Doing Qualitative Research 3rd Edition Benjamin F. Crabtree
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- 6. DOING QUALITATIVE RESEARCH Third Edition Benjamin F. Crabtree Rutgers, The State University of New Jersey William L. Miller Lehigh Valley Health Network, Pennsylvania Los Angeles London New Delhi Singapore
- 8. Copyright © 2023 by SAGE Publications, Inc. All rights reserved. Except as permitted by U.S. copyright law, no part of this work may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without permission in writing from the publisher. All third-party trademarks referenced or depicted herein are included solely for the purpose of illustration and are the property of their respective owners. Reference to these trademarks in no way indicates any relationship with, or endorsement by, the trademark owner. FOR INFORMATION: SAGE Publications, Inc. 2455 Teller Road Thousand Oaks, California 91320 E-mail: order@sagepub.com SAGE Publications Ltd. 1 Oliver’s Yard 55 City Road London EC1Y 1SP United Kingdom SAGE Publications India Pvt. Ltd.
- 9. B 1/I 1 Mohan Cooperative Industrial Area Mathura Road, New Delhi 110 044 India SAGE Publications Asia-Pacific Pte. Ltd. 18 Cross Street #10-10/11/12 China Square Central Singapore 048423 Library of Congress Cataloging-in-Publication Data Names: Crabtree, Benjamin F., author. | Miller, William L. (William Lloyd), 1949- author. Title: Doing qualitative research / Benjamin F. Crabtree, William L. Miller. Identifiers: LCCN 2022011299 | ISBN 9781506302812 (paperback; alk. paper) | ISBN 9781506302805 (adobe pdf) | ISBN 9781506302836 (epub) | ISBN 9781506302829 (epub) Subjects: LCSH: Primary care (Medicine)—Research—Methodology. | Social medicine—Research—Methodology. | Social sciences—Research—Methodology. | Qualitative research. Classification: LCC R853.S64 D65 2023 | DDC 362.1072—dc23/eng/20220329 LC record available at https://lccn.loc.gov/2022011299 Printed in the United States of America This book is printed on acid-free paper. 22 23 24 25 26 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Leah Fargotstein Product Associate: Paloma Phelps Production Editor: Vijayakumar
- 10. Copy Editor: Christobel Colleen Hopman Typesetter: TNQ Technologies Proofreader: Benny Willy Stephen Indexer: TNQ Technologies Cover Designer: Candice Harman Marketing Manager: Victoria Velasquez
- 12. BRIEF CONTENTS Preface Acknowledgments About the Authors Introduction Part I Read Me First: Overview of Qualitative Research Chapter 1 Clinical Research: A Qualitative Trail Map Within a Mixed-Methods World Chapter 2 Creating Collaborative Space and Research Teams Chapter 3 Reflexivity Chapter 4 Research Design: Start With the Stories Part II Discovery: Data Collection Strategies Chapter 5 Depth Interviews Chapter 6 Group Interviews and Focus Groups Chapter 7 Observation Chapter 8 Key Informant Interviews Chapter 9 Material Artifacts Part III Analysis and Interpretation Strategies Chapter 10 The Dance of Interpretation and Frustrations of Sisyphus Chapter 11 Editing Organizing Style of Analysis Chapter 12 Template Organizing Style of Analysis Chapter 13 Immersion/Crystallization Organizing Style of Analysis Chapter 14 Computers and Data Management Part IV Special Applications Chapter 15 Case Studies Chapter 16 Qualitative Methods in Intervention Studies Chapter 17 Qualitative Methods in Participatory Healthcare Research Part V The Rest of the Story Chapter 18 Doing Good Qualitative Research
- 13. Chapter 19 Getting Funded and Getting Published Chapter 20 The Future of Qualitative Methods in a Mixed- Methods World References Index
- 15. DETAILED CONTENTS Preface Acknowledgments About the Authors Introduction Part I Read Me First: Overview of Qualitative Research Chapter 1 Clinical Research: A Qualitative Trail Map Within a Mixed-Methods World What’s Coming? A Mixed-Methods Research Approach Research Aims Worldviews, Paradigms, and Theory Choosing a Research Style and Methods Qualitative Methods: A Map, Sampling, and Design Overview Sampling Collecting Data The Interpretive Process From Whence It Came: Qualitative Research Traditions Summary Questions at the Edge Chapter 2 Creating Collaborative Space and Research Teams What’s Coming? A Typology of Cross-Disciplinary Research A Collaborative Team Story Creating Collaborative Space and Research Teams Developing Collaborative Research Relationships Barriers to Collaborative Process Clearing the Flow for Collaborative Conversations Summary Questions at the Edge Chapter 3 Reflexivity
- 16. What’s Coming? Tools for Doing and Teaching Reflexivity Traps of Perception and Understanding Reflexivity Tools Reflexivity Before the Fieldwork Begins Reflexivity During Data Collection Reflexivity During Analysis and Interpretation Reflexivity During Dissemination Summary Questions at the Edge Chapter 4 Research Design: Start With the Stories What’s Coming? A Clinical Story Anomalies and Research Questions How Are Healing Relationships Developed and Maintained in Primary Care? What Are Patient Preferences Regarding the Role of the Primary Care Physician in Their Extended Cancer Follow-Up Care? How Do Exemplar Primary Care Practices Deliver Care for Cancer Survivors Like Mrs. Brown? What Are the Experiences of Early Implementers of Primary Care-Focused Cancer Survivorship Delivery Models? What Are Practices Experiences When Participating in a Quality Improvement Intervention? Summary Questions at the Edge Part II Discovery: Data Collection Strategies Chapter 5 Depth Interviews What’s Coming? Partnership, Communicative Performance, and Conversational Journey Depth Interviews Preparing for the Journey: The Literature and Beyond
- 17. Designing: Selecting the Actors and Creating the Script Preparing: Staging the Scene Interviewing: Let the Improvisation Begin Debriefing: Capturing Context Transcribing: The Final Script A Plethora of Primary Care Examples Interviewer Training Consent and Ethical Considerations Summary Questions at the Edge Chapter 6 Group Interviews and Focus Groups What’s Coming? The Larger Genre of Group Interviews Focus Groups What Types of Questions Are Best for Focus Groups? Sampling in Focus Groups Recruitment of Participants Number of Groups Group Size Length of Focus Groups The Role of the Moderator Developing the Interview Guide Recording and Other Logistics Moderating Focus Groups Transcription Options Analysis and Interpretation Is Tricky Reporting Focus Group Findings Consent and Ethical Considerations Summary Questions at the Edge Chapter 7 Observation What’s Coming? Why Participant Observation? A Primer on Participant Observation
- 18. Overview of the Project Into the Field and Gaining Entry Initial Contact Establishing Rapport The Mechanics of Observation The Participation Continuum Informants Fieldnotes: A Dialogue With Self What: The Content of Fieldnotes How: The Form of Fieldnotes When: The Process of Writing Fieldnotes Technologies for Recording and Managing Fieldnotes Individual Versus Team Research Some Tips on Training and Skill Building Informed Consent and Ethics Summary Questions at the Edge Chapter 8 Key Informant Interviews What’s Coming? What Are Key Informant Interviews? Why Use Key Informants? Who Is a Key Informant? How to Select Key Informants? Learning From Key Informants Questioning Language Texts and Sources Ethical Considerations Applications in Primary Care Key Informants Within an Ethnographic Study Key Informants in Case Study Research Key Informants as Sole Source of Data Key Informant to Enhance a Depth Interview Guide Limitations of Key Informant Interviews Summary
- 19. Questions at the Edge Chapter 9 Material Artifacts What’s Coming? Analyzing and Interpreting Television Commercials Photographs as Artifacts Collecting and Analyzing Online Artifacts Collecting Documents in a Case Study Summary Questions at the Edge Part III Analysis and Interpretation Strategies Chapter 10 The Dance of Interpretation and Frustrations of Sisyphus What’s Coming? Where Are We? Interpretation as Dance Who Are the Dancers? How to Dance? Describing Organizing Connecting Corroborating/Legitimating Representing the Account Tools for the Dance Selecting the Tools Principles, Pitfalls, and Pearls Questions at the Edge Chapter 11 Editing Organizing Style of Analysis What’s Coming? Stepping Through the Process Step 1: Text Segment Identification and Making Comments Step 2: Expansion of Comments Step 3: Comparison of Expanded Comments Step 4: Theme Development Step 5: Comparison of Interview Themes Published Examples
- 20. Three Focus Groups Is a Piece of Cake Editing Also Possible With Many More Interviews Dancing With Your Data: Immersion Before Editing More Dancing Using All Three Styles: Editing, Template, and Immersion Using an Editing Organizing Style Within a Large Dataset Summary Questions at the Edge Chapter 12 Template Organizing Style of Analysis What’s Coming? The Dance and Use of Codes in Template and Editing Styles Examples of Template Organizing Style Using an A Priori Codebook Creating and Using an Evolving Codebook Using a Post Hoc Confirmatory Codebook The Mechanics of a Template Organizing Style Approaches for Developing a Codebook or Code Manual Codebook Illustration Coding Text Sorting Segments Connecting and Corroborating/Legitimating Summary Questions at the Edge Chapter 13 Immersion/Crystallization Organizing Style of Analysis What’s Coming? The Requirements The Core Process of Immersion/Crystallization Initial Engagement With the Topic and Reflexivity Crystallization During Gathering Process Immersion and Crystallization of Insights During Interpretive Process
- 21. Corroboration/Legitimation and Alternative Interpretations Representing the Account Immersion/Crystallization Variations, Influences, and Pitfalls Variations and Influences Pitfalls Summary Questions at the Edge Chapter 14 Computers and Data Management What’s Coming? Types of CAQDAS Programs A Brief Summary of Five Common CAQDAS Programs To the Field! Pearls and Pitfalls Summary Questions at the Edge Part IV Special Applications Chapter 15 Case Studies What’s Coming? Background Preparing for the Journey Setting the Context Living It Getting Ready Sampling: Finding a Place Entering the Field Collecting Data Gathering Additional Data Processing and Managing Data Comparative Case Analysis Strategies Spelunking: The Dark Side Crawling Toward Light: Turns and Decisions Single Case Studies Summary Questions at the Edge
- 22. Chapter 16 Qualitative Methods in Intervention Studies What’s Coming? Using Qualitative Assessments to Tailor Interventions Conducting Process Evaluations During Interventions Conducting Independent Evaluations of Research Initiatives/Programs Qualitative Input on Intervention Design and on a Learning Evaluation Summary Questions at the Edge Chapter 17 Qualitative Methods in Participatory Healthcare Research What’s Coming? Participatory Research: Typical Forms, Assumptions, and Issues Participatory Research in Health Care Challenges Doing Participatory Research: Four Examples Designing a Knowledge Workshop in Participatory Action Research Boot Camp Translation in a PBRN Using a CBPR Framework Using Online Community Salons With Community Organizations Using Photovoice in Participatory Research The Way Beyond On Participation What’s in a Name? Summary Questions at the Edge Part V The Rest of the Story Chapter 18 Doing Good Qualitative Research What’s Coming? Seven Essentials for Good Qualitative Research Question/Design Match Information-Rich Sampling
- 23. Iteration Context Incongruous Evidence Self-Reflexivity Group Reflexivity Rules Are Written for the Novice Summary Questions at the Edge Chapter 19 Getting Funded and Getting Published What’s Coming? Getting Funded Writing the Cancer Survivor Care Application Significance: Start With the Story Investigators: Promoting Yourself and Your Team Innovation: What’s New and Unique Here? Approach: Avoid Jargon and Give Details Environment: No Place Like Home Some Final Thoughts on Getting Funded Getting Published Finding the Right Journal What Should Be in Your Journal Article Relevance Question/Design Match Information Rich Sampling Iteration Context Accounting for Incongruous Evidence Reflexivity: Self and Group Believability Summary Questions at the Edge Chapter 20 The Future of Qualitative Methods in a Mixed- Methods World What’s Coming? Training for the Future
- 24. Keeping Up With Accelerating Change Technology, the Locations of Social Space, and Politics Climate Change, Ecology, and Health Ways of Knowing, Research Design, and Knowledge Democracy Mixed-Methods Imperative and Real Integration Changing the Evidence: Round Tables, Solidarity Research, and Knowledge Democracy Final Thoughts Questions at the Edge References Index
- 26. PREFACE When does a text about research become a book about passion and joy? Here and now! Welcome to the third edition of Doing Qualitative Research. We love doing, learning, and teaching qualitative research in the context of our clinical mixed-methods world. We love the excitement of discovery, the developing depths of understanding, the surprises, the dilemmas, the uncertainties that emerge, the relationships that grow from working together, the creativity, the magic of exploring new settings and meeting new people, and the insights about self and other that arise. Join us for the adventure and cocreate your own inspired research stories.
- 27. PURPOSE The global COVID-19 pandemic has accelerated both the uncovering of vulnerabilities and deficiencies in our healthcare systems and dramatic changes in the platforms and structures of care delivery, especially at the level of primary health care. The need for exceptional qualitative clinical research within a mixed-methods context has never been greater. Enter this book. As a result, this third edition of Doing Qualitative Research is substantively a new volume. The goal of the first two editions was to introduce qualitative methods to those hoping to begin and do qualitative research in primary care settings. In those first two editions, we sought to honor the past traditions of qualitative research while also finding a way to make it actionable and accessible to primary care researchers. The third edition goes beyond those goals and seeks to expand the use of qualitative methods in clinical research, to improve the quality of that research and to better align with those we study. Now, 23 years since the second edition, so much has transpired and changed. We are no longer novice researchers and have personally completed or participated in multiple clinical studies with multiple collaborators across the qualitative research spectrum. Qualitative approaches have not only thrived on their own with many supporting journals and journal review panels, but their use has expanded with the rapid growth of mixed-methods strategies in clinical research. And yet, something feels amiss, something more than simplification, sloppiness, and superficial acceptance. We began the adventure into qualitative research by searching for methods to answer the questions arising in our lives. We wanted to give voice to those not being heard, to recover the importance of context, to disrupt the powerful hierarchies in health care, and to change the conversation about the meaning of evidence that matters. Little of that has happened and was made worse by the global pandemic. We decided
- 28. to write this third edition in hopes of revitalizing the hidden potential for excellent qualitative research.
- 29. AUDIENCES We wrote this book for a target audience of investigators actively conducting clinical research, particularly the rapidly growing number of clinical researchers engaged in mixed-methods research. Many (perhaps most) have little or no formal training or foundation in qualitative research, so this book is designed as a resource for them. We hope the book will also be a useful and practical resource for Master of Public Health (MPH) or graduate level programs or for short courses like those hosted by the National Institutes of Health (NIH). This third edition of Doing Qualitative Research can also serve as a core text for a wide range of healthcare disciplines, including public health, primary care medicine, nursing, social work, behavioral health, medical anthropology, medical sociology, and health services research. As a pragmatic qualitative methods text written within a mixed-methods framework, this third edition serves as a strong companion text to other SAGE publications on mixed-methods designs. Because both qualitative and mixed-methods research are rapidly emerging in the health sciences, this book, with its clear and concise descriptions of the most widely used qualitative methods and its pragmatic suggestions for writing grant applications and journal publications, is particularly relevant to many researchers. The generous use of relevant published clinical research examples, many from studies conducted by the authors, distinguishes this book from others currently available that deal with the same or similar topics.
- 30. WHY THIS THIRD EDITION The goal of the earlier edited editions of Doing Qualitative Research was to encourage primary care clinical researchers to take up qualitative methods. We felt that many investigators doing clinical research were never going to have time to go back and get the thorough disciplinary training upon which qualitative work is based. When we put the first edition together, we were novice researchers brimming with enthusiasm and collaborated with others to organize a pre-conference on qualitative methods at the May 1991 Annual Meeting of the North American Primary Care Research Group (NAPCRG) in Quebec City. SAGE published a series of six edited volumes on primary care research, with Doing Qualitative Research being the third in the series. Several chapters related to qualitative research were in other volumes in that series, so we worked with SAGE to publish a more comprehensive second edition in 1999. No longer editors, we are now the sole authors for all chapters in this third edition. Everything is revised based not only on the growth and development within the field but also on what we have learned during our 35 years of extensive experience doing qualitative research. Seven chapters from the previous edition were dropped and eight new chapters added. We comprehensively revised and updated second edition chapters originally written by us and included new examples and references. Several of the chapters from the second edition originally written by other authors are also substantially revised by us and now include fresh examples and updated references. Some of the material from several second edition chapters that were dropped is incorporated into other chapters of this new edition. We feel the first four chapters in this third edition are critical reading and set the stage for both those new to qualitative research and established researchers. They are intended to address the concerns
- 31. raised earlier about the superficiality of some published qualitative work. Chapter 1 grounds qualitative research and qualitative methods within the larger research enterprise including an overview of the diverse traditions from which they arose and more detail on theory. In this book, we repeatedly stress the critical and essential role of collaborative teams and ensembles (Chapter 2), reflexivity (Chapter 3), and tailoring research methods and designs to the question and not vice versa (Chapter 4). We also note that parts of Chapter 2, “Creating Collaborative Space and Research Teams,” were previously published in the edited volume from SAGE Publications, Exploring Collaborative Research in Primary Care (Crabtree et al., 1994). In addition, some of Chapter 11, “Editing Organizing Style of Analysis,” was previously published in the edited volume from SAGE Publications, Tools for Primary Care Research (Stewart et al., 1992).
- 32. MAJOR FEATURES AND BENEFITS In writing this new volume, we tap into our wide-ranging experience as clinical mixed-methods and qualitative researchers to target the specific needs of researchers working in health-related disciplines. We believe we have made this third edition a more coherent whole by being sole authors, by drawing on projects we personally participated in so we can share the back stories, and by better connecting key concepts and ideas across chapters. The generous use of relevant published clinical research examples, many from studies conducted by us and many that were an integral part of larger mixed-methods investigations, distinguish this book from others currently available that deal with the same or similar topics. The detailed chapters filled with practical tips on team and ensemble development (Chapter 2), reflexivity (Chapter 3), improvising research design (Chapter 4), and getting funded and getting published (Chapter 19) also differentiate this book from others. This text reflects the diverse lived experiences and perspectives of a career-long partnership of a full-time medical anthropologist researcher and a practicing family physician, administrator in a large health system and educator of family medicine residents and medical students. Combined, we have done the research, incorporated it into our teaching, and used the findings to try to change health care and improve the health of those we serve. Everything is this book is grounded in those experiences and filled with our passion and joy for this work. We hope that grounding helps this book feel more alive.
- 33. PEDAGOGICAL FEATURES As a core or supplemental text, this book will especially appeal to teachers who value creativity, adult learning, and tailoring to each learner, and who prefer an experiential learning style (Kolb, 1984). Each chapter is written with Kolb’s learning cycle in mind. They begin with the sharing of a concrete experience, either a clinical story or a research case. Interspersed throughout are questions for prompting reflective observation and quickly shadowed by presentation of the tools and concepts, the abstract conceptualizations, needed to help investigate the dilemmas of the story. Multiple examples of others actively experimenting with the tools and concepts follow and urge the reader to experiment themselves. We encourage using this cycle in your own face-to-face or virtual classrooms. All the chapters share numerous cases, and, usually, multiple tables and figures to enhance the practical value of the material. Each chapter begins with “What’s Coming,” a quick synopsis based on the detailed table of contents to help educators and learners easily see what’s coming and where to anticipate it in the chapter. The chapters end with a few of what we call, “Questions at the Edge.” These are questions that often don’t have simple or final answers. They are intended to encourage exploring and expanding the material just covered at the edge of shared understanding. Anticipate exciting conversations.
- 34. START DOING We hope this third edition of Doing Qualitative Research inspires and emboldens more clinical researchers to do qualitative research in our new mixed-methods world. We also hope it helps all of us do better research and serves as a trail map for embarking on new qualitative research adventures. Discovering ourselves, working together, improvising in support of meaningful questions, empowering those who participate in the research, and doing it all well motivated our work. We hope yours as well. Read on, join the adventure, start doing qualitative research, and help change the conversation in health care.
- 36. ACKNOWLEDGMENTS We put together and edited the first two editions of this book with the help and partnerships of many friends and collaborators. They motivated and inspired us to begin and to persist on the lifetime adventure of doing qualitative research. We appreciate first edition authors for getting us started and joining us on this qualitative research journey: Anton Kuzel, Stephen Bogdewic, Valerie Gilchrist, Richard Addison, Alfred Reid, Jr., Moira Stewart, Miguel Bedolia, Howard Brody, Dennis Willms, Nancy Arbuthnot Johnson, Norman White, David Morgan, Stephen Zyzanski, Ian McWhinney, and Robin Blake. Many of these same authors continued with us on the journey onto the second edition and were joined by Robert Williams, Judith Belle Brown, Jeffrey Borkan, Lynn Meadows, Diane Dodendorf, Jessica Muller, Virginia Elderkin-Thompson, Howard Waitzkin, Virginia Aita, Helen McIlvain, Janecke Thesen, Kirsti Malterud, Richard Frankel, Lucy Candib, Kurt Stange, and Wendy Levinson. We are profoundly grateful for the insights, friendship, and collaboration you provided us. We cannot thank you all enough. Since the second edition was published in 1999, we expanded on the foundation laid by these collaborations and continued our voyage over a clinical ocean filled with a bounty of new friends and a multitude of qualitative and mixed-methods studies that are brought to life in this third edition. We want to use this opportunity to gratefully acknowledge several of the people who significantly influenced and supported our early emotional and intellectual development. Dr. David Evans at Wake Forest University was a patient and creative shepherd for Will during his undergraduate and graduate school years. J. Jerome Smith at the University of South Florida and Pertti J. Pelto of the University of Connecticut served similar roles for Ben. Will’s first adventures into family practice were nurtured by his practice partners, Mike Abgott, Dale Grove, and his dad, Warren Miller. The late David Schmidt, MD,
- 37. brought us together at the Department of Family Medicine, University of Connecticut, where along with our remarkable colleagues and Director of Research, Patrick J. O’Connor, we began exploring the exciting opportunities of collaborative, qualitative, and mixed-methods primary care research. We have also been blessed with wonderful research companions at the University of Nebraska Medical Center, Rutgers Robert Wood Johnson Medical School, and Lehigh Valley Health Network. Just when we needed it, we were fortunate to be introduced to the late Reuben R. McDaniel, Jr. who motivated us with the metaphor “drink good whiskey” and continually reminded us not to waste time doing trivial things. A special thanks to all for your friendship and support. We are particularly appreciative of Kurt Stange, Carlos Jaén, Robin Gotler, and Paul Nutting who, as close friends and collaborators for over 20 years, created a transdisciplinary space for creative thinking and reflection. Together, and with funding from the American Academy of Family Physicians, we created the Center for Research in Family Medicine and Primary Care that allowed us to hold regular working retreats for sharing ideas and developing projects. We became a true ensemble performing some amazing improvisational jazzy research, and we supported and nurtured each other like a second family. While the Center is no longer active, the friendships, support, and research partnerships persist. Its memory inspires us to encourage others to build their careers and lives upon meaningful relationships and not climbing ladders toward individual achievement. We also thank SAGE acquisitions editor, Leah Fargotstein, who has shown incredible patience as we struggled through career transitions and the COVID-19 pandemic to write this volume. As we wrote the chapters for the third edition, we continually sought input and feedback from kindred souls who reviewed early drafts of chapters. Kurt Stange showed considerable patience and support as Ben repeatedly shared ideas and drafts of chapters for months on
- 38. end. We specifically recognize Ellen Rubinstein who carefully reviewed draft chapters and added personal touches describing her experiences in the field working on the comparative case study on care of cancer survivors in primary care used as an example in many chapters. Sarah Ono and Jack Westfall graciously provided materials on their work in participatory research and reviewed drafts of the chapter. Rutgers colleagues Jenna Howard and Jennifer Hemler read and provided feedback on several chapters. The weight of writing this volume was greatly lightened knowing who was helping us along the way. At the heart of creative abundance rests the mysterious and gracious nest of kith and kin. Our families are the deep well from which we draw our water and to which our energies and love returns. We offer our profound thanks to our very significant partners, Eiko Crabtree and Deb Miller, and to our children, Martin, Mari, and Christina Crabtree and Ethan and his partner Kate and Lindsay Miller, and, especially, to Will’s grandson Loren. Being home together, as we relearned during the COVID-19 pandemic, can be messy and challenging like qualitative research, and it is the real garden of love and delight. Thanks everyone! SAGE and the authors are grateful for feedback from the following reviewers in the development of this text: Brittany Anne Chozinski, Our Lady of the Lake University Carly Levy, Massachusetts College of Pharmacy and Health Sciences Victoria Sherif, Wichita State University
- 40. ABOUT THE AUTHORS Benjamin F. Crabtree, PhD, MA, is a medical anthropologist and Distinguished Professor in the Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School. He is a full member of the Rutgers Cancer Institute of New Jersey in the Cancer Prevention and Control Research Program. Ben earned his Master’s Degree in Applied Anthropology from the University of South Florida and his Doctorate in Medical Anthropology from the University of Connecticut. Prior to his current appointment, Ben was on the faculty of the Departments of Family Medicine at the University of Connecticut and the University of Nebraska Medical Center. Ben has collaborated on many in-depth interview and focus group studies where he’s learned to appreciate the experiences of illness and health care from the perspectives of both clinicians and patients. Ben’s recent research focuses on quality of healthcare delivery, primary medical care practice organization, and organizational change. He has been principal investigator on five National Institutes of Health R01 grants that used qualitative methods and mixed- methods for enhancing quality of care in primary care practices. His current National Cancer Institute R01 grant engages diverse stakeholders in identifying actionable, practice-based activities for provision of long-term breast cancer survivorship care using depth interviews and then implements and evaluates an intervention for delivering care for breast cancer survivors in primary care. Ben has contributed to more than 225 peer-reviewed journal articles and numerous book chapters, and served as coeditor on two books, Doing Qualitative Research and Exploring Collaborative Research in Primary Care. In 2014, Ben and coauthor Will Miller were jointly awarded the prestigious Curtis G. Hames Research Award for lifetime contributions to family medicine research. Ben volunteered twice with the United States Peace Corps, first in the Ethiopian Smallpox
- 41. Eradication Program and then in the Korean National Tuberculosis Program. He completed his dissertation research in Korea conducting a mixed-methods study of rural birthing practices in the face of modern medicine. He and his wife Eiko travel extensively in Japan and enjoy taking long walks and gardening. William L. Miller, MD, MA, is a family physician anthropologist and Chair Emeritus at the Lehigh Valley Health Network (LVHN), Department of Family Medicine in Allentown, Pennsylvania, and a Professor of Family Medicine at the University of South Florida Morsani School of Medicine for which LVHN serves as a branch campus. Will earned a Master’s Degree in Medical Anthropology from Wake Forest University and received his Medical Degree from the University of North Carolina School of Medicine. After completing his family medicine residency at Harrisburg Hospital, Will entered private practice in Bethlehem, Pennsylvania, where he honed his craft for four years. Prior to joining Lehigh Valley Health Network as the first Leonard Parker Pool Endowed Chair of Family Medicine, he was on the faculty in the Department of Family Medicine at the University of Connecticut. Will has been aptly nicknamed “coyote” for his propensity for “pushing the envelope,” not only as an organizational leader, teacher, and clinician but also in his research focused on observing, implementing, and evaluating NIH-funded national primary care practice improvement efforts along with investigations of healing relationships and the clinical encounter, collaborative care, and professional socialization. Some of this work has focused on how primary care practices respond to new innovations in care, with one of the outcomes being the development of the relationship-centered Practice Change Model. He was founding consulting editor for the Annals of Family Medicine, served as co-editor on two books, Doing Qualitative Research and Exploring Collaborative Research in Primary Care, and received, along with Ben Crabtree, the 2014 Curtis G. Hames Research Award for lifetime achievement in family medicine scholarship. He was an advisor and evaluator for the American
- 42. Another Random Scribd Document with Unrelated Content
- 43. "Aw telt him that Aw was, and Aw started to carry up thae peppermints, and a damned hard job it was, man. They werena the ordinary pepperies, ye ken; they were great muckle things like curlin' stanes. Weelaweel, Aw got them a' carried up, and Aw was standin' wipin' the sweat frae my face when the Sultan comes anower to me. "'Aye, captain,' says he, 'that'll be dry wark?' "'Yes, sir,' says I, 'gey dry.' "'Are ye a 'totaller?' says he. "'No,' says I, and he taks me by the arm and says: 'C'wa and hae a nip!' "Weel, we gaed into a pub, and he ordered twa nips ... aye, and damned guid whiskey it was too. We had another twa nips, and Aw'm standin' wi' the Sultan at the door, just aboot to shak hands wi' him, ye ken, and he says to me, says he: 'Captain, wud ye like to see the harem?' and Aw said Aw wud verra much. So he taks haud o' my arm and we goes up the brae. We cam to a great muckle hoose, and he taks a gold key oot o' his pooch, and opens the door. "Man, Aw never saw the likes o' yon! The floor was a' gold, and the window-blinds was gold. And the wemen! (The mariner conveyed his admiration by a long whistle.) "Weel, Aw was standin' just inside the door wi' my bonnet in my hand, when a bonny bit lassie comes up to me and threw hersell at my feet and took haud o' my knees and sang: 'Far awa to bonny Scotland!' "Man, the tears cam into my een as she was singin'. "Syne the Sultan turns to me. "'Aye, man,' he says, says he, 'speakin' aboot Scotland: Scotland's the finest country on earth; but there's wan thing Aw canna stand
- 44. aboot Scotland, and that's yer dawmed green kail. There's no a continental stammick will haud it doon.'" My friend informed me that he never met an Englishman who appreciated that yarn. * * * I begin to wonder whether I am falling in love. Ever since Margaret blushed when she passed me on the brae I have been extremely conscious of her existence. I find that I am beginning to look for her, and I go to the dairy on the flimsiest of pretences. I was there three times this afternoon. "What do you want this time?" she asked with a laugh at my third appearance. "I hardly know," I said slowly, "but I think I wanted to see your bare arms again." She hastily drew down her sleeves and reddened; then to cover her confusion she made a show of putting me out forcibly. How I managed to refrain from kissing her tempting lips I don't know. I nearly fell ... but it suddenly came to me that a kiss might mean so very much to her and so little to me and ... I resisted the temptation. She is fast losing her shyness, and she talks to me with growing frankness. She has begun to read much lately, and she devours penny novelettes with avidity. She has a romantic mind, and my realism sometimes shocks her. I happened to meet her in town last Saturday, and I took her to the pictures. She was intensely moved by a romantic film story, and when I explained that the stuff was rank sentimentalism and rhetoric she seemed to be offended. "You criticise everything," she cried angrily, "don't you believe that there is any good in the world?"
- 45. "You will never be happy," she added seriously, "you criticise too much." "Surely," I cried, "you don't imagine that I criticise you!" "I do," she said bitterly. "You criticise yourself and me and everybody. I am always in terror that I make a slip in grammar before you." "Margaret!" I cried with real sorrow, "I hate to think that I have given you that impression." I was silent for a long time. "Kid," I said, "you are quite right. I do criticise everything and everybody, but a better word is analyse; I analyse myself and then I try to analyse you." "As a boy," I added, "my chief pastime was buying sixpenny watches and tearing their insides out to see how they worked ... but I never saw how they worked." "Yes," she said, "and that's what you would do if you had a wife; you would tear her to bits just to see how she worked ... and you would never find out how she worked either." "Perhaps I might," I said with a smile. "When I dissected watches I was inexperienced; nowadays I could take a watch to pieces and find out how it worked. Perhaps I might manage to put my wife together again, Margaret." "There would be one or two wheels left over," she laughed. "I should like her better without them," said I. "Oh!" she cried impatiently, "why can't you be like other men? What's the use of looking into the inside of everything? Look at father; he never bothered about what mother was; he just thought her perfect and look how happy he is!"
- 46. "Ah!" I said teasingly, "I understand! You don't want a man to analyse you in case he discovers that you aren't perfect!" She looked at me frankly. "I wouldn't like to be thought perfect," she said slowly. "I sometimes think that mother would think far more of father if he saw some faults in her." "I am quite puzzled," I said; "you grumble because I analyse people and now you grumble because your father doesn't. What do you mean, child?" But she shook her head helplessly. "Oh, I don't know," she cried, and she sat for a long time in deep thought. As I sat by her side in the picture-house tea-room I recollected a saying of her's one day last week. I was sitting at the bothy door reading The New Age, and at my feet lay The Nation and The New Statesman. She picked up The Nation and glanced at its pages. "I don't know why you waste your money on papers like that," she said petulantly. "You spend eighteenpence a week on papers, and father only gets John Bull and The People's Journal." It suddenly came to me that Margaret was not thinking of the money side of the question at all; what annoyed her was the thought that these papers were a symbol of a world that she did not know. And now I wonder whether woman is not always jealous of a man's work. It is a long time since I read Antony and Cleopatra, but I half fancy that Cleopatra was much more jealous of Antony's work than of his wife.
- 47. VI. Dickie Gibson cut me dead to-night, and I think that Jim Jackson will one day look the other way when I pass. It is very sad, and I feel to- night that all my work was in vain. I cannot, however, blame Macdonald this time, for Dickie has left the school. I feel somewhat grieved at not being able to lay the fault at Macdonald's door. I should blame myself if I honestly could, but I cannot, for Dickie was a lad who loved the school. I recollect the morning when we arrived to find a huge stone cast in the middle of the pond. "It's been some of the big lads," said Dickie. "But why?" I asked. "Why should they do a dirty trick like that? Would you do a thing like that, Dickie, after you had left the school?" He thought for a minute. "Aye," he said slowly, "if Aw was with bigger lads and they did it Aw wud do it too." I suppose that if I had been a really great man I might have conquered the spirit of the village. I was only a poor pioneer striving to make these bairns happier and better. Dickie's cutting me proves that I was not good enough to lead him away from the atmosphere of the village. I used to forget about the homes; I used to forget that many a child had to listen to harsh criticisms of my methods. I marvel now that they were so nice at school. I wonder whether we could not form a Board to enquire into the upbringing of children. We might call it the Board of Parental Control. It would bring parents before it and examine them. Parents convicted of stupidity would be ordered to hand over their children to a Playyard School, and each
- 48. child would be so taught that it could take in hand the education of its parents when it was seventeen. My idea was to produce a generation that would be better than the present one, and I thought that I could successfully fight the environment of home. I failed.... Dickie has cut me. The fight was unequal; the village won. After all I had Dickie for two short years, and the village has had him for fourteen. Poor boy, he has much good in him, much innate kindliness. But the village is stupid and spiteful. I am absolutely sure that Dickie cut me because he wanted to follow the public opinion of the village. Am I magnifying a merely personal matter? Am I merely piqued because I was cut? No one likes to be cut; it isn't a compliment at any time. No, I am not piqued: I am intensely angry, not at poor Dickie, but at the dirty environment that makes him a cad. Lucky is the dominie who teaches bairns from good homes. Last summer when I spent half a day in the King Alfred School in Hampstead I envied John Russell his pupils. They were all children of parents who were intellectual enough to seek a free education for their children in a land where the schools are barracks. "If I only had children like these!" I said to him, but a moment later I thought of my little school up north and I said: "No! Mine need freedom more than these." The King Alfred School is a delightful place. There is co-education ... a marvellous thing to an Englishman, but not noticeable by a Scot who has never known any other kind. There is no reward and no punishment, no marks, no competition. A child looks on each task as a work of art, and his one desire is to please himself rather than please his teacher. The tone of the school is excellent; the pupils are frankly critical and delightfully self-possessed. And since parents choose this school voluntarily I presume that the education we call home-life is ideal. How easy it must be for John Russell! If my Dickie had been going home each night to a father and mother who were as eager for truth and freedom as I was, I don't think that Dickie would have cut me to-night.
- 49. * * * Dickie came up for his milk to-night, and I hailed him as he went down the brae. "Here, Dickie!" I called, "why have you given up looking at me?" He grew very red, and he stood kicking a stone with his heel. "I don't want you to touch your cap, Dickie, but you might at least say Hullo to me in the passing. Some of the big lads who left school before I came look at me impudently, and I know that their look means: 'Bah! I've left the school and I don't care a button for you or any other dominie!' But, Dickie, you know me well; you never were afraid of me, and I know that you don't think me your enemy. Why in all the earth should you pretend that you do?" I held out my hand. "Dickie," I said, "are you and I to be friends or not?" He hesitated for a moment, then he took my hand. "Friends," he said weakly, and his eyes filled with tears. Then I knew that I had not been mistaken in thinking that there was much good in the boy. Having made it up with Dickie I set off with a light heart to attend a meeting of the Gifts for Local Soldiers Committee. The chairman was absent and I was invited to take the chair. Bill Watson brought forward a motion that the Committee should get up a concert to provide funds. "Mr. Watson's proposal is that we arrange a concert," I said. "Is there any seconder?" "Aweel," said Andrew Findlay, "Aw think that a concert wud be a verra guid thing. The nichts is beginnin' to draw in, and it wud be best to hae it as soon as possible. The tatties will be on in twa three days."
- 50. "The proposal is seconded. Any amendment, gentlemen?" "Man," said Peter MacMannish the cobbler, "man, Aw was just lookin' at Lappiedub's tatties the nicht. Man, yon's a dawmed guid crap." "Them that's in the wast field is better," said Andrew. "But the best crap o' wheat Aw seen the year," said Dauvid Peters, "was Torrydyke's." "Any amendment, gentlemen?" "Torrydyke ay has graund wheat," said Peter. "D'ye mind yon year— ninety-sax ... or was it ninety-seeven?—man, they tell me that he made a pile o' siller that year." "Ninety-sax," growled William Mackenzie the farmer of Brigend, "it was ninety-sax, for Aw mind that my broon coo dee'd that summer." "Aw mind o' her," nodded Andrew, "grass disease, wasn't it?" "Aye," said Mackenzie. "Aw sent to Lochars for the vet but he was awa frae hame. Syne Aw sent a telegram to the Wanners vet, and when he cam he says to me, says he—" "Any amendment, gentlemen?" I said. "Goad, lads," said Andrew sitting up in his chair, "we'll hae to get on wi' the business." "No amendment," I said. "Are we all agreed about this concert?" and they grunted their assent. "And now we'll settle the date," I said briskly. Peter MacMannish looked over at Mackenzie. "When are ye thinkin' o' killin' that black swine o' yours, John?" he asked. Mackenzie growled and shook his head.
- 51. "She's no fattenin' up as Aw cud wish to see her, Peter," he replied. There followed an animated discussion of the merits and demerits of various feeding-stuffs. After a two hours' sitting the Committee unanimously appointed me secretary and organiser of the concert. I was given authority to fix a date and arrange a programme. Attendance at many democratic meetings of this kind has led me to a complete understanding of Parliament. * * * It is Sunday to-day. I sat reading in the afternoon and a knock came at my bothy door. "Come in!" I shouted, and Annie walked in. "Me and Janet and Ellen are going for a walk over the hill, and we thocht you might like to come too." "Certainly!" I cried, and I threw Shaw's latest volume of plays into the bed. "Margaret's wi' us too," said Annie as if it were an afterthought. There was a fight for my arms. "Annie was first," I said, "and we'll toss up for the other arm." "Let Margaret get it," said Janet mischievously, and Margaret's nose went almost imperceptibly higher in the air. "Excellent!" I said, and I took her arm and placed it through mine. Janet and Ellen walked behind, and they sniggered a good deal. "Just fancy the mester noo!" said Janet, "linkit wi' Maggie! He'll hae to marry her noo, Ellen!" And poor Margaret became very red and began to talk at a great rate. "G'wa, Jan," I heard Ellen say, "he's far ower auld. Maggie's only twenty next month, and he's—he could be her faither."
- 52. "He's no very auld, Ellen; he hasna a mootache yet!" "Aw wudna like a man wi' a mootache, Jan; Liz Macqueen says that she gave up Jock Wilson cos his mootache was ower kittly." "Weel, she was tellin' a big lee," said Janet firmly. "If she loved him she wud ha' telt him to shave it off." We lay down in the wood at the top of the hill. Annie was in a reminiscent mood. "D'ye mind the letters we used to write to one another?" she asked. I pretended that I had forgotten them. "Do ye no mind? One day when I wasna attendin' to the lesson ye wrote 'Annie Miller is sacked' on a bit paper and gave it to me?" "Ah, yes, I remember, Annie, now that you come to mention it. But I can't remember your reply." "Aw took another bit o' paper, and Aw wrote: 'Mr. Neill is sacked for not making me attend.'" "Yes, you besom, I remember now. I'll sack you!" and I rolled her over in the grass. "There was another letter, Annie," I said, "do you remember it?" and she said "No!" so quickly that I knew she did remember it. I turned to Margaret. "Annie came to school one day with her hair most beautifully done in ringlets," I explained, "and of course I fell in love with her at once. I wrote her a letter.... 'My Dear Annie, do you think yourself bonny to- day?' and the wee besom replied: 'No, I don't!' Then I wrote her again.... 'Do you ever tell lies?' and to this she answered: 'No, never!' Then I calmly handed her the Life of George Washington." "But Aw never read it!" she cried with a gay laugh.
- 53. "I know ... and that's why you have never reformed, my dear kid," I said. "Ellen," said Janet, "d'ye mind that day when you and me got up and walked oot o' the room?" "What day was that?" I asked; "you two went out of the room so often that I gave up trying to see you." "It was the day when a man cam to the schule and stood in the room when ye was teachin' us. There was a new boy, the caravan boy that had never been to schule in his life, and ye said that he was better than any o' us." "So Jan and me took the tig," said Ellen, "and we went oot and sat on the dike." Janet hee-heed. "D'ye mind what we said, Ellen? We said we werena to go back to the schule; we were to go up to Rinsley schule to Mester Lawson." "Aye," said Ellen, "and we said we wudna gie ye another sweetie ... no, never!" "And I suppose you gave me sweeties next day?" I suggested. "We gave ye a whole ha'penny worth o' chocolate caramels," said Janet. Her head rested on my knee and she smiled up in my face. "Ye were far ower easy wi' us," she said seriously, "we never did half the lessons ye gave us to do." "I know, Jan, but I didn't particularly want you to do lessons; all I wanted was that you should be Janet Brown and no one else. I wanted you to be a good kind lassie ... and of course, as you know, I failed." And she pulled my nose at this. "I didn't like the school when I was there," said Margaret; "I never was so glad in my life as when I was fourteen."
- 54. "Poor Margaret," I said, "your schooling should be the pleasantest memory of your life. What you learned from books doesn't matter at all; what matters is what you were. And it seems that memory will bring to you a picture of an unhappy Margaret longing to leave school. What a tragedy!" "Is being happy the best thing in life?" asked Margaret. "Not the best," I answered; "the best thing in life is making other people happy ... and that's what the books mean by 'service.'" * * * Margaret came over to my bothy to-night to ask if I would help Nancy with her home lessons. "She's crying like anything," said Margaret. I went over to the farmhouse. Nancy sat at the kitchen table with her books spread out before her. She was wiping her eyes and looked like beginning to weep again. "It's her pottery," explained Frank, "she canna get it up at all." Macdonald had ordered the class to learn the first six verses of Gray's Elegy, and threatened dire penalties if each scholar wasn't word perfect. "I'm afraid I can't help you much, Nancy," I said. "You'll just have to set your teeth and get it up. Don't repeat it line by line; read the six verses over, then read them again, then again. Read them twenty times, then shut the book and imagine the page is before you, and see how much of the stuff you can say." I used to find this method very effectual when I got up long recitations in my younger days. Macdonald gives his higher classes long poems. They have learned up pages of Marmion and pages of The Lady of the Lake; and now he is giving them the long and difficult Elegy. I must ask him some day what his idea is. I made learning poetry optional when I was in
- 55. the school. I eschewed all long poems, and I never asked a child to stand up and "say" a piece. My view was that school poetry should be school folk-song; I used to write short pieces on the board and the classes recited them in unison. I gave no hint of expression, for expression should always be a natural thing. I have been timid of expression ever since the day I heard, or rather saw, a youth recite The Dream of Eugene Aram. When he came to the climax ... "And lo! the faithless stream was dry!" I suddenly discovered that I was dry too, and I did not wait until Eugene was led away with "gyves upon his wrists." I once saw Sir Henry Irving in The Bells. I was a schoolboy at the time and I straightway spent all my pocket money on books dealing with elocution; I also would tear my hair before the footlights! Looking back now I wonder why Irving bothered with stuff of that sort; why his sense of humour allowed him to grope about the stage for the axe to kill the Polish Jew I don't understand. All that melodramatic romantic business is simply theatrical gush. It appeals to the classes that devour the Police News. Expression when taught is gush. When I gave my bairns a bit of The Ancient Mariner the whole crowd brightened up and shouted when they came to the verse:— I bit my arm, I sucked the blood And cried: "A sail! A sail!" They understood that part, but they put no special expression into the stanza:— All in a hot and copper sky, The bloody sun at noon Right up above the mast did stand, No bigger than the moon.
- 56. The boys used to emphasise the adjective in the second line, but that was perhaps natural in a community where strong language is the prerogative of grown-ups. I suppose that a teacher of expression would have pointed out that the right arm must be raised gracefully at the third line, and the voice lowered awfully to show the marvellous significance of the fact that the crudoric sun was no bigger than the moon. All I tried to give my bairns was an appreciation of rhythm. They loved the trochaic rhythm of a poem, Marsh Marigolds, by G. F. Bradby, that I discovered in a school anthology:— Slaty skies and a whistling wind and a grim grey land, April here with a sullen mind and a frozen hand, Hardly a bird with the heart to sing, or a bud that dares to pry, Only the plovers hovering, On the lonely marsh, with a heavy wing And a sad slow cry. And it used to make me joyful to hear them gallop through Stevenson's delightful My Ship and I:— Oh! it's I that am the captain of a tidy little ship, Of a ship that goes a-sailing on the pond, And my ship it keeps a-turning all around and all about, But when I'm a little older I shall find the secret out How to send my vessel sailing on beyond! I never gave them a poem that needed any explanation. I picture Macdonald painfully explaining the Elegy.... "Yes, children, the phrase 'incense-breathing morn' means...."
- 57. I'm gravelled; I haven't the faintest notion of what the phrase means. Gray annoys me; he is far too perfect for me. I fancy that he rewrote each line about a score of times in his mania for the correct word. Gray is Milton with a dictionary. I once read that Stevenson studied the dictionary often, used to spend a rainy day reading the thing, and his prose does give me the impression that he cared more for how he said a thing than for the thing itself. I think George Douglas a greater writer; indeed I should call him the greatest novelist Scotland has produced. His style is inevitable; his whole attention seems to be riveted on the matter of his story, and his arresting phrases seem to come from him naturally and thoughtlessly. When you read of Gourlay's agony in Barbie market on the day that his son's disgrace is known to everyone, you see the great hulk of a man, you hear his great breaths ... you are one of the villagers who peep at him fearfully. Every word is inevitable; the picture is perfect. I should be surprised if anyone told me that Douglas altered a single word after he had written it. When I want to feel humble I take up The House with the Green Shutters. I have read it a score of times, and I hope to read it a score of times again.
- 58. VII. Margaret looked up from the novelette she was reading. "Are the aristocracy really like what they are in this story?" she asked. "I don't know," I replied; "I'm not acquainted with the aristocracy, but I should say that they aren't like the aristocracy in that yarn. You see, Margaret, I happen to know some of the men who write these novelettes. Murray is a don at them; he'll turn one out between breakfast and dinner. To the best of my knowledge Murray has never dined in any restaurant more expensive than an A.B.C. shop ... and his characters always dine at the Ritz." "But have you never met anybody with a title?" "I once collided with a man at the British Museum door," I said. "He was a Scot.... I know that because neither of us apologised; we merely jerked out 'Oh!' I am almost sure that the man was Sir J. M. Barrie. And I shook hands with two dukes and three lords at a university dinner, but they possibly have forgotten the incident." No. I don't know the aristocracy well. I met a titled lady last summer. I was staying at a country house near London, and this lady had the neighbouring house. She came over on the Sunday afternoon. My host informed me that she had lost two sons in the war. After she had gone I was asked what I thought of the English aristocracy, and I gave my opinion in these words:—"To the English aristocracy property alone is sacred. That woman has given the lives of her two sons willingly for her country, but if she were asked to give half an acre of her estate to help pay for the war she would go mad with rage and disgust."
- 59. When I heard that lady grumble about the wickedness of the munition-workers.... "And, my dear, women in shawls are buying pianos and seal-skin jackets!" ... I realised how hopeless was the cry of The New Age for the Conscription of Wealth. The powerful classes will resist Conscription of Wealth as strenuously as they resist the Germans. Yet the Conscription of Men was in very many cases a Conscription of Wealth. One had only to read the Tribunal cases to discover that thousands of men had to deliver up all their wealth when they joined the army. There was Wrangler the actor; his property was his talent to portray character, and from that he drew his income. His property was conscripted along with him. It was fitting that he should give up all when the State required him to give it up. But the State requires all the wealth of the moneyed classes, and because economic power controls political power the State will not conscript the wealth of its real governors. I see now that our education is founded on the unpleasant fact that property is more sacred than life. Teachers are encouraged to make their pupils patriotic; every boy must be brought up in the belief that it is great and glorious to die for one's country. A real patriotism would lead a boy to realise that it is a great and glorious thing to live for one's country; the true patriot would teach his lads to make their country a great and glorious country to die for. Somehow our schools for the most part ignore this branch of patriotism; it does not seem so important as the flag-waving and standing to attention that passes for patriotism. Macdonald is decorating the walls of the school with coloured prints of our warships. "To make them realise how much the navy means to them," he explained to me as I looked at them. "Excellent!" I said. "The navy deserves all the respect we can give it. But, Macdonald, in your position I should give a further lesson on patriotism; I should point out to these bairns that while the glorious navy is defending our shores from a foreign enemy the enemy within is plundering the nation. I should tell them that under the protection of the navy the profiteers are raising the prices of necessaries hand
- 60. over fist. All the patriotic flag-waving in the world won't help these bairns to understand that the patriotism of the masses is being exploited by the self-seeking of the dirty few." Patriotism! We have popular weeklies that endeavour to make the people patriotic. They lash themselves into a fury over momentous questions: The Ich Dien on the crest of the Prince of Wales Must Go; The Duke of So-and-So must have his Garter taken from him; Who was the Spy who sent Kitchener to his doom? The only way to encourage children to be patriotic is to tell them the sober truth about the important things of life. The invention of the word "shirker" managed to effect that the most timid of men should fight for his country; public opinion will always look after the patriotism necessary for war. But my complaint is that public opinion will not look after the patriotism necessary for peace. If we were all true patriots there would be no slums, no exploitation, no profiteering. And the "patriotic" lesson in school should deal with economics instead of jingo ballads of victories won. * * * I cycled twelve miles to-night, and I raised a comfortable thirst. When I came to the village I dropped into the Glamis Arms and had a bottle of lager. As I came out I ran into Macdonald. "Lucky fellow!" he laughed, "you have no position to maintain now and you can afford to quench a thirst!" "Position be blowed!" I said, "I drink when I'm dry, and I always did. When I was dominie here I dropped in here more than once in the hot weather." "And they sacked you!" "Not because of that," I said, "but in spite of it. Believe me it was the one thing that made one or two villagers more amiable to me."
- 61. The Scot's attitude to the public-house is entertaining. If you have any position to keep up you must not enter a public-house ... you must get it in by the dozen. When I first went to London and entered a saloon bar in the Strand I was amazed to find women sitting with their husbands; I was also amazed to find no drunks about. In a Scots bar the most apparent phenomenon is wrangling. I never heard an argument in a London bar, and I have been in many: I never saw a drunk man in London, and I was there for two years. The public-house in Scotland is not respectable: in England it is. Why this should be I can only guess. The Scot may be a bigger hypocrite than the Englishman; what is more probable is that he may be a harder drinker. In Scotland entering a public-house is synonymous with getting drunk. Yet there are what you might call alcoholic gradations. A respectable farmer may enter a bar without comment, but a teacher must not enter it. He is the guide of the young, and he must be an example. Teachers seldom enter village bars ... and yet Scotland is notorious for drinking. If the teachers determined to become regular bar customers I conclude that Scotland would drink herself off the face of the map. I have a theory that the Calvinistic attitude to the public-house is the chief cause of Scots drunkenness. When a Scot enters a bar he knows that he won't have the courage to be seen coming out again ... and he very naturally says to himself: "Ach, to hell! Aw'll hae another just to fortify mysel' for gaein' oot!" The public-house isn't a public-house at all; it is the most private of houses. Peter Soutar the leading elder in the kirk here always carries a bundle of church magazines in his hand when he enters the Glamis Arms; when the date is past magazine time he enters by the back door. Jeemes Walker the leading Free Kirk elder goes in to read the gospel to old Mrs. Melville the invalid mother of the landlord, and the village is uncharitable enough to remark in his hearing that he really goes to interview his brother "Johnny." I think that it was the doctor who originated that joke. A public-house is no place for a public man in Scotland.
- 62. * * * The opening of the coal mines has brought to the neighbourhood a new type of person. He is usually an engineer who has spent a good few years abroad, and he is usually married ... very much married. His wife is always a grade above the wife of the engineer next door, and the men appear to spend most of their leisure time in mending quarrels that their wives began. Most of the men are amiable fellows with the minimum of ideas and the maximum of knowledge of fishing and card-playing. They have a certain dignity, and they instantly freeze if you casually ask where such-and-such a light railway is to run. The wives seem to have no interest other than in servants and their manifold wickedness and cussedness. They hold their noses high when they pass through the village, and they bully the local shopkeepers. When I was a dominie these women patronised me delightfully, but now that I am a cattleman they are quite frank with me. I puzzled over this for some time, and the solution came to me suddenly. They are all English women, and in the English village the dominie is on very much the same social level as the vicar's gardener. Mrs. Martinlake likes to chat to me now. She is a middle-aged lady who loves to reminisce about duchesses she has known. She once complained to me because the boys did not touch their caps to her, and on my suggesting that they hadn't been introduced she became very indignant. She called to me this morning as she passed the field I was working in. "Ah! Good morning! I've been looking for you for a long time. I wanted to tell you how much the children have improved; every village boy touches his cap to me now!" and she laughed gaily. "Good!" I cried. "If this sort of thing goes on they will be touching their caps to their mothers next."
- 63. "And why not?" she demanded with a slight touch of aggression. I shrugged my shoulders. "As you say—why not? I think that you ought to persuade your little boy to touch his cap to all the mothers in the village. I notice that he doesn't do it. You take my tip and send him down to Macdonald's school; he'll soon pick it up." She went off without a word, and I realised that I had been distinctly rude to her. Somehow I felt glad that I had been rude to her. I told Margaret about the incident afterwards. "I hate manners, Margaret," I said. "But," she said wonderingly, "you are very mannerly." "To you I believe I am, Margaret," I laughed. "But that is because you don't look for manners. Mrs. Martinlake is eternally looking for manners, and to her manners mean respect, deference, boot-licking. She doesn't want the boys to doff their caps to her because she is a woman; no, she wants them to recognise the fact that she is Mrs. Martinlake, self-alleged friend of duchesses. She doesn't care a tupenny damn for the boys and their lives; she is thinking of Mrs. Martinlake all the time. She once talked to me of the respect due to motherhood ... and you know that she sacked Liz Smith when she discovered that Liz had had an illegitimate child. "Women of that type get my back up," I went on. "They are stupid, low-minded, arrogant. They are poor imitations of the Parisian ladies who curled their lips contemptuously at the plebeian rabble that led them to the guillotine. The Parisian ladies had a fine pride of race to redeem their arrogance, but these women have nothing but pride of class. Margaret, if a teacher failed to teach a boy anything except the truth that deference is one of the Seven Deadly Virtues, I should say that that teacher was a successful teacher."
- 64. * * * The concert was a success to-night. The singing was good, but the speech of the chairman, Peter MacMannish, was great. "Ladies and Gentlemen, "We're a' verra weel pleased to see sik a big turn-oot the nicht. Aw need hardly say onything aboot the object o' this concert, but it's to get a puckle bawbees to send oot a clean pair o' socks and maybe a clean sark to oor local sojers oot in France.—(Cheers). "Weel, ladies and gentlemen, Aw've made mony a speech on this platform in the days when Aw fought for the Conservative Candidate, Mester Fletcher (cheers, and a voice: 'Gie it a drink, cobbler!')" The light of battle leapt to Peter's eyes. "Aw ken that wheezin' Radical's voice!" he cried, "and Aw wud just like to tell that voice that there's no room for Radicals in this war. What was the attitude o' that man's party to Protection? When Mester Chamberlain stood up in Glesga Toon Hall what did he say?" I gently touched Peter on the arm and reminded him of the concert and its object. "Ladies and Gentlemen, we'll no touch on thae topics here, for ye cam here for another object than to listen to me (several voices: 'Hear, hear!') Afore we begin to the programme Aw wud just like to say that we have to thank oor late dominie for gettin' up this concert. Some o' us had no love for him as a dominie, but Aw say let bygones be bygones. We a' ken that he's no a teacher (laughter), but he's a clever fellow for a' that, and we'll maybe see him in Parliament yet. That hoose has muckle need o' new blood. When Aw think o' Lloyd George and that man Churchill; when Aw see the condeetion they've brocht the country till; when Aw think o' the slack wye they've let the Trade Unions rob the country; when Aw see —" I coughed here, and Peter drew up.
- 65. "Weel, Ladies and Gentlemen, this is no a poleetical meetin', and Aw've muckle pleasure in callin' upon Miss Jean Black for a sang," he peered at his programme, "a sang enteeled: A Moonlight Sonnita." Miss Jean Black forthwith sat down at the piano. During the interval Peter digged me in the ribs. "What d'ye think o' my suggestion, dominie, eh?" "What suggestion?" "Aboot standin' for Parliament. It's a payin' game noo-a-days ... fower hunner a year and yer tea when the hoose is sittin'. Goad, dominie, think o' sittin' takkin' yer tea wi' Airthur Balfoor!" and he sighed wistfully as a child sighs when it dreams of fairyland and wakes to reality. "Aye," he said after a long pause, "Aw wance shook hands wi' Joe Chamberlain. His lawware says to him: 'This is Mester MacMannish, wan o' yer chief supporters in the county,' and Aw just taks my hand oot o' my breek pooch. 'Verra pleased to meet ye,' says Aw ... 'and hoo is yer missis and the bairns?' Man, he lauched at that. Goad he lauched!" Peter forgot the crowded hall; he stared at the ceiling unseeingly, and he lived over again the greatest day of his life. It was fitting that a Scot should have originated the title "Heroes and Hero-Worship."
- 66. VIII. Macdonald came up to-night. I hadn't seen him for weeks. "I am making out a scheme of work for the Evening School," he said. "What line did you take?" "My scheme was simple," I replied, "and luckily I had an inspector who appreciated what I was trying to do. I made the history lessons lessons in elementary political economy. Arithmetic and Algebra were the usual thing." "What about Reading and Grammar?" he asked. "We read David Copperfield, and I meant to read a play of Shakespeare and Ibsen's An Enemy of the People, but I never found time for them. The class became a sort of debating society. I gave out subjects. We discussed Votes for Women, Should Women Smoke? Is Money the Reward of Ability? I told them about the theory of evolution; I began to trace the history of mankind, or rather tried to make out a likely history, but at the end of the session we hadn't arrived at the dawn of written history." "Did you find any pupil improving?" "Macdonald, you are a demon for tangible results. The only tangible result of my heresies I can think of is the fact that Margaret Thomson smokes my cigarettes now." "Have a look at this scheme," he said, and he handed me a lengthy manuscript. The arithmetic was a detailed list of utilitarian sums ... how to measure ricks of hay and fields, how to calculate the price of papering walls and so on. My own attitude to utilitarian sums is this: if you know the principles of pure mathematics all these things come
- 67. easily to you, hence teach pure mathematics and let the utilitarian part take care of itself. His English part dealt minutely with grammar; he was to give much parsing and analysis; compound sentences were to be broken up into their component parts. In History he was to do the Stuart Period, and Geography was to cover the whole world "special attention being paid to the agricultural produce of the British Colonies." "It is a 'correct' scheme," I said. "Give me your candid opinion of it." "Well, Macdonald, your ways are not my ways, and candidly I wouldn't teach quite a lot of the stuff you mean to teach. Grammar for instance. What's the use of knowing the parts of a sentence? I don't suppose that Shakespeare knew them. If education is meant to make people think, your Evening School would be much better employed reading books. If you read a lot your grammar takes care of itself. "The Stuart Period is all right if you don't emphasise the importance of battles and plots. I haven't the faintest notion whether Cromwell won the battle of Marston Moor or lost it, but I have a fair idea of what the constitutional battle meant to England. The political war was over before the first shot was fired; the Civil War was a religious war. If I were you I should take the broad principles of the whole thing and skip all the battles and plots and executions. "As for the British Colonies and their agriculture you can turn emigration officer if you fancy the job. The idea is good enough. My own personal predilection in geography is the problem of race. I used to tell my pupils about the different 'niggers' I met at the university, and of the detestable attitude of the colonials to these men." Macdonald shook his head.
- 68. "No, no," he said, "a black man isn't as good as a white man." So we went off at a tangent. I told him that personally I had not enough knowledge of black men to lay down the law about them, but I handed him a very suggestive article in this week's New Age on the subject. The writer's theory is that in India black men are ostracised merely because they are a subject race, and he points out that in Germany and France the coloured man is treated as an equal. When I was told by a friend that the natives of India despised Keir Hardie because he carried his own bag off the vessel when he arrived in India I realised that the colour question was too complicated for me to settle. I have a sneaking suspicion that the coloured man is maligned; the average Anglo-Indian is so stupid in his attitude to most things that I can scarcely suspect him of being wise in his attitude to the native. I regret very much that I had not the moral courage to chum up with the coloured man at the university: prejudices leave one after one has left the university. I wish I knew what Modern Geography means. A few years ago the geography lesson was placed in the hands of the science teacher in our higher grade schools, and the educational papers commenced to talk of isotherms. I have never discovered what an isotherm is; I came very near to discovering once; I asked Dickson, a man of science, what they were, but a girl smiled to me before he got well into the subject (we were in a café), and I never discovered what an isotherm was. The old-fashioned geography wasn't a bad thing in its way. You got to know where places were, and your newspaper became intelligible. It is true that you wasted many an hour memorising stuff that was of no great importance. I recollect learning that Hexham was noted for hats and gloves. I stopped there once when I was motor-cycling. I asked an aged inhabitant what his town was noted for. "When I coom to think of it," he said as he scratched his head, "the North Eastern Railway passes through it."
- 69. But the old geography familiarised you with the look of the map. Where it failed was in the appeal to the imagination. You learned a lot of facts but you never asked why. I should imagine that the new geography may deal with reasons why; it may enquire into racial differences; it may ask why London is situated where it is, why New York grew so big. For weeks before I left my school my geography lesson consisted of readings from Foster Fraser's The Real Siberia. I began to feel at home in Siberia, and what had been a large ugly chunk of pink on the map of Asia became a real place. There is a scarcity of books of this kind. Every school should have a book on every country written in Fraser's manner. I don't say that Fraser sees very deeply into the life of the Russian. I am quite content with his delightful stories of wayside stations and dirty peasants. He paints the place as it is; if I want to know what the philosophy of the Russian is I can take up Tolstoy or Dostoeivsky or Maxim Gorki. To return to isotherms ... well, no, I think I'll get to bed instead. * * * I was down in the village this morning. A motor-car came up, and two ladies and a gentleman alighted. "Where is the village school?" asked the gentleman, and I pointed to the ugly pile. "We are Americans," he drawled in unrequired explanation, "and we've come all the way from Leeds to see the great experiment." "Yes," said one of the ladies—the pretty one—"we are dying to see the paradise of A Dominie's Log. Is it so very wonderful?" "Marvellous!" I cried. "But the Dominie is a funny sort of chap, sensitive and very shy. You mustn't give him a hint that you know anything about his book; simply say that you want to see a Scots school at work."
- 70. They thanked me, and set off for the school. I loafed about until they returned. "Well?" I said, "what do you think of it?" "The fellow is an impostor!" said the man indignantly. "I expected to see them all out of doors chewing gum and sweets, and—" "There wasn't a chin moving in the whole crowd!" cried the young lady. "The book was a parcel of lies," said the other lady, "and when I next want a dollar's worth of fiction I reckon I'll plump for Hall Caine or Robert Chambers. The man wouldn't speak." "I mentioned Dewey's Schools of To-Day," said the man, "and he stared at me as if I were talking Greek." I directed them to the village inn for lunch, and I walked up the brae chuckling. I had had my dinner, and was having a smoke in the bothy when I heard the American's voice: "We want to see the dominie!" Margaret came to the door, and I walked out into the yard. The trio gasped when they saw me; then the man placed his arms akimbo and looked at me. "Well I'm damned!" he said with vehemence. "Not so bad as that," I said with a grin, "had is a better word." Then they all began to talk at once. He explained that he was a lawyer from Baltimore: I told him that his concern about the absence of chewing-gum had led me to conjecture that he manufactured that substance. This seemed to tickle him and he made a note of it. "Be careful!" smiled the pretty lady—his daughter—, "he'll hand over his notes to the newspaper man when he goes back home."
- 71. The lawyer knew something about education, and he told me many things about the new education of America; he was one of the directors of a modern school in his own county. "Come over to the States," he said with eagerness; "we want men of your ideas over there. I reckon that you and the new schools there don't differ at all." I gave him my impressions of the American schools described by Dewey in his book. "It seems to me," I said, "that these schools over-emphasise the 'learn by doing' business. Almost every modern reformer in education talks of 'child processes'; the kindergarten idea is carried all the way. Children are encouraged to shape things with their hands." "Sure," he said, "but that's only a preliminary to shaping things with their heads." "I'm not so sure that the one naturally leads to the other," I went on. "Learning by doing is a fine thing, but when little Willie asks why rabbits have white tails the learning by doing business breaks down. In America you have workshops where boys mould metal; you have school farms. But I hold that a child can have all that for years and yet be badly educated." He looked amazed. "But I thought that was your line," he said with puzzled expression, "Montessori, and all that kind of thing!" "I don't know what Montessorianism is," I said; "I have forgotten everything I ever read about Froebel and Pestalozzi. All I know is that reformers want the child to follow its own processes—whatever that phrase may mean. I heartily agree with them when they say that the child should choose its own line, and should discover knowledge for itself. But my point is that a boy may act every incident in history, for instance, and never realise what history
- 72. means. I can't see the educational value of children acting the incident of Alfred and the burnt cakes." "Ah! but isn't self-expression a great thing?" "It is," I answered, "but the actor doesn't express himself. Irving expressed himself ... and the result was that Shakespeare was Irvingised. A school pageant of the accession of Henry IV. may be a fine spectacle, but it is emphasising all the stuff that doesn't matter a damn in history." "But," he protested, "it is the stuff that matters to children. You forget that a child isn't a little adult." "This brings us to the vexed question of the coming in of the adult," I said. "You and I agree that the adult should interfere as little as possible; but the adult will come in in spite of us. Leave children to themselves and they express their personalities the livelong day. Every game is an expression of individuality. The adult steps in and says 'We must guide these children,' and he takes their attention from playing houses to playing scenes from history. And I want to know the educational value of it all." "It is like travel," he said. "When you travel places become real to you, and when you travel back into mediæval times the whole thing becomes real to you." "I see your point," I said, "and in a manner I agree with you. But why select pageants? You will agree with me when I say that the condition of the people in feudal times is of far greater importance than the display of a Henry." "Certainly, I do." "And the things of real importance in history are incapable of being dramatised. You can make a modern school act the Signing of Magna Charta, but the children won't understand the meaning of Magna Charta any the better. You can't dramatise the Enclosure of the Public Lands in Tudor Times; you can't dramatise the John Ball
- 73. insurrection; all the acting in the world won't help you to understand the Puritan Revolution." "You are thinking of children as little adults," he said. "But they are little adults! Every game is an imitation of adult processes; the ring games down at the school there nearly all deal with love and matrimony; the girls make houses and take in lodgers. And if you persuade them to act the part of King Alfred you are encouraging them to be little adults. They are children when they cry and run and jump; whenever they reason they reason as adults. They are very often in the company of adults ... and that's one of the reasons why you cannot trust what are called child processes. Child processes naturally induce a child to make a row ... and daddy won't put up with a row. The child cannot escape being a little adult. It's all very well for a Rousseau to deal abstractly with child psychology. I am not Rousseau, and I tackle the lesser problem of adult psychology. The problem before me is—or rather was— painfully concrete. I set out to counteract the adult influence of the home. I saw Peter MacMannish shy divots at the Radical candidate because Peter's father was a Tory; I saw Lizzie Peters put out her tongue at the local Christabel Pankhurst because Lizzie's mother had said forcibly that woman's place is the home." "I see," said the American thoughtfully, "you used your adult personality on the ground that it was the lesser of two evils? But don't you think that that was a mistake? Was the freedom of behaviour and criticism you allowed them not the best antidote to home prejudices?" "If the children had not been going to homes at night I should have trusted to freedom alone. As it was the poor bairns were between two fires. I gave them freedom ... and their parents cursed me. One woman sent a verbal message to me to the effect that I was an idiot; one bright little lassie came to me one day with the words of the woman next door, 'It's just waste o' time attendin' that schule.'