Being Female in America: A Risk Factor

In my time here at HMS, I have had the pleasure of interacting with all kinds of people. I’ve of course interacted with my excellent colleagues, brilliant professors, trusted advisors, and a few living legends; however, no one has touched me like the patients I’ve spoken with while in clinic, my patient-doctor class, and in various other settings. These people are truly my greatest teachers. The lessons they teach me are often accompanied with a hodgepodge of emotions that make them so memorable. These are lessons one cannot learn from any textbook, case-study, or didactic lecture because they are taught by patients and reinforced by the feelings that arise when witnessing human suffering with my own eyes and ears. These experiences change me. They make me more aware. I want to share, with her permission, a small anecdote from one such person who touched my life in an everlasting way. I shall call her Mrs. L. (That has no relation to her actual name).

Mrs. L is a woman from the northeastern United States. She holds a doctoral degree and suffers from anorexia nervosa. This disease disproportionately affects young women, which is well documented in the literature. She has suffered from this debilitating disease since early adolescence. She is in extremely poor physical health because of her illness. Looking at her is emotional for me because she is severely emaciated, weighing far less than 70 lbs. There is little flesh covering her bones, making them very distinct and identifiable through her skin. There was one story she told to a classmate of mine, who was actually asking the questions, that I’ve been thinking about ever since. She told a story of an experience she had while acting as a pre-teen model where she had gained a few pounds since her previous weigh-in. Mrs. L goes on to explain that she was chastised because of this sudden gain. She remembers thinking to herself, “I’m twelve; am I supposed to weigh XX lbs. forever?” She then remarked on the fact that she weighs exactly XX lbs. today.

Mrs. L, like many other women who suffer from disease, is a victim of acts of verbal and societal violence. This is not something she did; it is something that was done to her. Diseases like anorexia bring up all kinds of questions of whom/what is responsible, who/what is to blame, and what can be done about it. In my opinion, our society has substantial culpability in Mrs. L’s suffering. Modeling agents are only a reflection of society. Things like Photoshop further exacerbate the situation by presenting an unattainable form of “beauty” as a standard. As Jean Kilbourne pointed out, Cindy Crawford even once stated, “I wish I looked like Cindy Crawford.” As part of society, I too share some of this responsibility. This both saddens and angers me, especially because I see where this societal view manifests itself in my own perception of female beauty.

To better understand my role in this, I took an online implicit association test (IAT) to see if I had an implicit bias against people who are classified as obese. As I suspected, I do. And per the results of Harvard’s Project Implicit, so do the overwhelming majority of people who took such a test. I understand that our personal biases can affect the quality of care we deliver. So, what do I do about it? After some reflection and deep thought, I came up with little or nothing I could do that would truly impact the way society views beauty in women or the ways that this ideology negatively affects women’s health. However, I have committed myself to being hyperaware of my biases and being extremely vigilant in ensuring that they never affect the quality of care I provide. This is only a small and very personal step in the right direction. This is not going to help people like Mrs. L or future Mrs. L’s for that matter. I suppose I could join an advocacy group, but are they even effective? How do we address the pressures that young girls feel to fit a certain mold? Is education an affective tool? Is it even possible to change this in a meaningful way? I don’t know, but I hope someone figures it out so that I can stop being part of the problem and start being part of the solution.