Black and Blue. John Hoberman
Читать онлайн книгу.
motivated and medically harmful behaviors that have been proven beyond a doubt to exist. It is, therefore, no accident that this book-length examination of the racially motivated mental habits and professional mores of doctors is the work of an outsider to the medical profession.
At the same time, I would point out that this history and analysis of medical racism is the work of a grateful outsider. The criticism of the medical profession presented in this book is not motivated by personal dissatisfaction with doctors. On the contrary, physicians have served me well throughout a long life that has included an open-heart surgery that saved me from a debilitating future of congestive heart failure. My father was a physician-scientist, and his commitment to his patients was inspiring. I learned about medical racism in the library while doing research for another book. I was stunned by the overt racism that appeared in medical journals such as the Journal of the American Medical Association or the American Heart Journal during the first half of the twentieth century. So was my father, who received his M.D. in 1946, a man of anti-racist principles, who knew the famous African American physician Charles Drew in Boston before the latter's premature death in 1950. As a Jew who had experienced anti-Semitic insults, my father was aware of the reality of bigotry in American society. But the medical racism of American physicians during his lifetime had somehow passed him by.
“AVOIDANCE AND EVASION”
“The general awkwardness surrounding racial issues in our society bleeds into medicine,” the prominent African American cardiologist Clyde Yancy observed in 2009.4 This awkwardness about practicing and discussing race relations has long been a fact of medical life the profession has been slow to recognize or deal with in a deliberate or systematic way. The political conservatism of the medical establishment was evident even during the civil rights movement, as the national leadership of the American Medical Association (AMA) deferred to the racist exclusionary policies of state medical societies and refused to intervene on behalf of black physicians who sought membership in the AMA and the professional status they had long been denied.5
Today the great majority of doctors are likely to regard information about medical racism as of little relevance to their professional lives. This is hardly surprising, given that large majorities of white Americans take little or no interest in the special problems their African American fellow citizens experience. There has long been, and there remains, a widespread conviction among whites today that the disadvantages blacks face are of their own making, since formal racial equality was established by the civil rights and voting rights laws and affirmative action initiatives, all of which date from the 1960s. And there is no reason to assume that the racial views of doctors differ in any significant ways from those of the general population.
My own firsthand exposure to how physicians receive news about medical racism occurred on a chilly evening in New York City in November 1999. A friendly bioethicist had arranged for me to attend a discussion of the medical profession's treatment of African Americans at the New York Academy of Medicine at Fifth Avenue and 103rd Street in Manhattan. The host, as I recall, was the vice president of the academy. He stood before a seated group of his medical colleagues and told them what the medical literature had by now demonstrated beyond a doubt: American medicine was failing to serve the African American population in a racially equitable manner. The question before them, he said, was whether or not they as a profession were going to choose to “own” this issue, to take responsibility for the uncomfortable reality of racially unequal medical treatment.
Fifty professionally and financially comfortable physicians listened to this pitch in their chairs. I saw no one on the edge of his or her seat. While it was clear that the speaker took this matter seriously, the tone of his comments did not convey a sense of urgency or an expectation of medical activism from those who sat before him. On the contrary, it was clear that making the effort to repair this injustice and take more responsibility for the health of black people was being presented, not as an ethical obligation, but as an option. The ethical obligation was real to the speaker, but one sensed that he did not really expect his colleagues to rally to this cause.
American medicine's disengagement from the black population is only one dimension of the much larger racial disengagement that characterizes American society as a whole. Ignoring African Americans or relegating them to marginal status has been a deeply rooted American habit. In his classic An American Dilemma (1944), Gunnar Myrdal commented that, in the literature on American democracy he had read, “the subject of the Negro is a void or is taken care of by some awkward, mostly un-informed and helpless, excuses.” Ralph Bunche, whose extraordinary career as a black academic foreign policy expert and international diplomat culminated in the 1950 Nobel Peace Prize, told Myrdal in 1940 that “consciously or unconsciously, America has contrived an artful technique of avoidance and evasion” to separate itself from its Negro citizens.6
A generation later the famous black psychologist Kenneth B. Clark explained white racial detachment as a form of emotional self-defense on the part of whites. “The tendency to discuss disturbing social issues such as racial discrimination, segregation, and economic exploitation in detached, legal, political, socio-economic, or psychological terms as if these persistent problems did not involve the suffering of actual human beings,” Clark wrote in Dark Ghetto (1965), “is so contrary to empirical evidence that it must be interpreted as a protective device.” The “purist approach rooted in the belief that detachment or enforced distance from the human consequences of persistent injustice is objectively desirable,” and he added, is “a subconscious protection against personal pain and direct involvement in moral controversies.”7 For many people, the most threatening controversy that might personally implicate them is racism. Maurice Berger has pointed out that, in an age of political correctness, “most people will do almost anything to preserve the comfortable illusion of themselves as free of prejudice.”8
The sheer magnitude of the African American health disaster can produce both emotional detachment and a dehumanizing sociological reduction of black life to its bleakest essentials. The recitation of endless statistics documenting medical racial disparities depersonalizes the human dimension of what is happening to black people. Our attention is displaced from the specific behaviors and predicaments of doctors and patients into an abstract dimension of enormous and hopelessly complicated social processes that can only be imagined. What is more, as one Indian-British physician has noted, “documenting inequalities may have little impact on reducing them.”9
The statistical depersonalization of black people and its association with disease were recognized as far back as 1951 by James Baldwin, long before sociology became the conceptual language of race relations during the heady days of the Great Society in the mid-1960s. The Negro, he wrote, “is a social and not a personal or human problem; to think of him is to think of statistics, slums, rapes, injustices, remote violence; it is to be confronted with an endless cataloguing of losses, gains, skirmishes; it is to feel virtuous, outraged, helpless, as though his continuing status among us were somehow analogous to disease—cancer, perhaps, or tuberculosis—which must be checked, even though it cannot be cured.”10 The black person exists in the form of various social disasters, human life conceived as numerical formulas, and threatening but incurable disease processes. The black individual remains invisible and unknown, and this too has its consequences. For as Baldwin points out, “The privacy or obscurity of Negro life makes that life capable, in our imaginations, of producing anything at all,”11 including all of the dysfunctional behaviors that physicians and many others customarily associate with black people.
The traditional detachment of the medical profession from identifying and solving its racial problems has been evident in the medical literature and in the work of medical authors who are at liberty to range farther and deeper into social and personal issues than is possible in medical journals. David Satcher, a young black physician who became surgeon general of the United States in 1998, pointed out in 1973 that: “Much has been written about the doctor-patient relationship and its many challenges and ramifications. However, almost nothing is written about the effects of race on this relationship.”12 (In his pioneering commentary on doctor-patient race relations, David Levy made the same point about the pediatric literature in 1985.13) Then, as now, the great majority of doctors were white men whose ignorance