, sometimes with awful consequences, such as the suicides of cyberbullied young people. The abuse extends to hate-filled and inflammatory comments appended to the online versions of newspaper articles-comments that hijack legitimate discussions of current events and discourage people from participating. Anonymity also facilitates the posting of anti-Semitic, racist and homophobic content across the Web.1
In my view, anonymous “flaming” on the Internet is both a symptom and a cause: it is a symptom of a society in which, all too often, “anything goes,” and a contributing cause of further abusive behavior. Declining levels of civility in our culture have encouraged anonymous, “drive by” postings on the Internet, but these postings, in turn, encourage further abusive remarks, in a vicious cycle of reinforcement. Alas, physicians are far from immune to this contagion of incivility and too often contribute to it.
To be sure, as Wolf points out, “. . . we have had a great tradition of anonymous political speech” in this country. And, there are occasionally compelling reasons for maintaining anonymity, or for using a pseudonym, when posting blogs or comments on the Internet. A man or woman who risks physical abuse or stalking from a psychopathic ex-spouse; a political dissident who faces retaliation by an authoritarian regime; an employee who is likely to be fired if the boss reads what he or she has posted online-all these parties may have legitimate reasons for disguising their identities on line. And, in rare cases, it may be necessary to disguise one’s identity in order to protect another person’s safety or privacy-say, that of a patient whose case one urgently wants to discuss in an online forum. (Most such cases, however, may be sufficiently disguised by altering or omitting key elements of the patient’s identity, age, etc.)2
All that said, I very much doubt that these considerations apply to the overwhelming majority of anonymous-and sometimes, abusive-online commentators. For the abusers, maintaining anonymity is merely an excuse to unleash a barrage of insulting or hateful language-cost-free! As a health care professional, I find it particularly galling when someone claims to be a physician and posts an anonymous, “flaming” comment directed against a named colleague. This is not merely obnoxious and professionally irresponsible-it is also cowardly.
It was therefore with great satisfaction that I learned of a new (6/27/12) policy on the popular medical Web site, Medscape; ie, “. . . we have removed the ability to post comments anonymously in our physician-only discussion forum, Medscape Connect, and in all Medscape blogs.” A similar policy is in place on the Psychiatric Times Web site, though some comments are posted under obviously false names. On the other hand, I was shocked, some months ago, to find that the widely respected New York Times Magazine now publishes, in its print edition, anonymous or pseudonymous letters. This, in my view, sets a very bad precedent for print journalism-but I fear it is a harbinger of things to come.
A free society thrives on robust and passionate debate. I am not arguing that our online discourse should sound like conversation over tea and crumpets at Buckingham Palace. However, I am urging that our exchanges be marked by basic respect and civility-and by a willingness to take personal responsibility for what we say and how we say it. Physicians ought to be in the vanguard of such an Internet reformation.
1.Wolf C. Sunday Dialogue: Anonymity and Incivility on the Internet. The New York Times. November 26, 2011. http://www.nytimes.com/2011/11/27/opinion/sunday/sunday-dialogue-anonymity-and-incivility-on-the-internet.html. Accessed August 16, 2012.
2. Pies R, Kantrowitz JL. Case studies and the therapeutic relationship: commentary by Ronald Pies, MD, and Judy L. Kantrowitz, PhD. Virtual Mentor. 2011;13:425-434. http://virtualmentor.ama-assn.org/2011/07/ccas1-1107.html. Accessed August 16, 2012.
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