Good Girl, Up Speak and Thinking In

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I have a confession.

It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.

As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise we are raising women to wear to navigate the complexities of race, gender, and politics in the classroom and the workplace.

So here goes…

I change my voice to make other people comfortable.

In general, I have a high-pitched voice. It’s genetic. My grandmother spoke in a higher register and I guess I’m following in her shrill footsteps. But my grandmother had style and when she squealed in laughter or sang the soprano out of a church hymn, it sounded like wind chimes in a summer breeze. Her piercing tone commanded authority and carried assurance. She was authentic and her voice was the instrument that ushered her power.

My voice may be naturally high, but when I’m the only African-American or woman at the table, or when I hold a particularly contentious opinion, I go EVEN higher. Instead of wielding the power of my pitch, I ritually sacrifice my self-expression somewhere in the back of my throat and barter my pride for the perceived benefits of social normalcy. I phonetically transform what I physically cannot change, I am an educated black woman with an opinion.

My sister calls this guise “good girl, up speak.” It is the rising tone of voice I enter to placate others. I summon the “good girl” voice as a part of a physical transformation I have grown accustomed to, first in the classroom and now in the workplace. At some point, I have, consciously or unconsciously, accepted the misogynist edict that women, and women of color in particular, are to be seen and not heard. And I have learned that edict from other women.

Careful experience has taught me that speaking assertively may make males, and white males in particular, uncomfortable. Why else would intelligent women, in the media, in my classroom, and in my profession, soften their voice almost to the pleasant vacancy of a child, to communicate their thoughts? We’ve all seen it. So rather than fully challenge my male colleagues to engage in the mental and social exercise of trying to understand what my black, female body is communicating, I too make my words, however cutting, fall softly on their ears, lest they be offended by both my point of view and my tone of voice.

It is not so much playing dumb as it is playing docile. But what’s the difference when you are trying to be heard? In Harvard Business Review, Deborah Tannen, a sociolinguistic researcher, wrote a piece called The Power of Talk: Who Gets Heard and Why. In it she says, “Language is a learned social behavior.” As such, it is infused with the power dynamics that are socialized into each of us as children; dynamics that communicate competence and confidence, and dynamics that can translate into stereotyped gender roles. According to her, “Language negotiates relationships” and the way you address people and how you are addressed, reveals an unspoken social order that defines how we understand each other and how we value each other.

Lately, much has been made of the sociopolitical posturing (“leaning in,” if you will) women must undertake to exercise their power and influence. Yet our greatest instrument of power is our authentic voice. Any time we silence that voice, we miss the opportunity to value other women. For example, by assuming “good girl, up speak,” I validate the antiquated social order that decrees women, and women of color in particular, must infantilize their voice to be heard. Each time I do this, I implicitly encourage women around me to adopt similar positions of subordination to express their feelings. In so doing, I am complicit in the creation and maintenance of the very systems that oppress women in leadership and suppress female thought.

So instead of “leaning in,” the real exercise women may need is “thinking in” or creating a space to re-evaluate how our patterns of behavior undermine our authentic voice and contribute to our disenfranchisement as a group. One of those patterns of behavior is how we speak, another is how we conceptualize our role as leaders. If we continue to define ourselves between a 2-dimensional chasm of “should” and “should not” quandaries that pit domestic aspirations against professional salience, women will always lose. This rigid dichotomy ignores the important and dynamic roles women can fulfill over their lifetime and the opportunity we carry, either in our wombs or our briefcases (or backpacks, as the case may be), to shape the world in which we live with our authentic presence and voice.

When we, as women, strip away the guise, we can be more “I am woman. Hear me roar.” and less “I am woman. Don’t call me bossy.” Instead of being afraid of words, let’s own them. Let’s speak with the authority that our education, experience, and the roles we fulfill, provide us, be that sister, mother, student, physician, or CEO.

New feminism is about women, work, and the will to be authentic. And future generations will rely on us to use the tools at our disposal – the vote, free speech, globalization, and growing numbers of college graduates – to dismantle the structures that demand we conform to misogynist inventions of who we are. For modern American women, we don’t have to be the “good girl” to be the boss. As Deborah Tannen says, “The way we speak is who we are and who we want to be.” Our influence spans the home, office, clinic, and classroom, and who we can be and what we can be is defined by how we use our voice to empower other each other. At its best then, feminism is a collective notion that lifts each of us, despite our color or creed, to live authentically.

Update: This post is also being featured on Kevin.MD. Click here to check it out!

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The Way

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But somehow I wonder if

Despite their silent exterior

Away from the purview of others

In a darkness all their own

They endure the painful pruning of transition

Of transformation

Old is new

And new is you

And butterflies bleed too.

There are those among us who are treading on unmarked ground, fresh soil devoid of the comfort of patterned steps heralding the way. We are straying from tradition and daring to redefine the boundaries of our professions as we venture in new directions. It is not just that we don’t fit the mould, but that in some ways, we reject the idea of moulds all together.

For me, social justice medicine is the new direction. It is the practice of clinical medicine in a thoughtful way that creates and sustains health equity. It requires community engagement, civic participation, political advocacy, apt use of new media and technology, and interdisciplinary collaboration with local organizations and community leaders. It is essential to build a more just, equal, and free society and so far, it doesn’t really exist.

6 months ago, at the end of my pediatric residency, I took a position as a community pediatrician and have been eagerly piecing together a career in the practice of social justice medicine ever since. Sometimes, in moments of uncertainty, when my mind is quiet enough to admit my fears, I find myself in the throes of a great transition, worried I have no idea what I’m doing or where I’m going.

In medical school, I took a class called Let Your Life Speak. It was based on a vocational guide by the same title, and it helped medical students identify our gifts and consider potential careers. In the book, author Parker J. Palmer presents the idea of “way” or the path on which each of us walk toward our purpose. I’ve been looking for my “way” since college and as my blog header articulates, it is an ongoing journey. Recently, I found some clarity.

In any hierarchical assent, “way” seems to form in front of you, with each opportunity striding towards the next. But the truth is, that “way” was already there, worn by the feet of others, and ending at a predetermined destination. Sometimes paths are created as “way” closes behind you. When opportunity doesn’t knock, it quietly closes the door, making new, unseen paths available.

To stretch the confines of what it means to be a doctor, I have to stretch my understanding of how to get there. In doing so, it has become clear that “way” is not linear and does not have directionality. It is the iterative process of curiosity, experiment, discovery, and failure that builds the experiences necessary to create an unconventional career. Although the cyclical process of preparation, pruning, and readiness may be difficult, the product will be beautiful and uniquely yours.

But somehow I wonder if

Despite their silent exterior

Away from the purview of others

In a darkness all their own

They endure the painful pruning of transition

Of transformation

Old is new

And new is you

And butterflies bleed too.

Raising Resilence

One of my goals as a physician and particularly as a pediatrician is to touch young lives and make them better. Health is not just about check ups and sports physicals and vaccines (although all of those are important components of healthy living). Health is about embodying a spirit of wellness and adopting a lifestyle that nurtures that spirit. This is part of what drew me to medicine – the opportunity to look into the face of our youth and encourage their spirit; to see the potential rising in children and partner with families and communities to protect that potential and mold young lives around healthy concepts of living and growing. For me, this goal is personal and professional.

This past week, I completed a project where I hung old photos of my family and dearest friends around the head of my bed. I did it so that when I dream, when I think of all the possibilities of what life holds for me, I am surrounded by the faces of people who love me and support me and whose encouragement lifts me up.

I think James Baldwin said it best when he said, “Your crown has been bought and paid for. All you have to do is put it on your head.”

What an important and wonderful concept to internalize. The idea that –

You are valuable and you cannot escape that value because it is already yours by virtue of the work and sacrifices of the people who have gone before you – be they family, community, or historical ancestors.

This principle reminds of why those faces now hang above my bed; they create a space where I am free to acknowledge my personal worth and the people whose love, time, support, and prayer softens the ground below my daily steps.

As a professional who works in the art of healing, this lesson from my personal life also finds meaning in my professional life.

As a pediatrician, I know there are vulnerable periods in a child’s life when physical, emotional, financial, and social stress can impair mental and physical development. Some refer to that stress as “toxic stress,” because when chronically exposed to it, the physiology of children’s bodies and brains are changed – down to their very genes – in a way that places them at risk for a number of poor health outcomes over the course of their lifetime AND passes that risk on to their progeny (Have you ever wondered why poverty can be generational?). If I know that stress retards growth and development and keeps children from realizing the potential of a full and healthy life, what is my role as a pediatrician in providing children and communities with the tools to build resilience – a psycho-physiologic shield against the adverse effects of stress, or, a potential protector.

Others, have also pondered this and it is becoming more professionally accepted that physicians and pediatricians must be the faces in the community that encourage the spirit of children to protect their value and potential.

So how can pediatrics as a field and I, as a professional, systematically create spaces that recognize and utilize the value of every child; such that children are free to know their potential and build healthy relationships and lifestyles in partnership with the community around them? And how do we as a field, begin to understand how issues of poverty separate children and adolescents from knowing and working towards their value, a value that has been paid for generation after generation?

The short answer is, I don’t know. But I have joined a group of bold pediatricians from across the nation charged to address issues of poverty and toxic stress through medical practice. While part of our work will challenge traditional concepts of the role of physicians in community and increase public awareness of the adverse health effects of poverty, I also hope the outcome of our work directly helps children internalize their value and rise to their potential. Because the longer answer recognizes that poverty does not just create physical barriers to health, but also complicates the path by which children come to know and live out their value in the world. Thus as doctors, as champions of health, we must also be purveyors of justice and defenders of the value and potential in the most vulnerable among us.

If it takes a village to raise a child, what will you do today to embrace your value and the value of those in your community to raise resilience?