Some changes in social behavior are spontaneous; others come down from above by decree. The latter, if imposed with sufficient consistency, eventually take on the unselfconscious quality of custom, making a return to the status quo ante difficult, if not impossible.
In Britain, the educational hierarchy that oversees the nursing profession has instructed nurses to change the way they address patients. Only a few years ago, nurses would naturally have addressed patients by their surnames, preceded by respectful "Mr.," "Mrs.," or "Miss"; but the nursing schools decided, without any prompting from the patients themselves, that it would be friendlier, more informal, less intimidating, and altogether more sympathetic for nurses to call patients by their first names—even, if possible, by nicknames.
I confess that I squirm with a mixture of shame, embarrassment, and anger whenever I hear a young nurse call a 90-year-old "Betty" or "Bill," often in a tone that suggests that, in addition to being aged and deaf, the elderly patient is almost certainly dotty as well. It is not so very long ago in England, after all, that even many working-class men and women would not address their wives or husbands by their first names, for to do so would have indicated lack of respect. For elderly patients to be addressed now with such leveling informality must be grating indeed.
But, some might argue, at least the young nurses are not aware of the humiliation they inflict upon their elders. Yet, something that I have noticed persuades me otherwise, and also casts a lurid light on the values that modern British culture and education have inculcated in our young nurses.
When these nurses work in the prison where I work, they always address their patients, or refer to them in reports, as "Mr." Smith or "Mr." Jones: no more Bobs, Bills, or Freds. Indeed, they repeat "Mr." ad nauseam, with an earnest emphasis that shows how acutely aware they are of the social significance of differing forms of address. They understand that to call a man "Mr." Smith accords him at least minimal respect. Thus, they must also understand the social meaning, in British circumstances, of calling a stranger of 90 Bill or Bob.
Humiliation is administered, and respect dispensed, according to a scale of values. That nurses should call prisoners, uniquely of all British patients, "Mr." indicates a kind of moral Gnosticism that has infected our whole society. The professed intent may be to assure prisoners that they remain fully human to those who minister to their ills; the effect is to suggest that only those who have behaved badly are truly good, and only the unworthy are truly worthy.