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” !

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.

Where does this quotation end?

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….said my prof as she tried to unravel my latest draft paper. A good question and one I have been mulling over at length.  In the spirit of academic metaphors, at the moment I feel my reading is like a game of pick up sticks or perhaps Jenga. I can’t touch one thing, or idea, without bumping up against another.  A good friend who has been through this told me that “after the proposal” was the best time in her professional doctorate, you have the ground work done and can actually get on and do the thing you’ve been working towards for (often) years.  That bit before the proposal though, and before the comprehensive exam? That’s the teetering Jenga tower, the mess of sticks … the time when you realise how much you don’t know and what it’s going to take to stand up in front of the comprehensive exam panel, your supervisory committee and convince them that you’re ready to get going.

So my reading has been around theory, both queer and feminist, and then a quick tour around my conceptual framework – meaning what concepts will be foundational to my future work and how do they fit together? My research question is how do LGB radiation therapists manage their identities at work? How do they negotiate the complexities of coming out – and how do they decide? When you unpack this idea it’s obvious some work will have to be done on non-heterosexual identities, what “being out” means and why it’s (still) an issue. Our fundamental idea of being “professional” relies on an underlying and usually unarticulated assumption that the person at work is male (rational, unemotional), straight, white, able bodied etc. (Colgan and Rumens, 2015).  So sexual orientation in the workplace is an area of research that has examined this tension – with a small subset that looks at the health care workplace.  It’s also good to see a growing body of work on improving the experience of queer patients, this will also be important to look at – although most of it assumes they (we) are a “problem” to fix  (with our inconveniently high rates of cancer, mental illness and whatnot).

From my own experiences, I think the results won’t be unequivocally “this is what it is like”, but I do have a sense that some of the issues above will be important. There are likely others that I can’t see yet, or might not know until I have talked to the participants of the study. But I’ve already found a chance reference; discussion or recommendation can open up a new way of looking at something.  A paper I found by accident, for example, that looked at how LGB practitioners manage clinical examination of their patients (including scenarios where they may have a chaperone for an opposite-sex patient). The authors concluded that:

 (LGB) healthcare professionals engage in a complex interplay of identity management strategies to avoid homophobic abuse; as a signal of safety from homophobia and understanding for their lesbian, gay, and bisexual patients and as a desexualisation strategy principally for gay men and their women patients. (Riordan, p. 1227)

 I love the idea of “a signal of safety” – healthcare professionals flagging to queer patients that they are understood, and that they are safe to come out. We strive for that level of cultural competence and empathy for many different groups; it’s rarely discussed for queer patients.  One part of the Jenga tower, one of the entangled sticks but hopefully one that will remain.

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Concept map exercise

References:

Colgan, F., & Rumens, N. (2015). Understanding sexual orientation at work. In F. Colgan & N. Rumens (Eds.), Sexual orientation at work: Contemporary issues and perspectives. New York, NY, USA: Routledge

Riordan, D. C. (2004). Interaction strategies of lesbian, gay, and bisexual healthcare practitioners in the clinical examination of patients: qualitative study. BMJ, 328(7450), 1227–1229

What’s the question???

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Our last summer course was intended to get us to take the first steps towards our research question. We looked at conceptual frameworks and methods, literature reviewing and tried to find a “home” – or a way of thinking about research that felt right to us. We all vaguely knew what our fellow-cohort members were thinking about investigating but we workshopped, we brainstormed with flip charts, we picked holes and (sometimes) we patted backs. A few people have thrown out the research thoughts they started with and found new ones, job roles have changed, interests have shifted and the cold light of day is starting to show some of the cracks in our idealistic initial ideas.

One of the reasons I wanted to do this degree was the luxury to be able to focus on a substantial piece of research. I had always wanted to re-examine my experience as a queer health care professional (HCP) – partly for me, as I get older I find I want to look at things from another angle, perhaps to see what I missed the first time. The other reason is that quite a bit of attention has been paid to making the experiences of LGB patients better – but almost all research that looks at HCPs is from a deficit perspective – focusing on negative experiences such as bullying or homophobia in the workplace. I think it is a lot more nuanced than that – I know that LGB staff can help LGB patients feel more “at home” –  but I also think that the delicate and daily dance of coming out still looms large in many HCPs’ lives and that we can do a better job at understanding, and supporting, us/them.

So after a brief dalliance with patient experiences (see last blog!), and a pretty hot and heavy flirtation with Dorothy Smith this summer (of Institutional Ethnography fame), I am back to the beginning.  Last year I was thinking of using interviews, and phenomenology – but the further I travel, the more I want to bring my own experience into the mix. Isn’t that why I got into this? In one of my assignments I talked about this process being like a “late life coming out” and after having stood up a few times and “exposed myself” as a lesbian behind a podium talking about my recent paper…..in front of my actual work colleagues, peers and friends…..that is exactly what it feels like.  I wrote in February about finding my research voice – it’s clear that my voice is critical, and very personal.  I mean critical in the way described by Kinchloe and McLaren (2005, p. 304) in that research can never be entirely neutral or value free, and that “mainstream research practices are generally, although most often unwittingly, implicated in the reproduction of class, race and gender oppression.”

This fall I am looking at narrative inquiry (my last elective) – and reading a lot! In health care storytelling pops up in narrative medicine (described in this Ted talk by Rita Charon) and in illness narratives like those of Arthur Frank in “The Wounded Storyteller” where he explores the very human need to make sense and meaning from illness (interestingly, he says that he wrote it partly as an exercise in “self-healing . . . to assure myself I wasn’t crazy”).  As a lifelong lover of reading, I think I may have found the perfect fit for my research approach!

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Year Two, yeah!

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Year two of my EdD has begun with a new class (Organizational Analysis) and it feels like the end of the course work is actually a possibility. This is a six week stretch, with two classes back to back. Then one elective and a final doctoral seminar in the New Year. Four of my 2015 cohort are taking this class and I am impressed and proud at how far we’ve come. I remember this time last year, having no idea who 90% of the theorists we discussed were (now it’s probably down to around 70%). I think it’s fair to say that most of us felt the same. Compare to this week – when one us casually mentioned Foucault’s focus on governmentality related to field theory in new institutionalism! I know, right! have to point out that wasn’t me…. and it’s a good job that most of these critical theorists have YouTube videos made by people smarter than us that I can cheat from*!

I started off last year with a strong sense of what I wanted to study – LGB health care professionals and how their sexual orientation affects the patient-provider relationship. I segued (via a policy class) into LGBT patients and how their care and access is affected because of their minority status. This led to a collaborative paper, and a couple of conference talks on the subject. The research and presentations have been oddly cathartic. As with a lot of our discussion on social justice, it has given me language and data to support what my gut already knew. I don’t think I am finished with it – I would like to present the work within my own workplace and continue to push for improvements. However – the burning desire to find out and talk about it has dimmed a little bit. I am not sure what this means for my dissertation. I am reluctant to throw the LGBT baby out with the bathwater, but I am wondering if I would find anything new if I looked at BC Cancer Agency (BCCA) with an organizational analysis lens (now you can see why I am doing this class!)

I’ve been interested in patient education for a long time, and more lately the language and focus has shifted to “patient engagement” and “patient experience”. It’s (to me) old wine in new bottles – we know from narratives, qualitative research and just plain listening to patients that they want to be treated like human beings. However our systems are usually set up in direct opposition to this. A casual conversation with one of our leadership team at BCCA has got me thinking of a new way of providing patients with education, in the form of other people’s experiences. We know that patients coming for treatment want to know primarily “what will it be like”? Reading well-crafted stories can help with that. I am thinking about the great website Faces of Health Care from Ontario as an exemplar, or the UK’s Health Experiences Research Group. A friend from the UK has also co-developed a radiation therapy specific site along these lines. How cool would it be to have one for BCCA, with local stories and experiences, hints and tips and the normalisation of feelings related to diagnosis, treatment and beyond? I am wondering if narrative inquiry could be used for this – a brand new area for me but … I do love stories!

So…lots of ideas and possibilities and horizons opening up for miles! Onwards and upwards!

Taking a different (re)view

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One of the oft cited benefits of higher education is the shift in perception that comes with taking a wider view. I remember it from my Master’s degree – it was harder to take things at face value, issues were approached with a more critical lens and research projects were developed left right and centre! We all agree… there is just something that happens when you take comfortable, preconceived ways of doing things and give them a good shake with a whole load of new stuff. Change happens.

Change – it is generally understood in health care (and in life) – to be inevitable. It is also seen as difficult, sometimes resisted, and often hard to implement. In the last blog I talked about how reflexivity can lead to a literally changed mind.  What I have been feeling, these last few weeks, is the result of that changed mind in an environment that hasn’t changed.

The paper I’ve been co-authoring on discrimination in LGBTQ health care (and how to make things better) has made it to the peer review stage. As an associate editor, I know the value and the limitations of the process. I’ve wrangled some terrible reviews – some that are so short they are of no practical use, some that are (to be honest) really, really rude and some that list 56 typos and grammatical errors but tell me nothing about the actual publishability of the paper.  Of course this is #notallreviewers! Most are hardworking, experts in their fields who generously give up their limited spare time to help advance their profession. The trouble is, we’re not an especially academic profession (yet) and most of us (me included) are making this up/learning as we go.  Anyway, you can see where this is going! One review was respectful, polite, well considered and had some great suggestions for change that were very helpful. Reviewer 2 (it’s always Reviewer 2!) questioned the need for the paper because there are anti-discrimination policies in workplaces – so surely I am exaggerating? Gay people don’t experience this – at least not to the degree that we are claiming! Despite using references from many studies and position papers, the paper was really more of a “political manifesto” than anything else.  Woah!

Reading reviews is always an emotional experience! The first response is often “they just don’t get it”. I tend to skim the comments, leave it for a few days, read again, leave a day or so and then start to work on the changes. That takes some of the emotion out of it, allowing you to see where the reviewers have valid points, and (sometimes) where you still feel the original should stand. I did this last week – and still have a hard time with Reviewer 2. It comes down to (I think) the fact that I am standing in the same spot, dealing with the same issues at work but with a different set of eyes. I can see that – yes, there are policies, but oppression is institutionalised. I think, what this boils down to, is a general blindness about types of oppression and how they work. To a (I am taking a wild guess here) straight person, the fact that some people do have problems and are treated differently because of their sexual orientation or gender identity is antithetical to how the system is supposed to work.  Yes, of course HCPs are usually kind, compassionate people but they work within a system that professes patient centred care but does a poor job of treating patients as individuals.

And – I get it! It took a concentrated 8 months at UBC for me to even begin to see outside my ordered, comfortable, health care-centric box. As a white woman, I am highly privileged – and had the privilege to be able to ignore the not-so-privileged experiences of other groups. As a queer woman, I thought not being able to marry who I wanted, having multiple barriers in place for parenthood and doing the exhausting dance of being both in and out of the closet was just my thing to deal with. Turns out it really wasn’t. So Reviewer 2, I understand you! But just because you haven’t seen it, doesn’t mean it doesn’t exist.

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Acts of cannibalism and homosexuality

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I’ve written previously about the tension, excitement and uncertainty that accompanies researching/talking about/writing about LGBT-ness. Way back last summer we read an excerpt from a book Covering by Kenji Yoshino. It’s a lovely piece about a gay academic, lawyer and professor who initially “passes” as straight – but after a few years comes out. However, he still limits his public actions such as displays of (same-sex) affection, and self-censors what he writes about. Yoshino says “this was not the same as passing, because my colleagues knew I was gay. Yet I did not know a word for this attempt to tone down my known gayness.”  His revelation (and the perfect word) comes after reading Erving Goffman’s book “Stigma“. Goffman describes how groups with “spoiled” identities (such as the elderly and the disabled) make a conscious effort to downplay their stigma by what he calls “covering” (or “not shoving it in people’s faces”).  Yoshino says “this explained why I wasn’t done with conformity to straight norms when I came out of the closet. The demand not to write on gay subjects was not a demand to pass. It was a demand to cover.”

I also read this with a loud “aha”! That’s what it was called – this self-stigma, the desire to fit in, the “not flaunting it”, this covered life. And what I was doing now was fully uncovering – being more of who I was, and now my uncovered eyes would be seeing a whole lot more.  This turned out to be true!

I am co-authoring a paper on LGBT health care – my part is a reworking of a paper from our policy class. My co-author (Sean Ralph) is a clinical therapy radiographer and researcher from the UK who (among other things) facilitates support groups for MSM* with prostate cancer. His input has made the paper about a million times better, more readable and a lot more practical. The paper presents a lot of background, and three main categories of suggestions for improvement. These are changes to the physical environment, improvement in health/intake forms and staff awareness/sensitivity training. In the last few weeks, Sean and I have both been advocating for some of these changes in our respective places of work. Here’s a quick recap of our progress so far:

  1. Changes to the physical environment: Our paper says: “if the department is involved in any health promotion/awareness campaigns then these should contain inclusive imagery and language”. What happened at work:  one of us raised the point at a meeting that we should include LGBT faces in a poster advertising emotional support for cancer patients, the response was “well, any of them could be gay” and “that would be stereotyping.”
  2. Improvement in health/intake forms: Our paper says: “including information about sexual orientation and gender identity on intake forms is important to help health care professionals (HCPs) better identify the patient’s health needs and social situation and provide better care”. What happened at work: at a meeting of a group revising the organisation’s intake forms one of us asked about adding sexual orientation to the form. The response was “we might upset people” and “why would we need to know that?” One participant pointed out that if we identify LGBT people on a form staff may then discriminate against them.
  3. Staff awareness/sensitivity training: Our paper says: “unfortunately, many LGBT HCPs have experienced discrimination at work and many health care staff say they don’t feel able to challenge discriminatory language or behaviour”.  What happened at work: at a meeting to discuss a new electronic record, one of us raised the issue of having non-binary gender options (not just male/female). The response from the IT person (when the questioner was out of earshot) was to laugh and say “why don’t we also have a section for people who have sex with animals?”

I am not using these examples because I think where we work is particularly bad.  I don’t. Most people are genuinely well meaning (except for the idiot in IT, he is obviously a dick). I use them because they are pretty typical – and because it takes effort and energy to bring these things up….and then to keep bringing them up. This is the act of uncovering and it is neither easy nor comfortable.

So – what about acts of cannibalism and homosexuality??? That popped up when I was reading The Self we Live By**. The authors are discussing an ethnographer, embedded in a South American tribe who observes the aforementioned shenanigans.  It’s more than a bit homophobic – but makes a great blog title.

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*Men who have sex with men

**Thank you Angie Eddy!