The Status of Women, 1999-2019

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What happens for men when women speak Feminism?

I intend to ask this question to more men in my life from now on.  What do you hear as Feminism?  Where do you think it comes from?  What do you think women are trying to accomplish by talking about equity and representation?  What moves a man to ally with women in this movement?  What keeps him from doing so?  What are the risks, costs, and benefits for us all when he does and does not?

AP QUICK HITS THE 99ERS S SOC FILE USA CA

Women in Sports

The US Women have just won their fourth World Cup Soccer title, kicking balls and ass, I like to say.  What an accomplishment, and how far they’ve come since winning the first ever Women’s World Cup in 1991, the year I graduated high school.  I don’t follow soccer, but as an American woman, this victory carries meaning for me.  At halftime this morning I read about Brandi Chastain, the 1999 US World Cup champion midfielder who famously, spontaneously, took off her jersey in unadulterated celebration after firing the winning penalty kick in double overtime against China to win it all.  The New York Times featured her story yesterday, commenting on the evolution of our perceptions and treatment of female athletes over these 20 years:

In that pivotal moment of arrival for women’s team sports in the United States and around the world, viewers saw Chastain removing her jersey and twirling it like a lariat, spinning around and falling to her knees, pumping her arms in exultant triumph. What resulted was perhaps the most iconic photograph ever taken of a female athlete, a depiction of pure spontaneous joy.

It was a moment of freedom and liberation, Marlene Bjornsrud, a longtime women’s coach and an influential sports executive, once told me. She called it a “casting off the burden of everything that kept us down and said, ‘You can’t do that because you are a woman.’ It was a moment that screamed, ‘Yes, I can.’”

Title IX was signed into law by President Nixon in 1972, one year before I was born.  So I took it for granted that girls could play sports just like boys in school—not every sport, but most.  I also took for granted the inherent assumptions about women in athletics—that we cannot be as fast, as strong, or as competitive as men.  I have so much more appreciation now for icons like Billy Jean King, Martina Navratilova, and Pat Summitt. I think about the WNBA, and women coaching in the NBA, NHL, and NFL, and I marvel at how far we have come.  Take a look at this timeline of women’s sports in the US to get a fuller perspective.  I know many will say we have a long way yet to go.  But today, let us joyfully celebrate all that we have accomplished already.  Wahoo!! [fist bump and dancing woman emojis]

 

Ortho women residents 1999-2013 jbjs jan 2012

Journal of Bone and Joint Surgery, January 2012

Women at Work

I’m thinking about the culture of orthopaedic surgery.  In the twenty years since I graduated from medical school, I see more and more women in this field (as well as other surgical specialties), which makes me proud.  While women comprise only 5% of practicing orthopaedic surgeons, 15% of American orthopaedic residents are now women, which is roughly double the percentage in 1999.  But what’s it like to be a woman in orthopaedics?  How do these women present, perhaps differently, at work compared to in their personal lives?  Is it truly safe for them to be themselves as surgeons?  The American Orthopaedic Association held their annual meeting recently.  My orthopod friend returned from the conference and commented that the rare women leaders in his field seem ‘fierce’ and ‘tough’—but in a good way?  It struck him to wonder if they are just like that in general, or do they have to be that way to navigate their male-dominated specialty.  He wondered how they would be seen if they displayed sensitivity and emotion, “because a man can be seen as sensitive and kind” and not only does it cost him nothing, his social status is likely to be elevated because of it.  My friend was not sure this is the case for his female colleagues, and he seemed both empathetic and powerless at the idea.  Looks like gender parity may take a bit longer in medicine than in sports.

At work in general, women’s status varies considerably.  But research points to common issues such a 22% pay gap and too few women in leadership (5% of US corporate CEOs), though these are improving.  One need not look far for abundant evidence that having more women on the corporate team improves earnings and morale.  Much is also written on strategies for improving gender equity at work.  Two of my favorites are exit interviews and work-life balance initiatives for all employees, not just women.  But as I wrote last week, it’s not just about including women as participants in the workforce.  It’s about truly appreciating the diversity of experience, biology, and contribution that women bring to any group they serve.

 

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Women and Men

There is no way I can do justice to this topic in the remainder of this post.  So let me just share some ideas and resources I will continue to explore in the months and years to come.

I asked at the beginning what happens for men when women speak Feminism.  A corollary question is what happens for all of us when we hear the words ‘toxic masculinity’?  My guess is men get defensive and women get aggressive.  Personally I love the phrase because it’s so incisively descriptive.  But it can also be a flashpoint phrase, one that immediately incites conflict and emotional hijack.  Let me be clear: toxic masculinity does not imply that men and manhood are toxic by nature.  Quite the contrary, the phrase refers to a culture of expectations of men that is just as toxic for men as it is for women.  Male surgeons may well benefit from being sensitive and kind, but not too much so, lest they be seen as weak.  This is a vast oversimplification, by the way; the history and complexity of toxic masculinity are explored articulately here.

Readers of this blog know how much I love Brené Brown.  Her explanations of how shame (where toxic masculinity is born) manifests and organizes around gender—and why it is toxic for both men and women–are the most poignant and real.  Read her first hand comments to Ms. magazine here, and a stay-at-home dad writer’s interpretation of them here.  If you seek a nonjudgmental, objective, and real-life exploration of the complex dynamics between men and women, read The Gifts of Imperfection and Daring Greatly.  Sister (she’s not old enough to be Aunt) Brené’s books are the most accessible form of evidence-based, all-around relationship advice I have ever read, and I’m so grateful for her.  From the Ms. Interview:

What role do you think vulnerability played in the #MeToo movement?

Know what I love about the #MeToo movement?—and, me too—I thought until I was 25 or 30, that sexual harassment was just the price of entry.  The greatest casualty of trauma is the ability to be vulnerable. So this #MeToo movement is re-defining and re-claiming vulnerability, and putting vulnerability in the context it belongs in, which is power and courage. 

 What gives you hope?

The thing that scares me about the world today is the same thing that gives me hope. I believe we’re witnessing white male power over. It’s making its last stand right now. And it’s scary because last stands are dangerous, and people get very backed into a corner. I think this is the last stand, and that we’re going to see a shift, mercifully, from white male power to inclusive power with it too. And I think from that paradigm, we can do anything, change anything, and be anything. 

And it’s not just women who can claim agency against misogyny and sexism.  Men who identify as feminists serve as allies for gender equity and respect.  But men can also help themselves and each other break free from the restraints of machismo and chauvinism.  Movements like The Good Men Project and Evryman give men a forum for honest, vulnerable emotional expression and connection.  Just like women surgeons and corporate executives, all men need inclusive spaces where they can feel true belonging, where they are free to be all of themselves—hard emotions and all—for all our sakes.

Men I admire in this space include Nate Green, Ozan Varol, and David Brooks.

* * * * *

To lift my spirits here at the end of this long post, I’m listening to a song on repeat: Woman, Amen by Dierks Bentley.  It’s such a shining anthem of a man’s unabashed love and appreciation for his partner.  I can also imagine modifying the lyrics and hearing Faith Hill singing about her man Tim McGraw.

Thanks for reading to the end, friends.

Our relationships kill us or save us, and we really need to be better at taking care of each other, locally and globally.  We, men and women alike, are all in this together, inextricably, in sickness and in health, forever.

Only Love can save us.  Let’s get on it.

 

Elephant to Elephant:  How to Change People’s Minds

 

Friends!!  If you read only one thing today, stop here and click on this link to James Clear’s essay on why facts do not change minds.  It’s very similar to Ozan Varol’s post of a similar title from last year.  That piece prompted a prolonged conversation on my Facebook page two months ago, which I described and shared here.

The Trigger

I’m thinking hard again about facts and changing minds now, as the number of new measles cases skyrockets not just in the US but around the world.  I’m so angry that we have to fight his war again—a war we had won as of 2000.  I’m so frustrated that because of the actions of a relative few, the health and safety of the very many and vulnerable are once again at risk.  I know my colleagues and many in the general public share my sentiments, and we often end up shaming and deriding our ‘anti-vaxxer’ peers.  We hurl facts and statistics at them, incredulous at their intransigence to the truth of science.

In the end everybody digs in, feelings get hurt, relationships suffer, and the outbreaks progress.

There is a better way.

James and Ozan (I imagine them as friends and so refer to them by first name) explain it eloquently in the posts I share here, and I really encourage you to click on those links.

The Metaphor

Personally, I return often to Jonathan Haidt’s analogy of our mind as an elephant (the emotional, limbic brain) and its rider (cognitive, rational brain).  We think, as rational beings, that our riders steer our elephants.  But psychology research and evidence tells us that the elephant goes where it wants; the rider rationalizes the path.  That is why facts do not change people’s minds—they are the rider’s domain.

Chip and Dan Heath, in their book Switch, take Haidt’s idea further in their formula for behavior change:

  1. Direct the rider (provide the facts, rationale, and method),
  2. Motivate the elephant (make the message meaningful on a personal, emotional level), and
  3. Shape the path (shorten the distance, remove obstacles).

It occurred to me recently that when I flood you with facts about measles and vaccines, I speak only through my rider.  You listen (or not) as both rider and elephant.  But as Simon Sinek describes eloquently in Start With Why, the elephant limbic brain has no capacity for language.  And facts, conveyed in words, have no emotional meaning or context.  So unless your rider is somehow really driving in this moment, my rider’s appeal will not move you.  Your elephant does not understand my rider, thus I cannot steer you where I want you to go.

The Approach

So how can I motivate your elephant?  If I’m using words, I can tell a story.  But the words of any story matter far less than the emotions the story evokes.  If I can relate with your own past experience, point you to a loss, a gratitude, or some shared connecting experience between us, then your elephant may hear me.  If I tell my story with honesty, authenticity, and humility, then my rider serves as translator for my elephant, communicating directly with your elephant.

But the most important connection between our elephants, if I really want to change your mind, is my presence.  Researchers agree that a vast majority of communication, up to 90%, occurs non-verbally.  Even if my rider interpreter tells a great story, my attitude carries the real message.  This manifests in my tone of voice, facial expressions, posture, stance, and all kinds of other subtle, nonverbal, subconscious cues—all seen and understood by your elephant, because they emanate from mine.  Even if my story tugs at your heart strings, you will defend your position if you feel me to be righteous, shaming, condescending, etc.  Elephants are smart; they know not to come out if it’s not safe.  And if my elephant is at all on the attack (see anger and frustration above), your elephant knows full well not to show itself.

It’s not the words we say or the things we do—it’s not the method that counts.  It’s how we are, how we make people feel—the approach—that gains us access to people’s consciousness and allows us to influence their thinking (which is really their feeling).

So I calm my rider and elephant first.  Deep breaths.  Then instead of my rider jumping off my elephant and charging at you with a wad of sharp verbal sticks, she sits back in her seat.  My elephant humbly ambles alongside yours on the savannah of community and (humanity), shares some sweet grass, points to the water hole where we both want to go.  I invite your inner pachyderm lovingly on a shared adventure toward optimal health for us all.  Rather than rush, berate, or agitate you, I wait.  I encourage.  I welcome.

James Clear writes, “Facts don’t change minds.  Friendship does,” and “Be kind first, be right later.”

My elephant fully concurs.

 

Some Facts, because I’m a doctor after all:

  • As of last Friday, May 3, 2019, there were 764 known cases of measles in the United States. According to the CDC, “This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.”
  • About 2/3 of patients are unvaccinated; 1/10 have been vaccinated, and the vaccination status of the rest is unknown.
  • 44% of patients are children under 4 years of age.

See this article in the Washington Post from today for more statistics.

For answers to frequently asked questions about Measles, please refer to the CDC measles FAQ webpage.

Please talk to your doctor if you are unsure about your risk.

 

“People Don’t Care…

Lily Pad Lake trail weather coming

…how much you know until they know how much you care.”   –Teddy Roosevelt (the most common attribution—but at this point, who knows?)

Friends, I had a great conversation on Facebook this week that really made me think!  I have pasted it below so you can decide what you think of it—please share your impressions, as my own have evolved as I reread it.

I initially shared an article by Ozan Varol entitled, “Facts Don’t Change People’s Minds.  Here’s What Does”.  In it he outlines steps to help others and ourselves change our minds rather than dig in:

  1. Make it psychologically safe to admit they (or we) were wrong before—stop shaming one another for our diverse beliefs
  2. Disentangle ourselves from our beliefs—hold them loosely rather than in identity-defining death grips
  3. Practice empathy
  4. Exit our echo chambers

I thought this was all pretty good, and my friend agreed that the method is effective, and also ‘morally ambiguous.’  At the end of the conversation my understanding of his perspective (again, please see for yourself below) is that he opposes ‘tricking’ people by manipulating their emotions into agreeing with us, while ignoring facts and evidence.  I agree with this opposition, and I also see this article as not actually suggesting we do this.

Basically it got me thinking:  It’s not that we can either argue/convince with facts or we can’t.  It’s that we have to make a personal, emotional connection before someone in opposition can be open to our facts and evidence.  This is not an either/or proposition.  It is both/and, as most things are.

After the two-day thread concluded I felt an urge to listen again to Never Split the Difference, a book on negotiation by Chris Voss, a former FBI hostage negotiator.  Funny how that came up…  In it he references Daniel Kahneman’s book, Thinking, Fast and Slow.  Kahneman describes two aspects of mind, System I, our intuitive, limbic, subconscious mind, and System II, our rational, logical, cognitive mind.  Voss’s and the FBI’s most successful negotiation strategies are founded on the understanding that System I is the primary driver of human behavior and action, though we would like to think otherwise.  This reminded me of Jonathan Haidt’s analogy of the mind as an elephant (System I) and a rider (System II).  He also posits that though we assume the rider steers the elephant, really the elephant goes where it wants and the rider rationalizes the path.

None of this is meant as a negative judgment on humanity or to say that we are not the super-intelligent, creative, and highest order creatures we claim to be.  It is simply the reality of how our minds work, a consequence of evolution for individual survival and tribal living.  When confronted with someone I perceive as an enemy (someone who shames me, threatens my sense of self and belonging, even if unintentionally), why in the world would I open my mind and experience to her point of view, even it would benefit me in practical terms?  Under threat of attack (of my ideas, beliefs, and identity), the elephant will stampede and trample, not stop, put its snout to its forehead, and consider thoughtfully.  But if my own tribe member, whom I already trust implicitly and with whom I feel relaxed and open, encourages me to change our usual path to the water hole because she has found one that bypasses the lion pride, I am far more open to the idea.

Similarly, if we consider ‘changing our minds’ as analogous to behavior change, we see how knowing the facts and evidence is definitely not enough to change anything.  I know I should eat less if I want to lose weight.  I know added sugars and simple starches are not healthful staples for my diet.  I know that eating late wrecks my metabolism.  So why do I still eat big, yummy brownies at 10PM?  Some days I can muster the motivation to head off self-sabotage; other days not so much.  I stress eat, especially when I’m sleep deprived.  So now I’m also listening again to Chip and Dan Heath’s book Switch: How to Change Things When Change Is Hard.  They propose a three-pronged approach to behavior change at the individual, organizational, and societal levels:  1. Direct the Rider (know the facts and have them ready to present).  2. Motivate the Elephant (find meaning for motivation).  3. Shape the Path (make it easy, remove obstacles).  All of these articles and books reflect the same reality: we are emotional beings who think, in that order.

Of course changing people’s minds, especially about emotionally charged and controversial ideas, is hard!  And of course facts and evidence are crucial and we absolutely should not ignore or abondon them!  And, we would all benefit from practicing a little more generosity, patience, empathy, kindness, and charity in our approach to one another—whether we’re trying to change minds or not.

 

*    *   *   *

CC

Friends, please read.
Applies to vaccines, politics, family conflicts, and relationship communication in general.

 

JM

I’m a total believer in the successfulness of this philosophy as a general rule, and I also find it Machiavellian and morally troubling. A great many people have a severely limited ability to understand the facts they believe. They can hold contradictory views easily and they prize simplistic notions of tribal loyalty, common sense vs actual knowledge and nostalgia for a past that never existed. Until we prize critical thinking as a a skill, we won’t display it as a people. And of course, this article correctly but tragically argues that since we don’t, and since we all just walk along blasting confirmation bias all over the place, it’s pointless to attempt persuasion with critical thinking skills and one should instead seek to trick people into doing what’s right through revisionist personal histories (you aren’t responsible for your past failures in critical thinking) and personalized sales pitches (who cares about the principled notions of the greater good or what’s just! Let’s talk about you and your family’s short term best interests!)

 

CC

Thanks, Jonathan. I wonder what you think of this post that I wrote, then?https://catherinechengmd.com/…/talking-to-the-opposed…/

 

JM

In this article you don’t have a clearly stated goal. So while I gather that you support vaccination, you don’t seem too bothered by patients who opt not to vaccinate. I see this as raising a question. If you learned that a parent was deliberately harming a child you wouldn’t casually suggest the idea that next year you revisit the benefits of not abusing kids. You’d act. You’d report. You’d get authorities involved. You’d protect the kids, even against the parents wishes. And you would do it now. So as I said, it raises the question: how bad is it to not vaccinate? Your article implies that it’s not that bad. In fact, you give two examples of outcomes: one of a child who gets autism and one of a child who gets whooping cough. Can you see how this implies balance in the perspectives? Are these views equally valid? Sympathy towards the emotional struggle of making the right decisions for kids should not be conflated with sympathy for endangering children -both one’s own and others in the community. Is there reasonable doubt about whether vaccines cause autism or not? That’s not only testable but actually repeatedly and widely tested already. Let me state it in reverse: I currently vaccinate but if verifiable scientific evidence started raining doubts about whether vaccines caused autism, I would want my doctor to tell me ASAP and explain it emphatically and with little regard to my previously erroneously held belief.

 

CC 

Thanks for your feedback, Jonathan. I actually do state a clear goal: “my primary objective is actually to cultivate our relationship.” Of course I think it’s harmful to both the child and the community to not vaccinate. I am absolutely bothered by non- and anti-vaxxers (as evidenced by multiple posts on this page). And I also have to take into account the likely outcomes of my actions. My goal is to get everybody vaccinated, no question. But demanding it now, as if it’s really the same as witnessing a parent beating a child physically, is not often productive. I have learned in multiple relationship settings that chasing agreement and acquiescence gets me the opposite result. In this case, taking the long view and strategy, with a soft front, works.  Just this flu season, I estimate my ‘conversion’ rate at about 60-70%, which I assess as successful. And I did so while maintaining and strengthening the physician-patient relationship, which is even better. And for those who continue to defer vaccination, at least they are still with me and I have more chances to continue the conversation and eventually make an impact. To me that’s worth a little waiting in the short term, which could be long term waiting and making people dig in harder against, if I came at them too aggressively.

 

JM

all that sounds great. My comments were only about that article, not your actions.

 

CC

Huh, okay… The article I wrote speaks directly to my actions, so I am not sure what the distinction is? Regardless, I respect your opinion so I hope I have your confidence in me as a physician and a steward of public health.

 

JM

you do!
—next day—

CC

 I’m beating the dead horse! Feel free to ignore. Here is an article along the same lines, which I saved at the time it was published. Interesting to read it again now.https://hbr.org/…/how-to-build-an-exit-ramp-for-trump…

 

JM

Yup. Same deal. Machiavellian. Ends justify means. Critical thinking is not taught or valued so let’s ditch it in favor of methods that are effective at achieving the desired result. That may actually achieve the most social good in the end. But it’s still morally ambiguous. When does an elephant in the room become so large that you simply can’t claim not to have seen it? Must we always pretend that it’s reasonable to have thought it was a grey desk to give people an out? These articles seem to say yes. They might be right. I’m just not happy about it.

 

Oh, and I do apply this to “both sides”. There is a position I’ve heard espoused on the Left that argues that holding people accountable for stupidity is a form of prejudice. <insert shock face emoji here> It’s apparently “ableist”. And that it’s inappropriate to expect people to all be able to reason and know things. Any things. That one leaves me speechless. It seems more about a race to decry the most possible prejudices than an attempt to help improve our world. Virtue signaling. I’M SO WOKE! I’M EVEN MORE WOKE! I WOKE UP WOKE!

 

CC

Thank you for engaging, Jonathan! Your perspective is so interesting to me, I don’t see it these strategies as nearly as manipulative as you see them. To me, they are enlightening paths of empathy, leading to clearer and more compassionate, understanding communication. Underlying the methods I see an implication that we all may be more open-minded than we know, if given space and connection to explore alternative perspectives to our own. The methods themselves are simply a way to uncover and allow that openness, and thus possibility for change and growth, to emerge. If one practices these strategies with NO commitment to a particular outcome, but simply for the sake of continuing a conversation or relationship–an exchange of perspectives for mutual understanding and respect–if we all practiced this we all might end up changing, little by little, for the better, and better together.

 

JM

We’d be more open to dialogue in the non-judgmental world you describe. But, while it’s popular to embrace profound egalitarianism as positive, that is a disaster in practice. Not every viewpoint should enjoy the same privileges. For instance, slavery is a viewpoint. Might makes right is a viewpoint. The Nazis had a viewpoint. Should these all be engaged with with respect for a differing worldview? I don’t think so. Determining your actual reason for why not is key. It’s because we believe deep down in hierarchies. Even egalitarians tend to believe that egalitarianism is BETTER than non-egalitarianism. There is a Buddhist parable in which the student asks: “If we meet bandits on the road, and they try to kills us, how are we to act compassionately as our noble truths dictate?” The teacher answers “You must cut them down with your sword, compassionately.”

 

CC

I agree with everything you write here. But is this not a tangent? Do any of these articles or any of my comments claim that all viewpoints are equal? This conversation is not about ‘profound egalitarianism’ and its merits or lack thereof. Being slightly more open minded and empathetic toward our fellow humans (which is the point of these articles, in my view) does not equal throwing away all forms of morality and ethics, absolving ourselves of any and all judgment, or elevating slavery, xenophobia, and genocide to anything remotely acceptable. So I’m curious. When you encounter people whose opinion or whatever is opposed to your own, how do you engage? What are your objectives when you interact with them on these topics? For instance on this thread–why are you still here? You go first and then I’ll tell you mine. 

 

JM

Firstly, I’m arguing from the edges. Is an approach sound? You can test it by how it handles just such situations. The articles discuss a successful methodology for achieving a change in position. You can describe that most generously as sympathetic openness combined with non-confrontation. That is presented for its effectiveness. When I engage with people with differing opinions, it matters greatly what the opinions are. I evaluate them based on the soundness of the facts and theory underlying them. When more sound than my own, I change my views. When less sound, I can safely place them back in the bin of the disproven, false or less effective. I’m typically delighted to be convinced of a new position. I don’t view all positions as being basically equal. I view positions as very often being hierarchical. Some are intrinsically better than others. That means when I change position for just reasons, I am improving myself and the world at large. My engagement here is based on the warmth of our relationship and the desire to see higher truths recognized wherever possible -the ultimate purpose of information exchange. If the real purpose of the articles is to “be suuuuuuper nice before and while presenting your logic” then that’s just “getting more bees with honey than vinegar”. I don’t disagree. But some part reads to me like an acceptance of tribalism. In other words, this system doesn’t increase the likelihood of the “right” answer or the just answer. Just the answer of the person most effectively using the technique.

 

CC

THANK YOU, I understand you much better now!! I very much appreciate what you wrote here, and I wholeheartedly agree, especially with the self-improvement part. You have elevated my point of view and I will refer back to this conversation often now! So on my end, I engaged because I noticed myself feeling defensive and I wanted to understand what I was feeling a need to defend against. Now I don’t feel defensive at all, and I am so glad we continued the exchange! Big hugs, old friend! 😀