| On Race, Privilege, and Medicine |
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It's a rare moment these days, at least for me, when I get to sit in a room full of progressive Asian folks and talk about the state of affairs of Asian and Pacific Islanders in this country* (especially one kicked off by Grace Lee Boggs | APIA collective interview with her). And so it was with much anticipation that I drove down to Detroit on Saturday morning to catch the second half the APIA People's Movement Assembly at USSF. (Unfortunately, I was unable to make the Friday evening component due to seminar.)
The session the night before drew over 80 people and they were able to lay much of the groundwork for the discussion and focused on three main questions:
Like many consensus statements, it's an important starting point for group dialogue and decision making. Like many consensus statements, it says everything without saying anything at all. And so the task for the second session was to attempt to identify action points. However, before we could get there, somehow the time evaporated. In the end we decided to at least brainstorm ways to make sure the discussion continued post-USSF. At the time it was easy to grow frustrated and point at the debate about the most effective way to structure our discussion as the culprit. But upon further reflection, I think our inability to move onto concrete goals was reflective of our own internal issues as a community. The Saturday session was like a handful of excited kindergartners being picked up after an exciting day and clamoring to tell their parents what happened all at the same time. The APIA community is so diverse, with so many important issues to address, that the opportunity to hear voices that consistently go unheard (both in larger society and within the APIA community) was overwhelming; and while the facilitator did her best to keep the discussion “on track,” it was more like a series of disparate ideas and concerns all being aired one after another. Ultimately, no one is willing to move forward as a group until we all perceive ourselves to be on the same page and that won't happen until we all feel validated as a member of that group. In many ways the APIA community reflects many of the struggles that the larger people of color collective in this country face. While we are all connected by broad common experiences such as immigration and minority status, many of us don't actually have a whole lot in common. Many of the issues that we find most salient to our individual experiences do not overlap. And so we find ourselves allied not only for things we have in common, but also for things that we all don't have in common with the majority in this country. It occurs to me that had it been practical to extend Friday's session, it might have been more productive. That group came together to make the consensus statement and that process undoubtedly included discussion and thus recognition of the variety of issues that our communities face. With that emotional validation, it might have been possible to move forward to common action points. However, during the Saturday session, though we could agree on the consensus statement, having not been part of that process, we had no such emotional trust in each other so there was no way that we could have moved forward without spending time establishing that all over again. Personally, I probably wouldn't have cared if we accomplished nothing that morning. Simply sitting in a room of only APIA, much less social justice oriented APIA, was refreshing and inspiring for me given the desert known as medical school of which I currently reside. It was a rare moment of safety among strangers that seems nearly impossible to find if you're a queer, radical person of color. And, who knows, perhaps something will come of this. As hard as it may be to create a unified, nationwide coalition, we all know it's necessary. I'm down for trying as many times as it takes to succeed. PS -- definitely check out the APIA Collective website. It is an ongoing documentation and collecting project that will continue well beyond USSF. *Like most things, there is a bit of discussion over the most appropriate terminology. I will use the term APIA (Asian and Pacific Islanders in America) because I find it the most inclusive. By “API” I am referring to not only what we traditionally consider as East, South, and South East Asians, as well as Pacific Islanders; but also, folks who are part of the larger Asian subcontinent who have been traditionally relegated to “other.” I say “in America” to recognize that our community includes all folks regardless of our country's opinion of their immigration status. I limit my discussion to the United States because I think API in this country have unique issues and circumstances that warrant their own exploration. Also, I live here and have no idea what it's like elsewhere. The second US Social Forum is in Detroit and I've been lucky enough to have had some half days off so I could catch a few workshops. Though all of the workshops are leftist, the topics vary greatly (everything from gender to environment and race to armament) and the attendees reflect this in their diversity. While walking around the conference, it certainly feels like a heterogenous jumble of progressives, but not surprisingly, as soon as you enter a workshop the crowd becomes more homogenous as it filters by interest. Thus while attending the workshop on class privilege and activism [organized by resourcegeneration.org], I found myself in a room full of white, deodorant-boycotting hippies. I couldn't help but feel like I had time warped back to my college co-op living days.
Because I had clinic in the morning, I wasn't able to get there until it was one hour into the two hour time-slot so I slipped into the back and listened. It seemed that the workshop was largely geared towards those who identified as having class privilege, how to recognize it, and how to how oneself accountable. By the time I arrived we were completing the final prewrite and small group sharing. The “report back to large group phase” turned into a mishmash of disparate ideas and guilty confessions that made only enough sense to imply that a significant amount of deliberation and emotion had sparked their existence. At some point one of the five people of color in the room raised her hand and remarked that she had come to this workshop not because she identified as having class privilege, but because she was trying to learn how to talk to well meaning folks who try to help but in their self-assured ignorance, only end up fucking shit up more. Meanwhile, I was struggling with my own conflicted feelings. I had come to the workshop because I wanted to work on my own accountability to class privilege. However, upon being faced with a group of not just white folks, but young, hippy, white folks, I was having difficulty engaging with my own privilege due to an inability to identify, and my own lingering irritation, with the folks around me. I was tempted to allow my angry feelings to carry the day, but it occurred to me that doing that would only enable me to avoid the issue that brought me to this workshop to begin with, my privilege. As I reflected on this I was finally able to verbalize something that I'd been worrying about, but too proud and scared to admit: sometimes I use my minority status as a person of color to diminish my privilege as an educated member of the upper class. It's much more comfortable to focus on our oppressed-selves rather than our oppressor-selves. It's fucked up and it's painful to have to admit that I do it too. Upon continued meditation, it occurs to me that this sort of behavior is problematic in other ways as well. Not only does it prevent me from acknowledging my own privilege, it actually disrespects the legitimate feelings I have about being a person of color. Both my anger over the state of race relations in this country/world and my pride as a person of color are important and justified; I must have the confidence to remember that being part of the upper class does not take away from its validity. More importantly, using race as a distracter every time I feel defensive or protective of my class privilege is not only irritating to others and a disservice to myself, but it also cheapens the movement of folks of color. And that's fucked up too. PS: Check out resourcegeneration.org when you get a chance. They organize folks with class privilege and help direct resources responsibly.  Part of the GLMA conference's celebrations this year included marking the 30th anniversary of NALGAP, The National Association of Lesbian and Gay Addition Professionals. Founded in 1979 by Dana Finnegan and Emily McNally, NALGAP was the first substance abuse organization sensitive to the needs of the LGBT community. To this day, they are the only international organization dedicated to substance abuse in the LGBT population. Like smoking in the lesbian population, the fact that the LGBT population is at a greater risk for substance abuse was not a new fact for me. In addition to all the risks that the general population faces for substance abuse and dependence, when it comes to the LGBT community you also throw in stigma, self-loathing, depression, isolation, a social scene that often revolves around drugs and alcohol, the not uncommon need for a catalyst to lower our own inhibitions, and the aforementioned advertisers (this time beer instead of philip-morris). What I hadn't thought about was what would happen if a queer patient sought treatment: folks getting turned away because they're LGBT, folks too scared to come out and thus unable to address possibly a critical player in their abuse motivators, practitioners who don't understand the difficulties of being LGBT, folks not even being diagnosed in the first place because the pattern of abuse in LGBT folks can be different. And the lack of data. So much data unknown. For example, it's been shown that alcohol use in teenagers (and thus theoretically alcohol abuse and dependence) can be reduced through school programs that focus on resisting peer pressure and the dangers of drug use and drunk driving. But does that work for the queer teenager who drinks because s/he doesn't know how else to deal with coming to terms with being queer? According to the National Center On Addiction and Substance Abuse, the rate for the general population is around 18%. Statistics vary in their estimates of substance abuse/dependence in the LGBT community but the range seems to be something like 30-55%. I don't cite any studies because there are none worth citing. They're all old. They're all small. Nobody has looked. Not even organizations that do annual surveys. They can't bother to tack on another question.  Anyway, one of the highlights for me this conference was meeting the two women who started NALGAP, Emily and Dana. And they're lesbians. And they're together. And they're old.
Undoubtedly, they've experienced more homophobia than I ever have and perhaps ever will. And yet, there they are, still together, and still smiling. Even I'm surprised at how touched I am to see them together. Why do I have tears in my eyes? And then I realize how much anxiety I must have been squashing down for the past few years. Gone are the years inside the protective bubble of college. And while the prospect of full-fledged adulthood is exciting, it also brings colder realities. Homophobia is no longer just hurtful, it carries real life consequences like residency applications, poor rotation evaluations, marriage, health insurance, and family planning. With no way to really resolve these issues, I've just been pretending they aren't there. Looking back, it occurs to me that previous to this moment, I didn't actually know any older lesbians. Though I've believed them to exist, I had never even SEEN any in real life. Once, I saw a couple in a movie, but it was a really sad story. And now I'm suddenly faced with Dana and Emily and I realize that that it is possible. They have not only endured but also thrived, and the relief that comes along with finally knowing, and not just hoping and reassuring myself, that it is, in fact, possible to "make it", is overwhelming. I want a cigarette. I suppose that on it's own, that's not a particularly strange thought. Throughout my life, most people would probably consider me a social smoker. I smoke when I'm drunk, when I'm around friends who are smoking, when I'm upset. Especially when I'm upset. Always when I'm upset. But lately, I've been trying much harder to quit; not the usual, "Yea, yea. It's so bad for me. I know. I should stop," but a much more adamant, "I no longer want to do bad things to myself and this is definitely bad for me and an unhealthy pattern that is empowering to break."  I want a cigarette right now, but I'm not drunk. No one around me is smoking. I'm a medical student who just finished learning about all the terrible things that smokers are at hugely increased risk for. I've watched COPD patients suffocate while just sitting in a room. I'm even at a conference on LGBT health issues, sitting in a talk on how queer women have higher rates of smoking. It's an issue that plagues our community. I'm sitting in a huge room with fluorescent lights. There is nothing sexy about this situation. If cold showers are effective combatants of sexual arousal, I'm sitting in the proverbial "ice bath" of smoking. But I can't ever remember wanting a cigarette in the recent past more than I do right now. Most people who have ever sat through a lecture on LGBT health issues probably know that queer women have a higher rate of smoking than the general population. We smoke as a coping mechanism for stigma. We smoke because it's a community norm. We smoke because we have internalized self-hate and don't feel like we deserve to be healthy. We smoke because compared to many of the other issues that plague the LGBT community, smoking just doesn't seem like that big of a deal. We smoke because it's "masculine." We smoke more because smoking cessation programs are rarely culturally sensitive. Tobacco companies specifically target LGBT communities.  These explanations are not new to me, though it's certainly useful to be reminded. But what's left such a large impression on me is how effective these advertisements are. I want to smoke a cigarette right now because the presenter has shown us examples of cigarette ads targeting lesbian consumers. And these ads are so effective that even when presented in the context of, "look how terrible this is, we must not fall for it," they're still compelling. I try to think back to the last time that I saw myself validated in popular media. I try to recall the last time I was told that walking down the street with my girlfriend could be cool instead of anxiety-provoking. Suddenly I'm presented with a world where that's the case. And I want to be a part of it. Badly. It's not that tobacco companies don't advertise heavily to all demographics and tailor their advertisements accordingly, that makes them so effective. It's that when straight folks see an ad, it's just one of the millions of ads that surround them. LGBT folks, we're so hungry for acceptance, our representations so few, that queer friendly ads are like water for a person dying of thirst. Allies are few. Financial support is spotty. Opposition is high. Not surprisingly, the LGBT community is fiercely loyal. And that's a good thing. Our allies must know that our support matters; that if we say we'll mobilize and support an issue, that it will be significant. But we have to be loyal to ourselves first and that means allying only with folks that will truly benefit our community, not tobacco and beer companies that exploit our marginalization. Will I smoke again? Probably. Probably less and eventually, insha'allah, none. My next tattoo: Don't let other's people's prejudices give you COPD too. some links: on smoking in lgbt communities and tobacco advertising: http://www.lgbttobacco.org/ on increased nicotine levels in cigarettes targeted for minorities and teenagers: http://www.smoking-cessation.org/nicotine_in_cigarettes_increases.asp 
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 about this blogA place where I can write my thoughts on race, on privilege, on class, on being a doctor. Part of the endless struggle to become a little bit more enlightened and feel a little less alienated.
Agree with me. Call me out. Pass it on. I post once or twice a month with smaller comments on mini-blog. about meMy name is Jess. In the interest of full disclosure: I'm a 30-something-year-old Chinese American and believer that the quest for social justice and equity must be an intentional and active one. I'm a Family Medicine physician. I'm queer. I'm a radical. I grew up in a mostly white suburb and my parents are white-collar workers. And I don't eat meat, but I miss it sometimes. categories
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