Denis, your story strikes a Romanian chord. The situation around here is even worse, from what I can tell. But it is quite a fascinating question, with different answers from different points of view.
For an economist, it is a matter of price formation. In the state system, Romanian doctors are paid a fixed (and miserable) wage, largely unrelated to quality or effort. The incentive to pocket bribes is huge, and patients know it so well. In the private sector (with transparent and varied prices for medical services), bribes are almost unheard of. Also, there is a more or less efficient market for bribes. Patients find out how much a doctor expects, usually from past patients, or from other doctors. Surgeons receive more than GPs, professors more than debutants, etc.
But I think there is something more about "medical envelopes", from a cognitive point of view. First of all, there is a vast asymmetry of competence between doctors and patients, which gives the former a large freedom of action. Is this pill better, or another one? Surgery or not? Home treatment or hospitalisation? To make things worse, the post-hoc reckoning is not very helpful, since most decisions may be medically justified, but you might also end up dead. The patient is at the mercy of the practitioner since she does not know what choices are better. The best way to make sure one gets the proper treatment is to insure the benevolence of the doctor, and a bribe is the simplest path to gain the doctor's amity.
Second, there is something special about this particular social exchange: the patient is dealing in an ultimate value - her health. Something everyone in Romania says is that there is no price too high to be healthy. (Paradoxically, giving up smoking somehow does not make the list - self-hint-hint-nudge-nudge). If people would risk not bribing a policeman to avoid a fine, they are extremely unlikely to jeopardise their health in this manner. One cannot afford to stick to abstract principles (like discouraging corruption) when her life is at stake.
Finally, there is something like a Maussian gift in the affair: one passes a fat envelope even without the explicit mention of an economic exchange. It is not that the surgeon would not operate without being bribed - the patient just shows gratitude without visible economic reckoning. Of course, under the veil of generosity stands the solid self-interest of the patient. The fat envelope is meant to make sure that no scalpel is lost in her belly. But no-one says it out loud. It's a "I know that you know that I know etc" which makes sure that the transaction is smooth and polite.
To end with a personal anecdote: I was (and to some extent I still am) very wary of giving out envelopes to doctors. A little bit of moral prudishness, a little bit of fear (what if he feels insulted?), a bit of monetary unsaviness. Those who are more competent in these matters reassured me: "just put the envelope on his desk - he knows what to do next" After all, he is the expert, and I am not.
http://ehrafworldcultures.yale.edu
Cross-searching on the codes relating to infancy/childhood and language, I found the following from LeVine et al. (1994):
"Observation showed that Gusii mothers talk to their babies during the first 9 to 10 months after birth only about half as frequently as their American counterparts. They are verbally responsive to infant vocalization less often than the American mothers are, and we rarely found Gusii mothers attempting to elicit a vocal response or carrying on a sustained verbal exchange with a baby or even a toddler. Mothers do not eagerly await or promote the toddler's speech skills, and calling a young child omokwani (a talker) is closer to criticism than to praise."
Indeed as I understand it, it is well established that middle-class Euro-American mothers talk to their infants unusually frequently. (I think you should also be able to find references for low-SES Euro-Americans talking to infants less frequently.) The anthropologists' finding that non-Euro-Americans talk to infants much less often may have become exaggerated in linguists' minds, as anecdotes often do, until it became not talking to them at all. It may even have been presented as such in its anthropological source: immediately following the passage above, LeVine et al. note that
"Nevertheless, mothers and other caregivers do talk to babies, and what they say is revealing."
They go on to present a careful quantitative analysis of infant-directed speech, based on observations recorded by native, female fieldworkers. It is easy to see how less careful male ethnographers, who had little contact with women and children and an urge to present the other culture as alien, might have left it at: "They almost never talk to their infants".
Reference:
R. A. LeVine et al., 1994, "Communication and social learning during infancy". In R. A. LeVine et al., eds., Child care and culture: Lessons from Africa. New York: Cambridge University Press.
Hi Alex et al
Thanks for raising this topic. Ever since I heard it mentioned at a CEU summer course back in 2005, it's been hanging around the back of my mind, nagging...
For those cultures where the analysis of infant-directed speech has been characterized (infant-directed here meaning literally directed to an infant, rather than meaning motherese) -- is anything known about the course (timing/order) of acquisition in language learners? Or of pragmatic competency (understanding turn-taking, etc)? I'm particularly interested in the Kaluli infants, whose primary caregivers appear to speak *for* their infants, rather than speaking *to* their infants. Do the infants appear to understand the special social meaning of this scenario, including their intended "role"? Or is such a coversation just another adult-adult conversation they are observing, no different from any other?
Let's assume the anthroplogy has been done well and there exists incredible variability in the quality/quantity/timing of social interaction and linguistic input during development. If there were then no measurable differences in the rate/skill-level of language acquisition as a consequence, this would be an important problem for several accounts of social cognitive development, no? Especially pedagogy.
Thank you for the interesting original post and comments. I've enjoyed reading this discussion. I did a bit of research on this and think there could be a few references to add.
(1) Ingram., D. (1989) First language acquisition: Method, description and explanation. New York: Cambridge University Press.
In this book he argues that cultures differ considerably in the degree to which adults modify their child directed speech in a way that differs from normal adult speech. Nevertheless, the learning curves on standard measures of language acquisition (e.g. vocabulary size, syntactic complexity, mean utterance length) do not vary cross-culturally in the ways one might expect.
(2) Tamis-LeMonda, C., Bornstein, M.H., Baumwell, L. (2001) Maternal responsiveness and children's achievement of language milestones. Child Development, 72, 748-767.
In this article, the authors provide empirical evidence that in western cultures (at least in America), mother responsiveness (descriptions, play and imitation) combined with empathy predict the timing of language milestones during acquisition. However, it is still worth noting that pretty much all of these children end up talking. It more seems to be the case that parental interaction can speed up or slow down a natural growth process.
I also recommend Frank Keil's new text book on this called "Developmental Psychology." Chapter 8 has a great review of all this literature and more.
In press at Developmental Science:
Language input and acquisition in a Mayan village: how important is directed speech?
Laura A. Shneidman and Susan Goldin-Meadow
Article first published online: 18 JUN 2012 | DOI: 10.1111/j.1467-7687.2012.01168.x