Taming the Bureaucrat

Taming the Bureaucrat

By Gerald W. Grumet, M.D.

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© Copyright 2011, Gerald W. Grumet, M.D.

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Library of Congress Number: 2001118483

ISBN: 978-1-60414-390-4

This book is dedicated to my grandparents,

Meyer Max Grumet, Itta Kurtz Grumet, Joseph Ross,

and Rebecca Levy Ross, all of whom had the good fortune to

come to America while Adolf Hitler

was still a small child.

PREFACE

I am a practicing psychiatrist who became, in the middle 1980s, an unwilling conscript of the information age. I began to notice that the paperwork which had previously taken five or ten minutes now consumed an hour or two. I also noted that my patients were becoming commoditized and nurses were becoming clericalized. Soon it dawned on me that my experiences with user-hostile bureaucracies and user-hostile bureaucrats were not unique to the field of medicine but constituted a general phenomenon of modern society. Virtually every citizen that one encounters nowadays has bureaucratic nightmares to report and the United States federal government has gradually become a bulging encyclopedia of duplication, triplication, quadruplication and beyond.

Though people rant against bureaucrats, to the point that the term has become a cussword, the problem continues to grow be-cause its root causes remain unclear. After studying bureaucracies and bureaucrats for a while, I have come to believe that the nucleus of the problem resides in the rigid, obsessional, orderly or structured personalities that form the functional core of advanced societies. As one examines the bureaucrat and his sinister cousin, the totalitarian, one usually finds strong elements of compulsivity or what Freud termed the anal personality. This is the focus of my book. I hope that it will provide the reader with some useful in-sights into the bureaucrat and the bureau in which he dwells.

FOREWARD

I wish to express thanks to my children who provided ideas and commentary for this work; my daughters Amanda, a musician and comedienne, Jessica, an attorney, and my son, Jason, an environ-mentalist.

Thanks are also due to two learned chums who proofread the manuscript: Stanley L. Engerman, an economic historian and au-thor, and Adrian Leibovici, a geriatric psychiatrist. I appreciate the valuable editorial advice of Anca Leibovici and Toni Morris.

Gratitude is also due to the staff members at Rochester General Hospital, the Rochester Mental Health Center, and other lo-cal Rochester facilities who both wittingly and unwittingly pro-vided useful examples of bureaucratic phenomena. Social workers Barbara Mittiga and Julie Malinchak and several lunchtime physician-conversationalists were especially helpful.

Some ideas expressed in this book were earlier enunciated in articles appearing in The New England Journal of Medicine, Perceptual and Motor Skills, Psychological Reports, Readings, and The Stanford Law and Policy Review, which are referenced within.

CHAPTER ONE — INTRODUCTION

Like others who report revelations or moments of truth, I am able to focus on a single event that galvanized my identity as a bureaucracy-fighter. Many health insurers began in recent years to ratchet up their requirements for authorizations, documents and treatment reports under the guise of quality control. Actually, these were mostly pseudo-requirements or hoops designed by insurance companies for the patient and physician to jump through and thereby increase the process, so as to slow down the outflow of funds. Coincident with these developments, some health insurers developed an incredible knack for losing the bills submitted to them and created egregiously inept and error-ridden payment systems that called to mind the expertise of people like Curly, Mo and Larry. In my dealings with one such insurer, a request for a small payment was reported lost and I was advised to submit a second request. When that, too, was lost and several months had elapsed, I made a few long-distance phone calls and each time was placed on Musak-hold for protracted periods. My feelings of frustration continued to mount until this one little unpaid bill be-came a sort of cause celebre. It symbolized a collection of frustra-tions with a world that had lost its simplicity and honor, one that was losing its purpose admidst botanical proliferations of process. By the time a human voice answered my final call, I had no perspective. Like Saul on the road to Damascus, the experience had changed me. Out poured long held frustrations, a tirade that far exceeded the trivial transaction at hand. I informed the young insurance clerk that she was working for a criminal organization, one that was involved in the theft of professional services. As I ranted on, she said that she had had no contact with this lost claim but was merely doing her assigned job. I countered with another vehement monologue, announcing that she was like a foot soldier in Hitler’s Wehrmacht, not independently evil perhaps, but marching to a pathological drummer. She continued to de-fend herself and promised immediate personal attention to the error. When the small payment arrived a couple of weeks later, I realized my behavior had been out of line.

What would John Romano have done? I wondered Professor John Romano (1908—1994) was a pioneering psychiatric educator who had trained many hundreds of psychiatrists, psychologists and physicians after founding the University of Rochester’s Department of Psychiatry in 1946. He was a father-figure and mentor to many of us in this community and followed a spirit of scientific inquiry and dignified, scholarly debate. His approach could probably be summarized by the statement of Dutch philosopher Baruch Spinoza: Not to laugh, not to lament, not to curse, but to understand. With this in mind I began an effort toward a reasoned examination of what was happening to me, a practicing physician in Rochester, N.Y. and to my world. I placed a cardboard carton in my back room and, each time a problem arose with a health-insurer, made a note of it and tossed it into the box. After a few months, a large pile of notes and claim forms could be examined in an effort to sort out this phenomenon. It seemed as if a large component of these insurance difficulties rested on the willful efforts of insurance carriers to delay, obstruct and confuse physicians and patients so as to hamper the procedures for authorization, treatment and payment. I collected these ideas and wrote a brief article entitled, Health Care Rationing Through Inconvenience: the third party’s secret weapon.¹ But other problems seemed to be present: inefficiency, delay, confusion and obstruction were not limited to organizations involved in financial payouts, but were also seen in the mechanisms by which organizations collected money. The United States Internal Revenue Service (IRS), for example, has constructed a gargantuan system of nearly impenetrable complexity which impedes the inflow of funds. The Standard Federal Tax Reporter, in early 1996, listed 97,409 pages of regulations and interpretations of the U.S. Tax Code.² By early 1997 its length has grown to 98,409 pages. This seems a bit excessive when one considers that the entire U.S. Bill of Rights was spelled out by Americas founding fathers in just 462 words. The IRS poses 42 questions merely to ascertain if one is the head of a household, and Americans spend an estimated 5.4 billion hours per year in filling out income tax forms.³ No wonder that there are about 10 million non-filers annually, and interestingly, about one-third of them are due refunds.⁴ Non-compliance with the labyrinthine tax code is not limited to footloose or delinquent persons, as many people of intellect and goodwill find it nearly impossible to understand and comply with it. Take, for example, the so-called nanny tax, required for employing household help. Before it was simplified in 1995, after some prominent non-filers were exposed, the IRS required that an employer fill out an employment eligibility verification form, obtain the employee’s Social Security number or file a form FF5 to obtain one from the IRS, file a quarterly 942 form for payment of Social Security taxes, file a W4 form, file an annual 940 form for unemployment taxes and give the employee an annual W2 form. By the IRS’s own estimate, 75% of household help employers violated these rules.⁵ Included among the nanny-tax delinquents were two nominees for the post of U.S. Attorney General, Zöe Baird and Kimba Wood, California Governor Pete Wilson and Admiral Bobby Ray Inman, who was nominated to lead the Department of Defense. But it should be of no real surprise, since people of high intellect and great accomplishment rise to the pinnacle of their professions by being able to discard irrelevancies so as to focus selectively on what is important. The collective good sense of high achievers like those just mentioned was to sidestep the unwieldy, error-prone, time-consuming machinations of the IRS in favor of simple and informal two-party dealings between employer and employee. They chose to refuse the Hirohito-type challenge, which the Internal Revenue Service has made to the American Taxpayer: I am asking you to decipher the indecipherable, to penetrate the impenetrable, and to explicate the inexplicable.

I may have been more sensitive than most of my colleagues to these unwanted intrusions, since I had no secretary and was there-fore on the front lines in dealing with the paper and telephone work required by various health bureaucracies. When I initially began practice in 1968, I had tried to follow the pattern of an old country doctor shunning a commercialized style of practice, while embracing a personal approach.

I sent out my bills in longhand, and refused to become a corporate-type, volume-oriented practitioner. Unfortunately, the old family doctor tradition has gone the way of wind-up Victrolas, celluloid collars and spats.

The Obsessional Character

And so, it gradually began to dawn on me that the annoying complexity which I encountered in dealing with health insurers was not limited to willful obstructionism. A far deeper problem was involved. How did the IRS, founded as a modest unit of the Treasury Department in 1862, grow to its mammoth proportions? And how did the 16th Amendment to the U.S. Constitution— thirty words in length—which permitted the Federal Government in 1913 to begin collecting corporate and individual taxes, allow the IRS to metastasize into the giant, hydra-headed bureaucratic monster which we know today? Why is almost every government action now surrounded by an extensive bureaucratic scaffolding of procedures, documentations, communications, authorizations and reviews? What animates the people who feel so at home within the anonymous megastructures of government? Who are the keyboard-tapping functionaries who inundate us daily with a flood of poorly-worded memoranda? It soon became clear that bureaucratic expansionism originates at the uneasy interface between the well-organized bureaucrat on one hand, and the disorderly world which surrounds him. His procedures, rule-books, categories, information systems and unending paperwork—the white plague of modern America—seem to reflect an effort to exert control and discipline upon an untidy country and its untidy inhabitants.

Another insight became obvious through multiple dealings with the impersonal bureaucratic mandarins of the health industry: these people are rigid, humorless, and hypoemotional. They usually reside at the obsesional or compulsive side of the character spectrum, lacking in warmth, empathy, individuality or playfulness. The hardwired bureaucrat often harbors what Sigmund Freud and his psychoanalytic colleagues termed an anal personality.

While many people curse bureaucrats and their convoluted procedures, few real solutions have been offered. Most of the themes of remedy seem to address the symptoms of the problem rather than its root cause. Suggestions are often simplistic, such as: fire the bureaucrats, reduce taxes, shrink the size of government, get the FDA to approve drugs faster, close the Commerce Department, get the government off our backs, and so forth. Al-though these hollow solutions are of little use, the field of medi-cine offers some ideas for confronting the bureaucratic scourge.

A Disease Model of Bureaucracy

The physicians natural instinct in confronting a health problem is to first gain an understanding of its etiology or cause, as well as its pathogenesis or mechanism of disease development. But the history of medicine is replete with well-meaning, yet misguided, efforts at treating illnesses that were misunderstood or only partly understood. Take, for example, the case of hospital-borne infections. Prior to an understanding that microbes caused infections, it was believed that tainted air and ill vapors within the hospital caused infections to spread, while fresh breezes were the best way to prevent them. Nursing pioneer Florence Nightingale (1820—1910) seized upon the atmospheric contamination idea and urged hospital designs and nursing procedures that would rid the hospital of its putrefactions and fermentations. She rejected the germ theory, preferring a holistic (and somewhat moralistic) approach that would see an end to poor ventilation, chamber pots that lay unemptied for hours, slovenly nursing care, sinks and drains that were located where they would contaminate the atmosphere, etc. This approach led to the pavilion hospitals of the 19th Century, with their large hallways and sunrooms, and vast open terraces and porches. But it was not until later in the 19th Century that Glasgow surgeon Joseph Lister, impressed with the work of Louis Pasteur, realized that it was not so much the hospital atmosphere but specific disease particles, i.e., germs, that were the true culprits. He introduced aseptic surgical techniques, hospital disinfectants and heat sterilization of instruments which more than any other medical discovery led to the development of the modern hospital at the beginning of the 20th Century.⁶

Unfortunately, our understanding of the bureaucratic disease remains at the vague, moralistic level of Florence Nightingale. It is not enough to rant about government waste and inefficiency, or to claim that all politicians are crooks. Needed now are not crude efforts to throw out both baby and bath water but an approach that seeks to understand why our society has become choked with elephantine bureaus of mind-boggling complexity that spew forth technical rules and bloated documents that puzzle even the experts. As I became aware that the structured or obsessional character type was the underlying microbe that caused this disease, it dawned on me that my first exposure to this affliction was not as a physician in the 1980s but as a small child in the 1940s. I realized that I had been oppressed by rigid personalities since I entered elementary school at the age of six.

Public School 187

In September, 1943 I entered the first grade in the Washing-ton Heights section of Manhattan. It was a typical urban public elementary school with a strong emphasis on authoritarian control and conformity. The students were lined up by size, then marched to their assigned seats, where attendance was taken in an alpha-betical roll-call from Abrams to Zaretzsky. On assembly day, every student wore the required white shirt and blue tie. We marched from class to class when the bell rang, like little robots. No teacher ever asked me who I was, or what my needs, wishes, opinions or beliefs were. When the three o’clock bell rang, the students came cascading out of the doors like animals let loose, jubilant in their release from bondage. In the early grades, fear was the guiding principle: the ultimate threat was that a misbehaving student would be sent to sit on Miss Roberts’ bench. Miss Roberts, the principal, was an elderly dowager who had a large wooden bench in front of her office that carried, like Miss Roberts herself, a mystique of ultimate horror. The implications of being required to sit on the bench were never quite clear to me. Like most other good students, I was too terrorized to ever attempt to find out but vaguely associated it with the electric chair at the Sing Sing correctional facility. To sit there meant, in essence, that one’s useful life was over. As students reached the upper elementary grades of this school, the bench no longer held that special, paralyzing deterrent to misbehavior. Consequently, the teaching staff shifted to a threat of symbolic penalty that could allegedly damage one’s future life: if misbehavior occurred, a notation would be made on one’s permanent record card. The reality of this sanction and its implications, if any, remain unclear to me to the present day, but supposedly each pupil had a never-to-be-erased 5 by 7 inch file card of some sort upon which an unfriendly comment would register an indelible stain upon one’s future life. In looking back, this mini-terror campaign relied upon mysterious, ill-defined but severe conse-quences. It was not until I reached the 5th grade that I encountered at last, a friendly teacher, one with a sense of humor who liked children. But by that time the damage had been done.

Incredibly, in the autumn of 1994, some women in my class were able to track down most of the alumni of P.S. 187 and convene a reunion at the school gymnasium. Many of us, now middle-aged men and women, made a pilgrimage to the still-present wooden bench, symbol of our childhood terror. At this reunion some of us puzzled over the school’s basic unanswered question: How was the New York City Board of Education able to assemble such a dour, uninspired and humorless group of spinster teachers? My only regret, in retrospect, is that never did I express my appreciation to the very few among them who showed us some kindness and friendship. I’m sure that those few found the ambiance of the school in those days as oppressive as we did and would have welcomed some amicable feedback.

Many years later I took my own children to view the high school marching bands which performed at the annual Memorial Day Parades in Rochester, New York. An interesting phenomenon caught my eye. Most of the young marchers seemed happy, smiled at familiar faces along the parade route, or joked and whispered clandestinely among themselves. But a few of the marchers seemed to shun this frivolity. Stone-faced and grim, with eyes fixed for-ward, these marchers trudged ahead ramrod straight and unamused. Their attitude was one of solemnity, of duty, of sobriety. They seemed destined to become the stern fathers, the fearsome bosses, and the humorless bureaucrats of tomorrow.

Some Biological Notes

In viewing the behavior of bureaucrats, one typically finds them performing rigid, sequential actions which often have no inherent purpose but are performed because that’s the way it’s done. One sees in the bureaucrat’s behavior a close parallel to some of the instinctive patterns of lower creatures. The solitary or digger female wasp will instinctively dig a hole for a nest, find a caterpillar, paralyze it with a sting, drag it to the nest, push it in, and after a few other caterpillars are similarly added, lay her eggs and seal the nest. This sequence is performed by rote and, even if the caterpillars are removed in the middle of the operation, she lays her eggs and seals the nest. Bureaucratic procedures, which have long since lost any grounding in purpose, are perpetuated in a similar manner.

A honeybee colony may consist of as many as 50,000 individuals: a queen, perhaps 3,000 drones—some of whom mate with the queen, and a large number of workers. How different is this from a large corporation with a CEO, a few managers, and a large number of employees? Some of the worker bees, like sales representatives, scout the countryside for nectar-bearing flowers, while other workers buzz around the hive entrance acting as sentries to screen out strangers—sort of like corporate security guards checking identity badges. Similarly, the well-known visual displays of birds draw a close analogy to the explicit uniforms, decorative medallions and ritualized salutes or military personnel. Animal patterns of food-hoarding, dominance hierarchies, territorial be-havior and the elaborate social routines among higher species are readily recognizable in corporate rituals. Like the stereotyped, fixed-action patterns of lower creatures, the human bureaucrat frequently comes ro worship the status quo, falling into a ritualized pattern of busywork while clinging tenaciously to protocol, structure and routine.

The evolution of mankind is stated to have experienced its greatest natural selection pressures over several hundreds of thou-sands of years, with relatively little change having occurred in the last 10,000 or so years.⁷ In other words, Mother Nature deposited the human nervous system in the Stone Age and has done very little since to prepare us to cope with the changes occurring in the last few millenniums of recorded history. Primitive humans lived in hunter-gatherer bands of around fifty to two hundred people⁸ and, according to mathematician John von Neumann, we have brains with a level of precision in the order of only two or three decimal points, if unaided by machines.⁹ How then did humans cope with the rapid advances that were to follow? I believe the answer is that we have fallen back upon the survival mechanisms of our animal ancestors, especially those involved with defense, territoriality, rigid behavioral routines, hierarchical pecking orders, hoarding of resources, wariness toward strangers and so forth. How different is the modern man reviewing his stock portfolio from the squirrel and his stockpile of acorns? And is the modern, rational student surfing the Internet or E-mailing data to a colleague all that different from his Cro-Magnon ancestor of the Paleolithic Period (Old Stone Age) who prepared fine spearheads and organized communal hunting parties to stalk the wild horse or reindeer of forty thousand years ago?

Henry Jacoby, in a book called The Bureaucratization Of The World,¹⁰ noted that the flow of history has been toward increasing control, organization and regulation of human activities or what he calls the administered world. This belief was shared by French philosopher and historian, Michel Foucault (1926—1984), who saw society as developing systems of power, knowledge, finance, and commerce so that people’s behavior could be rendered predictable and organized. He noted strong basic similarities between factories, hospitals, schools, military barracks and prisons.¹¹

As early as the 5th Dynasty of Egypt (2500-2350 B.C.) census records listed every citizen along with his employment, in-come and property—which were kept in a central location for tax purposes.¹² The Agricultural Age is generally believed to have arisen as early as 8,000 B.C.¹³ in the fertile regions of ancient Mesopotamia near the Tigris and Euphrates Rivers and in Egypt near the Nile. The Agricultural Era began to be superseded by the Industrial Age, whose onset is often dated to 1765— when James Watt in-vented the steam engine. The Industrial Age was subsequently replaced by the Information Age. According to John Naisbitt, this occurred in about 1956, in America at least, when industrial workers began to be outnumbered by information workers. By 1982, about 60% of American workers held information jobs: teachers, lawyers, doctors, accountants, writers, bankers, brokers, clerks, librarians, secretaries, programmers, systems analysts, managers, social workers, administrators and, of course, bureaucrats. Their primary efforts involve creating, distributing and processing various kinds of information.¹⁴

Ascent of the Structured Personality

As mankind advanced, the need to organize has transcended considerations of geography, language, politics, religion, economics, culture or morality. The world’s growing complexity has drawn us all inexorably toward more fully articulated and explicit rules of behavior. As one historian wrote, a universal tendency for people to organize ... unites, like a great geologic substratum, the end-less range and diversity of the social scene under one compelling principle.¹⁵ Of interest is that the most dramatic modern examples of tightly-structured bureaucracies are seen in military organizations. Frederick William I, the King of Prussia from 1713 to 1740, devised systems of military organization that are the ancestors of military structures still actively used. His system had 143 clearly defined ranks from Field Marshall down to cellar clerk. His son, Frederick II (Frederick the Great), who was the Prussian King from 1740 to 1786, initiated some of the basic principles of classical management theory that still survive today: centralized authority, strict discipline, and explicit divisions of responsibility. In the U.S., modern business organization techniques can also be traced to military origins. In 1817, the fourth superintendent of the U.S. Military Academy, Sylvanus Thayer, introduced a system by which the organization was ruled through exchanges of memoranda, re-ports, charts, personnel files and more. Two of his students were later to become business leaders: Daniel Tyler and George Whistler (the father of artist James Whistler). They expanded upon Thayer’s techniques, introducing accounting systems, methods for quality control, productivity norms and other management tools that were propagated throughout the country and are credited with creating a management infrastructure for the modern American corporation.¹⁶ In the 1820s American railroad companies be-gan to develop formal command-and-control operating systems to guarantee the safety of trains going in opposite directions on single-track lines.¹⁷ As America developed industrially, large manufactur-ers, wholesalers and retailers experienced increasing problems in orchestrating their sales inventories, deliveries, billing operations and cash flow. During the 1850s the Erie Railroad, which was the first trunk line connecting East and West, experienced enormous confusion in their operations, sometimes misplacing railroad cars for months at a time.¹⁸ The time was ripe for well-organized, operational, structured thinkers to take the lead.

John Dewey wrote in 1931: Quantification, mechanization and standardization: these are … the marks of the Americanization that is conquering the world … they have invaded mind and character, and subdued the soul to their own dye. He noted that America’s preoccupation with industrial, technical and commercial success had led to creation of the business mind as the prevailing personality of our age.¹⁹ This is a culturally patterned personality configuration that has come to dominate others as a ba-sic or modal character type within American society.²⁰,²¹ It also reflects the obsessional character or structured thinker, who increasingly has come to dominate affairs within post-industrial societies. There has been a functional ascendancy of these character traits in the modern world and their ultimate effect has been what Warren Bennis called an "unconscious conspiracy to immerse us in routine. ²²

CHAPTER 2 — THE STRUCTURED PERSONALITY

The term structured personality is essentially what Sigmund Freud called the anal personality but I have chosen to rename it so as to avoid the pejorative connotations of Freud’s term. It overlaps other terms that are used to highlight selective aspects of this basic character structure, e.g., the rigid, compulsive, authoritarian, obsessional, or bureaucratic character style. It is a personality that is primarily defensive in nature, with emphasis on self-protection, control, the hoarding of vital resources, a heightened awareness of territorial boundaries, an acute sensitivity to one’s position in the pecking order, aloofness, wariness toward others and a strict containment of affiliative impulses. The structured person is also a creature of routine, with an enormous capacity for work, making him well-suited to organizations and bureaucracies of the modern era. At the other side of the character spectrum lies the hysteroid or expressionistic character type which is basically affiliative in nature and preoccupies itself with interpersonal relationships, amorous emotions, sentimental or erotic interactions, and their various derivatives in music, poetry, drama, humor and other hu-man-contact endeavors. At the risk of oversimplification it can be said that the obsessive character perceives the world as a dangerous place and seeks to obtain security, while the hysteroid character sees the world as a lonely place and seeks to obtain love. The obsessional and the histrionic personalities are, of course, idealized and simplified character types, rarely existing in pure form, since most of us have traits that allow us to make both love and war. From an evolutionary perspective, the structured traits were selected over the generations for their value in guaranteeing survival of the individual, while the hysteroid traits proved effective in guaranteeing survival of the species.

I can recall a clear depiction of the contrast between structured and histrionic character types. During the 1950s and 1960s Dragnet was a popular TV police show in which actor Jack Webb played the role of a laconic, hypoemotional, bass-voiced detective, Joe Friday. A frequently used dramatic contrivance within the weekly drama was the arrival of Webb and his equally subdued partner at a crime scene where some dreadful offense had just taken place. Webb attempted to elicit information from an hysterical witness, usually a woman who was in the throes of great emotional distress. Agitated and hyperventilating, she gasped, It … it … it … was awful … I … I … I … never thought anybody could do such a thing … I … I. … opened the window … and … and he had a gun … it … it … it was terrible … that poor girl … oh … oh … At this point, Webb, wearing a grim expression and his signature pork-pie hat attempted to shift the focus from emotion to cognition with his famous line, Just the facts, ma’am.

Sigmund Freud’s original 1908 description of the anal personality rested upon three core features of this character type, some-times called the anal triad: orderliness, obstinacy, and parsimony.¹ Although initial theories that this personality might somehow be related to toileting functions have long since been laid to rest, Freud’s anal character description is one psychoanalytic concept that has stood the test of time. More recent statistical reviews have verified that anal traits tend to cluster together in a syndrome.² A wide assortment of related traits are included in the syndrome, such as cleanliness, punctuality and a tendency toward collecting and hoarding. The anal person is often involved in many activities that are readily recognized among bureaucrats, such as taking plea-sure in listing, indexing and cataloguing items and a tendency toward overcaution and indecision, with the anal character tending to ruminate over hairsplitting nuances for protracted periods. Such people are often addicted to the prescribed rules of conduct without much in the way of flexibility, creativity or imagination. And the anal personality frequently demonstrates an enormous capacity for work, even if he is accomplishing nothing, a phenomenon that has been termed nonproductive perserverance.³ These are cautious, deliberate and rational people, who tend to be very orderly, disciplined, frugal and usually behave in a reliable and predictable manner, traits that are fetishized in modern corporate America. It has been suggested that society owes much of its stability and its efficiency to its more obsessional members,⁴ and the adaptive function of such behavior has come to be recognized and acknowledged as being of great utilitarian value in a culture that honors productivity and the work ethic.⁵

But structured persons also carry with them some serious drawbacks. Erich Fromm described the anal character as living in a fortified position. For such a person, isolation spells security while love, closeness or intimacy spell danger.⁶ This was echoed by Wilhelm Reich, who noted that compulsive people tend to be overly controlled and restrained and lack ordinary spontaneity. He called these people living machines and suggested that they spend a great deal of their energies to control underlying sadistic impulses, which sometimes eventuates in a chronic hypertonia of the muscles: Hence the ‘hard,’ somewhat mask-like physiognomy of compulsive characters, and their physical awkwardness.⁷ This feature was also noted by David Shapiro, who described the driven quality of such persons: The activity—one could just as well say the life—of these people is char-acterized by a more or less continuous experience of tense deliberateness, a sense of effort, and of trying.⁸ Such people are rigidly attentive, and do not allow their minds to wander or meander passively or impressionistically. For them, relaxation, spontaneity, following one’s desires, getting a hunch or becoming swept up in emotion are viewed as signs of weakness, giving-in or losing control. The obsessional person imposes upon himself outside authoritative values and regulations which supersede his own inclinations and judgments. He replaces the volitional I want to with the dutiful I should, becoming estranged from his inner feelings and wishes. When called upon to make subjective personal decisions, such a person may experience a sense of tortured paralysis, for which the term obsessional indecision has been suggested.⁹

Shapiro noted that the obsessional person sometimes makes a forced but usually unsuccessful effort at good cheer: One some-times witnesses the unhappy spectacle of such a person deliberately attempting to achieve a state of mind or … a mood of gaiety, for which a relaxation of such deliberateness is the first prereq-uisite.¹⁰ This phenomenon is commonly witnessed at office Christ-mas parties during which time corporate employees take leave of their rigid pecking orders and their controlled workplace scripts and become intoxicated so as to engage boisterously with one an-other in an atmosphere of emphatic spontaneity and forced cama-raderie. I have witnessed an example of staged informality at a very fine accounting firm which prepares my income taxes. The accountants are well-trained, always neatly dressed, and have spacious modern offices with all of the latest computer equipment and software programs. They are quite finicky about paperwork and calculations so as to protect their clients from the dreaded Internal Revenue Service. But during the tax season, the firm al-lows a respite from the usually strict dress code on Fridays and Saturdays. This, of course, is spelled out in clear detail: on Fridays business-casual dress is allowed (pressed pants, collared shirt, no tie, loafers), while on Saturdays casual-casual dress is permitted (dungarees, or shorts, sport shirt and sneakers). Clients often wit-ness the incongruous spectacle of highly-trained but slovenly-at-tired tax accountants tapping away at: their computer keyboards with their usual meticulous precision.

I can also remember some years ago attending a beer party for physicians at which casual dress was recommended. All of the attendees showed up with baggy pants, dungarees, moccasins and similar scruffy attire; that is, all but one. He was a classically rigid personality type whose appearance that day typified the staged informality seen in the anal personality at play: he arrived with a neatly-pressed, short-sleeved white shirt, a bow tie, pressed shorts, high socks, and neatly polished wing-tipped shoes. His stiff efforts to be exuberant put a damper on the festivities for the rest of us.

The Obsessional Character Disorder

The aforementioned personality idiosyncrasies are termed character traits or character types. This indicates that we are dealing with a pattern of behavior or a style of relating to others that has identifiable characteristics but is not seen as a medical affliction requiring a clinical diagnosis. Some rigid personalities, however, are so extreme as to be unadaptive and to interfere with functioning to the point that they are considered personality or character disorders and find themselves in the manual of psychiatric illnesses. Leon Salzman gave the example of a graduate student whose quest for perfection and completeness was so great that he spent ten years trying to finish his doctoral dissertation. Every new publication that appeared in his field compelled him to revise and update his thesis. He could not make closure.¹¹ Psychiatrist Sandor Rado provided some other examples of severely obsessive people who focus on inconsequential details in a manner reminiscent of the stilted ceremonials of some bureaucrats: A patient recorded all his railroad travels from grammar school to high school, listing all the station stops, even when repeating the same trip. Another had his secretary keep a pyramid of indexes to his private files—a regular index, an ever-growing series of cross indexes, and an index of the indexes … Another, so instructed by his equally obsessive mother who always worried that he might catch cold, kept his supply of socks in the drawer in carefully separated piles marked ‘heavy,’ ‘light heavy,’ ‘heavy light,’ and ‘light.’ ¹²

Psychiatric Nomenclature

The aforementioned disturbance is listed in The American Psychiatric Association’s diagnostic manual as obsessive-compulsive personality disorder.¹³ But regrettably, the diagnosis of obsessionalism is itself clouded by obsessionalism. Over the years, the Diagnostic and Statistical Manual (DSM) of America’s national psychiatric association has gradually increased in length: 1952-132 pages, 1968-119 pages, 1980-494 pages, 1987-567 pages, 1994—886 pages. It is a sad fact that my own field is becoming subsumed by the same sorts of impenetrable jargon and mountainous artifact seen in the legal profession, the Inter-nal Revenue Service, and other inefficient bureaucracies. But de-spite this continuous arborization of diagnoses, confusion seems to be increasing rather than decreasing.

The term obsession (from the Latin obsidere, to besiege) refers to thoughts or preoccupations that persist abnormally and can often not be dispelled. Obsessions often co-exist with compulsions, which are urges to perform repetitively some sort of act or ritual. But, unfortunately, obsessive and compulsive each have two distinct meanings within the field of psychiatry. Just as the word ounce means both 1/16 of a fluid pint and 1/16 of a pound in avoirdupois weight, so do obsessive and compulsive each refer to two different phenomena. The first, obsessive-compulsive personality disorder, refers to the severe examples of rigidity and bureaucratic behavior just described. But the diagnosis obsessive-compulsive disorder (OCD) is a neurobehavioral illness which appears to be a distinct phenomenon, in it, people may feel compelled to wash their hands repetitively, check the door locks or the gas jets, or perform other foolish rituals that they know to be non-sensical. Unfortunately, in many people’s minds the obsessional character problems seen in the bureaucrat, are incorrectly lumped together with the problems of the OCD sufferer despite expand-ing diagnostic texts and the advancement of nomenclature.

Obsessive compulsive disorder (OCD) is actually a state of disordered compulsivity, while the bureaucrat’s character problems are a form of normal compulsivity.¹⁴ Figure 1 attempts to portray this difference. The term ego-dystonic compulsivity is sometimes used for the OCD sufferer who experiences a feeling of anxious dread as he performs the rituals which he often perceives as repugnant. By contrast, the structured personality or the bureaucrat has an ego-syntonic sort of compulsivity which is acceptable to him. Recent research shows that OCD sufferers often have minor neurological impairments (soft signs)¹⁵ and may have other signs of disordered compulsivity such as kleptomania, hair-plucking (trichotillomania), pathological gambling, tics, compulsive sexuality and other disorders that are theorized to be caused by a disregulation of serotonin-controlled neural systems.¹⁶ It has been theorized that in OCD there may be a breakdown in the normal balance between areas of the frontal lobes and the basal ganglia, especially the caudate nuclei, leading to a state of pathological hyperactivity and release of programmed behavioral pat-terns laid down for survival. The result is that these programmed patterns of behavior associated with survival, (checking for danger, washing, avoiding contaminants, etc.) are released over and over again.¹⁷ In any case, this sort of disturbance is not seen in people with rigid, anal or obsessional character types despite the overlapping uses of the terms obsessive and compulsive. It is another reason why I prefer to use the term structured personality.

Features of the Structured Personality

Why would someone aspire to become just another anonymous, gray-suited figure within the vast bureaucratic tableau of government? Why would a citizen choose to locate himself in some remote bureaucratic archipelago to spend the totality of his working life in the cold embrace of a government agency? The answer, I believe, is that such people yearn for the certainty, predictability and security of such a life. For them, emotional stimulation, change and adventure are dangers to be avoided. They seek the serenity of tedium and the safety of anonymity. The structured thinker is most at home with pre-arranged, pre-shaped, predictable events; he is molded by expectation, order, and control.

The anonymity and emotional emptiness that came about with America’s post-World War II corporate expansionism was recorded in several classical books of that era: A Nation of Strangers,¹⁸ The Lonely Crowd,¹⁹ The Organization Man,²⁰ and The Man in the Gray Flannel Suit.²¹ Tom Rath, the protagonist in the last of these books noted, … all I could see was a lot of bright young men in gray flannel suits rushing around New York in a frantic parade to nowhere. They seemed to me to be pursuing neither ideals nor happiness—they were pursuing a routine. William H. Whyte noted that corporations of that era sought for their work force people who would blend nicely into a suburban conformity and yearned to join a happy work team with high morale within a corporation that valued normalcy. He cited one corporate executive who revealed his underlying dislike of unorthodox thinkers by noting, We want a well-rounded person who can handle well-rounded people.²² Similarly, the yearning for homogenous, conforming personalities was spelled out in an interview with the mother of a 14-year-old boy who showed genuine interest in playing classical music on the piano. She reported that she was limiting his piano practicing time and pushing him to excel in sports. I hope to keep him a normal boy, she said.²³

I believe that one must understand the workings of the structured mind in order to understand bureaucracy and bureaucratic behavior. Some of the main features follow.

Inexcitability and Emotional Control

The typical structured personality presents an image of one who is composed, collected and unruffled. He performs his duties in a dispassionate manner and under-reacts to stimuli that might excite or perturb others. This is, of course, a valued trait in military situations or during interpersonal conflicts or crises. A student of corporate management noted that managers typically exhibited a behavioral style of smoothness, polish and a cool veneer. They had a mannerly lack of intensity: Nothing seemed to matter very much. No values seemed to be deeply held. Additionally, these people appeared to lack affect and seemed smitten by a moral numbness. This was especially noticeable in their pat-tern of speech: Their speech lacked variety in tone and content. It was passionless. Neither anger nor joy ruffled their affability; no experience or issue seemed to touch their emotions … and their beliefs—about the corporation or anything else—were spoken with-out warmth.²⁴

Emotional control is achieved by a host of mental mechanisms which were initially theorized by psychoanalysts but have since been generally accepted by most of the psychological disciplines. All people use these mechanisms, although the structured personality has mastered them most fully in achieving a high level of control. These include isolation in which emotions are split off from thoughts. An example might be a fighter pilot who releases a missile and follows its path in a technical manner but chooses not to consider the exploding building and mangled bodies that will result. Another emotion-control mechanism is denial, which is exemplified by the person who lives in an earthquake zone or flood plain and disregards the danger. Still another is called repression, the major ego defense by which painful emotions or troubling thoughts are automatically (unconsciously) kept from awareness. People simply don’t remember some of the most troubling things. The conscious equivalent of repression is suppression in which one decides not to think about an upsetting topic. The list goes on to include rationalization in which a more acceptable but less logical explanation is given for one’s action, such as the boss who fires an employee and reassures himself, It’s for his own good … he’ll have better opportunities in another company. He might also employ the defense of undoing by giving the fired worker a gift at his departure or an inflated letter of reference. Emotional control may also be achieved by displacement, in which one directs emotion away from its logical target. An ex-ample might be the infuriated worker who after smiling amicably at his tyrannical boss screams at his wife and children. Another common defense is intellectualization, by which one exerts a great deal of cognitive effort—often involving minutiae—to avoid having to confront unpleasantness. This might be seen in a pediatric hematologist who has the horrendous task of engaging with a young couple who have just been traumatized by learning that their child has leukemia. The hematologist might preoccupy him-self with an arcane discussion of stem cells, lymphoblasts, myeloblasts and monoblasts, as a defense against this terrible ordeal. Another common mechanism is reaction formation, which is applied to situations where one handles troubling feelings by trans-forming them into their opposites. The hyperfriendly and obsequious individual that one encounters in so many settings may actually be struggling to convert hostile and tyrannical impulses into socially acceptable ones.

The roster of mental maneuvers by which one controls emotions, like so much else in psychiatry, consists of vaguely defined and overlapping qualities. One may ask what the purposes of these mechanisms are. Most would agree that excessive emotions will usually undermine one’s ability to focus attention and to perform difficult cognitive tasks. It would not be useful for an astronaut on the launching pad to say, "My God! I’m sitting on top of a 363-foot 3,000-ton Saturn V rocket full of liquid oxygen and hydrogen, about to be hurtled into space!’’ Obviously, such emotions would be counterproductive. Similarly, when Columbia Broad-casting System (CBS) journalist Dan Rather interviewed a U.S. soldier about to leave for Bosnia, his request for emotional information yielded cognitive responses:

Q – How do you feel about going to Bosnia?

A – I feel it’s the right thing to do.

Q – Are you scared?

A – There’s a lot of land mines out there that we’ve got to watch out for.²⁵

Emotional control is especially important when the emotions requiring control are unpleasant ones. As first-year medical students we were assigned cadavers to dissect in our anatomy course. The cadavers first appeared as repugnant, shrunken, phenol-impregnated corpses. We wondered who these people were, and how they lived and died. It seemed at first morbid and obscene to be picking apart these bodies, but such emotional ruminations soon vanished under the pressures of academic survival in medical school. Our concerns quickly shifted to the challenge of memorizing the vast number of anatomical components within each body part. After a few days the cadavers had lost their human qualities and had become mere specimens, lacking emotional impact. At noon, an occasional student might throw a canvas tarpaulin over his cadaver, pull out a sandwich, and grab a quick lunch without a second thought. The class was our first exercise in scientific objectivity—necessary training if the physician-to-be was to learn how to put his emotions aside so as to master a difficult academic discipline. But it was also an exercise in depersonalization and dehumanization, one that most would agree was benign in its motives and likely to benefit mankind in the long run. Still, it exemplified the phenomenon in which emotions are suppressed in favor of cognition, which can then proceed uncontaminated by the distracting influences of affect. It is the kind of functioning required in the technical activities needed by the successful practitioner of the modern healing arts.

But a detached clinical attitude has its risks as well. The case was described of Dr. John E. Smith, a 63-year-old Minneapolis family practitioner—who seemed to have a very structured, hypoemotional approach to his patients. An awkward communicator, Dr. Smith was perceived by some of his younger, newer patients as strange, odd or cold. His thorough lung and breast exams were viewed by some of his female patients as nontherapeutic or sexual in nature. While no one can pretend to have a full understanding of Dr. Smiths subjective mental state during these physical examinations, my familiarity with the hypoemotional, cognitive character type leads me to suspect that Dr. Smith’s motives were legitimately clinical. While closely scrutinizing a woman’s body for enlarged lymph nodes, breast tumors, cardiac irregularities and so forth, the detached Dr. Smith was probably unaware of his patients’ subjective experiences. The patient, meanwhile, in a state of nakedness and vulnerability found herself in prolonged intimate contact with an unfamiliar man who was touching private parts of her body and saying little, a situation usually associated with amorous or sexual encounters. She felt uneasy, became stirred up emotionally and may have viewed the exam as a personal rather than a clinical exercise. Meanwhile, this hypoemotional physician remained oblivious to his patient’s emotional reactions, until complaints were registered. His behavior suggested an absent-minded professor orientation, with a psy-chic style of low-feedback on issues of emotional sensitivity. He was almost completely vindicated by a professional assessment panel, although it was clear that his interpersonal skills needed some polishing.²⁶

One incentive for limiting the emotional intensity of one’s activities, is the simple conservation of energy: emotional reactions require a great deal of energy and can leave one exhausted. In the wild, lower animals typically follow calm routines of eating, sleeping, grazing, drinking, eliminating, etc., without great energy ex-penditures. But if an intruder unexpectedly wanders into their midst, there are immediate emotional stirrings: cries of alert are heard, vigilance is heightened, catecholamines are released, pupils dilate, cardiac rhythms increase, oxygen consumption rises, as the group prepares for flight or a fight. Such alarm systems trigger energy-expending emergency reactions which are all-too-familiar among humans in the commercial wilderness of modern society as we enter a 21st century of intense competition, time pressures and stimulus overload. The structured thinker understandably gravitates toward order and regularity, preferring established systems and routines, being most at home with pre-arranged, pre-shaped, predictable events. He is molded by expectation and the safety which it connotes. What he lacks in creativity and imagination he gains in serenity and stability.

This general phenomenon was demonstrated to me when I compared notes with a social worker colleague. I was complaining at the time about the exhaustion I experienced working in a hospital emergency department into which poured large numbers of violent, psychotic and dangerous patients. Many arrived in police custody, screaming and fighting, often requiring intramuscular doses of psychotropic medications or brief placement in leather restraints for safety. Threats of violence, profanity and assaultiveness were common. After three or four hours of working in this setting, I was usually exhausted and sometimes in a cold sweat. My colleague reported that, by contrast, he was able to work in his office for as long as 11 hours with only a small lunch break and without fatigue. He specialized in family therapy, and when I encountered him bidding farewell to a family under his care, the disparity of our experiences became immediately clear. Leaving his office that day was a handsome young couple with two attractive children that seemed to have stepped out of a Peter and Peggy book. He was obviously not being subjected to the same blood and thunder emotionalism that I encountered in the emergency department and was better able to conserve his resources during an 11-hour workday.

Impersonality

A highly effective method of reducing one’s emotional outpourings is to remain impersonal. Many bureaucrats are quite skillful in concealing their personal identities behind a veil of anonymity so as to remain unencumbered with emotions. So often one receives a letter from a government bureau or a corporation that concludes not with the name of a human being but with an impersonal salutation like, Sincerely, Customer Relations Department, or, Yours truly, XYZ Corporation. Some government bureaus author letters that end abruptly without even the pre-tense of a human touch: Parking Violations Bureau, Depart-ment of Motor Vehicles, or Internal Revenue Service.

Another technique used by some organizations is to provide a semi-personal or humanoid form of engagement. This is common among insurance companies where a phone call might be answered with a response like, Customer Services, Debbie speaking. How may I help you?, or, Provider Relations, this is Wendy. The New York State Department of Social Services Disabilities Office has a different approach to semi-anonymity: their correspondence gives a last name but no first name. A letter from them may close, Sincerely, T Johnson, Disability Reviewer. Of course, one does not know if one is dealing with Ted Johnson, Tom Johnson or Thelma Johnson. (I usually begin my response as follows: Dear Mr./Mrs./Miss/or Ms. Johnson …)

The anonymous or semi-anonymous bureaucratic style works adequately where large numbers of people require rapid processing in shallow, standardized ways—such as issuing tickets or boarding passes for airplanes, license bureaus, visits for automobile registrations, postal services, serial vaccinations of military recruits, taking tickets in a movie theater, collecting highway tolls, etc. But these so-called people pipelines²⁷ are inadequate if such processing fails to offer more than a shallow engagement with the client when a fuller human interaction is required. Barbara Garson used the term hamburger science to denote the techniques of fast-food automation that are becoming increasingly applied to human activities for which short-order technology is inappropriate.²⁸ The modern computerized school report cards