Zooming In and Out part 2 (Trayvon Martin)

I’m not writing about my main reactions to the verdict because I have nothing new to say about them. If it’s too soon for an intellectual reaction, don’t read this.

Zooming in and out can change a narrative by highlighting certain facts and putting others in the background or off the screen entirely. What George Zimmerman’s lawyer did, like Rodney King’s assailants’ lawyer, was change the zoom level. The focus was on the moment when teenaged Trayvon Martin was on top of George Zimmerman, a tight closeup on Zimmerman’s banged-up head and face. In that frame, it looked like shooting Martin was justified. How Martin and Zimmerman got to that point was left offscreen. Similarly, slow-motion replays of Rodney King trying to get up and thereby justifying the police’s use of force tightly framed the narrative as an interplay between a suspect’s refusal to lie still and the police response. This led to their acquittal.

Zoom out a little and it looks like an armed man followed an unarmed teenager and killed him. Zoom out a little further, and it looks like a race-motivated armed property owner followed and killed a black male. Who knows what he said to get Trayvon Martin so angry or frightened?

Many people, especially black people and others who identify with them, simply don’t believe that the jury weighed the relevant evidence and not the races of the parties. Or, if they did, and it’s the shooter’s subjective experience of fear that justifies an escalation to deadly force, then the case stands for a license to shoot people that make you nervous. Since many black people make many white people nervous, the verdict seems to be a license to shoot black people in Florida.

Suppose that Trayvon really did sit on Zimmerman’s chest, provoked somehow into banging Zimmerman’s head on the pavement. Suppose the cries for help really did come from Zimmerman. How is this different from the cops beating Rodney King? The white jury in that case was told, and believed, that King controlled the cops by refusing to lie still. Every movement of King’s justified the cops’ continued beating of him. Why doesn’t Trayvon get a free pass for beating a man who wouldn’t shut up and lie still?

Well, the answer of course is that Zimmerman is white (looks white, which is the exact same thing), while Trayvon looks black. But keeping the zoom at a level that includes only Zimmerman’s thoughts and feelings at the moment he drew his weapon ignores all that.

So if you zoom in to the same level used in the Rodney King defense, Zimmerman is responsible for whatever beating he received, as Rodney King was found to be. And if you zoom out to the level of common sense (armed white guy provokes a confrontation with an unarmed black teenager and kills him), Zimmerman is guilty. The prosecutors didn’t do as good a job as Zimmerman’s lawyer of controlling the zoom level.

If angry girls are told they’re tired, what are angry boys told?

Skinner said, late in life, that one of the humilities of old age was that, after having a good idea, he would realize that he’d already had that idea in 1953. One of my humilities is that, after having a good idea, I often recall that Skinner had that idea in 1953.

So the main point of my previous post wasn’t that many women think they’re tired when they’re angry; my main point was that you can only describe your emotions as you were taught to describe them by the people observing you (what Skinner calls the verbal community). Still, a commenter asked what I think is the boys’ analogy to tired girls.

Anger is the emotional state in which observing damage (to the object of one’s anger) operates as a reinforcer. Damage doesn’t have to mean a broken arm; it can mean a loss of face, a disappointment, or a look of concern.

I think many Americans are less upset by angry boys than by angry girls, so boys are more likely to learn that they are angry when they are angry. On the other hand, society’s relative comfort with boys being angry and with being angry at boys means that many boys don’t learn to disguise their anger, and they are therefore more likely to incur punishment for anger. This in turn makes boys more likely to avoid authority figures and to express anger when they are not being watched. Women are therefore more likely to comfort themselves with food and napping when angry, and to hurt people while acting manifestly within social norms, while men are more likely to avoid self-monitoring when angry and to express it in ways that breach social norms. Parents who recognize, accept, and manage their children’s anger produce adults who recognize, accept, and manage their own anger.

So, I’d say that many boys think they are bad when they are angry, but they recognize that they are angry. Other boys are taught that they are confused, and then they seek order through obsessive-compulsive behaviors when angry.

Boys are more likely to be mislabeled as tired when they want to snuggle. Tired or weak. Some men can snuggle only when they think they are tired. One of the many things I love about Janna is that when I come home at the end of the day and want soothing comfort, she provides it without metacommunicating that I should man up or stop complaining or, worst of all, take care of her. How did I go from purveying Southern machismo as a child to feeling comfortable with my own dependency needs? I’d say a lot of it had to do with the times I grew up in, with feminism to thank for redefining the role of men, and a lot of it had to do with my high school girlfriend, who tolerated my disgust with my desire for physical comfort without construing me as weak for wanting it. If your first love was someone who genuinely liked you, you are blessed. Last love, too.

Zooming In and Out

The maps on my computer and phone tell a different story depending on how far in or out you zoom. At the closest level, the story is about the state of the yardwork around my house (somebody should trim that overgrown bush in the front yard). Then there’s a story about what a cool neighborhood I live in, surrounded by restaurants and retail. Then there’s a story about how far my commute is, and a story about the pioneers who settled down when they got to the mountains even though there is no navigable waterway, and then a story about how far away the ocean is. You get the idea.

People narrate events in a way that, without their knowing it, supports their happiness or unhappiness, that supports their sense that things are going well or badly. (Happiness when things are actually going badly is an opiate that keeps you from improving things; unhappiness when things are actually going well keeps you from enjoying things.) When it comes to unhappiness, psychotherapy can be construed as changing the narrative to one that remains true to reality but connotes a different meaning. One way to think about that narration is to consider the zoom level patients are using, rather than just to consider what they are making of the different events. (Zoom can be considered an example of what systems theorists mean by punctuation, although punctuation typically refers to the question of how far back in time the narrative goes—who started the conflict.)

A man is obsessed with whether his wife is cheating on him. He sees only the wistful smile on her face as she contemplated lunch with a business associate. He does not zoom in for details of the smile; he does not zoom out for an assessment of her character or their marriage.

An employee repeatedly reprimands people for not doing their jobs. She sees slackers and sinners, supported by a zoom level that highlights work not done. She does not zoom in to consider her feelings about the work or her associations to slacking; she does not zoom out to consider the relative unimportance of the work to the overall functioning of the business or to consider her confusing role in the organization (maybe she thinks that being there longer than others means that she is in charge of them).

All the major theoretical orientations have zoom buttons for going in or out. Psychoanalysis zooms in on affect or out to personal history; behaviorism zooms in to specific behaviors or out to occasioning environments; cognitive-behavior therapy tends to zoom only in, to thoughts and patterns of thinking; systems theory zooms in to role-relationships or out to roles in larger systems.

So when you’re unhappy, try hitting the plus or minus button on that little scale on the side of your visual field. You could change your perspective without even changing your seat.

The Myth of Independence

“He depends too much on the opinions of others for his self-esteem.” How many times have you heard this or its equivalent? A significant number of psychotherapies take something like this as their goal; they try to promote self-esteem independent of the esteem accorded to the patient by other people. “She turns to others instead of feeling self-confident.” Same deal: the therapist wants to help her feel good about herself regardless of what other people think. (Of course, these same therapists are all-too-often quick to praise their patients, apparently unaware that they are selling dependence on the therapist as a kind of methadone treatment for the addiction to other people.)

George Eliot, in Daniel Deronda, had this to say on the subject: “independence, as we rather arbitrarily call one of the more arduous and dignified forms of our dependence.” She meant that the relational posture we call independence is not, after all, independent of other people but is instead one that requires the “independent” person to avoid appearing needy, and since we are an extremely socially needy animal, maintaining that appearance can wear you down. Independence means you can’t ask your friends if you talked too much at dinner; you can’t express feelings of being hurt when you are left out of plans; you can’t make your partner feel important. In other words, independence means you won’t get corrective feedback; you will be left out of plans; and your partner will either be someone who doesn’t feel a right to be important or who starts to look elsewhere for that feeling. That’s the arduous part. It’s “dignified,” because, as Skinner teaches us, “dignity” just means that the things that drive you are kept hidden from other people.

Instead of trying to feel good about yourself, you should spend more time with people who feel good about you. This is not easy to do, because those people are not easy to find. One reason they are not easy to find is that many people were raised by people who don’t particularly like human beings (especially the basic human qualities of sexuality, aggression, humor, and insight), so many of the people you come into contact with won’t like you if they get a glimpse of your sexuality, aggression, humor, or insight. You imagine the best you can do is to surround yourself with people who tolerate you, and you feel bad about yourself. These people feel good about you, but they don’t really know you.

Two people I can pretty much guarantee will get you and like you are George Eliot and Leo Tolstoy. Spend time with them and their kind; find yourself in their work; experience their fondness and humor.

You can also cultivate people who will like you by liking them first, not their affability and politeness but their basic human qualities. This will change the norms of whatever group you’re in and make it more likely that your own sexuality, aggression, humor, and insight will be appreciated.

People who don’t like your basic human qualities will snap at you or otherwise disapprove of you for gravitating toward people who like you, or for expressing affection for other people’s human qualities. But you can manage such punishers in the same way you manage people who simply don’t like you: ignore them and concentrate on better people.

Another problem is that you might confuse self-praise with feeling good about yourself, and you might confuse other people’s praise with being appreciated. This will make you pursue people who praise you rather than people who appreciate your sexuality, aggression, humor, and insight. Praise often communicates that you are such a loser that you need the praise to make you feel good. Its function is often to cultivate obedience to group norms rather than to offer social approval for the basic human qualities that groups often marginalize. Praise is like alcohol; it can take the edge off, but it’s not going to make you a better person like acceptance and appreciation can. We’ve all met people who praise themselves; they’re not much fun compared to people who appreciate themselves. If you want to foster the latter and not the former, appreciate rather than praise other people.

True self-esteem is, as Skinner said, the feeling you get when you have skills. An important set of skills involves negotiating social terrain, but if you do it at the expense of your sexuality, aggression, humor, and insight, you’re not really solving the problem. So go ahead. Let other people know you need them, and spend more time with the ones who don’t exploit that knowledge or act superior about it.

Finding Sugar Man

The astonishingly true story in the documentary, Searching for Sugar Man, has a lesson for each of us. The film is about Rodriguez, a pleasant Detroit home remodeler and sometime musician who cut a couple of albums decades ago. The albums never sold, but that was okay, because he wasn’t all about success anyway. Without his knowing, bootlegged versions of his music made him a huge star in South Africa, where it was rumored he was dead. In South Africa, he was bigger than the Stones. Only recently did South African music buffs track him down to Detroit, where he still lives and works, and tell him that on the other side of the world, he is a celebrated star of the first order. Since then, he has gone on tour and become wildly successful wherever he goes. It couldn’t happen to a nicer guy.

Each of us deserves some unexpected, special country where we are celebrated, where they wait at the airport for our plane to land, where they line the streets to hail our motorcade, where they scream with passionate appreciation for what we do. And every country deserves its own special musician, appreciated there more than anywhere else.

You can become someone else’s special country only if you are capable of adoration and gratitude. Maslow memorably acknowledged that you see your lover differently from the way other people do, but his delicious spin was that we see our lovers as they really are. You can become someone else’s Rodriguez only if you are capable of revealing yourself (the analogy to recording his albums in the first place); otherwise, other people’s appreciation is unlikely to be activated and, if it is, it will never soak through your social masks to soothe you where it hurts.

Psychotherapy can be one path to celebration. The patient discovers he can adore without being exploited and that he can reveal himself and still be embraced. In my view of psychotherapy, it’s just as important for the patient to get an opportunity to love safely as it is for the patient to feel safely loved. Another path is to grow up in a family that gets you and cherishes you. Another is to fall in love with someone who falls in love with you. But if you want to be Rodriguez without also being someone’s special country, their adoration of you will be hollow, and you will eventually look at them with contempt. And if you want to be someone’s special country without taking the risks of also being their Rodriguez, your love will turn to resentment and drain you dry.

Janna Goodwin is my South Africa (though without that country’s inequity, racism, and crime). She is also my Rodriguez.

The Myth of Intrinsic Motivation

You often hear that a student who reads the assignment to get a good grade is extrinsically motived, and one who doesn’t care much about the grade is intrinsically motivated. Similar language describes the behavior of athletes, professionals, and just about everyone making an effort. Generally, it is considered better to be intrinsically motivated, lest one be accused of shallowness or lacking in persistence.

There is no such thing as intrinsic motivation.

When we can identify a reinforcing consequence or schedule that maintains a behavior, we use the extrinsic label. When we can’t identify the reinforcing consequence or schedule, we use the intrinsic label. It’s that simple.

Nothing anyone does in relation to a soda machine will be labeled intrinsic motivation. The person can joyfully feed quarters into the slot, poetically describe the sound of the coins dropping into the mechanism, and dance circles of ecstasy after each quarter is deposited; we know she wants a soda. But the same person reading a book for school, delightedly turning pages, sharing well-written passages with her roommate, and cherishing the book itself appears to be intrinsically motivated when we have good evidence that she doesn’t care too much about the grade. Rather than look for other reinforcers, we invent an internal explanation (she loves learning).

Schedules of reinforcement are also important. If someone puts quarters in a slot machine, he will be rewarded, largely or minutely, at random and often enough to create a persistent behavior. The soda machine provides a soda nearly every time. If he walks into a casino, puts a dollar in a slot machine, and nothing comes out, he will not be too upset, even though he just lost out on a payout of $100,000. If he then walks over to the soda machine and puts in a dollar and nothing happens, he will bang the machine, maybe kick it, and pull the coin return lever several times, even though he only lost out on a soda. If a behavior is consistently reinforced, extinction is quick (and experienced as frustration). That’s why you get mad at your loving spouse more quickly than at your officemate when neither notices your new shirt or your clever remark. When behavior is reinforced intermittently, as in a casino, it takes a lot of failures before you stop trying (extinction is slow), and the process is experienced more as despair or longing than frustration.

A stranger to the situation would describe the person at an unyielding soda machine as extrinsically motivated by whatever’s in the machine and the person at an unyielding slot machine as intrinsically motivated since the person doesn’t seem to expect anything from the machine.

The main reason we can’t identify reinforcers, according to Skinner, is because it is undignified to get caught working for a reward. Erving Goffman and Keith Johnstone would say it is undignified because it is something that children can’t avoid, and adults get status-enhancement (Johnstone) or avoid stigma (Goffman) by acting in ways that children can’t. Children obviously stare at the cake all through dinner and wolf down their dessert. Adults lose face if they get caught doing either. The name for the mutual agreement to disguise our motivations at dinner is “table manners.” (I acknowledge that “table manners” also describes behavior that makes the meal more appetizing to other diners.)

The main problem with the concept of intrinsic reinforcement is that it doesn’t give the teacher much to do to build skills. Mainly, the concept makes teachers shame students who reveal what reinforces their behavior. But if teachers know which reinforcers are effective, they can use the knowledge by arranging for the reinforcement to depend on approximations of the skills that will serve the student later. Or the teacher can create conditioned reinforcers by associating, say, passing the ball with, say, winning to create a reinforcer the teacher can control.

First Things First, a Review of Descartes’s Discourse on Method in 14 Lines

If I invent a character in prose,
His presence does not prove that I exist.
If anything, that’s not the way it goes:
Existence is an attribute of his.

I thought what mattered was to make my mark
But then I found that marks all wash away.
“I think therefore I am” has lost its spark
“I am therefore I think” holds firmer sway.

When mystery outside your window clatters,
Look not for unseen goblins but for knocking.
And let the conversation be what matters:
Discussion, not the minds behind the talking.

So do not put the cart before the horse,
And do not put Descartes before discourse.

Was Mount Rushmore Designed?

Those who reject Darwinism point to elegant works of nature and find in them an intelligent design at work. They argue that you can tell just by looking at Mount Rushmore that there was a designer behind it; it’s not makeshift, jury-rigged, or accidental. Certain features of nature are so elegantly well-suited to their environment and function that they seem as crafted as a sculpture. Typically, the biologist responds by accepting the design of Mount Rushmore while disputing the design of, say, the human eye or some bacteria’s flagella. The biologists then provide a detailed account of how the flagella or the eye evolved, the crucial elements of which are that each variation arose at random as a small step, and each step produced reproductive or survival advantages and was thus “selected” by the environment. The engine of change in evolution is random genetic variation that gives the possessor of the gene an advantage so that more genes like the useful one get passed on.

Another way to refute the claim would be to argue that Mount Rushmore wasn’t designed, either. This argument is annoying, even enraging, because it implies that you are not the boss of you, that when you “decide” to do something, you are no more in control of what you do than Al Michaels is when he describes what is happening on the field during a football game. Even the offensive coordinator “chooses” a play that works best in his imagination, and his success as an offensive coordinator depends on the extent to which the opponents in his imagination are like the opponents on the field. We want to believe that we control ourselves, and attachment to that belief creates great confusion in psychology. A science of natural laws holds that if there is a God in Heaven, he isn’t affecting events on earth; a corollary is that if you have a soul, it isn’t pulling any strings, either.

From my book on early memories:

There is just no getting around the fact that Skinner does not believe in the mind. In a behavioristic account, there is the body and there is behavior and there is nothing left over to ascribe to a mind. … Put simply, the only evidence we have of a mind is the seeing of images that are not in front of us, hearing ourselves think, and feeling, tasting, and smelling things that are not there. The fact that every bit of evidence that we have of minds comes from our five bodily senses I find a bit suspicious. The fact that the mind is said to be the part of us that is immortal I find even more suspicious. We believe in an entity of which we have no evidence and the existence of which would allay our deepest fears. Descartes said, I think therefore I am, claiming that the existence of his mind was the one thing he was certain of. A behavioristic reply might be: I hear words when nobody is speaking them, and even though I call this thinking, all it proves is that I have ears and I have heard people speak.

The behavioristic notion of not having a mind analogizes people to rats and pigeons. Even biologists who are utterly committed intellectually to our descent from other animals balk at this analogy. They think there must be something in the complexity and size of the human brain that produces consciousness, and they believe that this consciousness distinguishes us from other animals (Wilson, 1998). As noted, though, there is nothing in what is called consciousness that is different from what we hear, see, and so on. Behaviorists think that people are certainly more complicated than pigeons, because our bigger brains make us more responsive to deferred consequences, conflictual contingencies, and peculiar reinforcers. However, behaviorists do not see us as fundamentally different from pigeons. Objections to behaviorism include statements like, pigeons roost on statues of people, not the other way around. These arguments are designed to appeal to our pride, not to our reason. Skinner (1971) answered these arguments in his book, Beyond Freedom and Dignity, and I will not rehash his rebuttal here, except to note his use of the word, dignity. A behavioristic account of humanity is an undignified account; it is therefore a humble account, and it is not surprising that many behaviorists are drawn to similarly humble accounts of humanity, such as Taoism and Buddhism (Hayes, Follette, & Linehan, 2004; Baer, 2003).

Mount Rushmore did not spring full-blown like Athena from the head of Zeus. Tourism was sparse in South Dakota. One famous tourist beacon was New Hampshire’s Old Man of the Mountain, which virtually everybody accepted as looking like a person only coincidentally (it collapsed in 2003). I’m certain that a lot of people had a lot of ideas about how to bring tourists to South Dakota. I’m certain that even the guy who “thought it up” had a lot of ideas. I put “thought it up” in quotes because what he really did was generate a whole bunch of images and words, and then he recognized one of them as having merit and promoted it. His idea met with success and failure, and the aspects of the idea that met with success continued and the aspects that met with failure died out. For example, he suggested one mountain range for the attraction, but the Lakota said no. He also suggested that the figures depict famous people from the West, but the sculptor and eventually Congress said no. When the four presidents were decided upon, the sculptor wanted torsos included for Washington and Lincoln, but production ended with busts when war-production replaced public works expenditures.

Even the sculpting itself, like all art, was a process of editing and imagination. Imagination, selected by survival advantages, enables us to try out an action with very little cost. As noted, an imagination is only as useful as its alignment with reality. Artists have a lot of ideas and edit them. Good artists continue editing them even after they are expressed. The editing ends when the artist sees what she expected to see, or when she sees something better and can’t imagine anything even better than that, or when she runs out of time. An artist can only be as good as her aesthetic judgment, just as someone with no sense of humor cannot reliably write comedy.

So rather than concede that Mount Rushmore was designed, I prefer to say that a lot of ideas were considered, some of them were expressed, some were selected and some not. This applies not only to the blueprints but also to the execution. Chisel here or chisel there? According to the artist’s image of Lincoln, here, not there. The mountain and the expectations of funding sources controlled the sculptor’s behavior as surely as a golf course controls Tiger Woods’ behavior. In fact, what makes Tiger Woods a great golfer is that the golf course controls his behavior more thoroughly than anyone else’s.

Marriage Reflection

If I had married her then I’d be him.
How else can you explain his reticence?
Her rage, her manic conduct on a whim
Would drive to silence anyone with sense.
Her unpredictability assaults
Him like a Caribbean hurricane.
His levees, walls, and sandbags aren’t faults.
Who wouldn’t seek protection from her rain?

The more he hides the more she must attack
To penetrate his stony barricades.
And when she fights he never does fight back,
And so her lonely fury never fades.
She storms for a response but he’ll defer.
If I had married him then I’d be her.

Not a Can of Peas

Part of my work over the last 30 years has been to highlight the risks of moving young children from one home to another and disrupting their relationships with previous caregivers. Between roughly 5 months and roughly 5 years, but especially for the first two years of this span, children are developing attachments that, if disrupted, may never be rebuilt.

One way to think about attachment is to consider that relating to people is a skill, and we learn to relate to people and to ourselves by generalizing from early relationships. In infancy and toddlerhood, the child has only one or two or maybe three sets of skills, each set being a repertoire of behavior that is reliably reinforced by a caregiver. The child learns first how to make her parents smile, and then generalizes to learning how to make other people smile. The parents’ smiles are reinforcers because they are associated with nurturance, whereas it takes much longer for other people’s smiles to become potentiated as reinforcers. If you lose a set of skills when you only have two or three repertoires, they are hard to replace; on balance, relating to others may become aversive because a large percentage of such relationships led early on to loss. Later, there are other fish in the sea, but in infancy, there are only a few fish in the sea. Losing one of them can make a child give up on fish.

I’ve frequently said, when professionals are considering moving a child out of a home, that a child is not a can of peas. I was gratified once to hear a judge reproach an attorney with this phrase, which meant to me that perhaps I was having an effect on the system. The idea, of course, was that a child is affected by these moves, whereas a can of peas isn’t affected by transportation. A child cannot be put in storage in with no ill effects.

But now, I also see how the phrase stands for the proposition that people won’t protect something if they don’t think there’s anything to protect. Children can be taught to close the door behind them out of obedience, or they can be taught how heat escapes or flies enter. If the former, then they will only close the door when they think someone is watching, and they will feel guilty and anxious about it. If the latter, they will close the door pro-socially, and they’ll feel good about it. But first they have to see that there is something to protect (heat or freedom from insects).

Psychotherapy practitioners and rule-makers make decisions about psychotherapy often without considering whether there is anything to protect. Nowadays, every therapist is legally obligated to call the potential victim in addition to the police if a patient makes a credible violent threat against an identified person. When this incursion on therapy first developed, many therapists were aghast at the intrusion on the therapy space. The same was true of the obligation to report child abuse. All things considered, politicians decided that the potential harm to the psychotherapy process was less pressing than the potential benefits of saving a life or preventing further injuries to children. I generally agree.

Concerns about a slippery slope were, however, well-placed. Colorado politicians recently decided that every patient should be given a mini-lecture on the different kinds of licenses in the state. I doubt this was seriously weighed against the drawbacks of intruding on the therapy process; instead, it has all the earmarks of being thought up by a group that simply did not consider any drawbacks. At the last minute, this requirement was dropped from the statute, but a therapist still has to produce a document that recites the same material, along with a lot of other intrusive information, and the therapist and client have to go through the charade of pretending that the client reads the document.

No one will protect the therapy process unless there is awareness of something to protect.

The therapy process and its ground rules are designed to create a unique kind of relationship in which patients feel like discarding their social masks and in which therapists are authorized to comment on their patients’ behavior. The problem, currently, is that clinical psychology wants to be a health profession, partly to help people and partly to chase the medical dollar. The problem is that, not only is the therapy process not seen as something to protect in a medical setting, it is downright hostile to a medical setting. This is true for two reasons. One, a medical setting is about diagnosis and treatment, not about understanding narratives and changing them. Wondering about narratives makes the medical frame seem arbitrary when it is important to medical treatment that it be seen as real. Two, the kinds of therapy patients best conceptualized medically (those with schizophrenia, some types of bipolar disorder, organic depression, and so on) are the kinds of people who react most intensely and negatively to the kind of closeness promoted by a therapy process. There is less process to protect with these patients, and the process can distract practitioners from the patients’ medical needs.

So, please, treat people in a medical model who can benefit from it and, especially, who cannot currently benefit from the therapy process. But don’t tell me it’s good for everyone to have a public waiting area, a clipboard of pre-visit inquiries, a receptionist to manage payments, and a complete and utter confusion about the difference between legal confidentiality and actual privacy. Don’t tell me that patients are cans of peas.