How Medical Students Can Learn Empathy from Their Cadavers – The Atlantic
Health Learning Empathy From the Dead The first-year dissection is often an experience that teaches medical students to emotionally detach from their patients. By forcing future doctors to learn about the lives of their cadavers, some medical schools are trying to reverse the effect.
John Tyler Allen Jul 28, 2015
Charles Dharapak / AP On a Thursday afternoon in August 2008, Joe Thurman was sitting at the National Cowboy and Western Heritage museum in Oklahoma City, wearing his best suit and staring anxiously at the three empty chairs across from him.
It was the end of a week-long orientation for Thurman, a first-year medical student at the University of Oklahoma College of Medicine. Seated at the table around him were the new classmates with whom he would share a cadaver during first-year Gross Anatomy lab. For most of the students at the table, the dissection, set to begin five weeks later, would be their first experience with the visceral textures of the human body. For example, tearing through fascia, the thin layers of tissue covering the muscles and internal organs, isn’t always easy. To tug off the top of someone’s skull (it’s supposed to sound like ripping Velcro), you’ll need a bone saw and a bit of force.
But before the students experienced any of this, they would have to share a meal with the three people who would soon occupy those empty chairs: the relatives of the woman they would disassemble.
“That was the only thing tempering our excitement about medical school,” Thurman later told me. “You have no idea how this will go. You’re sitting there wondering, ‘How am I supposed to talk to these people?’”
* * *
Most physicians could list the benefits of getting to know the people they treat. Not everyone will walk into an exam room and open up with complete transparency; in some cases, an accurate diagnosis can depend on a physician’s ability to engage with his or her patients.
In highly emotional situations, though, some doctors can find it hard to do so. Physicians have “taught themselves to see this distress and ignore it,” says Jerry Vannatta, the former executive dean of OU College of Medicine. “They know it’s there, but instead of engaging in the distress, saying, ‘My goodness, you look sad, tell me about that,’ they ignore it and say, ‘So how’s the chemo going? You getting the radiation? Any nausea?’” Now a professor of medicine at the university, Vannatta researches and teaches a course on narrative medicine, an emerging field that uses storytelling and literature to help physicians learn to better relate to their patients.
A group of students work on a cadaver in the gross anatomy lab at the medical school at Indiana University Northwest in Gary, Indiana. (Stacy Thacker / AP) He’s also the founder of the Donor Luncheon, as it’s called. The meal is the first lesson students receive at OU College of Medicine. Vannatta got the idea for the program in 2000, while in Taiwan to teach a workshop on American medical-education practices. He asked the workshop attendees, faculty from 10 Taiwanese medical schools, to each tell him about something unique to their respective institutions. A physician from Tzu Chi University College of Medicine told him that his school has recently implemented a program to remove the cultural stigma of disturbing the dead: The families of anatomical donors were invited to join the students in a Buddhist prayer ceremony before dissections began, and the school had built a hall of honor to display the cremated remains of previous donors, now referred to as “honorable teachers.”
Vannatta immediately recognized the potential. “I said, ‘You bring your students in? These students who are going to dissect that body, and they meet with the family?’” he told me. “‘That’s one of the most brilliant ideas I’ve ever heard!’” He organized the first Donor Luncheon for the following academic year.
His initial hope for the Donor Luncheon, Vannatta said, was that it might equip the students to better cope with the dissection, which can be a traumatic experience. “To walk into a room and start cutting up a human being’s body, it’s not normal,” he said.
The natural response, he explained, is to find some way to deflect the strangeness of the situation—a need that often manifests itself as gallows humor. Students may invent stories about their cadaver or perform what Vannatta called “cadaver tricks,” in which the bodies will be objectified for comedic effect. A group of students might open the tank holding their cadaver and find the body wearing a bow tie, for example, or a student might enter the lab for a late-night study session and see his cadaver propped up and staring at him. In 2013, a University of Pennsylvania study examined what is perhaps the most common coping mechanism seen in the lab: cadaver naming. Two-thirds of the medical students surveyed (1,152 from 12 different medical schools) gave their cadavers nicknames, many of them unflattering references to a specific bodily feature. A particularly wrinkly donor, for example, was named “A Wrinkle in Time,” a donor with an abnormally large heart was “The Tin Man,” and a donor who died of respiratory failure was known as “Wheezy.”
“Inventive naming,” the study authors wrote, “allows students to acknowledge the cadaver’s personhood, while psychologically shielding themselves enough to be comfortable with the dissection.”
But Vannatta stressed that this “inventive naming,” like other unchecked coping mechanisms, can have implications for clinical practice later on. “Instead of referring to Mr. Jones in room 306,” Vannatta said, a physician might say, “‘Let’s go see the terminal in 306. Let’s go see the lung,’ referring to the patient as their sick organ. ‘The liver.’ ‘The yellow man.’” Before they’ve ever walked into an exam room, young physicians have already learned from the dissection that a little bit of comfort can be gained by putting space between the body and the human identity.
The Donor Luncheon, he said, provided a chance to close that gap, “to make it crystal-clear in [students’] minds that this was a person who lived a life—was a father, was an uncle, was an aunt, was a grandmother, was an engineer, an architect.” He added, “It’s changed the whole atmosphere of the Gross Anatomy experience in our medical school.”
* * *
Cadaver dissections usually begin with three simple cuts: a horizontal cut from shoulder to shoulder, a vertical cut following the spine, and another horizontal cut above the tailbone. The skin of the back should peel away relatively easily, exposing a gelatinous layer of fat. If the skin doesn’t lift, another smaller incision can create a sort of buttonhole, allowing a finger to hook and tug. When a student finishes removing (or “picking”) the fat and cutting through the thin layers of fascia, the muscles of the human back are revealed.
Technically, these first cuts are among the simplest a student will make. Emotionally, they’re often the most grueling.
Thurman, now in his third year of surgery residency at a hospital in North Carolina, remembers the first time his Gross Anatomy group opened the doors of the stainless-steel tank, roughly the size of a casket, that held their cadaver. The tank doors hinged open from both sides to reveal the body wrapped in formaldehyde-soaked sheets; they had to turn a crank to raise her to a workable height, and then peel back the layers.
Seven years later, he can still recall the discomfort of the moment: “She’s just this frail little woman,” he said, “and we’re about to take her skin off.”
Her face, after preservation, only vaguely resembled the family photos he’d seen at the luncheon, and the students immediately covered it back up. They also covered her hands, which were wrinkled with bright-pink fingernail polish—the most human thing about her, Thurman recalled. (It’s not uncommon in labs for a cadaver to lay splayed open at the chest while the face and hands are kept conservatively wrapped.)
The woman was laying supine, face upward, and to begin cutting her back, they needed her in a prone position. But dead bodies are heavy and awkward, and most of the students had never touched one before. They discussed the most efficient way to flip her. “You’re trying to be as delicate as you would be with your own grandmother,” Thurman said. “But there’s really nothing graceful about it.” Finally, the students moved to her hips and shoulders, one at her head, one at her feet. They counted to three and lifted.
* * *
In the early 1900s, medical schools in the U.S. bore little resemblance to what we know as medical school today. For-profit institutions frequently admitted students who had never finished high school, educated them for a single year, and granted them their license with their degree upon graduation. In 1908, in an attempt to raise educational standards and stem the flow of unqualified doctors, the American Medical Association hired the education reformer Abraham Flexner to tour and evaluate each of the country’s 155 medical schools. Two years later, Flexner published his findings as Medical Education in the United States and Canada , a 363-page report detailing, with acid verve, the shortcomings of American medical education. “The deans … occasionally know more about modern advertising than about modern medical teaching,” he wrote. “They may be uncertain about the relation of the clinical laboratory to bedside instruction; but they have calculated to a nicety which ‘medium’ brings the largest ‘return.’” The proliferation of doctors was “something worse than waste,” he lamented. “For the superfluous doctor is usually a poor doctor … [T]here is no need to make poor doctors, still less to make too many of them.”
Flexner’s disapproval came through most clearly, though, when he addressed medical schools’ failure to adopt recent advancements in laboratory science. Old treatments like bloodletting had fallen out of favor among physicians in the mid-1800s, Flexner noted, and “medicine, hitherto empirical, was beginning to develop a scientific basis and method”—but even so, schools had been frustratingly slow to respond to changes in the field. “The stethoscope had been in use for over 30 years before … its first mention in the catalogue of the Harvard Medical School in 1868-9,” he reported. “The microscope is first mentioned the following year.”
To make the study of medicine both more rigorous and more exclusive, Flexner called for a “uniformly arduous and expensive medical education.” State licensing boards and medical schools were quick to agree, and the reform that followed was the largest in the history of U.S. medical education: Admissions requirements became tougher. Tuition costs rose dramatically. Curriculums were updated to reflect the new scientific standards of the day.
In the decades after the reform, though, medical educators began to notice a change in their students. In the 1950s, the sociologist Robert Merton led a team of researchers at Columbia University’s Bureau of Applied Social Research (BASR) in a large-scale study of the “professional socialization” of medical students, or the ways in which their professional values and behavior were shaped by their training.
The results of the study were unambiguous: Hospitals, the sociologists said, promoted a distinctly sterile and un-empathic culture. And medical school, they argued, implicitly trained students to thrive in this environment.
Students and doctors attend a ceremony in the gross anatomy lab honoring those who donated their bodies to science at the Indiana University Northwest medical school. (Stacy Thacker / AP) Among the members of Merton’s team was the Columbia sociologist Renee Claire Fox, who gathered qualitative data as the chief observer at Cornell University Medical College, the site of the study’s most extensive field research. Based on student diary entries and interviews, Fox later wrote in her autobiography , she developed the concept of “attitude-learning sequences,” events that had a “strong emotional, symbolic, and rite-of-passage impact on students.”
Cadaver dissection is the earliest event associated with the attitude-learning sequences Fox identified (other events included taking a patient’s history for the first time, assisting in the birth of a baby, and witnessing a patient death). In the anatomy lab, “students were introduced simultaneously to the cadaver, death, nudity, and anonymity, and to both the obligation and prerogative to cut and explore the human body,” she wrote in an essay summarizing her findings. The first glimpse of a naked cadaver is emotional, the students had confessed; the first cut, even more so. Students were taught to approach the dissection with an attitude Fox labeled “detached concern,” in which they were expected to regard patients with a balance of empathy and clinical objectivity.
However, Fox also found that teaching hospitals ultimately exhibited “more detached than concerned care.” Stoicism became the litmus test for professionalism, and students began to welcome their “greater composure,” Fox said, as a sign of “progression in achieving the professional detachment” they needed to develop as doctors. But, slowly, their feelings began to change. The students in Fox’s study began to report an uneasiness that they were becoming callous or blasé. One student wrote, “We find ourselves not taking as personal an attitude [with the body]. For example, not thinking and feeling, ‘Here is a person who was living and is now dead’ to the extent that we once would have.”
Fox’s findings sparked a wave of academic scrutiny of the effects of cadaver dissection and the consequences of detached concern. In the 1970s, through qualitative methods similar to Fox’s, the medical sociologist Frederic Hafferty conducted a series of studies on the “emotional socialization” of medical students, concluding that the anatomy lab was “a unique emotional test” where students learned “maladaptive coping strategies in clinical settings.” Later, a 1990 Stanford University study by the psychiatrist Peter Finkelstein and the anatomy professor Lawrence Mathers found that student reactions to dissection “bore a striking resemblance to post-traumatic stress disorder.”
* * *
According to a 2013 Mayo Clinic study , 96 percent of American medical-school anatomy programs hold some type of post-dissection ceremony, most of them formal and student-led, to commemorate the anatomical donors and help students process their emotions surrounding the dissection. A student might recite a poem written for their donor, for example, or read a diary entry written after a poignant experience in the lab. Speeches are common, as are portraits of the donors. If the program is among the small fraction that invites donor families to the service, a meet-and-greet will often follow.
Lawrence Rizzolo, a director of medical studies at the Yale School of Medicine, stressed the importance of Yale’s Service of Gratitude, as it’s formally known. It’s crucial, he said, for the students to “feel they have a place and a community in which they can express themselves, and develop their understanding of their emotional response.” He also emphasized that these “one-time events”—memorial services and donor luncheons alike—aren’t enough on their own: In cultivating empathy, it’s also important that students feel they’re allowed to express emotions throughout their learning. It’s the instructors’ responsibility, he said, to demonstrate that emotions have a place in medicine.
“Medical-school training works very hard to beat humanity out of you,” he said, a phenomenon that can’t just be attributed to the demands placed on students. Equally to blame, he believes, is what educators now call a “hidden curriculum,” the set of values tacitly instilled in students by their environment (analogous to the implicit learning identified by Fox). A 2001 Academic Medicine article argued that while medical schools may include lessons on things like listening skills and fostering trust, tacitly, students are learning to value “objectivity, detachment, wariness, and distrust of emotions.” Or, as Rizzolo described the attitude to me: “Buck up, you’re going to be a doctor and you’ll see worse than this.”
Instead of suppressing emotions, Rizzolo said, students should learn to manage them—and emotions can’t be managed if they aren’t acknowledged at all. Once, while demonstrating a dissection of the vagina, a particularly difficult dissection both technically and emotionally, one of Rizzolo’s students gasped. Instead of simply asking if the student was okay—“Everyone’s going to say [they’re okay] because no one wants to be perceived as weak,” Rizzolo noted—he stopped the dissection and remarked at how troubling it was that the previous cuts so closely resembled female circumcision. When one student hadn’t heard of female circumcision, Rizzolo engaged the group in a discussion about it before continuing his demonstration. “Don’t just forge ahead,” he said. “By recognizing [the emotional difficulty], we can allay people’s anxieties.” He added, “I expect my instructors to do that. To pay attention. Notice what’s going on with their students.”
When students have an emotional moment, he advises his colleagues, just give them the time and the space to express it. Break the barrier. Don’t let students hide their trauma from their instructor. But this approach, he added, isn’t a quick fix: Creating a more empathetic profession is something that requires a long-term solution, one that requires professors to exhibit the values they wish to cultivate in their students. “Cultures change very slowly,” he said.
* * *
When his donor’s family—a nephew, a niece, and the niece’s daughter—arrived at the Cowboy and Western Heritage Museum back in 2008, the conversation started out easier than he had expected, Thurman recalled.
The niece, who had been the woman’s primary caretaker, pulled out a picture frame containing a series of faded photos from her aunt’s life. She stood alone in some; in others, she posed with members of her family. Passing the frame around the table to the students, the niece launched into her deceased aunt’s life story: She was born in Eastern Europe during the 1920s. As a child, she fled the Nazis with her grandmother and escaped to the United States, first to New York City, then to California. She could do a handstand at age 70. Her mind never went. She sneaked cigarettes in the bathroom until the end.
Lunch was served sometime during the story and empty plates were cleared before the family finished their biography. When the story caught up with the present—ending with the donor willing her body to OU College of Medicine—the students sat for a moment in silence. “It was humbling,” Thurman recalled, “to think she was our first teacher.”
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John Tyler Allen is a writer based in New York. Twitter
Apparently, raping someone is common practice for policemen
Apparently, raping someone is common practice for policemen Posted on Tweet 0
Disclaimer: Contains strong language, sexual content, adult humor, and other themes that may not be suitable for minors. Parental guidance is strongly advised.
Police officers are the last people you’d expect to commit a crime. But the harsh reality is there are evil people out there and some of them are in the stations we always thought were safe. Last night, it was reported that a 15-year-old girl was raped by an officer in exchange of her parents’ freedom.
According to GMA News , the teen’s parents were apprehended last Friday for suspected illegal drug possession. They are now detained at the Manila Police District. The mother told reporters that the suspect, PO1 Edgardo Valencia, took away their daughter.
Valencia allegedly proposed for the girl to sleep with him so her parents’ crimes would go away. She said no but was still taken to a motel where she was raped. The police officer first denied the accusations, but a medical examination on the girl showed genital lacerations.
When Valencia was confronted by NCRPO Director Guillermo Eleazar, he defended himself by saying he has a family and a teenage daughter too, and that he wouldn’t do such a thing—classic rapist excuse. But what’s more disgusting was when he said, “Sir, hindi na po bago sa’ting mga operatiba yung gano’n kapag may nahuhuli po tayong drug pusher.” (Sir, this act isn’t new to us operatives when we catch a drug pusher.) ANG BABOY NG PNP! 😡
“Sir, hindi na po bago sa’ting mga operatiba ‘yung gano’n (panggagahasa) kapag may nahuhuli po tayong drug pusher, sir.”
PO1 Eduardo Valencia admitted that it is normal for the police to rape relatives of those who are allegedly involved in illegal drugs. pic.twitter.com/Ekr7q7kuk6
— Roentgen (@ronaldgem) October 28, 2018
Yes, ladies and gentlemen, this man just admitted that raping someone in exchange of freedom is a common practice in the Philippine National Police (PNP). Before you scream “not all police officers,” do remember that the act of this one man can taint an entire government agency, especially since he implied that he may not be the only one who’s done this to defenseless women and girls.
What’s even more upsetting was how Valencia felt the need to use his family as leverage to prove his innocence. News flash: You don’t use your wife, daughter, sister, and mother as an excuse. It shouldn’t take any woman, or person, to make yourself a decent human being . What happened is already proof that he didn’t think of his family or the people he was going to hurt, most especially the young victim.
The situation will also make it even more difficult for victims of sexual abuse to seek help from authorities. If one cop had the audacity to do this, how can people be so sure that other officers don’t have similar bad intentions? They’re supposed to keep us safe, not make us feel like we’re perpetually in danger.
We hope officer Valencia stays in jail for a long period of time for what he did to that 15-year-old girl and her parents. Let this also be an example for other officers who think they can get away with their disgusting crimes.
The Story of Outlaw Country in 33 Songs
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The story of outlaw country starts in very different places, depending on who is spinning the yarn. Historian Joe Nick Patoski wonders if it all started in 1972, after Willie Nelson’s home outside Nashville caught fire, prompting him to move back to Austin and play dancehalls around Texas. “ Outlaws & Armadillos , ” the Country Music Hall of Fame’s current exhibition, insists the movement started with Bobby Bare in the 1970s, when the headstrong country star negotiated a new contract with RCA Records that allowed him to produce his own albums; soon, Nelson and Waylon Jennings scored similar deals and made thematically cohesive albums like 1974’s Phases & Stages and 1973’s Honky Tonk Heroes . Or, as Steve Earle recalls—and he’s an expert—the whole affair happened because of Doug Sahm. (More on that in a minute.)
While the locations and players change, what all these origin stories have in common is motivation: The outlaws wanted freedom. The singers wanted to sing the songs they liked, written by people like Guy Clark, Ray Wylie Hubbard, and Billy Joe Shaver, among others. They wanted to record at independent studios like Tompall Glaser’s “Hillbilly Central,” the Nashville hub for pretty much everybody even tangentially associated with the outlaw movement. They wanted to play the dancehalls like Armadillo World Headquarters in Austin, where long-haired hippies and buzzcut rednecks struck a precarious truce to enjoy some good tunes together. In short, they wanted to control their own musical destinies.
Even before the term “outlaw” was popularly used to describe this movement, many of these artists were writing about their lives on the road with sophisticated self-reflection, self-deprecating humor, and desperado pathos. The outlaw lifestyle became their most prominent subject, for better or for worse. Jennings summed it all up with two crucial questions: In 1975, he released his signature hit, “Are You Sure Hank Done It This Way?”—a self-aware consideration of the changing nature of the industry. Three years later, he followed it with “Don’t You Think This Outlaw Bit’s Done Got Out of Hand?” which chronicled the drug busts and break-ups that accompanied the outlaw mantle.
By the late 1970s, the scene was already dying down. Nelson moved out to L.A., even recording an album of standards called Stardust in 1978. Armadillo World Headquarters closed two years later. But while the movement may have sputtered, the animating idea behind it remained powerful well into the ’80s, when the country mainstream made room for twangy eccentrics like k.d. lang and Lyle Lovett, as well as upstarts like Earle, Dwight Yoakam, and Lucinda Williams. In the ’90s, it was largely supplanted by alt-country rebels flipping the bird in the general direction of Nashville; however, in the last 10 years, the outlaw ethos has inspired a new generation of artists such as Miranda Lambert, Jason Isbell, and Sturgill Simpson, who provide a musical—and often political—alternative to the arena country mainstream.
In compiling these 33 representative songs, we’ve tried to keep our definition of “outlaw country” as broad as possible, in order to track many of its phases and stages. Our list, while by no means exhaustive, traces this music’s grit and glory from its contested origins to the present moment, from Texas dancehalls to streaming playlists, from Johnny Cash to Miranda Lambert.
But before we dig into all that, let’s take a moment to check in with a man who has seen every stage of the outlaw movement and lived to tell the tale: Steve Earle . A Texas native who cut his teeth in the Texas outlaw scene before moving to Nashville and learning the ropes from Guy Clark and Townes Van Zandt, he’s released 16 studio albums in the last 30 years—the most recent of which, last year’s So You Wannabe an Outlaw , reconsiders the heroes of his youth. Last Exit to Nashville: A Conversation With Steve Earle Pitchfork: You were there at the early days of the Texas outlaw scene. How did that start?
Steve Earle: The outlaw thing happened because of Doug Sahm. Doug, mainly because he couldn’t get Big Red—a bright-red soft drink that tastes like bubblegum—leaves Mill Valley [outside San Francisco] and goes back to Texas. It was Doug who told Willie Nelson he should play Armadillo World Headquarters, and he told [Atlantic president] Jerry Wexler, “If you want progressive country music, you need to sign Willie.” That’s how we got Shotgun Willie and Phases & Stages .
I saw a lot of weirdness and rampant drug and alcohol use in Texas. Not that I didn’t use alcohol and drugs, but it was out of control. I though Nashville would be more serious. What was Nashville like when you arrived?
When I got there, in November of ’74, the inmates were in charge of the fucking asylum. But it was shocking how few places there were to play, but that actually turned out to be a strength. One place was called Bishop’s Pub, and you could do a set and pass the hat or you could have two beers, but you couldn’t do both. There was a place called the Village, which is still there. Once a month there was the original Nashville writers’ night at the Exit/In. That was really hard to get on. How did you manage to land that gig?
I got on it because Guy Clark insisted. There was always an established act that closed the night, and he volunteered in order to get me on the show. Since there were so few places to play, any night of the week, we’d be at somebody’s house or in a hotel room, a bunch of people with guitars. We were trying to impress each other with what we’d written—or, mainly, we were trying to impress [Guy Clark’s wife] Susanna.
Coke hadn’t quite hit yet when I got there. When I got there, it was just pot and a lot of alcohol and speed. There was a doctor named Snap, believe it or not, in East Nashville. My initiation was: Somebody took me out to him ’cause I was another person who could have a prescription. There wasn’t enough speed to go around to get the songs written. First thing Guy Clark did when he met me was ask me if I had any, because I was so wired up. But I just kinda came like that. That’s one drug I’ve never taken a lot of. I read that Waylon Jennings wore a special bandana as a show of support while you were in prison in the early 1990s.
That’s one of those things that makes me cry. I’d been furloughed out of jail into a treatment center, and it’s pretty emotional when you’re detoxing. I got letters from my parents and my uncle, but I got three letters from other musicians. I got one from Johnny Cash, I got one from Emmy [Harris], and I got one from Waylon. There wasn’t even a letter, just a letter with a snapshot of him, and on the back of it in his big, huge scrawl, it said, “I’m wearing this bandana for you.” It was a big deal for me. Steve Earle. Graphic by Martine Ehrhart. He seems like someone who was very supportive of songwriters, like you and Billy Joe Shaver.
Waylon was complicated. He was pretty hard-headed, but he liked me for some reason, once I got on his radar. He recorded my song “The Devil’s Right Hand” and then later brought it into a Highwaymen session with Johnny, Willie, and Kris [Kristofferson]. I also produced a bonus track for the 20th anniversary of Wanted! The Outlaws [the best-selling 1976 compilation album with Jennings, Nelson, and more]. He did a song of mine called “Nowhere Road,” a duet with Willie. That might have been the last time I saw him. It was only a couple years before he passed away. I was on the road all the time and he was on the road all the time. Then he got sick. He lost a leg. But he kept working right up ’til the end. A lot of the songs coming out of the outlaw movement seem to be about documenting that scene, that life on the road, like Waylon’s “Are You Sure Hank Done It This Way?”
The part of it that you’re talking about, where it began to document itself, is part of its demise. The worst of all those songs David Allan Coe wrote was “Willie, Waylon, and Me.” I really hate it. And I wrote some of those songs, like “It’s Our Town” and “Little Rock ’N’ Roller.” So I’m not innocent in this, but I didn’t do it on purpose. I didn’t do it because I was smart. I stumbled into it, but I learned a lesson from it.
I remember reading in Country Music magazine, I think it was [the art and music critic] Dave Hickey who wrote about being on an airplane and sitting next to this roughneck coming in from an offshore rig. They got to talking, and he asked Dave what he did. He said, “I write about country music.” That guy says, “Those country singers, they used to sing about us. Now all they do is sing about each other.” You mentioned you learned a lesson from this. What was it?
You do lose touch with your audience. Johnny Cash told me once, “I really love that song of yours, ‘Little Rock ’N’ Roller.’” About a week later, I was at a truck stop, and this truck driver came up to me and said the same thing. That was when the light went on. The reason they both relate to that song is because they both have kids and they both miss their kids when they’re on the road. That song is still valid because it wasn’t just about people feeling sorry for themselves because they’re riding around on a bus that cost more than most people’s houses. That’s what audiences don’t want to hear. Who do you think embody some of those outlaw principles these day?
A lot of them are girls. Miranda Lambert’s last record is a fucking masterpiece. Women are being marginalized in country music more than ever, just because bro country thinks it’s such a dude thing. Women are reacting to it and they’re the best songwriters. A lot of it’s Brandy Clark. She’s in the middle of it all and she’s a badass.
Essay and interview by Stephen Deusner
Listen to selections from this list on our Spotify playlist and Apple Music playlist . RCA Victor “Streets of Baltimore” 1966
Gram Parsons may have made it famous, but “Streets of Baltimore” belongs to Bobby Bare, who first recorded the dramatic tune in 1966. From his album of the same name, “Streets of Baltimore” is a relic of Bare’s first stint on the RCA Victor label, widely regarded to be his breakout period in country music. Lyrically, the Tompball Glaser and Harlan Howards-penned song takes romantic devotion to its heart-wrenching extreme, telling of a man who “sold the farm to take [his] woman where she longed to be,” before getting unceremoniously kicked to the curb. Bare’s tender croon lends the song believable longing and regret, while the otherwise simple arrangement ups the drama with countrypolitan “oohs” and “ahhs.” Bare would go on to work with a laundry list of country artists, including Kris Kristofferson and Rosanne Cash, but “Streets of Baltimore” is a classic look at how he began with a truly outsider spirit: lonely, defiant, and searching for home. –Brittney McKenna