Category Archives: education

Southeast Asia Marginalized in Islamic Studies

From Robert W. Hefner’s introduction to Islam in an Era of Nation-States: Politics and Religious Renewal in Muslim Southeast Asia, ed. by Robert W. Hefner and Patricia Horvatich (U. Hawai‘i Press, 1997), pp. pp. 8-9 (references omitted):

One of the most serious impediments to the development of a systematic understanding of Islam in Southeast Asia is the fact that the topic has long been marginalized in the fields of Islamic and Southeast Asian studies. In Islamic studies Western and Middle Eastern scholars alike have tended to place Southeast Asia at the intellectual periphery of the Islamic world. Still today in some overviews of Islamic history and civilization, Southeast Asian Muslims are mentioned briefly if at all. Though Southeast Asian Islam has almost two hundred million believers, it is not uncommon for observers, even learned specialists, to identify Islam with the Middle East and to regard Southeast Asia as, at best, intellectually and institutionally derivative of Middle Eastern Islam.

There is a larger and, in one sense, understandable logic to this neglect. By comparison to Persia and the Arabian heartland, in insular Southeast Asia Islam became a civilizational force relatively late in Islamic history. Though Arab-Muslim traders traveled through island Southeast Asia as early as the seventh and eighth centuries, there was little settlement until the late thirteenth, when a Muslim town, inhabited in part by Arab-speaking foreigners, was established in the Pasai region of north Sumatra, an entrepôt for the trade with Muslim India and Arabia. Shortly thereafter, a Muslim presence appears to have been established in port towns along Java’s north coast, territories still then under the control of the Hindu-Buddhist kingdom of Majapahit. Ruling elites in the Malay peninsula were converted in the fifteenth and sixteenth centuries, and those in coastal Sulawesi and much of the southern Philippines were won to the faith in the seventeenth and eighteenth centuries.

The primary impetus for this wave of conversion was not conquest or religious warfare, as had been the case in Islam’s early expansion in Arabia and North Africa, but trade and interethnic intercourse. Certainly, as Anthony Reid has noted, Muslim potentates (like their Theravada Buddhist counterparts in mainland Southeast Asia) regarded forcible conversion of neighbors as “an honourable motive for conquest,” and Muslim rulers periodically engaged in warfare with their Hindu-Buddhist, animist, or, in later times, Christian neighbors. However, as Thomas McKenna’s essay in this volume illustrates, the causes of these conflicts were as much commercial and dynastic as they were religious.

More decisively, the rapid and relatively uniform spread of Islam to the insular world’s maritime centers was related to broader historical developments, especially the growth of international commerce from the fifteenth to seventeenth centuries and the movement of large numbers of people out of localized societies into a multiethnic and interregional macrocosm. Most of the map of modern Muslim Southeast Asia was laid out during this “age of commerce,” as Anthony Reid has so aptly described it. A few remote corners of Southeast Asia have been converted to Islam in this century, some even in the last decades. In general, however, the dynamism of Islam in contemporary times has had less to do with a new wave of conversion than with the reform and rationalization of religion among established Muslim populations.

By itself, the comparatively late arrival of Islam in Southeast Asia neither explains nor justifies this region’s marginalization within the field of Islamic studies. Given the genesis of what has come to be regarded as “classical” Islamic civilization within the Arabic- and Persian-speaking world, however, there was a tendency on the part of early Western Islamicists to devote their attention to regions where the classical tradition was first composed. This emphasis was reinforced by the focus of this early scholarship on Islamic “culture,” not in the modern, social-historical or anthropological sense of this term, but in its great-traditional sense, as in written literature, philosophy, art and architecture, and law. With several notable exceptions, the Orientalist commentaries that introduced Islamic civilization to a Western readership in the late nineteenth and early twentieth centuries were concerned with high culture, not the everyday meaning of Islam for ordinary Muslims. The focus of this writing was leading thinkers and civilizationwide achievements, especially those preserved for time in the printed word.

As a result of this textual emphasis, Southeast Asia—and other areas marginalized in the Orientalist understanding of the Muslim world, such as Central Asia, Bengal, and West Africa—was accorded only a minor role in early accounts of Islamic civilization.

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Two Schoolgirls in Kabul, 1992

From A Thousand Splendid Suns, by Khaled Hosseini (Riverhead Books, 2007), pp. 159-161:

IN JUNE OF THAT YEAR, 1992, there was heavy fighting in West Kabul between the Pashtun forces of the warlord Sayyaf and the Hazaras of the Wahdat faction. The shelling knocked down power lines, pulverized entire blocks of shops and homes. Laila heard that Pashtun militiamen were attacking Hazara households, breaking in and shooting entire families, execution style, and that Hazaras were retaliating by abducting Pashtun civilians, raping Pashtun girls, shelling Pashtun neighborhoods, and killing indiscriminately. Every day, bodies were found tied to trees, sometimes burned beyond recognition. Often, they’d been shot in the head, had had their eyes gouged out, their tongues cut out.

Babi tried again to convince Mammy to leave Kabul. “They’ll work it out,” Mammy said. “This fighting is temporary. They’ll sit down and figure something out.””Fariba, all these people know is war,” said Babi. “They learned to walk with a milk bottle in one hand and a gun in the other.”

“Who are you to say?” Mammy shot back. “Did you fight jihad? Did you abandon everything you had and risk your life? If not for the Mujahideen, we’d still be the Soviets’ servants, remember. And now you’d have us betray them!”

“We aren’t the ones doing the betraying, Fariba.”

“You go, then. Take your daughter and run away. Send me a postcard. But peace is coming, and I, for one, am going to wait for it.”

The streets became so unsafe that Babi did an unthinkable thing: He had Laila drop out of school.

He took over the teaching duties himself. Laila went into his study every day after sundown, and, as Hekmatyar launched his rockets at Massoud from the southern outskirts of the city, Babi and she discussed the ghazals of Hafez and the works of the beloved Afghan poet Ustad Khalilullah Khalili. Babi taught her to derive the quadratic equation, showed her how to factor polynomials and plot parametric curves. When he was teaching, Babi was transformed. In his element, amid his books, he looked taller to Laila. His voice seemed to rise from a calmer, deeper place, and he didn’t blink nearly as much. Laila pictured him as he must have been once, erasing his blackboard with graceful swipes, looking over a student’s shoulder, fatherly and attentive….

ONE DAY THAT same month of June, Giti was walking home from school with two classmates. Only three blocks from Giti’s house, a stray rocket struck the girls. Later that terrible day, Laila learned that Nila, Giti’s mother, had run up and down the street where Giti was killed, collecting pieces ofher daughter’s flesh in an apron, screech- ing hysterically. Giti’s decomposing right foot, still in its nylon sock and purple sneaker, would be found on a rooftop two weeks later.

At Giti’s fatiha, the day after the killings, Laila sat stunned in a roomful of weeping women. This was the first time that someone whom Laila had known, been close to, loved, had died. She couldn’t get around the unfathomable reality that Giti wasn’t alive anymore. Giti, with whom Laila had exchanged secret notes in class, whose fingernails she had polished, whose chin hair she had plucked with tweezers. Giti, who was going to marry Sabir the goalkeeper. Giti was dead. Dead. Blown to pieces. At last, Laila began to weep for her friend. And all the tears that she hadn’t been able to shed at her [Mujahideen] brothers’ funeral came pouring down.

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On Cultural Explanations for Lightning Strikes

I think what depresses me most about the state of the world is not so much what happens—so much of which is out of any free society’s control—as what the Politically Voiced make of what happens after the fact: the international news media, political leaders, and the blogosphere. Lightning cannot strike in the forest without someone being vilified for letting it happen—or conspiring to make it happen. What a world of Tuesday-morning totalitarians the Voiced have become.

Of course I’ve been following the unfolding of events at Virginia Tech, as have people in India, Kenya, Moldova, Peru, Romania, the UAE, and elsewhere around the world. This hits close to home for me for several reasons. My maternal roots go back to Southwest Virginia and the Shenandoah Valley. My maternal grandmother died at Lewis-Gale Hospital in Salem, and my mother died at Roanoke Memorial Hospital—neither of them from gunshot wounds. My mother is buried on a hillside south of Roanoke overlooking her beloved Blue Ridge Mountains. After resigning from the mission field, my father served as chaplain of Virginia Baptist Children’s Home in Salem, and later as pastor or interim/supply pastor for just about every other little Baptist church between Lynchburg and South Boston, Va. And some old family friends from Honolulu (orginally from Sri Lanka) sent both their daughters to Virginia Tech after they moved to Fairfax, Va.

My heart goes out to all the victims of the shooting and their families and friends, including to the parents and elder sister of the shooter. Cho Seung-hui graduated from high school the same year as my own daughter.

The South Korean government, for what I hope to be invalid reasons, seems to expect the U.S. government to exploit the shooting for xenophobic purposes, just as the ROK government, media, and Netizens exploit every crime committed by foreigners in Korea. I don’t understand why this should have any effect on Korean–American relations, or why the shooter should be considered representative of Koreans in general—or Americans in general, or immigrants in general, for that matter. Should the ROK foreign minister resign? The ROK interior minister did so in the wake of the worst spree killing on record, that of Woo Bum-Kon, a deranged policeman who killed 58 people and wounded 35 in South Korea in 1982?

Nevertheless, two Korea blogs, the Marmot’s Hole and the Metropolitician have compiled lengthy examples of critical Koreanalysis, with long comment threads full of arguments and counterarguments about cultural factors. I don’t think cultural explanations make much sense when one is attempting to explain individual pathologies that constitute statistical blips within huge sample populations.

Last September, a Canadian journalist of Chinese ancestry, Jan Wong (Huáng Míngzhēn), caused a huge popular outcry by suggesting cultural explanations for three notable killing sprees in Quebec: at Dawson College in September 2006, at Concordia University in August 1992, and at the École Polytechnique in December 1989. Of course, Wong is (or was) a Maoist, so perhaps she tends to see cultural traditions as the root cause of most of the world’s problems—and great proletarian cultural revolutions as their solution.

A large number of spree killings around the world have occurred on school campuses, from kindergartens to universities. What is it about academic culture around the world that encourages such reactions? Or are schools just prime locations for finding large herds of sheep for the slaughter? What is it about the culture of post offices in the U.S.?

Would someone please attempt a cultural explanation for the Bath School killings in Michigan in 1927, in which anal-retentive school superintendent and tax protestor Andrew Kehoe killed 45 people and injured 58—all without the use of guns or the lure of television cameras. The Ku Klux Klan managed to blame it on Kehoe’s Roman Catholicism. Those nowadays who cannot let any tragedy pass without using it to advance their political agendas are in good company.

The Wikipedia entry on school massacres also notes:

In contrast to Columbine, the 1927 Bath School disaster, in which 45 people died, engendered no copycat attempts. Following the forty-five deaths that resulted from the Bath School disaster in Bath, Michigan, there was much less media reporting on the event and no legislative response on any level other than local legislation to appropriate small amounts of money for the victims’ families.

In some respects, those were good old days.

UPDATE: Liminality offers some thoughtful ruminations about differing reactions by Koreans and Americans.

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Good Soldier Outlier: Student Teacher

The only reason I ended up in the Army in 1969 was because I had dropped out of college while the draft was still on. But I quickly resumed my formal and informal education as soon as I finished boot camp. After my idyllic nine months of formal but fun Romanian language study at the Defense Language Institute–West Coast, I was assigned to the do-nothing 95th Civil Affairs Group at Fort Gordon near Augusta, Georgia.

At Fort Gordon, I initially spent a lot of my off-duty time at the small public library near my barracks and even took a couple of on-base extension courses from Augusta College: physical anthropology and “humanities” (mostly Greek classics). But as my language skills atrophied from disuse, I began spending time at the language lab on base, where I tried to refresh my childhood Japanese by plodding through Eleanor Jordan’s Japanese language textbooks—listening to the audio portion on vinyl records!

The language lab didn’t have any Romanian materials, but it did offer occasional introductory classes in languages soldiers might expect to encounter when posted abroad. I signed up for a short introduction to Korean, taught by a ROK army officer who might have been studying at the Army Signal School. He managed to teach his class of beginners a few very formal phrases, the rudiments of the most excellent Korean alphabet, and one version of the national folksong, Arirang.

The director of the lab (and its sole full-time employee) was a friendly DoD civilian from Puerto Rico. I spent as much time chatting with him as I did trying to study Japanese on my own, and he recruited me to teach a few English conversation classes, one to a group of lovely GI wives, mostly from Thailand, and another to a rather tougher group of officers from South Korea, Turkey, and possibly Iran.

By that time, my civil affairs unit had transferred to Fort Bragg, North Carolina, leaving me behind with the base Personnel Control Facility because I was due to get out soon. In order to escape my boring new duty of escorting would-be deserters to their military tribunals, I had signed up for a six-week, full-time cement masonry class under Project Transition, designed ostensibly to help us become productive civilians.

One problem for me was that both my daytime class studying cement masonry and my evening class teaching English to foreign officers were a long way from my barracks, and I no longer had a car. I had to wear my uniform during Project Transition, but there was no way I was going to appear in my enlisted man’s uniform in front of a class of status-conscious foreign officers. So I had to hike a long way back and forth to my barracks at the far end of the post every evening in order to make the transition from student soldier to (ostensibly) civilian teacher.

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Teaching a Fishy English Lesson, Nhatrang, 1978

Jimmy and I attended the local elementary school, where our studies focused on math, literature, history, and science. All were taught from the Communist point of view. Miss San, who continued to teach my class, decided to hold a free tutorial session at her home every Sunday afternoon. Those were the only lectures in my experience that were not delivered with any political overtone.

Miss San lived in a two-story dwelling several blocks away from my street. She used her first floor as a fish-sauce factory, and three enormous earthenware jars were constantly at work there. Each container could hold two to three hundred pounds of fish, marinating in an equal amount of salt. She explained to us that making fish sauce was her main source of income. Teaching was just a recreational activity. The rancid smell of rotten fish was deadly, like the stench of tooth decay, only stronger. The odor permanently clung to her clothes, seeped into her hair, and like a miasma, spread to her surroundings. The adults, especially men, avoided her. They feared her eccentric nature. Children, however, were drawn to her warm personality, and no one found her more magnetic than I did.

As each Sunday afternoon approached, we eagerly wondered what surprise she had in store for us this week. Sitting on the floor in her rumpled bedroom among her scattered clothes, we waited for her appearance like the audience of a performing artist. One of Miss San’s favorite subjects was English. “The only way for us to grow as a nation is to learn from other countries’ technologies,” she often told us. “How can you learn their technologies? You can start by learning the universal language — English.”

She winked at us with a mischievous smile. “Today, let’s not learn from the textbook. Instead, let’s test our vocabularies, shall we? For the next hour, all of us must speak in English. I know this is a very difficult game, but we can try. Let’s have some fun together.”

We were trembling with excitement. Abandoning our language in a large group discussion such as this one was a forbidden act, yet it seemed so natural and harmless to us in that moment. As if she sensed our uncertainty, Miss San continued, “Let’s keep this our own little secret, children.”

She switched to English and the lesson began. “Duy went out last night,” she said, and I saw my friend sit up a little straighter. Pointing at a small girl in a ponytail, Miss San ordered, “Chi, please finish that thought.”

Chi pondered a few seconds and then said carefully, “Duy went out with a girl last night.”

There were some giggles among the students. The image of Duy with a girl was funny in any language. Miss San turned to me. “Kien, please?” she asked.

“Who was that girl? ” I formed a sentence quickly.

“Yes, that is a good question,” she said. “Tell us who that girl was, Duy.”

Duy stood up. Scratching his ears, he stuttered, searching the room for help. Someone whispered an answer, and he seized it as though he were drowning. “That girl was — was — was — my — mother,” he shouted. His voice cracked from the excitement. We fell into each other’s arms with laughter. Leaning against the wall, Miss San, too, was smiling. In the shadow of the room, I thought she was quite a beautiful lady, almost like a vision.

SOURCE: The Unwanted: A Memoir of Childhood, by Kien Nguyen (Back Bay, 2002), pp. 139-141

Miss San abruptly disappeared soon thereafter.

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Debunking the Self-Esteem Industry

The latest issue of New York Magazine reports on new research that not only debunks the self-esteem mania that prevails in Western educational theory, but suggests why the constant criticism that prevails in much Asian teaching and learning seems to get better results.

Since the 1969 publication of The Psychology of Self-Esteem, in which Nathaniel Branden opined that self-esteem was the single most important facet of a person, the belief that one must do whatever he can to achieve positive self-esteem has become a movement with broad societal effects. Anything potentially damaging to kids’ self-esteem was axed. Competitions were frowned upon. Soccer coaches stopped counting goals and handed out trophies to everyone. Teachers threw out their red pencils. Criticism was replaced with ubiquitous, even undeserved, praise.

[Carol] Dweck and [Lisa] Blackwell’s work is part of a larger academic challenge to one of the self-esteem movement’s key tenets: that praise, self-esteem, and performance rise and fall together. From 1970 to 2000, there were over 15,000 scholarly articles written on self-esteem and its relationship to everything—from sex to career advancement. But results were often contradictory or inconclusive. So in 2003 the Association for Psychological Science asked Dr. Roy Baumeister, then a leading proponent of self-esteem, to review this literature. His team concluded that self-esteem was polluted with flawed science. Only 200 of those 15,000 studies met their rigorous standards.

After reviewing those 200 studies, Baumeister concluded that having high self-esteem didn’t improve grades or career achievement. It didn’t even reduce alcohol usage. And it especially did not lower violence of any sort. (Highly aggressive, violent people happen to think very highly of themselves, debunking the theory that people are aggressive to make up for low self-esteem.) At the time, Baumeister was quoted as saying that his findings were “the biggest disappointment of my career.”

Now he’s on Dweck’s side of the argument, and his work is going in a similar direction: He will soon publish an article showing that for college students on the verge of failing in class, esteem-building praise causes their grades to sink further. Baumeister has come to believe the continued appeal of self-esteem is largely tied to parents’ pride in their children’s achievements: It’s so strong that “when they praise their kids, it’s not that far from praising themselves.”…

Psychologist Wulf-Uwe Meyer, a pioneer in the field, conducted a series of studies where children watched other students receive praise. According to Meyer’s findings, by the age of 12, children believe that earning praise from a teacher is not a sign you did well—it’s actually a sign you lack ability and the teacher thinks you need extra encouragement. And teens, Meyer found, discounted praise to such an extent that they believed it’s a teacher’s criticism—not praise at all—that really conveys a positive belief in a student’s aptitude.

In the opinion of cognitive scientist Daniel T. Willingham, a teacher who praises a child may be unwittingly sending the message that the student reached the limit of his innate ability, while a teacher who criticizes a pupil conveys the message that he can improve his performance even further.

via Arts & Letters Daily

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Pamuk on Humiliation as a Teaching Method

In his memoirs, Falaka and Nights, Ahmet Rasim wrote at length about his school days a century ago, when teachers in Ottoman schools held rods so long they could hit their pupils without even rising from their seats; our teachers encouraged us to read these books, perhaps to show us how lucky we were to have been spared the pre-Republican, pre-Atatürk era of the falaka [= bastinado]. But even in wealthy Nişantaşı, in the well-endowed Işık Lycée School, the old teachers left over from the Ottoman period found in some “modern” technical innovations new tools for oppressing the weak and defenseless: Our French-made rulers, and especially the thin hard strips of mica inserted into their sides, could, in their practiced hands, be as effective as the falaka and the rod.

In spite of myself, I almost rejoiced whenever someone else was disciplined for being lazy, uncivilized, stupid, or insolent. I was happy to see it applied to one gregarious girl who came to school in a chauffeur-driven car; a teacher’s pet, she was always standing up before us to do a croaky rendition of “Jingle Bells” in English, but this earned her no clemency when she was found guilty of doing sloppy homework. There were always a few who hadn’t done their homework but pretended they had, acting as if it was somewhere in their notebook if only they could find it. They’d cry out, “I can’t find it right now, teacher!” just to delay the inevitable for a few seconds, but it only added to the violence with which the teacher smacked them or pulled their ear.

When we’d moved on from the sweet and motherly women teachers of our early years to the angry old embittered men who taught us religion, music, and gymnastics in the upper grades, these rituals of humiliation became more elaborate, and there were times when the lessons were so boring that I was glad for the few minutes of entertainment the punishments provided….

I’d watch these scenes—first a scolding, then an angry shower of books and notebooks, while the rest of the class sat in frozen silence—thankful I was not one of those hapless pupils marked for humiliation. I shared my good fortune with about a third of the class. If this had been a school for children of all backgrounds, the line that set the lucky ones apart might have been more distinct, but this was a private school and all the pupils came from wealthy families. In the playground during recess, we enjoyed a childish fellowship that made the line disappear, but whenever I watched the beating and humiliation, I, like the awesome figure seated at the teacher’s desk, would ask myself why it was that some children could be so lazy, dishonorable, weak-willed, insensitive, or brainless. There were no answers to my dark moral probings in the comic books I’d begun reading; their evil characters were always drawn with crooked mouths. Finding nothing, either, in the shadowy depths of my own childish heart, I’d let the question fade away. I came to understand that the place they called school had no part in answering life’s most profound questions; rather, its main function was to prepare us for “real life” in all its political brutality. And so, until I reached lycée, I preferred to raise my hand and remain safely on the right side of the line.

SOURCE: Istanbul: Memories and the City, by Orhan Pamuk (Vintage, 2006), pp. 124-126

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Montessori Schools Turn 100, Find New Fans

The Montessori approach to education is now 100 years old, reports today’s Seattle Post-Intelligencer.

Its teaching methods once revolutionary are now used in traditional classrooms, with many public schools, including a few in Seattle, making a home for Montessori programs. Still, the trend toward standardized tests — and the need to prepare students for those exams — is making Montessori a little less popular in public school districts.

At the same time, the unpopularity of standardized tests is driving some parents to Montessori schools….

“It’s a lot more free-form,” said Troy Basel as he finished his lunch. “It’s a lot easier to get to the teachers.”

Montessori does have structure. But classrooms are based on creating natural connections to reading, writing and arithmetic. Children study algebra, U.S. history, Shakespeare, physics, biology and chemistry, yet are also “free to be who you want to be,” added 14-year-old Kate Rzegocki.

Pacific Crest also is predominantly white — 10 percent of its students are members of minorities. Historically, people thought of Montessori schools as dominated by wealthier, and often white, families, even though Maria Montessori created the system to serve poor children, said Laura Holt, who is on the board of the Pacific North West Montessori Association.

The image is changing around the city. Today, the Islamic School of Seattle offers a Montessori program. On Capitol Hill, one quarter of the students at the Learning Tree Montessori preschool are members of minorities, and the same percentage receives tuition subsidies, said Holt, assistant director of the school.

After a very regimented year in a Chinese preschool when she was 2 (and passing for 3), our daughter attended Montessori schools from preschool through 6th grade, and still thinks fondly of those years. I still remember how excited her teachers were when she finally found the courage to cross the threshold into the room where slightly older kids were doing their activities.

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"Poor students need only love, idealism and martyrdom"

In today’s New York Times, a 10th-grade history teacher at a public school in
the Bronx reviews Hollywood’s latest inspirational-teacher flick.

The great misconception of these films is not that actual schools are more chaotic and decrepit — many schools in poor neighborhoods are clean and orderly yet still don’t have enough teachers or money for supplies. No, the most dangerous message such films promote is that what schools really need are heroes. This is the Myth of the Great Teacher.

Films like “Freedom Writers” portray teachers more as missionaries than professionals, eager to give up their lives and comfort for the benefit of others, without need of compensation. Ms. Gruwell sacrifices money, time and even her marriage for her job….

“Freedom Writers,” like all teacher movies this side of “The Prime of Miss Jean Brodie,” is presented as a celebration of teaching, but its message is that poor students need only love, idealism and martyrdom.

I won’t argue the need for more of the first two, but I’m always surprised at how, once a Ms. Gruwell wins over a class with clowning, tears, rewards and motivational speeches, there is nothing those kids can’t do. It is as if all the previously insurmountable obstacles students face could be erased by a 10-minute pep talk or a fancy dinner. This trivializes not only the difficulties many real students must overcome, but also the hard-earned skill and tireless effort real teachers must use to help those students succeed.

It seems to me that Hollywood takes exactly the same short-attention-span approach to foreign policy. Each international crisis is a movie project. Activists devote their attention to it for six months or so, generating media events and raising tons of cash. When that’s done, they take several months off, then they’re ready for new causes, new projects, new scripts, new locations, new casts, new marriages. Nothing can’t be solved by media events, cash, and lots of feel-good self-congratulation. Who cares if their solution bombs with the people it aims to rescue. They’re not really the audience. They’re somebody else’s responsibility. And it was all somebody else’s money to begin with.

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Medical Professionalization in Medieval Europe, 1300s

On November 2, 1322, Madame Felicie was convicted of violating an ordinance that prohibited unlicensed healers from visiting, prescribing medications, or performing other duties for a patient, except under the guidance of a university-trained and licensed physician. The conviction was a major victory for the Paris Medical Faculty, a principal architect of the new medical pecking order, which had a pyramid-like shape. At the pinnacle was a relatively small coterie of the university-trained physicians; they practiced what we would call internal medicine. Beneath them were the general surgeons, who usually lacked academic training, although that was changing. By the early fourteenth century surgery was beginning to find a place in the medical schools. A surgeon could treat wounds, sores, abscesses, fractures, and other disorders of the limbs and skin. Beneath the general surgeon “was the barber surgeon, a kind of paramedic, who could perform minor operations, including bleeding, cupping, and applying leeches, as well as cutting hair and pulling teeth; next came the apothecary and the empiric, who usually specialized in a single condition, like hernias or cataracts. At the base of the pyramid were thousands of unlicensed healers like Madame Felicie.

To reflect their new eminence, in the decades prior to the plague, physicians began to adopt a more professional—that is, authoritative—demeanor and code of behavior. A cardinal “don’t” in the new medical etiquette was: don’t jeopardize your professional dignity by visiting patients to solicit business. “Your visit means you are putting yourself in the patient’s hands,” warned William of Saliceto, “and that is just the opposite of what you want to do, which is getting him to express a commitment to you.” A cardinal “do” in the new etiquette was to conduct a comprehensive physical exam on a first visit; the exam should include not just urinalysis, but a detailed medical history and an analysis of the patient’s breath odor, skin color, muscle tone, saliva, sweat, phlegm, and stool. Some physicians also cast a patient’s horoscope on the first visit. Another cardinal “don’t” in the new etiquette was to admit to diagnostic uncertainty. Even when in doubt, said Arnauld of Villanova, a physician should look and act authoritative and confident. For the uncertain physician, Arnauld recommended prescribing a medicine, any medicine, “that may do some good but you know can do no harm.” Another strategy was to “tell the patient and his family that [you are] prescribing this or that drug to cause this or that condition in the patient so that [they] will always be looking for something new to happen.” A third “don’t” in the new etiquette was volubility. Reticence conveyed authority, especially when combined with a grave manner; besides, said one savant, the physician who discusses his medical reasoning with the patient and his family risks letting them think that they know as much as he does, and that may tempt them to dispense with his services.

What made the university-trained physician such an impressive figure to laymen, however, was not only his authoritative bedside manner but his mastery of the arcanae of the New Galenism. Its signature principle was the theory of the four humors. For the ancient Greeks, whose thinking shaped so much medieval medicine, the number four was, like the atom, a universal building block. Everything, the Greeks believed, was made out of four of something. In the case of the physical world, the four elements were earth, wind, water, and fire; in the case of the human body, the four humors were blood, black bile, yellow bile, and phlegm. An important element in the humoral theory were the four qualities of all matter: hot and cold, wet and dry. Thus, blood was said to be hot and moist; black bile, cold and dry; yellow bile, hot and dry; and phlegm, cold and wet.

SOURCE: The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time, by John Kelly (Harper Perennial, 2006), pp. 167-169

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