Sometimes the Twain Should Meet

That we are, each of us, different is a given; that societies and the cultures they produce are different, is also self-evident. But that any one individual picked at random should be representative of that difference is another matter. We humans tend to be bicameral when and if it suits us. For example: my Asian friend is clever and devious, so most Asians are probably clever and devious (inductive reasoning); but at other times: everybody knows the French are rude, so perhaps I should not hire that French person (deductive reasoning).

How much credence can we put in either type of reasoning when it comes to judging world views of different cultures? There was an interesting article in BBC News about this a while ago: http://www.bbc.com/future/story/20170118-how-east-and-west-think-in-profoundly-different-ways  And as you can imagine, the issue is complex: ‘From the broad differences between East and West, to subtle variation between U.S. states, it is becoming increasingly clear that history, geography and culture can change how we all think, in subtle and surprising ways – right down to our visual perception. Our thinking may even have been shaped by the kinds of crops our ancestors used to farm, and a single river may mark the boundaries between two different cognitive styles.’

‘[…] our “social orientation” appears to spill over into more fundamental aspects of reasoning. People in more collectivist societies tend to be more ‘holistic’ in the way they think about problems, focusing more on the relationships and the context of the situation at hand, while people in individualistic societies tend to focus on separate elements, and to consider situations as fixed and unchanging.’

For example: ‘An eye-tracking study by Richard Nisbett at the University of Michigan found that participants from East Asia tend to spend more time looking around the background of an image – working out the context – whereas people in America tended to spend more time concentrating on the main focus of the picture.’ So, ‘[…] this narrow or diverse focus directly determines what we remember of a scene at a later date.’ But because things like these seem to be so widely dispersed in a population, is it a genetic difference, or merely a learned, culturally favoured response? ‘Alex Mesoudi at the University of Exeter recently profiled the thinking styles of British Bangladeshi families in East London. He found that within one generation, the children of immigrants had started to adopt some elements of the more individualistic outlook, and less holistic cognitive styles. Media use, in particular, tended to be the biggest predictor of the shift. “It tended to be more important than schooling in explaining that shift.”’

The article goes on to suggest several theories as to why the so-called East-West differences arose in the first place -everything from epidemics, to types of crops grown by different populations, but the problem still remains: the differences lie on a spectrum –‘broad trends across vast numbers of people’. And yet even so, especially in small interpersonal discussions –dare I say ‘arguments’?- we are very likely to use whatever generalization makes our point.

But, for many of us, that tends to preclude any semblance of critical analysis. It’s far easier to succumb to the prevailing opinion without questioning the reasons for its presence, let alone its validity. And it’s not just the so-called East/West divide –the potential seems to arise whenever any culture examines another. Perhaps an example that stands out clearly in contemporary life, is that of the hijab –the headscarf. Sometimes the objections are couched in religiosecular terms of course, but they often boil down to simple perspective –Weltanschauung.

Aaisha, a Muslim friend of mine recently decided to wear the hijab, and although there were no prohibitive policies or objections from her bosses at work, she encountered resistance from a source she had not anticipated –her co-workers.

Some of it was just petty –“Why would you want to cover your hair?” one woman said to her, adding “It’s so beautiful” no doubt to take the sting out of her rudeness. But the woman had never complimented her hair before, so it rang hollow to Aaisha.

And then she told me about another, a man who had just joined the company a few months before and who seemed quite uncomfortable with hijab and glared at her whenever he passed her desk. Finally, she decided to talk to him about it.

“You keep staring at me, Jeffrey,” she said, smiling confidently as she walked up to his desk. “I get the impression you’re unhappy about something.”

He acted surprised at first, and then his scowl returned and he pointed at her head. “You didn’t used to wear that scarf, Aaisha,” he said, trying to keep his tone friendly.

Her smile broadened and she pointed to his tie. “I don’t remember you wearing that tie before, either, Jeffrey.”

He blinked uncomprehendingly. “It’s just a tie. I wear different ties all the time…”

She didn’t skip a beat. “It’s just a hijab,” she said, obviously proud of the word and pointing to her head.. “And you may have noticed, I also wear different ones all the time…”

His eyes narrowed and his forehead wrinkled. “A tie is different, Aaisha…”

She waited for him to continue, but he seemed to think his answer was complete –and for him, it probably was. Finally, she decided to ask the obvious question. “Oh…?  And how is it different?”

He actually rolled his eyes at the stupidity of the question. “It’s what men are expected to wear to work.”

The smile never left her face and she pointed to another man at the next desk. “John never wears a tie…”

Jeffrey shrugged. “We’re different, that’s all… And anyway, I’m my own person.”

Aaisha stood there, for a moment, and then blinked. “And so am I, I guess…”

Jeffrey seemed surprised at her answer, then shook his head. “Nobody makes me wear the tie…”

At this point, Aaisha laughed. “And nobody makes me wear a hijab, Jeffrey.”

He didn’t seem to know how to react. “But… Well, how about your husband?”

She shook her head, still smiling. “I’m not married… And my father and brothers are still back in England -just in case you want to involve them,” she added with a laugh.

Jeffrey began to sense he was losing the argument. “It’s a family tradition -and also a society thing- Aaisha. My father always wore a tie to work –and his father before him…” But his voice was less confident.

Aisha sighed. “Should I tell you about my mother, and her sisters? They all wore the hijab back in London –and not because they were forced to, they’d be quick to tell you. They just felt more a part of the community wearing hijab, so it, too, was a society-thing as you called it…”

He blinked, but slowly. “Your society, Aaisha, not ours!”

The smile returned, and she nodded her head towards John again. “And what about John? Does he belong to another society, as well? We’re all immigrants, Jeff; we’re all other if you go back a generation or two. And thank god we don’t all have to dress the same,” she said, touching the sleeve of his fraying shirt with her hand and winking coyly at him.

And for the first time, he smiled at her.

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Kegel Exercises in Pregnancy

Okay, okay, I was wrong! It happens. Sometimes the brain gets in the way of scientific studies –prejudges them. Alters them in little ways so they do not conflict with its own opinions. Or, worse still, is influenced by a confirmation bias that precludes even the perusal of any information that makes it uncomfortable. The brain can be its own editor, redacting reams of otherwise useful knowledge, recusing itself inappropriately. None of us readily admit guilt in this respect, of course. In a sense, we are blind to it… or want to be.

I’m a gynaecologist as well as an obstetrician, so I have long been aware of the value of strengthening the pelvic floor muscles to prevent urinary incontinence amongst other things. There are a set of muscles –the levator ani muscles- that act as a kind of pelvic platform and help support the various organs that transit through the area, notably the bladder, uterus, and rectum. Exercising them was proposed by a Dr. Kegel in 1952, albeit to strengthen their ability to narrow the vagina and hence the ease of orgasm. I think a more frequently admitted use, is to reduce urinary incontinence, however. Indeed, to discover  the correct muscle for training, the woman need only attempt to stop her urinary stream and she has identified the correct one.

Prominent among the levator ani muscles is the pubococcygeus muscle. (The name merely describes where the muscle starts –the pubic bone, and where it ends- the coccyx, or tail-bone. On its journey, it wraps around, first the urethra –the tube that empties the bladder-  and then the vagina, and finally the rectum, like a series of hammocks). The fact that strengthening it can constrict the vaginal diameter when contracted, has always been a kind of two-edged sword for those of us who deliver babies. On the one hand, there is some fairly longstanding and convincing evidence that it can indeed help to prevent the involuntary loss of urine (urinary incontinence). But remember that it not only helps support the bladder and its opening, it is also a hammock that supports and constricts the vaginal canal. Well, that’s what the baby has to squeeze through… So, does the one benefit become a detriment to the other? Are you robbing Petra to pay Paula?

I have to admit that I was one of the exercise skeptics; it made sense to me that the stronger the muscles that surround the vagina -the greater their bulk- the narrower and more difficult the passageway for the baby to pass through at delivery. At the very least, I reasoned, it would take a greater effort on the part of the mother to force her baby through. And all this at a time when she is already exhausted from her labour. Maybe it would make more sense to work on strengthening those muscles in the weeks and months after delivery. Everything in the area was stretched or torn from the effort of actually pushing the baby’s head out, so perhaps the benefits would accrue if those muscles were strengthen then –a sort of postpartum rehabilitation.

In other words, would strong pelvic floor muscles increase complications in either labour or birth? Would there be a higher incidence of Caesarian Sections, for example? Or the need for episiotomy (cutting the skin at the opening of the vagina) to allow more room for the baby’s head to descend? Would there be a greater need for so-called operative delivery (forceps or vacuum extraction)?

Well, here’s where the information from large studies are more helpful than personal experience. Each of us carries a bias –acknowledged, or buried deep within our own reminiscences of similar situations. If I, for example, believe that the Kegel exercises are a hindrance to normal delivery, I am more likely to remember any episodes in my career where that might indeed have played a role –unaware, or maybe conveniently forgetting  (or not even asking about) times when it didn’t. Confirmation bias again. Limited, or selective, observations are not necessarily a valid reflection of the collective reality. They amount to opinions, not proof, and carry only as much weight as the prestige of the propounder allows. In my case, it was never very much…

The benefit of Kegel exercises in pregnancy remained somewhat controversial in the obstetrical community –at least amongst us iconoclasts- until some Norwegian researchers, notably Kari Bo at the Norwegian School of Sport Sciences, decided to investigate it in a large group of women (18,865 primiparous women) who practiced Kegel exercises at various frequencies per week during pregnancy. The group then looked at the outcome and complications of their labours and deliveries. http://www.ncbi.nlm.gov/pubmed/19461423 There was no difference in outcomes between those who did Kegels religiously in pregnancy, and those who did not. Presumably, the pelvic floor muscles –as strong (and bulky?) as they had become- were able to relax enough to allow normal passage of the baby.

I learned a lot from that paper –and a lot about the way my beliefs interpret my experience. A lot, too, about the way many of us travel through our lives, influenced as we are by only limited familiarity or exposure to events, and drawing perhaps unwarranted –or at least unproven- conclusions from them. And although it is inductive reasoning with all of its inherent uncertainty, deriving conclusions that are reliable and from sufficient observations can be a problem. Generalizing, in other words: probabilistic forecasting from limited available data. An example sometimes given is: all the swans I’ve ever seen have been white, so therefore it would seem reasonable to conclude that all swans must be white… until, that is I see a black swan. Obviously, any one person’s experience must be limited, so any conclusions derived from them, must also be limited.

All generalizations are false, including this one, as Mark Twain famously observed. I’m not sure I’d go that far, though. I think George Bernard Shaw was closer to what I have learned about depending on one’s own experience to the exclusion of competing views: Beware of false knowledge; it is more dangerous than ignorance.