One’s name is coterminous with one’s identity. To have it used carelessly shows lack of respect for one’s humanity. To decide how another shall be addressed is to take power over him.
The accused in the dock is addressed as the bench decides he shall be addressed. He is called by his surname, his personal name totally ignored throughout the proceedings other than for the purpose of identification. Thus his powerlessness is made clear to him and contrasted with the awesome power of the bench.
The same method is used in military relationships, to clarify who has authority over whom. It even used to be the norm in hospitals, with nurses addressing each other and their subordinates by surname only. (As a toddler, I only knew my mother’s nursing friends by their surnames.) But that had to go, of course, in the name of the trade-unionised egalitarianism of comrades.
Everyone, especially the vulnerable, should be asked how they wish to be addressed and when this is not possible the default should be the full formal form. It places the small distance between equal persons which is necessary to denote that neither has control of the other and that intimacy will not be assumed without permission. To do otherwise is invasion of privacy. In some circumstances, especially with the vulnerable, it intimidates and can even feel close to assault.
This used to be part of basic training for all hospital personnel. Why is this no longer the case?
Beyond patronisation, there is a disguised aggression in the presumptive use of someone’s first name. This custom migrated to the UK in the 1970s from the USA where it originated in the sales training manuals of the business schools. It harnesses for commercial purpose the common but by no means universal use of first names which is inherent but only to an extent in American republican egalitarianism.
The sales psychologists in the business schools correctly saw that to be the first to use someone’s personal name in an initial encounter is to invade the other’s privacy, thus taking power over them while disguising the gambit as a gesture of faux-friendship. The other is placed at a disadvantage, risking seeming churlish if they should refuse what purports to be an amiable gesture when in fact there is nothing amiable about it. It is aggression to a purpose, a vital strategic step in sales or other negotiations. R L Stevenson said that everyone lives by selling something, which was never and nowhere more true than in the USA where half one’s neighbours are ‘in sales’. The new sales behaviour quickly became a societal norm.
The imposition of the presumptive use of first names has been one of the chief components of the erosion of respect for and the increase of aggression towards the other which is now a major problem in many Anglophone societies but especially the UK and the USA.
The importance of forms of address and above all of the use of first names has been known in all societies over millennia. It has been taught in folk tales and founding myths for thousands of generations through fairy tales like Rumpelstiltskin and the Biblical (Exodus) story in which God speaks to Moses from the Burning Bush. God addresses Moses by his personal name but refuses to divulge his own name. ‘I am Who Am.’ Thus are power relationships established and enforced by those who take the initiative in deciding to divulge, use or not use personal names.
A frail old person does not need his vulnerability emphasised by those with power to invade his privacy and his person.
Amen, amen I say to thee, when thou wast younger, thou didst gird thyself, and didst walk where thou wouldst. But when thou shalt be old, thou shalt stretch forth thy hands, and another shall gird thee, and lead thee whither thou wouldst not. John XXI 18.
The reality of the power relationship is already clear and frightening. The first action by the person with power must be to comfort the frail, frightened one by bringing about and demonstrating balance in the power relationship. This can be achieved swiftly and simply by the use of formal address which immediately acknowledges and pays respect to the unique identity, value and rights of the weaker individual. It underlines the innate equality of the individual human persons regardless of their roles and the balance of power between them.
At last some of this, and its importance in the treatment of and the prospects for health in the old and frail has been recognised in today’s report. But again one must ask why this simple and very basic psychological insight was ever omitted from the training of those working in the medical or other care of the elderly?
Unlike other societies, the British – almost uniquely – long ago dropped the routine use of Sir and Madam. Maybe it is time to bring them back.
(Also posted at my own blog.)