tag:blogger.com,1999:blog-2752793986869193186.post9020172743720418996..comments2022-12-12T10:49:47.419-05:00Comments on Patient Modesty & Privacy <center>Concerns</center>: HISTORY OF MODESTY, PART 2Joel Sherman MDhttp://www.blogger.com/profile/15302609163683972129noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-2752793986869193186.post-77724024128270311772011-03-07T00:18:15.805-05:002011-03-07T00:18:15.805-05:00Doug – I wasn’t aware of “A history of private lif...Doug – I wasn’t aware of “A history of private life.” Turns out my local library has all five volumes available for check out. There’s so much to read!<br /><br />Dr. Joe – Thanks for reading (I know it’s long), leaving a comment here, and stopping by my website.Jan Hendersonhttps://www.blogger.com/profile/01650769510334814641noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-90558019400333910572011-03-06T21:31:23.215-05:002011-03-06T21:31:23.215-05:00It took me a while to read all two posts but it su...It took me a while to read all two posts but it sure was a great read. Even if we have seen the human body for a thousand times, I still want my patients to be at ease with the whole process. Yes, the long line of patients outside and our busy lives strips my patients of their modesty at times. I do hope patients can read this article.DIY Healthhttp://www.drjoetoday.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-57335525213925806202011-03-06T20:53:25.646-05:002011-03-06T20:53:25.646-05:00Yes, good beds were expensive. And people think Sh...Yes, good beds were expensive. And people think Shakespeare cheap for living his wife his second best bed!!<br /> I've read At Day's Close. An excellent book. There's also that five volume series on the history of private life -- have you read it? I'm going through it again to see what I can find about what we're talking about. There's quite a bit there about privacy and bodily functions.<br /> Doug/MERDoug Caprahttps://www.blogger.com/profile/15722777627862939708noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-50741322884488812552011-03-06T18:52:59.495-05:002011-03-06T18:52:59.495-05:00Hi Doug – Yes, that’s a good book. I haven’t finis...Hi Doug – Yes, that’s a good book. I haven’t finished reading it. I remember reading somewhere about women in the late 19th century who took baths their whole lives with their clothes on. They were never supposed to see their own naked body.<br /><br />Roy Porter (a great medical historian) writes about the diary of a woman in 1807 who mentions preferring to change her clothes in private. “I like to be alone when I dress and undress.” She comments that this is an exceptional attitude for the time. Both she and her brother were taught to have a high regard for personal modesty. “I like to bathe alone,” she writes. <br /><br />As you say, there are various trends that should be tracked. And they’re all interesting. I have a book on the history of undergarments. There is the change in attitudes towards bodily functions. There’s the architectural opportunity for more privacy. There are changes in sleeping practices. <br /><br />There’s a fascinating book called “At Day’s Close: Night in times past.” The author – a historian – spent 20 years reading diaries and legal records for references to what happened at night in pre-industrial times. It used to be quite common to have “bedfellows.” People slept in the same bed, for various reasons – warmth, fear, a lack of beds – they were the most expensive material possession (for those who didn’t sleep on hay on the floor).Jan Hendersonhttp://www.TheHealthCulture.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-90292222126609478142011-03-05T13:52:49.710-05:002011-03-05T13:52:49.710-05:00This comment has been removed by the author.Suzy Furno-Mariclehttps://www.blogger.com/profile/09656508287697541479noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-46408862188202658802011-03-03T23:49:42.779-05:002011-03-03T23:49:42.779-05:00I recently read a book called "The Body Proje...I recently read a book called "The Body Project," about the history of young women and the relationship with their bodies. Very interesting. According to the book, in the 19th century (Victorian) many women had sex clothed and rarely took clothing off for the doctors. A change occurred in the early 20th century, the book said. It doesn't explain the factors that caused the change. But unclothed sex became more common and many women seemed less concerned with nakedness, doctors reported. Of course, we need to consider from what sources the notice of these changes are coming? Are we getting these reports from doctors, women, men?<br /> These are the kinds of trends we need to track, I think, to try to understand attitudes toward modesty. What factors are causing these changes. <br /> Doug/MERDoug Caprahttps://www.blogger.com/profile/15722777627862939708noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-90226756322359798112011-03-03T20:49:12.571-05:002011-03-03T20:49:12.571-05:00Dr. Sherman – I didn’t mean to imply that there wa...Dr. Sherman – I didn’t mean to imply that there was a connection between male modesty and male nudity in the past. Merely that women – in the absence of any direct knowledge – might have been making an (incorrect) assumption about male attitudes towards nudity (in an all-male context).<br /><br />Unfortunately it is sad but true that we now know young men have been victims of sexual abuse.<br /><br />There are a number of comments on male nudity in Barcan’s book “Nudity.” One is that naked male bodies in public spaces are considered more “dangerous” than naked female bodies. This relates to the cultural assumptions about male sexuality that I mentioned in my reply to Doug. <br /><br />Barcan repeatedly points out that nudity is associated with sexuality, and in modern times the association has become especially intense due to the use of idealized, partially clothed bodies to sell products and the widespread availability of porn on the Internet. With respect to modesty, she points out that advertising has made people more aware of – and unhappy with – their bodies. As a result there is an increased desire for privacy. <br /><br />I would wager that close to 100% of what’s been written over the last few decades about attitudes towards our bodies (originating in feminist studies) focuses on women’s bodies. But it makes sense that an increased need for privacy, stimulated by the excess of beautiful bodies we view everyday, should be true for both men and women.Jan Hendersonhttp://www.TheHealthCulture.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-29473224152936030982011-03-03T20:11:43.332-05:002011-03-03T20:11:43.332-05:00Doug – You’re absolutely right about the differenc...Doug – You’re absolutely right about the difference between an all male locker room and a female urologist. What I’m realizing here is that there were no 19th century modesty complaints from men because there were (virtually) no women doctors. Office (vs. home) visits didn’t start until the early 20th century. There may have been female office staff at that time, but cultural morés would undoubtedly have sought to protect women from seeing naked men rather than protect men from being seen. There were female nurses in the 19th century, but hospitals were limited to treating the indigent and soldiers injured in battle. So the issue of male modesty came up rarely until … when? Even through the post-WW II era, female doctors were the exception. It strikes me that, since the sixties, there’s been a projection of (not necessarily correct) assumptions about male sexuality (an example at http://bit.ly/eq8A9H) onto assumptions about male modesty. You and Dr. Sherman have a tough job ahead of you in educating the public, but it’s an extremely worthy endeavor.<br /><br />I appreciate your comment on how men have projected their modesty fears onto women. The idea that women’s modesty must be protected because of the effect it has on men is part of the long history of cultural assumptions about men that you’re up against.Jan Hendersonhttp://www.TheHealthCulture.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-42091208667388841772011-03-01T10:25:14.647-05:002011-03-01T10:25:14.647-05:00Jan, as we've discussed elsewhere little is kn...Jan, as we've discussed elsewhere little is known or studied about male modesty. But I don't think the historical lack of concern about it is due to the fact that men have been used to all male nudity in the past (though no longer). I believe it relates more to the attitude that men 'don't need modesty.' That is to say that men are at much less risk of sexual assault or rape than women. That at least is the theory though its validity can be questioned as the statistics show that boys have been assaulted at a highly significant rate, roughly 50% that of women. Mores are changing and now young men are very aware of increased susceptibility to assault when they are exposed.Joel Sherman MDhttps://www.blogger.com/profile/15302609163683972129noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-35042655869984304122011-03-01T01:04:08.287-05:002011-03-01T01:04:08.287-05:00" I wonder if women assume that men are used ..." I wonder if women assume that men are used to being naked in the locker room and so nudity doesn’t bother them."<br /><br />Jan -- I could never understand that argument. Yes, my generation of men (and earlier generations) felt quite comfortable being nude with other men in situations like showers. But there were no women present. Many of these kind of events were male bonding rituals, historically. Nudity was part of it.<br /> How men feel when they're in a shower with other men has nothing to do with how some men feel when having no other choice but to be examined or treated intimately by a female caregiver. Male nudity rituals rarely involved women in the past. <br /> Re the research of Havelock Ellis and the writings of Augustine, I think there's an argument that men are more modest than women for reasons Augustine goes into in detail. Men have projected their modesty fears on to women. Women's modesty must be protected because of the affect it has on men, physically. Women's sexuality is dangerous to men. <br /> Jan -- Your thoughts on this?<br /> Doug/MErDoug Caprahttps://www.blogger.com/profile/15722777627862939708noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-52457555563611975502011-02-28T22:57:19.368-05:002011-02-28T22:57:19.368-05:00Doug – That’s a good distinction between not being...Doug – That’s a good distinction between not being especially modest, but being justifiably upset when exposed in an unacceptable way.<br /><br />I think you’re right that it’s no longer a male or female issue. I suspect most women get used to having an annual Pap test, and most ob/gyn’s are now female, which was not the case just decades ago. <br /><br />The thing that struck me when I first read the Bioethics Discussion blog several years ago was male modesty. It hadn’t occurred to me. I wonder if women assume that men are used to being naked in the locker room and so nudity doesn’t bother them. In reading through the historical data, I didn’t find any references to male modestly. The 19th century complaints from men were about how doctors shouldn’t be examining women.Jan Hendersonhttp://www.TheHealthCulture.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-54251727281582329872011-02-26T22:07:14.990-05:002011-02-26T22:07:14.990-05:00Suzy – I’m not as well-informed as you and Doug an...Suzy – I’m not as well-informed as you and Doug and Dr. Sherman are about contemporary patient’s attitudes towards modesty and privacy. I remember the first time I came across a discussion of the subject on Dr. Maurices’ Bioethics blog, it was pretty eye-opening. <br /><br />My sense is that this issue is not brought to the attention of doctors very often (not to mention all the other medical personnel who see patients). That’s based on reading the mainstream medical journals (JAMA, NEJM, The Lancet) and seeing what gets discussed at a site like KevinMD (with the exception of the guest post from this blog). The journals don’t seem to publish any studies on the topic. I wonder if the research is happening elsewhere, like among medical sociologists.Jan Hendersonhttp://www.TheHealthCulture.comnoreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-53470351618394384012011-02-24T17:46:50.862-05:002011-02-24T17:46:50.862-05:00I really don't see this so much as a "mal...I really don't see this so much as a "male" or "female' modesty issue anymore. Not really. I see it more as a human dignity issue. A patient autonomy issue. A patient-centered philosophy issue. Even if a person isn't modesty at all, he or she could be treated without dignity in terms of unacceptable bodily exposure. I think most people are not either "modest" or "not modest." I think the context is essential. Nude art models can be very modest in different contexts. Male and female strippers can be modest in different situations. Nudists can be easily humiliated or shamed with their own nudity in the correct contexts. For example, even if a nudist doesn't mind parading around the hospital nude, that's not acceptable from several points of view -- if it's allowed, it sets a standard of acceptability. It may offend other patients or staff. Within cultural parameters, there are boundaries, standards. Within the confines of the exam room, doctors and nurse can be more flexible depending upon the patient's comfort (and their own comfort). But the key is the patient comfort. Medical professionals need to learn that "modesty" is a complex and variable concept. If they really care, the most common way they're going to learn about how most patients feel about the issue is to ask and accept that there are preferences depending upon varied contexts. But I don't see that happening unless it's forced due to the nature of the historic and current medical culture. Some caregivers are sensitive to this issues. Others are not. Some don’t consider it an issue. A few are completely oblivious to it. Others have changed and see it better. But money and profit drives medicine today, and time drives money and profit, and expediency and efficiency drives all this. Technology has done tremendously good things to save our lives. But technology has also distanced doctors and nurses from patients as human beings. We as patients have become more like"images" that are read than human beings who are listened to and examined. Of course there rare exceptions to this generalization. There many good caregivers out there to know this and try to mitigate it. <br /> As to Suzy’s question -- I don’t doubt her observation. As I become more knowledgeable and comfortable debating this topic, I find that when the modesty issue is realistically tied into ethics and human dignity, there really is no argument or debate. Many caregivers know this. They see better than anyone the flaws in the system since they work within it every day. To some, the problems are overwhelming. And the power dynamic within the healthcare hierarchy frightens many of them away from revealing who they are. Depending upon the culture of their workplace, it may not be politically correct (or even considered intellectual) to advocate for patient modesty. Thus, if we argue this issue as a human dignity issue -- not mere modesty -- caregivers don’t have much of an argument. The core values of their institutions, their codes of ethics, their patient rights and responsibilities documents -- all advocate for patient dignity, respect and autonomy.<br /> Doug/MERDoug Caprahttps://www.blogger.com/profile/15722777627862939708noreply@blogger.comtag:blogger.com,1999:blog-2752793986869193186.post-36480617318562682312011-02-24T14:05:03.996-05:002011-02-24T14:05:03.996-05:00Jan:
Very interesting part 2. It's easy for re...Jan:<br />Very interesting part 2. It's easy for readers to understand how the medical field attempted to break down modesty barriers, which was necessary to achieve more accurate care. How to handle this "new idea" of no modesty was certainly experimental, as there were no other coercive techniques existing quite like this one. Perhaps they did the best that they could within this new era of medicine. <br />As you said, however, "technology is always pushing doctors to new frontiers", and part of that new frontier is the advent of the modern savvy patient. It seems that the past antiquated 'conditioning' is still projected onto patients. Patients who still have respect for a medical provider but not with tha same passive carte-blanc attitude toward each person or every procedure. I would say that it is the medical arena who finds it difficult to keep up with changing patient expectations, therefore: it is easier to ignore it.<br /> It is indeed " always a brave new world". Well said. It encompasses the changes I see in patients willingness to speak up for the respect of their bodies.<br /><br />I don't know if Dr. Sherman and Doug can speak to this, but I speak with more and more people who drop the anonymous aspect of speaking up for modesty. Conversely, more people who want to make it a non-issue are taking the anonymous seat. This is an important psychological dynamic, as it openly changes the power structure: a move that can not be overstated.<br />While we may not be becoming vogue, (yet)at least we are more readily accepted.<br /><br />Your straight forward articles are certainly an important and informative read. I hope advocates and patients come here to review this history.<br />And thanx for the kind words regarding my blog....<br /><br />SuzySuzy Furno-Mariclehttps://www.blogger.com/profile/09656508287697541479noreply@blogger.com