We have to embrace humility and first accept that we have biases, prejudices, and privileges in certain contexts. We must then do the hard work of recognizing when our biases show up in interactions, examine our past experiences that contributed to the development of our biases, and acknowledge the hurt that may be caused by our biases to ourselves and others. If we truly want to stop harassment and create equity, we have to do this emotional work every day. And we should do it to stop harassment and create equity for not just women, but for everyone.
Lifelong Learning in Clinical Excellence | May 30, 2019 | 9 min read
By Kali Cyrus, MD, MPH, Johns Hopkins Medicine
Often, people of color are taught from a young age to prudently enter into social relationships with white people as a means of protection against the impact of racism. Through trial and error, I developed my own process to judiciously entrust my white peers, mentors, and friends with my well-being. Since President Trump was elected, I have had to revise my process to discern trustworthiness more frequently, and unexpectedly, than I would prefer. Many of my relationship-reassessments have led to the breakage of intimate bonds that were harmful to my emotional well-being as a woman of color. Most of the relationships I have walked away from have involved individuals, mostly women, who are neither Black, nor people of color.
To the surprise of many, two months ago I made a decision that would certainly be considered injudicious per the aforementioned standards – I agreed to be a founding member of TIME’S UP Healthcare (TUH) as a black, queer, androgynous yet cis woman, and psychiatrist. In other words, I voluntarily agreed to participate in an women’s advocacy organization, a space well-known to queers and women of color to be occupied primarily by white women. Depending on the audience, when I bring up TIME’S UP, women are either very excited about the initiative, or skeptical of its intentions to actually advocate for women with marginal identities.
Like the views which differ drastically depending on the audience of my friends, I too, am excited but skeptical of the intended goals of TUH.
History of gender equity for some, not all
I am skeptical that women’s advocacy organizations can avoid coalescing around the goals set by the majority, which represent a homogenous phenotype of the group. Unfortunately, one does not need to look too far back in history to find evidence of advocacy organizations created to expand women’s’ rights, but not for all women. For example, in 1848 with the women’s suffrage movement, and then the women’s liberation movement in the 1960’s, Black women protested alongside white women for the right to vote, and later, for the reproductive rights.
But, somehow, these movements did not result in Black women having acquired the right to vote, or the right to not be forcibly sterilized as many women of color and women with disabilities were subjected to until the 1980’s (and even later in some states like California). More recently, in 2016, 53% of white women voted to elect a President who explicitly and implicitly accepts violence against communities of color. In addition to the baseline preoccupation of being discriminated against because of my skin color, every time I leave my apartment I am acutely aware that I could fall victim to being shot if the cop in the car I pass in Bethesda decides to pull me over. Or, perhaps more distressing, is that almost one of every two white women I interact with in a department meeting, at a happy hour, or who attended the Women’s March may admit to being an ally, but neglects to mention voting for a President who tacitly encourages xenophobia. Frequently, I learn that white women who have occupied liberal spaces, and my space, eventually open up to voting for Trump for “economic reasons.” Worse, many women launch into defense of their rationale in hopes that I will pardon them to assuage their fragility.
My defense strategy is to avoid forming new relationships with white women, yet I joined TUH, a subsidiary of the Times UP Now nonprofit comprised of mostly white women, and made famous by re-branding #MeToo, without initial involvement from its originator, a Black woman. Since joining, I have been pacified by the warmth in response to my declarations of mistrust and the efforts to build trust. Despite all this, I am aware that as a Black woman, it is not only in my best interest, but also in that of the group maintain a healthy sense of skepticism in our process to grow. I am skeptical that the leaders of women’s advocacy organizations do not appreciate the value of intersectionality amongst its members, thereby failing to foster a culture of curiosity and inclusivity.
Little room for intersectionality in gender equity
As someone who has been either the only, or one of few, Black and queer women throughout my medical training, participating in women’s groups has not generally been a positive experience. While my insecurity as an outsider certainly contributes to my sense of belonging in women’s only spaces, the agenda, activities, and informal socializing do not typically prioritize the experience of women who are queer, brown, non-binary, or have disabilities. On my medicine rotation in medical school, I remember the awkwardness of wondering how or if I could chime in while my classmate and supervising resident discussed their boyfriends and engagement plans. As a resident, I remember feeling invisible as my female classmate and attending delightfully discussed their mutual interests of horseback riding. While I appreciated my invites to multiple girls’ nights, I usually decline as the festivities entail drinks and dancing at the nearby pub (also known as a straight bar). As an attending, I remember rushing to a Women in Medicine lunch, only to spend most of my time listening to strategies to time pregnancy, take time off for pregnancy, or strike work-life balance as a new mother.
These conversations can stir up feelings of exclusion for many who are not heterosexual, do not want children, and do not want to be married. Like most, I can certainly tolerate discussion that may be irrelevant in nature to me. However, the frequency, the number of settings, and sense of normalcy in which these conversations occur and are facilitated by the homogenous majority of the group can be quite frankly, demoralizing. Although the founding members of TUH are majority white, with more seniority and power relative to the entire group, curiosity about the experience of all of types of women is very much welcomed. Since our first meeting, I have been encouraged to share my perspectives which are actually incorporated into our strategy. For me, this is encouraging, but I question whether curiosity amongst the group will actually lead to inclusivity and equity in action. Therefore, my skepticism persists for now.
Gender equity in an unjust system?
I am also skeptical of the system, and the rigid cultural norms of medicine, in which TUH presumes its ability to impact change. Throughout history, leaders in medicine, physicians in particular, have not always advocated for changes to benefit the greater good. Before medical school, I learned about the efforts of the American Medical Association (AMA) to resist membership of African American physicians until the late 1960’s, which undoubtedly contributes to the low rates of African American male physicians which exist today. The AMA also opposed the establishment of Medicare, until concessions were made allowing physicians to determine reasonable fees for their own services, which undoubtedly contributed to today’s excessive baseline cost of healthcare in the United States.
Both then and now, I’m sure that there were physicians who advocated for equitable care and dedicated their lives to practicing medicine in communities with the most need. However, the self-serving interests of bad actors continue to exert a long-lasting impact in the institutions of medicine leading to ever-growing disparities in access, treatment, and outcomes between demographic groups. While the number of women as leaders in medicine has grown, pay is still unequal. In addition to pay, the culture in medical communities has led to burnout, peer-to-peer sabotage, and at times a toxic environment which not only stifles, but punishes whistleblowers. Although I am thankful for any efforts to bring equity to healthcare, I am not confident that this system will bend to efforts by TUH. In fact, I worry that instead of bending, the system will first try to capitalize on the labor of vulnerable individuals, and then ultimately harm them for advocating for change; because this happened to me.
Taking an emotional risk
In the end, my skepticism motivated me to join TUH. I, like many of my friends, question TUH’s commitment to advocate for equity for all types of women. I also question TUH’s ability to establish norms that do not promulgate dynamics of privilege and oppression. Mostly, I question whether I can trust TUH to use the vulnerability I share as a Black and queer woman for the benefit of the greater good, which includes myself, rather than to the detriment of the same.
In this tense sociopolitical climate, my trust depends on reciprocal vulnerability shared between individuals, which is challenging as it pertains to oppression’s differential impact on intersectional identities. It is not easy to talk to about racism, or white fragility, or even superficial personality differences, but it is possible because I have done it. The proof is in my relationships with women who could not be more different from me, but recognize the value of equal access to opportunities, equal treatment by all members of society, and the vulnerability it requires to reap the rich benefits of our differences.
A friend concerned about my depression post-election asked for permission to discuss my feelings, first acknowledging that by virtue of her skin color, she valued my sharing as she would never be put in my position. On many occasions, I have refused to discuss issues related to race, queerness, or exclusion with white friends who respect my wishes, but eventually gain my trust by their ability to listen without doubting my experience, or making excuses for perpetrator’s behaviors, or somehow asking me for reassurance. My friendships with white women only grow stronger when they share their vulnerability to broach courageous conversations about why I might be uncomfortable attending their birthday party of mostly white guests, or why I may not want to go to a restaurant recently in the news for poor treatment of queer customers. I know they gained that courage because they gained the courage to have those conversations with themselves, their family or friends, and therapists.
I may not be optimistic, but I am hopeful that the combined efforts of a diverse group of committed people can affect change. Overcoming each other’s skepticisms may be impossible, but I believe that we’ve made the commitment to work as hard as we can at it. The harder we work, the larger and more diverse our members will become, and the higher the likelihood of achieving equity across identities.
So, for all the skeptics, believers, and those in between—we’d love to have you in Times UP Healthcare as long as you’re willing to work. The work starts from within. It takes work to acknowledge that we may believe the pain of a patient is a 10 out of 10, only when that patient is a woman who looks like us. It takes work to acknowledge that we only recommend female colleagues as referrals when they look like us. It takes work to acknowledge that we have a seat at the table to vote on departmental policies, and most of the people at that table look like us. Until we can do this work within ourselves, we can’t effectively do this work with others.