Sophia, Phronesis and Stultitia

AIMS Journal, 2021, Vol 34, No 1

By Alex Smith

I often wonder why so many healthy women, women who express strong concerns about induction, reach 41+ weeks and just go along with it. We know that fear and coercion play a big part, but is wisdom also involved? The ancient Greeks had different words for wisdom. In this article, I reflect on two of these - and throw in a third word of Latin origin - to help me better understand the disparity between women’s general preference for a straightforward labour, uncomplicated by excessive medicalisation, and their apparent willingness to accept the ever increasing offer of induction. I invite you to imagine three sisters.

The first sister Sophia is named after the Greek word for wisdom - wisdom that relates to the possession of knowledge. She has lots of information, has read the research and her facts are up to date. Sophia knows all there is to know, and in this way she is considered wise and sophisticated (I will come back to that word later). The second sister Phronesis is named after the Greek word for a more advanced form of wisdom - wisdom that assumes the possession of knowledge but also the ability to appraise it, understand its implications, and to take action. Phronesis envisions the good end to which she will apply her understanding in a practical way, and has a plan for how to go about this. While Sophia knows how a car works, Phronesis knows how to drive, where she wants to go, and how to get there.

The third sister, the younger Stultitia, has a name that comes from the Latin word for stupidity or folly (her parents should have checked). Stultitia is far from stupid or foolish but she has somehow come to believe that ordinary people don’t drive a car, that they cannot be that wise. Her self-determination (her inner drive) has become dulled and she has lost any enthusiasm or initiative; she has become stultified. Stultification is the effect of having every enthusiasm, initiative, or freedom of action stifled by others to the point where it would feel foolish to even think of exercising autonomy; and nobody wants to appear foolish. Stultitia has developed an external locus of control^[1], a general belief that success or failure results from external factors beyond her control. She believes that any attempt to think for herself would be folly. Stultitia is driven where others think best and without question.

When these three sisters (now expecting babies) are offered induction of labour at 41 weeks, they talk together and all agree that, based on what they have heard from friends, this is not what they had wanted. Stultitia feels dazed and helpless; “What can you do except go with the flow? It is out of my hands”, she says. Her fear is that if she holds out for a normal birth she will look silly when that doesn’t happen. It would be foolish to question the experts; her friends agree. Sophia, reads the NICE guidelines and the hospital protocols and accepts the recommendations without question because, if the experts and scientists have decided on these, they need no further analysis. She steps onto the induction conveyor belt in the full knowledge of why this has been offered, and to some extent, of what to expect, but quickly realises that she doesn’t like the direction in which the belt is moving. Sophia senses that she should have known better, but can’t admit that as her wider circle of friends and family all agree that she made a wise decision. Phronesis has read more widely; she is aware that much of the evidence on which the recommendations are based is either of poor quality or is not relevant to her and, moreover, that induction itself is not without risk. She realises the risk balance is marginal and very difficult to weigh for any one person, so she consults her gut instinct and adopts her personal rule-of-thumb philosophy for these situations. Phronesis schedules a Doppler scan of her placenta, checks in on the baby, and declines induction for the time being at least. Stultitia thinks Phronesis is crazy and Sophia feels judged by her. The three sisters are at odds.

Meanwhile, Phronesis contacts AIMS just to hear a supportive voice. She says that she is feeling coerced by the midwife and by society at large; everyone is making her feel that she is risking her baby’s life, but even her doctor was unable to provide actual numbers to back this up. Being Phronesis is not easy. She is aware of the disparity between the immense fear that is evoked by her declining induction and the very low level of actual risk as outlined in the research, and she oscillates between anxiety and confidence. Phronesis manages this by putting her plan into practice; she uses her calm breathing, positive affirmations, like-minded friends and her deepest instincts to allow the wisdom of her body to prevail. But how long can she hold out?

In real life, Sophia, Phronesis and Stultitia rarely live alone, they reside together within each of us - complexly entwined and still very much at odds. Their separate voices argue back and forth as we grapple with their different persuasions. Sometimes they reach a consensus, but that often feels like compromise and is cloaked in anxiety and disappointment. When one sister wins the internal debate it will be the sister most nurtured by the socio-cultural and family influences surrounding that person; it is rarely Phronesis.

While the Greeks considered phronesis to be the highest form of wisdom, Phronesis the sister was considered to be the difficult child. She would never just do as she was told and her mother would say that she ‘could argue the hind leg off a donkey!’ Sophia did well at school, Stultitia was meek and compliant, but Phronesis, though top of the debating society and just as studious as Sophia, was often in trouble and not always liked. Her feistiness and intentionality were unsettling and tightly reined in by her parents and teachers; her behaviour was punished while her sisters’ was rewarded. Grown up, Phronesis is still perceived as the wild child and her actions as destabilising.

Just as the individual maternity service user experiences this internal conflict, so does each individual midwife and doctor. Generally it is a combination of Sophia’s received and conventional wisdom and Stultitia’s compliance that shapes the decisions and behaviours of everyone involved, while Phronesis experiences institutional bullying when she tries to campaign or to question the status quo. And this is why, even when a woman says that she hopes not to be induced, and even when her midwife and doctor empathise, and even when our collective societal Phronesis suspects that there is something fishy about the sheer extent of medicalisation of birth, our collective Sophia and Stultitia (having been so often rewarded and much more strongly nurtured) hold sway.

By way of an epilogue, let's go back to the word ‘sophisticated’^[2]. It has a double meaning. It shares roots with the word sophia (wisdom), but its other meaning is ‘adulterated’, ‘tampered with’ or ‘deprived of simplicity’, with its antonym being ‘uncorrupted’. Etymologically, sophistication carries a sense that it has been attained through the use of fallacious argument, and sophistry is defined as the use of clever but false arguments, especially with the intention of deceiving. Many parents would feel that they have witnessed this in the ‘shroud-waving’ they experience on declining induction. The medical model of maternity care has become very sophisticated, and phronetic efforts to counter this are easily stultified… for maternity service users and practitioners alike. An epilogue ought to serve as a conclusion, but one escapes me… suggestions on a postcard please.