Month: November 2017

Categories
General Lifestyle Opinion

Too Many Eyes Between the Thighs: Sex and Surveillance

There’s a special bond between students and their teachers. As someone who used to teach young children, I know firsthand how students can trust teachers with certain aspects of their lives that they don’t feel comfortable disclosing to other adults. But, students in the Salem-Kaiser school district in Oregon may want to think twice about what they tell their teachers. That’s because district policy stipulates that teachers are mandatory reporters of all student sexual activity. This policy means that teachers who have knowledge or suspicion of students’ sexual activities must file a formal report with the Department of Human Services, local law enforcement, or a school resource officer. What’s more, because they are mandatory reporters, a teacher could actually face disciplinary action and fines if they fail to report known student sexual activity. This law even applies to faculty members making reports on their own children if they are students in the district. The year is 2017, but this puritanical policy is straight out of the 17th century.

As a former high school student, I’m appalled by this policy. As a future doctor, I’m deeply troubled. When culture permits our libidinous drive to become an object of surveillance, sex becomes a deviant activity. In criminalizing the natural and healthy exploration of sexuality, we imbue sex with shame.

I could not help but see a link between this policy and the reports of sexual violence that have been dominating the media over the past month. My immediate reaction was that this attitude of surveillance around sex is the fertile soil from which the Harvey Weinsteins of the earth spring forth. In an article about the Harvey Weinstein scandal published in New York magazine, Rebecca Traister writes “What we keep missing, as we talk and reveal and expose, is that this conversation cannot be just about personal revelation or speaking up or being heard or even just about the banal ubiquity of abuse; it must also address the reasons why we replay this scene, over and over again.” Traister sees the perpetuation of crimes of sexual abuse as indicative of a foundational gender injustice; I see them as the result of a culture that was built upon austerity.

America is littered with vestiges of our Puritanical culture. The very fact that we can’t show the bare breast on Instagram, or that we’re still trotting out the story of Janet Jackson’s costume malfunction from Super Bowl 2004 is, to me, an indication that the body is subjected to surveillance when it’s recognized as a vessel of sexuality. Sarah Silverman’s June 2017 appearance on Jimmy Kimmel Live! illustrates this. She holds up a picture of a penis that she drew while hospitalized and correctly assumes that the picture is intentionally blurred to viewers at home, per FCC regulations. She then facetiously tells producers that what she actually drew was a stalk of asparagus, and the picture instantly becomes clear. The image is, in a way, treated as criminal, and is subject to surveillance via pixelation, and yet that surveillance is instantly removed when the association with sexuality is removed.

In a way, we’re all responsible for allowing crimes of sexual violence to occur. My intention here is not to negate the free will of an individual who chooses irresponsible, repugnant behaviors, but to suggest that we have fostered a culture which, in a way, suggests that abhorrent sexual behaviors may be the basest way to get one’s needs met. When two 16-year-olds are in a healthy, consensual sexual relationship, and this relationship gets reported to the authorities, we are sending the message that even an appropriate sexual encounter is considered an act of deviance. And it starts even at a more localized level than the school. If kids are not hearing about sex in their households and are not raised with the understanding that sexual appetite is as normal a bodily function as urination or defecation, the overwhelming message is, at the very least, that sex is something that needs to be hidden away, or more damaging still, that sex is shameful.

Sexual violence is borne from the “sex = shame” mentality. When we classify the perpetrators of these crimes as being “sex addicts,” it excuses these damaging and vile behaviors as an unfortunate error of biology rather than viewing them as a product of learned behavior. This is not to say that sex addiction isn’t a real pathology, but rather to point out that we may be confounding biology with behavior. Though sex addiction has never been classified as a diagnosis in the Diagnostic and Statistics Manual (DSM), most experts agree that the diagnosis of a sex addiction would require a higher-than-average sex drive coupled with compulsive sexual behaviors even in the face of negative consequences. Sexual drive is a difficult feature to quantitatively measure, but I suspect that a high sex drive is not the cause for most crimes of sexual violence. I strongly believe that by committing acts of sexual violence, perpetrators are primitively attempting to meet their needs. In other words, while the sexual appetite is normal, the internalization of the “sex = shame” mentality is so embedded in the psyche that the sexual act becomes a part of this narrative. When one believes that one’s sexual drive is shameful, libidinous urges cannot be openly discussed, and instead may be dealt with in a way that is clandestine and non-consensual. Larger issues of power and privilege, though out of the scope of this writing, come into play when individuals are enabled to act out these violent behaviors.

Sexual violence is systemic. If we don’t change our cultural attitudes toward sex, we will continue to foster an environment which is likely to create sexual criminals. Young people who are just beginning to explore their identities as sexual beings through relationships with others are most susceptible to the internalization of the “sex = shame” narrative. If we don’t learn to shed our Puritanical vestiges and celebrate the healthy, safe, and consensual sexual exploration of these young people, we will continue to support a society of people who are reduced to committing crimes of sexual violence.

References:

YThe Conversation We Should Be Having: https://www.thecut.com/2017/10/harvey-weinstein-donald-trump-sexual-assault-stories.html

Internet sex addiction: A review of empirical research: http://www.tandfonline.com/doi/abs/10.3109/16066359.2011.588351

Is Sex Addiction Curable? http://www.newsweek.com/sex-addiction-curable-kevin-spacey-seeks-rehab-condition-does-not-exist-703541

Salem-Keizer staff told to report student sexual activity, including own kids: http://www.statesmanjournal.com/story/news/education/2017/10/31/oregon-mandated-reporter-salem-keizer-staff-told-report-student-sexual-activity-including-own-kids/798865001/

Sarah Silverman on Near Death Experience: http://abc.go.com/shows/jimmy-kimmel-live/video/featured/VDKA3871414

Photo Credit: Wyatt Fisher

Categories
General Reflection

Gender Application Gap

Gender stereotypes are pervasive in medicine. Last year, JAMA reported on the gender pay gap in medicine, and I found myself wondering if other stereotypes in medicine were true. I have seen some of it and heard more of it – from Scrubs, to blogs, to my own preceptors – ortho-bros, Ob/gyn girls, etc. According to a report using 2015 data from the AAMC and a study in the Journal of the American College of Surgeons that used the same data, these stereotypes seem to fit. The top male-dominated specialties by resident in the GME class of 2013-2014 were orthopaedic surgery (87%), radiology (73%), anesthesia (63%), emergency medicine (62%), and general surgery (59%). Women made up 85% of Ob/gyn, 75% of pediatrics residents, 57% of psychiatry residents, and 58% of family medicine residents. What I was really interested in, though, was whether there is any sort of advantage or disadvantage in being a male or female applicant in a sex-dominated field.

Luckily, this must have been on the minds of the ERAS stats department beacuse one of the headline charts on their FACTS web page is a table of specialty application data broken down by sex. The table includes the total number of applications per specialty and average number of applications per specialty broken down by sex. The data included all types of applicants – IMGs, DOs, and MDs. In working with the data, I chose to focus on Family Medicine, OB/gyn, Urology, Orthopaedic Surgery, General Surgery, and Family Medicine based on the AAMC data for sex-dominance as well as the stereotype of the field. I’ll admit that the latter is not a scientific method, but I don’t think I’m going out a limb here to say that there are (rightly or wrongly) generally agreed-upon stereotypes in medical fields. The modified table can be found below:

Specialty Female Applicants Mean Number of Female Applications Male Applicants Mean Number of Male Applications
Anesthesiology 1268 28.5 2524 30.9
Family Medicine 7168 49.4 7260 51.8
Obstetrics and Gynecology 2019 47.7 758 41.1
Orthopaedic Surgery 193 79.2 1116 74.8
Pediatrics 4576 36.7 2490 33.6
Surgery-General 2606 37.2 4871 37.7
Urology 110 64.2 383 62

Nothing shocking here. Male-dominated specialties like urology and orthopaedic surgery have more male applicants, female-dominated specialties like OB/gyn and pediatrics have more female applicants, and more evenly distributed fields have about an equal number of applicants.

What is more interesting is the average number of applications submitted per applicant by sex to the different specialties. Urology and orthopaedic surgery, probably the two specialties most culturally male-dominated both have higher number of applications submitted per female applicant. This seems to fit. Perhaps female applicants, knowing that the culture is male-dominated, feel pressure to submit more applications in order to be more certain that they will secure a residency in the male-dominated field. Ob/gyn, though, is the opposite. The most female-dominated specialty (both culturally and by AAMC data) has fewer applications per male applicant than female applicant. Even though 85% of the residency class of 2013-2014 was female, and even though far more women applied to OB/gyn than men, men do not seem to feel the need to overcome any sort of cultural disadvantage like women do when applying to male-dominated specialties.

This trend of male advantage in overcoming residency stereotypes holds true among other female-dominated fields like pediatrics where there are likewise more female applicants, but men submit fewer applications per applicant. I should note that this data does not include matriculation – only applications – so it is possible that men submit fewer applications and then do not get residencies. Also, this trend is not universal. Anesthesia is a male-dominated field where women submit fewer applications per applicant, though culturally it is not stereotyped to the same level as orthopaedic surgery or OB/gyn.

The New York Times wrote about this trend in 2001, noting that while men still made up the majority of practicing OB/gyns, upwards of 80% of residency applicants were female. But, according to the article, female OBs were taking a stand. They did not want OB/gyn to become a women-only field with some even supporting the reverse sex-descrimination argument that a few male OBs had taken to the courts. What is amazing in this scenario is that in spite of patient preference being the driving factor in making OB/gyn female-dominated, residencies see this as a problem and appear to be giving male applicants an advantage for residency positions. Meanwhile, male-dominated fields do not appear to have a problem with their male to female ratio. What does it say when women physicians are advocating for more men in their field over the preference of their patients?

Photo Credit: European Parliament

Categories
Lifestyle Public Health Reflection

#BoPo: Body positivity in the age of obesity

When I was younger, I loved watching the televised broadcasts of New York Fashion Week. I grew up in the heyday of heroin chic, which meant that the runway was a seemingly endless parade of vampire-pale, stick-thin waifs. I knew I would never grow up to look like these women, no matter how hard I tried. Even though I was perfectly happy to develop my own unique sense of style, I had an awareness that no one on television looked like me.

Fast forward two decades. The landscape of beauty has changed dramatically. I can’t yet say we’re living in a whole new world, but as a society, we’re making steady progress toward diversifying our expectations of beauty. More colors, shapes, sizes, and sexual identities are being beamed over the airwaves and into our living rooms.

The strides we’ve made toward diversifying our media did not just happen overnight. They occur as part of a larger historical context that has rebelled against normative standards of beauty for decades. The Fat Acceptance Movement, started in the mid 1960’s, is considered to be an offshoot of Second Wave Feminism. In 1967, the group held a 500 person “fat-in” in Central Park, NY wherein people carried signs of pro-fat messages and burned diet books. This was followed in 1969 by the creation of the National Association to Aid Fat Americans (NAAFA) which held a yearly summer convention until 2015. More recently, in 1996, the Body Positivity Movement was started by friends Connie Sobczak and Elizabeth Scott. Their goal was to help girls and women foster positive self-images so they could lead more fulfilling lives. Today it exists as an organization known as the Body Positive. Just a few weeks ago, this organization hosted the third annual CurvyCon. This convention was organized by two self-described plus size fashion bloggers to help women “chat curvy, shop curvy and embrace curvy.” All of these organizations and movements undoubtedly have their own platforms, but what they all share is a desire for bodies of all appearances to be accepted into society.

I firmly believe that every body is worth loving, but moreover, that every body is a body worth caring for. I see care as being a balance between the emotional and physical aspects of well-being. While I am hopeful that the shifting tide of acceptance in media translates more broadly to mean that us non-Hollywood folk also find value in ourselves and others no matter our physical appearance, as a health care provider, I am concerned that the Body Positivity Movement may be construed as an acceptance of obesity. If we accept ourselves for who we are, and who we are is unhealthy, then I question whether we are really showing ourselves the love that we claim.

I think what the Body Positivity Movement does well is emphasize self-value on the emotional spectrum of care. Where body positivity endeavors seem to lag, however, is in the promotion of physical health. Physical health can be just as challenging to realize as emotional health, yet it is just as important. Diabetes, hypertension, and hyperlipidemia are real diseases whose prevalence strongly correlates with obesity. They do not discriminate between people who love their bodies and those who don’t. They can affect and ultimately kill anyone whose body mass index falls into an unhealthy range. Our government makes the realization of physical health all the more difficult by setting up barriers for people to receive quality health insurance. Financial barriers are only one aspect of this problem. Any policy that allows for the proviso of health barriers, in the form of exclusions, special criteria, and added financial burden for people with pre-existing conditions, is a policy that does not believe all people to be equally worthy of care and is therefore an injustice.

Even though a key focus of the Body Positivity Movement is self-love, this does not mean people have to go it alone. As future physicians, we can partner with our patients and aim to help them strike a balance between their emotional and physical care. To me, this means helping our patients foster emotional self-love while also being conscious of physical health. While monitoring sensitive aspects of our patient’s physical health such as weight, infectious disease, and heritable conditions may be challenging, perhaps in part because they may draw on our own personal insecurities, we can discuss these topics using sensitive, collaborative approaches that are respectful of the patient’s emotional well-being. Ultimately, our goal should be to meet our patients where they’re at in terms of care and be a supportive force to propel them forward.

References:

The Body Positive: http://www.thebodypositive.org/about

Brief History: The Fat-Acceptance Movement: http://content.time.com/time/nation/article/0,8599,1913858,00.html

The Curvy Con: http://www.thecurvycon.com/about

Overweight and Obesity: Signs, Symptoms, and Complications: https://www.nhlbi.nih.gov/health/health-topics/topics/obe/signs

Photo Credit: Crystal Coleman