The real problem with prejudice is closed-mindedness: too often our first impression – our prejudice – remains our only impression.
M-80 Firecrackers & Garrison Keillor
In my internship many years ago in Maine, I was working the ER and this fool comes in who’s blown open his hand with an M-80 firecracker. His wounds were skin lacerations, nothing deep is damaged. The guy was wearing steel-toed boots, a grey uniform with dirt and oil smudges, dirt under his fingernails, needed a shave. We all know the type.
Or we think we do.
Hands heal up very well if there’s no infection. So I sewed what I could pull together, and cleaned and bandaged the other wounds but otherwise left them open to heal on their own. I asked him what he did for a living, and in his Maine accent he said, “I’m ah fo’klift drivah.” I explained that I didn’t want him driving for the next week or two, his hand needed to heal.
“Just as well, Ah can listen to tha radio.” Making small talk while I finished his paperwork, I asked him what he liked to listen to.
Bronze cast believed to be made from the hands of Franz Liszt.
“Bach,” he says.
I paused, and looked at him anew. I said, “You know, before I came to work I was listening to some Liszt.”
“Oh!” he said, “Liszt was a vereh contr’versial composah.”
I took that in for a moment, and then asked him if he ever listened to Garrison Keillor’s A Prairie Home Companion on NPR. He responded excitedly, “Ev’r’ othah weekend! I have t’ work on th’ othah ones.” So I ask him if he’d read Keillor’s Lake Wobegone Days which had just been published.
“No,” he said, “but Ah’m dyin’ to get m’hands on a copeh!”
Upset Prejudices
The ER often provides rare glimpses into humanity. For me, part of the fascination is that from time to time I run into people who upset my prejudices. Someone comes in who is ‘clearly’ of some category, and then in talking with them I discover that I was completely wrong. It’s a fun way to be wrong.
The word ‘prejudice’ is from the Latin pre (before) + iūdicō (to pass judgement) or to ‘pre-judge.’ Of course, I am quite prejudiced in the ER; it’s my job. I’ve got to make quick decisions about your disease, which means I have to make quick decisions about you. Almost all of those things that are politically incorrect in normal conversation can be clues about what’s going on, about what questions to ask, and about how to treat you.
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Prejudice in Medicine
In fact, all doctors are trained to be prejudiced. If you have high blood pressure, I need to consider whether you’re white or black, because the causes and therapeutic courses for the two tend to be different. The poorly educated may respond to my questions by telling me what they think I want to hear rather that what’s really going on. When you ask children where their belly pain is, they almost always point to their belly buttons. White kids get lice, black kids don’t. There are diseases that tend to be limited to one or a few races. International visitors and recent immigrants may carry diseases that I never see, and I may need to hit the books, or even medical resources on the Internet, before I make decision. And so on.
Sex, sexual activity, and sexual orientation are constant considerations. Diagnosing a heart attack is harder in women, because the symptoms are different and more subtle. If you have lower abdominal pain, a woman is more likely to have a bladder infection, but an older man, a prostate infection. If the abdominal pain is located in other places, I need to consider whether you’re male or female, young or old, skinny or fat. If you have arthritis in a single joint, it makes a different whether you’re 60 (probably degenerative, maybe rheumatoid arthritis) or 20 (gonorrhea until proven otherwise). And if you’re in between, I’m thinking gout.
Open-Mindedness in Medicine
The critical thing is not the prejudice, but keeping an open mind. In almost all of the malpractice lawsuits I have seen, the problem didn’t happen because the doctor or medical support staff didn’t know the underlying medicine, but because they wouldn’t listen. They made a quick decision, and then refused to take in more information.
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Medicine, like all complex decision-making, is about having an understanding of the relative probabilities, and considering the most likely problems first. That prejudice can spill into social considerations. Sometimes that’s because the social aspect is important for medical decisions, but sometimes not. Doctors are people like everyone else, and we are constantly making assumptions about what’s going on around us.
Schizophrenia, Crime and Punishment
I remember a psych patient at Charity-New Orleans, a schizophrenic woman who lived on the street. The attending psychiatrist interviewed her and noted afterward that she was probably borderline mentally retarded. But the nurses had told me when we admitted her that she knew her hospital number from memory. She knew her Social Security number, too, but she remembered her lengthy hospital number from her previous admissions. So I politely expressed my doubts. He stood his ground.
A bit later that day in completing her history and physical, I asked her if she ever read. She said she used to, but couldn’t concentrate anymore. I asked her what she used to read. She thought a moment, and then said, “Everything.” I asked her to name an author she liked.
She paused and a few moments and said…
“Dostoevsky.”
I looked at her dubiously. I asked her what she’d read by him. She paused again and said, “Crime and Punishment.
“And The Brothers Karamozov.”
The next morning at rounds, I said to the attending, “You know Ms X, you suspected she was probably mentally retarded?” He nodded.
I tried not to look smug when I said, “Before her schizophrenia got bad, she read Dostoevsky.”
The Gangsta’s Kids
Recently I had a couple in, both very large African Americans, him in unlaced sneakers, low-rider pants with a plumber’s crack, her in a tube top with hoochie-mama shorts and stiletto heels. We all know the type.
No, we don’t.
They were there because their kids had the sniffles. The kids? Both dressed in neat school uniforms, polite to a fault, and avid readers. While I chatted with the kids about their favorite books, the parents beamed.
The Tough Kid
And then not too long ago I saw a kid with a laceration that he got while playing in the woods. His parents had tried to clean him up, but he was still covered with dirt and a bit of blood, and he had several older scrapes & scratches. Meanwhile, his father was sitting quietly by the stretcher in a brown truck-delivery uniform. You know the types.
No, you don’t.
Talking with the kid while I was getting my equipment together, I asked my standard, “Do you like to read?” He said he did. I figured he liked comic books, or maybe the Diary of a Wimpy Kid series. So I asked him what his favorite book was.
“Number the Stars,” he said. That stopped me cold.
The Real Problem with Prejudice
Some people say they are not prejudiced. I always doubt them. I think that, rather than deny our prejudices, we should be aware of them. Rather than take an inflexible position about prejudice, we need to understand it, and decide when it is helpful, and when it is not. And above all else, we should watch for how wrong we can be, and even learn to laugh at ourselves.
Because the real problem isn’t the prejudice. The problem is, What are you going to do with your prejudices? How will you use them? To help people, or harm them?
And even more important: Do your prejudices stop you from looking further? My black friends often talk about getting pulled over for ‘DWB,’ ‘Driving While Black.’ I remember a pre-med student some years back, a young black man whose father was a surgeon. His dad had given him his second-hand Mercedes two-seater convertible.
The local cops pulled him over constantly. Black man + expensive car = drug dealer.
Looking Beyond Prejudice
The police who stopped him were racial profiling. But if they had just looked and thought about what they were seeing, they would have recognized what was really there: a clean-cut young man, dressed in a polo shirt or button-down Oxford, driving a conservatively-appointed 10 year-old Mercedes. Highly unlikely drug dealer.
If you look at the people complaining about racial profiling, they’re not worried about the police pulling over obviously suspicious people. They’re complaining because some cops don’t look beyond race. They see nothing but suspicious people.
Looking at skin color, and missing the whole picture is not only unfair, it’s bad investigative work. It’s bad in medicine, it’s bad in law enforcement, it’s bad everywhere.
Knowledge as Prejudice
I can take the position that everything we ‘know’ is a type of prejudice. Experience and research teaches us that doing a will produce b. But it’s not always true; quite often a does not produce b. The doctor, the entrepreneur, and the lawyer cannot promise an outcome, we cannot guarantee that a decision will succeed; what we have is knowledge of what worked in the past, and therefore what will probably work in the future. This accumulated experience comprises many jots of knowledge, each of which is a kind of prejudice, something we expect in certain situations.
Where we get into trouble is when we look at only one or two factors, rather than the larger picture. It gets worse when we choose to focus on less important variables rather than the biggest ones, and finally it becomes toxic when we refuse to look further, when we do not consider new information that should change our decisions.
I see it all the time in medicine. The doctor makes a decision, perhaps a reasonable decision. But as more information comes in, he/she refuses to reconsider, and that leads to problems. I have seen more than one person die from such things.
Prejudice vs Closed-Mindedness
My point is, prejudice is not the real problem; in fact, prejudice is essential. The problem is when the prejudgement, the before judging, becomes the final judging. The problem, as always, is closed-mindedness.
This closed mindset is currently a major problem on the national stage. We, as a nation, have been talking about using racial and religious profiling in our immigration practices. It does no good to point out that the people who commit most acts of US terrorism, or that most criminals and welfare recipients, are white, Christian, and born right here in the USA.
And now the problem of closed-mindedness has exploded in respect to policing.
Some people look at large social and political problems in the same way they look at minorities. They don’t know the facts, and they make it clear they don’t care to learn about the facts.
They aren’t interested in the larger picture. The problem is always the same: closed-mindedness.
When we look at situations, and people, with a closed mind, our pre-judging becomes toti-judging; our first impression is our only impression. That is where prejudice creates injustice. When used with an open mind, our prejudices can be used to help people. With a closed mind, they become harmful.
Which is the point here. If we look closely at injustice, the deep problem isn’t prejudice.
The deep problem is hammer thinking. It’s pigeon-holed approaches.
It’s closed mindedness.
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Bronze cast of Franz Liszt’s hands courtesy of ChopinLiszt on Tumblr.