Caring for Adolescents in the Adult Intensive Care Unit

In 1956, Horace Miner¹ published an anthropological parody, “Body Ritual Among the Nacirema,” about the seemingly bizarre culture of the Nacirema (American spelled backward). His essay provides a provocative framework for discussing the subculture of ill American adolescents that is in conflict with the adult-dominated culture of the adult intensive care unit (ICU). Miner addresses Nacireman rituals in the latipso (hospital), where personal freedoms are greatly restricted and body secrecy is generally violated. The male patient, for example, whose own wife has never seen him perform an excretory act, suddenly finds himself “naked and assisted by a vestal maiden [nurse] while he performs his natural functions into a sacred vessel [bedpan]. . . . Female clients, on the other hand, find their naked bodies are subjected to the scrutiny, manipulation and prodding of the medicine men [obstetricians and gynecologists].” To the adult staff and patients, teenagers’ behaviors may...