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A Canadian Privacy Heritage Minute: Surveillance, Discipline, and Nursing Education

posted by:James Wishart // 11:59 PM // September 25, 2007 // ID TRAIL MIX

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In this particular historical moment of fetishized “security” and state-sponsored surveillance carried out “for our own good,” it is tempting for some of us to think that we are reaching some low point in the history of privacy, where new technologies already allow the deployment of an Orwellian omniscience by states and corporations. This may indeed be so, but some research I did some years ago on the history of nursing education (of all things) has inclined me (a privacy advocacy neophyte) to wonder if the drive for total surveillance is neither novel nor dependent upon new technologies. In the spirit of Heritage Canada’s iconic television spots, I offer my own “Privacy Heritage Minute,” with all the skeletal theoretical framework, carefully-selected facts and simplistic moral that such an approach implies.

Prior to the 1950s, most Canadian nurses (who were predominantly young, white, unmarried women) were trained through an apprenticeship system, learning their craft by working for three years unpaid on hospital wards. This training was extremely arduous and strictly regimented, and was overseen by a limited number of paid nurse overseers and by senior nurse apprentices. The vast bulk of nursing labour in hospitals was completed by students, who lived on the hospital campus and seldom left the site until their training was complete.

Beginning in the late 19th century, it was understood that moral rectitude (read virginity) and feminine deference (read unquestioning obedience) were key characteristics of the ideal nurse. In part this was because prevailing models of health contained an unmistakably moral component (as arguably they still do – see the rhetoric around obesity, heart disease, HIV, etc.). Likewise hospitals, which were in competition for the dollars of wealthy patients and donors, used the image of the physically and morally clean (female) student nurse as advertising to convince the well-to-do of the safety and efficacy of institutional health care. [1]

Hospitals posted extensive lists of rules intended to ensure the proper behaviour of their student nurses. Obedience was far too important to be entrusted simply to sets of rules, however. As was explained in one nurses’ orientation manual, each individual would be “carefully watched to ensure strict obedience.” Surveillance, embodied in the policies, procedures, and the very architecture of the training school and Nurses’ Home, provided the disciplinary backbone for nursing training. Michel Foucault described similar developments with respect to 18th-century reform schools and prisons in Discipline and Punish: “We have here a sketch of an institution ... in which three procedures are integrated into a single mechanism: teaching proper, the acquisition of knowledge by the very practice of the pedagogical activity, and a reciprocal, hierarchised observation.”

Surveillance of student nurses began from the moment they applied to their training. Candidates underwent gynecological screening tests, which allowed hospital management to determine whether the candidates showed signs of sexually transmitted diseases, previous pregnancy, or loss of virginity. Applicants who showed evidence of such indiscretions were likely to be rejected as “not suitable to become a nurse.” This managerial anxiety over sexuality permeated the apprenticeship program. Of particular concern in these all-female spaces was homosexuality, a “vice” that dared not speak its name but that nevertheless attracted careful scrutiny by managers and hospital trustees. As one former nurse explained to me,

A rule was posted that ‘only one may bathe at a time’. We didn’t have time to wait in the mornings, so we often shared showers and tubs. The bathrooms were patrolled [by matrons] and so if a matronly voice said ‘is there only one of you in the tub,’ our rule was that only the one in the middle would call out ‘Yes, miss!’. I realized later that they were scared stiff of lesbianism.

In some residences, bath doors were designed like the swinging doors of saloons with spaces above and below, a technology of observation noted by Foucault at Paris-Duverney's Ecole Militaire. [2]

Surveillance was also trained upon the movements of apprentice nurses in their leisure time and private spaces. Purpose-built Nurses’ Homes were designed along panoptic principles, situating the Matron’s quarters adjacent to the main exit, an arrangement that gave the impression that the foyer was under constant supervision. Anyone entering or exiting the residence was required to sign a log, and bedrooms were checked for absent (or extra) bodies every evening. Strict curfews were enforced with the threat of dismissal, and reinforced with the possibility of character assassination for young women seen “out on the town” after curfew. In this latter area, the hospital enlisted the aid of the surrounding community as observers and judges of nurses’ conduct, and upright citizens regularly informed managers of suspected infractions by students.

On the hospital wards, surveillance took its shape via the ideology of scientific management. By the 1910’s, hospital managers had joined the cult of efficiency, and strongly believed that minute regulation of workers’ time and motion would lead to increased production and lower costs, concepts which fit awkwardly into the provision of health care but which nevertheless persist in hospital management to this day. [3] To this end, nurses were monitored carefully as they learned nursing tasks in a deskilled [4], routinized manner, with harsh discipline as the reward for lapses of technique or behaviour. A fundamental goal of this system was that students would internalize the observing eye, and like Jeremy Bentham’s panopticized prisoners, govern their behaviour according to the priorities of the institution.

Although there were obvious functional reasons for hospitals to maintain strict control over their unpaid labour force, the diligence with which such controls were implemented cannot be explained without attention to the larger discursive webs in which hospitals and nurses were caught. Rapid urbanisation and economic change in Canada, with the attendant increases in single women's urban employment and public visibility, fostered in the imaginations of civic leaders the spectre of the 'woman adrift', the young working girl living in unsupervised residences in an urban environment, untended by patriarchal authority. Promoting women's chaperoned boarding houses, the Toronto Star-Weekly prodaimed in 1917: "It would seem to be but our duty, from an economic as well as a humanitarian stand-point, to see that [the working girl] lives under conditions which tend to make her more efficient, as well as a worthy citizen. It is not too much to say that the future of our country lies in the hands of these girls.” This disingenuous language reflects (in part) anxieties about “degeneracy” that brought us such historical highlights as eugenic sterilization and the Chinese head tax. Regulation of the young female student nurses was thereby elevated to the level of a patriotic duty. Hospitals as major Canadian institutions bought into this wholesale, boasting that their system of discipline and training worked to produce “the best type of Canadian womanhood.”

With the future of the nation apparently at stake, there was little or no concern expressed about the privacy or autonomy of student nurses. [5] No privacy laws governed the surveillance of these young women – there were compelling moral, economic, political, medical, and other reasons to watch them, and so they were watched.

Without overstating the case, I wonder whether this Heritage Minute tells us a couple of things about reasonable expectations of privacy. To me it says that where fear and prejudice coalesce into social panic, surveillance is a ready tool for the identification and punishment of deviance, and privacy rights will be among the first in a long line of casualties. It also implies that surveillance technology takes the form of whatever is at hand. Hospitals used architectural techniques, documents, holes in walls, and human eyes to watch nurses, and socialized their students to watch themselves and each other. So although resisting the development of new methods of surveillance is important, it’s maybe just as important to keep our eyes on the core reasons why our privacy comes under constant assault. The longevity of the hospital system of nursing training suggests that where serious abrogations of privacy rights have apparent social or economic utility, or where they support the societal status quo, they may persist invisibly or unremarkably for decades.

Thank you. This has been a Canadian Privacy Heritage Minute brought to you by the idTrail.


[1] Even until the 1920’s, most hospital health care was “charitable,” reserved for persons who could not afford home visits by doctors and nurses. Hospitals had poor reputations as charnel-houses until they became the centralized repositories of expensive medical technologies like X-Rays, antiseptic operating theatres, and professional nursing care. This is a long story, for which there is not room here.
[2] Discipline and Punish (NY: Random House Vintage Books, 1979) at 172-173.
[3] Recently some RFID manufacturers and hospital administrators have proposed that increased efficiency could be achieved by attaching RFID tags to the bodies of hospital workers and patients, thus facilitating a constant surveillance of their motions through real-time monitoring from a central site.
[4] The “skill” level of the tasks taught to nurses is the subject of a healthy historical debate which has the “professional” status of nursing at stake in its outcome.
[5] Student nurses themselves expressed such concerns, and acted on them in important and effective ways, but that is a story for another time.

Comments

Erratum: The "iconic heritage minutes" were produced by the CRB Foundation, not Heritage Canada.
I sincerely apologize for any inconvenience.
James

Posted by: James Wisnart at September 26, 2007 10:39 PM

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