Combating Sexism: A Special Role for Psychiatrists

Since October 2017, there has been an almost continuous uproar about sexual assault and harassment by men in positions of power. This attention is welcome and long overdue, but it focuses only on the more egregious forms of sexism encountered by women. According to a poll reported by National Public Radio on February 21, 81 percent of women have experienced sexual harassment in the workplace. What is unknown is the percentage of women who have experienced sexism. Without detracting from the importance of overt sexual harassment, this article concerns a form of sexism encountered by women throughout their academic and occupational lives and an invitation to psychiatrists to help mitigate sexism’s effects on women’s well-being.

It is difficult to call out certain behaviors as sexist because the person displaying the behavior may be unconscious of it, and the recipients of the behavior may have trouble articulating exactly what happened. Here are some examples culled from my own or my patients’ experiences. A female college student in an advanced chemistry class answers a difficult question correctly and the male teacher’s jaw drops. A female faculty member, while team teaching with a male colleague of equal rank, notices that the students approach her with administrative questions (such as when the final paper is due) and approach the male faculty with substantive questions about the didactic material. A female fellow at an academic medical center notices that when she rounds with a male intern, the patient and patient’s family look to the intern for confirmation of the information given by the fellow despite her superior rank and expertise. At the hospital cafeteria, a man in scrubs is reflexively addressed by the staff as “Doctor,” while a woman in scrubs is not assumed to be a doctor and is addressed as “Miss.”

The effect of this subtle sexism takes a toll on women’s self-confidence and self-esteem. Women ask themselves: Did the chemistry teacher’s jaw drop because the woman is less intelligent than the male students, so he was justified in believing she was incapable of understanding the material? Do the seminar participants approach the woman for administrative tasks but not for didactic information because her grasp of the material is inadequate? Is there something wrong with the way the fellow presents information to patients so that they must seek confirmation from the intern? Daily exposure to this subtle undermining of one’s confidence and authority can result in anxiety, depression, anger, or a combination of all three.

These examples of sexism can be thought of as microaggressions. Microaggression, a term coined in 1970 by Harvard University professor Chester Pierce, M.D., signifies the casual, everyday exchanges that send denigrating messages to persons belonging to any marginalized group. So while this column concerns subtle sexism, it could be rewritten to address subtle bias shown to people because of their race, religion, immigration status, age, sexual orientation, gender identity, body size, or physical disability.

Bias is inevitable. We are all subject to unconscious assumptions and beliefs. Our task is to strive to become aware of our biases and conscientiously work to overcome them. Psychiatrists, by dint of our training in self-observation and reflection, are well situated to notice these microaggressions in ourselves and in those with whom we interact. Psychiatrists have experience with presenting difficult information in such a way that it can be heard, so we may be adept at pointing out subtle bias when we recognize it. Certainly, we can validate and empathize with the experiences reported to us by our patients, trainees, and colleagues. But we could go further than merely offering support.

The ethical principles adopted by the AMA and annotated by APA encourage us to “recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” (Principles of Medical Ethics With Annotations Especially Applicable for Psychiatry, Section 7). We uphold this principle and behave honorably when we speak to colleagues about our perception that they may be influenced by unconscious bias. If we notice a group dynamic that appears to diminish a member of the group, we can intentionally counterbalance that with our own display of respect for that marginalized person and call out the microaggression for what it is. Perhaps most important, when we become aware that we have unwittingly performed a microaggression ourselves, we should apologize and do whatever we can to correct the injustice so that the aggrieved individual feels whole. ■