The Court of Public Opinion -an interesting phrase to be sure. It implies the judgemental assessment of an action, an idea -an opinion- by society at large. An interpretation, not necessarily impartial or even appropriate. A reaction, really, to something that stands out as different in some way from that Public’s perceived norms.
A Culture’s value system is usually encapsulated in what sociologists have termed its folkways -unconscious guides of conduct and thinking- and its mores -its more important customs. These have an even greater significance than may seem obvious at first glance: they are assumed, taken for granted and thus largely unexamined. And of course they vary from country to country, culture to culture -although less so nowadays with our ubiquitous interconnectedness; they are what have always made foreign travel so exciting. So broadening: that others espouse something terribly alien to what we have been acculturated to accept… to expect… Epiphanous that our own customary behaviour is actually heretical somewhere else. That norms, in fact, aren’t necessarily normative.
All of this suggests that societal expectations can vary; not all values transcend geography; ideas that once held sway are ultimately mutable -inevitably changing as society itself evolves. But existent mores are powerful creatures nonetheless; they channel behaviours and engender punishments for perceived transgressions. When an act conflicts with canon, there are consequences -if only those of guilt and remorse, or the necessity of an obsequious denial of responsibility.
And once an act is deemed aberrant, anomalous -or just plain wrong– it is anathema to be seen or suspected of performing it. Think of our current attitude to, say, drinking and driving: years ago it was a subject of humorous tolerance; now it incurs not only societal, but also legal penalties. The same with such diverse things as domestic violence, or even animal abuse: once occasioning an uncomfortable averting of the eyes, they are now subject to intervention and prosecution.
It is difficult to know or predict what will fall within the purview of acceptable behaviour, but moralists are not without hope that their particular vision will be thus incorporated and often actively pursue campaigns to that end. Smoking is perhaps the quintessential example. While there is little debate about the adverse health issues visited upon the smoker, this was generalized to include his immediate vicinity in an ever-expanding circle that soon came to include the room where he smoked, the adjacent rooms, the floor, the building, and finally the grounds upon which the entire complex rested. Now, with a few disgruntled cynics it is largely accepted as appropriate and well within the bounds of common sense.
Public Health authorities have long recognized the value of trying to convince their public that certain issues should not be ignored. They are so important that to allow the behaviour is tantamount to endangering the health of innocent bystanders: vaccination for example and its benefit of ‘herd immunity’ whereby the more people are protected from some communicable disease, the less of them are available to transmit it. And for some reason while the reliability of vaccination seems to vacillate between acceptable and questionable in some populations, other health issues have been more thoroughly encapsulated into popular wisdom. Smoking in pregnancy, for example, or excessive alcohol consumption -indeed any alcohol consumption- by an obviously pregnant woman, are now behaviours that draw critical glances from friends and even uninvolved strangers. These have apparently slipped into the unconscious mores of a more-observant Society. They are unhealthy acts, selfish acts. We all now know this to be the case… How dare anybody disagree?
And there are even deeper levels of disapproval directed towards illicit drug use in pregnancy. Never tolerated or understood by most of us at the best of times, their use is so unacceptable in pregnancy as to engender almost universal anger and condemnation of the individual and her unfortunate circumstances.
I make these observations, not to deride what most of us would be willing to tolerate in a society, but more to draw attention to what this bias -however appropriate and well-meaning- is likely to do to someone caught on the other side of the equation. The opinions of others -their respect and approbation- is deeply influential, even required by most of us. So much so, the offending behaviour is often hidden or denied in an attempt to be seen to adhere to what is considered ‘proper’. To admit the deviance is to be excluded, criticized, judged.
How then, to help someone who is reluctant to admit to something of which she is ashamed? Something she might feel would prejudice your opinion of her? Your willingness to accept her without contempt? Alter the way you deal with her..?
An obviously thorny issue in obstetrical care, it is also a delicate one. Printed, official-looking prenatal forms with multiple tick-off boxes of questions go some way to alleviating her concerns: her issues might seem to be only a small part of a general interrogation aimed at all pregnant women -not just her… And yet concerns about who might have access to the information in the hospital setting might impede accurate answers. If she admits to drug use, will the hospital social worker take action to apprehend her baby, for example? Will she be treated differently if it is known that she was consuming alcohol in the pregnancy? If she was smoking? If she was the subject of ongoing domestic violence..? Will her personal integrity and wishes be questioned, or even disregarded in the name of some perceived Greater Good? With unknowns like these, would denial be her best option?
And how should the care-giver react? If the patient admits to something unhealthy, something seen as unacceptable, is the greater good to be realized by trying to change her behaviour and perhaps not writing it in the chart to protect her ‘secret’, or by alerting the appropriate authorities: pediatricians, medical specialists, and the like? It is an obvious choice for most of us, I suspect. But if a well-intentioned cover-up is initially chosen at the mother’s behest, suppose despite all efforts, her behaviour persists -does one then direct one’s attention to the baby, the mother… Society? And at what point? Is it a betrayal? It is a decisional labyrinth with untoward consequences down every path.
Ultimately, trust is probably the most likely factor affecting the honesty of the response for both parties. Trust that the person she has delegated to care for her in the pregnancy will honour her; trust that the route taken will be chosen with care and understanding. Trust does not always end at the expected destination of course, but hopefully it will be a fully explained and acceptable compromise. A place where she and her baby can live without regrets: in society… Where else is there, after all?