At the same time, because this is a blog about what I learned yesterday, I’m reflecting on similar actions in our nation’s capital in 2008 that I was at:
What I learned is that LGBTQ communities have become healthier, more able to control its destiny, and in an intersectional, non-binary way, in 10 years.
And why wouldn’t they?
Resilient people and companies face reality with staunchness, make meaning of hardship instead of crying out in despair, and improvise solutions from thin air. Others do not. This is the nature of resilience, and we will never completely understand it. – Coutu DL. How resilience works. Harv. Bus. Rev. 2002;80(5):46.
Earlier in my career, I remember a colleague saying to me, in a challenge to observed, biased behavior, “this is organization x, those things don’t happen here.” He said it with a dismissive chuckle. And yet, it did happen…
One of the authors, Daniel Effron now at London Business School (@lbs), has written another piece more recently which I’ll post on next.
It’s yet-another-place where the professions outside of medicine can teach us a lot, and why shouldn’t they, we need each other, and our patients need us to perform our best for them.
Moral Self-License, a fascinating concept that shapes our actions
When under the threat that their next action might be (or appear to be) morally dubious, individuals can derive confidence from their past moral behavior, such that an impeccable track record increases their propensity to engage in otherwise suspect actions. Such moral self-licensing (Monin & Miller, 2001) occurs when past moral behavior makes people more likely to do poten- tially immoral things without worrying about feeling or appearing immoral.
Several study situations of note (summarized here, you can review for control situations, etc):
When people expressed support for a Black presidential candidate (Barack Obama), they were more likely to subsequently express bias toward less-qualified White candidates for a police job.
People asked to describe a time in their past when they acted immorally were more likely to endorse prosocial activities such as giving to charities.
The converse situation, people describing a moral act in the past were more likely to cheat on a math task
So there is something about doing (or even thinking) about past behavior that causes people to engage in less-than-virtuous behavior or to minimize the less-than-virtuousness of the behavior.
What does this mean for health care?
There is much public controversy presently around institutions and people who express commitment to an unbiased environment, and yet biased environments persist.
Interestingly, further research shows that there is greater sensitivity to what is seen as hypocrisy by people in the affected, targeted groups, which makes sense. The converse, however, is that people who are not in the targeted groups are less likely to see hypocrisy and license biased behavior, which allows it to persist. This is a difficult problem if the actors and the licensors are all part of the same ingroup – there will be less introspection.
Here’s a reason why this is important
Because, today, medical students feel comfortable explicitly stating bias against lesbian and gay individuals (and even more bias against obese individuals), an atmosphere of moral license (“we don’t do that here, our policies say so”) can allow this to continue.
There appears to be a protective effect in the understanding of a person’s commitment (who they are and what they stand for) versus what they do (progress toward a goal). Labeling is tied into this:
several studies have found that labeling people as ‘‘helpful’’ after they agree to a small request increases their likelihood of acting consistently by agreeing to a subsequent, large request
Value of Listening, Introspection
There are a few more papers that I’m going to summarize here, because this is such a fascinating topic, and frankly, a head scratcher for people in vulnerable groups who observe repeated, biased behavior in people who otherwise are committed to being bias free.
The reconciliation of all of this is that we are all human, and the “this doesn’t happen here” turns out to be one of the most dangerous statements that can ever be made.
Right now, I think one of the most topic areas for this exploration is the work of being an ally, to a group of people that is not your own. This is a space where the research points to a great risk of moral license (because the actor and the target are not in the same ingroup), and where, consistency is needed the most for the persons an ally is working to support.
Maybe good advice here is to be introspective about actions, query those who you are working to be an ally for about actions, and listen to their answer. Otherwise, a person may be inadvertently licensing themselves to do things they will not notice are unhelpful, and later regret. It’s what all humans do, therefore, work with other humans to mitigate this risk :).
In my intersectionality as a family physician, a patient (we are all patients), member of and advocate for the LGBTQ community, ally, Washington, DC resident (all of these in no particular order), here are a few points from Washington, DC.
Love won this weekend
DC Capital Pride (@CapitalPrideDC) was held on schedule, safely, and with all humans respected and represented. The organizers did an excellent job. I am proud that Kaiser Permanente Mid-Atlantic States (@KPMidAtlantic) was visible as a platinum sponsor for Capital Pride as well as Capital TransPride (@TransPrideDC).
The world is learning to love better
There was a time, I have been told, when Washington, DC’s first night clubs to allow same-sex dancing began to thrive because the police simply couldn’t arrest people fast enough. In 2016, the President of the United States acknowledged their central place as spaces of refuge, empowerment, and connection to community.
In my medical professional world, just 3 years ago a transgender woman would be told that her health needs wouldn’t be met and she would just have to live or die in her identity. Now, a transgender woman I know (of several) is being asked to teach the health system, not about being transgender, about leadership and innovation. And she’s getting medically supervised, evidence-based care 😃 .
The 20th Century was a long time ago; it’s not coming back
I regularly encounter people who are of the mind/attitude/behavior, explicitly endorsed or not, that we are still living in the 20th Century. It’s impressive to me that people still cling to that notion, but then again one need not go far to see that we’re living in a new century.
Washington, DC is really at the vanguard of living in a new millennium. It’s the most protective in policy of LGBTQ humans in the United States. More protective than California. Whenever I leave the district, I have to do a double take every time I see a gender segregated single-stall restroom.
If you want to study resilience, study the LGBTQ community
The LGBTQ community understands resilience. The drive to live as one’s true self is among the most powerful in human existence – so powerful that when denied it can overcome a person’s will to live. And also so powerful to create the most effective social movements of our time. I recall being at a White House Champions for Change event around environmental stewardship when a panelist said to the audience, “If you want to see effective organizing, look to the LGBTQ community.” And he was right.
First, the LGBT community has never given up on a struggle, even if it took decades to achieve. And second, in the end, they always win.
That’s because love always wins.
A few suggestions
Look 3 feet away from you as well as 3000 miles away from you
What is your environment like? Are people enabled to live as their authentic selves? Are people targeted for assisting others or advocating for equality?
Targeting happens in various ways, sometimes explicit, sometimes more insidious.
The most dangerous environments are the ones where people say, “That doesn’t happen here.” If people think it doesn’t happen, start a conversation about what’s happening, because it’s happening. The science demonstrates the more objective people believe they are, the more biased they behave.
I have seen and experienced all forms of the above. It’s humbling, it’s terrifying, it’s empowering.
One pleasant discovery I have found is that by a factor of about 1:1000, the person who I least expected to be curious about this community and their health wiped away so much animus from so many others with a simple expression of kindness.
I felt it this weekend from the texts, notes, tweets I received from people. It really is amazing what one person can do to help another.
Look inside yourself
We’re all human and have biases that are sometimes explicit and sometimes hidden within our unconscious, that affect our behavior. You deserve to know about these biases so they can be modulated.
Those are my notes from Washington, DC. Enjoy the photographs, questions, comments in the comments (of course).
Our generation of physicians came to health care with a dream that we’d be able to change everything so that every human could achieve their life goals. It’s totally happening, and we have a ton of allies joining us in the future.