Monday, June 4, 2012

Virtuosity vs. Virtual-osity

I often have conversations with people who've been lifting weights for a few years, put up some adequate numbers, and maybe even trained a few people. In real life, most of these people are humble and open to learning new things, but I'll run across the occasional hard-ass - you know, the trainer that's read every T-Mag article and can recite this year's complete NFL combine results without batting an eye. Their enthusiasm is infectious. Unfortunately, their pretentiousness is tough to take. 
There's a wisdom vs. knowledge thing here that they're missing. For every "Well, I've tried this with quite a few kids and they did well..." you offer, they come back with "WELL, SO AND SO ATTACHED AN ELECTRODE TO 5 PEOPLE'S ASSES AND THE RESEARCH SHOWS...." I'm all for research. I really am. I believe it points us in new directions and raises questions where we might have previously followed blindly. And I believe in the value of this amazing thing we call the internet. I really do. At our fingertips, we have endless resources - when I was growing up, you had to go to a gym to ask questions about "lifting", but now a five-second search will give you hundreds of potentially valuable links. But let's not get ahead of ourselves - a study or two does not completely invalidate training exercises and methods that thousands have found to be effective, and time in the virtual world reading articles and commenting on GymRat89's training log does not, does NOT equal time in the gym training yourself and others. 

From "Virtually You":  
With all this information at our fingertips - information that previous generations would have had to work very hard to track down - many of us feel informed in a diverse range of fields, or at the very least capable of quickly becoming informed in the time it takes to do a few Google searches. But the surfeit of false information circulating online, from the extreme (conspiracy theories on 9/11) to the subtle (the misspelling of a historical figure's name), can make it difficult to separate truth from lies, fact from opinion. In fact, the Internet bestows on many of us a false mastery of knowledge as it convinces us that we are more qualified, educated, or mature than we truly are. In doing so, it facilitates a potentially dangerous social phenomenon - the dissolution of offline hierarchical relationships when it comes to information, be they child-parent, student-teacher, patient-doctor, or layman-expert.
Hailed by many as the "great equalizer," the Internet is a societal leveler the likes of which humankind has never seen before. In the way it spreads information, the Internet evens out the playing field by bringing together people whose lives would otherwise never intersect and whose voices in almost every other setting would carry differential weight, in proportion to their class, race, profession, or age. Here is the analogy that early Internet proponent Howard Rheingold used in 1991 to describe the promise of emerging e-mail technology: "Just as the advent of the Colt .45 revolver during the taming of the West equalized the balance between a small person and a larger one, telecommunications, properly used, can equalize the balance of power between citizens and power brokers." Computer-mediated communications were at long last going to peaceably erase unwarranted privilege, bringing us closer in class and stature to one another than ever before, thereby boosting our democratic system of governance and way of life.
Almost 20 years later, however, one can say that there has been a downside to this "Athens without slaves," as Rheingold called it. A lack of boundaries between groups online has led to situations that challenge the utopian version of democracy, as everybody feels equally informed and qualified. The free flow of information, open access to knowledge, and glut of data can be seen, paradoxically, as threatening our democratic ideals. The life experiences of a fifty-year-old mother, for instance, ideally should help inform decisions made by her fourteen-year-old daughter, particularly in matters on which parents and children may disagree: choice of school, dress code, alcohol, drugs, and sex. Similarly, in matters of health, the medical opinion of a board-certified physician should carry more weight than the smattering of information gleaned, either from Internet sites or by exposure to drug companies' direct-consumer marketing, by a layperson. However, the daughter and the layperson may nurse the illusion, fostered by the Internet, that their opinion is as valid as the mother's or the doctor's, a phenomenon that can impede the efforts of the parent or the doctor to have seasoned, evidence-based advice accepted. An example from my practice helps illustrate the limits of "one man, one vote" in the virtual era.
Ashley, a sixteen-[year]old ballet student, was brought in by her mother to see me for a consultation. Ashley had already decided to prescribe to herself the antidepressant Wellbutrin, ostensibly for depression, and was on the verge of ordering it online from an overseas supplier when her mother insisted on making the appointment. "I'm sure Wellbutrin would help," she told her daughter, avoiding a fight that might have made Ashley reluctant to see a doctor. "But let's at least have a specialist prescribe it. This way we know we're getting the real thing."
Ashley's mother, a medical social worker, had used her maternal and clinical instincts to accurately diagnose her child's problem: not depression but a serious case of anorexia nervosa that required immediate medical attention. Objective signs for the disorder abounded: the smell of vomit in the bathroom shortly after the family's meals, the weight loss and accompanying arrest in menstruation, the obsessive calorie counting, and the number of bookmarked nutrition Web sites on the family computer.
It didn't take long during my first meeting with Ashley to agree with her mother that she was not depressed. Ashley was social, enjoyed ballet, was doing relatively well in school, and smiled broadly when a text message from a friend arrived to her cell phone during the meeting. Yet she quickly blurted out, "Insomnia, poor concentration, poor energy, and anhedonia" in describing to me how she was doing. When I asked her to explain what she meant by anhedonia, a formal clinical term with a Greek pedigree, Ashley grew nervous and impatient. It was obvious that whatever Web site she had consulted to memorize the symptoms of clinical depression apparently did not explain what anhedonia was. (She could have looked up the term on Wikipedia, where it is accurately defined as the "inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social or sexual interaction.") I told Ashley that given her very low weight Wellbutrin was a poor choice for antidepressant, as it could cause serious seizures in underweight people and might lead to further weight loss. That had little effect on Ashley, however, who threatened to buy the medication on the Web if I did not write her a prescription for something she "knew would work for her."
Wellbutrin, I had learned from other patients with anorexia, had a reputation in online eating disorders circles for being an appetite suppressant and is commonly sought out by anorexics to help them lose weight. Just as Ashley learned online how to more effectively induce vomiting ("stick the bottom of a toothbrush down your throat, it'll all come out," according to, she also learned how to manipulate her mother and doctor into prescribing the last medication she needed.
Still, I did not completely close the door on the possibility of prescribing this medication at some point in the future for Ashley, in part to keep her in my clinic and to encourage her to join an eating disorders therapy group. Unfortunately, Ashley barely last two meetings before the psychologist running the group, a colleague of mine, had to ask her to leave. She could not handle Ashley's constant defiance and the distorted, partial knowledge clearly gleaned online that Ashley would use to refute every fact the group leader was trying to communicate - how, for instance, the human race did not evolve to eat 2,000 calories a day; how the research showing that the brain of anorexics shrinks as the disease progresses was "seriously flawed" because it "didn't include a control group"; and how most religions of the world have incorporated some element of fasting into their rituals, so how bad can it be? In addition, Ashley would blurt things out, drown out other participants, and speak out of turn. "She acted like she was in a chat room!" my exasperated colleague commented. "She wouldn't let me do my job of moderating the group."
It's easy to see how children and teenagers like Ashley can pretend to be adults and make adultlike decisions about their health and other important matters without being equipped, experience-wise, to be making those decisions. It is also easy to see why people like Ashley have a  hard time accepting the fact that, in real life, one person's voice sometimes should carry more weight than another's - this is not the case online, where everyone's opinion is equal. Increasingly, whenever their half-facts are challenged, people are quick to accuse others of dismissing the vast knowledge and equal status they have earned through hours of ... surfing.

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