Black and Blue. John Hoberman
time, these emotional stressors and their effects remain unknown to the great majority of whites, who assume that Americans of all skin colors share an essentially homogenous and egalitarian social environment in which everyone has an opportunity to thrive. Physicians who share this overly sanguine view of the black experience and who treat African American patients will eventually overlook signs or symptoms that are relevant to the proper diagnosis and treatment of people who are under more stress than the doctors perceive.
The behaviors of these amateur anthropologists are culturally aberrant only in their frank self-assertion. Most racial curiosity remains just that—an unexpressed interest in racial differences that might take the form of speculations about racial athletic aptitude or IQ scores or sexual prowess. Speculations of this kind originate in the traditional racial folklore that persists inside the heads of the vast majority of modern people, including the great majority of doctors, regardless of whether they are black or white.
The presence of discomfiting racial folklore inside the heads of modern people is continually on display in the awkward statements that prominent people have made in recent decades. In 2005, William J. Bennett, a former Republican secretary of education in the Reagan administration, ignited a national controversy when he fantasized on his radio program that “if you wanted to reduce crime, you could, if that were your sole purpose, you could abort every black baby in this country, and your crime rate would go down.” He then added: “That would be an impossible, ridiculous, and morally reprehensible thing to do, but your crime rate would go down.”132 While Bennett defended his remarks as a “thought experiment about public policy,” a black journalist at The New York Times called them “twisted fantasies.”133 Another African American commentator who was “shocked and angered” by these remarks noted that Bennett had “instantly connected crime and race.”134 Bennett countered that he could not grasp why a genocidal fantasy about a vulnerable racial minority descended from slaves might offend anyone. The Pulitzer Prize-winning syndicated columnist Charles Krauthammer, a graduate of Harvard Medical School, described “crack babies” in 1988 as a “biologic underclass whose biological inferiority is stamped at birth”135— a judgment that turned out to be as mistaken as it was heartless.
Another fantasy about racial biology appeared in a comment Senator Daniel Patrick Moynihan made in 1994 about the consequences of the outof-wedlock births that occur at a higher rate among African Americans. “I mean, if you were a biologist, you could find yourself talking about speciation here,” that is, the creation of a new species. “It has something to do [with] a changed condition in biological circumstances.”136 A year later the president of Rutgers University, a liberal affirmative-action proponent named Francis Lawrence, told a faculty meeting the following: “The average SAT (score) for African Americans is 750. Do we set standards in the future so we don't admit anybody? Or do we deal with a disadvantaged population that doesn't have that genetic, hereditary background to have a higher average?”137 While none of the more than 30 faculty members who were present took exception to this assessment of African American intelligence, the release of a tape recording of the remark provoked a storm of publicity that almost cost Lawrence his job.138
None of these men belong to the racist fringe as it is traditionally de-fined; on the contrary, all of them have occupied leadership positions in mainstream American institutions: state or presidential cabinets, a flagship state university, syndicated journalism, the United States Senate. None of them were dismissed or demoted for endorsing or playing with race biological themes in controversial or offensive ways. Only the hapless and obsessive Reyn Archer, isolated in his Jim Crow world of uppity blacks and the specter of lynching, lacked the facile talent to talk his way out of trouble. The desperate Francis Lawrence, by way of contrast, claimed that, while he and his wife had refused on principle to read The Bell Curve, his preoccupation with its outrageous claims about racial intelligence had somehow reversed the ideological force field in his brain and prompted him to say the exact opposite of what he had meant.
These incidents offer useful evidence because they expose the private racial imaginations of modern people to public scrutiny. What they show is that race-biological ideas can still inform white thinking about blacks to a degree that goes unacknowledged in our episodic and fitful “dialogue on race” that promises so much and accomplishes so little. It should be obvious that physicians, given their intimate contact with patients' minds and bodies, participate in this process as much as or more than most other people. It is possible that physicians are exposed to more racial folklore than other professionals, precisely because they absorb the ideas that circulate in society at large as well as those that are generated within the medical culture and circulate by word of mouth.
One of the central claims of this book is that folkloric beliefs about racial differences have persisted over many generations and have kept an evolving racial anthropology alive both inside and outside the medical profession. American medical authors seem to be unaware of or uninterested in folkloric material of this kind. Reports of racially awkward incidents involving white doctors and black patients (or, for that matter, black doctors and white patients) almost never appear in print. An anesthesiologist who told a nonphysician I know that the spinal fluid of black patients is thicker than that of whites will never appear as a case study in a medical journal because editors do not regard reports of this kind as suitable for publication. Medical journals are more disposed to describing on occasion the folkloric beliefs of patients. A senior physician at a Veterans Administration hospital in New York told me: “In my experience, when the notion of folklore enters medical discourse it invariably concerns the patient's folklore about himself—a folk remedy, a ‘primitive’/uneducated/unscientific/old country notion they have about their body. That doctors have a ‘folklore’ about their patients, let alone that they operate on the basis of folklore, is hardly ever recognized, talked about or acknowledged. The flip side of course is that the patients have their own folkloric concepts of their doctors (e.g., ‘you just want to experiment’)”.139 It is not surprising that doctors can think of themselves as immune to folkloric thinking while ascribing such beliefs to their unsophisticated patients. This is, however, an illusion that is encouraged and maintained by the absence of appropriate instruction about racial folklore in medical school curricula and continuing education.
Medically significant racial folklore is known among African Americans and some doctors as the “silent curriculum” or, as the VA hospital physician reported to me, as the “hidden curriculum.”140 “Are you aware of the term 'hidden curriculum' as it applies to medical student education?” the VA doctor asked me:
The term is very much in vogue in med-ed [medical education] circles. It refers to precisely what you're referencing…the under-the-radar shaping of attitudes and behaviors that can lead to a lifetime of bad habits, a parallel education picked up despite the best efforts of formal lectures and rounds. So much of medical education is informal, anecdotal, on the fly, and unsupervised. Residents are largely educated by other residents. It's all very intense, imitative, personal, hierarchical and riddled with “dependency issues.” An off-hand remark in a midnight I.C.U. to a sleep deprived intern can make an impression disproportionate to its accuracy.141
This insider's account of how medical habits are acquired focuses on the role of oral tradition—the private transmission of concepts and information, whether accurate, inaccurate, or innocuous—beyond the purview of formal instruction or supervision. Dr. Judith Gwaltmey, a professor of medicine and physiology at Boston University, puts it as follows: “There are lots of little stories that physicians believe that are neither scientifically based nor proven. That's the problem.”142 As the VA doctor points out, the oral transmission of these “little stories” can have a profound influence on how medical personnel interpret a patient and his or her symptoms:
Are you aware that the in-hospital case presentations frequently begin something like: Mr. Jones is a 70-year-old African-American/ white/Hispanic (choose one) male with a chief complaint of x-y-z? The racial identifier has a privileged status, up front, implying that everything that follows is potentially colored (no pun intended) by that fact as importantly as the facts of sex or age. The alternative in the case presentation format is to put that piece of information into what is called the social history or physical exam, assuming