Let Every Eye Negotiate for Itself

We are very attuned to patterns, aren’t we? We see them even when they aren’t there, filling in the lines, reading the shadows to complete the image. But does the face we see in the play of light on forest leaves, or the finger in the sinuous beckoning of the windblown grass really fool a mind that can do mathematics in its head? Or is it just a brief dalliance, a foray into a theatre for a moment or two? A titillating fantasy that fades when the eye moves on to other, more important, things?

A stereotype is a pattern too, but more deeply etched, and coloured so convincingly it is mistaken for the thing itself. Not recognized as a simulacrum, it is treated as archetypal, requiring few, if any, revisions –so self-evident it is almost a causa sui. And yet, hic sunt dracones, to continue the Latin –here be dragons- for stereotypes are, by default, fancifully-charted territories. Like incomplete maps filled in with imagined beasts, they are not reliable guides. They do not help.

And yet they are so prevalent, it is often difficult to recognize them, let alone extract them from the gestalt. So they persist, and like a Where’s Waldo face, only emerge from the background if we make a concerted effort to find them. But usually, there has to be a motivation to look –something that shakes us from our apathy. Our indifference.

It’s so easy to slip into somnolence, isn’t it? So easy to let things pass us by unexamined as long as they don’t threaten to disrupt our day. And yet, to escape the pastel hues in which our waking hours are often painted, it is sometimes an adventure to search for the chiaroscuro hiding in plain sight.

There was a delightful article I noticed a while back that managed to open my eyes again: http://www.bbc.com/news/world-latin-america-38132503

It recounts the story of a a 19-year-old woman from Guatemala who designs clothes for people with Down’s syndrome. The thing is, ‘Before she was an internationally-recognised designer, Isabella Springmuhl says she was rejected by two fashion schools in her native Guatemala because she has Down syndrome. “They said I would not be able to cope,” recalls the 19-year-old. But that rejection was exactly what Isabella needed to turn her life around […].’

So, instead, her mother took her to a sewing academy that would accept her. ‘While learning how to sew, Isabella was asked to design outfits for worry dolls – traditionally hand-made dolls originating from Guatemalan and Mexican folk traditions. The tiny dolls are usually put under children’s pillows in the hope that they will take away their sorrows while they sleep.

‘Isabella took a different approach.

‘”Isabella didn’t want to design clothes for… finger-sized dolls,” says Mrs Tejada [her mother]. “She created life-sized dolls and dressed them in the colourful embroidered jackets and ponchos that she’s now famous for.”

‘Isabella moved from designing for dolls to people, and soon enough produced a collection that gained the attention of the fashion world. Earlier this year, she became the first designer with Down’s syndrome to take part in London Fashion Week.’

But it didn’t stop there. Isabella points out that her main inspiration for designing arose after a struggle to find well-fitting clothing for her body type.

“It was difficult for me to get clothes,” Isabella says. “We have a different body constitution; we are shorter, wider, or very thin. My mother always had to fix the clothes she bought for me. So I decided to design clothes that fit people with Down’s syndrome, plus I really love Guatemalan textiles and the diversity of colours and textures they represent.”’

Wow! I get a shiver down my spine when I think of the odds that Isabella was willing to tackle. But, I wonder if she ever thought of them as odds, or merely as challenges that needed extra effort each time they arrived. Not only are there rivers to ford as a young person hoping to succeed in a highly competitive field, but the water sweeps all but the most determined, the most talented, downstream with barely a ripple.

But what am I? asks Tennyson, An infant crying in the night, An infant crying for the light, And with no language but a cry. I doubt that Isabella ever thought of herself like that. From time to time, there arise those exceptional people who do not understand the concept of failure. Who do not doubt or lose their way. Who are so confident in themselves, no matter the circumstance, that they press on and build on what they know they have, and are ingenious about what they don’t.

Stereotypes fail these individuals, as they do anything unique. How can you epitomize a Caesar, or cage a Churchill? How can you oversimplify a courageous person? How to paint the journey of a cloud? Tennyson, again from In Memoriam A.H.H:

The hills are shadows, and they flow

From form to form, and nothing stands;

They melt like mist, the solid lands,

Like clouds they shape themselves and go.

And so, how to stereotype a syndrome? In Down syndrome, or trisomy 21, there is an extra (part or whole) chromosome 21, which causes an assemblage of physical and intellectual features, including a characteristic, recognizable, but variable facial dysmorphia. It is the latter that may prejudice unthinking employers into feeling that they couldn’t cope, that the individual could never fit in, or perform like the rest of their employees –or other students, in Isabella’s case. But they were wrong.

Creativity knows no boundaries; we all fit somewhere on a spectrum –individuals with Down syndrome included. And imagination, like courage, does not stop at the edge of a chromosome.

Let every eye negotiate for itself, says Shakespeare’s Claudio in Much Ado About Nothing, And trust no agent, for beauty is a witch against whose charms faith melteth into blood.

I think Isabella is a beautiful person, don’t you…? And how do you stereotype that?

 

 

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Barbie in the Mirror

As an Ob/Gyn specialist I have been, I suppose, more than a passive observer of women over the years. But society has not been passive, either. Depending on where you live and in what cultural milieu, issues such as our sizes and shapes have become sources of real anxiety. Unrealistic expectations of morphology no doubt arise from multiple origins, but the end result is often the same -many of us don’t even come close to meeting them.

And as if that worry wasn’t enough, there has now been added the perhaps more troublesome issue of health. Despite the euphemism ‘plus-sized’ there is no disguising the stigma of the special term for many women –particularly when it comes wrapped with innuendoes of obesity and diminished well-being… not to mention beauty. Shakespeare would have us believe that ‘Love looks not with the eyes but with the mind.’ But does it? https://blogs.harvard.edu/marianabockarova/2014/05/29/the-science-of-beauty/ Once again, morphology rears its stilted head.

But we are a curious lot, we humans, influenced as we are by fashion and culture. Fickle in our choices, mercurial in our attitudes to those who fall outside the norms, we deride those who fail to satisfy the arbitrary boundaries –temporal though they may be.

Some have argued that one of the barometers of expectation is the shape of dolls –Barbie dolls in particular. They become, after all, the matrix of imaginary play and serve as proxies for the roles the children are trying to understand. http://www.bbc.com/news/magazine-35670446

A fuss seems to have been engendered by the release of three new types of Barbies: curvy, petite and tall. There are also skin colour differences, presumably to reflect the diversity in modern societies. But also, one could argue, to deflect the criticism of pandering to the thin, blond phenotype so prevalent in their models up to now. ‘Mattel [the makers of the doll] argues Barbie shouldn’t be expected to represent average proportions in the first place. “Barbie is a doll. She is not meant to reflect a real woman’s body,” says Sarah Allen from Mattel UK. “The purpose of introducing three new bodies into the range is variety and differentiation. When you look at the dolls collectively you can see the range in relationship between the dolls. “’ It’s a start, I suppose.

Therein lies the problem, of course, and it seems to me that it is hydra-headed. On the one hand to portray a doll that is truly representative of the reality that the child sees around her, would be to normalize –legitimize, really- the scourge of the 21st century: obesity and all of the health risks that entails: ‘[…]were Mattel required to accurately reflect the average British and American woman across all ages, the dolls would be overweight or obese.’ And yet, from a more modulated perspective, ‘Lenore Wright, from Baylor University, Texas, conducted a study in 2003 that explored the role of Barbie. She found Barbie’s shape didn’t really matter to children – her function was more important.’ Dolls, in other words, are just pretend –they’re substitutes that are merely assigned the role the child is exploring. The child knows they are not real.

But ‘Wright adds that Mattel’s new line has been criticized by some feminist scholars for reinforcing an old stereotype – that women are defined by their bodies.’ As I suggested, there are many divergent perspectives but remember that a Minotaur waits at the center of the labyrinth. We must be careful not to wander too far in our approach; we must not let our zeal mislead us.

It seems to me that children have always played with dolls and represented them according to their needs. To criticize a stick-doll, for example, or to confuse it with the reality the child apprehends is to stray dangerously far into revisionism. We are not children and we do not think as children. In a world where dolls are doctors, and dogs are patients, we are now strangers. Adults. Other… Forgive me for referencing Corinthians, but I think its advice was prescient: ‘When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.’

Amen to that.

 

 

 

 

 

Stereotypes in Medicine

I suppose we are all, at times, seduced by stereotypes. They are, after all, a simplified way of processing the other world –underlining how they are different from us. Even the etymology of the word, derived from Greek, seems as if it would be helpful: stereos –firm, or solid; typos –impression. But unfortunately it has wandered from its first use in the printing field as something that would reliably duplicate what was engraved on the master plate, to its use in 1922 in a book entitled Public Opinion that suggested a ‘preconceived and oversimplified notion of characteristics typical of a person or group’.  It has grown and metastasized, cancer-like, from there. Now, any attribution is suspect. Any observation, coloured. What was once felt to be useful is now recognized as impossibly simplistic. Naïve.

We are far too complex to fit into labelled baskets that purport to describe our essence or predict our opinions. Indeed, to stereotype a group is to consider it different –perhaps not unreasonable as an observation, but also dangerously close to slipping into an us/them perspective with its risk of discrimination and prejudice. As Wikipedia (sorry!) summarizes it: ‘Stereotypes, prejudice, and discrimination are understood as related but different concepts. Stereotypes are regarded as the most cognitive component and often occurs without conscious awareness, whereas prejudice is the affective component of stereotyping and discrimination is one of the behavioral components of prejudicial reactions. In this tripartite view of intergroup attitudes, stereotypes reflect expectations and beliefs about the characteristics of members of groups perceived as different from one’s own, prejudice represents the emotional response, and discrimination refers to actions.’

So, the stereotyping of an individual, or worse, the group to which she presumably belongs, can have consequences well beyond the initial encounter –‘unintended consequences’, as we are so fond of saying in retrospect- and yet we still seem genuinely surprised that things would turn out like that. I am always heartened, therefore, when I read about those who are able to pierce the curtain and see what lives outside the window: http://www.bbc.co.uk/news/technology-34359936

I like to tell myself that all my years in practice have dissolved the last dregs of stereotypes from my psyche, and yet my guilt, my terror of succumbing, is still alive and well –if tucked away. But, if stereotyping can occur without conscious awareness, the very act of trying to avoid it suggests that there is something there in the first place…

Manipulation always reminds me of the danger. Not my manipulation, you understand (and besides, I don’t call it that); no, my patients’ attempts at beguiling me. My mother was a masterful manipulator and I’ve always noticed similar attempts by others. Perhaps the very labelling of their actions as manipulations is itself a stereotype, but I’m getting ahead of myself.

I still remember a time, several years ago now, when I was discussing the pros and cons of vaccination against HPV, the sexually transmitted virus responsible for cancer of the uterine cervix. The woman, a well-educated software engineer at a local start-up company, had asked me what I thought of her daughter being vaccinated in school.

“She’s only in grade six, doctor -11 years old! She hasn’t even thought about…” Loretta hesitated briefly as she sorted through her vocabulary. Clearly, even the thought of her daughter as a sexually active individual was uncomfortable for her. “…being intimate.” She immediately blushed at the word.

It’s a delicate topic for parents and I nodded sympathetically. “Not intimate yet, I’m sure,” I said and smiled to diffuse her embarrassment. “But when she gets older, it would be nice to know she will be protected against the virus, don’t you think?”

Loretta’s face hardened at the thought –or maybe at the fact that I needed to bring it to her attention. Her expression was adamant: her daughter was not like that. She studied my face for a moment, her eyes made short angry excursions onto it, then, finding nowhere to roost, hurried back to safety. “I think I will decide when she is older and more able to understand.”

I tried to disguise a sigh. “Sometimes our children understand a lot more than we suspect, Loretta…”

I could see her stiffen in her chair. “I know my daughter. You may be a parent…” She paused to run her eyes up and down what she could see of me from where she sat, obviously trying to decide whether even that was possible. “But you are not a woman, doctor; you couldn’t possibly understand the mother/daughter bond!”

My only possible response was a smile, so I parried with the best one I could muster under attack. “You did ask for my opinion, Loretta,” I managed to reply in an even voice.

She unleashed her eyes on my face again, this time as birds of prey, and as they circled for the kill, she managed to answer in a polite monotone. “You health practitioners are all the same, aren’t you? You think you have all the answers. You, my GP, the school doctor –even the school nurse- prattling on about anticipated behaviours and how you want to deal with them as if you were all decanting untasted wine from the same expensive bottle.”

My smile broadened at her use of the simile but my reaction only seemed to fluster her more. I shook my head slowly. “Most of us certainly don’t think we have all the answers, Loretta.” Her eyelids fluttered as if I were a politician trying to convince a wary population. “But I suppose we do try to prevent problems when we see them coming. Cancer of the cervix used to be a major problem until we recognized it was caused by a common sexually transmitted virus. The obvious next step was to see if we could develop a vaccine to protect against it like we did with small pox –or polio…” I shrugged as if I had just made an irrefutable point.

She stared out the window for a moment, undecided, and then I could see her body language change. Soften. Her eyes were sparrows again –finches, maybe: curious, but playful. “I just stereotyped you didn’t I?” I hadn’t thought of it that way, I have to admit; the accusation usually comes from the opposite direction. I nodded in pleasant agreement. “But it’s a two way street isn’t it?” she added with an impish smile, obviously unwilling to let me off unscathed. “I saw you rolling your eyes at the mother-daughter bond thing.” She could hardly talk for her smile. “Over-protective mother meets omniscient doctor, right?” She settled back more comfortably in her chair. “Both of us using our unique and non-reciprocable roles to pull rank. To manipulate each other –ad hominem stuff…” she added and then chuckled.

Suddenly she became serious and I could sense she needed an answer. “Tell me, doctor,” she said, carefully choosing her words, “If I were your daughter, would you advise me to have your granddaughter vaccinated?”

A serious question; a personal question -and I didn’t hesitate to respond. I nodded my head immediately.

She relaxed again. “Then I have my answer, don’t I?” she said and started to put on her coat. She stopped at the door and turned to me with a little smile waving for attention on her face. “Did I just get swept up in another stereotype?”

I had to shrug. I’m just not sure anymore.