School as Hospital
n a quick overview of educational publications, medical metaphors are easy to spot. While a few schools are seen as healthy, theorists are quick to
diagnose weak programs and prescribe solutions to cure their ills. Ailing schools may require an infusion of funds. There are classes for remedial (remedy) students and those with various learning disorders. Students are given batteries of diagnostic tests. In this metaphors, schools are perceived as places children go to have whatever is wrong with them fixed (healed)!
Where school is a hospital, teachers are cast as physicians. In fact, some consciously choose that metaphor as demonstrated in the following comment from an education website.
"As a teacher I see myself like a physician…During the all-too-brief time that the students are in my care I must try to help "fix" acute needs while offering a prescription for chronic needs that will last beyond my interactions with the students."
This quote highlights a destructive belief inherent in the school as hospital metaphor—the assumption that students are sick and need to be cured (or broken and in need of fixing). The metaphor forces educators to focus on the negative rather than the positive, just as Western medicine has for so long focused on curing illness rather than promoting wellness. Let's face it. How many schools perceive themselves as "wellness" clinics working to maintain and stregnthen the good health of students?
Parker Palmer suggests that when the medical metaphor is used, "The dominant diagnosis…is that our 'patients' are brain-dead. Small wonder, then, that the dominant treatment is to drip data bits into our students' veins, wheeling their comatose forms from one information source to the next until the prescribed course of treatment is complete, hoping they will absorb enough intellectual nutrients to maintain their vital signs until they have graduated …[O]ur assumption that students are brain-dead leads to pedagogies that deaden their brains."(1)
Despite its negative entailments, we can use the medical metaphor to gain insight into educational issues. Let's consider the approach that standards-based policies claim will improtve the learning of the lowest performing students.
Many researchers agree that students who arrive at school physically, mentally, or emotionally undernourished must, before they are able to digest the traditional food of schools, be treated for those deficiencies. These students are effectively like premature infants who must be nurtured intensively until they reach the size of a full-term infant. They may not reach that weight for several months or longer, and often develop at slower rates than full-term infants. This does not mean that they don't (or can't) eventually reach or exceed the development of full-term children. It's simply that their development does not occur along the same general timeline.
Critics of standards-based policies have pointed out that they do not adequately address the need for "preemie nurseries" where physically and mentally undernourished children can receive the developmental care they need.(2)
Instead, in the apparent belief that "expecting" and/or "demanding" great things of every student will magically cause them to develop more rapidly, the government insists that all children of a certain age be held to the same standards. If the children do not meet those standards, the school "fails" and teachers are blamed for bad teaching and/or "low expectations."
Of course, expectations are important! Studies have repeatedly shown that there is a positive relationship between a teacher's expectations and the child's learning. But there are also such things as unrealistic expectations. Is it realistic to "expect" a preemie to have the same physical development at six months as the child born at full term? Is it the fault of hospitals, nurses, or parents if they don't? Does setting a "standard" for growth and development help?
We "expect" preemies to achieve as rapid a development as they are able, given the appropriate supportive care. But that differs from one infant to another! The type of nourishment and external conditions are based on the individual infant's needs! In the same way, educators must "expect" each and every child to progress as rapidly as he or she is capable. But without providing for the unique needs of each child, that expectation means little or nothing!
Suggesting that students who enter school impoverished in mind or body should not be held to the same expectations as other students is, in the words of former President Bush, "the soft bigotry of low expectations." I would suggest that not providing each child with the care and support s/he needs is the true bigotry. Like the care of premature infants in the hospital, the role of schools, with the assistance of the community, must be to provide the support and nourishment to promote each child's development. This must occur before confronting students with the traditional demands of schooling.
And what about so-called "normal" children. Parents readily accept that there is a range of ages at which children reach certain developmental levels, such as weight or height. They also accept that, as children age, there are enormous differences in physical characteristics, dependent on genetics, environment, nutrition, etc. Why then, would we expect children to exhibit the same mental development at the same age?
Equal educational opportunity is not synonymous with the same education for all. One-Size-Fits-All education is both scientifically unsound pedagogy and "bad medicine."
In the next article in our series on transforming schools, we'll once again examine the factory metaphor of schools. The factory metaphor is arguably the most pervasive influence on public education, and for good reason! It is the model on which American public schools were deliberately shaped. It's no coincidence that it "fits" the cultural values of productivity, efficiency, and technology.
- Palmer, P. J. (1998). The Courage to Teach: Exploring the Inner Landscape of a Teacher's Life. San Francisco: Jossey-Bass, 41-42.
- Bainbridge, W. L. (2003) Leaders Show Ignorance About Education, Editorial from the Columbus Dispatch, Feb. 24, 2003.
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