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I met Bill freshman year. He was a local boy, born and raised in the Boston area, and an outstanding pre-medical student. I did not see much of him during my sophomore year (his junior year). In fact, when I found him sitting in the middle of the hallway on the fourth floor of Barnard Hall at 6:30 a.m. one morning during my junior year, it was the first time I had seen him in at least eight months.
He was sitting on the floor, legs crossed, the latest issue of Psychology Today in his lap, wearing a baggy pair of wrinkled pajamas, desperately fumbling to unlock the hallway phone that he shared with his neighbors. Sweat poured off his brow:
"Hey, Jeff, how's it going? Can you help me unlock the phone? I gotta call someone."
It was pathetic. Bill looked and acted like he had been on dexedrine nonstop for two weeks. He showed me an article about a medical researcher in California. He was so excited by her findings and her particular point of view that he wanted to call her. I tried to explain to him that it was 3:30 a.m. in California, but Bill persisted.
"She's like me, I'm sure she's still up working all night on the project...I'll call her at the lab. She'll probably be so glad that someone cares so much for her research and knows all about it, she'll offer me a job; it's just what I was interested in..."
Bill was almost screaming, his voice echoing up and down Barnard's stark halls, so I tried to quiet him down. I left him there, sitting wild-eyed in the hallway, counting the rings on the other end of the line (I'll let it go to 50 'cause she's probably right at some critical point.").-Bill was flipping out. Within a month he withdrew from school.
By now, tragedies like Bill's are old hat. Everyone knows all about the so-called new mood on campus--grade consciousness, the pre-professional crunch and ruthless competition--and what it drives some students to do. College administrators seek more than ever to downplay the morbid and to be more tolerant of the ethical transgressions (Harvard, for instance, readmitted this year a student who last year forged a series of medical school and scholarship recommendations). The media, on the other hand, has feasted on this emerging spectacle; few major publications have failed to make a big splash out of some variation on the theme. Invariably the focus of attention has been on the "victims" of the pressures; those who have crumbled under the weight and been forced to drop out of the race, or those who have been disqualified for unethical or immoral violations of the rules.
But there is one side of the "new mood" syndrome that has not received that much attention: What impact has the pre-professional crunch (particularly in law and medicine) had on the type of individuals who stick it out and finally emerge as full-fledged professionals?
Besides presenting an indictment of the ruthless process we rely on to choose our future doctors and lawyers, Bill's story also poses chilling questions that have yet to be adequately examined. Bill was a brilliant student. He was a shoe-in for almost any medical school if he could have hung in there for a few more months. But what if he had? How many brilliant Bill's are lasting a little longer and getting out into the world as doctors today? And, going one step further, is this selection process, with performance emphases that often push young students to the brink of sanity or dull their senses of right and wrong, weeding out many of those individuals who could best deliver health care and legal services to those who need it most? The ability to deal adequately and compassionately with human medical problems is surely rooted as much in social and human understanding as in technical knowledge. What, then, does an educational process that dehumanizes and isolates many of the survivors mean for the people in this country who genuinely need good health care and legal assistance?
The roots to understanding this problem may lie in a dichotomy emphasized over 25 years ago by David Reisman, Nathan Glazer and Reuel Denney in The Lonely Crowd. In this study of the changing American social character, the authors identified traits of two opposing social characters: those they called "inner-directed" and those deemed "other directed." The inner-directed person, they said, "tends to think of work in terms of non-human objects," wanting money or power or fame or some other tangible reward for performance, and seeing and experiencing things primarily "in terms of technological and intellectual processes." On the other hand, the other-directed person tends to think of work more "in terms of people--people seen as something more than the sum of their workmanlike skills and qualities."
The Lonely Crowd traced a gradual development from the 19th-century emphasis on inner-direction to what the authors believed was a more other-direction orientation of post-World War II middle-class youth. While finding fault with both extremes, they appeared to be particularly concerned lest the balance shift too far towards other-directional orientation (as they later implied it did in the turmoil of the 1960s).
However, several by-products of the trend towards other-direction that the authors said were healthy developments are the ones that appear to be most lacking in today's pre-professional education circles. The other directed youth, according to Reisman, et al., asks more of a career than conventional status and pecuniary requirements, questions ways of going about things and is not content to follow blindly the ways of the past; and is more attuned to social concerns of people than towards personal illusions of grandeur and reward.
With the "new mood" on campus, though, successful navigation through pre-professional waters seems more to require those traits The Lonely Crowd assigned to the inner-direction of the 19th century: goal and achievement orientation; the urge to outdistance, at all costs, one's competitors; the need always to establish for one's self an isolated and recognizable claim on a new piece of territory.
Even if one grants that a cadre of inner-directed souls--something akin to the innovator class that Joseph Schumpeter said is the driving force behind social and economic progress--is necessary in every profession, something is wrong with a process that is fundamentally geared toward inner direction. An educational system in which the very ground rules act as a powerful deterrent to the other-directed individuals whose interests and motivations are rooted in providing care to the entire population obviously begs for re-examination and re-structuring. All this is one more piece of evidence pointing to an obvious conclusion: that the health care and legal services networks in this country are neither sensitive to nor able to cope with the needs of the nation.
To be sure, Harvard still has many "other-directed" individuals who are genuinely committed to serving rather than attaining and to whom law and medical education means far more than security, status and the chance to rise above the rabble. But the patch is not an easy one to hoe for these individuals, both because of the pressures imposed upon them in specific academic situations and because of the criteria emphasized by professional school admission committees. Many of these other-directed individuals who make it through the pre-professional maze face intermittent disillusionment, many compromises and the knowledge that they can do everything that is expected of them but that they cannot bring themselves to do it.
Mark, a senior from West Virginia who is graduating today with high honors in Anthropology, is one such other-directed person who has finally (and barely) achieved his goal of being admitted to medical school. His commitment to medicine, particularly rural medicine in his home state, is unimpeachable. He spent last summer researching a summa cum laude anthropology thesis on rural health care delivery in Clay County, W. Va. For another summer, he worked in a clinic in Morgantown, W. Va.
Although most of his anthropology work was done under the tutelage of a medical anthropologist with a Ph. D. and an M.D. and his science grades were high, Mark was rejected at every medical school to which he applied. Finally, at the beginning of this month, he was notified that West Virginia University had reevaluated his application and accepted him.
No one can claim that Mark should have, under any criteria, been accepted at all the med schools. Yet, when his pre-medical advisor began late this spring to make inquiries about Mark's weaknesses, the responses were illuminating. In his applications, Mark explicitly stated his desire to become involved in grass roots health care, treating the medical problems of people as social as well as medical phenomenon. This data and his undergraduate degree in anthropology, in spite of his good medical and science grades and several research projects he participated in at Harvard, led admissions officers to question seriously his commitment to medical science.
With West Virginia, the problem was even more appalling. In August 1974, after a summer of Chem 20 at Harvard, Mark wrote a letter to his hometown newspaper decrying the pressures of pre-medical studies and questioning whether such a system could effectively prepare individuals to deal with the human beings experiencing the medical problems. In its first look, the West Virginia admissions committee saw the letter as an indication that Mark could not make a good, technical doctor, that he was more concerned with social problems than medical ones.
The sympathies expressed by Mark were indeed as social as they were medical, but they sprang from a fundamental belief on his part that getting along with and understanding people and their social problems is a primary part of the healing process, particularly in rural health care.
The letter itself was prompted by a series of frustrating events that culminated on the evening Richard Nixon resigned. As all the students in his Tuesday/Thursday five-hour Chem 20 lab were filing downstairs to watch Nixon give his resignation speech, a water hose broke loose and wetted every lab sample except Mark's. Since he was one of the last to leave the room, Mark says he felt immediately that everyone, including the section leader, suspected that he had purposely sabotaged the lab.
"That sort of suspicion and the fact that it always had to exist between all the students really got me thinking," Mark says. "It drowns out the importance of conscientiously trying to be good to other people...people who are in there busting ass to be the best and only worried about their own status don't realize that they need other people and that coming across as a decent person is a vital part of medicine."
For many who resist the rigorous pressures of conformity that pervade the pre-professional scene, the difficulties begin long before they attempt to take their case to professional school admissions committees. At no point in any pre-professional curriculum or course at Harvard are students encouraged, let alone required, to address broader questions of ideology, orientation and ethical and moral dilemmas. Those who seek to structure their education to examine such issues often find themselves left in the wake of students who abide by the pre-professional rules.
Steve was among the group of Harvard students that senior professor John Finley '25 classifies as the class-president type. Steve came to Harvard as a real politico, interested in law school and "into being president of everything." But by the end of freshman year the whole game seemed perverted to him.
"I began to see that overachieving wasn't the be-all and end-all. The whole drive for power, the insatiable desire to get to a name law school and a name firm, seemed to be grabbing people all around me. And yet no one really knew why: there they were grubbing for grades, their goals in a course set by their teachers, kissing ass, making connections, working like crazy, not because that's what they really wanted, but because that's the only way they could stay on top."
What upset Steve the most was that all around him he saw extremely bright individuals who permitted themselves to focus more and more narrowly on their own worlds and become further and further removed from social reality: "To me," he says, "the major thing about a Harvard education is the chance it could give to people to sit back and become concerned with far-reaching questions about our society. Harvard should be breeding people who are going to help this society look at how the pie is divided, not how to get a bigger slice for themselves. Life is more than a buck, and I felt that all these people with a golden opportunity to do something for others were just slipping into a slot where it was easy for them to make it; they are cheating themselves, allowing themselves to be less than they could be, fitting the mold when they're the ones who don't have to."
After graduation last year, Steve went to Washington to work for Sen. Frank Church (D.-Idaho), but he found the same difficulty there: no one really seemed concerned with "Joe Farmer or Joe Factory Worker back home bustin' ass in the fields or the saw mill all day so a bunch of guys could live high in Washington." After a year back in an Idaho sawmill, Steve now says that he is "de-Harvardized" enough to try school again. He wants to become a labor lawyer and return to Idaho: "A good lawyer out here could really help the little guy; do a big service and earn a decent living. It's the personal satisfaction of helping someone who needs it that I think I need now, not the money or enough status to hold my head high at the country club."
Given that there must be some process for selecting students who will go on to over-subscribed law and medical schools, there is no doubt that the present pre-professional structure is an effective market device. But the problem is that the "invisible hand" that drives some along the treadmill faster than others deters many of the other-directed individuals like Mark and Steve, who see the professions as a means of serving people, not as a pathway to security, wealth and status. The upshot is that more and more of those who emerge from the obstacle course have no conception of the basic human needs and values that underlie the service-delivery professions and instead allocate their skills according to the market: that is, to the big corporate law firms and lucrative medical practices that bring the big buck.
In the meantime, besides imposing inner-directed orientations on those who climb aboard the pre-professional train, this structure will continue to drive countless Bills over the fine line it draws between unreality and insanity. The new mood on campus and the pre-professional crunch are symptoms of a malady much wider in scope than the pre-professional education structure. But perhaps it is about time that Harvard came more to grips with the question of whether those it sends on to the professional schools are these most qualified for and concerned about providing health care and legal services to society, or those who happen to survive the undergraduate contest.
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