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Provider Resilience while treating the Racially Comatose 

5/19/2016

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One of my favorite parts of being a family med doc is talking with kids. During the routine preventative visits I ask them what they want to be when they grow up, not just as a way to get to know them better, but also to be another small voice telling them that they are worth believing in.
 
Yesterday, the most astonishing thing happened. I asked QiLing, a 7-year-old with bright eyes, that very question and she responded, “I want to teach ignorant people about race so the world will be better for my children.”
 
I told her that she should consider the field of medicine instead because it would be more relaxing and pay more.
 
Right. No one believes that happened.
 
It didn’t happen. Why? Because nobody grows up wanting to be a race educator. Sometimes a child might say they want to fight “bad guys” when they grow up, but not once have I heard any child dream about addressing race inequities.

So it’s shocking to me that some white folks see people of color who do race work as self-promotional. It’s not self-promotion; it’s self-preservation.  We’re forced into this work because we see no other course of action when racism is thrown up in our face constantly.  Back thousands of years ago children did not say to themselves, “I want to be a gatherer!” They just needed food so that’s what they did.
 
But that self-preservation, attempting to address injustice can simultaneously be self-destructive.

Recently I went to a talk by Touré on microaggressions and was pleasantly surprised. I went assuming he would teach about microaggressions – afterall isn’t everything in the world setup for ignorant white people? Instead, he spoke to the black people in the room and discussed strategies for coping with microaggressions.
 
One of the key tenets that he focused on was not fixing or teaching.  He cites an experience when his team at MSNBC was asked to do a segment on Black History Month. A white man next to him groaned and then said, “Well what about White History month?” Hurtful? Yes. Ignorant? Yes. Teachable moment? According to Touré, no.
 
He points out that people who say comments like that have values that deeply are ingrained in their psyche. No amount of rational discussion will change their mind. It’s a waste of energy to discuss it with them.
 
When your colleague says something that hurts you, it’s not only deflating in the moment, but also steals precious energy that you should be using to pursue your own happiness.  That’s energy that you could have been using to further your career but instead used to brainstorm explanations that might enlighten your colleague.  It saps energy that you would have had to enjoy time with your family after work because you’re sad and want to tell your partner about the shitty thing your colleague said.  Or even worse, the comment is so insidious that you spend emotional energy trying not to internalize that person’s bias.
 
Arguably, your success as a person of color is a more effective strategy to combat racism than teaching folks one at a time.
 
Touré is absolutely right. It’s not the job of a minority group to educate the majority group. On the other hand, it seems unlikely that our society will rectify racism solely from the work of majority allies.
 
The distinction that wasn’t explicitly stated was the nature of each person’s work. The vast majority of folks do not have professional careers focused on teaching about race.  But for those of us who teach about race as a profession, it is our job.
 
It’s important work and what Touré failed to mention is the inspiration and positive energy that can fuel your life when you help catalyze another person's growth. It can be just as exhilarating as it can be demoralizing.  Touré had a four-prong strategy that he uses to shield himself from the damaging impact of microaggressions. Inspired by him and influenced by my medical training, I’ve put together a diagnostic and treatment framework for those of us who engage in race teaching to preserve energy, maximized effectiveness, and build resilience.
 
Diagnosis is paramount to effective medicine. The experience of treating a patient with a treatment plan that doesn’t fit their diagnosis is frustrating.  Nothing improves. Sometimes things get worse. It frustrates the patient. It frustrates the physician. You end up hating each other. The same goes for teaching:
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​It’s pretty self explanatory, but it deserves a few clarifications.
 
The first and most important is that you don’t have to engage unless you are getting paid. Work/Life boundaries are important and we all know working outside of designated work times leads to burnout.
 
The other is that this is generally a standard progression. Nobody can become a Light Sleeper without first dozing for a bit. They might not doze for long, but they will go through a period where they are aware of racism but are still trying to return to a more comfortable state of being where racism doesn’t exist.
 
Recognizing Dozers and the Ambien-Induced-Comatose can be a difficult. Sure, there are really obvious examples such as KKK members and Donald Trump, but I think these extreme examples cause us to forget that there are more subtle presentations of these diseases. It’s the subtle cases, those Dozers and Comatose folks that we misdiagnose as Light Sleepers that burn us out.
 
For example, the multitudes of white people in Seattle that identify as liberal but are unable to have any meaningful conversation about race because their white guilt cripples them. They are Dozers.
 
Similarly, white liberals who are doing antiracism for the ego boost. White “activists” who refuse to recognize that their leadership actually perpetuates racial inequity as opposed to sharing their privilege to allow folks of color to lead. All Dozers.
 
And then there are the folks who cannot ever be moved, the Comatose. The most recent example I saw of this was in a white, older, straight man.  He’s liberal. He supports Bernie.
 
And yet when his own racist interpretation of scientific research is questioned he cannot even consider that his bias is blinding him. It doesn’t give him pause that a room full of very smart colleagues disagrees with him (the confidence of white men just knowing they are right is astonishing). Every rational argument against his stance has been explained. He just mansplains even more fervently.
 
He has dedicated his career to the underserved. He recognizes that racism exists. He might even be a proponent of the Black Lives Matter movement. He’s still got Ambien on board.  What has to be recognized is that all those explanations would have swayed a Light Sleeper long ago.
 
You can try to come up with just the right analogy to make him understand. You can lament teachable moments that you missed or regret not saying just the perfect thing that would have swayed him. You will wish you were more eloquent. You might discuss his case with your friends instead of enjoying each other’s company. It will drive you crazy. You’ll cry. You might drink. You’ll want to kill yourself.
 
And meanwhile, he is just continuing on in his life happy as a clam, secure in his righteousness.
 
These people wander around in an Ambien haze. Just as there are reports of sleep driving and sleep eating on Ambien, these people are perpetuating racist ideas without any conscious knowledge of their actions.
 
You can’t rationally inform a sleepwalker that they are doing a dangerous thing. All you can do in quarantine them to protect themselves and others. Similarly, the proper treatment for the Comatose is not teaching. It’s containment. Contain his emotional impact on you. Contain his opinion so that it doesn’t infect he Dozers and Light Sleepers around him.
 
The final point is that there is still use in engaging with the Comatose, but you have to be clear about your purpose. You cannot teach them, but you can have discussions for the sake of the Dozers and Light Sleepers that surround you. Use the conversation with the Comatose to address issues that the Light Sleepers might be grappling with. Use the conversation to show Dozers how ridiculous they could sound. Use them as a point to bring up important issues and make larger points through protest.
 
May we all transform those sessions of beating your head against a wall into victories by adjusting our goals.
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