A System of Fear

by Stephen C. Nelson, MD

In addition to training and consulting with Hackman Consulting Group, Stephen Nelson is currently a physician specializing in the treatment of Sickle Cell Disease at Children’s Hospital in Minneapolis, MN. Dr. Nelson received a Bush Fellowship in 2009 to study the role of racism in the treatment of patients with Sickle Cell Disease, and regularly trains and presents on racism in medicine, provider bias, and transforming racial disparities in health care.

As I listen to conversations about the events surrounding the homicides in Ferguson and Staten Island at the hands of the police, I am struck by some similarities that I encounter in healthcare. Too often, it appears we get stuck on single, isolated incidents at the expense of appreciating the “big” picture. By focusing on individual acts, we lose sight of broader systems that may be affecting these individual acts.

I was especially disheartened to hear a particular conversation on NPR on the way home from work the other evening. I was listening intently to the interview on December 5th with civil rights attorney Constance Rice on how she built trust with police. I was particularly frustrated to hear her say:

“Cops can get into a state of mind where they’re scared to death. When they’re in that really, really frightened place they panic and they act out on that panic. I have known cops who haven’t had a racist bone in their bodies and in fact had adopted black children, they went to black churches on the weekend; and these are white cops. They really weren’t overtly racist. They weren’t consciously racist. But you know what they had in their minds that made them act out and beat a black suspect unwarrantedly? They had fear.”

I was frustrated to hear her use the word” racist” when talking about these individual white cops. This makes racism an individual act and not a broader system of oppression. What I believe she really meant to say was that these white cops were not prejudiced. By focusing on the individual police officers, she failed to acknowledge the systems of racism and white supremacy in our society that led these police officers to fear black men. I absolutely believe that many white cops fear black men. But, she didn’t discuss why this is true.

White people are scared of black people. Just admit it. We are. We are not proud of it.

This is how we were raised. This is how we were taught. This is “just the way it was”, especially in the South, especially in Virginia where I grew up in the 60s and 70s. But this miseducation didn’t stop in the 60s and 70s. It continues today.

So, if I am honest with you I will say that I still have some fear of black people. Think about it… Use the “dark alley” scenario, or “walking down the street alone” and you hear foot steps behind you. Are you relieved in either situation when you realize the person behind you is white?

As with many of us, we learn this fear at a very young age. For me, it was when our family was in Atlanta visiting friends. I had finished 7th grade. It was the summer of 1973. Dad got tickets for us to see the Atlanta Braves play the New York Mets. He was especially excited because Tom Seaver was pitching for the Mets that night. We were driving to Fulton County Stadium and some neighborhood children had placed a detour sign to force traffic down their street. The goal, as I discovered, was to give you directions to the parking lot and then ask for money. When we turned down that dark street, my mother reached around and locked all of the doors to the car. She was afraid. So I was afraid. The boys giving us directions were black. We were in an all black neighborhood at night in Atlanta in 1973. It was subtle. It was very quiet. But, it reinforced a feeling deep inside me that I carry to this day. I was to fear black people.

We have a college friend who apparently does this a lot. Every time she would lock her car door her husband would ask “Did you see a black person, Linda?” My husband Peter and I would start asking each other the same question if we locked our door. “Did you see a black person, Linda?” We’d ask friends or family when they locked their car door “Did you see a black person, Linda?” We thought it was funny. This was before I started recognizing my white privilege, before I started to understand how racism really works in our society, and before I began to look at my world with a critical race lens to see, to really see how people of color are treated in our country.

This fear is now automatic. Thanks to the ingenuity of the American automobile industry, we don’t have to think about it anymore. Our car doors lock automatically. Sure, this is for our own safety, right? Or is it so we don’t have to ask “Did you see a black person, Linda?”

This fear is ingrained. It is automated. It is immediate. It is engaged even if we are not conscious of it. We don’t have to do anything to make it happen. It just does. Just like my car doors locking; my stereotyping, bias, and fears play out automatically. Sometimes I’m aware of this, and sometimes I’m not.

Stereotyping, unconscious bias, and fear have affected, in such profound ways, the care that I have given to my patients and families of color. Like my car doors, I was unaware. It just happened. I never even noticed it.

Turns out, my patients and families noticed. How do I know this? Dr. Hackman and I asked. Race matters. Race and racism affect the delivery of health care. To learn more you can read our manuscript published last year: “Race matters: Perceptions of race and racism in a sickle cell center.” Pediatr Blood Cancer 2013;60:451–454 as well as our chapter “Dismantling racism to improve health equity” in Health Disparities: Epidemiology, Racial/Ethnic and Socioeconomic Risk Factors and Strategies for Elimination. Nova Publishers, New York, 2013, Chapter VI, 147-160.

Physicians and health care providers, for the most part, are good people. We go into medicine to give quality care and to help patients and families. We like to think that our healthcare system somehow functions in a vacuum, outside of our highly racialized society. We are not taught how the structure and systems of our society (racism) affect the social determinants of health such as poverty, education, incarceration, homelessness, unemployment and insurance. The disparities seen with these social factors in people of color are partly to blame for the profound racial health inequities seen in the United States.

Some of the blame also lies with us, the healthcare system itself. We are overwhelmingly white. According to 2010 U.S. Census data, Minnesota is now 5.2% black and 4.7% Latino/Latina. However, of the 13,083 licensed physicians in Minnesota only 261 are black and 313 are Latino/Latina. The numbers are even more disparate when looking at the nursing workforce. Of the 57,639 RNs in Minnesota, only 105 are black and 30 are Latino/Latina. And, of the 220 graduates from the University of Minnesota Medical School in 2013, one was black.

The education and miseducation I received growing up that led to my fear of blacks was not very different from my medical education. Who teaches us in medical school? Whites. Only 4% of American medical school faculty are from under-represented minorities (black, Latino, Native American). What are we taught? Evidence-based protocols developed by majority white researchers, using majority white patients, carried out by the majority white health care system.

What are we not taught? We are not taught about the social determinants of health and how racism affects these as well as health outcomes. We are not taught to see our own unconscious biases and stereotyping.

Just as police officers may fall prey to their own biases, stereotyping and fears; so too may the health care provider. In both cases, the result may be deadly for people of color. While the presence of more significant training for providers regarding racism may help to lessen the racial disparities in health care, the opposite is also true. The absence of substantial training on issues of race and racism will serve to perpetuate and potentially exacerbate racial health care disparities. Until racial issues are honestly addressed by the health care team as well as the judicial system, it is unlikely that we will see significant improvements in racial disparities for Americans.

Fear is real. But, we can lose it.

Here’s wishing for a less fearful and more joyful 2015 for all of us!

A Week At the White Privilege Conference – Musings On Tone

Talking about white privilege is hard, no doubt about it. Talking about it in groups is even more difficult. To be sure, therefore, talking about it with over 2000 people is beyond the pale (pun intended). But, two weeks ago I was in Seattle for the 14th Annual White Privilege Conference (WPC) and it was several days of challenging and very engaging dialogue. Fears arose, brilliant insights were shared, guilt popped up everywhere, different levels of awareness had folks verbally and intellectually “bumping into each other”, tears were shed, hearts were opened, and all in all it made for an exhilarating several days.


But, amid all this inspiration there is one thing that stuck in my craw a bit…and it was the issue of tone, specifically the use of cynical, sarcastic, “judgy” tones on the part of white folks to other white folks. It’s a pretty standard phenomenon, really. White people are quite scared when talking about issues of race, and specifically white privilege, and out of this fear often react in a range of ways depending of course on their level of knowledge, experience, and skill. More specifically, in the case of public settings such as this conference, some of the more problematic ways that white folks respond to these issues is through the vehicles of cynicism (to show how analytical one can be), talking non-stop (to show how much one knows about the issue), or self-criticism (to show how serious and truly progressive one is about the issues), and it is these means of engaging that got my attention at this year’s conference. The act of calling oneself out as a hypocrite or as a “white ally with a lot more work to do” has its utility, but only if it is done in balance with principles of compassion, empathy and care. This is not merely my opinion, it’s just good pedagogy. I have seen very few students in my classes, or participants in my trainings, be motivated both intellectually and emotionally through my use of cynicism, by talking “at” them, or via incessant criticism of myself, and by its passive-aggressive implication, them. And given that best practices in education, new studies in learning theory, and basic brain analysis tell us that the best learning definitely takes place when the cognitive and affective dimensions are both engaged, it makes absolutely no sense to engage with each other in a way that shuts down the heart, primes the mind for criticism and attack/defend, and ultimately discourages deep learning.


However, despite the above knowledge there were several moments over the 4 days of the conference where it felt like whites were almost competing with each other in their use of cynical, self-critical, incessant dialogue in the service of calling out whiteness – which was often just cover for accusing other white folks for not doing enough, as well as a way to “prove” what a good anti-racist the speaker was. As stated above, it definitely is important for white folks to hold ourselves accountable for our privilege and our role in racial injustice/justice in this society, but at this conference I was able to see the starkness in contrast between doing so out of a place of criticism, self-righteousness, and what in the end felt like (and was) arrogance versus a place of love, care, empathy and deep sense of community (while not holding back on the honest and thoughtful observations of whiteness).


Case in point: In one session I was able to see the speaker presenting what was quite powerful information, albeit quite sharp and possibly difficult to digest, in a manner that was so indirectly (and eventually directly) accusatory of the participants that after a while people simply shut down. In racial justice circles this shutting down is often read as “resistance” and yet in this session what I was seeing was not resistance coming out of a place of privilege, but simply the body not being able to hold one more nugget of information in the form it was being presented. This I am sure, was the opposite effect the facilitator wanted, and yet the means by which this white person was presenting the information eventually made it impossible for many in the session to both cognitively and affectively take any more of it in; the affective shut down, leaving less room for the cognitive.


Instead, it would have been preferable if the facilitator could have simply paused, recognized in a sincere and humble manner his own humanness, his own feelings, and ultimately his own body, and then continued with his workshop in a more embodied and grounded way. Had he done this, he might have felt his own disconnection from the content and then extrapolated that perhaps the attendees were also feeling this way, thus suggesting a slight change of tack in his delivery. Unfortunately, this did not happen and I watched every single person within my line of sight thoroughly check out of the workshop well before it ended.


Let me say again that I am not suggesting that we coddle whites as we struggle with accepting the reality of white privilege. The crisis state of racial dynamics in this country demands a clear and powerful turn of attention on the part of whites to issues of whiteness and how we fuel the systemic oppression of people of color. But, we have to get past the rhetoric of progressive cynicism in the name of “doing the hard work” and instead come from a place of compassion and care as we wade into the morass of pain and confusion that is the legacy multi-generational whites must face in order to get to the root of whiteness within each of us and in turn in this society.



A Week At the White Privilege Conference – Introduction

My apologies for the delay in blog posts, but these last few weeks I have been preparing to present at the White Privilege Conference and that took time away from writing. As I write this, I am just returning from Seattle and the 14th White Privilege Conference and it was once again an excellent experience. I want to give a huge thanks to both the national and local teams for their tireless work, the countless volunteers supporting the conference, and to the many presenters who contributed their energy and brilliance to make the conference such a success. I strongly encourage anyone committed to racial justice work to consider attending the WPC next year as it is a transformative experience.


And what makes it so? Well, the very name of the conference makes it an exceptional event because it places myriad elements of white privilege at the center of analysis and discussion in a manner that is rarely undertaken. Certainly there are many conferences around the country that address racial issues, cultural issues and/or racism, but very few conferences “call out” what is at the heart of the system of racial inequity in this society in the way WPC does. And this is a critical point: so often when I ask white folks why racial oppression is such a pervasive and powerful force in this country, they invariably say it is because of “prejudice”, or the “systems that target people of color”. And while it is true that both of these are massive factors in the propagation of racial oppression, it is important to note that the driver of racial inequality is actually neither of those things. Let me explain…


Prejudice, as we know from the ample body of research on the psychology (both individual and group) of prejudice, the sociology of prejudice, the brain functions associated with prejudice based on socially constructed axes of difference such as race (skin color), has to be taught/learned and as such can be un-taught/unlearned. Therefore, it seems illogical that something which has to first be taught and that can be unlearned in a generation or two is the sole reason why racial oppression is so persistent in the U.S. Similarly, because the oppression of people of color takes such an inordinate amount of resources to enact, has no logical function for any healthy society, and cannot be justified in any reasonable way, there has to be a deeper reason, a more compelling reason for racial oppression’s enduring presence. That “more compelling reason” is that the group doing the oppressing is getting something out of it. And, in this case, white people are getting something very tangible and very powerful out of the structure of racial oppression.


To illustrate, it is common knowledge that red lining was (and still is, just not as overtly) used to intentionally racially segregate housing across the U.S. whereby people of color are denied access to homes in communities with the better schools, transportation, parks, and overall living conditions. Obviously, however, these houses do not go away as a result of this process, and therefore “someone” has to fill them – that “someone” is of course white people. Thus, the end result of denying preferred housing to people of color is that more houses (and all of the other benefits that come from safe, healthy housing) are available to whites in these areas.* And so, for every resource denied to people of color in this country at the hands of structural racism, there are more resources available to whites. And when we consider that racial oppression operates in exactly this way throughout every sector of this society, it becomes apparent why the real driver of racial oppression in this country is the endless list of benefits and advantages that white people accrue as a result of it. For this reason, creating an entire conference that so openly and honestly addresses this underlying motivation for the maintenance of racial oppression in the U.S. is a bold, powerful, and much needed event.


So what does it mean to have a conference about White Privilege? Some fear that it is all about “hating white people”, and yet in point of fact the exact opposite is true; this conference is committed to the liberation of everyone from the limiting and violent confines of racial oppression. For me in the few years I have been attending it, this liberatory message has come as much from the keynotes and workshops as it has from the personal and relational commitment attendees make to lean into these issues, do our own work, and seek a more racially just society together. This alone is a challenge to the highly individualized, overly intellectual, non-relational, and emotionally distant macro racial narrative of U.S. whiteness and says quite powerfully that we are going to challenge these issues as a community in order for all of us to be able to live peacefully in a racially just world. We cannot achieve this alone, we cannot hope for this just for ourselves or for those immediately around us, and we must strive for racial justice as if our small lifeboats are lashed to everyone else’s lifeboat and we will either all rise and be liberated together – a far cry from white liberalism, and a more likely recipe for the achievement of social justice in this society. And this is one of the elements of WPC that makes it vastly different form other professional conferences: it’s about the “we” and our human commitments to being our best selves with and for each other.


If you are reading this and have not attended the WPC or have not even examined issues of white privilege before, I strongly encourage you to do so and use it as a place for deeper investigation and incredible motivation as we all strive for a better society.


* An excellent and more detailed discussion of this and other race-based means of denying resources to people of color and allocating resources to white people can be found in George Lipsitz’s book The Possessive Investment of Whiteness.