Review of the Final Examination

The Bowleg reading demonstrates how a lack of intersectionality in public health and correlated health services leads to health inequities for marginalized groups. Currently, the field of public health understands health disparities by looking at singular social categories, such as race, independently and largely understands issues from a white middle-class perspective. This ignores the complex way that interlocking social identities intersect and especially ignores the experiences of historically oppressed groups which leads to a disconnect between health providers and their clients when providing care.

Public health initiatives, such as HIV prevention efforts, fail to deliver services to clients in a way that matches their lived experience as a person with an intersectional identity, such as a black man who has sex with men and therefore contribute to health disparities (Bowleg, 2012).

The concept of consciousness illuminates why individuals have more trouble identifying their privileged statuses than their oppressed statuses. Consciousness is an awareness of self as an actor and an awareness that the social world around us affects our identity of self and how we think and feel. When someone has a privileged status, such as being white, the social world around them mirrors their own self-identity. Therefore, they don’t experience disequilibrium when their own self-identity does not match their social world or is rejected by the social world and do not internalize or become aware of this identity. On the other hand, people with oppressed statuses, constantly live in a social world that does not reflect their self-identity and even rejects it at times, therefore are sharply aware of their oppressed status as a part of their consciousness (Miller & Garran, Chapter 5, 2017).

Poststructuralism argues that people are not autonomous, self-directed entities, but rather products of a social world that created them. One of the concepts of poststructuralism, supplementary argues that meanings are constructed through difference. Therefore, for heterosexuality to exist there must also be homosexuality. The problem lies in the fact that describing differences in sex and gender that fall outside of the heteronormative framework use language that is derived from and still situated in the heteronormative framework. Furthermore, by using language derived from the heteronormative framework to describe non-normative sexuality or gender such as bisexual, gay, or transgender, it strengthens heterosexuality itself. This is because non-heteronormative identities are viewed are relegated to “parenthetical status” and proved to be marginal (Namaste, 1994, p.225)

Many transgender and gender nonconforming people do not have insurance, largely due to the fact that many people in this group are not employed which is likely due to employment discrimination. Therefore, a large portion of this group does not have access to medical care.

Those who do have insurance are typically denied coverage for gender affirming medical conditions because these conditions are considered pre-existing, cosmetic or medically unnecessary. The barrier to access leads individuals to pay out of pocket for procedures, and buy hormones illegally. It also leads to increased rates of depression, suicidality, self-injury and suicide for this group. Finally, there is a lack of trained healthcare providers attuned to the needs of the transgender or gender non-conforming people. Physicians typically cannot provide competent or sensitive care leading many transgender people to travel long distances to get care from appropriate physicians, pay out of pocket for competent professions, or even postpone healthcare altogether (Hughto, Resiner, & Pachankis, 2015).

It has been well established that there is no biological basis to racism. That is, people are not biologically superior or inferior on the basis of biology or genetics. However, that does not mean that race does not play a significant role in people’s lives. Race is a social construct that influences all aspects of American culture. Race and the racial contract influenced the way this country was created and permeates our macro, mezzo, and micro structures to this day (Miller & Garran, Chapter 4, 2017). Critical Race Theory argues that although these biological underpinnings do not exist, people are still categorized and stereotyped according to observable physical characteristics based on race. This separation and segregation has a profound influence on a person’s life chances and trajectory (Abrams & Moio, 2009).

Institutional racism refers to the way that different institutions and systems in society work together to create and maintain inequalities and maintain white supremacy. There are many examples of ways that systems work to privilege dominant groups and oppress subordinate groups, but one of the most sinister and disturbing is structural racism in health services. Racism in health services can be observed in the macro, mezzo and micro level. People of color have less access to health insurance than whites and less access to health services. A lack of insurance can be attributed to structural discrimination in employment among other barriers. Beyond that, people of color are more likely to be misdiagnosed and less likely to have necessary medical testing, more likely to be subjected to invasive surgery, and less likely to be treated adequately for pain. Much of the difference of experience in health settings by people of color can be attributed to unexamined and unacknowledged racism by health professionals (Miller & Garran, Chapter 4, 2017). Although race may not attribute to differences in biology and genetics, the social construction of race in the US and how it is embedded in our health systems creates real and undeniable risks and difference. Therefore, it is crucial for the profession of social work to understand and respond to the way that racism plays out in our society and for our clients.

One of the basic tenets of Critical Race Theory calls for the creating of counter narratives. By giving voice to people of color who have been routinely denied the chance to share their perspective, it works to simultaneously empower individuals and challenge ideas of color blindness, neutrality, and universal truths (Abrams & Moio, 2009). This is incredibly important in social work practice. Social workers will undoubtedly serve clients who have been negatively impacted by racism in the U.S. Therefore, it is their duty and obligation to allow their clients to tell their experiences in their own words without challenging their beliefs and realities. Minority groups, due to institutional racism, are often mandated to treatment and many times subjected to working with a white social worker. This particular dyadic experience necessitates that the professional worker in the case understand the influence racism may have on their client’s life experience and current situation. It also requires the social worker to avoid engaging in color blindness and engage in conversations about race and racism in order to build an effective alliance and truly help the client. Without genuine regard for the client’s individual experience, the worker may not only miss the chance to help an individual client but also further contribute to their oppression (Sue et al, 2007).

Social workers in micro practice already have many of the tools to implement Critical Race Theory and challenge the dominate narrative. By eliciting information about the problem from the client’s point of view, providing emotional support and empathic responses, and being honest and genuine about their own social position, workers can engage in anti-oppressive practice (Abrams & Moio, 2009). In mezzo and macro level practice, social workers must bring attention to the invisible forces of power and privilege and allow for counter-narratives.

The concept of minority stress can be used to see how binary thinking affects the well-being of individuals who do not fit into categorical thinking. Minority stress theory discusses the process of categorization in which individuals develop self-worth and self-identity through interactions and intergroup processes. If an individual does not fit into established heteronormative categories of sexuality and gender, it is likely that they will experience negative evaluation from others in the group. Prejudice and discrimination derived from the experience of not fitting into established categories is extremely damaging because human beings evaluate themselves through their relationships to others. This alienation leads to psychological distress and health consequences for people who do not fit into dominant categories (Meyer, 2003). However, in-group cohesiveness and solidarity found in places like the LGBTQ center can act as a protective factor for minority members and lessen stress (Meyer, 2003).

Gender Dysphoria is a classification found in the DSM-V that is used to describe the discomfort that arises when a person’s assigned sex at birth does not fit with their gender identity (Roberts & Fantz, 2014). According to the Minority Stress Theory, minority people, including those with a diagnosis of Gender Dysphoria, experience stress based on their social position that is beyond life stress. The experience of discrimination and devaluation by society alone is incredibly psychologically distressing, but they also experience structural discrimination. Therefore, adverse mental health for individuals with Gender Dysphoria is likely, if not expected (Meyer, 2003). However, the change in the DSM-V from Gender Identity Disorder to Gender Dysphoria aims to destigmatize gender non-conforming or transgender people. There is reason to believe that this new diagnosis, that aims to remove pathology from the individual who does not fit into the gender binary, has the ability to reduce stigma, and in turn, reduce stress and poor mental health outcomes in this group (Roberts & Fantz, 2014).

Jacque Derrida, in his perspective on poststructuralism, would use the concept of supplementary to describe how cisgender and heterosexual people need gender non-conforming, transgender, homosexual, queer, and bisexual people for their existence. His argument is what appears to be outside of a system is what is already inside of it, and what appears to be natural is what is historical. In terms of gender, a cisgender person is perceived to be natural because it has been the historical way that gender expression has been understood. However, in order for the cisgender person to exist there must be the existence of gender non-conforming or transgender people. In that way, our societal understanding already includes gender nonconforming and transgender people outside of the traditional categories of gender because it needs those to define the norm of cisgender. This system of definitions and interpretations by presence and absence lead to binary oppositions and categorical understandings of sexuality and gender (Namaste, 1994).

Gender Dysphoria illuminates the poststructuralist idea of the social production of identities. For example, the social discourse around homosexuality and its inclusion in judicial, medical, and psychiatric circles, led to social controls for this group, but eventually allowed this group to use this category to define itself and speak on its own behalf. This led to demands for inclusion and legitimacy. The argument could be used for gender non-conforming people today. The recent proliferation of discourse around gender non-conforming and transgender people, although these identities have always existed, have created new social definitions. Gender Dysphoria, with its updated and de-stigmatized definition in the DSM-V, is an example of how the social world can create new understandings and definitions of identity and that our language and beliefs are influenced by the social world (Namaste, 1994).

In her interview on The Out List, Wanda Sykes presents her individual experience as a black, Christian, gay woman of celebrity status. Focusing on Wanda’s intersectional identity rather than essentializing her experience to one aspect of her identity such as race, gives the audience the chance to fully understand the complexity of her identity and the ways in which she has experienced privilege and oppression (Abrams & Moio, 2009). Wanda seems to express that her race and sexual orientation have a stronger transparency than other aspects of her identity such as her gender. This is most likely due to the fact that Wanda has experienced the most marginalization based on these statuses (Croteau, Talbot, Lance & Evans, 2002).

It could be argued that Wanda has privilege by identifying as a Christian. However, Wanda experienced a degree of internal strife because same sex relationships are sanctioned in the Christian Church. Wanda also notes that the African American community has been deeply influenced by the Christian Church hinting at historical underpinnings of the experience of African American people in the U.S. Her identity as a black gay woman today must be understood in the historical context of race in American society. Wanda’s celebrity status is a way that she experiences privilege. There is an assumption of some degree of economic security and acceptance that comes along with fame. Wanda likely has been able to find a group that affirms her identity and values her, reducing minority stress (Meyer, 2003). However, her celebrity privilege was complicated by race in Wanda’s coming out experience. There is an argument that the LGBTQ movement has historically focused on white middle-class individuals. Therefore, being a black woman who was openly out as gay meant something different for Wanda.

Although there was a degree of privilege in Wanda’s celebrity status it was influenced by her marginalized statuses as well. Wanda discusses the experience of being chastised by audience members who expect her to be a vocal advocate for gay rights in her comedy routine. These comments are arguably a microaggression because they make the assumption that Wanda, as a black gay woman of celebrity status, should be performing her advocacy role in a certain way and invalidating her experience of advocacy through her creation of a counter-narrative.

Wanda’s heart wrenching retelling of the rejection she experienced when she first expressed her attraction to women fits squarely into the second wave feminism mantra “the personal is political.” Wanda’s experiences of being rejected and told that her sexual orientation was not acceptable were mirrored in the social structures. Wanda grew up in a time where same sex relationships were not legally permitted or religiously sanctioned. The reciprocal nature between her individual experiences and the systems she interacted with sent the message that her attraction to women was not allowed. Again, Wanda’s experience was not only influenced by her gender and sexual orientation, but also her race. Wanda’s narrative, that conveys her intersectional identity and unique experience, is also demonstrative of third wave feminism. Third wave feminism, with its influence from women of color, focused on how gender cannot be understood alone, but must be understood in the context of other identities (Samuels, 2008).

In her narrative on The Out List and in her comedy performances, Wanda creates a counter-narrative. She powerfully speaks of her relationship with her wife and their family and thereby challenges dominant ideas about relationships and families. By creating a counter-narrative, Wanda challenges categorizations around sexuality and gender. In revealing intimate details about her relationship with her wife, she veers the discourse around gender roles in the family and heteronormative sexuality. By doing this, Wanda creates a space where people who do not fit into the binary can find representation and a picture of what their life could look like.

References

1. Abrams, L. S., & Moio, J. (2009). Critical race theory and the cultural competence dilemma in social work education. Journal of Social Work Education, 45(2), 245-262.
2. Bowleg, Lisa. (2012). The problem with the phrase women and minorities: Intersectionality— an important theoretical framework for public health. American Journal of Public Health, 102(7), 1267-1273.
3. Croteau, J. M., Talbot, D. M., Lance, T. S., & Evans, N. J. (2002). A qualitative study of the interplay between privilege and oppression. Journal of Multicultural Counseling and Development, 30, 239-258.
4. Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222-231
5. Meyer, I. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674– 697
6. Miller, J., & Garran, A. M. Chapter 4. The web of institutional racism
7. Miller, J., & Garran, A. M. Chapter 5. Why Is It So Difficult for People with Privilege to See Racism?
8. Namaste, K. (1994). The politics of inside/out: Queer theory, post-structuralism, and a sociological approach to sexuality Sociological Theory, 12(2), 220-231.
9. Roberts, T. K., & Fantz, C. R. (2014). Barriers to quality health care for the transgender population. Clinical Biochemistry, 47(10), 983-987.
10. Samuels, G. M., & Ross-Sheriff, F. (2008). Identity, oppression, and power: Feminisms and intersectionality theory. Affilia, 23(1), 5-9.
11. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., Esquilin, M. (2007). Racial micro-aggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271-286.

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