Posting while female

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I love interacting online. My Twitter friends and colleagues have enriched my professional life and offered lots of opportunities for collaboration, research, lecture opportunities and general social banter. I have many “friends I haven’t met yet” that are a source of support for my writing and study, and whose work I follow with interest and admiration. Social media has widened my world and I am all the better for it.

I post as a radiation therapist, researcher, woman, mum and lesbian. I often talk about work, what I am doing, what other people are up to – and my posts and my interests reflect the intersection of all my identities.  Work can be tricky though. Usually when an organization dips its toes into the swirly maelstrom of social media it begins with risk management. Often this results in a policy or statement – and usually that statement is more a list of what not to do. Of course we need to protect patients’ privacy, and be professional about how we conduct ourselves online. Moaning about work on an open platform is probably not a good idea as it’s easy to figure out who is saying what about where (or whom). I find, though, that these kinds of guidelines often scare people – I’ve asked at work a couple of times if I can tweet about an interesting project (for example) and invariably the response is “we should check with the communications office”.  So it’s a balancing act between the personal and the professional – which is the subject of some research I am doing at the moment for my EdD. When we are at work we want to “be professional”. In healthcare this usually means adopting a neutral persona, not bringing our “private life” into the workplace and so on. But our (unstated, often unexamined) norm for “professional” is male – part of the long association of women with hearth and home, and men with work. This spills into all sorts of areas, obviously there’s a long history of gender occupational inequity where women (still) earn less than man in many cases, hold less senior management positions and still shoulder the majority of domestic (unpaid) work. None of this is news.

What is also fairly well known is the amount of hassle some women get online when they start to talk about these things and start pushing into territory traditionally occupied by men. Examples abound, including the horrendous abuse the Gamergate women endured and the ridiculous fuss made about the Ghostbusters remake and subsequent trolling of Leslie Jones. Social media has also been used to fight back – such as the fabulous #DistractinglySexy campaign by female scientists reacting to Tim Hunt’s unfortunate sexist remarks. It’s part of the risk of posting anything while female – and is more risky if the stakes are higher and you’re questioning long held gender norms.

Most of my online interactions are overwhelmingly positive. However a few are not. A few examples include a few nasty tweets after I posted something pretty innocuous with #EverydaySexism. One persistent guy bombarded me with information about “reverse sexism” and why men were oppressed by female-only spaces. He helpfully also sent me a couple of emails to follow up as I obviously didn’t understand how feminism worked. A few times people have demanded to know why I am making a fuss, as no one is directly oppressing me. If you are a feminist, it seems, you are in charge of the party manifesto and responsible for all actions taken since Simone de Beauvoir. It always amazes me how angry some of these men are. You can express all sorts of daft things online but once you start flirting with feminism you’re fair game. I posted a question on a closed professional FB group yesterday – asking about gender mix in a (technical) subspecialty of our profession. After my research I was wondering if this non-patient area attracted more men.  Not because it is a leadership role, but because people working in that area do less “emotion work” (usually associated with women).  The majority of the responses were helpful and neutral, and didn’t seem to confirm what I thought at all (which was useful!). However, a couple of the guys seemed to think I should shut up and sit down. I was surprised and shocked; this site has always been a great source of information and collaboration. Why (I thought as I opened a bottle of wine at home) would anyone express this online to their colleagues all over the world? If I had been looking at race, would they have told me to back off because things were fine just the way they were? There are loads of amazing feminist men that will read this with sympathy and understanding, and thank goodness for them because they are helping us change things one unpleasant interaction at a time. In the meantime I decided to share this (after a lot of thought and with names changed) because this happens and if we don’t talk about it and/or step in it will continue.*

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*And a virtual sisterly fistbump to “Sarah J” !

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Your tissues have issues

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I went to my first Yin yoga class last week. Rather alarmingly I was the only person who showed up, which meant I got a lot of personal attention. The instructor, Lisa, gave me the run down – Yin is meant to go deep, to the level of the fascia, and poses are held longer than traditional yoga. There is lots of time to reflect, Lisa told me, and sometimes emotions will rise up. “Your tissues,” she said, “have issues”. The hips hold anger, our shoulders are stiff and sore because they often hold the weight of the world.

I loved this, as I lay with my face on a bolster in child’s pose, I thought about the reading I had been doing about embodiment, how feelings can become carried in the body. In my “real life” as a radiation therapist and researcher, I have pretty much stripped the emotion from my academic work. Although as clinicians we need to be empathetic, compassionate and connect with the people we meet in the treatment room, this caring and warmth is discouraged in a publication. We can get angry at the system, the restrictions, the endless edicts to measure more, work harder – but that is tamped down when we’re at the podium talking about the latest lean initiative and how it makes our work lives better. I’ve said before that starting this doctorate has reintroduced me to finding other ways to speak and share, ways that involve hearts as well as minds.

Scientific dispassion emerges from the old idea that research should be value neutral, conducted by a dispassionate observer. This (male, White, Christian etc) constant observer is mainly unquestioned. It was a revelation to begin to read some feminist researchers who pointed out that this doesn’t always serve us well (at least the non-White, non-male portion of the population). My chosen lens is critical theory, where people feel pretty passionate about stuff! It is meant to be emancipatory, to make a difference in the world – emotions are part of the work, not a distraction to be written out. Feelings including pain, old hurts, injustices can be triggers to make things right, to change (at least part of) the world. Shame and rage can become the motivation for striving for recognition and political resistance, sometimes it is only by “regaining the possibility of active conduct that individuals can dispel the state of emotional tension into which they are forced” (Honneth, p. 138).

Feminist research eschews the emotion vs reason binary and admits us, whole, into the messy business of finding out. Emotions are triggers that something is up, can flag a wrongdoing, transgression or injustice. Our prof this week told us “you are allowed to be passionate”  – and I agree, without that why would we be doing this often difficult and frustrating work?

Reference:

Honneth A. The struggle for recognition: The moral grammar of social conflicts. 1995.

Rethinking evidence

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We are now embroiled in a research methods class. As good grad students, we’re tasked with reflecting on our experiences with research (or actually “reflecting on ourselves reflecting….which is all a bit meta for me). It was a useful exercise before we start trying on some theories and approaches for size over the next year. My instinctive “what does research mean to you” landing spot was evidence based medicine/practice. As a radiation therapist (and allied health professional) EBM is infused in our work. We all know the ubiquitous evidence pyramid crowned by the king of evidence, the meta-analysis. The ultimate distillation of all that lovely hard data from those meticulously carried out randomised controlled trials (RCTs). EBM – coupled with the patient’s preferences and the physician’s clinical judgement will deliver beautiful, neutral, quantitative, value-free answers to all our tricky questions.

Except, of course, it really doesn’t. EBM gives us a set of rules that work sometimes, for a certain group of people. And what do we mean by evidence? What about other, less quantifiable factors? What about qualitative research? How, exactly, do we incorporate the patient and provider’s viewpoints and experience? Even as I wrote about the valorisation of EBM – I felt a creeping sense of unease. There was no way I was going to get away with this, in a university full of post-positivists and in a classroom full of educators.

And….even a cursory look around reveals some interesting counter arguments. Firstly, there’s the feminist lens that challenges the positivistic concept of a true detached and neutral observer of events.  Indeed what we mean by “observer” is arguably limited to a small group of educated and privileged white men. Empirical epistemology (foundational to EBM) reduces gender and other differences to “bias” which excludes and perhaps even harms women. Female research also over-focuses on reproductive related issues and fails to investigate gender-dimensions of other illnesses (such as HIV/AIDs research, heart disease, depression and TB). There is a well-documented male enrollment bias in clinical trials. How much faith would you put in that evidence-based cardiac disease guideline for a 50-something female now?

My old friend phenomenology also has something to say. The argument rests on the way we divide people into mind and body – science mostly concerned with fixing the body. The so called subjective features of illness are usually deemed unimportant by clinicians but are vital to the person’s experience of their illness. Treating the patient, not the disease, would actually be “patient centred care” and the person’s experiences, stories and ways of seeing the world would all become important parts of the diagnosis. This type of “evidence”, however, has little place in EBM, despite the development of “shared” decision making and other attempts to incorporate patient’s values. The evidence that is given precedence (RCTs and meta-analyses) might not be as reliable as we think; there are a number of biases inherent in both that include (ironically) a lack of evidence of efficacy, and a limited usefulness for individual (not aggregated) patients. Additionally – methods that might pick up phenomenological factors (qualitative, for example) have no place in the EBM hierarchy. I love the recent paper by Eakin, where she states:

“it is indeed transgressive to practice qualitative research within the medical and health sciences – a land in which the randomised controlled trial (RCT) is considered the apex of the methodological food chain, and where evidence based practice (EBP), a creed anchored in quantitative measurement and epidemiological reasoning, has been widely embraced across the clinical professions” (p. 107).

The readings and discussions we’ve had in class have solidified my feeling that EBM is a useful tool, but also that it “does not increase objectivity, but rather obscures the subjective elements that inescapably enter all forms of human inquiry” (Goldenberg, 2006. P. 2631). As health care professionals, when we claim that we need to make decisions based on “evidence” – let’s be careful about what evidence we mean and why. Evidence-based and best practice are not always the same thing.

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Informed by these readings (if you want one, pick Goldenberg!)

Cohen, A. M., Stavri, P. Z., & Hersh, W. R. (2004). A categorization and analysis of the criticisms of Evidence-Based Medicine. International Journal of Medical Informatics, 73, 35–43. http://doi.org/10.1016/j.ijmedinf.2003.11.002

Eakin, J. M. (2016). Educating critical qualitative health researchers in the land of the randomised clinical trial”. Qualitative Inquiry, 22(2), 107- 118.  doi:10.1177/1077800415617207

Goldenberg, M. J. (2006). On evidence and evidence-based medicine : Lessons from the philosophy of science, 62, 2621–2632. http://doi.org/10.1016/j.socscimed.2005.11.031

Greenhalgh, T. (1999). Narrative based medicine: narrative based medicine in an evidence based world. BMJ (Clinical Research Ed.), 318(7179), 323–325. http://doi.org/10.1136/bmj.318.7179.323

Rogers, W. (2004). Evidence-based medicine and women: do the principles and practice of EBM further women’s health? Bioethics, 18(1), 50–71. http://doi.org/10.1111/j.1467-8519.2004.00378.x

May contain nudity and coarse language.

UBC

This is my first go at actual, real university type-learning. You could argue that distance education, even done with great tutors, is university based learning but I am talking about your bum in the seat of an actual campus. UBC was a good place to start; it’s tucked away on a piece of land that juts into the Pacific. Not only does it boast killer views, it is also home to Canada’s most famous nude beach. Wreck beach is a thigh-cramping walk down a long flight of stairs to a gorgeous sweep of beach, littered with cedar logs rolled up from the ocean. Made slightly less gorgeous (in my jaded opinion) by the large number of brown and leathery men who frequent the beach, proudly airing what nature gave them. Some of them sell hot dogs (really), some sell sarongs, but most just lie, splash, play ball and generally cavort. There are a few women, it’s true, but they are easily overlooked as the wind-swept and sea-salty men strut and display. My first look at Wreck beach happened the same week we started to discuss feminism in class. Our professor talked about feminism without apology, and the oppression of women like it was an established fact. This might sound odd, but I don’t think I have ever been in a room where that has happened. There is usually some sort of outcry, and the usual need to establish that, yes, we know #notallmen and yes, men can be victims of domestic violence and, yes, harassment really does happen even if you haven’t seen it. It was unbelievably refreshing – and don’t get me started on heteronormativity! Wreck beach became a weird kind of analogy to my regular life. Women are in there, but we’re often tucked away to the side. We might be talking, but sometimes it’s hard to hear over the ubiquitous noise of male concerns and the startling sight of all those swinging dicks. The classroom was the anti-beach. The rules were different. It was (and is) incredibly exciting.

Questioning, shaking off established ideas, shifting viewpoints can be really uncomfortable. I have spent a lot of time fretting, pondering and downright panicking. Did I pick the right research idea? I’ve gone from a therapist/educator/radiation therapy leader to a gay/lesbian/queer (nomenclature shifts according to my mood) therapist/educator/radiation therapy leader. I spend a lot of time worrying about that. LGBTQ people spend their lives in a state of what’s been called double consciousness (as do other stigmatised groups). The term was coined by W.E.B Du Bois in the context of black lives. We worry, are we being too gay? Should we say “wife” – or could we be accused of “flaunting”? We look at the world simultaneously as a minority and as the dominant majority, consciously or subconsciously adjusting our behaviour to fit the situation. We often don’t even notice that we’re doing it. Suddenly talking about my sexual orientation (in the context of my research, the gaps I see at work, the policy paper I am writing) feels just as uncomfortable as I imagine I would be if I stripped down and joined the guys on Wreck Beach. But uncomfortable in a “I think this is going to turn out really well in the end” kind of way rather than a “I have burns on a part of my body that should never have seen the sun” kind of way. If you know what I mean.

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