Woke Insanity Detected in Another Patient: Tulane School of Medicine

I n my 37 years as a psychiatrist, I’ve worked in community mental-health centers, the VA, prisons, and at training hospitals. So it takes a lot for me to be surprised. But the outbreak of mass irrationality at the respected medical school where I now work and teach has done just that. It now appears that Tulane School of Medicine has revised its mission to ensure that our faculty and students receive indoctrination that divides us into either “oppressors” or “victims.” This mindset, as unreasonable as it is inflexible, is degrading our ability to deal with the health-care world as it really is.

I’m from Louisiana, so I know racism when I see it. I grew up surrounded by it, and I consider myself very fortunate to now live in a culture that has worked hard to eradicate this cancer from our society. Nevertheless, I’m not inclined to take our progress for granted, since individual attitudes of bias and intolerance can still potentially rear their ugly heads. That’s why it made sense for Tulane to offer and encourage optional courses covering cultural sensitivity, diversity, and related issues for the faculty and staff. I consider these resources to be potentially quite helpful for clinical care, since New Orleans has such a rich cultural heritage.

But that’s not what Tulane is promoting now. Over the summer, every member of the department of psychiatry was ordered to attend a daylong “Diversity, Equity, and Inclusion Retreat.” My turn came on October 1, when my colleagues and I were subjected to seven hours of stereotyping and shaming. It stigmatized white people as being responsible for the ongoing oppression of others and insisted that the only way Caucasians may demonstrate opposition to racism is to acknowledge and admit to being racist. I’m still scratching my head over that one.

We also learned that oppressors are inherently distinguishable by simple observation of white skin color, male or cisgender sexual preference, traditional religious beliefs, English as a first language, Canadian or American nationality, privileged access to higher education, and other characteristics. The presentation included a handy checklist that allowed me to determine where I fall in the hierarchy of oppressors. We were essentially told that providing equity in access and outcome should be our goal in medicine, rather than providing the best care to the patient in front of us.

Some of my younger colleagues seemed to be quite taken by all this. Yet for all seven hours, most of us made no comments to the larger group. At one point during a breakout group session I was asked for my thoughts, and I responded with a quotation: “All animals are equal, but some are more equal than others.” Neither the presenter nor any of the younger crowd seemed to get the Animal Farm reference.

Passive silence — both during the retreat and subsequently — is a frightening response. We have acquiesced to self-censorship that extends far beyond the one day of mandatory indoctrination, and this will now inhibit our interactions 365 days a year. One of my black colleagues put it this way: “If you speak out, well it’s sort of expected, since after all, you’re a white guy, and assumed to be racist. But if I speak up, then I’m a race traitor.”

Yet silence and professional timidity carry a price for our patients. Physicians, and especially psychiatrists, must be willing to delve deeply into the history and sensibilities of each patient to provide the best treatment. Tulane should be teaching our residents and students how to competently and empathically finesse this delicate and difficult process. Instead, my colleagues and I are increasingly concerned that our frank guidance could be interpreted as microaggressions or manifestations of our “oppression” and “privilege.” Out of self-preservation, we are thus likely to limit the instruction and feedback we give future physicians, depriving them (and their future patients) of the skills vital for optimal treatment.

That’s especially evident when considering Tulane’s new “bias in curriculum reporting form.” Introduced in late October, it allows any student or resident to report any instructors whom they consider to be biased in any manner. Naturally, there is no standard for what constitutes a transgression. These complaints are of course subject to higher review, but if denunciations are determined by the sensitivities of the beholder, then the ranks of skilled educators will diminish. Sure enough, one of our most respected senior instructors resigned recently out of concern that he could no longer be an effective mentor in this political minefield. Several others tell me they may retire at the end of the academic year — quite a surrender by those labeled as ostensible oppressors.

Should Tulane School of Medicine continue to define us by our differences, then it will do so at the expense of our willingness to surmount them. Future physicians cannot remain focused on perceived grievances and still fully attend to the real medical needs of our patients. Institutional denial of this priority is one condition I just don’t know how to treat.