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The color of success: African American and Japanese American physicians in Los Angeles

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The color of success: African American and Japanese American physicians in Los Angeles

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THE COLOR OF SUCCESS:

AFRICAN AMERICAN AND JAPANESE

AMERICAN PHYSICIANS IN LOS ANGELES

by

Melissa Komeno Fujiwara

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIOLOGY)

May 2012

Copyright 2012 Melissa Komeno Fujiwara
ii
DEDICATION

For my parents:
Thomas and Yetsuko Fujiwara, who inspired my critical sociological lens.

For the three most supportive loves of my life:
My daughters Makela and Miya Fujiwara and my partner Aaron Hollenbaugh,
Without each one of you, this would mean nothing. Thank you for everything.
iii
ACKNOWLEDGEMENTS

As many could attest, writing a dissertation can be a long and laborious task and
trying on everyone around the dissertator! I am thankful to many who helped me see this
dissertation to the end.
First and foremost, without the generous time lent by the physicians whose life
stories fill these pages, this dissertation would never have come to life. I sincerely thank
and appreciate each of the physicians who took significant amounts of time out of their
very busy and pressing schedules to share their invaluable personal experiences and
insights. I truly enjoyed our interviews and hope that I do justice to the stories you all
shared with me.
Having two children while a graduate student lent to a very non-traditional
graduate school trajectory. I am immensely grateful that I carried out my graduate
studies under the advisement of a committee chair that supported my personal priorities
and allowed me to achieve a professional aspiration on a timeline that concurrently
enabled me to carryout my own personal priorities.
I will always remember a conversation with my chair, Leland Saito, when my first
daughter was still a young baby. We were discussing my timeline to my qualifying
exams and, sensing my anxiety about balancing two time sensitive needs in my life—
completing my PhD program in a timely manner and wanting and needing to be present,
engaged and involved with my first born daughter—he said something along the lines of,
“You know, geez, your quals will get done. I know you will finish them. But I’d hate for
years down the line for you to regretfully think back and say, ‘I missed some important
iv
milestones in her life because I was studying for quals.” Leland really captured what was
and continues to be most important to me and allowed me to follow my heart and what
matters most to me without feeling the guilt that many women professionals constantly
face as they make sacrifices in their careers or their family lives. I will forever be
grateful that Leland allowed me to carve out my own unique path that fit my goals and
priorities. His words always carried me through the dissertation writing stages as that
guilt sometimes crept in on both ends, and I’m sure it will continue to sustain my
decisions as I embark on very new terrain for me when I move on to build a professional
career. With all sincerity, thank you Leland for this great gift.
Mike Messner and George Sanchez, additional members on my dissertation
committee were equally supportive of my dual needs as mother. They never questioned
or scrutinized me for my choices; yet always provided the most valuable feedback to help
me push my work to be the best that it could be. I am thankful to Mike Messner for the
amount of time he spent introducing and guiding me through the race and gender
scholarship as I searched to find the right project. I first had the privilege of being a part
of George Sanchez’ brilliance during the Irvine Foundation’s Summer Dissertation
Workshop. His insights have always taken my work to better places and have always
provided critical feedback, guidance, and mentorship from a purely positive and
encouraging place. I felt great comfort that I could always turn to him for advice
whenever in doubt.
Writing a dissertation is never a solo endeavor, but I probably carried out my
graduate studies in almost the most secluded way possible! Nonetheless, in my early
v
years as a graduate student I met a handful of people who provided support and
sustenance through those difficult times that surely most graduate students encounter.
Belinda Lum, Michelle Stewart Thomas, Karen Yonemoto, James Thing, James
McKeever and Lara Murti: You each provided collegial support, but more important,
we’ve also shared friendship and laughter. Tim Biblarz provided unparalleled
mentorship in my earliest graduate student years that I continue to feel extremely
thankful for. Anyone that has Tim as a teacher will experience an extremely devoted and
giving mentor.
I am very grateful to my family of origin, Genelle Gaudinez, and Dr. Kari
Yoshimura for instilling and supporting me through my dissertation and much, much
more.
To my parents, Thomas and Yetsuko Fujiwara, I am grateful for the support and
encouragement that you always extended to me as I struggled to figure out how to
prioritize and balance my graduate work with being a mom. I thank you for opening my
eyes at such a young age to the injustices that can happen simply due to the arbitrariness
of one’s ethnic/racial background. Interned as young children to Mazanar, California and
Santa Anita Racetrack, then Amache, Colorado, I felt through both of you what yellow
peril meant, while also witnessing contradictory model minority depictions that did not fit
our lives. Your hardships encouraged and inspired me to want to do something that
would interrogate social inequalities. I can’t thank you enough for the love you have
shown to Makela, Miya, and Aaron which has provided a source of support as I worked
my way through so many years of school! To my siblings and their families, Mitchell
vi
Fujiwara, Cheryl Dennison, Brittany Paulson, and Maxi Fujiwara; Mark Fujiwara, Simin
Nasiri and Ashkan Nasiri; and Lynn Fujiwara, Steve Morozumi, Kyra Ioppolo, Joanna
Fujiwara-Morozumi and Martin Fujiwara-Morozumi, I thank you for the moments of
laughter and happiness we have shared. To my cousins Beth Asamen and Tim Asamen,
thank you both for providing a source of happiness, humor and genuine care. It has really
uplifted and helped me much more than you might know!
Genelle, we met in graduate school, but I am so happy that our friendship grew
into so much more. Present for the birth of both of my daughters, I could never thank
you enough for always being there. You know and understand me and have cared about
my family, and I could never thank you enough for that. I admire your courage,
confidence, honesty and loyalty. You are truly a best friend.
Kari Yoshimura, I could never thank you enough for all that you have done for
me. I am very certain that without the guidance, support, care, nurturing, honest insights,
and the continual encouraging support you show me, this dissertation would never have
been completed nor would I experience the joys that I do with Aaron, Makela and Miya.
I am so truly, beyond words, thankful for all that you have taught and shown me about
what is important in life. I am truly thankful that you were there for me as I went through
numerous life transitions and transformations just in the time that this dissertation was
written. No one out there could ever help me more than you already have. Thank you for
everything.
To my partner, best friend and co-parent, Aaron Hollenbaugh, your unending
support also sustained me and kept me going as I slowly worked away on this
vii
dissertation. I am beyond appreciative that you have sacrificed and compromised so
much to enable me to get my PhD while being the kind of mom that I want to be. I love
our family and we would not be who we are without you. Since we met, you have always
shown me nothing but deeply unconditional and genuine love and support. Who knew
when we met as practically children ourselves nineteen years ago, that we would have
created our current lives! We share history and so much more. Together we earned
PhDs and together we share the journey of parenthood. No matter what we are doing or
what we do, I know we will find enjoyment, fulfillment and happiness if we do it
together. I hope that the next nineteen years will lead to just as much excitement,
accomplishment and love for us. There really is no one else I would rather go through
life with. Thank you for everything.
To my amazing, beautiful, smart, funny, sensitive, witty, bright and loving little
girls. Makela Yetsuko Fujiwara and Miya Kiyoko Fujiwara. Above all else, I am
“infinity” grateful that you two came into my life. You both push me to be better than I
ever thought I could be just out of my deep hope for you two to always have the best of
everything, if not for fear of a lecture from you that I could do better! You two are truly
amazing and I love living life with you two! I cannot wait to see what the future has in
store for you! I love you three with all my heart and soul, infinity times, and feel
thankful every day that you are my family and that we shared the journey of this
dissertation together.
viii
TABLE OF CONTENTS

Dedication ii

Acknowledgements iii

List of Tables ix

Abstract x

Chapter 1: Introduction 1

Chapter 2: More Than Meets the Eye: Moving beyond the notion that racism
is tangible barrier 39

Chapter 3: Race Work Outside the Double Doors: The private lives of
African American and Japanese American physicians 82

Chapter 4: Race, Mobility and Medicine: The work lives of African
American and Japanese American physicians 153

Chapter 5: ‘Know Your Place’: The confinements of race and gender for
African American and Japanese American female and African
American male physicians 226

Chapter 6: Conclusion 290

Bibliography 311
ix
LIST OF TABLES

Table 1: Physicians by Gender and Race, 2008 157

Table 2: Medical School Graduates by Race and Gender, 2010 264
x
ABSTRACT

This dissertation responds to colorblind ideology that treats race as an
insignificant human characteristic or trait that no longer carries any real meaning or
bearing on people’s lives and life chances. It also responds to a tendency in the sociology
of race literature to utilize quantitative findings of socioeconomic achievement as the
measure for racial equality. Following Bonilla-Sliva (2003b:3), I contend that in this
colorblind era, racial inequality is accomplished through covert behaviors more
frequently than the overtly discriminatory practices of the past.
Through in-depth interviews with African American and Japanese American
physicians practicing in Los Angeles, I inquired about professional and personal
experiences related to their race and gender status. Studying physicians also allowed me
to test the notion that socioeconomic success represents an overcoming of racial barriers
and racially antagonistic attitudes.
Contrary to what many assimilationist arguments profess, I show, through both
mundane and dramatic examples, that despite high levels of occupational prestige and
socioeconomic status, race remains a meaningful, significant and salient feature for
African American and Japanese American physicians both in and out of the office. The
racial microaggressions that African American physicians encounter pivot around themes
of inferiority for African Americans physicians and themes of citizenship for Japanese
American physicians. As differentially racialized, these two groups also differ somewhat
in their perceptions about the nature of race in America. These physicians describe what
I call “race work,” where they negotiate an increased amount interactional pressures that
xi
emerge from their racial and gendered statuses. The emotional labor of maintaining a
particular racial consciousness and the ghostly remains of racial pasts create additional
layers of race work that, as racialized minorities, these physicians must contend with
daily.
I find that gender also plays quite an important role in mediating the life
experiences of these physicians. The unique intersection between race and gender led to
highly contrasting personal and professional experiences between the African American
and Japanese American women physicians and their male counterparts. The women of
color physicians described disproportionate amount of family labor, which intrudes and
impact upon their career development beginning with choosing specialty and extending
all the way to managing and maintaining practices and advancement.
Similarly, the African American male physicians described severe limitations in
their private and professional lives that differed distinctly from the descriptions of the
other physicians. Indeed, the African American male physicians shared an abundance of
racial encounters that included bullying and the policing and social control of their lives,
personally and professionally. I show how the social construction of Black masculinity
forces these physicians to “take low,” or swallow, stonewall, and suppress, the anger,
frustration, and humiliation that arises in the face of these continual confrontations.
In all, the lived experiences of the African American and Japanese American
physicians in this study exemplify that the portrait of the United States as a “colorblind”
society is not reality.
1
CHAPTER 1:
INTRODUCTION

On November 3, 2008, Americans witnessed history in the making with the
election of Barack Obama as the first African American President of the United States.
All forty-three previous Presidents of the United States have been white men.
Undoubtedly, no other position in the U.S. carries as much status and prominence in most
American minds than that of Commander-In-Chief. As such, this truly was an epic and
historic moment for all Americans and the election of a Black man to this position led
many to claim that it represented the end of antagonistic and unequal race relations; a
vigorous discussion has since ensued relating to the complex meaning of Obama’s
election and its larger meaning (Teasley and Ikard 2010; Võ 2010). It seems that many
Americans were eager to proclaim the achievement of racial justice immediately
following the election of President Obama to the highest position in American politics.
In response to this monumental moment, President Bush claimed that “[a] lot of people in
America did not think they’d ever see an African American President,” but Obama’s
election “renewed faith in the system” (Hackett and Westfall 2008). Yet, while President
Obama did achieve a title and level of attainment and success that only an elite few
experience, his racial background continues to provide a source and vehicle for the
constant scrutiny of his decisions, actions, and legitimacy, unlike the realities of his white
predecessors; thus, a real and serious indication that eager claims speaking to the
“unending magic and sense of justice of our country” were miscalculated and premature
(Noonan 2009, cited in Pettigrew (2009)).
2
While many Americans were patting themselves on the back for the nation’s so-
called triumph against a shameful racial past, racist sentiments were bubbling up all over
the place. Drawing on Oliver and Shapiro’s (1995) concept “sedimentation of
inequality,” Saito emphasizes that even seemingly race-neutral practices are predisposed
and shaped by previous racial politics and societal ideologies and can also lead to
racialized outcomes (Saito 2009). In his analysis of Obama’s victory, Pettigrew
(2009:286) illuminates the inconsistencies:
Cross-burnings, threats, intimidation, and racist graffiti proliferated across the
nation but typically did not receive nationwide publicity. In New York, a Black
teenager was assaulted by bat-wielding White men shouting, “Obama.” School
children on a bus in Idaho chanted “assassinate Obama”; and, on election night, a
Black church in Massachusetts was burned in a suspicious fire. The Secret
Service reported that there had been more threats on Obama’s life than for any
previous president-elect.

Even educated liberals, often regarded as advocates and champions of racial equality,
invoked anti-Black racist imagery to undermine President Obama during the campaign.
For example,
Two highly-ranked staff members [from Hilary Clinton’s primary campaign]
accused Obama of having been a drug dealer in Chicago in an attempt to arouse
White fears of the ghetto criminal. Her staff leaked a photograph of Obama in
Somalian garb to further the fiction that he was a Muslim. Her husband, the
former President, implied that Obama was only a marginal Black candidate like
Jesse Jackson—who is perceived by many White Southerners as a threatening
Black leader (Pettigrew 2009:286).

Thus, President Obama’s personal victory as the first African American President
exposes a prevailing contradictory, although subtle, racial dynamic inherent in
contemporary, post-civil rights colorblind America that imagines a society beyond race
(Winant 2001). This contradictory, yet subtle dynamic is the focus of this dissertation.
3
The “sincere fictions” (Feagin and Vera 1994) of many white Americans coupled
with “the new racism” (aka colorblind racism) (Bonilla-Silva 2001:90), that defines our
post-civil rights era (Bonilla-Silva 2003b), helps to explain what Memmi (2000, cited in
Bonilla-Silva (2003b):1) describes as “a strange kind of enigma associated with the
problem of racism.” A colorblind world is replete with “racism without racists” (Bonilla-
Silva 2003b:29) because, as the misappropriated neoconservative saying goes, “I don’t
see color, I only see people.” In our racially complex society, “No one, or almost no one,
wishes to see themselves as racist; still, racism persists, real and tenacious” (Memmi
2000, cited in Bonilla-Silva (2003b):1). Indeed, many Americans are eager to put our
collective racial pasts behind us and the election of the country’s first Black President
along with other socioeconomic achievements by racial minorities have fueled increasing
claims that race is no longer a salient feature of American life. In this dissertation I
question these assumptions and ask: 1) Do lived experiences contradict colorblind
ideology, and if so, how? More specifically, how is racism expressed, communicated
and conveyed in this post-racial colorblind era? 2) Does socioeconomic success
signify a transcendence of racial problems? 3) Do gender ideologies intersect with
race to lead to qualitatively different life experiences and outcomes?

Background and Research Context

Over three decades ago in The declining significance of race : Blacks and
changing American institutions, William Julius Wilson argued that “[r]ace relations in
America have undergone fundamental changes in recent years, so much so that now the
4
life chances of individual blacks have more to do with their economic class position than
with their day-to-day encounters with whites” (1980:1). Wilson
1
asserts that a
fundamental shift in the state’s agenda from promoting racial inequality to promoting
racial equality is what really differentiates the more recent modern industrial stage of
race relations from the previous pre-industrial and industrial stages of race relations.
Indeed, Wilson believes that “[r]acial oppression was deliberate, overt, and…easily
documented, ranging from slavery to segregation” during the antebellum period all the
way through the first half of the twentieth century (1980:1). Racial oppression during
these eras was explicit and tangible. In this vein, the elimination of Jim Crow laws and
the application of Affirmative Action marked key changes in governmental policies that
represented a dynamic, purpose-driven transition within the government that led to the
decreased importance of race in the everyday lives of Blacks and other disadvantaged
minorities (cf. Johnson 1965). “The problem for Blacks today, in terms of government
practices, is no longer one of legalized racial inequality.” (Wilson 1980:19). While
Wilson acknowledges that it would be “shortsighted” to claim that the “traditional forms
of racial segregation and discrimination [have] essentially disappeared in contemporary
America,” his argument implies that race no longer plays a fundamental role in shaping
or structuring the lives of Blacks and other racial minorities because racial oppression is
no longer “deliberate, overt, and easily documented” as in the slavery and segregation

1
It is important to recognize that Wilson explains that while he does contend that American race relations
have moved from a system primarily characterized by racial oppression to one in which class subordination
is key to explaining the positionality of “underclass” African Americans, he does not “mean to suggest that
racial conflicts have disappeared or have even been substantially reduced” (Wilson 1980:23).
5
time periods (1980:1). This sort of logic helped fuel the notion that upward mobility or
socioeconomic attainment signifies a loosening of racial restrictions.
Journalistic and scholarly accounts of Asian American socioeconomic success as
well as the growth of the Black middle class are used to support myths of American
egalitarianism, assimilation, and attitudes about racial progress. There is a tendency in
the sociology of race literature to concentrate on material indicators of well-being
(ranging from variables such as education, income and occupation as well as rates of
racial intermarriage) as evidence of the presence or absence of racism (Alba and Nee
2003; Wilson 1980). For example, Alba and Nee (2003) contend that certain Asian
American ethnic groups now constitute a collective composite culture, making them part
of what defines the mainstream. Their primary evidence for this is based on various
quantitative measures such as: language, socioeconomic attainment, spatial assimilation
and social relations including intermarriage. Further, in a fairly recent article, Kaba
contends that African American women “are gradually becoming a model minority too”
(Kaba 2008:309). While acknowledging that African American women still lag in
various social and economic indicators, Kaba cites other quantifiable measures such as
“the relatively high college enrollment and degree attainment rates for Black women,”
the finding that “proportionally, fewer Black females than Black males, white males and
white females commit suicide,” the finding that a “higher proportion of Black women are
100 years and over, compared to Black males and whites,” as well as a few other
measurements (309). However, pointing to various quantitative measures as evidence of
whether or not a group has been able to ‘overcome’ racial disadvantage is troublesome
6
because racism can persist even in the face of ‘having made it.’ Further, the full scope of
racial meaning and salience cannot be entirely captured by quantitative analyses only.
I will show that race continues to play a central and salient role in Americans’
lives, but has been obfuscated by colorblind ideology as well as the inaccurate tendency
to equate socioeconomic status with racial equality. Thus, in order to theorize a full
understanding of the ways race maintains meaning and inequality, we need a closer
examination of the covert and subtle ways that race continues to play out in our lives as
Americans. Indeed, in a period where we, as a nation, have witnessed increasing levels
of mobility among professionals of color—as evidenced by the swearing-in of our first
African American President, a growing Black middle class, and well documented
socioeconomic gains by East Asians, particularly Chinese and Japanese Americans—we
need to understand the less obvious and micro-level functions of race and racial
inequality. While the measurable disparities represented in quantitative studies are also
essential to a complete understanding of the ways that race remains salient in our lives,
subtle and micro level interactive processes through which racial inequality is produced
and maintained have gained importance, in this colorblind era where racial inequality “is
no longer accomplished through overtly discriminatory practices…[but through] “covert
behaviors” (Bonilla-Silva 2003b:3).
C. Wright Mills (1959:3) states, “[n]either the life of an individual nor the history
of a society can be understood without understanding both.” This dissertation seeks to do
both by revealing and connecting the dialectical exchange between the structural and
cultural / ideological constituents of race and racism. Indeed, it needs to be more widely
7
recognized that, “…racism is much more subtle, elusive, and widespread than
sociologists have acknowledged” (see also Pettigrew 2004; Wellman 1993:xi).
Formal and legalized forms of racism may no longer intervene in this post-civil
rights, color-blind era, but informal racist or at least racially biased patterns, routines,
interactions, sensibilities, etc. abound. I argue that these seemingly random “individual”
experiences are in themselves institutionalized and systematic as they are driven by
hegemonic racial ideology that privileges and reveres whiteness. The insult from the
grocer, and the slight by the banker, the ‘look’ of a stranger—are not random—but are
linked, accumulate and operate under a dominant frame of white supremacy. I contend
that it is the subtleness, elusiveness, insidiousness, and pervasiveness of the way racism
lingers and intervenes as a part of everyday life that makes race a uniquely powerful and
significant aspect of individual and institutional life. It is my hope that an examination of
the micro-level interactions through which race continues to remain salient in this
colorblind era, will add to our understanding of the “structural regime that is everyday
racism” (Feagin and McKinney 2003:18).

METHODOLOGY
In order to accomplish the above stated goals, this dissertation qualitatively
examines the private and public experiences of African American and Japanese American
physicians practicing in Los Angles.
2
Physicians provided a sound sample because it is

2
My sense is that by focusing on people situated in the middle-class or higher, helps to control for the
possibility that some of my findings will be spurious due to class factors. If I were to study working class
or poor people of color there is the chance that the race-related emotional traumas that I may uncover might
actually be due to their class location, or intersection of the two. I feel as though concentrating on those
8
people from these echelons of society that are used as the model of success and triumph
over racial injustice; their success in part signifies the complexity of contemporary race
relations. Indeed, doctors are regarded as high status professionals, whom many would
expect to have fully achieved the “American Dream,” and no longer encounter race
related problems. It is often assumed that to reach career success in a field like medicine
people must have evaluated and made judgments about you; therefore, the fact that you
were able to move forward indicates that racial barriers preventing mobility must have
been minimal. This sort of premature assumption misses the very subtle micro level
interactions that transpire in very opaque ways, often noticeable and obvious only to the
trained eye (read: racial minorities who are acutely aware of the cues and codes) which,
signifies at the very least a continuing racial taxonomy that centers and privileges
whiteness.
I chose to focus on these two racial/ethnic groups because they in a sense are
located on two opposite ends of the racial hierarchy – one typically thought of as the
underclass, and the other as the model minority, sometimes posited as being in superior
positions than even whites. I also argue that these two groups are racialized along very
different axes of oppression (Ancheta 1998; Kim 1999); this contrast adds compelling
aspect to my final analysis. To this end, only second generation and beyond Japanese
Americans and African Americans were included in this study. I chose to limit my
sample along generational lines for the following reasons: 1) A large portion of the
scholarly work on Asian Americans focuses on immigrant and second generation

who are seen to be of high status and financially secure, maximizes my chance of finding purely race
related problems.
9
experiences including levels of incorporation, adaptation, and assimilation into American
life (Zhou 1997); 2) Including immigrants could cause my findings to overlap with other
factors, such as language barriers and anti-immigrant sentiment; 3) I wanted to capture
experiences and feelings about race and belonging from those who grew up under the
American system of race relations. My sense is that the attitudes, perspectives, and
interpretations of racial exclusion among immigrants may differ from older generation
Asian/Japanese Americans who only know the U.S. as their home.
3
Similarly, Black
immigrants are likely to have a different understanding and relationship with American
racial hierarchies. A racially comparative study allowed me to investigate the potentially
divergent impact of, as well as the ways in which race and racism is experienced, made
sense of, and coped with, thereby allowing for a more informed analysis and
understanding of the continuing importance of race in American life.

In Depth Interviews

I conducted thirty-one semi-structured in-depth interviews with African American
and Japanese American physicians. I began recruiting participants by contacting various
professional associations and those with ethnic affiliations in Los Angeles. When I
eventually got in touch with physicians through these channels, I recruited them to
participate, and many accepted. Initially I believed it would be very difficult to get

3
In fact, important generational differences among Asian American professionals were noted by Min and
Kim (2000) who find that none of the immigrants in their study expressed psychological turmoil over their
developing racial identities, whereas this made up the bulk of the content of the 1.5 and second-generation
essays. Further while the immigrant generation of this study was more likely to hold racist views of
African Americans and Latinos, many of the second-generation essayists identified more with African
Americans and Latinos than whites.
10
physicians to agree to in-depth interviews given their busy schedules, yet I was surprised
at how willing those physicians I asked were to join the project. After conducting the
initial interviews gained through physicians’ professional and ethnic organizations, I
asked interviewees if they knew of any other physicians who might be willing to speak to
me. This snowball sampling technique proved effective, and again I found I was
receiving great leads from the physicians I interviewed. Interviews lasted an average of
one-hour and ten minutes and all interviewees were asked to complete an information
sheet to collect general demographic characteristics. Names, institutions and other
identifying information have been changed to protect the identity of the physicians.

Other Methodological Issues: Feminist Epistemology
The methodology of this dissertation rests on the idea that lived experiences grant
a standpoint based on situated knowledge (Haraway 1988; Smith 1990). Standpoint
epistemologies within race, class and gender scholarship reject universalistic tendencies
that privilege either men or white women and strive to center the unique and multiple
angles of vision that lived existences offer (Collins 1986; 2000a). While standpoint
epistemologies challenge the notion of a rational, objective, scientific and value-free
empiricism, feminist of color standpoint theorists further argue that their positionality
within multiple hierarchies grant them “less false” knowledge about the conditions and
realities of racialized women (Harding 1991; Hartsock 1983).
For example, “playing the race card” became a common catchphrase during and
since the O.J. Simpson trial (Higginbotham, Francois, and Yueh 1997) as whites were
11
unable to fathom that race could have been a motivating factor in unsavory behavior from
Fuhrman and other law enforcement agents connected to the high profile case. There is
such a significant disconnect between whites and non-whites’ perceptions of the presence
or absence of contemporary racism. For example, a 2009 Gallup (2009) poll found that
while forty nine percent of whites believe racism against Blacks is widespread, forty six
percent of whites believe racism against whites is also widespread. Seventy-two percent
of African American respondents on the other hand believed racism against Blacks was
widespread, while only 39 percent thought racism against whites was widespread (Gallup
2009). People of color experience a very different racial reality, which is further
distinguished along specific ethnic and racial lines based on personal and community
lived experiences as racial subordinates (Waters 1990). Therefore, recognizing and
accepting the significance and value of lived experience, especially the centrality of one’s
personal, familial and community history is essential for a full appreciation of the
intricate ways that race and racism differentiate the experiences, dynamics and processes
of being American. The unique standpoint of a racially marginalized positionality
(oftentimes within multiple hierarchies) arms people of color with “less false”
knowledge, and a particular level of authority, on racial matters in the U.S. (Harding
1991; Hartsock 1983).
Dr. Johns-Washington, an African American Psychiatrist who participated in this
project, explained that “she was sensitized to things” because she had so many
experiences and encounters with racism as a young girl, which provided her with an
informed ability to detect, see and believe in the existence of an unequal racial reality
12
even when it may not present in obvious forms. As Dr. Johns-Washington explains, it
doesn’t mean that “it [racism] isn’t going on,” but that others just don’t know how to
detect it because of their lack of first hand experience.
Dr. Johns-Washington’s husband, Dr. Parker adds his perspective:
‘…and I tell people, ‘you don’t understand it unless you live it…’ I mean, I’m
driving down the street and I know I’m fine. Black and white [police car] pulls in
behind me and I’m pulling in the review mirror and I don’t care how cool and
collected you are, my pulse starts to quicken. And it’s just from past experiences.
I mean when we were in junior high and you are hanging out and you’re standing
around and the police come by, ‘what are you guys doing out here?’ We’re out in
front of my house, ‘what do you think we’re doing out here?’ I mean, yeah, stop
hanging around…you were cautious, you were very cautious and the police
weren’t necessarily your friend.

As a Black male, Dr. Parker carries with him today, even as a highly respected and
accomplished General Surgeon, his past experiences with racial profiling, police and state
harassment and surveillance which undoubtedly arms Dr. Parker and other Black men
with an unmatched level of knowledge about the ways that race and racism can shape
one’s life chances.
Thus, standpoint epistemology frames the overall design of this dissertation.
Standpoint epistemology treats experience as the staring point (Denzin 1997); thus, it is
the everyday and often hidden experiences with race and racism, punctuated by gender
and class, that this dissertation is built around and seeks to illuminate by speaking
directly to the targets of racial subjectification.

13
REVIEW OF THE LITERATURE
Three sections organize this literature. I begin by addressing the “micro” /
”macro” split in the sociology of race literature because this dissertation aims to bridge
the structural and interactive elements of racial inequality. This is not intended to be an
exhaustive review, but rather a glimpse at the early scholarship—mostly during the
1940s, 1950s, and 1960s—that was influential in shaping the trajectory of the field. I
then address color-blind ideology since it is one of the primary discourses this
dissertation is responding to. Second, I provide a discussion of the sociological empirical
work that has explored the micro-level dynamics of race. Thirdly, I explore the work of
DuBois as a classical race scholar, and interdisciplinary scholarship that I draw on to
understand this understudied terrain.

Deconstructing Hegemonic Frames in the Sociology of Race Literature: Prejudice
Based Explanations and Color-Blind Racism

Stokely and Carmichael revolutionized the way many understood racial inequality
at the time. Prior to their theorization of “institutional racism,” racism was typically
regarded as an individualistic problem. Indeed, the earliest theorizing on race
inadequately engaged it only on an individual level, attributing racism to an a-structural
problem of individual prejudice (Pettigrew 1980a; Wellman 1993; Winant 2000). In this
vein U.S. racism was understood as a pathological aberration afflicting various
individuals in what was viewed as an otherwise healthy egalitarian society (Bettelheim
14
1949; Myrdal 1962 [1944]; Park 1950 [1928]).
4
Therefore, solutions to racial inequality
relied on curing irrational thoughts, behaviors, and perceptions of individual racists; thus,
education aimed at eliminating ignorance and prejudice was thought to be a wide scale
solution to race prejudice (Cole 1943; Haynes 1945; Marcson 1945; Thomas 1904).
Understanding race and racism in this limited frame was no doubt informed by
work in psychology, which emphasized prejudice on an interpersonal level in its analyses
of race relations. In fact, from 1944-1968, two psychological works
5
(Adorno 1950;
Allport 1954) were among “the most cited books” in the sociology of race literature
(Pettigrew 1980b:133). Ultimately this led some structural scholars (e.g. Wilson 1980) to
the point of almost “denying that racial oppression damages human beings” (Pettigrew
1980b:xxxii). While the structural intervention was essential to advancing our
understanding of the deeply systemic, thus the widespread and diffuse nature of racial
inequality, I maintain that it is also important not to lose sight of the micro level
implications within the structural social context. While it was imperative that we moved
beyond the kind of thinking that espoused racism as an individual pathological
aberration, rather than an ideological mainstream norm with deep roots in the institutions
and core structure of the society, we must not lose sight of the equally important reality
that subtle, mundane and ordinary interactions involving people of color also remain of

4
While Myrdal also indicated that the Black community’s economic and social conditions need to change
in order for them to advance, he principally envisioned assimilation as the means by which change would
occur.

5
Much of the psychological work on racism during this time understood racism as a byproduct of a
naturally occurring phenomenon affecting all individuals due to a propensity “to form generalizations,
concepts, categories” (Allport 1954:27). In this sense, “the nature of prejudice” is a product of the
“irrational categories” [attitudes, beliefs, generalizations, stereotypes] that particular individuals have
developed about members of an “out-group” (Allport 1954:27, 48).
15
central importance to a full awareness and understanding of race and racial inequality.
While it was essential for Americans to understand that racism and white supremacy
were the anchors of formal, legalized, de jure acts of discrimination in employment,
housing, education, etc., which in their legal forms were dismantled through various Civil
Rights legislation, it is equally essential to recognize that just because the
institutionalized state sanctioned forms of racial discrimination were undermined, that
does not serve as an indication that the racists ideologies that upheld all of those policies
for so long just vanished. My dissertation bridges the gap in the literature which has been
circumscribed by this “theoretical bifurcation” by linking structure with the personal
(Wellman 1993:5). At the same time, I expand on a conceptualization of institutional
racism by showing that what appears to be solely individual or random and dispersed
experiences with racism actually constitute a form of institutional racism in itself (Feagin
and McKinney 2003; Feagin and Sikes 1994). I will address the work of classical race,
post-colonial and intersectionality scholars in the final section of this review in order to
clarify how I will make sense of this understudied terrain. Next, I will briefly examine
the ideology of color-blindness because it is one of the primary racial discourses that my
study is responding to.

Color-Blind Racism

We live in an era where the racial order is largely perceived to be “’beyond race,
‘color-blind,’ multicultural, and post-racial (Bobo and Smith 1998; Bonilla-Silva 2003a;
Bonilla-Silva 2003b; Winant 2001:xiv). The core assumption of color-blindness is that
racial discrimination and inequality mostly dissolved with the passage of the civil rights
16
laws of the 1960s (D'Souza 1995; Thernstrom and Thernstrom 1997) to the point that we
are now “a country without race” (Sleeper 1997). Those who adopt this kind of thinking
claim that the (politically liberal) “voices of racial pessimism” perpetuate and maintain
racial divides by failing to acknowledge the great gains made toward racial harmony
(Thernstrom and Thernstrom 1997:16). Essentially, proponents of colorblind ideology
believe that US society is meritocratic; (Forman 2004); therefore, any remaining
struggles that Blacks, Latinos or other people of color continue to face are explained by
other factors such as maladaptive cultural patterns and behaviors (D'Souza 1995:24), the
inability of liberals to “let race go” (Sleeper 1997:182), social policies that are color-
conscious and not color-blind (Sleeper 1997; D'Souza 1995; Thernstrom and Thernstrom
1997:540), the inability of Blacks to acculturate (Jacoby 1998:539), and inadequacies in
“educational attainment, the structure of the Black family, and the rise in Black crime”
(Thernstrom and Thernstrom 1997:534).
Critiques of color-blindness articulate this ideology as a political maneuver to
undermine the efforts of anti-racism scholarship and activism by camouflaging their
arguments in a language of liberalism so as not to appear as racist while allowing the
persistence of seditious, institutional racism and discrimination in contemporary U.S.
society to flourish (Bonilla-Silva 2003b; Brown, Carnoy, Currie, Duster, Oppenheimer,
Shultz, and Wellman 2003). Color-blind racism obscures U.S. legacies of Western
colonization and exploitation, chattel slavery and genocide, white supremacy and
xenophobia as well as the continued organization of society along racial (and gender,
class, sexuality, etc.) lines. As Bonilla-Silva (2000) demonstrates, this racism-in-disguise
17
attitude in the current color-blind global racial order reinforces already deeply entrenched
systems of white, male, and class privilege. It is imperative for race scholars to intervene
in this politicized terrain of racial discourse by offering explanations that incorporate
agency and structure as well as other mutually constitutive structures of domination such
as gender and class, which is what my dissertation project aspires to accomplish.

EMPIRICAL SCHOLARSHIP ON THE MICRO-LEVEL DYNAMICS OF RACE

Empirically investigating the damages of racism, Essed calls attention to the ways
racism impairs the “everyday lives” of people of color. Essed’s (1991:3) concept
“everyday racism” elucidates the “systematic, recurrent, [and] familiar practices” by
which racism and tangible forms of discrimination disperse around us. One of the most
debilitating aspects of contemporary racism, which is grounded in color-blind discourses,
is that it is subtle and often appears to whites as ordinary, normal patterns of engagement,
which makes it even harder to identify (Pettigrew 2004). Most importantly, these are not
isolated acts; rather they accumulate: “some major, some minor—the cumulative effect of
which is the slow death of the psyche, the soul, and the persona” (Wing 1997:28). The
psychic costs are so great that Carmichael and Hamilton (1967:vii) defined success
within the Black community as not just having political and economic control but the
ability to “exercise control over our lives…psychically.” Due to the deep intersection of
class and race, investigating professional classes should provide an opportunity to look at
race without a dislocated class position clouding our conclusions.
Although not a study on the costs of racism, the classic “social-psychological
approach to class” by Sennett and Cobb, The Hidden Injuries of Class (1973:75),
18
illuminates the types of damages that accumulate as a result of occupying a marginal
class position, which might also lend useful parallels to my own end analysis of racially
marginal positionalities. The upwardly mobile, blue-collar white men in the study
expressed feeling caught between two worlds because they had successfully transcended
the poor class backgrounds of their childhoods; yet as mostly lower middle class and
manual labor workers, these men lacked the freedom and independence of higher-status
men. Very much in line with my own thinking about my project, Sennett and Cobb find
that on paper and in day-to-day interactions, these men appear to be doing well, but upon
closer examination they often feel disrespected, inadequate, generally dissatisfied,
powerless, vulnerable, and unprotected, culminating in what Sennett and Cobb term,
“troubled dignity.” These men, like other middle-class workers, strongly believed in the
ethos of individual meritocracy. They believed that it was their own individual ability
that propelled them forward; yet lacking true power and freedom in their blue-collar jobs,
these men continued to experience alienation from their labor and due to their
individualistic orientation, they internalized the class conflict, blaming themselves for
their “failure” to attain the type of occupation that would bestow true dignity. While their
discussion of alienation is grounded in a Marxian context, this concept may be helpful in
understanding the type of alienation that African and Asian American professionals
might experience as racial subordinates. Further, they argue that the alienation,
internalization of class conflict, and injured dignities all occur through insidious and
subtle patterns that are built into the structures of everyday life and the way in which
19
work and labor is organized. This finding helps to validate my own empirical
questioning of the subtlety and insidious by which racial subordination occurs.
Bonilla Silva argues that a central feature of colorblind racism is that racial
inequality is “no longer accomplished through overtly discriminatory practices”
(2003b:3). Rather, “covert behaviors,” which this dissertation explores in greater detail,
maintain an unequal and antagonist racial structure (Bonilla-Silva 2003b:3). For
example, as Bonilla Silva points out, racial segregation, which continues to be a social
problem is achieved more through “smiling face” discrimination than outright racist
policies and practices. I contend that unconscious prejudices and racist attitudes and
beliefs are a central source fueling these covert behaviors (which also explains why so
many Americans truly believe they are colorblind as if being colorblind is inherently a
good thing).
Social psychologists, through their experimental research methods, have made
needed and compelling theoretical connections between the collective ideologies of
people and patterns of racial inequities that empirical researchers document in sociology.
Dovidio (2002) suggests that the shifting nature of racism since the civil rights movement
has fostered mistrust and misunderstanding among people of color and whites rooted in
differential lived experiences and the subtle nature of contemporary discrimination. In
contemporary U.S., racial prejudice is much more unconscious, colorblind to use Bonilla-
Silva’s terminology, originating partly in the systemic patterns of differential cultural
representations or stereotypes of racial groups in the US. Social Psychologists argue that
these stereotypes unconsciously shape people’s perceptions and actions towards others.
20
For example, stereotypes about Black criminality may cause whites to unconsciously feel
anxiety and uncertainty about African Americans in certain circumstances, which may
cause them to do things like clutch their purse when passing by an African American
person. However, they may be completely unaware of these feelings and behaviors
(Dovidio and Gaertner 2002). Dovidio refers to much of contemporary racism as
“aversive racism” because he contends the vast majority of whites are averse to the idea
of racism per se; yet, they often unwittingly reproduce it because racial ideas and
associations we are exposed to inform our behaviors (Dovidio and Gaertner 2000).
Tests that show these subtle prejudices are exposed not when people face obvious
choices—such as hiring a job candidate who is clearly a cut above other candidates—but,
rather when ambiguous decisions must be made. When job candidates are closely
matched, Dovidio and Gaertner (2000) found that whites favor whites by giving them the
benefit of the doubt, driven by subtle prejudices they may be consciously opposed to
believing but which they have been repeatedly exposed to. These results help explain the
notable job discrimination found in Pager’s (2003) experimental study, in which white
job-seekers with felony convictions were pursued by employers more frequently than
Black job-seekers with no criminal record.
Work on racial microaggressions links these patterned social ideologies regarding
racial and ethnic groups to how members of these groups experience their daily lives,
careers and public spaces while being racially marked. Racial microaggressions is a term
used by Psychologists in reference to the “subtle, stunning, often automatic and non-
verbal exchanges which are ‘put downs’” with “cumulative weight” and occur daily
21
(Pierce, Carew, Pierce-Gonzalez, and Wills 1977:65). According to Pierce, who
originally coined the term in 1970, “[i]n and of itself a microaggression may seem
harmless, but the cumulative burden of a life-time of microaggressions can theoretically
contribute to diminished mortality, augmented morbidity, and flattened confidence”
(Pierce 1995). Interdisciplinary research on systemic racism should not only take note of
these important findings but also incorporate them into our sociological approaches to
build a more complete understanding of contemporary inequality.

Asian American Professionals and the Black Middle Class
As my study will be focusing on African American and Asian American
professionals, I want to explore the major findings in the literature that touches on the
social and emotional well being of these two groups. Much of the work on Asian
American professionals has focused on the employment sector, and continued problems
with the glass ceiling affecting occupational mobility (Woo 2000). Several other studies
pay attention to the construction and management of identities among the professional
class (Dhingra 2007; Min and Kim 2000; Sun 2006). This work on identities focuses on
the relationship between culture and identity, with a particular emphasis on the ways
identities are constructed in relation to the cultural scripts of a particular space or domain
(e.g. home, work) in which they are located (Dhingra 2007). The discussion in this
literature relates somewhat to DuBois articulation of the veil and double consciousness in
the way that Asian American professionals report feelings of invisibility; yet demonstrate
skill at negotiating mainstream and ethnic cultures by retaining a bicultural orientation as
22
well as knowing when and how to switch between the two. While the work on identities
among Asian American professional makes important interventions in the assimilation
literature, my dissertation adds to this scholarship by further unpacking the contradictions
of appearing as a model minority within a context of racialized and gendered controlling
images that cast Asian Americans unequal foreigners.
Studies of middle-class African Americans have also addressed employment
sector issues such as the glass ceiling (Feagin and Sikes 1994:380; Higginbotham 1994;
Weber and Higginbotham 1997), and the politics of affirmative action in the hiring,
incorporation, and promotion of middle Black workers (Collins 1997). However, some
important works also pay more attention to the social-emotional implications of structural
inequalities. For example, Cose (1993) discusses the frustration, anger, and rage that
members of the Black middle class feel due to the perpetual subordination they encounter
despite their own personal achievements; they’ve done everything required of them to
succeed, but when they reach middle class status, they find very little has changed. Other
studies also find that as middle-class Blacks come into more face-to-face contact with
whites they encounter more discrimination because they are increasingly in more white
dominated spaces (Willie 1978) and accordingly, must manage double identities by
“code-switching” (Anderson 2002).
In two separate books, Feagin, along with other colleagues, explores the
challenges facing the Black middle class as well as the many costs of racism as
experienced by middle class Blacks (Feagin and McKinney 2003; Feagin and Sikes
1994). In Living With Racism, Feagin and Sikes (1994) report that despite all of their
23
accomplishments, middle-class African Americans continue to encounter discrimination
and hostility in seeking public accommodations, educational institutions, workplace, and
neighborhood. They argue that these stressful and painful encounters accumulate and
ultimately profoundly impact one’s outlook. Also focusing on the “everyday,” in The
Many Costs of Racism, Feagin and McKinney draw a connection between psychological
and physiological problems associated with exposure to everyday discrimination among
middle-class African Americans. Feagin and McKinney (2003:66) assert, “the everyday
realities of systemic racism cause great psychological distress that, in turn, creates
moderate-to-severe physical health problems for many people.” Chronic headaches,
fatigue, hypertension, anxiety, and depression are a few of the physiological and
psychological problems respondents partially attributed to the “pain, anguish, anger, and
rage” resulting from recurring encounters with racial hatred; from disrespect to physical
assault and de facto exclusion (Feagin and McKinney 2003:44). In all, more so than the
work on Asian American professionals, the literature on the Black middle class has
provided an important language for inspecting personal injuries and everyday racism. I
will now turn to a discussion of the work that will most critically inform my own
analysis.
CLASSICAL SOCIOLOGY OF RACE AND INTERDISCIPLINARY THEORETICAL
CONTRIBUTIONS: MAPPING THE SCHOLARSHIP OF DUBOIS & POST-COLONIAL,
CRITICAL RACE, AND INTERSECTIONALITY SCHOLARS

W.E.B. Du Bois was one of the earliest social scientists to study urban problems,
one of the earliest social scientists to utilize ethnography, and one of the earliest social
scientists to study people of color; he was also among the first social scientists to use a
24
theoretical language as a way of understanding the emotional labor and internalized
processes that accompany living in a marked body. In the analogous metaphors “the
veil” and “double consciousness,” Du Bois (1989 [1903]) captures the type of
“wrenching of the soul, a peculiar sense of doubt and bewilderment” caused by racial
subordination. The veil symbolically demonstrates the physical segregation and social
isolation that Blacks endured through institutionally racist practices of slavery, Jim Crow
as well as the everyday interactions with individual racism. Du Bois illuminates the
feelings of invisibility, that you don’t matter enough to be seen or remembered; of
alienation, that you are an outcast in your own country. These reactions emerge from
living in a structurally unequal and racially hateful society.
Further, Du Bois (1999 [1903]) revealed how life within the veil created a double
consciousness, a dubious sense of being both American and Black, a split personality of
sorts. Unable to fully develop their own liberated self-consciousness, African Americans
were forced to see themselves “through the eyes of others, of measuring one’s soul by the
tape of a world that looks on in amused contempt and pity” (Du Bois 1989 [1903]). By
connecting the psychological costs of racial subordination to structural and institutional
barriers that undermined Black well-being, Du Bois clarifies how the blending of racism
and white structural privilege shunned African Americans behind the veil and into a state
of double consciousness. Living in phenotypically marked bodies, all people of color are
in a sense stigmatized and denied equal membership in society (Goffman 1963). The
concepts of the veil and double conscious speak to the “othering” and state of “duality”
that people of color feel due to marginalization that continues to occur on structural levels
25
as well as in everyday face-to-face interactions (Madrid 1995). My dissertation
empirically demonstrates through documenting the lived experiences of my interviewees
that this taxing duality persists even in this post-civil rights era and has the potential to
dramatically impact daily life.
Building on Du Bois’ idea of double consciousness, post-colonial race theorist
Albert Memmi (1991 [1957]) describes what sometimes happens when people of color
are forced to see themselves through the eyes of their oppressor. Bombarded with
demeaning controlling images, denied citizenship rights, and forced into paternalistic
dependency, the colonized are vulnerable to internalizing the racism of the oppressor.
This internalized racism causes the subordinated to adopt the ideology of the dominant
class, thereby supporting hegemonic racial rule. “It is common knowledge that the
ideology of a governing class is adopted in large measure by the governed classes… By
agreeing to this ideology, the dominated classes practically confirm the role assigned to
them…[O]ppression is tolerated willy-nilly by the oppressed themselves” (Memmi 1991
[1957]). This complicated idea is important in allowing us as race scholars to understand
full circle the complicated processes involved in racial domination that can not be
addressed by analyzing the social structure or institutions only.
6
For example, this
concept of internalized racism explains what happens frequently with Asian Americans
who embrace the model minority image and other racial minority groups who believe it,

6
I emphasize only here because I want to stress that I feel a complete understanding of race, racialization,
race relations, and racial oppression require a combination of both “macro” and “micro” approaches.

26
which ultimately serves as a hegemonic device allowing the continued rule of all people
of color by separating their interests (Osajima 1993).
7

Memmi is useful because race scholars have shied away from looking at micro-
level realities due to a valid concern that such an analysis would, 1) obscure the large-
scale and institutionalized nature of racism and racial discrimination (Wellman 1993),
and 2) somehow pathologize the emotional manifestations thereby situating the problem
in the individual, while blaming them at the same time (hooks 2003). Combining
Memmi’s ideas with the Gramscian concept of hegemony allows us to understand the
interplay between agency and structure which continually rearticulate racial hierarchies
(Hall 1986). This work helps to validate my project while also creating a potentially
useful lens of analysis that provides a sociological context for individual experiences with
racism. Indeed, a central argument of this dissertation is that race gains meaning and
salience largely through the intersection of social interaction and social forces.
Fanon (1967:143) asserts “a normal Negro child, having grown up within a
normal family, will become abnormal on the slightest contact with the white world.”
Emotional damage occurs in large part due to “multiple traumas, frequently analogous
and repeated” in the context of colonial oppression (Fanon 1967:144). Fanon maintains
that the devaluation and lack of acknowledgement of their very existence generates
profound feelings of misery and devaluation among Blacks forced to live in a white

7
It is my contention the model minority myth lures unsuspecting Asian Americans into a false sense of
acceptance and approval on behalf of those in power. It cause Asian Americans to believe that they have
“made it” due to some individual ethic and fortitude while blaming other racial minorities for their inability
to also achieve upward mobility. Tensions spark between people of color who could ally themselves as a
pan-racial collectivity, while whites escape without having to claim ownership of their role in the continued
subordination and oppression of all people of color.
27
dominated world. Critical race feminist scholars call these numerous and recurring
assaults to the psyche and soul “spirit-murder[s].” These incite feelings of rage, are
psychically intrusive and psychically violent, and affect people of color “in the depths of
poverty or in the heights of academe (James 1997b; Wing 1997:28). Many may argue
that these racially discriminatory incidents and interactions that occur on a micro level
are trivial and minor (Feagin and McKinney 2003), but it is the insidiousness and
pervasiveness of racism that makes it so devastating and costly to the human psyche.
Further, these are not isolated incidents; they accumulate, creating rage and toxicity.
There is a strong possibility that it is much more difficult to psychically overcome these
thinly veiled covert racist actions, whose existence whites often successfully deny, than
more overt forms that are recognized as unjust, and in turn allow some sort of redress
(Essed 1990).

Intersectionality

As institutionally embedded belief systems, white supremacy and patriarchy
structure, organize, and govern all facets of American life, which in turn immeasurably
constrain the everyday lives and identities of people of color (Almaguer 1994;
Carmichael and Hamilton 1967; Connell 2002; Feagin 2006). Simply put by Omi &
Winant, “…[r]ace is gendered and gender is racialized” (1994:68). Although not an
integral part of the sociology of race literature, many gender scholars have theoretically
grappled with the complicated intersection between race, gender, and class (Baca Zinn
and Dill 1994a; Collins 2000a; Crenshaw, Gotanda, Peller, and Thomas 1995; Espiritu
1997; Glenn 1985; Glenn 1986; Glenn 2002). Intersectionality scholarship, which
28
recognizes the simultaneity and multiplicity of large structures of domination such as
race, gender, and class, arose as a corrective to white feminist scholarship and activism
that essentialized the doubly and triply bound experiences and realities of women of color
under the falsely universalistic rubric of womanhood (Collins 1999; King 1995).
Intersectionality scholarship treats race, gender, and class as socially constructed
structures, identities, ideologies, and realities which are interlocking, historically and
politically informed, and mutually constituted (Andersen and Collins 1992; Baca Zinn
and Dill 2000; Collins 2000b; Glenn 2002; Spelman 1988). Multiracial feminism not
only calls attention to divergent experiences between white women and women of color,
but also recognizes that important differences exist between women of color,
emphasizing that people are located in multiple hierarchies at once (Baca Zinn and Dill
1994b). Similarly, under the term, intersectionality Crenshaw (1995a:358, 360) explains
that “…the experiences of women of color are frequently the product of intersecting
patterns of racism and sexism…,” meaning that women of color do not experience racism
in the same way as men of color and they do not experience sexism in the same way as
white women. Building on Crenshaw’s notion of intersectionality, Collins (Collins
2000a:18) uses the term matrix of domination to emphasize that these intersecting
oppressions are institutionally and historically embedded within power structures and
organized along four interconnected domains of power: structural, disciplinary,
hegemonic, and interpersonal.
According to Evelyn Nakano Glenn (1999), “[h]istorically, gender and race have
constituted separate fields of scholarly inquiry. By studying each in isolation, however,
29
each field marginalized major segments of the communities it claimed to represent.” My
dissertation strives to avoid this weakness and add to a growing body of scholarship that
has sought to bridge these gaps. Drawing on the intersectionality literature (Baca Zinn
and Dill 1994a; Collins 2000a; Crenshaw 1995c; Espiritu 1997; Glenn 2002) will allow
me to fully capture the fluidity, simultaneity, and multiplicity of the race, gender, class
nexus. The intersectionality literature will provide a theoretical frame and language to
help me understand the complicated and significant ways the racialized experiences of
the doctors and nurses in my study will likely vary by gender. Moreover, as I anticipate
interviewing both male and female African American and Asian American doctors, I aim
to build on our understanding of the nuanced ways hegemonic masculinity (Connell
1987) and hegemonic femininity (Pyke and Johnson 2003) inform the experiences of both
women and men of color in high status positions. My dissertation research further
problematizes the complex relationship between race and gender by using an
intersectional approach to understand the gendered and raced relations between
hegemonic and subordinate masculinities and femininities. Finally, the emphasis on the
“synthesis” (Combahee River Collective 1995 [1977]) of multiple forms of oppression
offers a lens through which we can understand the simultaneity of being a racial and/or
gender subordinate while also being situated in occupationally high status and high-
income positions.
Taken together, these bodies literature provide a critical framework that guides
my research in terms of methodological design and theoretical standpoint. In particular, I
attempt to intervene in the broader sociology of race literature that tends to be
30
“theoretically bifurcated” (Wellman 1993) between macro and micro levels of analyses
by correcting the assumption that micro-level research is a-structural. Rather, I view and
analyze micro-level interactions for patterns suggest the linkages between the micro and
macro social structures; indeed, I suggest that these patterns that exist at the micro level
constitute a structural element alone. The literature on colorblind racism, the empirical
scholarship on the micro-level dynamics of race as well as the scholarship of DuBois and
interdisciplinary work from intersectionality scholars guides my own analyses and how I
interpret the experiences and patterns relayed to me by the physicians who participated in
this project.

SIGNIFICANCE OF THE STUDY & CONTRIBUTIONS TO THE LITERATURE

Studying race based on lived experience and seeking to illuminate the everyday
subtle insults that occur, has the potential of enhancing our understanding of current day
problems of racial inequality and oppression. Indeed, I see this more “micro-level”
approach to studying race contributing to the sociology of race literature in three
significant ways. First, an understanding of the micro-level processes of racism can
destabilize assimilationist assertions that “incorporation,” is signified by various tangible,
quantitative markers and indicates, “having made it.” Second, it challenges color-blind
sensibilities, which abound in public discourses, and claim that race is no longer a serious
issue in American life. Third, it strengthens anti-racist scholarship and lines of reasoning
by “covering all the bases” that racism touches upon in the lives of people of color.
31
First, the lived experiences of the physicians who participated in this project will
challenge assimilationist and structuralist arguments that associate socioeconomic
success with a declining importance of race. Assimilationists imply that assimilation
signifies a resolution of difference, where, in the end, individuals coexist harmoniously,
or at least with little conflict. All of these ideas downplay power relations, systematic
structural inequalities and the continuing significance of heritage, even when ‘structural’
indicators would indicate ‘full’ assimilation (Nishi 1995). Thus, one can be married to a
white person (assuming this person is most emblematic of the ‘host society’), dress like
the mainstream core, and be professionally employed yet continue to endure racial bias,
violence, exclusion, and alienation and consequentially feel like an outsider (Comer
1995). This may happen through overt discriminatory efforts or it may happen through
small-scale everyday insidious interactions. Hence, many people of color may appear to
be structurally and culturally “incorporated,” but further investigation into their personal
lives tells us that racism and xenophobia continue to pervade and shape their everyday
lives. In studying Japanese American and African American professionals who appear to
have “made it” will help provide a better understanding of the extent and nature of their
supposed “incorporation.” Has their incorporation really happened or are their
peculiarities to this incorporation that we have yet to learn about?
Similarly, in their new study on Assimilation, Alba and Nee (Alba and Nee 2003)
strive to update the definition of assimilation as well as expand the way we think about
the mainstream in order to account for the racial and ethnic diversity of contemporary
immigration. While they still believe that assimilation involves a “decline” in ethnic
32
cultural practices and ethnic identity, they do not believe that it requires the complete
obliteration of ethnicity as early Chicago School assimilationists envisioned (Alba and
Nee 2003:11). They also contend that assimilation does not just involve the adoption of
mainstream values and ways of life by the immigrant group; rather, assimilation occurs
through the “interpenetration” of two cultures, (Alba and Nee 2003:10), where both the
host society and the immigrant group adapt to each other by each making cultural
exchanges in their separate lifestyles.
This point leads to the major intervention of this work: Alba and Nee argue that
the mainstream also changes through the process of assimilation. Rather than remaining
a static sort of idealized core that immigrants aspire to become incorporated into, they
claim that by adopting and taking on cultural elements of immigrant groups, the
mainstream itself will embody the racial diversity that makes up the nation’s populace.
They see the host society taking on “cultural elements” of the immigrant group such as
“cuisine and highbrow and middlebrow forms of entertainment and artistic expression”
(Alba and Nee 2003:12). In this regard, they put forth the term “composite culture” to
describe the “mixed, hybrid character of the ensemble of cultural practices” that they see
making up the contemporary American mainstream (Alba and Nee 2003:10). They point
to the “ready acceptance of intermarriage between whites and Asian Americans and the
ongoing incorporation into the American mainstream of cultural practices and cuisine
from East Asia” as well as the inclusion of “Judaism and Catholicism as mainstream
American religions” as examples of this newly expanded, more inclusive hybrid
American mainstream (Alba and Nee 2003:13).
33
Alba an Nee’s conceptualization of assimilation presents another example of the
dubious reliance on identifiable and measurable indicators of social processes like
‘inclusion,’ ‘incorporation,’ and ‘assimilation.’ I contend that their discussion does not
pay adequate attention to the ethos of white superiority and white supremacy that pervade
the thoughts, ideologies, understandings and behaviors of American culture, whether it be
constituted by a mainstream constituent or a composite culture. For example, one can
still be racist or hold racially ignorant attitudes and still be married to a person of color.
Indeed, many white men married to Asian American women may at the same time
describe Asian American women as exotic, a controlling image used to subordinate Asian
American women under white women and white men. Similarly, just because it is now
popular and en vogue to eat sushi, this does not mean that Japanese ethnicity is now
represented in the mainstream in qualitatively powerful ways. As my data will show,
Alba and Nee overlook the continued importance of race as a social category rather than
just ethnicity and culture.
Second, it is now common for people to claim that they couldn’t hold prejudiced
beliefs about people of color because they “don’t see color”, they “just see people”
(Bonilla-Silva 2003b:1), in spite of qualitative evidence showing that once this opinion is
dissected, the color-blind façade fades (Bonilla-Silva and Forman 2000). This color-
blind racism justifies continued racial discrimination while relieving white complicity in
racial inequality. Additionally, this ideology makes racist behavior more covert and
illusory, making the illumination of the hidden experiences with racial inequality that
people of color encounter as they interact with color-blind racists more important.
34
Racists try to blame people of color for their unequal status in society by denying racial
bias and mistreatment (Ryan 1971), but the actual testimonies of people who know
otherwise cannot easily be denied (Andersen and Collins 1995). Further, color-blind
racism is based on whites’ perceptions of racism and racial oppression (Bonilla-Silva
2003b). Attending to the voices of those who are the actual targets of this supposedly
reformed racism weakens and undermines claims made by whites that seek to obscure
racism and their “attempts to dismiss race as a holdover from a benighted past, something
now well on the way to being transcended”—to treat “race as a ‘problem’ that is finally
being ‘solved’” (Winant 2001:xiv).
Finally, while the material / class disadvantages racial minorities face relative to
whites have been well documented (Blauner 1972; Feagin 2001; Lieberson 1980; Massey
and Denton 1993; Oliver and Shapiro 1995; Wilson 1980; Wilson 1987; Wilson 1996), I
contend that the anti-racist work in the trajectory of sociological race scholarship would
be greatly enhanced by a complementary focus on the interactive process that produce
and uphold racial inequality. In fact, gender scholar Connell (1987) suggests that three
primary pillars uphold gender relations: 1) labor (division of labor); 2) power (patriarchy
/ gender relations between men and women); 3) cathexis (emotionally charged
relationships). I assert that the study of race relations can be described similarly. Yet,
there is a need for the literature to further explore how emotionally charged relationships
fit into the structure of race relations.
In this age of color-blind racism we risk the obliteration of any recognition of
racial inequality if we continue to focus on glaring and tangible markers of disadvantage.
35
For example, as Feagin acknowledges, “[e]conomically successful African Americans are
most often viewed by white Americans as having achieved equality, success in their
workplace, full content and happiness, and the American dream to at least the same
degree as middle-class whites” (Feagin and McKinney 2003:8). When we rely on
material indicators as proof of marginalization, assimilationist assumptions that deem
successful employment as evidence of incorporation, coupled with a color-blind
discourse, enable people to believe that middle-class African Americans “have made it;”
that they are now in every important way equal with their white counterparts, despite the
reality that their quality of life is still impacted substantially by their racial status (Feagin
and Sikes 1994). This is why it is so important to broaden our usual arguments that rely
on class-based factors (e.g. unemployment, poor schooling, unequal pay, housing
discrimination); we need to demonstrate that regardless of material well-being, the
overall quality of life of people of color is compromised due to both historical and
contemporary racially hostile conditions (hooks 2003) that are traceable to the ideological
system described by Omi & Winant (1994). Thus, while I fully believe that we, as anti-
racist scholars, need to continue to study each of the class-based inequalities that I cite
above, I also strongly feel that we need to direct attention to the emotionally and
psychologically laden race-related problems that persist for people of color despite the
appearance of having made it.

36
CONCLUSION
Through this dissertation, I hope to add to the sociological scholarship on race
that focuses on race and racism in everyday life. In particular, my goal is to explore the
subtle, mundane, and seemingly innocuous ways race remains a salient and significant
aspect of American life. I posit that we need to move beyond the structural and
institutional levels that scholars have lingered in and address the ways that structures of
everyday racism continue to play out in the everyday lives of people of color. I believe
that the daily lives, and the stories of mundane disrespect not only deserve attention, but
can also work to denounce the false notion that racial equality in America is a done deal.
Through this project I hope to achieve three accomplishments: 1) expand our knowledge
and understanding about race and racism by demonstrating that racism does not exist
only through formal and tangible patterns and exchanges by clarifying the insidious,
pervasive, ordinary, and informal ways in which racism transpires just throughout the
daily interactions of our everyday lives; 2) begin to identify the various micro level ways
that race is still meaningful and salient (e.g. emotional labor); and 3) empirically illustrate
that race gains meaning and is experienced through gendered ideologies. If these
objectives are accomplished, we will better understand the significance and complexity of
race in our everyday lives, the fortitude of racism, and the resilience of marginalized
racial subjects.
In chapter two, I explore how colorblind logic shapes the way we understand race
and racial inequality. In particular, I address the type of reasoning that some of the
physicians utilize in their attempts to understand perceived racial progress. I contend that
37
the reliance on tangible and overt expressions of racial intolerance to prove the existence
of racism leads to an incomplete understanding of race and how racism manifests. I
argue that by moving past numerical evidence-based understandings of race and racism
allows us to see the significance and salience of race that is sometimes concealed by
statistics and quantitative indicators or measurements that falsely equate socioeconomic
success with racial acceptance and inclusion.
In chapter three, I explore the interactive and micro level ways (e.g. racial
microaggressions) that race remains significant and salient in personal and private lives
of African American and Japanese American physicians; despite assumptions that race is
no longer a meaningful entity for this socioeconomically successful group. I also explore
other micro-level ways through which race remains important. For example, in addition
to addressing the interactive ways that racial microaggressions are directed toward people
of color, I discuss the internal work and emotional labor that these physicians expend in
trying to negotiate the racialized terrains of their everyday lives. I also explore how lived
experience; the past and community racial legacies continue to resonate in their
perceptions of race and their social relationships.
In chapter four, I explore how race informs their positionality as physicians. I
address the ways race enters into their relationships in work environments, the particular
institutional and interpersonal challenges that remain, and how their professional
experiences as racialized physicians challenge assumptions about their perceived social
status.
38
In chapter five, I examine the ways that gender and race intersect and create
different challenges for African American and Japanese American women physicians as
well as African American male physicians. I address the particular difficulties these
groups encounter such as career/family balance issues and strategies the women
physicians deploy in an effort to fit both career and family into their lives. I also discuss
the unique positionality of African American men. I address the intense level of hostility
and fear that is expressed toward Black men and how ‘taking low’ is the only strategy
they have been able to utilize in order to keep moving forward.
39
CHAPTER 2:
MORE THAN MEETS THE EYE:
MOVING BEYOND THE NOTION THAT RACISM IS A TANGIBLE BARRIER

Arguably, very little has divided the people of this country as much as race, or
perceived racial differences. Yet, for many of us, our core foundational understandings
and sensibilities about race are misinformed and incomplete. Race is more than a status
marker measured by average incomes, educational attainment and housing segregation.
Likewise, racial inequality is accomplished through much more complex processes than
outright, obvious and tangible racial barriers alone. Traditional indicators of racial
discrimination that suggest socioeconomic mobility is correlated to the breakdown of
race as an important social marker are inadequate. This perspective can therefore
minimize the real significance race carries in people’s lives and how it can remain salient,
even in cases of professional success.
In this chapter, I begin to question the racially hegemonic, positivist and
colorblind assumptions that frame people’s beliefs about race and their understanding
about the degree of racial progress in the U.S., which ultimately poses many problematic
challenges to racial justice and equality. First, I will critically explore the positivist
language and concepts that the physicians I spoke with, much like many other
Americans, draw from as they express their perceptions and feelings about the role of
race in their own lives (even when they might not necessarily define themselves as
‘colorblind’). Next, I will explore in greater depth the interviews with two of the
physicians—one African American and one Japanese American, both male—in order to
40
further uncover some of the contradictions inherent in a positivist discursive framework.
Focusing on these two physicians in greater depth allows me to pay closer attention to the
details and very subtle contradictions of post-racial sensibilities that I begin to look at in
earlier parts of this chapter. Indeed, both of these physicians represent a somewhat
common standpoint about race and racism; yet, a closer look into their actions and
thoughts, reveals a much more complicated racial reality that ultimately undermines post-
racial ideologies. In the end, this tension will help to illuminate the need for a broader
conceptualization of race in this colorblind era. Finally, I close the chapter with a brief
discussion of some of the physicians’ observations and comments about the current
nature of race and race relations in the U.S.; specifically the ways in which race
maintains salience and significance in Americans’ lives despite outward claims of
colorblindness. This section provides a transition into chapter three.

THE NEO-CONSERVATIVE AND POSITIVIST SWAY ON AMERICAN RACIAL
SENSIBILITIES

THE FALLACY OF ‘OBJECTIVE,’ ‘NEUTRAL,’ ‘RATIONAL,’ AND ‘MEASURABLE’ ‘EVIDENCE’
For most people numbers provide hard and tangible facts they can easily point to
when trying to “prove” their point in any given argument (Best 2001). Many erroneously
believe that statistical facts and figures possess objectivity, neutrality and rationality,
which makes them robust and reliable pieces of evidence without regard to complex
underlying methodological issues (Glassner 1999; Harding 1987; Zuberi 2008). I
contend that much of what we understand about social problems springs from the number
crunching of social scientists, economists, and other specialists investigating various
41
social phenomena. For example, the quantitative focus on the socioeconomic mobility
experienced by some groups, such as particular Asian American ethnic groups as well as
growing numbers of African Americans who have moved into the middle class, has been
used to validate claims that the importance of race in American life is radically altered
(e.g. Alba and Nee 2003; Sakamoto, Wu, and Tzeng 2000). I argue that the use of
quantitative methodologies and statistics coupled with a positivist epistemological and
ideological positionality does not capture or allow us to discover the full scope of race
relations in the U.S. Indeed, a positivist orientation—one in which there is a belief that
hard facts and observable measures obtained through some objective examination or
scientific method—permeates both academic and public mentalities and ultimately leads
to an incomplete and narrow rendition of American racial progress and inaccurate
perceptions of how far we have come in terms of race relations (Allen and Chung 2000).
A foreshadowing of a subtle trend that would emerge mostly among the Japanese
Americans physicians, in my first interview for this project—Dr. Miyazawa, a highly
successful Japanese American male plastic surgeon--shared with me even before the
interview even began: “And that’s what the first thing will be for this because I’ve had
no barriers.” He was worried that he would not be able to “help” me because as he saw
it, he had no “barriers” to talk about. Interestingly though, when describing this project
to interview participants, I would initially present a sort of neutral standpoint; a
positionality that sought to understand the ways race and gender did or did not inform the
career and life trajectories of African American and Japanese American physicians. Yet,
upon hearing this broad topic and that it had to do with his racial experiences, Dr.
42
Miyazawa’s seemingly instinctual reaction was to identify race as a problem or barrier,
which prevents one from “doing,” a problem he is sure he never encountered in a
significant way.
Like Dr. Miyazawa, Dr. Ojima, Japanese American Dermatologist in her early
forties who practices in a middle class LA suburb, explained that she really doesn’t
remember race negatively impacting her life other than one experience in seventh or
eighth grade where she was with some friends and their families. They planned to go to
an old-time, very exclusive country club (that her friend’s white parents belonged to)
until they realized that they might not be able to get in because of the Jewish and
Japanese American kids that were with them. Dr. Ojima recalls realizing that “[i]t was
the one time when I felt like, ‘oh, I can’t do what they do, only because I’m Asian. So
that was one time…it was one of the first times that I realized that ‘oh, this may become
an issue at some point in time.” Thus, her experience with an explicit limitation with the
intention of excluding people of particular racial, ethnic, and or religious backgrounds
illuminated to Dr. Ojima the reality that her racial background may at some point hinder
her possibilities. Dr. Ojima expressed that this really is the only time she can remember
race being problematic in her life. Thus, a life free of de jure discrimination on the basis
of race (because those sorts of policies and practices were dismantled through Civil
Rights legislation) led Dr. Ojima to conclude that race has not been a problem for her in
her life. As I will soon discuss further, she feels very grateful that she can’t think of
anything that stands out in her mind as “some kind of barrier that [she] had to overcome,”
unlike the experiences of her Japanese American predecessors.
43
Similarly, despite several instances of sort of ‘tip-toeing’ around issues of
stereotypical attitudes subtly conveyed to her during medical school and other issues
pertaining to questions about her citizenship, Dr. Suzuki, a Japanese American female
surgeon, stated that she could only think of two instances where people negatively
communicated racial intolerance about Asian Americans to her. It is interesting that Dr.
Suzuki points out that it “was the only time” that she “physically witnessed” a patient
conveying racial intolerance. It again speaks to this dynamic where people look for
obvious insults as evidence or proof of racial intolerance. Likewise, when talking about
her own personal life, the only “negative” experience she shares is one where a racial
epithet is directed toward her. Yet, at other points in the interview she discusses issues
that reveal a sense of otherness subtly communicated to her by other medical
professionals and through other public interactions, which ultimately question her level of
Americanness and legitimate citizenship. The reality though is that nowadays people will
rarely explicitly express racially intolerant attitudes and beliefs due to fear of stigma and
straying outside of colorblind norms that currently predominate American culture
(Dovidio and Gaertner 2000; Dovidio, Gaertner, Kawakami, and Hodson 2002). It is not
surprising that this example where the person who called Dr. Suzuki a ‘Jap’ actually
happened fifteen years ago. In fact, many of the examples that the Japanese American
physicians shared with me that they felt illustrated their experiences with racism, were
actually quite early in their professional careers and very early in their personal lives. It
is precisely for these reasons that it is important for us to articulate a new paradigm by
which American racial attitudes get expressed and maintained.
44
Indeed, the absence of identifiable, blatant, measurable, barriers or expressions of
racial intolerance does not mean that these issues no longer exist. As will become clear
later in the chapter, despite some of these physician’s claims and sentiments that would
support a model minority story, a closer look will reveal that more complicated clues and
indications about racial meaning and racial significance in their lives lurk beneath the
surface. Thus, the absence of easily identifiable problems with race and the absence of
racial barriers may merely reflect the change from a clearer and more lucid form or racial
ideology to a post-racial sensibility where people are very cautious and careful not to
appear racist, prejudiced, or intolerant (Bobo, Kluegel, and Smith 1997). The art of
acting racist, or at minimum, benefiting from hegemonic whiteness and white privilege
without appearing racist or privileged is a foundational feature of colorblind post racial
sensibility (Bonilla-Silva 2003a; Bonilla-Silva 2003b).
Other than one experience of job discrimination due to racial bias, Dr. Satou, a
Japanese American physician in his early fifties who practices Family Medicine in Little
Tokyo, indicated that he did not encounter overt discriminatory practices, so he concludes
that race has not been a challenge for him. Before sharing a story where he lost a job
opportunity because of his racial background, Dr. Satou stated that “[w]e
were…evaluated on our merit and were pretty able to do anything, although I’ll tell you
an interesting story because it just goes to show you, is…because in some ways, I’ve
always been ethnically inclined and in some ways I wasn’t.” The following is Dr.
Satou’s story about the one time he recalls race preventing him from achieving an
opportunity he sought:
45
But when I came out of [medical school], I interviewed for [a hospital]
and I interviewed for a job in North County, San Diego- Encinitas. And
the irony was that the other guy that applied for the job was a guy that I
went to school with, and he had trained at a different program, but we
were very, very equally qualified. Very, very similar. I mean, it wouldn’t
have been – it would have been really hard to – he was a nice kid. He was
white. He was actually a very good friend of mine, and we went down
there and I talked to these guys, and I thought, “Gee, this is a pretty great
job.” There were two hospital guys, and they were in Encinitas, and I
really liked that area because it’s a nice area.
And then they were talking to this other guy, and then I kind of realized that they
weren’t that interested in me, and realistically – not trying to be egotistical – I
mean, there wasn’t people better than me because, I mean, I came from [an elite
public university]….I mean, there aren’t people better than…And then, a few
years later – I was talking to this guy – this friend of mine. He said, “Yeah, they
didn’t think that a Japanese doctor could succeed down there, that their white
patients wouldn’t see a Japanese doctor.”

And I thought about it and I said, “That’s ridiculous,” because I didn’t really think
people were that locked in, but they could have been. San Diego’s a bit of a Navy
town.

Yeah, and there always was a little bit of negative stuff there. And even when we
were at the VA hospital in La Jolla, that – occasionally some guy will call us a
“gook” or something. But it wasn’t – it wasn’t anything that I thought was any
big deal, and I don’t think it would have made any difference in their practice.
But it just goes to show you how narrow-minded these guys were. And so, after
that, I was kind of upset because that’s a pretty ridiculous, pretty naïve thing to
think, y’know?

But the irony was that – that I landed up here, which was better for me, anyways,
and what I always wanted to do and I can tell you, I’m wildly more successful
than they are.

I got the last laugh, y’know? The irony is – going back to my ethnic community
was a lot more rewarding, and it’s a good thing they didn’t take me or I’d be
down in San Diego, struggling. Here, it’s a lot easier and stuff like that.

In Dr. Satou’s mind, this story he shared captures the one instance he can remember
where he was not evaluated on merit alone; where he feels race arbitrarily blocked him
from reaching his goal. Before sharing his experience, he described this incident as an
46
example of a time when he has been ethnically “inclined.” It seems that for Dr. Satou,
being “ethnically inclined” happens when he thinks of issues from an ethnic perspective,
which it seems, is more likely to happen in instances of obvious discrimination such as
the denial of fair and equal opportunities.
In these particular instances, each physician seems to identify race as something
that involves a deliberate and clear instance or act of discrimination, whereby one
experiences a limit or blockage aimed at preventing them from opportunities or
participating in the social realms of their communities. They each gleaned from their
experiences and the absence of clear race-based barriers in their lives as a sign that they,
fortunately, have not had any problems with race. These physicians are certainly not
alone in these sentiments. Many people feel more confident when they can point to a
statistical fact or a blatant and obvious encounter that appears undeniable. The reality is
that nowadays far fewer overt and obvious instances of racial discrimination occur;
prejudices and stereotypes are systematically obscured from their targets’ view (Picca
and Feagin 2007), and or discrimination is hidden through rationales such as cost-benefit
analyses which systematically disfavor people of color in areas such as housing, lending
and credit (Pager and Shepherd 2008; James 1997a). The decline of overt manifestations
of white supremacist racial ideology steers people into assuming that race is no longer a
prominent force in Americans’ lives, even when personal experience may tell a different
story.

47
A Relic of the Past
Commonsensically, to many, including some social scientists (e.g. Loveman
1999), race is not understood as a significant social fact (Bonilla-Silva 1999:899), when
straightforward consequences related to race or ethnicity aren’t easily detected. In this
sense, race or racism becomes something to see, witness, experience, nail down, or
measure. As such, the past—when clear and obvious patterns of institutional and
individual racism were openly expressed—becomes a powerful tool in understanding,
interpreting and measuring the salience of race today. When reflecting and talking about
race and racism today, there is a tendency to think to past racial patterns and occurrences
in order to determine if race still affects one’s life presently. Thus, when one’s life
trajectories, personally and professionally, do not fit the models of the past—as many
will not given the contemporary colorblind racial milieu—it is easy to believe that race is
not longer a problem for you and/or that race is no longer a significant feature of
American life. This likelihood is especially true when we privilege certain types of
measurements and identifiable acts of discrimination as our standard of sound evidence.
Over three decades ago in The declining significance of race : Blacks and
changing American institutions, William Julius Wilson argued that “[r]ace relations in
America have undergone fundamental changes in recent years, so much so that now the
life chances of individual blacks have more to do with their economic class position than
with their day-to-day encounters with whites” (1980:1). Wilson
8
asserts that racial

8
It is important to recognize that Wilson explains that while he does contend that American race relations
have moved from a system primarily characterized by racial oppression to one in which class subordination
is key to explaining the positionality of “underclass” African Americans, he does not “mean to suggest that
racial conflicts have disappeared or have even been substantially reduced” (Wilson 1980:23).
48
oppression during these eras was explicit and tangible. In this vein, the elimination of
Jim Crow laws and the application of Affirmative Action marked key changes in
governmental policies that represented a dynamic, purpose-driven transition within the
government that led to the decreased importance of race in the everyday lives of Blacks
and other disadvantaged minorities (cf. Johnson 1965). “The problem for Blacks today,
in terms of government practices, is no longer one of legalized racial inequality.” (Wilson
1980:19). While Wilson acknowledges that it would be “shortsighted” to claim that the
“traditional forms of racial segregation and discrimination [have] essentially disappeared
in contemporary America,” his argument implies that race no longer plays a fundamental
role in shaping or structuring the lives of Blacks and other racial minorities because racial
oppression is no longer “deliberate, overt, and easily documented” as in the slavery and
segregation time periods (1980:1).
In the past, racism was easily detectable because it presented as a barrier or
obstacle that either had to be accepted or maneuvered around. Many of the Japanese
American physicians compared and interpreted their own experiences against these
models of obvious racial inequality in order to come to the conclusion that race has not
been a significant issue in their lives (Feagin 1981). In this way, their perceptions about
race and racial inequality mirror Wilson’s contention that a fundamental shift in the
state’s agenda from promoting racial inequality, where “[r]acial oppression was
deliberate, overt, and…easily documented, ranging from slavery to segregation” during
the antebellum period all the way through the first half of the twentieth century (1980:1)
signified a transition to promoting racial equality.
49
Indeed, many of the Japanese American physicians expressed feeling lucky or
fortunate that they did not have to overcome barriers or hurdles to get where they are in
their lives. They frequently indicated that the Japanese American physicians in the
previous generation are the ones who had to endure all sort of inequities and limited
opportunities. It was these physicians’ experiences that some of my interviewees
measured their own realities against. Dr. Ojima expressed gratitude to those in the
generation before her that eradicated the racial barriers that used to limit Japanese
American physicians in their efforts to practice medicine.
I can’t really think of anything that seems to me that it was some kind of barrier
that I had to overcome in particular….I definitely feel really thankful that I can
tell you that through school and of my experiences I haven’t really had a lot of
hurdles. That’s definitely a tribute to all the people that went before us… women
and Japanese-Americans that went before us and forged that path. Obviously,
they have instilled confidence and so that’s made it easier for all of the rest of us
to follow. There definitely were a lot of hurdles for them to overcome, and not
that long ago, really.

Interviewer: Do you know what kind of hurdles used to be there that aren’t in
place anymore?

Dr. Ojima: Well, I think if you look at – if you walk from the halls at [my
medical school] and the medical center, they have these large class pictures up
[of] the medical school classes. It’s so obvious just that you can count kind of on
your hand the number of women that are in the class. When I went to medical
school it was about 50-50. So that’s a big change, and a lot of the Japanese
American physicians have shared with us, during the war and shortly after, how
they couldn’t get privileges, staff privileges [in] the hospitals. That’s why some
of them got together and kind of formed their own little hospital… So there are a
lot of – it takes a lot of dedication to their profession because it wasn’t – they
didn’t just fill out their forms and their requests, letters of reference. They just
had to do a lot of their own work so they could do what they want to do instead of
just giving up and saying, ‘well, this is too hard; I’ll just do something else.’ They
could have done that. So I think that was probably not so long ago…people were
still overcoming a lot – maybe less. Forty or fifty years ago people were still
overcoming a lot of discrimination, so when you think about it that way, things
50
have changed a lot in a relatively short period of time. It’s definitely a lot easier
for us now.

Dr. Satou, the physician whose experience with losing a job opportunity in San
Diego seemingly due to his racial background, conveyed a similar sensibility about race
in the U.S. When asked if he encountered any particular differences in his effort to
become a doctor, or if he was aware of any differences current Asian American medical
students may experience, he responded:
No…I always tell people that probably the thing I always appreciated a lot is
[what] the guys in front of me did. They had a tough time. They actually
couldn’t become specialists. They couldn’t get in training programs, and so then I
came around and I was probably of the next generation of doctors that really
never had a whole lot of problems.” We were…evaluated on our merit and were
pretty able to do anything…

Similarly, Dr. Miyazawa, who stated at the outset that there were no barriers he had to
overcome in his educational or professional career expressed this same sense of gratitude
to older Japanese American physicians:
Dr. Miyazawa: So there’s absolutely no discrimination for me, but I know what I
achieved I did not achieve on my own. I’ve achieved because other people went
before me who had to eat the dust, who were discriminated upon. I know my dad
and my uncles were sorely discriminated upon.

Interviewer: When you say that, what kind of things happened to them that you
didn’t have to encounter?

Dr. Miyazawa: They were not allowed at that time into certain restaurants, not all
restaurants. They couldn’t use certain facilities... We could live only in certain
areas. …they lived on $0.05 a day for their meals. My dad used to go in and buy
a donut for $0.05. He’d have one for breakfast and have one for dinner, go and
get hot water, put ketchup in the water. That was their tomato soup. That’s the
way they lived.

Dr. Ojima, Dr. Satou and Dr. Miyazawa reiterate what many Americans believe:
that racism is a barrier or hurdle that limits one’s opportunities—whether those
51
opportunities involve participating in a particular social and/or athletic activity or club,
receiving an education, purchasing a house in a certain location, etc.—and leads to a
lower standard of living merely because of their skin color or national origin. Each of
these doctors genuinely feel that race or racism did not shape their medical school
experiences because they did not encounter legal or structural barriers preventing them
from going to medical school or gaining acceptance into prestigious residency programs
or obtaining hospital privileges anywhere; whereas Japanese American physicians in the
previous generation had to contend with and navigate around unequal racialized policies
and practices aimed at excluding people of color from the field of medicine (American
Medical Association 2011).
Indeed, Dr. Rin, a retired Japanese American general practitioner who practiced
for forty years and had herself endured the type of outward barriers the other Japanese
American physicians were thankful they did not experience, explained that “…we had a
Japanese hospital…because we weren’t accepted anywhere else.” Further, as an example
of a time where Dr. Miyazawa described “problems with discrimination,” he turned to a
clearly unfair and well document barrier that affected him as a child in Hawaii. He
explained that, “if you wanted to go to certain schools, if you wanted to live in certain
areas you were prohibited from – not prohibited, you were just not allowed to do
that…[a]s Japanese American or even Asian Americans.” He elaborates on his memory
and understanding of how racist policies and practices curtailed Japanese American
residential options:
We lived in Waikiki Beach, which was at that time the Japanese community
primarily, and then eventually we moved up to an area called Tantalus, which is
52
the rainforest above Punchbowl, which was considered to be a Caucasian area,
and until they opened up a piece of land that you could purchase no Asian could
purchase up there. So there was discrimination…A lot of segregation.

Thus, the barriers and denial of rights and opportunities based on race as it
pertained to Japanese Americans many years ago clearly stand out in the memories of the
Japanese American physicians I spoke with. Indeed, the formal laws and policies of the
past that overtly barred racial minorities from pursuing and achieving countless
opportunities that their white male counterparts freely pursued are seemingly non-existent
today, at least in terms of the Japanese American experience. While Japanese Americans
described the lack of barriers in their circumstances compared to the past, inequality for
Asian American physicians continues, for example, in terms of promotion (Palepu, Carr,
Friedman, Amos, Ash, and Moskowitz 1998). There is no doubt that racism looked much
different forty or fifty, or even twenty years ago, but racism or at least race as a social
construct, is still highly important and relevant in our lives today even though overt forms
of discrimination are no longer legally tolerated. It is understandable why the Japanese
American physicians I interviewed describe their experiences as being free of race related
barriers and feel such a deep sense of gratitude for those who paved the way before them;
they did not have to overcome the type of limitations that many before them broke down.
Yet, using the overt ways that racism was communicated in the past as the model or
definition by which we measure contemporary racism or racial meaning, is an
increasingly popular outlook characteristic of our current state of colorblindness that
obfuscates the ways race acquires meaning in our current “post-racial” circumstances.
53
Sometimes a deeper look can be very illuminating to the complicated, multi-
layered and very subtle, yet highly meaningful and significant aspects of race. As
Berger’s (1963) invitation suggests, a sociologists’ job is to look deeper and more
intently at our social world, at the collective ideas that influence and structure our daily
action. For example, what stands out as most interesting to me from my interview with
Dr. Ojima, is that while she feels thankful for the absence of “some kind of barrier that
[she] had to overcome,” she at the same time, shared that sometime around the eleventh
grade a preference to date only Asian Americans emerged. Her friends were also mostly
Asian, which continued through high school and medical school. She explained, “what I
felt more comfortable with…was a more shared level of certain values and maybe
cultural things, which is really important to me.” Dr. Ojima went on to share that
“…Japanese culture is very important to me, and so it’s just something that I wanted
someone to already share with me, so I didn’t have to teach them all about [it]… I didn’t
have to explain everything all the time.” She expressed that she felt a “certain comfort
level” when she didn’t have to teach or explain these cultural parts about herself and her
life; that it felt “cool” and “easy;” that this “feels good for me.” Her husband is also
Japanese American and a physician practicing in Los Angeles.
Again, Dr. Ojima considers herself fortunate that she has not had to overcome any
race-related barriers in her educational or professional career, or in her personal life
(other than the one experience where she could not get into the country club). Yet, while
she fortunately has not had to contend with a particular formalized practice aimed at
denying her due rights or preventing her from realizing her dreams, race actually has
54
played a central and qualitatively important role in her life. She actually remembers
making a conscious decision, or developing a preference to date only those who shared
and could understand her racial background. While this initially may seem insignificant
compared to being denied a job, an equal education or being interned by the American
government on the basis of national origin alone, it at least speaks to the continuing
significance of race in the decisions we make and the way we live and carry out our lives.
In this situation, Dr. Ojima’s preferences show that even in the absence of perceived
employment barriers or other race-based barriers, race and ethnicity can have a salient
place in structuring everyday lives.
Much like many Americans, Dr. Ojima does not feel that her racial background
has been a barrier in her life, although she does recognize that racism still leads to uneven
outcomes for some racial groups. Yet, perhaps unknowingly, Dr. Ojima did reveal that
even when it seems that race no longer overtly obstructs one’s life chances, it can loom
quite significantly in the choices and decisions people make. I argue that her conscious
decision to date and marry within her racial group due to reasons of cultural similarity,
comfort and understanding reflects the continual deep salience and significance of race.
Indeed, it says a lot about the importance of the subtle, yet insidious ways that race and
belonging, citizenship and inclusion are connected and need to be further studied
(Ancheta 1998; Gotanda 1985; Lowe 1996).
Dr. Ojima came across as a very relatable kind of person, especially for those who
easily identify with the values and positionality of middle class, mainstream America.
An active and involved mom to a young son about to enter Kindergarten, she became a
55
Dermatologist because this particular specialty (sometimes referred to as a “lifestyle”
specialty by many of the physicians I spoke with) allows her to live “a balanced
life…without regrets on either side.” By this she means that she hasn’t had to make
sacrifices in her professional or personal lives to accommodate one over the other (e.g.
Buddeberg-Fischer, Stamm, Buddeberg, Bauer, Hammig, Knecht, and Klaghofer 2010).
She described herself as feeling “completely comfortable,” meaning she doesn’t feel any
sense of racial intolerance or ignorance from others around her in her daily life. She did
express awareness of racial disparities in the field of medicine for Latino and African
American physicians who remain under-represented (Reede 2003). In general, she
reminded me of a lot of liberally minded Americans who feel fairly content with their
lives, may be aware of some racial inequities confronting African Americans and Latinos,
but does not perceive race to be a problem for Asian Americans, or for herself personally.
These characteristics are worth noting because I think she represents the general
attitude of many liberal leaning Americans. Thus, Dr. Ojima stands somewhat as an
emblematic figurehead of a demographic of Americans who believe that 1) race was a
problem in the past, 2) may still lead to challenges for some racial minorities, although,
likely not for Asian Americans, and 3) for the most part, racism is an unfortunate blip in
our country’s history. Yet, a closer look at Dr. Ojima’s life experiences and her
perceptions give reason to pause and question if perhaps race continues to play a more
salient part of our lives than many want to believe. To further explore this complicated
dynamic, I examine in greater depth and detail the personal and professional racial
experiences of two physicians in particular: both men, one Japanese American and one
56
African American. A close look at their experiences, perceptions and the way they
reason and make sense of their lives raises some questions about the continuing
importance and relevance of race despite what outward appearances might say about
these individuals and others like them, as well as in spite of their own conclusions about
race.

Dr. Miyazawa
Earlier in the chapter, I discussed a couple of Dr. Miyazawa’s statements, -the
physician whom I first interviewed for this project- but I want to explore more of his
insights in greater detail here. His background, experiences and thoughts capture the
dichotomy and ambiguity that partly defines Japanese American’s attitudes and
understanding of race and racism, which ultimately calls attention to some of the
problems, gaps and inadequacies of the way we think of race and racism in this so-called
‘post-racial’ era of colorblindness.
Dr. Miyazawa was born and raised in Hawaii and came from an exceptionally
driven and high achieving family; success, at least occupationally speaking, which seems
to continue through each subsequent generation of his family. Dr. Miyazawa spoke with
a lot of pride about his family. He explained that his family arrived in Hawaii sometime
in the 1870s from Hiroshima, Japan as “skilled workers” as opposed to most Japanese
immigrants who arrived as “hard labor[ers]” to work in the plantations of Hawaii at that
time. He described his mother’s family of ten—six boys and four girls—as
“overachievers” because “they all became professionals…three…physicians….two
57
attorneys and one…dentist” while all of the daughters were teachers. Dr. Miyazawa
shared that “it was very unusual to have a family of ten that rose to that level with a real
significant degree of discrimination.” He explained that at that time “they had a very
difficult time getting into school because they’re a minority and only certain schools
opened up to the Japanese population…The old school, which was at that time called
Marquette…allowed in a lot of Japanese professionals, [but]…these are not considered
now to be grade A schools….[more] like C schools.” Dr. Miyazawa’s father also came
from a big and occupationally successful family. Four of his uncles went into medicine
and his father was a dentist. His father attended Northwestern Dental School in 1932,
which “at that time was naturally considered one of the better schools for
dentistry…[and] in those days it was very difficult to get into.” Dr. Miyazawa recalls
that his father graduated either first or second in his class and returned to Hawaii to
practice. Dr. Miyazawa was born and raised in Hawaii, so his family did not directly
experience the mass incarceration of Japanese Americans during WWII.
Dr. Miyazawa was educated and trained in some of the most prestigious
institutions in the U.S. In Hawaii, Dr. Miyazawa attended two of the state’s elite college
preparatory schools. For ten years he attended Alohi, an Episcopalian boys’ school that
“happened to be primarily Japanese.” After being enticed by Kalani, an elite private
school, which “happened to be primarily Caucasian,” Dr. Miyazawa transferred schools.
Dr. Miyazawa also proudly, but not boastfully or arrogantly, described his and his older
brother’s educational achievements. Most importantly, while Dr. Miyazawa expressed
amazement at his father’s and aunts’ and uncles’ achievements in the face of “a real
58
significant degree of discrimination,” he described a much more harmonious experience
that he and his brother enjoyed. After graduating from Alohi—the predominantly
Japanese prep school—his brother attended [a liberal arts college] in [southern]
California.
…and my brother did well [as an undergraduate] and was accepted at an Ivy
League Medical School, no prejudice, no constraints, the sky is the limit. I
finished [university] and followed him there for Medical School. He did well
there. He did his internship at [a different Ivy League university], no prejudice.
He went into the Army and toured in the Army. He came back and is now
chairman of the department of… for 25 years, no prejudice. I finished my
medical school. I did my general surgery, internship in general surgery [back on
the west coast], went back to finished my plastic surgery [training].

Throughout the interview I learned that Dr. Miyazawa is an extremely talented physician
with an exceptional level of achievement. He describes himself as “always trying to get
out of the comfort zone and do things, even now.” He decided on plastic surgery as his
area of specialty through his Army experience in Vietnam. He shared that as a general
surgeon “it was always easy for me to take away things. General surgery was just, ‘take
it away’. So I’d try to put it back together, and put it back together in a functional and an
aesthetic way is more challenging that it is taking it away.” Dr. Miyazawa continues to
“do a lot of basic research, a lot of clinical research.” He teaches at the national and
international level and is or has been a visiting professor at schools in twenty-two
countries. “This year,” he said at the time I interviewed him, “I’m a visiting professor for
Saudi Arabia because of things I developed that are used by plastic surgeons around the
world.” Dr. Miyazawa developed a method of tissue expansion, among other clinical
therapies, and his expertise has been used in at least one high profile medical case in the
59
U.S. He has a nine-month waiting list for new patients, who reside the U.S. as well as
internationally.
I devoted a significant amount of space to talking about Dr. Miyazawa’s
background and career trajectory because with his degree of success and achievement, I
was surprised that as a third generation Japanese American who truly has witnessed his
family experience what others describe as the American Dream, he is as connected to
Japanese American cultural life as he conveyed. As I explained earlier, Dr. Miyazawa
initially began his education at Alohi and later transferred to Kalani, a predominantly
white school. When talking about the two schools, his decision to leave and his
experiences at both Alohi and Kalani, he shared that
…I would have been quite successful at Alohi, but Alohi at that time was a
family. The kids today in my class still get together, and whenever I go back to
Hawaii I associate with the Alohi. I don’t associate with Kalani because these
kinds of life experiences are pretty deep in the Asian population.

Interviewer: What kinds of life experiences?

Dr. Miyazawa: Things that are said and not said. You just know that you fit in
with the experiences of people of the same – not economic, somewhat economic,
but cultural background. You can hang out with them without any problems at
all. There’s no judgment issues. You’re accepted even though one happens to be
a professor, the other one happens to be a pharmacist, the other one happens to be
a businessman. Who cares kind of a thing, where everybody is happy that they
are succeeding, but there’s no judgment.

Dr. Miyazawa went on to explain that he partly chose to leave Alohi for Kalani because
he thought the co-educational experience of Kalani would enrich his overall educational
and social life. “But,” he said, “looking back upon it I have mixed feelings about that
decision, because my true friends are the Alohi. I don’t socialize that much with Kalani.”
Dr. Miyazawa expressed that he feels he “lost something in that relationship, which as
60
you get older is more valuable than what your success level is. They’re still my best
friends.” First, it is striking that his occupational success is somewhat overshadowed by
these deep connections he made during his childhood. This speaks to the importance,
power and value of interpersonal dynamics in relation to one’s sense of well being and
quality of life; issues that I argue remain at the core of contemporary race relations.
Second, it says a lot that he felt more comfortable with his Asian American friends at
Alohi. Despite his notable success, some amount of judgment is presumably still
communicated to him from non-Asians—“Things that are said and not said,” based on his
above statement. He doesn’t prefer to socialize with other Asians out of a sense of group
superiority, but because he feels there is a mutual fit, an open understanding and most
importantly, acceptance. Further, he mentions “life experiences” deep in the Asian
community, calling attention to the unique positionality of Asian Americans.
Indeed, the experience of being Asian American means that at the same time you
are told you are a model minority—that you are the kind of minority “those other”
underclass minorities should aspire to emulate (Osajima 1988)—you also detect often
hard to pinpoint subtle messages and cues that your Americanness is still questioned,
even by whites who have been in this country even fewer generations than yourself. As
an Asian American, your individual ethnic identity is often blurred and misunderstood
and although often lumped together as one homogenous group, vast differences can
separate you even from first generation immigrants of your own ethnic group. It is an
experience and positionality that often only other Asian Americans can appreciate and as
another third generation Japanese American myself, it is easy to see how and why Dr.
61
Miyazawa would feel that it is easier to hang out with his Alohi friends and why he feels
he doesn’t have to worry about being judged when he is with them. Dr. Ojima spoke of
this same issue as I pointed out earlier in this chapter; a powerful qualitative matter that
gets suppressed and ignored in favor of focusing on the socioeconomic attainment levels
of Asian Americans. It is essential that I also address other aspects of the interview that
involved this friendship theme that Dr. Miyazawa spoke of in quite a few instances,
returning to the subject many times.
Dr. Miyazawa clearly indicated that any regret he may feel regarding his decision
to leave Alohi for Kalani, comes from the friendships he feels he left behind at Alohi.
Yet, I want to emphasize that while Dr. Miyazawa clearly indicated that his best friends,
those that he truly feels comfortable and free of judgment with, are the Asian friends
from Alohi, he at many points in the interview communicates that he feels completely
accepted and apart of the mainstream. He is not unhappy with his life by any means. As
I discussed earlier, he stated that he feels lucky that his experience has been free of
prejudice and discrimination. Indeed, according to Dr. Miyazawa, “[o]ur generation had
no limitations.” Yet, an inherent contradiction seems to stand out. On the one hand, Dr.
Miyazawa conveys this message of assimilation and incorporation, but when speaking
freely and not about race in particular, he makes a very clear and revealing statement
about lack of understanding and acceptance that can characterize cross racial friendships.
He seems committed to endorsing this image of inclusion when the subject of race is
clear or at the surface of our conversation; but when just talking freely, more of what I
62
deem as his uncensored thoughts and feelings are given voice. When I asked what type
of judgment he senses from these other (non-Alohi) friendships, he recanted
I don’t think that – that’s not a really fair statement of mine, because some of it is
my own doing. When you leave a place and you don’t come back to the place for
over 50 years, close to 50 years, they go one direction and you go the other
direction and you have no life experiences together. So the group at Alohi – not
all of them, there were 20 or 30 of us, we’ve kept in contact. Now if I kept in
contact with the people at Kalani I’m sure it would be different, but that’s not
their fault. That may be my fault in doing that. So it’s not that they’re bad people
or I’m a bad person. It’s just that we just didn’t have the opportunity to continue
the relationship. I do see a few people from Kalani, but the people I hang around
with are usually when I go home are Alohi people.

Interviewer: How come you didn’t have the opportunity to hang out with them?

Dr. Miyazawa: Education. When you’re in surgery your life is predetermined.

I deeply respect and admire Dr. Miyazawa’s motivation to present a “fair” and
objective portrayal of the nature of his relationships with his classmates from Kalani. As
I mentioned earlier, even before I began the interview, Dr. Miyazawa quickly informed
me that he hasn’t had any barriers so he may not be of much help to me. When
discussing his educational and professional endeavors, he makes it clear that he has not
encountered any limitations and when asked to further elaborate or describe the
judgments he received from the Kalani group, he takes the responsibility for lost
communication. It is not rare to lose touch with childhood friends, so I do not want to
assign more significance than what is due; I find that the significance really lies in his
explanation as to why he is more comfortable with his Asian American friends from
Alohi- “life experiences…pretty deep in the Asian population…[the ability] to hang
out…without any problems at all…no judgment issues”- and the explanation he gave
63
when asked to elaborate more directly on this issue is exactly in line with contemporary
colorblind ideas.
As Bonilla-Silva (2002) has found, racism is a topic most people would like to
avoid, so when confronted directly they do so rather easily; yet an analysis of their
conversations yield a much more complex story. Dr. Miyazawa explains that the
circumstances of medical school prevented him from staying in touch with his friends
from Kalani, but for some reason, this was not the case with his Alohi friends. I make a
point of this contradiction because Dr. Miyazawa seems very committed to presenting a
professional and personal life free of racial strife. This was true of many of the Japanese
American physicians I interviewed. Yet, upon closer examination, a subtle rift remains
that denotes a sense of closeness to ethnic networks, which suggests that race as a social
fact and identity, is more important and salient than realized.
I am not arguing that Dr. Miyazawa falsely believes that he has not experienced
racism; I agree that Dr. Miyazawa was fortunate to pursue and succeed in the many
opportunities that may not have been open to his African American counterparts and
previous generations of Japanese American physicians, but my argument is that a sense
of difference remains that can make even the most successful people feel more
comfortable with others who share their cultural backgrounds; thus a shared history,
regardless of their level of material success (Wang 2000). In other words, occupational
and economic incorporation or assimilation does not necessarily mean that social
citizenship (Marshall 1992 [1950]), or belonging automatically follows; or as Alba and
Nee contend, that they help redefine or remake the mainstream (2003).
64
When I asked Dr. Miyazawa if he has ever been able to make a group of friends
with the same type of comfort that he speaks of with his Alohi friends, he replied:
Definitely. No, I think I’d be a pretty one-dimensional person. No, we are very
active here, my wife and I, into many things. We are involved pretty heavily in
the museum, into the symphony, into the Japanese American cultural center, into
the Japanese American Medical Association. My wife, again, was picked to be
president of the women’s side. I’ve been president for about six or eight years…
We’re tied into a lot of Japanese things.

As he spoke I was struck that almost everything he spoke of had ethnic origins, and, as he
pointed out, they “are tied into a lot of Japanese things.” I wondered whether other
physicians who are also third generation Americans are this connected to their cultural
communities? Do they need to be? At the very least, Dr. Miyazawa’s level of
involvement with the Japanese American community in Los Angeles indicates a deep
commitment, connection and sense of belonging to his ethnic heritage, a connection
representing a high level of value atypical among white Americans (Waters 1990) but
common among communities of color (Tatum 2003). Yet, in the context of his
comments that implied an unbridled sense of comfort and acceptance when among his
friends from Alohi, which we know are Asian American due to the way the school was
segregated at his time of attendance, and the fact that he explicitly connects this level of
comfort to the types of “life experiences” that are “pretty deep in the Asian population,” I
argue that Dr. Miyazawa’s participation in these various cultural organizations
undermines a simplistic view of the US as a near-colorblind society.
The fact that such a successful physician, whose barriers, in his opinion, have
been minimal, feels strong ethnic affiliations undermines the assumptions of colorblind
65
ideology, even if such a physician draws on the heuristics of that interpretation to
understand his own life trajectory. It is this contradictory aspect of colorblind ideology
that is so interesting and requires deep investigation and data analysis. Even where
evidence from a highly successful professional seems to imbue colorblind rhetoric with
strong support, the continued importance of his ethnic ties illuminates the importance of
shared experience, shared history and comfort that disallows the elimination of race from
our minds and analyses.

Dr. Henderson
I turn to a discussion of Dr. Henderson, a Black male physician in his mid forties,
who works as a surgeon at a large and prominent university hospital in the Los Angeles
area. His comments and experiences succinctly capture and summarize the ambiguities
and sometimes concealed racial significance that sits underneath the surface of our
actions and interpretations; thereby, providing a starting point to begin the discussion of
the next chapter: the subtleties of post-racial racism.
Similar to many of the Japanese American physicians discussed in this chapter
(but unlike the majority of the African American physicians in the entire sample), Dr.
Henderson expressed, “[I]’ve had very few blatantly racist experiences in my life now.”
Unlike most of the Japanese American physicians who described lives relatively free of
racism, Dr. Henderson discussed this perception of his in less absolute terms, thereby
calling attention to the complicated layers of racial ideology in this post-racial moment:
That doesn’t mean I haven’t had it. I’m sure I’ve had it. It just – that isn’t –
they’re not either obvious to me or I didn’t attribute it to it, attribute it to race,
which I’m kind of inclined not to do that. So, you know, that’s my bias to think
66
of [things] as probably not [racial], as opposed to some who might be biased to
think it is because it’s happened to them enough that, you know, it fits.

So, I don’t really have a lot of experience with that, but I hear it enough to know
that it’s there and to be suspicious of things. I’m just more inclined to sort of
write it off to, well, maybe it was not that, because it wasn’t overt enough for me
to see it.

First, Dr. Henderson reveals that he usually does not attribute experiences in his life to
race because they are not overt enough to know for sure that his racial background is the
cause for whatever he is experiencing. In this way, Dr. Henderson reflects what many
Americans believe about racism—you can’t really attribute something to racial
intolerance if you can’t really prove it or support your claim with tangible and
measurable pieces of evidence. I contend that this assumption causes people to overlook
the hard to pin-point sorts of exchanges that occur in the daily lives of people of color, in
an inherently structural way. This line of thinking helps to explain why many believe
that racism is a “relic of the past” (Winant 2000). Racism can really only emerge in overt
and unquestionable ways through laws, policies, practices, etc. that clearly deny rights
and opportunities or lead to differential treatment to individuals based on racial or ethnic
criteria. Due to civil rights legislations, these clearly racist practices are not legally
permissible and have become culturally taboo in some circumstances. That doesn’t mean
that seemingly benign laws, policies, and practices with inequitable racial outcomes or
consequences embedded into them are no longer at play.
Yet, Dr. Henderson states that he has the sense that he has encountered racist
experiences—a sense that seems to come from “this undercurrent,”—he is just inclined
not to look at it that way. Additionally, Dr. Henderson shared that “ [race is] thought
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about a lot…I think about race and how people might…interact with me.” In fact, Dr.
Henderson developed a website with his picture on it that potential patients are advised to
go to and part of the reason for the website with a photo of him “is that people can see
what I look like and learn about me before they come…so maybe the people who don’t
like Black doctors don’t show up…” He indicated that he did not encounter any overt
problems with patients before the website, but he suspected that some people may have
been “surprised to see that I was Black when they showed up, and that might’ve
determined, you know, if they decided to stay for treatment or not.”
This is very revealing about what it is like to carry out your life as an African
American male in this situational setting; but to varying degrees and extents, all people of
color have to make these types of negotiations, even if unconsciously a reality DuBois
(1989 [1903]) described as double-consciousness. I can’t imagine that a white doctor
would develop a website so that future patients could visit in part to see what s/he looks
like in order to be sure they are comfortable with his/her whiteness. This speaks to one
way in which Blacks and some other racial minorities have to expend extra amounts of
energy and labor just to comfortably carry out their lives. Again, Dr. Henderson did not
appear too troubled by the fact that he had to take these extra steps to warn future patients
that he is Black, he came across as very confident and happy with his life, and I do not
want to misrepresent the toll that this is taking on his quality of life.
I also argue that these types of maneuvers that are so normal to people of color
that they don’t stand out as a problem because they are just so commonly woven into
their lives that they aren’t even given a second thought as being inherently connected to
68
racism. Thus, much like Dr. Miyazawa, on paper Dr. Henderson appears extremely
successful occupationally speaking, especially at such a young age. If he were one
response in a survey measuring racial progress, where only restricted closed ended
question could be used, such as a recent Gallup (2009) poll, asking, “Would you say race
relations between (whites and blacks) as very good, somewhat good, somewhat bad, or
very bad?” It is likely that Dr. Henderson would have just answered: “very good” or
“somewhat good” and we would be left with the impression that ultimately would speak
to a decreasing importance of race; however, it was through further probing and analysis
that the contradictions and concealed meanings emerged, pointing to a much more
complex and nuanced racial reality in people’s lives. Indeed, by closely examining
people’s experiences, a different story comes out. A more complete analysis of the
significance of race and ethnicity in society must look at numbers and lived experiences,
and the messiness that does not always coincide with a progressive, consistent trajectory
that is leading more and more people of color to a promised land of race-neutrality.
I chose to focus in greater detail and depth on my interviews with Dr. Miyazawa
and Dr. Henderson because their experiences provide clear examples of the
contradictions inherent in a colorblind racial frame as well as some of the dangers and
pitfalls of drawing from a positivist or evidence-based repertoire in an effort to explain
and make sense of race and racism.
Similar to the story lines that Bonilla-Silva et. al (Bonilla-Silva, Lewis, and Embrick
2004) find that constitute the primary colorblind explanations of their participants, I also
detected the same type of discussions with my interview participants. For example,
69
relying on evidence based markers of racial problems and using the past as a yardstick for
current racial inequity represent just a couple of the ways that colorblind logic can
obfuscate concealed racial meaning and significance. Ultimately, both Dr. Miyazawa’s
and Dr. Henderson’ experiences challenge existing lines of thought about race. They
show that even as highly accomplished and well respected physicians- surgeons, in fact-
who share many mainstream notions about race and racism, such as the predominance of
fairness, they continue to encounter experiences that suggest at minimum, a sense of
otherness, which provides an opening to the contradictions in current colorblind racial
ideologies.
First, the notion that the significance and meaning of race can be measured by
“evidence” that focuses only on socioeconomic assimilation is called into question. Both
of these physicians can boast atypical markers of socioeconomic success. Yet, they both
still feel and do things in their lives that their white counterparts likely do not (e.g. setting
up a website in part so that your patients can see your racial background prior to your
first appointment). In this way, they also challenge prevailing commonsense ideas about
race and success; their very high socioeconomic status has not removed their racial and
ethnic identities nor has it made them blind to their underlying significance. As Dr.
Miyazawa, when speaking about his and his brother’s medical education at an elite
private university stated, “I’m sure that there was discrimination, but I did not see it.” A
follow-up queried, “why do you think that is?” His answer illuminates the unique
perspective of those relatively few, highly-skilled people whose success is difficult to
stop: “We were very good. We were top of the class. But you can be at the top of the
70
class and still be discriminated [against].” In other words, success doesn’t necessarily
reveal a lack of barriers; it sometimes reveals an incredible hurdler.
Similarly, Dr. Henderson shared that although racism “doesn’t manifest itself in a
way that is real to me…I’m sure I’ve had it.” Meaning, he is sure that he has encountered
racism in his life, despite the fact that it has not expressed itself in easily identifiable
overt ways to him. Thus, there is this deep sense that although one cannot easily point to
a particular experience or incident of overt racial inequality, this does not mean that racial
bias no longer exists, calling attention to the subtle, mundane covert patterns of racial
inequality. These physicians’ attitudes and beliefs about race in their lives and in the
U.S. are not unique; rather, they reflect mainstream attitudes about race. Yet, their actual
lived experiences distinguish them from the mainstream and call attention to the need to
uncover the hidden racial meaning lurking beneath the surface.
Next, to introduce the focus of the remaining chapters in this dissertation I briefly
discuss the comments made by physicians who express skepticism about colorblind racial
frames. This next section continues the previous discussion, where I began to question
more racially harmonious interpretations, and connects it to the themes and discussions
contained in the rest of the dissertation by exposing the notion that perhaps more than
meets the eye in terms of racial intolerance continues to lurk not too far beneath the
surface.

“[A]S FAR AS WE'VE COME, WE STILL HAVE FURTHER TO GO… IT'S AMERICA, HONEY.
WE'RE IN AMERICA:” THE UNCONSCIOUS REALITY OF COLORBLIND IDEOLOGY

71
As we are well aware, race is a social construct that changes through time; a
hegemonic construct that is rearticulated to adapt to the economic, sociopolitical and
ideological milieu of the time (Omi and Winant 1994). It is time for Americans to
acknowledge that this colorblind, post-racial sensibility that they embrace is really just a
rearticulated form of white privilege and racism, rather than a representation of racial
equality that many frame it as (Bobo and Hutchings 1996; Bobo and Smith 1998). I am
not arguing that the racism of today is just a disguised replica of the racism of the past.
The structural changes witnessed, despite the more recent dismantling and unraveling of
some of the Civil Rights achievements, led to or at least supported shifts in people’s
thinking, attitudes, beliefs and assumptions about race (see Gallup 2009 for attitude shifts
over time). Anti-racist efforts among people of color and whites have led to important
revisions in beliefs about non-whites on a micro-level as well as fundamental shifts on a
structural or macro-level.
Yet, despite some progress and shifts in thinking about race and the ways in
which we approach the topic, for many, underneath the revised and edited conscious
beliefs about race, remain deeply ingrained and sometimes unconscious feelings and
thoughts reflective of a racial ideology where whiteness is the center, the norm, the
normal, the familiar, the right way, the better way, the superior way, the truly American
identity (Wellman 1993 [1977]). In his study on urban politics, Saito (2009) documents
the failures of explicitly stated race-neutral policies in achieving race-neutral outcomes.
For example, historically, urban public policies were not race neutral and because the
racial ideologies of the larger society influence the dynamics, practices and people
72
engaged in localized political processes, pretending now that we can sweep race away as
if it no longer exists perpetuates racial inequality (Saito 2009). Further, based on his
analysis of ideological shifts as he studied them in the 1970’s, David Wellman explained
that the decline of outright racist ideas were replaced with a strong defense of white
interests coded in non-racism language. Bonilla-Silva (2003b:29) describes this ‘new’
post-civil rights racism, characterized by “racism without racists,” as color-blind racism.
A new report from the US2010 project by John Logan (2011) highlights some of
the major structural challenges to racial equality that are becoming more complex in the
‘post-racial’ era. Logan found that for Blacks, Hispanics and Asian Americans, high
income does not as frequently lead to living in a middle-class neighborhood. Among
Asian Americans and Latinos, their segregation away from whites has increased over the
past twenty years as their numbers have risen. For African Americans and Latinos the
result was particularly striking, as the families with over $75,000 in income lived in more
impoverished neighborhoods than even working class whites. Logan’s analysis indicated
that Black incomes are not the driving force in segregation and unequal neighborhoods;
rather, even when African Americans have higher incomes they either can’t translate that
into residential mobility or do not choose to. In other words, more affluent, professional
Black families may have limited opportunities to leave poor neighborhoods. A part of
these findings though suggest that these professional Blacks choose to live in
impoverished neighborhoods that are segregated rather than move to non-Black
neighborhoods that are more affluent, with all the amenities that go along with them. All
of these findings emphasize that income and markers of economic prosperity do not
73
capture the story of race in America. It is clear that the intricacies of daily life are
important in racial experiences and this chapter will show how they remain salient even
with the advantages of high socioeconomic achievement.
As one physician, Dr. Ando, a Japanese American male obstetrician in his mid-
fifties adds, “…it's become very, very obvious over the years that the racism's still there.
It's entrenched in this society. You see it in every aspect. I mean you look at
entertainment or get - you look at the workforce and you look at even academia, there's a
bit of it everywhere. There's no denying [it]…”
Dr. Itou, another Japanese American physician elaborates on Dr. Ando’s point,
emphasizing that much more complexity lurks beneath the surface of this colorblind
standpoint.
But I do think that there's more prejudice out there than people are willing to
state, and I think that applies kind of across the board, racially, politically, there's
a veneer of being open minded, and loving everybody and being all egalitarian,
and right below that, I think there's a lot more stuff.

'Cause I just think - and there's a lot of people on a one-on-one basis, they would
treat somebody decently and so forth. But if you gave them a situation to where
they didn't have an individual connection, it's not that far away. So it even comes
up in my practice with that. There's a physician in the community who I think is
really excellent. But when I refer, I try to kinda feel her out a little bit if I think
there's gonna be a problem.

In this portion of our conversation, Dr. Itou taps into what she perceives as some
of the holes in our contemporary racial frame, which allows and encourages people to act
as though racism no longer exists. It is very easy for people to invoke key buzzwords or
phrases (such as, ‘I don’t see color,’ ‘I only see people,’ ‘my good friend is Black,’ etc.)
in order to pass as racially egalitarian under this shared hegemonic understanding of
74
colorblind logic and discourse, when, in reality, much of the time a lot of unfavorable
attitudes and beliefs about particular ethnic and racial groups remain (Bonilla-Silva 2002;
Bonilla-Silva 2003a). As Dr. Itou begins to explain, even in her experience as a
physician, she has to feel patients out before referring them to a Black physician that she
feels is an excellent doctor. Yet, fully aware of the prejudices that people still carry with
them, despite what she calls a “veneer of being open minded,” Dr. Itou doesn’t feel she
can freely refer her patients to the physician due to the hidden anxieties and assumptions
grounded in racial intolerance and hysteria-especially in terms of anti-Black sentiment.
Thus, this racial ideology that idealizes a contemporary racial egalitarianism, only
obfuscates the reality that racial prejudice, bias and intolerance, continue to shape the
attitudes, beliefs and behaviors, despite what gets articulated in the open.
Echoing a similar sentiment, Dr. Kobayashi reiterates that the fundamental
ideologies that inspired the open hostilities, aggressions and just flat out obvious acts of
racial discrimination of the pre-Civil Rights eras continue to loom large.
…but clearly, I'm sure there are some bigots out there; just because we have civil
rights changes in the last 50 years, those same people that were racist are still
here. Because it's not overt anymore, when my grandparents were around, there
was clearly overt racism and discrimination and you know, this, a good example
is little Tokyo and how it evolved over the past several decades. You know, you
had to have Little Tokyo when the [Issei] were originally here because they
couldn't go anywhere else to get the ethnic foods and ___ and stuff like that and
conduct their businesses...The very people that did the overt discrimination and
hold prejudices are still out there. It's just that it's not politically correct to show
it. Which is a stupid thing in some ways because you don't know who's the racist
now, but you did before.

You just don't know it. They're just not going to express it. But it's there.

75
Dr. Kobayashi touches on some very important points. Indeed, just because
racism, bigotry and discrimination have been challenged from a legal standpoint, this
does not necessarily mean that individual or collective sensibilities have undergone the
same sorts of fundamental transformations. Moreover, individuals affected by
unconscious biases, or individuals just unaware of their biases for various reasons,
continue to run the same businesses, corporations, all the institutions that we must all
pass through and negotiate throughout the courses of our lives, thereby allowing the same
people to possess and yield a great amount of power over people’s life chances who do
not find themselves to inhabit those same positions of power. Further, Dr. Kobayashi
illuminates an extremely important aspect about the contemporary racial order by calling
attention to the reality that racism is not out in the open in the same way it presented
under other racial periods (e.g. Jim Crowe, anti-Affirmative Action), so it often leaves
people wondering and guessing after a particular interaction with someone who may truly
hold racist attitudes, but just can’t express those feelings as freely as in the past. I will
soon discuss the extra amount of labor people of color expend to decipher the subtle cues
and messages that they receive everyday in their interactions with others. As Dr.
Kobayashi said, “just because we have civil rights changes in the last 50 years, those
same people that were racist are still here…It's just that it's not politically correct to show
it.”
Another physician calls attention to the complexity of colorblind impressions that
overestimate the degree of racial progress by clarifying that while we as a society have
made considerable movement toward racial equality, we still have a ways to go. Thus,
76
despite outward appearances of growing racial tolerance and acceptance, people of color
continue to face challenges on a daily basis. Dr. Gellings poignantly articulates,
Yeah. Well, let us say, first we're in America and there's a certain, regardless of
how much we've changed, we still have a ways to go. Regardless of whether or not
we have a president who is a president of color, you still have stuff that happens
every day to people like you and me on a local level. So yeah, we've come a long
way. People who are minorities now going through medical school certainly will
fair better and have less obstacles and more role models than, say, I did 25, 30
years ago. Sure. It was competitive then, it's competitive now. As I say, as far as
we've come, we still have further to go.

As is the case with all of the physicians I interviewed, Dr. Gellings also strives to
approach the issue of racial progress with a “balanced” perspective despite accusations
that people of color too frequently ‘play the race card’ (Bonilla-Silva 2003b). She
acknowledges that we have witnessed some amount of racial progress in the field of
medicine; yet, both in medicine and broader society as a whole, a lot more work toward
the goal of racial equality remains (Reede 2003). She goes on to use as an example of the
work that remains, an email she received about a book display at a Barnes and Noble
store which conjured up long standing and highly degrading stereotypes of African
American as sub-human and ape-like.
When you can - I should show you this, there was a Barnes and Noble, I got sent
this, I have to go pick it up out of the computer. Someone sent me an e-mail
and…it said Barnes and Noble had a book display, it had Obama on a whole lot of
books, and in the middle of the display it was a picture of monkeys.

Yeah, so, you know, in terms of how far we've come, we still have a ways to go…
It's America, honey. We're in America. People get, I said, well you know, this is
the United States of America, you have a right to hate people. Let me know how
you really feel.

Thus, Dr. Gellings reveals the deep-seated disregard and hostility for African
Americans that continue to permeate the culture of this country and the very subtle and
77
insidious ways that this racism manifests in this age of colorblindness. While critics
might point to an incident like this as trivial, such a conclusion lacks an understanding of
the layers of racial meaning that are thrust into the consciousness of people of color as
they navigate daily life. Racist or race-tinged depictions may be avoidable for whites
(Gans 1979; Waters 1990; Wellman 1993), but for those whose lives will be affected,
they are not as easy to disregard (Sue, Capodilupo, Nadal, and Torino 2008). The civil
rights movement and other anti-racist efforts led to many changes that on the surface may
appear as racially egalitarian. A colorblind discourse exaggerates some of those
moments of growth and embellishes claims of racial progress (Omi and Winant 1994).
As Dr. Gellings points out, “we still have a ways to go.” The correlation of President
Obama to a monkey reflects deeply embedded, hard to eradicate and often invisible
attachments to hegemonic racial and cultural ideologies (Goff, Eberhardt, James, and
Jackson 2008; Hall 1993).
Interestingly, these observations are coming from physicians, an occupational
group of people who many consider to be emblematic of the “top echelon” of American
society. Yet, despite all of the protective mechanisms that their occupational status
affords them such as class privilege, an amount of deference, power and
command/authority due to their high level of education, the insights and experiences that
these physicians lend help to undermine the notion that race is no longer as salient as in
the past. It is this group of people who many of our contemporary claims of racial
equality are based on. As such, many might assume that these individuals no longer
encounter the kinds of racial barriers that we often associate more with those struggling
78
to get ahead such as the Black underclass, some Latino immigrants or maybe even some
first generation Asian ethnic groups. The assimilation and incorporation—or lack
thereof—of these groups into the economic and cultural mainstream have been the topics
of widely-read sociological analyses (see Wilson 1987; Wilson 1996; Zhou 1997). My
present focus on high-status, high-income professionals and their life experiences vis-à-
vis race and ethnicity provide a missing side of the analysis of inequality, one which
Willie (1978) described as unique and inclining as people of color move into more
predominantly white domains of social life. The experiences of physicians riding this
incline towards professional success tell complex stories of race in post-civil rights
America—success coupled with the continuing significance of race. I will continue to
discuss the ways that race and ethnicity maintain salience and significance in this post-
racial colorblind era in the chapters that follow.

CONCLUSION

Winant (2001:xiv) argues that concerns with racism are stalemated in this post-
civil rights era where many believe we have “solved” and “transcended” the “race
problem.” My data suggests that this premature and presumptuously optimistic outlook
about the decreasing significance of race in contemporary American society stems from
incomplete and inadequate definitions, theoretical frameworks and limiting
methodologies aimed at studying race relations that posture a supposed ‘objective’ and
‘neutral’ rationality (Bonilla-Silva and Zuberi 2008; Marks 2008). I argue that we are
stuck in a decades-long moment that has dangerously overemphasized the concrete,
tangible and easily identifiable aspects of racism. While these are core features of racial
79
inequality, and need to be regarded as a central and fundamental portion of an analysis of
racism or racial inequality, any complete theorization of race or race relations must also
include the “micro-macro linkages that shape racial issues” (Winant 2000:169), and the
“interactive processes inherent in racial inequality” (Stewart 2008:123), in order to
uncover the often concealed, but very powerful mechanisms of contemporary hegemonic
racial subordination and marginalization.
Further, the over reliance on what appear as objective and seemingly hard fact
lead to several problems. First, it leads to the tendency to conflate obvious acts of
discrimination with the existence of racism or a racist ideology. When discrimination—
the act of barring or prohibiting an individual on the basis of ethnic or racial origin, or
any other ascribed trait—is categorized synonymously with racism, the power, depth and
range of racial ideology is undermined and ignored. Thus, we end up in a situation where
many hold the opinion that the “apparent decline in overt, blatant…forms of race and sex
discrimination” are mistaken as an indication that racism is on the decline or “dead”
(Feagin 1981). Many of the physicians I spoke with most likely did not encounter an
explicitly stated guideline that barred them from particular opportunities or experiences
because discrimination on this level was no longer state sanctioned. Yet, it would be
shortsighted to believe that race did not continue to play a role in people’s lives, even
when it seemed as though we as a nation moved passed legalized racism and
discrimination.
Many sociologists participate in this misguided practice where certain types of
data are taken for granted as a reflection of better evidence (Marks 2008). For example,
80
in a conversation with fellow American Sociological Review (ASR) Deputy Editors,
Andrew Walder expressed that “the review process at major journals does tend to favor
certain kinds of work: work that is firmly grounded in evidence…” (Camic, Wilson,
Walder, Howard, Weakliem, Glenn, Bielby, and Halaby 2001). Privileging work
grounded in evidence, or subscribing to a particular idea based on purported evidence in
itself is not a bad thing. The concern is that for too many people—including many
sociologists—“evidence…usually means numbers, measurements, statistics” (Best, 2001,
6). This is not meant to be an attack on quantitative research, yet since the highly
influential study by Blau and Duncan (1967) on occupational mobility, studies of
inequality have often sought to quantify with seemingly impressive methodological tools
their studies of privilege and oppression. As Joel Best (2001) points out, “[t]he solution
to the problem of bad statistics is not to ignore all statistics, or to assume that every
number is false. Some statistics are bad, but others are pretty good, and we need
statistics—good statistics—to talk sensibly about social problems.”
My intention is to point out a tendency in the public and supported by experts in
academia and other authoritative institutions to follow and rely on partial evidence—the
numbers, statistics, measurements, and observable, obvious and overt acts—in order to
make sense of social problems and even life experiences (Feagin 1981). Partial evidence
can only lead to partial knowledge and distorted impressions. I argue that we need to
build on traditional ways of understanding and studying racism in order to take into
account matters of social inclusion that present in more broad, yet patterned, subtle and
81
taken for granted dynamics that constitute colorblind racial sensibilities. I will explore
this covert side of racism
9
in the following chapters.
CHAPTER 3:
RACE WORK OUTSIDE THE DOUBLE DOORS:
THE PRIVATE LIVES OF AFRICAN AMERICAN AND JAPANESE AMERICAN
PHYSICIANS

At the turn of the century, Winant stated “[s]o now, racial theory finds itself in a
new quandary. Empires have been ended and Jim Crow and apartheid abolished (at least
officially). How then is continuing racial inequality and bias to be explained”
(2000:171)? Indeed, this is the situation we find ourselves in when much of our research
has been predicated on a model that relies heavily on evidence that appears tangible,
factual and objective. In this chapter, I will explore some of the frequently overlooked
and neglected subtle and seemingly innocuous micro-level manifestations of racial bias
through the perceptions of the African American and Japanese American physicians I
spoke with. In doing so, I call attention to the deeply meaningful and powerful ways that
race remains significant in the everyday lives of racial minorities, even among those who
many would assume to no longer encounter race related problems due to their high
socioeconomic statuses.

9
I do not intend engage in an argument about whether or not racism is as bad or better now than in the past.
This is the type of discussion that I want to move away from. My point is focused more on illuminating the
various qualitative ways that race continues to remain a significant and meaningful aspect of all of our lives
despite hegemonic claims that we, as a society, have moved beyond race. I argue that instead of talking
about whether or not racial conditions are better now than in the past, it is more fruitful to examine the
ways that racial meaning has changed over time and how racial attitudes get expressed differently in order
to keep up with the norms and values of the time.
82
As racialized individuals, people of color must engage with the social world from
the vantage point of being phenotypically marked. As such, they must constantly
negotiate and engage in race work. I use the term race work to describe the management
of emotional, physical and psychological communications and contexts that contain racial
meaning. The concept has similarities with Hochshild’s (1979) “emotion work,” in that it
emphasizes often taken-for-granted aspects of everyday actions that involve emotional
investment and focus to ‘do life.’ to perform certain socially-appropriate tasks. I will
discuss race work and describe the three types clearly visible from my interviews further
below.
I contend that race work consists of all racially subordinating dynamics that lead
to detrimental, inequitable and/or differential life choices, sensibilities and positionalities
for people of color. In this chapter I draw on Pierce’s (1977) concept of racial
microaggressions in order to uncover how contemporary racial ideologies play out in
everyday social interactions. Racial microaggressions refer to the verbal and non-verbal
slights and insults, which are often subtle and unconscious; but communicate racially
antagonistic attitudes and feelings to people of color (Pierce, Carew, Pierce-Gonzalez,
and Wills 1977; Sue 2009; Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, and
Esquilin 2007). I contend that these racial microaggressions constitute one aspect of race
work. Further, I discuss the systemic, everyday interpersonal, emotional work that
people of color engage in as a response to racialized lived experience and in an effort to
minimize its harmful impact. For example, the “double consciousness” and awareness of
ones own racial positionality in relation to others around them continually remains a part
83
of the race work that people of color constantly engage in (Du Bois 1999 [1903]).
Finally, I explore how the ghostly remains (Gordon 1997) of our racial pasts are a
persistent feature of race relations and should be included as a component of any
complete racial theory. These ghosts of both collective racial pasts and racialized lived
experiences remain salient and, too, like racial microaggressions that come from the
outside (as they are directed from someone or something) and internal racial processing
(that typically resides within ones consciousness) constitute the daily race work that
people of color manage as they do life.
Therefore, in this chapter I organize my discussion of African American and
Japanese American physicians’ experiences with what I call race work around three
categories: 1) external race work, which is akin to racial microaggressions: the racialized
messages communicated from one person to another (Pierce, Carew, Pierce-Gonzalez,
and Wills 1977) 2) internal race work: the racial consciousness and awareness that leads
to immense amounts of emotional labor and racially motivated decisions about how to
carry out one’s life and (Du Bois 1999 [1903]) 3) contextual race work, where racial
conditions rooted in the past continue to shape and inform racial sensibilities and
positionalities (Gordon 1997).

THE RACE WORK OF AFRICAN AMERICAN AND JAPANESE AMERICAN PHYSICIANS
RACIAL MICROAGGRESSIONS, RACIAL CONSCIOUSNESS, GHOSTLY MATTERS

EVERYDAY RACIAL MICROAGGRESSIONS IN THE PUBLIC SPHERE

Racism in the age of colorblindness is predominantly expressed in very subtle and
insidious ways; ways that simply can not come into view through statistics or regression
84
models that are not as adept at picking up individualized, yet commonly linked personal
lived experiences. To use the words of Dr. Lee-Girard, an African American female
emergency medicine physician in her early forties, racism “has become so subtle; you
really don’t know who those people are and you really don’t know what it is.” As
Bonilla-Silva (2003b:3) put it, “today racial practices operate in ‘now you see, now you
don’t’ fashion.” I contend that the hidden and unclear aspect of this rearticulated form of
racism is what makes it particularly challenging and dangerous. Pierce’s concept of
Microaggressions is a useful place to begin in trying to make sense of contemporary
colorblind racism.
Originally coined by Pierce in 1970 (Sue et al. 2007), microaggressions refer to
the “subtle, stunning, often automatic and non-verbal exchanges which are ‘put downs’”
with “cumulative weight” and occur daily (Pierce, Carew, Pierce-Gonzalez, and Wills
1977:65). Pierce further elaborates, “[i]n and of itself a microaggression may seem
harmless, but the cumulative burden of a life-time of microaggressions can theoretically
contribute to diminished mortality, augmented morbidity, and flattened confidence”
(Pierce 1995). Solorzano, Ceja, and Yosso (2000:60) add that microaggressions are
“subtle insults (verbal, nonverbal, and/or visual) directed toward people of color, often
automatically or unconsciously.” Sue et. al define racial microaggressions as “brief and
commonplace daily verbal, behavioral, and environmental indignities, whether
intentional or unintentional, that communicate hostile, derogatory, or negative racial
slights and insults to the target person or group” (2007:273). Sue et. al also note that
microaggressions “are not limited to human encounters alone but may also be
85
environmental in nature,” such as when “one’s racial identity can be minimized or made
insignificant through the sheer exclusion of decorations or literature that represents
various racial groups” (2007:273-274).
10
A few examples of racial microaggressions
include “subtle snubs or dismissive looks, gestures, and tones;” exchanges which “are so
pervasive and automatic in daily conversations and interactions that they are often
dismissed and glossed over as being innocent and innocuous” (Sue et al. 2007:273).
Racial microaggressions are not always manifestations of unconscious racial biases, but
they often are and “are detrimental to persons of color because they impair performance
in a multitude of settings by sapping the psychic and spiritual energy of recipients and by
creating inequities” (Sue, Capodilupo, and Holder 2008; Sue et al. 2007:273).
Dr. Howard, a Black woman psychiatrist in her early sixties, shared her
understanding and insights about Pierce’s concept of microaggressions as a way to
describe to me how African Americans experience life in America:
Still today, you will get the same sort of subtle - what's referred to as micro-
aggression behavior - on the part of majority folk. Very, very subtle things like

10
Sue et. al (2007) constructed a “taxonomy of racial microaggressions in everyday life” (271) in order to
categorize the diffuse manifestations of these covert expressions of racial intolerance. According to Sue et.
al. (2007), racial microaggressions can be categorized into three subgroups: 1) Microinsults 2)
Microassaults 3) Microinvalidation (278). Microinsults and microinvalidations are often unconscious
manifestations of racial prejudice while microassaults are often conscious expressions of racism.
Microassaults are defined as “explicit racial derogations characterized primarily by a violent verbal or
nonverbal attack meant to hurt the intended victim though name-calling, avoidant behavior or purposeful
discriminatory actions” (Sue et al 2007, 278). Microinsults are defined as “behavioral/verbal remarks or
comments that convey rudeness, insensitivity and demean a person’s racial heritage or identity” (278). For
example, when talking so someone who is Black and commenting on how articulate he/she sounds, there
implying that they are surprised by his/her intelligence and conveying the expectation that as an African
American, he/she would not be intelligent. Microinvalidations are defined as “verbal comments or
behaviors that exclude, negate, or nullify the psychological thoughts, feelings, or experimental reality of a
person of color” (278). For example, asking a third generation Asian American, “where are you from?”
thereby implying that they are a foreigner and not American. Sue et. al (2007) identify another type of
racial microaggression which be connected to each of the three other categories. Environmental
microaggressions, they contend, are macro-level “racial assaults, insults and invalidation which are
manifested on systemic and environmental levels” (278).
86
ignoring you when you're waiting in line or inattention to physical contacts, which
is one of the vicissitudes of the experience of reality and the social dance that
occurred throughout the generations, beginning with the social wounds of slavery,
where you couldn't look a white person - look at a white person in the eye. You
weren't to speak until you were spoken to. Y'know, touching was a transgression
punishable by death; bizarre things like that.

So, those things remain subtly, sometimes even unconsciously, in our thinking
and behavior when we engage, particularly if we have been relatively isolated in
the African American community, and you will find large percentages -
particularly of the underclass - even though they may have migrated, say, from
the South to the urban area, don't really go much outside of the ghetto. There are
youth who spend, y'know, the first 20 years of their life never leaving their
neighborhood because it's trespassing.

Yeah, I really need to give you that article. Micro-aggression is a subtle verbal or
behavioral interaction that negatively impacts the emotional well-being of
somebody who is African American or other - like, a man against a woman or a
white against a Black or whatever. So, there are very subtle things like referring
to them in some sort of negative way that is race-related; ignoring them in terms
of access to services, y'know, like you're standing in line at the perfume counter
and you've been there for a while, and then someone walks up and they start to
wait on them, like, "Oh, I didn't know you were here." Well, bullshit; you knew I
was here. And maybe, maybe you didn't. Maybe you didn't even see me because
I'm Black. I mean, they're really, really very interesting behaviors because if you
point it out to white folks, then they're all shocked and dismayed and, "Not me; I
marched in the '70s," and all this stuff, blah, blah blah.

But these things are so very subtle and to the point of being unconscious that
they're just reflexes - automatic reflexes. And, y'know, for them to say they didn't
see you seems preposterous, but they have been trained for centuries to not see
Black people as human beings. They were just sort of objects. So, it's just like
you don't see dogs and cats. I mean, y'know, you just - you don't regard them.

Dr. Howard’s application of Pierce’s theoretical conceptualization of microaggressions to
the everyday experiences of African Americans helps to clarify some of the mundane
ways in which intolerance, ignorance, prejudice, aggression, hostility and racism continue
to get directed toward African Americans. As she emphasizes, racial microaggressions
are extremely subtle and unconscious, yet, extremely powerful because they are
87
ultimately rooted in a deep ideological history of white supremacy and an oppressive
regime of white power and domination. So what are some of the ways these subtle
microaggressions play out in the lives of people of color? In the following sections, I
will share some of the experiences and stories the physicians I interviewed generously
recalled with me in order to further illuminate some of the ways in which race work
becomes ubiquitous.
Upon first glance, microaggressions may seem like harmless slights that could, or
some might argue, should be shrugged off without further consideration; yet when they
are contextualized in a racial history that involves the individual, family and community,
these “slights” acquire much more meaning and significance; there is a patterned and
cumulative effect of these recurring racial microaggressions. Thus, while some may find
these interactions to be insignificant insults that everyone goes through--the kind of
behavior that white people might just shrug off or chalk up to someone just having a bad
day, causing them to accuse racial minorities of things too personally or playing the race
card—in actuality, these are really covert, subtle and passive aggressive manifestations of
racism contextualized in a milieu of racial antagonism, degradation and white power (Sue
2009).

External Assaults: The Microaggressions of Living in a Marked Body
The deployment of the body in material, social and cultural forms constitutes the
foundation of social constructions of race and racism (Creef 2004:8; Omi and Winant
1994). In fact, bodily differences are the primary mechanisms Omi and Winant’s
definition of race pivots around. Race, they say, “is a concept which signifies and
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symbolizes social conflicts and interests by referring to different types of human bodies”
(Omi and Winant 1994:55). Images, traits, and stereotypes are inscribed onto the body,
each of which are used to classify, signify, and symbolize to others, even if
unconsciously, particular social, cultural and historical representations about that person.
In other words, “[w]e use race to provide clues about who a person is” (Omi and Winant,
59). The body, then, acts as a “symbolic tool” (Schwalbe, Godwin, Holden, Schrock,
Thompson, and Wolkomir 2000) through which we other and exploit those deemed
subordinate (Schwalbe 2000). Phenotypical variations that stray from a white norm
often provide the vehicle through which feelings of curiosity, ignorance, hostility and
disdain toward non-whites get expressed (Kaw 1993; Patton 2006; Stepan 1998).
As Dr. Parker, an African American male surgeon in his late fifties put it,
And that's what's still very difficult for people of non-color to understand. And
you just cant unless you wear it, you just don't understand. And that's why I have
had, no, no. You know, once you step in a room, and everybody knows who you
are when you step in that room. It's different. There's no way unless you've
experience it to have 100 eyes on you when you step in the door. I mean, my
partner. He told me when his daughter was on the soccer team and they went to
Utah, everybody looked the same in Utah. And they stepped into the diner and
everybody was looking around... [like] what's going on. I mean, this is just a
couple of years ago; so until you live it, you just don't understand it.

Dr. Parker points out a dynamic of conspicuousness that follows people of color
everywhere they go when they are in minority situations; indeed, an unmistakable
visibility and distinctiveness goes along with having non-white skin or some other
physical feature that denotes to others one’s non-white racial status. The racial codes and
norms attached to the traits and features imprinted on the bodies of those also carrying a
subaltern racial positionality, entitle others to stare and gawk, ultimately questioning and
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undermining in a very subtle way that person’s social belonging. For example, when Dr.
Parker says, “once you step in a room, and everybody knows who you are when you step
in that room,” he is describing the on-going, never-ending context and meanings that are
intimately and deeply attached and embedded in the physicality of race as well as the
uneven power dynamics structured into the ways we share and inhabit public space. In
this way, “[r]ace becomes ‘common sense’—a way of comprehending, explaining, and
acting in the world” (Omi and Winant 1994:60).
Thus, for example, when you are African American and you step into a room,
others often feel inclined to stare and make assumptions about you based on your
appearance – regardless of your social class status or occupation - often without risk of
repercussion for such behavior. You may be a physician or an investment banker, but
when you enter a crowded restaurant, people may assume you are of questionable
character—perhaps a drug dealer, athlete, or someone who got ahead “unfairly” through
Affirmative Action—because of the existing stereotypes about African Americans
(McCabe 2009; Smith, Allen, and Danley 2007). “This racial ‘subjection’ is
quintessentially ideological. Everybody learns some combination, some version, of the
rules of racial classification, and of her own racial identity, often without obvious
teaching or conscious inculcation. Thus, we are inserted in a comprehensively racialized
social structure” (Omi and Winant 1994:60). The link Omi and Winant point to between
the microsocial pattern of interactions and the social structural is especially significant to
highlight because too frequently micro-sociological analyses are thought of as social
psychological, distanced from social institutions. Some of Goffman’s (1959) most basic
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descriptions of human behavior and its dependence on the structural and cultural milieu
are overlooked if we fail to view these everyday interactions in terms of the structures of
culture and hierarchy that make them possible and understandable.
In the quote above, Dr. Parker shared a memory about an incident that his
colleague, a Japanese American male surgeon encountered while traveling in a white
dominated setting. As Dr. Parker recalled, when Dr. Kondo and his daughter, both
Japanese American, walked into a diner everybody seemed perplexed by these clearly
foreign looking people in their midst. Again, through phenotypic distinctiveness, Dr.
Kondo takes with him everywhere he goes, messages to others about his own
positionality as an American. His Japanese physical characteristics entitle others to stare
and speculate about his level of belonging, ownership, authority, and relatability. Each
assumption is deeply connected to often taken for granted and unquestioned attitudes and
beliefs about Japanese Americans and masculinity. The types of generalizations that
others make about these “marked” individuals often inform the types and quality of
interactions they will engage in: will they make eye contact? Will the ignore them?
Will they be overfriendly? Will they gawk? Will they shoot disapproving glances at
them until they leave? Will they look uncomfortable that they have to share the space
with foreigners? Will they try to make them feel uncomfortable or reassured?
According to Goffman, “[t]he Greeks…” used the term ”stigma” to refer to bodily
signs designed to expose something unusual and bad about the moral status of the
signifier (Goffman 1963). Goffman elaborates that a stigma “is really a special kind of
relationship between attribute and stereotype…” including the “tribal stigma of race,
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nation, and religion” (Goffman 1963:4). Omi and Winant (1994) state that race is often
the first characteristic that we notice about someone when we meet them. Similarly,
Goffman discusses how we use a person’s physical traits and attributes to categorize
him/her; and, if an “undesired differentness” exists “we exercise varieties of
discrimination, through which we effectively, if often unthinkingly, reduce his life
chances.” We construct…an ideology to explain his inferiority and account for the danger
he represents, sometimes rationalizing an animosity based on other differences such as
social class” (Goffman 1963:5). The connection of stigma with subtle and unthinking
discrimination has been supported, for instance in experimental studies which show that
Americans continue to associate Blacks to apes, an old misconception of scientific racism
still subtly influencing people’s beliefs and values (Goff, Eberhardt, James, and Jackson
2008). While most of Goffman’s empirical data related to the socially outcast and
stigmatized experience of physically handicapped people, he considered race one
example of three broader categories of stigma. The racial project of subjecting bodies to
stigmatizing racial codes is a subtle process that many are not even aware of while it
helps in maintaining a racial order that excludes racial others from full social acceptance.
The Perpetual Foreigner: Japanese American Experiences with Racial Microaggressions
Stereotypes and racial myths exist about all ethnic and racial groups in the U.S.,
but phenotypic distinctiveness leaves most racial minorities particularly vulnerable and
susceptible to the racial microaggressions that flow from these preconceived assumptions
and beliefs. Yet, it is important to first look at the mechanisms by which people of color
as racial subjects are excluded from the social and cultural core of U.S. society. Race,
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gender and class are key institutional mechanisms for creating and maintaining
boundaries of inclusion and exclusion, but the nature of externalized racial
microaggressions seemed to manifest differently for the African Americans physicians
and Japanese American physicians I interviewed based on the inherent differences in the
stereotypes, myths, and positionalities of these two racial groups. In talking to African
American and Japanese American physicians who practice in Los Angeles about their
private lives and how they experience social spaces as they carry out their daily routines
and personal matters, I find that the nature and character of the microaggressions fell very
much in line with prevailing societal stereotypic depictions about African Americans and
Japanese Americans and the ways in which those contrived caricatures acquire new
meanings when they intersect with gendered norms and ideologies.
I contend that exclusion for African Americans transpires along the color line
(Collins 2004), while Asian Americans are excluded from full membership due to their
racialized status as foreigners (Gotanda 1985). Both systems are “subordinative: they are
rooted in racial power relations—between the dominant and the subordinate—and are
based on the definitions of “us” versus “them,” as set out by those who have the most
power to define the terms” (Ancheta 1998:64). Ancheta (1998:15) outlined the basic
ideas of this argument:
I argue that anti-Asian subordination is qualitatively different from anti-black
subordination. Rather than being centered on color, which divides racially
between the superior and the inferior, anti-Asian [and anti-Latino] subordination is
centered on citizenship, which divides racially between American and foreigner.
Asian Americans are thus perceived racially as foreign outsiders who lack the
rights of true “Americans.”

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Asian Americans have never embodied American-ness because they have always been
the “foreign other,” the “illegal alien” the “yellow peril,” the “enemy alien,” or the
“model minority”—each of which imply what Lisa Lowe (1996) calls “foreigner-within;”
and none of which are truly American identities. Indeed, from the earliest waves of
newcomers, anti-Asian sentiment has depicted Asians in the U.S. as outsiders (Ancheta
1998; Aoki 1996). Their American authenticity is always questioned. These
assumptions meant that Asians were labeled as unassimilable and viewed as so culturally
so distinct from Westerners that they were not accepted as equal and full members of
society (Daniels 1977; Saxton 1971; Takaki 1989). This is not to imply that African
Americans do not encounter social exclusion; just that their Americanness or allegiance is
not questioned as it is for Asian Americans and Latina/os (Tuan 1998). As later
discussions will show, African Americans are not necessarily excluded on the basis of
foreignness, but through cultural ideologies that depict them as marginally human.
Dr. Kawaratani discussed an experience she had as a Rotary member that
exemplifies this ‘foreigner-within’ status. She missed one of her regular meetings, so she
went to a meeting at a different location. The hospitality she received illuminated the
“otherness” with which people regarded and treated her. She explained that, “mostly
men, but some women” were present at the meeting, “but they were all Caucasian.”
Dr. Kawaratani: And so when I sat down at the table, I think they were, ‘What do
we talk about? Do we have anything in common?’ So that was kind of
interesting. I got a very cool reception. I was thinking, "Come on, we're all
Rotarians." What's the big deal? I'm a visiting Rotarian. We try to be warm and
accepting when people come to visit our club. We try to be as warm and friendly
as we can because in Rotary, service in itself is supposed to be our motto. So I
don't know. Maybe they didn't get very many visitors or whatever.
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But I did get a couple of snide comments from some of the men like, ‘We only get
the top people in our community to come to our Rotary meetings.’ I was like, ‘Oh
really? That's interesting to know.’ I didn't mention right off the bat, they said,
‘What do you do? You're a physician?’ It's that kind of stuff. So how much of it
was female or how much of it because I was Asian, I don't know.

Interviewer: Did their attitude change once they found out you were a physician?

Dr. Kawaratani: A little bit.

Interviewer: All of a sudden you had some status.

Dr. Kawaratani: Yeah, they're like oh, I guess she's okay to occupy that space.
And what surprised me is I would get that reaction from Rotarians. Because in
general, Rotary is an international organization and there are some certain
expectations. Whereas if I went to any other business meeting or walked into
some other business luncheon, I may not have those same expectations of civility.

Dr. Kawaratani’s experience doesn’t show anything out of the ordinary, in fact quite the
opposite it is disturbingly normal and expected. As her matter-of-fact reaction shows,
this is not an alien encounter but a familiar one. Unsure whether her status as a woman
or as an Asian American, or both were the salient forces at play, she is left in an
unresolved space where her status seemed outside of what was “normal” but in a very
unclear and unstated way. As has been stated, one of the biggest senses of confusion and
misunderstanding about contemporary inequalities is their subtle and hidden dimension
(Dovidio, Gaertner, Kawakami, and Hodson 2002).
Dr. Satou discussed a similar experience. As with all of the other physicians, he
took this interaction in stride, seemingly unsurprised upon stumbling into it. It provides a
glimpse into the automatic stereotypes and assumptions others buy into and act upon in
regards to Asian Americans in this situation, but arguably all racial minorities.
…a couple of years ago…a lady walked up to me, and, you know, in her defense,
she was trying to be nice. But she says…’Have you ever been to Japan?’ And I
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said, ‘No, never been to Japan.’ And this was like five years ago. I've since gone
to Japan. But she just assumed that idea about Japan because I was Japanese. So
I said, ‘Well, I don't know. I've never been to Japan.’ She said, ‘Why didn't you
go to Japan.’ And I said, ‘Well, never could afford to and never had any reason to
go.’ You know it's not like any other place in the world, you know. So she was
just flabbergasted that here I was Japanese and had never been to Japan. You
know, but that's the height of the fact that she was - she just generalized. ‘Well,
you're Japanese; you must go to Japan all the time. All of the Japanese love
Japan.’ I'm American. I live here. You know Japan is a foreign country just like
it's a foreign country to you…A friend of mine who is Caucasian looked at it and
started laughing. Such a ridiculous thing, he laughed about it. He kids me about
it all the time. And I probably shouldn't have said anything…Yeah, and you
know, she was just trying to be nice and to make conversation and it's the only
thing she could think of. You know, but she could have talked about the weather
or the Lakers or something. She wanted to talk about going to Japan and I'd never
been to Japan, so it was kind of funny.

Interestingly, in this age of colorblindness, where it is common for people to claim that
race is not a significant characteristic of what they notice about someone, Dr. Satou’s
race was the one thing this white woman zeroed in on. Although Dr. Satou recalls this
incident with humor and seemed to have let it roll off his back, you can sense his
eagerness to inform, “I’m American. I live here.” Indeed, Dr. Satou is a third generation
American who happens to be of Japanese heritage, and as he said, Japan is just as much a
foreign country to him as it is to any other American. What does it mean that this woman
was so flabbergasted that he had never been to Japan? What broader assumptions does
this speak to? The fact that this woman just couldn’t wrap her head around the fact that
Dr. Satou had never been to Japan speaks to the perpetual otherness of Japanese
Americans. Would it be so surprising if an American of Irish heritage hadn’t visited
Ireland? What is troubling to Dr. Satou on some level is not that this woman noticed that
he was Japanese American, but that her assumptions about what that meant were so
inaccurate. As Ron Wakabayashi, a former director of the Japanese American Citizens
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League (JACL) put it, “Asian Americans feel like we’re a guest in someone else’s house,
that we can never really relax and put our feet up on the table” (Moore 1988, cited in
Tuan (1998):4).

Racism along the Colorline: African American Male Experiences with Racial
Microaggressions

The types of racial microaggressions that the African American male physicians
talked about seemed to be fueled by a feeling of superiority by the offender. Where
Japanese Americans often discussed encounters with ‘otherness’ or the sense that their
belonging was not recognized, African Americans described encounters with people who
positioned themselves as superior and Blacks as unequal and inferior. As we talked, Dr.
Parker elaborated on the type of subtle racial microaggressions he can encounter
throughout the course of living his daily life, sharing that he experiences, “[j]ust subtle
stuff, like I said, somebody handed me the car keys. You know, [they mistake me for]
the valet.” Dr. Parker explained that he was dressed in a leather jacket and pants, but
another guest at the restaurant mistook him for an employee of the valet company. Now,
why would this other individual assume that Dr. Parker is the valet there to park his car
for him, rather than a fellow diner out for a nice meal at a nice restaurant, just as he is out
to do himself? Did this happen because Dr. Parker is a Black male? Would this have
been Dr. Parker’s experience if he were a white male or an Asian American male? The
subtle inclinations that motivate behavior are often unnoticed by perpetrators of racial
microaggressions as well as by people of color that experience them (Dovidio and
Gaertner 2002).
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It is very hard to “prove” the racialized motivations of people’s actions and
behaviors, but either way, this mundane interaction exemplifies that in that moment a
message was conveyed to Dr. Parker that he appeared to be someone who could be a
valet worker rather than a restaurant customer and the distinguished surgeon that he
really is. This experience fits with empirical evidence that associates African Americans
with lower status occupations (Bigler, Averhart, and Liben 2003; King, Mendoza,
Madera, Hebl, and Knight 2006). To assume that Dr. Parker is the valet worker
demonstrates the type of assumptions about Dr. Parker’s capabilities that this particular
individual made about him, and which we know is a systematic presumption made about
African Americans (King et al. 2006). Further, as Dr. Parker points out, sometimes it is
not a matter of proving one’s intensions or standpoint, but it is really about people’s
“perceptions.” In order to understand people’s perceptions, especially Dr. Parker’s
perceptions as a Black male in this country, we have to understand the multitude of past
racialized experiences he has encountered and that he continues to encounter, all of which
inform how he will read and interpret this “seemingly” benign encounter that many might
interpret as a non-racial interaction. We also have to understand what it means when a
white patron asks the Black patron to park their car. This also is deeply grounded in a
history of white supremacist racial ideals that encourages whites to, often unconsciously,
believe and act in very entitled ways when interacting with non-whites, especially
African Americans (Feagin and Sikes 1994, esp. ch. 4; McIntosh 2004).
Maintaining perspective on this interaction, it is important to acknowledge that
Dr. Parker has a very matter of fact attitude about these sorts of experiences he
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encounters, as he shared with me, “[s]o yeah, these things happen and uh, there are
certain situations where you know, you get upset, but I mean, these are things that happen
in America. I mean, this is it. I mean, it's not somebody beating you, but it's just
perceptions sometimes. But I will tell you, my heart races a little bit when the police pull
in behind me.” It is not necessarily being handed the keys that is so offensive, as what it
stands for and what it represents in terms of how people view African Americans as well
as how others occupy a positionality of racial entitlement. As Dr. Parker clarified, he
doesn’t compare this sort of interaction to the experience of being beaten but he chalks it
up to the kinds of racial disregard you have to expect living in this country. Subtle racial
microaggressions such as the ones referred to by Dr. Parker are not as easy to attribute to
racism as segregation, the violent beatings (under Jim Crow) or deliberate race-based
exclusion in the housing market, educational institutions, financial institutions, etc.; yet,
when studied within the larger hegemonic racial context, the pattern clearly points to a
presence of a racial undercurrent advantaging whiteness (Wise 2002). These subtle racial
microaggressions are not as violent or obvious as the undeniable racism of the past
11
, but
ultimately, they originate from the same hegemonic ideas and actions that benefit whites
at the disadvantage of people of color (Lipsitz 1998).

SURVEILLANCE, SCRUTINY AND SOCIAL CONTROL: EXPERIENCES WITH ‘LAW
ENFORCEMENT’

11
While racism is more likely to be communicated in covert ways than the overt discriminatory practices of
the past, this is not to say that people of color no longer encounter clear and obvious racial slights or
mistreatment.
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This ideological framework takes on particularly dangerous and oppressive
meanings when looking at how this plays out in matters of law enforcement, as Dr.
Parker alluded to. Racial profiling and police harassment are longstanding problems
facing the Black community, and in particular Black men of all class strata (Meehan and
Ponder 2002; Welch 2007). Dr. Viola, an African American female in her late forties
who practices internal medicine in Beverly Hills shared, “I’ve been in the car with my
boyfriend and my cousin when there is just no rhyme or reason why you’re being pulled
over. There’s just not.” Dr. Johns-Washington, an African American female psychiatrist
in her late fifties and wife to Dr. Parker, explained that “things have happened to my
husband that haven’t happened to me, y’know, like…walking around the neighborhood
one evening – he was just walking the dog and the police drive up and asked him what he
was doing there.” She went on the explain the type of questioning that ensues: “…he
said, ‘I'm walking my dog.’ ‘Well, where do you live?’ ‘Um, I live right around the
corner, over there.’” Dr. Johns-Washington shared that “[h]e's been pulled over a couple
of times, y'know, just walking around the neighborhood. Police just stopping and asking,
‘What are you doing here?’”
As Dr. Parker indicated, “…you can still be judged differently just by who you
are…there is still a double standard in this country and you can see that by the fact of
how many people of color are in prison.” Indeed, critics of social programs to increase
incarceration through harsher anti-drug laws point out that communities of color, African
American communities in particular, have been decimated to such an extent by selective
law enforcement that it amounts to a new form of second-class citizenship (Alexander
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2010). Dr. Kingston shared that he was handcuffed and detained on three separate
occasions by the Torrance police at his medical office. He described his office at that
time as an “old-style single bungalow office where we could actually park our car right
next to the office….” “…on three separate occasions,” he explained, “I had either been
in the office, or I was in my car getting something with my car door open, the office door
open, and the Torrance Police came and harassed me and had me - I've had guns drawn
on me. I've been handcuffed and thrown onto the hood of a car.” Dr. Kingston described
how each situation would always result in “somebody going into the office or them
pulling some I.D. out and saying that it was me, and the excuse was always there was a
report in the neighborhood that there was someone - a burglar around or suspicious
character—and this and that and the other.” Indeed, as Dr. Kingston went on the explain,
“…you know, I've got the door open and the lights on, I'm in my sock feet, I have my
shoes, my bag, and everything else at my desk that's there, burglars usually aren't - got all
the medical books open and got x-rays and other things that are there.” In order to
resolve the recurrent police harassment while he was at his office, Dr. Kingston ended up
having to go down to the police station and told them "I'm not tolerating this any longer.
You need to post my name, you need to post my pictures, and if it happens again, we're
going to have to have a lawsuit that goes on."
In another instance, Dr. Kingston was working at the hospital one night when the
police suspected a gang member escaped into the hospital. He described walking
downstairs with a couple of other doctors when the SWAT team drew their guns on them
and continued to search them even though they were in “full laboratory coat, pins and the
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rest of that, stethoscopes and all of that.” Dr. Kingston explained, “what it really said is
that, well, all of you are Black, so we can't tell the difference of what goes on.
Indeed, the level of surveillance and scrutiny that African Americans endure has
been well documented (Meehan and Ponder 2002). Again, prior to the more recent
period of colorblindness, the racist underpinnings of these mechanisms of control and
surveillance manifested in direct and overt discrimination; whereas now they present in
disguised form, often under the guise of ‘good policing’ (Harris 2002a; Harris 2002b). A
cop pulling a Black male over today would not provide racial background as the reason
for detainment; rather, the cop would use some reason, which in the end cannot really “be
proven,” such as, ‘your taillight was out,’ or ‘your vehicle matches the description of a
vehicle in suspicion of theft.’ This explanation could be true, but if the person driving the
vehicle were white, would they also be pulled over? In this way, race directly infringes
on the daily lifestyles of African Americans, notably men with regard to police
monitoring (Smith, Allen, and Danley 2007).
Dr. Parker, a Black male surgeon and the husband of Dr. Johns-Washington,
expressed:
My heart races a little bit when the police pull in behind me. I just hate that. I
have to say that again, DWB, even today, I'm 56 years old and the police pull in
behind me. I've been stopped multiple times and pull[ed] over, search[ed]. You
know, you look like somebody. Okay. You never know how those situations will
turn out…You never know, you never know.

The vulnerability that Dr. Parker is forced to experience simply because he is a
Black male is striking. At any moment, for “no rhyme or reason,” to use his wife’s
words, he can be pulled over, questioned, searched, and is completely at the mercy of the
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discretion of the officer who pulled him over in the first place and who may not even be
aware of the unconscious racial script running through his/her mind informing his/her
each and every interaction and every decision he/she makes. It is no wonder that Dr.
Parker’s heart races every time a cop pulls up behind him. He must walk such a fine line.
How many Americans have probably let their car registration lapse accidentally, or how
many Americans drive with a broken light somewhere on their car without too much
worry (other than the danger it puts them and others in)? Many Black Americans are not
allowed to let some of these matters go unchecked. “I mean, you better not have
anything wrong with your car and you better have your registration. You better have
everything 'cause they will definitely pull you over and they will all know. So yeah, you
make sure that when you hit Jefferson right there past Fedco, you make sure you are
going 30 miles an hour just like the sign says, not 31,” Dr. Parker states. The
surveillance is not only external, but causes self-surveillance based on the presumption
that at any time, as African Americans, they are vulnerable to outside assumptions about
their behavior and morality (Lee and Rasinski 2006). Much like Foucault’s (1995)
description of the power of a panopticon, a prison designed to allow custodians to
observe inmates at all times without their knowledge, African Americans are subjected to
the disempowering reality that their mundane daily actions could be labeled and used
against them if their Black bodies seem ‘out of place’.
Additionally, Dr. Kingston shared several stories with me that illustrate the type
of undermining questioning that confronts him not only from law authorities, but from
other individuals in pseudo-power positions. I will share three of the stories that Dr.
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Kingston described to me. They are lengthy, but a discussion of the significance and
meanings of these sobering examples will follow. In this first example, Dr. Kingston
described a series of interactions with various medical personnel he dealt with regarding
a sports injury his son was receiving treatment for.
I'm listening and I'm hearing, I'm seeing how things go, and as long as they don't
go too far off the mark, I don't need to say anything, but when they do start going
that way I have to let them know. If I say a few of the buzzwords then they sort
of know, okay he must be [a medical professional]. But the part that I want you
to hear is I took him to orthopedic hospital for a follow up, and my son had a set
of x-rays taken initially when he was hurt. Then he went to have it evaluated by
the orthopedist, they took a second set, the second set wasn't needed, but this was
a way that we know how medical economics runs so they're gonna have their own
thing. Saying, ‘Oh yeah it's a special this, so that we can see a higher
magnification,’ which is bull. The - you still aren't gonna be able to see anything
any different.

So when he goes for his follow up visit they immediately said, ‘Okay. You have
to go up and you have to get an x-ray.’ We go up and I say that he doesn't need
an x-ray, that they took an x-ray, and we also have a second set of x-rays, which
are there. They say, ‘Well, for a fracture we need to do this.’ He didn't have a
fracture. ‘Oh, okay. Well, you'll have to talk to the nurse.’ So I talk to the nurse
and I say, ‘Well I don't want my son to have either - he has no need to get another
set of x-rays.’
‘Well who are you?’ I said, ‘I'm Dr. Kingston.’

‘What kind of doctor?’

I said, ‘Well I'm the Medical Director for the [State] Athletic Commission.’ I
said, ‘I'm the Medical Director for the [Boxing] Council,’ and I said, ‘You know,
part of my duty and responsibilities are to determine whether these million and
multi-million dollar purse fighters can participate or not participate based on their
physical evaluation.’ I said, ‘I'm well versed in this, and I don't want you to take
any other x-rays, there's no reason for him to have three sets of x-rays in one
week.’

[The nurse says,] ‘But we have to see. Do you have a license or something that I
can see that says that?’

So after all the explanation they still did not believe that that's the case, and
then… when I got in the back, when the doctor was there, and I'm described [as],
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‘he's some type of doctor,’ [is] all that she's heard… [from this] whole
explanation, so when the doctor goes and he asked me, "I hear you're a physician,
what kind of physician?" I tell him… to cut to the chase with him I start naming
three or four people who are the head of the hospital, and the chief of staff is
there; I said, ‘I can make a call to them if we need to if there's some questions.’
He said, ‘Oh, no, no, no, you don't need to do that…’ So it continues along the
way. Clearly, I had been in situation[s] where I've seen my white colleagues just
say, ‘I'm Dr. such and such,’ and, boom.

The operative assumption that Dr. Kingston references here is that as a Black male, he is
continually subjected to a high level of questioning and scrutiny. He cannot be taken at
face value when he doesn’t match the assumptions others have of him due to his raced
and gendered status. He provides in-depth validation for his knowledge and authority in
this matter concerning his son, but with each medical professional with whom he
interfaces, he must start all over and explain himself over and over again. Regardless of
his occupational background, as the parent, he shouldn’t have to endure that kind of
pressure and interrogation when making a personal decision about his son’s medical care
and you can’t help but wonder if white men of his same stature and presentation would
experience the same degree of skepticism.
In the next example, Dr. Kingston explained another situation where people did
not believe that he was a physician.
But I was on a plane, a Northwestern flight. Two incidents happened on the
plane. They go - accident happens, or incident happens, "Is there a doctor on the
plane?" I'm like ‘no, no, no, no.’ So nobody answers and he says, ‘Well, the pilot
is concerned we may have to turn around we need a doctor,’ so I got that. So I
ring my light. ‘Are you a doctor?’ [the flight attendant asks]

‘Yes.’

‘Let me see your ID.’

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So I said, ‘well I've got my ID.’ So they look at my ID and it says California;
we're required to carry this.

They look at the ID, and she says, ‘Yeah, but there's no picture that's on it.
Well no, nobody has one that has a picture on it… [and they] could ask, ‘well
could I see your license to go with it so you can get a picture that goes with that?’
But to try to disqualify me [they] say, ‘Well, how do we know? There's no
picture…’

But then there was one other time when there was a woman who was in her
second trimester and had basically passed out, and I had been, again, questioned.
I said, ‘You know something I don't need to do that; you just go.’ Then they
came back begging me as her condition worsened…

They kinda kept asking... [about the identification] Then they asked me what
kind of practice I [have]... So it's just ingrained that, [I] say, ‘well I'm a
physician,’ and they'll say, ‘What are you a PA, or a nurse, or what? Do you
work?’ One hundred percent of the time, if I'm at [a certain private hospital]
even, they have to take a look at my badge and see that it says M.D. on it or they
think I'm one of the lab techs that are there. You just…there aren’t enough
African American males for there to be any comfort level in the majority of
institutions…

So in both of these situations, on a plane, someone is in need of medical service.
Dr. Kingston is offering a skill and service that very few can offer, but despite his high
occupational status, he does not command an automatic sense of respect or deference as
occurs with many physicians; rather, it just provides yet another aspect of his life that
others can question. As Dr. Kingston pointed out, when his state of California medical
badge did not display a photo (which he informed me, none do), rather than simply
asking to see his drivers license in order to verify his identity, the attendant simply points
out that his photo is not on it, thereby conveying a tone of disbelief; as though she is
coming from a standpoint of not believing him from the get go, rather than, a tone of ‘I
believe this man to be a doctor, I just need to verify it.’ A very fine and subtle difference,
but a profoundly different message communicated in each case. The implication is that
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in the subtleties lies deeper and invisible messages, where with a slightly different way of
communicating, the undeclared, albeit suggested tone moves from, ‘let me verify because
you seem upstanding and honest and you look like you could be a doctor,’ to ‘prove it to
me, you seem dishonest, like you might be trying to pull a fast one over me, because in
reality, you really don’t look like a doctor to me.’ One can imagine that this repeated
experience would not only be frustrating but potentially damaging and dehumanizing.
In this final experience, Dr. Kingston shares a frightening example of the
undermining and invalidating and insulting dynamic of racial microaggressions (Sue,
Capodilupo, and Holder 2008).
And I had a situation right over by your school at Exposition and Figueroa. I'm
coming home; I'm doing trauma surgeries there. I'm coming home from Martin
Luther King hospital [and] get off at that exit because I live further down. There's
an electric wheelchair coming northbound across Martin Luther King. The light
changes green and there's a car that I see that's coming off the freeway who circles
[and] tries to bypass the first one, two, three lanes and get all the way over to the
far light so that he could pass us up. It's about 1:30 in the morning.

The wheelchair's coming right in front of my car, I'm trying to honk, lights, do
whatever else 'cause I can see this car come coming, doesn't do anything. [Smack]

The chair goes up, and you're gonna see this, because you have the Chevron
station, you've got the bank, you've got the sports arena and you've got the cutout
mall that's right there. In the crosswalk, he hits this guy in the wheelchair, [who]
separates from the wheelchair. The wheelchair hits the sidewalk on the west side
of Figueroa and his body stops and falls down…did a fish out of water. In the
meantime, I get out [of] the car and I start to administer [CPR]. I mean I literally
just got off doing a shift of trauma surgeries, so I'm best qualified to do this.

And…there's a Caucasian nurse who also…was going some other way, so she
gets out does this that and the other.

So when the police come, I'm down there [with the injured party] and she goes,
‘I'm a nurse,’ and so the police make me get up and let her go down to tend to the
patient. I said, ‘I'm a physician. In fact, I do trauma surgeries.’ They want me to
show proof that I do it, and there's no proof that you have that you do trauma
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surgery on that, and they had the nurse go ahead and do that. So, I just said,
‘Hey,’ went home to my family and left - and went on vacation. I was on my way
to go to vacation. So that's the reality that still happens in 2009.

Dr. Kingston described two traumas: the obvious one being the car violently
colliding with a wheelchair; the other being the trauma of racial microaggression, of
which this example is one of many reported in the lives of the Black physicians I spoke
with. While hegemonic racial ideology in the US considers racial barriers against
African Americans and other people of color to largely be a thing of the past (Bobo and
Smith 1998; Gallup 2009; Omi and Winant 1994; Schuman, Bobo, and Krysan 2001),
their experiences in white America conclusively testify to quite the contrary. When we
consider racial microaggressions experienced by upper class professionals of color it is
clear that the US is not as radically different from the Jim Crow past as the colorblind
thesis suggests (Feagin and Sikes 1994). These forms of microaggressions result in
increased stress, emotional work, anger and marginalization among other impacts (Sue,
Capodilupo, and Holder 2008). Indeed, sometimes having to prove your identity and
your ability and validate the fact that you can actually attain an occupation with status
and reverence can get to be too tiring after a while. One strategy Dr. Rider, a Black male
surgeon used to address this problem of questioning was to just “dumb down” his
occupation.
Outside of the workplace, I had gotten to the point where if I was traveling or say,
going on vacation, I wouldn't say that I was a physician because I got tired of a lot
of the questioning that would follow.

It would almost be like, "Well because this person doesn't fit into the stereotype I
have for a physician - certain gender, certain race, certain age, what have you, I
need to question him more to see if he's really a physician."

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And so the amount of questions I would have to answer to validate [it] to me felt
like they weren't worth it. And so I would just start to tell people, "Well I'm an
electrician," and I wouldn't get any more questions.

Inferiority and Invisibility: Racial Microaggressions and African American and
Japanese American Women’s Experiences with Racial Microaggressions

So far I have discussed the frames that racial microaggressions are contextualized
in for Japanese Americans in general, and in the previous discussion, I explored the
context in which microaggressions directed toward African Americans, and in particular
men, are situated.
Racial microaggressions directed toward Japanese Americans tend to be framed
by perceptions of foreignness and citizenship, thereby implying through subtle
interactions that Japanese Americans, men and women, are not identifiably American and
do not belong in or own this country like whites do. While in the previous discussion, I
focused on the experiences of African American men, I contend that the theme of
inferiority—of being less capable and worthy as compared to whites—also applies to
African American women as well. However, the separate ways this overarching attitude
of white superiority unravels in interactions with African American men and women is
distinguished by the differing gender ideologies that frame, organize, and demarcate
women’s and men’s experiences and realities. Thus, while racism communicated to
African American men and women is framed by attitudes and feelings of superiority,
stereotypes and beliefs about Black masculinity differentiate racial microaggressions
toward Black men from Black women. While the racial microaggressions experienced
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by Black men feel very hostile and aggressive, racial microaggressions expressed toward
Black women convey a sense of invisibility and unimportance.
Dr. Viola, a Black woman physician who practices in Beverly Hills, shared an
experience that illustrates the subtle racial microaggressions that convey a sense of
invisibility to African American women:
So last Christmas, I'm in South Coast Plaza. It's during the Christmas holidays.
There are some angels. It looked like a little specialty shop, angels on the floor.
There were three different ones. So I'm looking to find one of each. There are
three sales people. Not one of them asked me for any help. A white lady walks
through the door, all three of them turned to say, ‘How can I help you?’

Yes, I did bring it to their attention. ‘Oh, I'm not racist.’ ‘What do you call that?
Not one of you asked to help me and I'm on the floor. This lady just walks in the
door. Maybe this is what you need to understand. This is racism and this is what
black folks talk about, because since you're so not aware of it, it makes it worse,
because your job is to help me, right? That's what you're hired to do.’

Indeed, due to stereotypes, Black consumers and self-employed African Americans suffer
from far lower levels of both service and patronage from non-Blacks (Austin 1994;
Borjas and Bronars 1989). Thus, being ignored in public spaces is not uncommon for
African Americans and creates major market disadvantages in terms of buying and
selling goods (Borjas and Bronars 1989). Dr. Viola went on to share that she no longer
patronizes one store in particular due to the consistent and blatant mistreatment.
There is one store that I even refuse to go in anymore, because I have not one time
ever entered that store and they ask, "Can I help you?" Not once. And this is a
boutique where I'm the only person in there. But the next white lady that comes
through, "Oh, let me show you our new wardrobe." That I get a lot. That is in
this one little section of Brentwood, I would have to say, because in [other
locations], there’s a lot of stores that I've never had any problems or experiences.

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Dr. Viola elaborated on the power differential between whites and Blacks even when the
African American consumer is of higher class status and a customer of the white person’s
service.
I think, in general, it's less eye contact, is what I think. It's almost as if you're
ignored or as if they just don't see you kind of a thing, because I don't think it's,
like you said, a blatant - like "You go to the back of the bus." It's sort of you're
just not even seen as opposed to a white person. I think that's true in stores.
That's true in restaurants.

Again, Dr. Viola illuminated the reality that the racial disdain some whites still
feel toward non-whites gets expressed in very subtle ways—so much so that it is almost
invisible to others unless they are paying close attention. These people may also be
completely unaware that these unconscious attitudes remain and that they unconsciously
act out their beliefs in these ways. Giving another example of the ways African
Americans are disregarded, Dr. Viola also explained that many times if she goes to a
restaurant and they sit a group of white folks down at the same time as a group of black
folks, they will ask the white folks, "‘What do you want?’” first. I think that that happens
often. I think black folks see that clearly and I've even seen it.”
Dr. Lee-Girard discussed how these race and class factors play out in her own life
in regards to matters of customer service.
…there are times, like if I'm just kind of running in the store, I've got like a
baseball cap on, I'm just in a t-shirt and jeans. You can see, and I think it's
because I'm accustomed to being treated with a certain level of service just
because that's what I'm accustomed to, and then I realize I'm not getting that for
whatever reason.

Here, Dr. Lee-Girard is sharing that as a physician, she as grown accustomed to receiving
a higher level of customer service. The problem arises, however, when she “dresses
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down,” apparently confirming dominant stereotypes that cast African Americans as
potentially suspicious. To avoid this or to increase her chances of receiving the kind of
service one would want, she told me,
So you've got to put forth the presentation that you're worthy of their attention
before you actually get that validation. So yeah, that's a problem, but I don't
know if others go through that. I think they just get that respect that they would
otherwise get regardless of what they have achieved...

Dr. Lee-Girard talks about a process that occurs prior to stepping out of one’s
private space and into the public arena that will help to ensure proper treatment. It is a
pertinent reminder of what Goffman (1959) referred to as backstage preparation for a
front stage performance and what DuBois (1989 [1903]) described as double
consciousness. However, Dr. Lee-Girard suggests, and the research supports, that some
people must do more preparation to receive a positive reception in public. Lee (2000) has
called the act of Blacks dressing and behaving to represent a higher social class standing
as “wearing one’s class.” The experiences of these physicians illustrate a heightened
level of preparation is not only needed but also very important in order to avoid
disrespectful and suspicious treatment in the public sphere. Thus, a message remains for
African Americans that a certain amount of work (on themselves) must be performed in
order to command respect, validation, and just overall common expressions of courtesy in
public spaces.
Yet, Dr. Lee-Girard also highlights an important aspect of racial
microaggressions- so much uncertainty remains after the interaction regarding the other
person’s perceptions, intentions, motivations, etc. As she said, “I don’t know if others go
through that.” Oftentimes, these subtle experiences of invalidation and standoffishness
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leave one unsure as to what the cause is, and create negative emotional responses in those
who experience them (Higgins and Gabbidon 2009). Studies demonstrate that Blacks are
underserved relative to whites in the customer service environment, most especially in
predominantly white areas (Lee 2000). Yet, colorblind logic challenges even those who
encounter these racist situations to question their own perceptions, an issue I will discuss
later in this chapter.
Dr. Kawaratani also shared that at times when she and her husband go out to eat,
“[w]e go into some restaurants and we end up waiting a while to get seated. My husband
will get very upset.” Dr. Kawaratani also shared problems she can encounter at times
when shopping. “…I have noticed sometimes at Bloomingdales, I'll go in and it'll take
me awhile to flag somebody down. I'm walking back and forth trying to flag people
down. It can sometimes get a little difficult, but I figure “ah, it's their problem.
Whatever.” Occasionally I've noticed it, but nothing overt.”
As an example of the various ways in which attitudes of racial superiority are
distinguished by gendered stereotypes and assumptions I turn to a story that Dr. Howard
shared about her ex-husband, a Black male attorney who was rudely denied service at
Cartier in Beverly Hills.
…I just remember he was upset about - he had a Cartier watch and he needed a
new band, and he went to the store to get a watch band, and - I don't remember
exactly what happened, but he was enraged by it.

…whether it was a verbal exchange or whether they shut the door in his face…I
just remember that, y'know, Cartier in Beverly Hills - you'd think they would be
much more sophisticated. And he didn't go in there, y'know, in rags. He probably
had a suit and tie on when he went in, y'know, because that's his daily dress and, I
mean, he didn't even own a pair of jeans, so I know he wasn't improperly dressed
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or anything that would cause somebody to suspect that he was, y'know - and no
matter what, even if you're homeless, you have a right to come and look in a store.

Dr. Howard begins to touch upon the confluence of race, gender and class stereotypes
about African Americans. Longstanding stereotypes about African Americans, what
Collins (2000a) terms “controlling images,” depict them as lazy, unintelligent, dishonest,
and criminal, among others, all emphasizing lower social status. Dr. Howard’s ex-
husband was left with the perception that the employees at Cartier denied him service due
to this positionality as a Black man. In trying to make sense of this Dr. Howard not only
reveals the level of emotional labor African Americans and other racial minorities engage
in regularly as they try to understand the continual disregard, standoffishness, and at
times flat out mistreatment they receive in random public spaces, but she also exposes the
closely connected, intertwined and interdependent race, gender and class constructions of
particular groups. Further, while the African American women physicians I spoke with
more often shared stories that illuminated a position of invisibility, this example helps to
clarify how the same racial ideology gets directed much more aggressively toward Black
men.
The subtle disregard that the physicians spoke about in the public sphere in
regards to issues of customer service provide random examples of the types of racial
microaggressions they encounter in just trying to live their daily lives. When one walks
through life engaging in their everyday mundane activities, they are entitled to a basic
modicum of human dignity. The act of being ignored can induce feelings of
insignificance and worthlessness, as if they are not as important, worthy, and do not
matter as much as the white people around them. Thus, these seemingly insignificant
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acts of disrespect, exclusion and ostracism- that to some, seem subtle while to others, not
so subtle- are reminders of the perpetual depreciating and casting down of African
Americans (and other racial minorities) relative to whites. Undermining interactions such
as these that occur on a daily basis, emanate from a hegemonic racial frame that draws on
leftover and rearticulated racial ideologies of the past that continue to position whites at
the top of a hierarchy, but now appear to many as natural and race-neutral (Schwalbe
2000). The power, validation, and entitlement that comes with whiteness to move
through the day in any way deemed fit is a very different reality than what many people
of color experience living in a society where race is a stigma that must be negotiated
(Howarth 2006; Wailoo 2006). Racially subordinate ‘others’ must figure out how to
handle, tolerate, and negotiate the multitude of racial slights and racialized contexts
attached to living in a racially marked body. The race work that is necessary to manage
their social interactions in the public sphere where race is emphasized is energy
consuming and socially restricting.

INTERNAL BURDENS: THE LABOR OF LIVING IN A MARKED BODY

In a social milieu where whiteness remains the centered and idealized standard,
the ‘Black body’ and the ‘Asian body’ are automatically singled out and consequentially
labeled as carriers of stigmatized, preconceived, essentialized, generalized and fallacious
character traits (Howarth 2006). The distinctiveness and conspicuousness of non-white
skin color, eye color and shape, hair color, texture, length, and other facial features and
bodily statures in connection with the socially constructed meanings attached to those
physical variations from the hegemonic white center, can contribute to a particular
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racialized reality that many whites may never have to consider (McIntosh 2004). This
alternate reality (to that of the hegemonic white experience) introduces additional layers
of emotional labor that people of color regularly negotiate just to get through each day
(Sue et al. 2007). In the previous section I discussed the various manifestations of racial
microaggressions as experienced by the African American and Japanese American
physicians I spoke with. In each of the examples, the physician’s encounters with racist
beliefs, perceptions, stereotypes, generalizations etc, were experienced through some
external source (e.g. white store worker, white police officer, etc.). Yet, the unseen race
work of these internalized processes that are connected to externally inflicted racial
transgressions constitute a central part of living in a “marked body.”
The ambiguous and enigmatic nature of colorblind racism, what Sue (2005) has
called “the conspiracy of silence”, heightens the need to understand the complicated ways
that people of color take in, absorb, digest and makes sense of their racialized realities. I
contend that this process acts as a continuation of externally inflicted racial
microaggressions; but additionally, can be seen as a type of racial microaggression in
itself, inflicting emotional strain and harm on the women and men who are regularly
confronted by its challenges.

Was that a Figment of my Imagination?

A few doctors discussed how the colorblind nature of racism now makes it very
difficult to know when a particular encounter has been fueled by racism. All the
colorblind catchphrases commonly in use automatically exonerate people from any
potential racial bias despite what their actions may indicate (Bonilla-Silva and Forman
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2000; Bonilla-Silva, Forman, Lewis, and Embrick 2003; Bonilla-Silva, Lewis, and
Embrick 2004). Again, as Dr. Parker hears whites saying a lot, “why don’t you just get
over it?” We’ve all heard these grand insights from whites – who have never
experienced racial subordination in the ways African American and other people of color
have endured- “What’s the big deal?” “It’s their loss.” “Not everything is about race.”
“Maybe they were just having a bad day.” “Maybe they just didn’t see you.” “Don’t
take it personally.” The reality is whites often don’t have to recognize Blacks or other
racial minorities. This in itself produces an extra level of labor and emotional strain as
these contradictions (the contradiction between what is said and what is done, within a
historical personal, familial, community context and within the broader social context and
social milieu of ethnocentricism, racism, and nationalism) cause one to constantly
question, “did that interaction just happen because of my race? Did that salesperson just
walk right past me and approach the first white customer they saw, even though I was
clearly in line first, because of my ethnic/racial background?” The second-guessing, the
rationalizing, the talking yourself down in the face of these sorts of racial
microaggressions can introduce a level of uncertainty, lack of control, and anxiety to
one’s life, which can be very distressing.
Dr. Higgens, an African American male pediatric surgeon in his late forties
described how this particular scenario plays out:
it's one of those things where you're like, ‘did they or did that situation, did it
involve that, or is it distress that everybody faces or the type of response that
everybody gets?’ Some friends of mine who happen to be African-American, we
describe - and I hear it from women who walk into a room…and they'll say what
does it really mean when [patients] say, ‘are you the doctor?’ when you clearly
have a white coat on. You clearly have a label that says you're a doctor.
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The particular situation Dr. Higgens described here exemplifies the sort of internal
dialogue that people of color often go through in their own minds upon a particular
experience that leaves them wondering about another’s assumptions. In this particular
case, Dr. Higgens explained that it always makes him wonder ‘why did they just ask me
if I am the doctor’ or ‘what does it mean that they just asked me if I am the doctor’ when
clearly the white coat he is wearing symbolizes that he is the doctor. Despite common
misperceptions that Blacks and other racial minorities jump to race as an explanation or
just “play the race card,” Dr. Higgens demonstrates quite the opposite. A lot of thought,
rationalization, questioning, second-guessing one’s instincts, observing, etc. goes into
one’s attempts to figure out the cause of what seems to be something guided by some sort
of racial bias or generalization.
Given past and current hegemonic racial frames that depict African Americans as
lazy, stupid, and unequal, it makes sense that patients would question that Dr. Higgens as
a Black male is indeed the doctor, and it make sense that Dr. Higgens would perceive
their questioning to come from a place of racial stereotyping, essentialism, and racism.
What doesn’t make sense is the colorblind approach, which would have us believe that
the cultural aspects embedded in society that describe racial characteristics, inferiority
and superiority, would dissolve in a few decades (Sue 2005). Indeed, each experience
with microaggressions (which these physicians had many of as discussed in the previous
section), does not occur in a vacuum. They are not isolated and insignificant. Rather,
they are connected together and reflective of a racially hegemonic standpoint intricately
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woven into every aspect of our social structure, which is why people of color are so often
left wondering, “did that just happen because of my ethnic/racial background?”

“Double Consciousness:” Juggling How Others See You

When understood and accepted theoretically that a hierarchical racial frame
structures all the institutional aspects of life, it becomes necessary to understand the ways
in which these external experiences impact the internalized aspect of one’s life, free of
the assumption that examination of an internalized state equates to studying the particular
individual. Indeed, on the contrary, some internalized reactions to living in a highly
racialized state produces shared, and patterned internal responses and reactions (not just
isolated to the individual). In these patterns of behavior and reactions to common social
stimuli the connections between the micro and macro levels of analysis are found (see
Lewis 2003).
DuBois (1999 [1903]) described double consciousness as the state where Blacks
not only had to be aware of their own behaviors and actions, but they would also need to
view their actions through the interpretive eyes of a hypothetical white person. Double
consciousness is a critical aspect of what I’ve referred to as internal race work. Dr. Lee-
Girard illustrated the self-reflexivity and deep level of self-awareness that people of color
juggle, often automatically as a result of embodying multiple “identities” – (e.g. one’s
true sense of self, the identity that others perceive of you given various ascribed and
social characteristics).
There were times, and this may have been my own little thing, that I had, my kids
are 11, 8, and 7, so they're all pretty close in age. There was a time when my
oldest daughter was three and I had a baby and was pregnant, and I remember
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being in the store, in the mall. There's a three year old, a baby, I'm pushing one,
and a big belly, and I just felt like people looked [at me] like, ‘can't she control
her reproduction? (Crosstalk) Don't you know about birth control?’

I almost wanted to have a sign that said,’ “I take care of my kids, I have a husband
who loves me and my children, and I'm not asking you to support me and my
family.’ I felt like that, and you get those looks like have you no control.
That could have been my own thing because truly my third child was a surprise to
us all. The youngest at that time was four months when I found out I was
pregnant with the third, so that may have been my own thing that I put on myself,
but I did feel as though it was looked upon like there's another one on [welfare].
Very subtle.

Dr. Lee-Girard astutely picked up on the subtle cues that the people shopping around shot
her way that reflected their judgmental and biased assumptions about her based on her
racial background, gender and the social class assumptions that follow African
Americans. Dr. Lee-Girard and the shoppers around her were all aware of the prevailing
stereotypes that depict Black women as sexually promiscuous. This controlling image
described by Collins, continues to have appeal in popular culture with dehumanizing
effects on Black women put in the position to negotiate and manage the depiction that “a
‘sex machine’ in turn becomes a ‘baby machine’” (2004:130). As such, the people
around her conveyed their judgmental biases to her in very discreet and subtle ways (e.g.
through insidious glances, looks, and stares). At the same time, Dr. Lee-Girard is forced
to juggle these layered identities and controlling images against what she know to be true
about herself as a highly intelligent, hard-working and highly accomplished physician
who is also married to a highly accomplished physician. Yet, so many negative
stereotypes and pre-judgments abound about Black women, especially with matters
relating to family and reproduction that socio-economic status doesn’t necessarily
provide a buffer of protection.
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Much thought about the presentation of oneself can enter into one’s emotional
space at any given moment when you are a person of color. Simply out to take care of
activities of daily living, Dr. Lee-Girard was quickly reminded that despite her
accomplishments, others presume her to be a welfare cheating, irresponsible Black
woman, prompting her to want to challenge and correct the looks and glances with a
truth-sign that would correctly revise the pervasive and insidious generalizations. Would
a white woman feel scrutiny on this same level? Would a white woman notice stares, or
would she possibly hear kind comments from passersby about her lovely family,
validating her expected femininity and care giving role? The intersection of gender and
race constructs a different set of expectations and experiences for Black and white
women in such a situation, which will be addressed in much further detail in chapter five.
Finally, Dr. Lee-Girard restated, “this may have been my own little thing,” a
couple of times in re-telling the incident to me. Some may argue, ‘see, even she herself
recognizes that she is just looking for the racism, it is her own perceptions.’ The answer
to that, is yes, it is her perceptions and her perceptions are rooted in a history and true
reality of deeply racist and sexist attitudes about Black women and their place in society.
Such attitudes relate not only to contemporary interactions but have set the stage for
extremely, and very real, controlling public policies aimed at Black women and families
(Roberts 1997). At some point we have to acknowledge that the stares and glances,
although seemingly harmless and/or insignificant, denote an undercurrent of racialized
attitudes, thoughts, assumptions and generalizations that mark the target or the object of
gaze, as inferior and/or different.
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Dr. Lee-Girard stated that she just wanted to wear a sign that would correct how
she perceived others saw and evaluated her. Although Dr. Itou indicated she hasn’t run
into a lot of these sorts of situations, she retold her own story where she felt in her own
way she did revise the presumptions of the stranger she felt conveyed stereotypical
attitudes toward her.
Dr. Itou: I remember I was at the airport. And again, there's gonna be isolated
examples of bigotry everywhere. But I was at the airport driving along, and this
woman rolled down her window and yelled at me, "Go home to your own
country."

And so I rolled down my window and I said, "Thank you, I am in my own
country."

'Cause I knew the second I spoke, she would know I'm not foreign, but there was
still that presumption, you know. There is still, like, the reputation of the Asian
woman driver….

I mean and maybe that's just somebody who wanted to be mean and race
happened to be the excuse and if, you know, if I were white they would have just
yelled a different thing. You know, something of that nature. But I don't know. I
think there's just more out there than we see on the surface. And yet, probably a
lot less than in the past. Some things that - I just think it's not quite all that's, like,
polished clean as people may [think]-

Interviewer: Yeah. When you say that there's these isolated incidents… when
did that happen, this incident at the airport. Was that in LA?

Dr. Itou: That was in LA. That was probably about seven, eight years ago. So a
long time ago, obviously, and yet, we're not talking about 20 years ago, even…It's
so funny how that stuck with me though. Why shouldn't I forget it like any other
imbecile [laughter]? Maybe 'cause I won.

And that's likely - that's probably more of a distant - an attitude of entitlement that
just got vented because I happened to be the excuse at the moment.

Again, the fact that Dr. Itou was aware that at the moment she spoke, the strangers
shouting at her would know that she was American, speaks to a level of racial
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consciousness that she carries with her everywhere she goes in a way that whites, as the
other driver demonstrates, rarely worry about. I experienced this myself so often living
in the Midwest. Every time I stepped into a store I was prepared for the looks and
glances, and not infrequently, the flat out standing in one spot prolonged staring, from
strangers around me. Living in a suburb that was 98% white, my brown skin and Asian
face was more of an oddity for them then the people I lived amongst in LA, but as with
Dr. Itou, I knew that the “perfect sounding” English that would come out of my mouth
would allow me to convey to these people that I, like them, am American.
The need to always prove yourself, to correct the misguided and often racist
assumptions of those around you can be never-ending for people of color; it is a
consciousness that whites never have to embody. Always having to be aware of who you
are while at the same time always keeping in mind what others perceive of you and acting
in a way that doesn’t give fuel or validation to their stereotypical generalizations about
you takes a lot of thought, energy and strength. Social psychologists call this concern
‘stereotype threat’ when an individual is in a situation where a group stereotype is active
(for example, women taking a math test) (Spencer, Steele, and Quinn 1999). Confronting
negative stereotypes consistently applies pressure and negatively affects performance,
sometime quite severely (Steele, Spencer, and Aronson 2002).
Where Dr. Itou sees an incident of interpersonal racism, she also says, “I think
there's just more out there than we see on the surface,” a sense that social scientists are
aware of is key to understanding race relations and discrimination in the post-civil rights
era. This subtle pattern of racial ideology that Dr. Itou alludes to is not only pervasive,
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but can play a role in mental health disorders such as depression and physical health
issues such as hypertension and compromised cardiovascular health (James, Neighbors,
and Jackson 2008). Much of the difference in health outcomes relate to socioeconomic
status, and living in segregated neighborhoods—which many professional African
Americans continue to do (Logan 2011)—but race and the discrimination that
accompanies it shows evidence of negative health affects regardless of socioeconomic
status (James 1999).
Dr. Ando explained the internal thought process that he sometimes goes through
when entering a public space where he is “the only one.” The concern and anxiety that
perhaps he might be singled out or treated differently due to his racial background springs
from an understanding that he is seen as ‘different’ and can be treated unequally or
differently, again always carrying that racial embodiment everywhere with him, unsure of
how it will play out.
Even now, when I walk into a restaurant at times, maybe we're somewhere else.
And I look around, and gosh, we are the only Asian family. It is a little odd
feeling. You kinda think, "Oh, maybe the waiters and the waitresses are gonna
treat us a little differently." It's funny because we were in France three, four
weeks ago. We spent a week and a-half in Paris, and I never felt an ounce of
racism there, not an ounce. Here, I could feel a ton of that…It's strange. You feel
like you're more accepted there.

Oftentimes, as illustrated in the previous section, people of color do experience a
different kind of service than other customers (Lee 2000); yet this is not really the point I
am trying to make here. While this often does happen, sometimes it does not.
Sometimes the service may be the same as, or may be even better when sometimes out of
“white guilt” a waiter or a customer service representative may overcompensate through
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quicker and friendlier service. Irrespective of this however, is the fact that whether or not
a person of color receives equal or unequal service, doesn’t change the fact that they
always have to be conscious of their ethnic/racial background and the type of treatment
they may or may not receive. History and their own personal experiences inform this
constant racial consciousness.
As Dr. Ando expressed, when vacationing in Paris, he never felt that sense of
racial subordination that he feels in his home country. It is possible however, that Dr.
Ando is just unaware of the cues that might show how race works in France, which
speaks even further to the subtlety and ambiguousness in which racial meanings get
communicated. In a sense, Dr. Ando is well versed in the hidden meanings embedded
within Americans’ verbal and non verbal communication patters and can more easily pick
up on racially coded interactions; but this level of awareness really comes from an
accumulation of experiences that provide him with firsthand knowledge and insight.
Given the constant stream of messages that, as a Japanese American, he is somehow
treated differently, as foreign and not as respected as white Americans, it makes complete
sense that Dr. Ando would wonder and speculate about the kind of service he might
receive upon entering a white dominated public space.
Dr. Kawaratani provides yet another glimpse into how deep and interwoven the
internal dynamics of a heightened racial consciousness operate. She explained how she
lives a very straight and narrow lifestyle to ensure she is never falsely accused of any
wrongdoing, ultimately relating back to the WWII internment of Japanese Americans.
Dr. Kawaratani: Well, it gives me pause for thought in that at any point in time,
any nationality is not necessarily safe.
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Interviewer: Still?

Dr. Kawaratani: Yeah. Because if you look at it from a historical perspective, the
whole reason why it was done is hysteria. It was an expedient thing for the
government to do to control the hysteria. And as far as that means for me, it's
happened to some of the Iranians and what have you. Whether it's been fair or
unfair or they really were guilty or not guilty, either way they were handled and
put into Guantanamo or whatever.

So…it brings up other thoughts… I was asked to be on a jury. But they had asked
me, "Could you be fair in sitting on the panel for this guy who's accused of a
serious crime?" It was his second offense; never mind whether he actually did it
or not. And I'm thinking, if he was here and convicted once, obviously he was
doing something wrong to be in a situation to be convicted again.
And the reason why this links to what you asked me is I'm thinking be careful not
to put myself in situations where I can be linked or associated with something that
people can accuse me of serious things. So you kind of pause and it makes me
think of what I do to some extent and who I associate with.

Interviewer: Can you tell me a little bit more about things that you do or avoid,
people you associate with or don't associate with to avoid being linked…?

Dr. Kawaratani: Well, basically in terms of my practice and what have you, I try
to be as above board. When people ask me to bend the rules I say, ‘no,’ much to
their dismay. Different things like that. I don't go clubbing. My husband doesn't
like that kind of stuff anyway. But even before that, I wasn't a person to go
clubbing. I go to group organization functions and things with people - always
with a group of people, not by myself.

Interviewer: Why is that?

Dr. Kawaratani: Well, I mean, if anyone were to be accused of anything at least
we all have witnesses for each other.

Ultimately, Dr. Kawaratani strives to live a life free of any potential trouble, as is
the case with many people. Yet, it seems somewhat extreme to only attend functions
with a group of people to avoid being falsely accused of a crime. She began this
discussion by talking about internment and then went on to talk about a potential case she
might have been a juror for. She shared her assumptions that the defendant must have
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done something questionable to wind up being accused of a crime for the second time.
She linked this same scenario back to internment, implying that people have wrongly
accused and incarcerated Japanese Americans in the past (United States Commission on
Wartime Relocation and Internment of Civilians 1997), so it is possible that that can
happen again and as a Japanese American citizen, she feels she needs to remain cognizant
of that. As Dr. Kawaratani stated, “at any point in time, any nationality is not necessarily
safe,” so she feels she better live the kind of life that will prevent her from ever being
falsely charged with any sort of wrongdoing. Living with this undercurrent of pressure to
not make a misstep because of the potential consequences at stake speaks to profound
level of racial insecurity- that at any moment because of your ethnic/racial background
and an imbalance of power, you can be falsely accused and punished for something you
did not participate in. Thus, Dr. Kawaratani illustrates the concept of double
consciousness which people of color are accustomed to: always aware of their racial
status and organizing their life often unconsciously around these ideologies about who
they are.

THE INTERNAL HAUNTINGS OF AFRICAN AMERICAN AND JAPANESE AMERICAN
GHOSTLY MATTERS

While the concept of racial microaggressions helps us understand the sorts of
interactions with others that make up our on-going and continuously shifting racial
realities, I am also interested in how the racial past influences how we make sense of
current racial interactions and occurrences as well as the decisions we might make today;
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this type of race work is what I refer to as contextual. Experiences from the past echo
across time, littering the present with crumbs of knowledge and understanding which
individuals and communities continue to feel and experience firsthand even when the
events occurred long-ago; and which can continue to inform their understanding and
perceptions of current racial matters and influence decisions even in seemingly race
neutral situations.
Indeed, a related and integral part of one’s experience and their reading of that
experience is their family and community history. I contend that the familial and
community racial context and legacy figures prominently in how people of color make
sense of their current and on-going experience-racial and otherwise. I suggest that
grappling with these racial pasts and ghostly intrusions, especially when traumatic to the
community, such as with slavery and the WWII incarceration of mainland Japanese
Americans, constitute a type of race work. For example, the legacies of slavery and
internment can have the same effect of other “subtle, stunning, often automatic and non-
verbal exchanges which are ‘put downs’” with “cumulative weight” and occur daily
(Pierce, Carew, Pierce-Gonzalez, and Wills 1977:65). Indeed, family stories and
community legacies of these watershed historical moments maintain a subtle daily
presence that can produce the same sorts of reactions and sensibilities as current more
subtle expressions of racism. This contextual race work is consistently providing a layer
of meaning, which can guide social interactions.
Our cultural histories arm us with a particular standpoint (grounded in a particular
racial framework) and lens through which we filter and make sense of each interaction
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we have. Thus, a snub by a department store worker may not be read as just that-but read
through our past experiences where we and/or previous generations were explicitly
denied service due to racial factors. But, also, these past traumas can also continue to run
as a subtext of insult in our own racial consciousness. And also, they still can materialize
in meaningful ways today, as I will soon show. Matters of the past still influence how we
carry out our lives today and how we feel about particular issues today.

The Past is the Present

I quoted C. Wright Mills earlier as stating, “[n]either the life of an individual nor
the history of a society can be understood without understanding both” (1959:3).
Understanding the intersection between our biographies and histories, within the context
of their social milieu can help us to understand that which is significant in our social
lives. Indeed, we are all haunted by our own personal, familial and community
biographies, intertwined as a “particular kind of social alchemy that eludes us as often as
it makes us look for it” (Gordon 1997:6). The “ghostly presence” of “what is usually
invisible or neglected or thought by most to be dead or gone” “makes its mark by being
there and not there at the same time” (Gordon 1997:6, 194-195). In other words, the
racial legacies of the past continue to shape the present day lives and realities of whites
and non-whites. Investigation into these lived experiences of the past (and the present)
“can lead to that dense site where history and subjectivity make social life” (Gordon
1997:8). Several of the physicians shared the ways in which not just personal
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experiences with racism shaped their outlook, but the impact they feel large scale racist
assaults against their communities continue to reverberate. In Dr. Parker’s words:
…there’s a lot in the history of this country that people really don’t understand
and when you want to take a stance and talk about well, you know, this is a great
country. Yeah, Yeah, we are, there’s a great POTENTIAL, there’s a great
POTENTIAL to be, but man, the history is really sordid. The history of this
country is really sordid. You Native Americans, the Mex[icans],…It’s a really,
really sordid history and a really violent history. So when things happen I say,
‘well, you really have to look at the history of this country and how this country
was born out of violence. You really have to look at that and what people’s
attitudes are.’…

The points that Dr. Parker makes here may seem fairly basic; yet he gets at such
an essential aspect of the racial misunderstanding of many Americans. In our interview,
he frequently discussed “why it is so important to UNDERSTAND people.” The
disbelief, lack of racial awareness or conscious and unconscious choice not to face our
past and present societal hauntings, can prevent people who come from and live in a
place of racial privilege from clearly noticing, grasping, and believing the types of
mistreatments and injustices that occur, to this day, on a daily basis in the lives of people
of color, especially when those mistreatments and injustices do not manifest in overt
ways. Further, the privilege to leave the past in the past marginalizes the “sordid”
histories that we all inherit, to the shadows of present day realities. As Toni Morrison
points out, “invisible things are not necessarily not-there” (Morrison 1989 cited in
Gordon 1997: 17). Indeed, “we are in [these stories], even now, even if we do not want
to be” (Gordon 1997:190). As with all histories and memories, there is not a neutral
‘past’ which is free of values and ideologies heaped on top of it to provide a lens of
interpretation (Halbwachs 1992; Schuman and Scott 1989). How the history of racial
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‘progress’ is defined, then, is not a matter of neutral facts as much as a negotiation
between various versions of reality (Lipsitz 1990). Deception and lying are a part of how
we construct collective memories and histories (Baumeister and Hastings 1997; Loewen
1994); in the case of race relations and traumatic, unjust and horrible offenses of the past,
these tend to become lessons of how much the nation has progressed if they are
acknowledged at all. The contemporary discourse of colorblindness only obfuscates
further the ability for many to comprehend and engage the continuing racial inequalities
of this country that many want to believe no longer exist and no longer manifest in
rearticulated forms.
Slavery

The a-historic nature of colorblindness is perhaps one of the most offensive and
problematic aspects of this racial framework. Somehow supporters of this ideology
believe that Blacks and other racial minorities ‘have nothing to complain about anymore’.
According to them, slavery ended long before they were born and things have changed
and are better now; everyone has the same chance to get ahead now, unlike in the past.
While sociological studies have demonstrated that institutional effects of the system of
slavery remain and continue to structure and organize opportunities, privileges and
disadvantages (Oliver and Shapiro 1995; Shapiro 2004), I want to explore the micro level
and covert remains of this institutional legacy.
First, some of the African American physicians discussed the institutionalized
effects of slavery that continue to influence and frame the opportunities, outcomes and
realities of all African Americans. As Dr. Parker expressed, “And as it is now…I said,
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you have to do something because the things that are still going on [educational
inequality] are all impacts from slavery. I said, they still are.” Dr. Howard expressed
similar sentiments:
Well, the impact of racism in this country - the impact of white-supremacist
slavery - on this particular group of people or anybody that is associated with
them - I mean, you could have come from Africa or from the Caribbean, y'know,
in this century, and still be impacted by these realities. And studies have shown
that after five years of living here, you become enmeshed in the same kinds of
difficulties. Or even if you are, for example, Filipino or East Indian - of dark hue
- you run into the same kinds of difficulties, so it's very, very - and of course you
will run into those in your country as well. (27)

Dr. Parker and Dr. Howard touch upon an important, yet often overlooked aspect of
racism: the white supremacist attitudes of the past (and many would argue that this same
sense of white supremacy still exists today, even if hidden) contributed to the formation
of educational, political, fiscal, and social systems that privilege whites to this day
through an uneven racial hierarchy. As Gordon writes, “[s]eething, it makes a striking
impression; seething, it makes everything we do see just as it is, charged with the
occluded and forgotten past…[t]he living effects, seething and lingering, of what seems
over and done with, the endings that are not over” (Gordon 1997:195). Furthermore, not
only does the ideological institution of white supremacy continue to haunt contemporary
social structures through deeply anchored hierarchies, these legacies, especially when
traumatic and catastrophic as in the case of chattel slavery, are imprinted into our
memories, bodies and souls as ghostly remains, hovering and lingering in everything that
we do, perceive and feel in our everyday lives (Leary 2005).
The institutional inequities that remain as a holdover from the era of white
supremacist slavery signify just one, albeit one of fundamental importance, of the ghostly
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remains of the past that continue to haunt the racial realities of the Black community. As
Dr. Kingston explained, the deeply rooted effects of slavery continue to structure the day-
to-day lives of all African Americans.
So, you have sort of the hierarchy, and then you actually have in African
Americans the - part of the whole slavery concept was that, hey, they taught you
not to like you, not to like your skin color, not to like your look ___ not to trust
anyone… The African American culture, that was all but stripped away. So you
strip away what the language is, 'til you strip away what the cultural backgrounds
were, then you just have a bunch of folks who were running around that have no
community, that have no history, that have no togetherness. So that's where
African Americans are in the U.S., and the last - since slavery, it's been trying to
close the gap and put that together…

The lasting effects of slavery, for Dr. Kingston, are as much about African American
communities as systematic anti-Black ideologies born to justify that institution. These
long-ago traumas were the result of arrangements designed to create a social system
productive and profitable for white elites which played white and Black workers against
one another (Du Bois 1973 [1935]); while the rationale for systemic racism against
Blacks has evolved and perhaps declined over the decades, racist cultural products
became rooted into the fabric of US society. The methodology slavery used to control
African Americans was destructive and traumatic, and while Black kinship systems
adapted to these difficult circumstances (Gutman 1976), the long-term consequences of
slavery resulted in extensive anti-Black ideology, with emotional and social trauma long
after slavery ended (Leary 2005). As Aird describes,
[T]he lie of Black inferiority, the most devastating and longest-lasting
consequences of the enslavement and colonization of African people, remains
with us. The lie of Black inferiority says that Black people are not as beautiful,
not as lovable, not as intelligent, not as capable, not as worthy as white people, or
any other people, for that matter. The lie was first told centuries ago to justify the
dehumanization and subjugation of the African people. For about three hundred
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fifty years, it has shaped other people’s views of Black people, and it has shaped
our views of ourselves. (Aird 2008:8-9).

Dr. Parker’s insight is especially valuable in understanding this ghostly dynamic
whereby your family and community’s legacies are brought with you into your future
particularly when the past is so traumatic.
And for instance, my wife's, all her relatives [are] from North Carolina, Virginia,
so they took a lot of trips down to see relatives, well, I mean, you experience first
hand… And I never had that kind of experience. I mean, you had the teachers
and that kind of thing, but you never had somebody tell you to go to the backdoor
and get something to eat. And pretty much, all my friends they had relatives
Georgia, South Carolina, Virginia, North Carolina, so you had those experiences
growing up as a child. So you carry that over and there is no way to get rid of
that. There is no place to put that. You know, if your dad has to go to the back
door to get a sandwich, I mean my father-in-law was an engineer, he's a chemical
engineer and he had to go to the back door to get lunch from some guy with a
junior high school education. You know, you didn't park on the road, you drove
straight through because you had no idea what was going to happen. You're in
fear, you're hoping your car doesn't break down. Sometimes you sleep in gas
stations with some public place, and so all of those things.

As Dr. Parker generously shared these personal familial and community stories of
dehumanizing subjugation, oppression and exploitation, I was deeply struck by the sheer
humiliating indignity and pure hideousness of American racial hegemony, which
engenders a sense of entitlement in whites with all sorts of material and emotional
consequences for African Americans that did not end with the abolition of slavery. To
live in fear, forced to sleep in cars in gas stations or other public spaces for physical
protection while traveling in the South, merely because of the color of your skin, forced
to the back door to retrieve your food as if you are sub-human; those sorts of lived
experiences will continue to haunt generations to come. Dr. Parker described how “the
blood starts to stir a little bit because you understand the indignity of all of that.” In fact,
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at one point during our interview, Dr. Parker shared, “[a]s a matter of fact, I can feel my
blood pressure going up right now.” He explained, “you try not to dwell on them [racist
experiences] because if you dwell on them, you can feel your blood pressure go up.”
As Dr. Parker said, “[t]here is no place to put that.” Indeed, “you carry that over
and there is no way to get rid of that.” “In haunting, organized forces and systemic
structures that appear removed from us make their impact felt in everyday life…”
(Gordon, 1997). Clinical evidence based on children of Holocaust survivors shows that
major trauma of parents contributes to their children’s childhood trauma (Yehuda,
Halligan, and Grossman 2001), and learning and physiological affects are also evident
intergenerational reactions to traumatic circumstances (Suomi and Levine 1998).
Again Dr. Parker sheds light on the mistaken belief that slavery is a ‘relic of the
past’ (Winant 2001). He shared with me, “[a]nd people say, how do you get over it?
And I, that's a phrase that I really have trouble with. You know, get over it.” Indeed,
these “racial stories” proclaiming “the past is in the past”(Bonilla-Silva, Lewis, and
Embrick 2004:563), detrimentally negate, invalidate and dismiss the actual significance
and weight of this American legacy, in what Sue et al. call a microinvalidation (2007).
As Dr. Parker explains, “…that's one of those phrases that I just yeah, okay, get over it.
You don't; it's not that easy. It's not a switch. You just don't turn those experiences on
and off because I've listened to a couple lectures talk about this, the psychological
impacts of it and how it's passed down from generation to generation to generation.”
Indeed, the legacies of chattel slavery and the institution of white supremacy, that is still
not abolished, haunt our present in material and tangible ways as well as through
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ideological, subtle and seemingly ghostly forms. Like other racial microaggressions,
these ghostly matters continue to conflict a great deal of harm and distress because as Dr.
Parker explained, “…there is not way to get rid of that.”

Internment

The mass incarceration of people of Japanese ancestry during WWII represents
another rupture of so-called American exceptionalism and stands as a particularly
traumatic piece of Japanese American history. This does not conflate the system of
slavery with the violation of a constitutional right that occurred during internment. The
enslavement of Africans and African Americans in a brutal, intergenerational system of
chattel slavery alongside the ideological assault that went with such a system is
incomparable. One of the most pernicious and enduring aspects of the slavery era was
the racist, anti-Black ideology. Whites and Blacks were brainwashed for hundreds of
years to believe lies of Black inferiority (Aird 2008), those same stories, controlling
images, and fictions continue to haunt Americans’ racial (un)consciousness today
(Effron, Cameron, and Monin 2009; Pearson, Dovidio, and Gaertner 2009), which is why
I contend that these ghostly matters constitute another category of racial microaggression.
White supremacy inherently frames the anti-Black racism of the past and present as it
also drives similar anti-Asian sentiments. Yet, I contend that the system of anti-Black
racism stands apart from other racist sensibilities in degree and scope. Asian Americans
can at once embody the yellow peril or the model minority; yet, these constructions are
rather fluid and dynamic and depend on the sociopolitical sway of the (global) moment,
while Blacks have continuously battled dehumanizing stereotypes and characterizations
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(Aoki 1996; Lee 1999; Lyman 2000). Needless to say, while I have never wanted to
quantify or measuring people’s level or degree of oppression, it is important for me to
disclose that I find something especially challenging and persistent about the racism
directed at Blacks. As a relatively modern (as compared to slavery) example of racial
subjugation, the internment of over 110,000 people of Japanese ancestry does represent,
however, a deeply harrowing legacy for the Japanese American community, and as such
provides another important and beneficial window into the ghostly microaggressions of
our present.
Executive Order 9066, signed by President Franklin D. Roosevelt, in 1942,
authorized the removal, detainment and incarceration of Americans with Japanese
heritage behind barbed wire like prisoners in internment camps located in harsh and
desolate inland regions of the country. Mass racial hysteria fueled this profound
injustice, in which “the majority of citizens favored harsh treatment of Japanese
Americans…Japanese Americans, viewed as treacherous, racially inferior, and
unassimilable, were easily excluded” (Nagata 1993:5-6). Thus, Japanese Americans,
many of whom had never even been to Japan nor called Japan home, were isolated,
alienated, and their citizenship rights cast aside with little advocacy. Yet, “[t]he cold
statistics fail…to convey the scars of mind and soul that many carried with them from the
camps” (Nagata 1993:14). Indeed, “…often with no explanation or indication of their
fate” removal, incarceration and resettlement were deeply traumatic experiences that left
scars in the generations to come that resemble the dynamics of the externally imposed
racial microaggressions discussed by psychologists.
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Dr. Ando expressed that “it took a long time for me to realize what influence, that
my parents’ background, their experience in camp had on me.” He says, “that undeniably
I was very strongly influenced by their camp experience…” Dr. Ando shared that he
feels “a lot of the men tend to be really critical…I think we are very judgmental…really
quick to judge.” Pierce argues that “defensive thinking” emerges as a consequence of
“racism and sexism, as in all the submission-dominance relationships,” (1995:281).
According to Pierce, the thinking process is “rapid since decision making incorporates
the anticipation of incessant racial and sexual assaults.” Thus, from a psychological
standpoint, it is evident why Dr. Ando notices a judgmental or critical tendency in
himself and other Nisei (second generation) and Sansei (third generation) men. While he
feels this is not necessarily “always bad,” he said that “it can be a little annoying.” Pierce
explains that this rapid, defensive type of thinking can be stressful because “one’s plight
is to possess defensive responsibility without commensurate authority, liberty, or power”
(1995:281).
For Dr. Tanaka, a degree of self doubt and lack of entitlement among Japanese
Americans grew out of internment, certainly among those who directly experienced it,
but also extending to their children. Dr. Tanaka’s insights provide elaboration:
…from my parents’ point of view, they were in a society that obviously was
against them, and there were certain – in some direct and indirect ways, you
know. And I think they were very insecure because of that, and that trickles down
to the next generation. In the sense that you, as a child, even though they didn’t
talk about the experiences, indirectly, I think, you get the sense that they’re not
confident parents. They’re not confident about their position in American society
and so forth, and what happens then is that you- that filters down to the next
generation about – you know, are you entitled to an education? Are you entitled
to your voice or your creative mind?

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Dr. Tanaka explained that the self-doubt the interned generations experienced continued
through to the next generation as self-doubt, blunted confidence and lack of entitlement.
Indeed trauma, even when not discussed, is visible in behaviors that children observe in
parents, which is one of the mechanisms by which trauma functions intergenerationally.
In his observations when you compare Hawaiian-born Japanese Americans to those on
the mainland, “there’s a lot more confidence and you know less self-doubt in the
islanders as opposed to the mainlanders who went through that experience.” Other
physicians also expressed that they sense differences between “Hawaiian Japanese” and
“Mainland Japanese.” Dr. Ando stated, “I think we’re a bit more driven and insecure
because we faced more racism here.” Dr. Suzuki, who is originally from Hawaii added,
…I think we’re [Japanese Americans from Hawaii] more comfortable in our own
skin.” She pointed out that “my background is different because I was not
interned or neither were my parents…So I don’t have that negative experience in
my family by hearing the stories about internment and losing business, losing
property and so forth. I imagine that would color somebody’s experience as a
Japanese American. So I didn’t have to prove my loyalty.

The stories that Dr. Suzuki points to and just the indirect sense of doubt that Dr. Tanaka
mentioned that you observe and feel in your parents and family can trickle down to the
subsequent generation in very subtle, yet significant ways. Dr. Suzuki further explained,
And so I think there is a difference where you were raised and how comfortable
you were there. Certainly, if you had a lot of slurs and derogatory things – it
would definitely make you more defensive and more wanting to prove that I’m an
American of Japanese decent. I’m still loyal to the U.S. I’m not a spy. Please
don’t pick on me just because I look like what you stereotype as negative. So you
definitely have more to overcome if you’re coming from that type of
background…”

Dr. Suzuki points out the importance of one’s history and previous experiences in
terms of the ways that that will impact how you see yourself in relation to others. Some
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of the physicians spoke to the differences that they detect between Hawaiian Japanese
and Mainland Japanese in terms of comfort and confidence,
12
calling attention to some of
the interpersonal and intergenerational legacies of internment, despite the outward
appearance of incorporation and material success.
Dr. Ishii adds to our understanding of the multigenerational effects of Japanese
American internment by pointing out some of the possible effects on the cohesion of the
Japanese American community.
Well, he - they would talk about it, but - y'know, the interesting thing with that
experience was that it was - for some people, it was an assimilation and they
didn't meet in front of Japanese school. Y'know, it wasn't a priority, so I think,
because of that camp, maybe people assimilated more and more quickly because
they were a lot more quite about their ethnicity than - y'know, today. Like,
Hispanics moving in here. I mean, they continue to speak Spanish everywhere
and, y'know, there's no, like - no reason for them to amend their culture. I think
Japanese people really, y'know, kind of suppressed some of their culture and
made it kind of more low-key because of that whole experience.

In her study about the cross generational impact of Japanese American Internment,
Nagata identifies “[t]he pressure to assimilate and minimize behaviors related to
Japanese American culture…as one major impact of the internment” (Nagata 1993:137).
Indeed, in the aftermath of internment, Japanese Americans as individuals and as a
community wanted to quietly blend in and not call attention to themselves. Dr. Itou
shared that while her dad “had a lot of pride in the Japanese…there was a little part of
him that kind of distanced himself from the culture.” For example, Dr. Itou recalled how
he “never really used chopsticks…So he’d end up eating rice out a bowl with a fork,”

12
Research on differences between the experiences of Asian Americans in Hawaii and Asian Americans in
the mainland US is rare. Indications are fairly clear that levels of occupational prejudice and discrimination
are greater on the mainland (Young 1977).
140
which she states, “…struck me as being kind of strange.” She continued to share how
there were “certain foods that he wouldn’t eat and he really didn’t speak the language
much.” Thus, in Dr. Itou’s memories, her father made an effort to distance himself from
the outward and symbolic appearances of his Japanese ancestry and culture. Yet, as Dr.
Itou points out, “it’s kind of…interesting, yet, most of his immediate friends were
Japanese American people.”
13

Dr. Kondo recalls how “my parents just made me American so much, you
know…[they] put me into Glendale, an all white community.” Dr. Kondo explained,
“my parents didn’t want me to be Japanese. It was not popular to be Japanese…[and]
they wanted me to go to a school where there was mainly all white students.” He recalled
that, “normally you go to Japanese school on weekends, but they said, ‘we don’t want
you going to Japanese school’, which is unfortunate now. I would like to have been able
to speak Japanese now. But…they wanted to make me white.” He shared that his
parents “never spoke Japanese…in the family even tough they were both fluent in
Japanese” and they “never said a word about camp.” Dr. Kawaratani also has the sense
that the WWII internment of Japanese Americans instilled a strong desire “to integrate.”
She remembers that her parents “encouraged [her] to do things with other people…Non-
Japanese.”
The internment experience fueled a geographic dispersion of the community post-
war (Daniels 1971; Nishimoto and Hirabayashi 1995). The resulting, sudden residential

13
This speaks to an important point that I address in chapter five. In short, although Japanese Americans
made a concerted effort to distance themselves from Japanese American culture, there is still a deep
connection and reliance that seems to reconnect JA’s together, especially later in life.
141
integration created a pressure-cooker style assimilation, a post-war experience shared by
mainland Japanese Americans. Indeed, Dr. Kondo pointed out, “a lot of Japanese
Americans assimilate. Like Koreans, they stay in Korea-town, you know, but Japanese
Americans, they’re all over. They don’t want to be together as one group or seen as one
group.”
Yet, the government also had an interest in diluting the cultural ties of the
community. During resettlement, the War Relocation Authority (WRA) played an
important role in relocating Japanese American families—and finding destinations for
them to move. While Japanese Americans showed an excessive level of patriotism, this
often came with a mandate to prove their loyalty and reject their Japanese ancestry,
including language and cultural artifacts (Daniels 1977; Tateishi 1984). This likely
translated into the very high ethnic out-marriage shown among Japanese Americans
relative to other racial and ethnic groups (Hwang, Saenz, and Aguirre 1994; Kitano,
Yeung, Chai, and Hatanaka 1984). Many of the Japanese American physicians
mentioned or expressed some amount of concern for what appears to be what Ogawa
called a “vanishing minority.” Dr. Miyazawa discussed changing demographics within
the Japanese American community and the sorts of struggles that accompany those shifts.
For example, Dr. Miyazawa anticipates that eventually there will be “no more Japanese.”
He expressed that “[t]he struggle is how do we prepare ourselves for that eventuality,
which will come.” In particular he cited formerly predominantly Japanese American
institutions such as Kairo nursing home, the Japanese symphony, and the Japanese
American National Museum, that are “not only Japanese now.”
142
I contend that the rapid assimilation of Japanese Americans and the trend towards
the disappearance of this ethnic group largely stems from the painful trauma and stigma
that Japanese American endured during the wartime and resettlement time periods.
Efforts within the community and coming from the government to prevent congregation
in particular geographical areas during resettlement, stimulated a rapid and intense
suppression of Japanese American culture. I argue that Japanese Americans feel a lot of
pressure, albeit not always consciously, to not rock the boat or stick out in any way. As
Dr. Tanaka put it, “Japanese American means getting along with everybody, you know?”
To me, this is a pretty powerful statement, because it implies a somewhat absent sense of
identity or at least a suppression of that identity in the name of not stirring the pot or
making waves or calling attention to oneself, and in a way that is at it’s core, attached to
being Japanese American. Dr. Ando added that he has learned that:
[y]ou can’t walk around with a chip on your shoulder. Of course, you don’t want
to do what your parents necessarily did and walk around completely without a
chip, without an awareness, and simply walk around knowing – just playing the
part, playing low. You have to, I think show a bit of courage and constraint in
being yourself, allowing yourself to be yourself, your ethnicity, your background,
being the person that you actually are.”

Indeed, it can take courage and constraint in “being yourself;” yet, this sensibility that as
Japanese Americans, we need to constrain ourselves, our ethnicity, our background, who
we actually are, has had a profound impact on the culture and cohesion of the community
and speaks to the constant unseen consciousness and labor always at play.
In discussing the past, and history, we collectively and individually spin a story to
fit both the neutral “facts” while also transforming the meaning of those memories so
they are contemporary and relevant (Linenthal 2001). The civil rights era represents a
143
period where many Americans believe we collectively dealt with the problem of racism
and discrimination and broke from the past, moving rapidly toward a colorblind present
(Winant 2001). While the clarity of racism has undoubtedly transformed (Dovidio,
Gaertner, Kawakami, and Hodson 2002), there is no doubt that race and ethnicity remain
salient, as shown in the experiences of the physicians in this chapter. Yet visualizing a
utopian idea—that race is unimportant—does not make it so; rather than being a break
from the present, the past haunts the here and now. The discrimination of the past not
only traumatizes, it leaves scars that are noticeable generations after physical scars have
healed and last witnesses buried. Racialized and ethnic trauma differentiates itself as
unique in that its origins lie in the stigmatization of a category of people and their
collective experiences with prejudice and discrimination. In this way, past racial events
and conditions constitute a particular type of race work that contextualizes daily
interactions.

The Enduring Strength of Community

Sometimes managing and negotiating this race work can be too overwhelming.
Both groups of physicians described a strong reliance on community. In some case,
especially for African Americans, retreating to the safety of the ‘Black Community’ is
what provides stability, security and relief from the constant negotiation of racial
microaggressions and the internal racial processes that come along with being a racial
minority.
Indeed, African Americans seem to draw a tremendous amount of strength and
support from the ‘Black community’. Dr. Johns-Washington explained how the Black
144
Power Movement helped to cope with the racism she endured as a child and adolescent.
She explained that “to be honest,” growing up on the East Coast and going to a primarily
white school and participating in white dominated activities, her “whole experience was
just so bad.” By the time she got to college she no longer had to try to negotiate white
people and spaces; she could surround herself with those who understood and supported
her, where she no longer had to silence herself just to coexist without tension. As I
mentioned previously, Dr. Johns-Washington often suppressed her own needs and rights
in order to avoid drawing attention to herself and creating tension because she knew that
as a young African American girl she already had a lot of negative attention fixated on
her. Yet, through the Black Power Movement of the seventies and immersion in a more
supportive and validating community, she managed to trade in the self-sacrificing coping
mechanisms of her past for a more empowered racial sensibility, that she arrived at
through community support.
Similarly, Dr. Howard discussed the need to “leave the university and work for
Black people,” so now, “[t]wo of the three [agencies she works for] are owned and
operated by African Americans.” She also shared that she primarily shops at Black
staffed stores and at no time in her life has she ever lived in a predominantly white
neighborhood because “[y]ou don’t want the hassle. You don’t want to have issues with
your neighbors.” When I asked her if these were conscious choices, she importantly
clarified that “it’s not only a conscious choice, but it’s also a function of racism in this
country.” Indeed, some of the African American physicians attributed fewer experiences
with racism and discrimination to the fact that they primarily live and shop in
145
predominantly Black settings. Indeed, the hostility and white supremacist attitudes that
Blacks can run into is very painful, which is why a conscious and deliberate effort is
made to avoid the toxicity of this dynamic.
Dr. Viola explained that the shared understanding and mutual respect fostered by
and among African Americans “influences…even things like vacation. I love going to
Jamaica where everybody looks like me. It's just a good sense of comfort. I'm not gonna
get any stereotyping, any racism, or at least I don't feel it anyway. I think that makes a
big difference.” Dr. Johns-Washington also stated that, “I admit that it’s nice to go places
where there are other Black people,” such as cruises to the Caribbean. She went on to
clarify that it isn’t that she wouldn’t go anywhere else; rather not having to deal with the
antagonism, stress, tensions, judgment, and hostility that can emerge out of racially
hegemonic settings allows for a greater sense of comfort and well-being.
It is clear why the African American physicians I spoke with turn to their racial
community for support. If it were not for their communities, many professional Blacks
would maintain socially isolated and emotionally conflicted lives-or more so than they
already do. Being in the company of others who share your community and lived
experiences, provides a sense of comfort, security, validation and relief from the race
work that is stronger when in integrated or white dominated spaces.

Japanese Americans Physicians
For African Americans, their racial heritage and community support provide a
source of empowerment, support, and validation that in part enables them to keep moving
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forward in spite of the barriers and obstacles they encounter from the outside and all the
emotional labor of being raced. For Japanese Americans, somewhat similar to African
Americans, they find a sense of comfort when in the company of other Japanese
Americans.
Using Dr. Kobayashi’s words, many of the Japanese American physicians
indicated that they “feel closer to their ethnic ties” partly due to the “shared culture,
shared understanding of your background and history.” As I mentioned previously some
of the Japanese American physicians discussed a push from their families, and to an
extent the broader Japanese American community, to ‘Americanize;’ thus they
experienced much of their childhood and adolescence in white dominated settings. These
physicians expressed that in college and later, they sought out other Japanese or Asian
American relationships. For example, although currently Dr. Kawaratani has a diverse
group of friends, she explained that in college, she “managed to hang out with a bunch of
Asians” as a member of the Asian American Christian Fellowship. “I had my own Asian
group to hang out with,” she recalled to me.
At one point in the interview, Dr. Kondo expressed that he felt he might not be
very much help to me due to his parent’s efforts to Americanize him. He shared a lot
about his childhood and in the end, said, “[w]ell, as it turned out later, socially, I was
more comfortable seeking out Japanese…” Recently divorced, he explained that “my
girlfriend is Japanese and I feel very…I really like that. She speaks Japanese and, you
know she has a lot of culture. And I really feel comfortable with that. It’s like, you
know, something I’ve been missing, so that’s good.”
147
Dr. Kondo talked about a newfound embracement of Japanese or Japanese
American culture. At one point in the interview he explained that he now loves going out
to eat at Japanese restaurants, something he really didn’t like doing in the past. At this
point I felt sadness for him out of what appeared to me a sort of forced abandonment of
his ethnic heritage due to his family’s, as well as the Japanese American community’s,
need to suppress any part of them that resembled Japanese American culture and
livelihood in attempt to avoid the painful stigmatization that was a product of such ethnic
identifiably, especially following WWII. Indeed, one’s cultural heritage is a central
component of one’s identity and sense of self, but for many Japanese Americans,
suppressing that aspect of their lives provided a way of coping with the racism of the
yellow peril.
Yet, the pull and force of one’s ethnic identity, while suppressed earlier in life as
a way to cope with uncontrollable racializing ideologies and as a way to keep moving
forward, it seems that later in life these Japanese American physicians, especially the
men somehow return to that core sense of themselves. Dr. Miyazawa also shared that he
feels “one gravitates eventually back to your ethnicity.” He stated, “but you come back
to the parts of your early experiences that you feel comfortable with,” that, “it may be
your ethnic kinds of issues that bring you closer to who you actually are.” It is true that
the shared ethnicity between individuals offers the comfort of what Dr. Kawaratani
described as a “cultural connection” that helps you to build relationships; yet, the
meaning and significance of these sensibilities about cultural heritage, cultural ties and
feelings of connectedness and comfort also suggest perhaps the haven of community
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where shared histories and lives experiences exist, also provide relief and respite from the
daily race work and racial negotiations (even if we are not conscious of this labor).
While some of the African American physicians state more explicitly that they stay close
to their community because this race work can be too much sometimes; Japanese
Americans don’t state the linkages as clearly. However, we may be able to draw on the
understandings and explanations of the African American physicians to help us
understand more clearly a parallel process that could be going on with the Japanese
American physicians.
When I asked Dr. Kondo why he thinks that upon getting older, he sort of returned
or re-embraced his ethnic roots, he said that he really doesn’t know why, but he offer
some speculation, “…maybe it is that you feel that there’s more of a prejudice than you
were aware of before and, therefore, you want to embrace your heritage more because
that’s where you find comfort.” Dr. Ando shared his own journey with this process, “…I
think as you get older you start realizing, you know, that you are different. I think the
layers start to peel off as time goes on and you do kind of start looking for that foundation
that started everything. And you actively search it out.” Interestingly, both Dr. Suzuki
and Dr. Kurniawan explained that they do not belong to the American Medical
Association (AMA), but they do pay dues and belong to the Japanese American Medical
Association (JAMA). The Japanese American Medical Association began in 1974, and
according to Dr. Miyazawa, a one time President of the organization, “…was an
extremely important organization,” with only two in the United States. “It became like
149
the health club. It was a place where families of similar background could support
themselves emotionally, socially, professionally…” Dr. Miyazawa informed me.
Thus, it seems that something powerful is at work here causing these physicians
to participate in an ethnic organization that really has no significant function, but do not
also participate in the hallmark organization in the field of medicine. As Dr. Miyazawa
indicated, “from a professional standpoint I don’t need the Japanese American Medical
Association…” Rather, his involvement in this ethnic professional organization comes
“from a personal standpoint and a commitment to our ethnicity as a medical
institution…”
In college Dr. Kondo recalls really feeling “that there was a racial thing.” He
shared that “I didn’t think I would be able to develop any close friends unless they were
Japanese.” Even now he shared that “a lot of our friends…are, you know, Caucasian.
And I think it helps that I’m a physician…’cause they know that…” When I inquired
about what he means when he says that being a physician helps his friendships with
Caucasians, he stated, “just respect;” thus, Dr. Kondo feels that the fact that he is a
physician helps him to gain the respect of his white friends. To me, this just perfectly
captures the positionality of Japanese Americans and part of the drive to excel so
exceedingly. Whether a conscious realization or not, I contend that Japanese Americans
sense that they need some sort of external validation to gain and maintain the respect of
whites, which is a lot of work and strain. As I discussed in chapter two, Dr. Ojima
explained that she really liked the ease that came along with dating other Asian
Americans. Dr. Ando explained that after living in and attending a predominantly white
150
school, “…once I got into high school it changed quite a bit dramatically. I felt more
comfortable being around other Asian kids. And since then, it’s probably been mostly
Asian social networking.”

CONCLUSION

In the mid 1990s an Advisory Board formed as a function of President Clinton’s
Initiative on Race. This Advisory Board concluded that
a) racism is one of the most divisive forces in our society, b) racial legacies of the
past continue to haunt current policies and practices that create unfair disparities
between minority and majority groups, c) racial inequities are so deeply ingrained
in American society that they are nearly invisible, and d) most White Americans
are unaware of the advantages they enjoy in this society and of how their attitudes
and actions unintentionally discriminate against persons of color” (President's
Initiative on Race (U.S.) Advisory Board 1998).

As it turns out, these issues constitute the central points I argued in this chapter.
First, in agreement with ‘point a’ of the Advisory Board, my research shows that racism
remains an extremely salient force in Americans’ lives today, even those situated in
higher socioeconomic classes. Second, I also argue, as does ‘point b,’ that “racial
legacies of the past continue to haunt current policies and practices” leading to unfair
disparities. Further, I add that perceptions are also rooted in history and lived
experiences, which ultimately inform what we see and how aware we are of certain
realities and how we make sense of and understand those realities. Thus, when people of
color talk about racism or interpret or understand certain interactions as “racist” or
racialized, it is not a matter of “playing the race card,” but an issue of having greater
understanding due to their personal, familial, community histories and experiences with
race in America. Third, a significant contention in this chapter falls in line with ‘point c’,
151
which finds that finds that contemporary racism is nearly invisible. Indeed, post-civil
rights colorblind racism presents in very subtle, opaque and insidious ways. This does
not mean however, that it is an individual problem. Rather, the subtlety that characterizes
person-to-person racial microaggressions nowadays requires us to reframe race within a
cohesive, stable, and structural framework that accounts for micro-level processes. These
types of racialized interactions are indeed highly individualized, but they are recurring,
cumulative, consistent, and patterned from one person to the next. Thus, they may look
like isolated and separate incidents; however, these racially motivated subordinating
interactions are actually held together and stabilized under a hegemonic frame of white
(patriarchal) supremacy, and often unconscious, automatic, unquestioned and a part of
our “common sense.” unconscious/automatic/unquestioned/”common sense”. Thus, I
argue for a broader awareness and understanding about race and racism—that extends
beyond the overt acts of discrimination or identifiable comments, slurs or attitudes of
bigotry— to include the subtle, insidious, and patterned covert interactions, the
intergenerational racial pasts and legacies as well as the internalized labor and
management of self that goes hand-in-hand with living in a phenotypically distinct body.
Race work is a concept that illuminates the centrality of race in the daily lives of people
of color, denoting the energy, planning and responses to racial experiences they
encounter.
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CHAPTER 4:
RACE, MOBILITY AND MEDICINE:
THE WORK LIVES OF AFRICAN AMERICAN AND JAPANESE AMERICAN PHYSICIANS

In the previous chapter I discussed the ways in which various racial
microaggressions manifest in the everyday personal lives of African American and
Japanese American physicians. As I discussed, the racial microaggressions directed
toward these two different groups fell along separate lines of bias and transgression; yet,
both spring from the same overarching ideology of white superiority. Similarly, due to
highly differentiated racial constructions, African American and Japanese American
physicians experience and describe very different sorts of work lives. I will first discuss
the way race differentially informs their career trajectories before discussing the
challenges both groups share.

RACE AND MEDICINE: A BRIEF PORTRAIT OF RACE IN MODERN MEDICINE
The medical profession is unique in its influence on both individuals and society;
yet, as with other institutions, it is a product of the time and place in which it exists.
Issues of race and ethnicity in medicine are as old as modern medicine itself, and the
physicians and organizations they interacted with did not distinguish themselves as more
racially progressive than the US at large (Baker, Washington, Olakanmi, Savitt, Jacobs,
Hoover, Wynia, Blanchard, Boulware, Braddock, Corbie-Smith, Crawley, LaVeist,
Maxey, Mills, Moseley, and James 2009). Modern science grew up with both modern
medicine and the reification of racial and ethnic categories as socially meaningful
(categories). Scientific inquiry was often used as a tool adding validity to the idea that
153
human groups were factually different quantitatively and qualitatively (Stepan and
Gilman 1991). The nineteenth century saw the study of humans move into the realm of
science, symbolized by the steady development in the US of anthropology as a
recognized discipline. An important part of the task of this new discipline was to study
and draw conclusions, based in science, as to the relative characteristics of various human
groups (Baker 1998). These conclusions, along with the now infamous craniometry
studies, validated the dominant, white supremacist ideologies of the day with a newfound
scientific basis (Gould 1993; Gould 1996). Supremacist notions that deemed “the Aryan
race,” as the pinnacle of humanity and civilization—as one of American Anthropology’s
cofounders John Wesley Powell described—were common ideas a century prior (see
Jefferson 2000 [1781]). What changed was society’s faith in science to answer questions
and solve problems, which transformed racism into scientific racism, a version buoyed by
images of systematic investigation and unbiased evidence (Baker 1998).
As Du Bois wrote, in a defiant rebuttal to this racial hijacking of scientific inquiry,
about his approach to the classic study of the late nineteenth century, The Philadelphia
Negro, “the Negro problem was in my mind a matter of systematic investigation and
intelligent understanding. The world was thinking wrong about race, because it did not
know. The ultimate evil was stupidity. The cure for it was knowledge based on scientific
investigation” (Du Bois 1984:58). Du Bois, a fellow in the American Association for the
Advancement of Science in 1904, and notable others railed against the movement of
scientific racism, notably anthropologist Franz Boas (Boas 1899; Boas 1912). Yet
science and medicine even now continue to see the repercussions of this history, whose
154
ideological underpinnings allowed incidents like the racist exploitation of African
Americans in the Tuskegee Syphilis experiment, which today still informs a greater
distrust of the medical establishment among African Americans (Freimuth, Quinn,
Thomas, Cole, Zook, and Duncan 2001; Thomas and Quinn 1991).
As Jim Crow and segregation guided the norm of behavior in the US, most strictly
in the US southern states, similarly, the segregation of African American physicians was
“nearly complete” at the turn of the twentieth century (Baker, Washington, Olakanmi,
Savitt, Jacobs, Hoover, and Wynia 2008:309). Until 1939 the American Medical
Association, which included a small number of northern Black physicians and relied on a
de facto policy of racial segregation, listed distinguished African American physicians as
“colored,” in its annual American Medical Directory, causing them professional harm in
their procurement of insurance and loans in particular (Baker et al. 2008:310). As
Barker, et al. (2008) wrote in their brief history of the segregation of African American
physicians, “As leaders of the medical profession come together and move into the
future, they should do so with a clear recognition of the effects of the past but also an
awareness that the story of African Americans and organized medicine is still being
written” (2008:312). Medical professionals have a unique institutional past that mirrored
racial trends in US society and the past remains important in the trends we see today.
Due to exclusion from the American Medical Association, African American
Physicians organized under the National Medical Association, which was founded
explicitly as a national organization where African American physicians could join and
take on leadership roles as they sought to serve their patients. The road for Black
155
physicians was very difficult. Regarding the declining number of African American
doctors, Time magazine printed in 1968, “Today relatively few ambitious young Negroes
are seeking careers in medicine. They have seen that it is a long, hard and costly road,
with the almost certain assurance of frustration and discrimination at the end. Only now
has the medical fraternity at large begun a substantial effort to remove the basis for that
fatalistic preconception” (Time 1968). Many of the physicians I interviewed maintained
membership in the National Medical Association today. As Dr. Samuels informed me,
the National Medical Association still “can be a source of referrals and support” for
African American physicians.
As recently as 1995, a demographic survey showed that 96 percent of AMA
members were white, 1 percent Black, 1 percent Hispanic and 2 percent Asian (AMA
Ethics Standards Group 2011). The Board of Trustees of the AMA in 1997 restated their
support for affirmative action programs to increase the number of physicians of color,
and while numbers of enrollments have increased, the progress in terms of graduation has
been more limited. As Table 1 shows, in 2008 only 5.8 percent of female physicians
were African American, and among men only 2.6 percent were African American.
14

Among African Americans the trend hasn’t improved in the past decade: in 2002, 7.4
percent of enrollees to US medical schools were Black, in 2010, the number declined to 7
percent. African Americans made up only 6.9 percent of medical school graduates in
2002, and were only 6.7 percent in 2010 (Association of American Medical Colleges
2010a; Association of American Medical Colleges 2010b). The issue is complex, but the

14
Notice that the number of whites reporting is artificially low—one consequence of the colorblind shift is
that many whites are refusing to acknowledge their race and therefore fall into the “unknown” category.
156
historic and continued under representation of African American and Latinas/os in
medical school creates a medical service problem in communities that need physicians to
serve their members (Komaromy, Grumbach, Drake, Vranizan, Lurie, Keane, and
Bindman 1996; Smedley, Stith, and Nelson 2003). In the wake of the 2003 US Supreme
Court decision upholding the University of Michigan’s affirmative action efforts, there
has been a renewed push, often using the popular appeal to public health as evidence, to
rekindle or defend affirmative action programs involving medical students and argue for
an increase in their representation (Lakhan 2003).

Table 1: Physicians by Gender and Race, 2008

Female Male
Race/Ethnicity Number % Race/Ethnicity Number %
White 136,136 49.2 White 383,704 56.6
Black 16,083 5.8 Black 17,698 2.6
Hispanic 15,303 5.5 Hispanic 31,204 4.6
Asian 43,209 15.6 Asian 73,203 10.8
Native American or
Alaskan 682 0.25
Native American or
Alaskan 912 0.13
Other 4,058 1.5 Other 8,961 1.3
Unknown 60,946 22 Unknown 162,125 23.9
TOTAL 276,417 100 TOTAL 677,807 100
Sources: Physician Characteristics and Distribution in the US, 2010 Edition. American Medical
Association.

It is clear from these data that while the institution of medicine has undergone
some transformations in terms of matters pertaining to ethnic and racial representation
and inclusion (more so for Asian physicians than for African American physicians), the
157
worrisome fact remains that the demographic portrait of American medical institutions
remains imbalanced when held up against the American general population. I explore the
qualitative experiences of current African American and Japanese American physicians
practicing in Los Angeles in this chapter in order to contribute to a deeper understanding
of what it is like to work and practice in an institution with deeply racially exclusive
historical roots.
In the last chapter I discussed the subtlety with which racism gets communicated
to people of color in this current moment of racial colorblindness. Racial
microaggressions are typically conveyed through covert or subtle insults, put-downs,
“snubs or dismissive looks, gestures and tones” throughout everyday interactions and
automatically, or unconsciously so that the perpetrator isn’t even aware of their biases
(Sue et al. 2007:273). I discussed how these physicians experience these seemingly
innocuous racial microaggressions throughout the course of their daily personal lives. I
find that, similarly, in their professional lives, as Dr. Tano said, “there [is not] anything
overt;” yet as Dr. Itou’s elaborates, “…there’s a tremendous amount of prejudice that’s
still out [there] that works at different levels.” Dr. Fujimoto feels “it would actually be
hard for me to point out anything…there’s only a few things, which are kind of
idiosyncratic, which I’m not certain about.” Indeed, the subtle, covert and insidious
nature of racial microaggressions makes it very difficult to pinpoint and identify the
racism or bias that one may perceive to exist, but remain unable to point out with
certainty. Yet, Dr. Fujimoto senses that, “[t]he fact that people look different, whatever
way it is, has some degree of effect. You know, whether we think that intellectually or
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not, that’s probably the case.” Dr. Johns-Washington also speaks to the importance of
others’ perceptions of you saying that, “I think that [race and gender] can matter, again,
in how other people perceive you and …being given a hard time by other people or
being…not overtly, but kind of covertly disrespected by other people; by patients, by
staff.” Thus, in this chapter, I will discuss the ways in which race continues, in this
colorblind era, to inform the work lives of the African American and Japanese American
physicians I spoke with.

African American Physicians: Continued Institutional Inequalities and Structural
Challenges in Achieving Representation and Diversity

Several of the physicians shared that initially, Affirmative Action led to an
increase in racial diversity within the field of medicine. Dr. Johns-Washington explained
that the primary “growth probably went through the mid- to late-'70s.” She said that the
period of time, “[when] I went to school was probably one of the better times… There
were certainly more Black people in the school - in all the schools - at that time. And
because it was a different time, again, of this really positive racial identity time, there
were a lot of things that were going on within the Black community, and outside of the
Black community, that were more inclusive.” Yet, according to Dr. Johns-Washington,
the success was short-lived. She finds that, “since the '70s - the late '70s…things have
kind of been swinging back the other way.” She continued to share her unique insight as
an insider within the field, indicating that,
as the late '70s hit, things began - and [Ronald] Reagan and some other people -
began to kind of change [things] and there was a slight backlash that started,
y'know, against things like Affirmative Action and racial inclusion, and I think it's
just continued, y'know, to slip. And I think the slip also was [as] economic times
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get worse, things slip, and I think that's partly what's going on with things slipping
now.

Dr. Ando feels that certain “exclusionary tactics” are deployed in order to “lock them
[African American] physicians out of the workplace.” For example, Dr. Ando noted that
“if an African American gets in and gets a job, that means he’s taken someone else’s
job,” so as a way to maintain the white male bias within the field of medicine, people
“[develop] ideas” to “maintain them” or keep them locked out of the field. As we saw
with the dismantling of affirmative action programs through the past twenty years, a
backlash against civil rights compelled many whites to vote their interests, and against
Black interests, in the political order (Blumer 1958). While the fear, anger and backlash
against African American civil rights was clear and less obtuse during the 1960s (Mayer
2001), as time passed, the anti-civil rights movement ironically attempted to co-opt the
words of Martin Luther King, Jr., that we should not be judged by skin color but by our
character to validate the elimination of programs aimed at increasing African American
access to education, income, and government jobs (Wicker 1996). Thus, while some
progress in terms of racial diversity within the field of medicine occurred after the
enactment of Affirmative Action legislation, as Dr. Howard said, “as soon as they opened
the door…then they closed it as soon as they could, with the help of the Connerlys of the
world…So it went up and then it went right back down.” While one physician, Dr. Tano
commented that, “I actually think Caucasian is in the minority now,” nearly each of the
other physicians, even the most staunchly appearing colorblind or post-racial Japanese
American physicians, were in agreement that African American and Latino physicians
continue to be problematically underrepresented in the field of medicine.
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“Only One”
Dr. Howard stated that her Ivy League class at contained “the second highest
[numbers of African American medical students] ever at my institution. And they've
gone back now to only having three or four in a class, where we had, like, 35.” Dr. Viola
noted, “UCLA has less than three percent African-Americans. That doesn’t even
represent our city. That’s not a good number.” Dr. Skillman, an African American
cardiologist noted that “[t]here’s still some medical schools that have taken very few
minorities over the years. And some – a few medical schools, [that have] never trained
an African American cardiologist.” Dr. Kingston pointed out that even at a large
university located right in the heart of a diverse metropolitan area, “you may never see a
Black male professor that’s there because the amount of Black male professors are just so
low.”
Indeed, many of the Black physicians who spoke with me have firsthand
experience at being “the first” or the “only one.” Dr. Gellings informed me she was
“[t]he first Black female intern where I did my internship, I was the first Black female
head/neck resident at [the West coast medical school I attended]…”
Dr. Parker shared from his own experience:
As the third African American resident at [a major metropolitan hospital], [which]
tells you something about the diversity right there. I mean, that program has been
in existence a long time and I was there from 1978 to 1983. And I was just the
third…Structurally, especially surgery, it was primarily, especially when I was in
medical school as well as training, it was basically an old boy network. I mean
you didn’t see any faces of color.

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Dr. Parker went on to describe his current experiences as a surgeon in Los Angeles,
indicating that he feels “it has changed, but it hasn’t changed dramatically.” For
example, “there are no other African American general surgeons” at the hospital where
Dr. Parker currently practices; “it’s just me,” he shared. As Dr. Parker tried to account
for how many African American physicians work regularly out of his hospital, I could
see him really reaching, and as I listened, I tried to picture in my mind a white male
surgeon trying to count how many other white male surgeons he could count as regular
colleagues, and of course, that picture never came into focus. Dr. Parker explained,
There are a few guys that do come and there’s a cardio-thoracic surgeon, an
orthopedic surgeon has come and gone. But that’s it for people who practice here
regularly right now. There is one African American that… comes regular[ly].
There are a couple of nephrologists. And I’m reaching…I mean, still you can
count on probably two hands and I’m thinking of the other specialties and there
really aren’t, I mean, there are guys who come and assist on occasion, but people
who are here regularly, there just aren’t that many.

Dr. Kingston added that, “[m]ost of the place[s] in which I go, most of the studies
in which I do, I am still in 2009, often the only black male or only black person that's in
these meetings.” Dr. Kingston elaborated on this experience, sharing
it's always expected if there's more than one black person there, if the two black
people migrate towards each other, give off some greetings and so on and so
forth, there's always some so-called friendly conversation [from whites] about,
‘Oh, you guys don't wanna join in with us?’ where there are 10 of them who are
already all together. And it's not a matter of them coming to [us]…

Given this type of dynamic and context, it is easy to understand why Dr. Parker’s states,
“it’s tough being an onlyist.” The toll of being “the only one” just adds more stress to an
already arduous path in a very hierarchical and status conscious field. Dr. Kingston
explained:
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There is comfort in being able to see like oneself or someone who has life
experience, they’re from the same country, they’re from the same – they speak the
same language, they’re from the same city, they like the same food, there’s
something you can relate to that isn’t foreign in everything you do. And
unfortunately, especially with the African American male, there is no familiarity
in anywhere you go.

Dr. Parker shared a tragic story about a friend and colleague of his who attended
medical school in the Midwest in the eighties and was sexually harassed by a professor.
He described her as a “very smart lady” who had “been labeled in Chicago [where she
grew up] as being ‘slow,’” which as Dr. Parker points out, “this frequently happened to a
lot of black kids. And so once you get labeled, you're stuck. You know, you just go from
one dummy class to the next dummy class and nobody really ever gets to the meat of the
issue.” For example, “You just need to learn in a different way. Maybe you need to
learn vocally. Maybe you need to learn with media, you know, with video or something.
Maybe you don't learn the same way. But you know, no one spends the time to unlock
that.”
He explained, that his friend overcame this too common and dangerous cycle she
endured as a young student of the public education system and ended up applying to
medical school. Dr. Parker helped her with her application, essays, etc. and she ended up
choosing a school in the Midwest where “she was a Black female among no other Black
females. She was dark skinned. She had very African features and basically she had a
complete mental break down.” Racially isolated without the familiar understanding of
others who could identify and relate to what she was going through she sought
counseling, which in the end, only made her situation worse because there were “no
people of color there to help her.” Dr. Parker shared, they “didn’t understand the source
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of her anger…you can’t function in that kind of condition.” After “[t]rying to get help
from professors and she’s very well endowed and having people trying to fondle you and
she said it was just an untenable situation for her and nobody had her back.” In the end,
Dr. Parker’s friend was institutionalized and they lost touch with each other.
This story was very hard for Dr. Parker to recall. He grew visibility angry,
commented about his blood pressure rising and he had to get up and walk around and get
a drink of water. I could feel the helplessness and anger that he felt as a Black male with
very little power to help his friend beyond the consoling or comforting that he could
extend. Also African American, he understands how she had to fight to get herself onto
the career path she chose for herself, with every step of the way fraught with one battle
after another. Near the pinnacle of her career, the powerlessness, the sexism and the
racism can engulf one with the isolation of being “the only one.” As Dr. Rider states, “it
helps…when situations like this or any other ones come up, you can – you have someone
to talk about it [with].” Indeed, few can understand the anger that emerges from the
injustice and having few other colleagues who can truly share your experiences can feel
very alienating and troublesome.
Dr. Rider also described what it feels like to work in a setting where very few
similarities exist:
Dr. Rider: And if there is not anyone else of that similar background at the
workplace, it may create a situation where you just lack comfortable camaraderie.
The camaraderie, I think, has to remain more at a professional level. And you
hope that it goes deeper, but oftentimes with someone of similar background and
ethnicity, you have more things in common…I don't know. I haven't established
close social interactions with many of the physicians here outside of work.

Interviewer: Is that something that you wish you had or it doesn't really…
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Dr. Rider: I think so. I wish I did. Yeah, because I think it would make work a
little more enjoyable and less isolating…Yeah, if there was someone here that I
was close to, we could - one, I would be able to trust them about issues I had at
work. And then too, maybe together we would just sit down and have some lunch
in the faculty center or something….Yeah. Usually I eat by myself. So yeah, it
would be a lot more collegial.

As I listened to Dr. Rider share with me the reality of his workplace environment,
I felt so saddened by the lack of closeness with his colleagues; while at the same time,
feeling and relating to his wanting of something more- friendship, understanding,
support, collegiality- qualities that many, especially those with so many shared
similarities such as residence, interests, hobbies and cultural background- can find when
they do not belong to an underrepresented demographic.
I wondered about Dr. Rider’s level of job satisfaction given the isolation and
loneliness that really stands out in his experience. He explained, “I would say - I guess
I'd have to divide it up…For professional development, I would give it about a nine
because I've learned a lot. Professional satisfaction, it would be pretty high. The
interactions with the faculty members and things like that, it would probably be pretty
low. I don't interact too much.” Just as racial minorities often seek out certain
geographic areas to live in an effort “to get away from areas where you might be more
subject to discriminatory types of treatment and so forth,” as Dr. James states; the task of
finding work environments that provide more common ground and therefore more
opportunity for making connections and building social and professional networks is
especially laborious for African Americans given the extreme under-representation in the
field of medicine.
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The support these physicians drew from the African American community helped
to sustain and push them forward and upward, professionally and personally. In terms of
their professional lives, the African American women physicians spoke of ethnic oriented
organizations, such as the Association of Black Women Physicians, as a significant
source of support. Dr. Viola, once apart of the leadership of the organization, explained
that the Association of Black Women Physicians “was actually started from residents and
students at UCLA. They saw that there was nothing else for black women to do, so they
were in different specialties and they just brought themselves together, because they had
no other support.” The organization provides mentorship to medical students as well as a
strong “social support network, according to Dr. Samuels. When I asked Dr. Viola what
the organization means to her she shared that, “it is that group of my colleagues; we had
similar upbringings.” This issue of having a shared history is a really important and
powerful aspect in forming personal relationships and support networks for everyone, but
especially meaningful for ethnic communities whose unique experiences are often
misunderstood, ignored, or outright denied by others.
As Dr. Viola elaborated on her experience and the gap that this particular
association fulfills: “[j]ust like when I go to conference, many times I'm the only woman.
Many times, I'm the only black physician and I think that's what all minority physicians
feel when they go somewhere. So who do you make conversation with? You're just kind
of sitting there alone. So I think that's why these groups form.” Thus, remaining
connected to the Black community in other ways takes on even more importance for
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African American physicians and other Black professionals. Explaining the importance
of community, Dr. Viola elaborated:
I belong to a group called, "Jack and Jill." It was developed when Blacks started
matriculating out of the inner-cities and intermingling, but it was a way for us to
stay together, so that our heritage stayed together. I think all that does is steal
your confidence…For my kids, I would make sure - yeah, you may live in a
predominately white area and go to predominately white school, but it's important
to be with blacks. It's important to know that heritage, for instance, because
otherwise, they're only going to get the racism that may be subtle, that they don't
really recognize, but that plays a role in their thought process and their personality
development.

Psychologist Beverly Tatum (2003) describes the importance not only of being
able to gain positive images of your salient social groups (e.g., race, gender, class,
sexuality, as a few examples) through interpersonal interactions, but also how important
it is to share experiences with those around you who can relate to your experiences. In
racially segregated settings where people of color and women frequently find themselves
as “the only one” or “one of only a few” there is an isolation that in part accounts for very
different experiences compared to white men in the workplace that have been
documented in other professional occupations (Smith and Calasanti 2005). Sharing a
similar cultural connection and/or common lived experience is especially important when
you feel you live on the margins or outside of the automatically accepted positionality.
For example, Dr. Kingston shared that he had one African American male professor in
his time at Berkeley, and that he purposely took his class out of wanting the safety that
accompanies the cultural connectedness.

Mentorship
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The lack of equal representation of African American physicians can lead to
disparities in other aspects within the field of medicine. Mentorship, for example is a key
element in the journey to becoming a physician, and mentors play a pivotal role in the
development of young physicians’ careers (Garmel 2004). Dr. Kawaratani shared that
“it's helpful if a student has a mentor. I think that goes especially for - well, for any
nationality, but perhaps more so for the "non-Caucasian" students, because the
Caucasians, there's so many other Caucasian physicians out there that could serve as
mentors, so in terms of availability, it's there. There's less of a tendency to want to
mentor the non-Caucasians.”
Dr. Samuels elaborated that the lack of role models can make the medical school
and training trajectory especially challenging for African American students who often
contend with class disadvantage as well:
“it's a reality in this country that statistically many African Americans are so - are
economically and educationally disadvantaged, because the school systems in
inner city areas don't always have, apparently, what is offered in some of more
suburban or very expensive private schools…And you [medical students]
compete with all of these people who come from so many different varied
backgrounds who may be, you know, more advantaged…The whole process is
such an expensive one.”

Dr. Samuels explained that it can be extra difficult to maneuver your way through the
process of becoming a physician “ you don't have the role models or the people who have
gone before to give you the insights or the assistance and support…” She continued to
explain:
that mentorship is very important for everyone in all fields, because it also gives
that realistic insight and the helping hand and the guidance to overcome some of
the hurdles…So, I think that it can be difficult…You know, it can be difficult to
find that if you don't have access to it outside of the medical field, because many
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of the medical schools have such big numbers that, for many folks, it's hard to
find, you know, that kind of help and support within.

Dr. Kingston put it this way, “…I think that you’re exploited all the way, and if
you don’t have some role model, if you don’t have a clear vision of [what] happens, you
can get lost in it all. And you don’t have any background experience of knowing what to
do.” The mistrust that complicates cross-racial interaction makes cross-racial mentorship
more difficult, as do differences in experiences (Cohen and Steele 2002). What is known
is that, among physicians, women and people of color are more frequently called upon to
be mentors, as race- and gender-matched relationships are more sought-after by mentees
(Rose, Rukstalis, and Schuckit 2005). Indeed, the lack of adequate representation leaves
current Black medical students without the kind of guidance and support that they need
due to racial disadvantages and for some, class disadvantages as well. Without the kind
of mentorship and modeling and outreach at an institutional level, we are left with a
dearth of Black physicians, which only fuels additional problems, such as a lack of health
providers for underserved communities (Komaromy et al. 1996; Xu, Fields, Laine,
Veloski, Barzansky, and Martini 1997). Both Dr. Samuels and Dr. Kingston speak to
issues pertaining to social capital and the reproduction of knowledge about how the field
of medicine works, which illustrate another way in which African American physicians
remain at a disadvantage compared to their non-Black and non-Latino colleagues.

Social Capital
As with the informal networking between physicians that can lead to patient
referrals, there is also a lot of informal exchange of information that helps to facilitate
one’s progress through the medical pipeline which helps to incorporate one into the
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cultural milieu of the institution of medicine. Dr. Samuels indicated that “[t]here’s also a
lot of not knowing. You know, it’s like I have no idea if all these other activities are
going on or not, you know, so…there is also a question of inclusivity, you know?” For
example, Dr. Samuels shared that in her own personal experience at an elite private
university, she went to school with a lot of people who previously attended exclusive
prep schools, which provided an instant network of support and connection. She shared
that these people had “known each other for years” so they “already have a study partner
or built-in network.” Dr. Samuels pointed out that the internet provides a helpful tool in
gaining access to some of the more informal information that gets passed through family,
friends, and other personal contacts, but, “that still isn’t having a mom or dad or relative
or working in a family business or anything like that
15
.” Dr. Kingston provided an inside
glimpse of how this process can unfold:
…my colleague's son, for example, who now works with him, he grew up in a
family of doctors. His grandfather was a doctor, his dad's a doctor, so for him to
think about being a doctor or being around doctors' offices, or seeing what a
patient's like, or understanding calling a pharmacy or understanding what it is to
go to an emergency room, that's just second nature to him.

It was easy for him to go through. And then when it's time for him to do his
externship or his internship, he went to some place that was his dad's friend, or
this other guy went to school with your dad.

And the African American kid is going, "Okay, where should I go such and such,
such and such." And he goes there, it's a bad experience…nothing he relates to,
the doc doesn't relate to him, he doesn't relate to the doc, doesn't listen to the
[same] music, doesn't eat the type of food, doesn't go to the kind of places, doesn't
have the experience. So there's just nothing there. So again, it's just a hard line,

15
For example, Dr. Samuels shared that she has found a tendency for Ophthalmologists to have a lot of
Ophthalmologists in one family, which provides a resource for a new physician starting out in terms of
general know-how and referrals.
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academic, minimal social involvement that is the 100 percent opposite [than] my
colleague's son.

And then when he graduated, what happened? The next day he went from being a
resident to making $100,000.00 working in his dad's place. There's no
applications, there's no seeing what goes on from there. So a completely different
nature of what happens and how you get there.

When my colleague's son did his externship, he was like, okay, work a couple
hours, he was at the beach four or five times a day for six weeks, and the other
guy is working, you know, 18-hour days and going through his oral exams; he's
being tested, where they're going and all having lunch together on the other side.

And that's what happens when you know enough….

In this example, Dr. Kingston clarified just how far personal connections can take you,
especially in such a competitive field marked by the presence of a still largely intact ‘old
boys network.’ Thus, it is clear that although a rule excluding people of color no longer
exists, a heightened level of advantage for some continues to maintain extreme
inequality.
Dr. Viola explained that Affirmative Action policies helped to ameliorate the
disparity between those advantages by higher levels of social capitol:
I went to [college] when there was Affirmative Action, so there was actually a
whole program that was set up that even before school, we went to like a pre-
school, a summer school sort of thing, but it was an orientation…We did a
program of what medical school was going to be about. To me, that took care of
that ‘my dad wasn’t a doctor. I had no exposure. This is gonna give me a little
bit of an advantage before I started.’ But that support was there all throughout the
year. We had one particular person who was assigned to our group and that’s
who you went to if you had problems with grades or problems with class. You
went to that person.

As Dr. Viola indicates, structural changes that came about as a result of Affirmative
Action inspired efforts to recruit, diversify and retain more students of color in medical
school provided her with the types of support her better-networked colleagues
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automatically benefited from, oftentimes a result of the intergenerational transmission of
social and economic capitol. Many critics have pointed exactly to the destruction of this
affirmative effort as the real harm in a society that extols a colorblind ideology, but where
inequity is so pervasive (Shapiro 2004).

Disrespect, Disregard and Doubt about the Abilities, Skills, and Qualifications of
African American Physicians

People use all sorts of different criteria when choosing a physician, including
location, size of practice, recommendation, medical school, years of practice, gender,
race, etc. Thus, to a certain extent, the type of interaction that will occur between patient
and physician may partly be determined before the patient even walks in the door. For
example, a male patient seeking a urologist may rule out any female physician prior to
the appointment if seeing a female physician for his medical concern makes him feel
uncomfortable. Likewise, people of color may seek out physicians of their same
ethnicity partly because it makes them feel more secure that they will not be
discriminated against or misunderstood (Saha, Taggart, Komaromy, and Bindman 2000).
Similarly, white patients may selectively search for a physician they feel comfortable
with, and part of that subtle comfort level may lead to race-matching for them as well. In
doing so, many overt expressions of racism that a patient might express to a physician of
color never come to the fore because the opportunity has been screened. Therefore,
turning to the subtleties in the patient – physician interactions as well as the comments
that white patients make when they think they are not speaking to a person of color,
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provides a more accurate sense for the ways that race still plays out in the professional
lives of Black and Japanese American physicians.
Indeed, an African American female physician stated, that when racial intolerance
is expressed, it is conveyed “…not overtly, but kind of covertly- disrespected by other
people, by patients, by staff”. Another African American woman, Dr. Viola echoed a
similar sentiment, although she also pointed out subtle ways that patients can convey
their racial biases and assumptions.
So I've never had anyone say they didn't wanna see me because I was black, even
though I've had a few incidences walking in the room where people are like - you
can just tell, they're [surprised] to see you. But no one ever said anything. I
probably can remember a couple of people who didn't come back and I do think
that was part of the reason why…every now and then, someone doesn’t like that I
am a Black physician…But otherwise, no one that was particularly insulting or
anything like that.

Dr. Viola continues to explain, “I've probably gotten more, ‘I don't want to see a woman,’
[more] than anything else,’” and that people will question her medical advice or insights
based on information they obtained off of the internet. However, according to Dr. Viola,
this type of questioning feels very different than the type of questioning she has received
from patients who may feel uncertain about her qualifications, which seem to originate
from racial stereotypes.
Some of the questioning that I get and more on a more negative level. People
bring in copies off the internet and they say, "I get a headache." That's a little
different than …’And what medical school did you go to?’ And, ‘How did you
do in medical school?’ ‘What kind of grades did you get?’ You have people that
are asking just a few detailed questions that you just kind of catch you off-guard,
that they're trying to pretty much say, ‘Well, you're not really good enough,’ kind
of an inclination. I think questioning you, your competence [whereas]…the
patients that say, "I don't really don't want a woman," are mostly men, and they're
just…[embarrassed]…and you can pretty much work around that.
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But the other part, because I'm a black physician, you can’t work around that and
most people don't come back. You pretty much know. You can just kinda feel
the tension there.

And during the process [of working with male patients], they become more
comfortable and just, "Oh, this is not as bad as I thought it would be,” because
those folks come back. So that's the difference. They're not like, "What grades
did you get?" It's not really about that.

As a Black woman physician, Dr. Viola has encountered patients who appeared
uncertain about going to her for their medical care either because of her sex or race, or
maybe a combination of the two factors. However, Dr. Viola believes that the kind of
discomfort she experienced from male patients came more from a place of
embarrassment about talking to a woman about certain medical concerns, just as many
women feel more comfortable seeing female doctors for their gynecological health needs.
In the end, she felt that together, they were able to work through the male patient’s
concerns as reflected in their return visits. This hesitancy had a much different feel than
the type of questioning and reassurance patient’s sought in order to validate her
competence, which Dr. Viola attributed to their stereotypical perceptions about African
Americans. Again, such a subtle interaction; yet, loaded with so many meanings
complicated by a multi-layered historical and current racial context. These subtle cues
are challenging to quantify, especially considering that subtle cues are often
communicated nonverbally, where questions of intent are even more difficult to define.
Yet, research on racially codified nonverbal communications unsurprisingly does show
clear patterns of differences. For instance, Irvine (1986) found that Black boys in
elementary school received more punitive nonverbal feedback than whites or Black girls.
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The racial microaggressions that the African American physicians experienced in
their professional lives typically related in some way to questions about their abilities and
competence. Some of Dr. Lee-Girard’s experiences as an African American woman
physician exemplified the kind of racist assumptions that patients can subtly convey; yet
clearly reflecting a disturbing belief that Blacks are unqualified or less able.
Well, I've had those things where they will question my judgment. They'll ask to
speak to [the] respiratory therapist who's a respiratory therapist, but he has the
look of a doctor. But in their minds he'll have more of a look….I'll introduce
myself as [the] doctor and I'll speak to them as their doctor, and yet they will then
say, "Where is the doctor? When am I going to see the doctor?"

Or they'll ask the nurse, the respiratory therapist, and they'll say, ‘Well, she's your
doctor. You should ask her those questions.’ And they're like, ‘oh okay.’

The race and gender interactions deeply influence other’s perceptions of Dr. Lee-Girard.
As a Black woman, she does not embody the characteristics that her patients assume a
physician to personify; but the respiratory therapist does have the socially appropriate
‘look’, so they assume that when they request to speak with the respiratory therapist, they
will have a conversation with a doctor; while in actuality, they will be speaking to
someone with less qualifications in terms of education and training than the Black
woman who actually is the doctor! But, as Dr. Lee-Girard shares, in their minds “he has
the look of a doctor.”
Dr. Lee-Girard humorously talked about various patients’ inability to hear or
believe that she is the physician. As she stated in the quote above, she can introduce
herself as the physician, but they will still inquire as to when they will see the doctor!
She later shared again, “[e]ven at times I would go in and I'd say, ‘Okay, I'm going to
discharge you, everything is wonderful, your labs are great, your x-rays look good,’ and
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they'll say, ‘Oh, did the doctor say we could go?’ And I'm like, ‘yeah, yeah, the doctor
said that,’ and I realize they're not going to get it. (Laughter) So fine. ‘Yeah, the doctor
said you can go.’” This whole interaction is so absurd that it becomes humorous as Dr.
Pascal-James relays it. In reality, the fact that some patients are unable to grasp that, as a
Black woman, Dr. Pascal-James is their physician, is really not funny at all; yet it
captures how racism and sexism are so deeply embedded in some people’s sensibilities.
These same patients may be among the ones to outwardly and vehemently denounce
racism and claim that they don’t judge people by the color of their skin, but the real story
about their racial attitudes really lies in the subtleties of their actions. Lacking the ability
to cognitively grasp that the Black woman who has been rendering their medical care,
reading and interpreting their test results for them and informing them that ‘she’ will be
discharging them is the doctor defies “common sense” racial logic ultimately grounded in
white superiority, and reflective of prevailing social expectations about social
positionality, race and gender. Goffman’s description of stigma is appropriate to
illuminate the qualities these physicians have described in their patients’ disbelief:
An individual who might have been received easily in ordinary social intercourse
possesses a trait that can obtrude itself upon attention and turn those of us whom he meets
away from him, breaking the claim that his other attributes have on us. He possesses a
stigma, an undesired differentness from what we had anticipated… By definition, of
course, we believe the person with a stigma is not quite human. On this assumption we
exercise varieties of discrimination, through which we effectively, if often unthinkingly,
reduce his life chances (Goffman 1963:5).
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Goffman’s emphasis on the unthinking nature of discrimination is more salient to
contemporary race relations than at any other time in US history, given current
misconceptions that racism is conscious, clear and obvious and has been replaced by
equal opportunity (Dovidio, Kawakami, Johnson, Johnson, and Howard 1997).
Dr. Pascal-James shared another scenario she encounters occasionally, again
another expression of disbelief that Black women can be qualified physicians. In the
previous example, the patient was unable to reconcile that she was the doctor. In the
exchange that I will now discuss, one that has happened more than once, the patient
seems unable to grasp that she is Black. They see that she is the doctor, but cannot
believe that she is also African American.
Then on the flip of that, when I'm at work and I have on my white coat, people
ask me what ethnicity am I. Or they'll ask, ‘where is your family from?’ I'll say
my parents are from Alabama, and they're like, ‘really? So where are they
originally from, you know, like what country?’ I'll tell them my usual, I have no
idea, I don't know. That I don't know, and even African Americans will ask me
that, and I never get asked that until I have on my coat.

So in their minds, I don't know if it's that, maybe she's from…I've had people say,
‘are you Filipino?’ I'm like no, where did that come from? It's so odd. Or Sri
Lanka, I mean I've gotten all these. Then I'll give them a pass because my
husband's last name is Pasqual and so the nurses will often say, ‘Oh,’ because
they don't say James-Pasqual, and I don't blame them because it's too long…

So they hear the name and I think they're thinking it's kind of got that
international flair. Or they'll ask, ’Pasqual, where's that name from? Well, it's
French.’ I'm like yeah, well, but that's not mine, I'm James. I'm thinking that
ought to tell it right there, and they're still like, ‘where is your family from?’ I
know where they're going with that kind of questioning, and I get that frequently,
but only when I'm at the hospital in my white coat. When I'm out and about,
never is there a question of my ethnicity.

So it's that, and that happens even with African Americans. Even African
Americans, they'll ask, ‘where are you from? What nationality are you?’ Then
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I'll say, "Come on." Then they'll say, "Well, you look mixed." My answer to
them is, ‘aren't we all? Aren't we all?’

Interestingly, as Dr. Lee-Girard points out, she never gets questioned about her ethnicity
when she is out and about living her personal life; it is only when she has her white coat
on- a symbol that she is the physician – that her ethnicity becomes a question to others, as
though it is impossible to believe that she is a physician who is also Black and a woman.
As she mentions, her hyphenated last name, with the French name of her husband,
compels others to believe she must not be African American. Dr. Lee-Girard also
explained that oftentimes, ER physicians will not wear their white coat, but the
administration spoke with her and informed her, “you need to probably wear your white
coat because no matter what you’re saying, they don’t think you’re the doctor, and maybe
the white coat would help.” Dr. Lee-Girard shared, “I’m thinking in my mind I have a lot
of colleagues, a lot of ER doctors don’t wear their white coat, I mean we just don’t” yet;
Dr. Lee-Girard, as her administration informed her, just couldn’t follow the same
practices as her colleagues who had the acceptable ‘look and feel’ of a physician.
Dr. Rider, an African American male physician shared that patients “tell me all
the time…‘oh, how come you’re not playing basketball? That’s what you look like you
should be doing’.” This captures some of the most pervasive stereotypical and racist
perceptions about African Americans, and African American men in particular. The
sensibility is that Black men do not belong in such a high-esteemed category; that as a
Black man, Dr. Rider should be using his body’s attributes rather than his intellectual
ones, is an old idea (Fredrickson 1987). What does it mean when someone you are caring
for, helping them to improve their quality of life, doles out such disrespect? Dr. Rider is
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a successful surgeon at a highly ranked southern California medical school; yet, some
patients completely disregard and disrespect the years of education and training he has
accomplished because of the entitlement and privilege they carry over Dr. Rider as an
African American man. Dr. Rider continued to explain that, “I used to joke around and
say, ‘oh yeah, I actually play. I just play at night, I’m a doctor during the day.’ And then
my sister told me – she’s an attorney- she said, I probably shouldn’t say that because it
will cause undue stress to the patient if they believe me. So I just don’t say anything.”
Just like Dr. Pascal-James, Dr. Rider, really has no other option but to remain silent and
unchallenging to the patient given the fine line that African Americans must follow. One
misstep and a complaint could be filed, their reputation could be undermined, and at
minimum they could be confronted with another headache that they just don’t have the
time or interest in battling. Confronting whites on their racism is a very precarious
undertaking, especially for African Americans in an environment where they are often
“the only one,” or “one of only a few.”
Dr. Rider also explained that “[e]ven with a white coat and a shirt and tie…[y]ou
get mistaken for the orderly or the lab tech” and that “that happens quite a bit.” Dr.
Parker, another African American male physician, shared his insights and experiences
with being mistaken for an orderly or lab tech.
You know, there are things that really [are] related to… it's not just [about] being
a physician as being Black in America and…the perceptions that people will
have…This happened a couple years ago: I was on the floor and I have been at
this hospital since 1993.

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And I was on the floor in the evening and the nurse thought I was there to collect
the…specimen.

Yeah, and I was there 15 years.

As Dr. Parker clarified, it is not just about being a Black physician, but being Black in
America. Being told that you look like you should be playing basketball rather than the
accomplished surgeon that you are, or frequently being mistaken as the specimen
collector, exemplifies the perceptions others often have about African Americans- it is
just automatically assumed that they must not be the physician; an assumption rooted in
deeply racist ideas about the intellectual capacity of African Americans. These
misperceptions are not neutral, they are microaggressions that often make working
environments difficult, decrease the quality of life for those who face them (Sue,
Capodilupo, and Holder 2008), and may have a significant negative health impact (Pierce
1995).
Dr. Johns-Washington remembers people mistaking her “as being the nurse or the
medical assistant or the receptionist,” while Dr. Kingston relays a common encounter
when participating in professional engagements as an expert, but is mistaken as an
employee of the facility:
…I'm a little bit different, I'm a national speaker for several companies, I'm on
their speaker's bureau and I travel, but I can't tell you how many times I've been
asked, ‘okay, how do I get to the bathroom?’ Or…’Can I get a drink?’

I don't work here, [I say].

‘You don't work here?’

No, I'm the speaker this evening.

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Dr. Kingston noted that these sorts of assumptions and automatic expectations about who
he is and what he is capable of “…never stops.” He explains, “[t]here's different levels of
it. Clearly, I'm not unemployed, nor am I lacking in terms of finances so that I can have
my house and my kids can go to school, so on and so forth. But, if you start talking about
other levels…” Indeed Dr. Kingston points out that unlike many working class African
Americans, he is doing okay socioeconomically; yet, as a Black professional, he endures
and contends with slights and disregard and disrespect in new ways and at different
levels. Nonetheless, despite the outward appearance of “having made it,” he still
interfaces with the deeply entrenched system of white supremacy on a daily basis. He
further elaborates:
…there's no assumed competency…anywhere that I go. I can evoke where I went
to school, I can talk about going to Berkley, I can talk about - and those
institutions will give me credibility in that, but my colleague - my white colleague
can walk in the door and if it's a matter of who's perceived to know the most, they
will always get the nod. I won't say always, they more than likely will get the
nod.

Each of the physicians I spoke with were educated and trained at top medical institutions
in the U.S., but, as Dr. Kingston points out, his white colleagues do not have to rely on
the prestige of the medical school they attended to validate their positions. It seems that
white physicians are more likely to automatically acquire a certain amount of respect and
even deference, while African American physicians have to work just to prove their merit
and credibility.
When African American physicians walk through the door they first tread through
a thick history of racial stereotypes, false representations of the “Black community,” and
a sense of superiority and entitlement that continues to permeate the cultural sensibilities
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of people from all racial groups. For example, when white physicians and likely some
Asian American physicians walk through the door with their white coat on, most will
probably assume without doubt that person to be the physician; while African Americans
must first cut through the constant stream of preconceived attitudes that deem African
Americans as less capable and therefore unlikely to attain the stature that physicians
attain. Hence, when Black physicians enter the room, the automatic assumption is ‘oh,
they must be the technician or the orderly’—colorblind racism at work.
It's always interesting when I've been the chief of staff or I've been the clinical or
medical director of different facilities on how often folks don't ever come to me
first. They will go to someone else or get some clarity and find out, now who's
the director? Who's so and so forth? And how many times I've been asked,
"We're looking for the director. We're looking for so and so," and they have chief
of staff that's written on the top [of my name tag]. I don't think people necessarily
do it maliciously, but I think that they have certainly been programmed and
socialized into not having an expectation of African Americans, not only being at
certain places, but leading that.

Like Dr. Lee-Girard who shared some of her experiences with patients who seemed
unable to grasp that she was the doctor, Dr. Kingston relayed similar problematic
encounters. Despite their display of all the obvious markers and symbols, that yes, they
are the physician or the chief of staff or the medical director, for African American
physicians, the white coat and the title are not enough to counter the deeply entrenched
racist expectations that others unconsciously carry around with them, informing their own
perceptions and assumptions.
In an interview with Dr. Higgens, a Black male surgeon at a prominent hospital in
Los Angeles, I asked if he might be able to tell me if he remembers any sort of
differences that he thinks he encountered as an African American medical student
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compared to his perceptions of the experiences of non-African American students. He
replied that he has been asked that question before and then went on to share a story that
he felt captured his and many other physicians of color’s experiences:
I'll tell you a funny story that really encapsulates the experiences that many
people might have had. So I recalled when I was training in Pittsburgh, I was
training at Children's Hospital in Pittsburgh, which was a very unique time for
that facility, and in particular the department of pediatric surgery at the time
because there were three black pediatric surgeons. Their only - at least at that
time, I think there were only 30 or 35 board certified, Black pediatric surgeons in
North America. So Pittsburgh had three. So I'll never forget the night - I got a
real kick out of this. But I believe it was a white woman. I don't know her ethnic
breakdown, but her skin color was white. I remember I described to her an
operation. I don't even remember what it was, but we were sort of in the pre-op
holding area. And I said, "Hi, how are you. I'm Dr. Higgens. I'm one of the
fellows working with doctor so and so." And it was like, "Well, are you the
doctor?" "Yes, I'm one of the fellows working with doctor so and so." And it was
sort of like, "Well, I need to speak to your boss," type tone. I need to speak to the
- and I said, "Oh, you will. Dr. Barksdale will be here shortly." And it was sort
of like, "Fine." Because the tone was interesting. But Dr. Barksdale was Black.
So immediately picking up those cues and codes that you hear people say, I'm like
cracking up. At this point I'm trying not to laugh because in comes Dr. Barksdale.
And the look on her face I just wish I had my camera out because then it was like,
"Hey." [Laughter] And then, as I said previously, "Are you so and so" - "Yes,
I'm Dr. Barksdale." And it's like where do you go? I mean, we're about to go
back to the operating room, and it is slowly coming to this person's realization
that this physician, who happens to be Black, is going to be taking her child for an
operation. And I don't recall - I always - I think we stretch the story at this point,
but we basically - I think there was even a response at that point was something,
and it was sort of like - I think the way we spun the story at that point was like, "I
need to talk to your boss." And the boss happened to be Black as well. So it -
there are episodes like this, but I think this is emblematic of some of the
challenges that people have… I mean, you walk around in the skin that you were
given all day, all night long, so it is what it is…At some level it inhibits your
behaviors and what you need to get done. On others it's like, please, I really don't
have the time to waste here. I need to get my job done, or I need to move my
family through this situation, and you need to get over your problem. Whatever it
is. I have no idea what your problem is, but you need to get over it.

In this example, Dr. Higgens revealed the complexities of being a Black male
physician. There are very subtle ways that people express their feelings of racial
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intolerance; Dr. Higgens referred to them as the “cues and codes” that operate like a red
flag to many people of color warning them of the type of person they are dealing with. In
her very subtle way, and even apart from her words, unaware that Dr. Higgens’s boss was
also a Black male, this patient revealed her hopes to be rescued by who she probably
assumed would be a white male supervisor, similar to the way an unsatisfied customer
will ask to speak to an employee’s boss after receiving inadequate or poor service.
Except in this situation, it seems Dr. Higgens’s ‘mistake’ was being a Black male. It
seems at the outset, through her tone and other non-verbal cues and codes, this patient
conveyed a sense of discomfort and doubt to Dr. Higgens in a reprimanding way that
questioned his competence.
Whether dealing with the institution, colleagues, patients or other staff members,
presumptions about the proper place of African Americans penetrates the milieu of all
social spaces. In fact on one of the days I spoke with Dr. Kingston, a security guard in
the hospital parking lot further exposed more of the automatic biases people function
from as he protested Dr. Kingston’s attempts to park in the doctor’s parking lot, of course
presuming he could not be a doctor based on his physical appearance.
In fact, it happened today. I pulled into a hospital and the guy says, "I'm sorry,
this is for doctors only." And so, I asked him, I say, ‘Do you think that I'm a
nurse or what do you think?’ ‘Well, I just want to let you know that it's for
doctors only.’ I said, ‘Thank you very much.’ So he says, ‘Well, you have to
move your car.’ And so then I pull out my badge, and then I gave him two
minutes of a lecture on how he's so programmed into thinking that black or brown
cannot and are not supposed to be here or in this position, that rather than asking
me - the first question he could have asked me was, ‘Are you a physician?’…then
he believed me or he didn't believe me, but that would have been the appropriate
way to go, not with the assumption that I wasn't...

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Ironically, this incident happened to occur on the same day I spoke with Dr. Kingston,
but it was not among the first things he mentioned to me. It was presented more as an
afterthought, ‘oh, yeah, and here is yet another example of the type of undermining
disrespect that I might encounter,’ of which Dr. Kingston had numerous examples. As
Dr. Kingston pointed out, the security guard could have easily asked to see his badge, but
to approach him from the standpoint that ‘this guy couldn’t be a doctor,’ perfectly
exemplifies the subtlety with which people’s racial biases get expressed unknowingly.
Race is a major factor in the work lives of people of color precisely because those
around them—staff and patients—define it as important. A 2007 study on the
professional lives of physicians of African descent highlights this in a quotation by a
physician who immigrated to the US as an undergraduate college student: “Race
influences the personalities of Americans much more deeply than for Africans or other
people not born in this country. As an African, my primary mode of identification is not
race. Still, most people [in this country] see me and for them it’s race…. So it definitely
affects what I do. It’s probably the most important thing” (Nunez-Smith, Curry, Bigby,
Berg, Krumholz, and Bradley 2007:47). It is notable that Nunez-Smith, et al. (2007) also
found among the 25 physicians of African descent they interviewed that they all reported
being either misidentified—as food service, maintenance employees, housekeeping or
janitors—or feeling invisible at work. While the quantitative advantages of professional
class status are notable, the qualitative experiences represented by race and ethnicity
remain important because in the US race continues to be a major marker by which people
make character assumptions.
185

MANAGING AND NEGOTIATING EXPECTATIONS

African American physicians utilize various strategies to help them manage the
racism they encounter: ranging from reliance on the ‘Black community,’ taking low (as
will be discussed in the next chapter) to setting expectations that they know are in line
with what they can expect to receive as African Americans in America and as African
Americans within the field of medicine. Setting expectations that fit with their
positionalities within broader societal racial hierarchies functions as a preventative
mechanism that can shield African Americans from disappointment and anger that might
arise otherwise, which ultimately helps them to continue moving forward despite the
many barriers and obstacles continually put in their way.
As one of the older physicians that I interviewed, Dr. James, faced a tremendous
amount of racism throughout his personal and professional trajectories, even continuing,
“right to today.” He warns, “[I]f you expect that you're going to get equal respect, you're
not going to get it.” Indeed, upon hearing the countless stories and examples of racial
injustice that the physicians I spoke with endured, I inquired about the qualitative impact
of those experiences on their lives. While the physicians were well aware of the various
ways race has played a profound role throughout their personal and professional
trajectories, each shared a “realistic” outlook of their all too common positionalities as
Black Americans. Many of the physicians discussed how they set expectations based on
what they envisioned as attainable future possibilities for them as African Americans. In
Dr. Howard’s words:
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As an African American, being Black in these United States for over 60 years, I
don't expect certain things. So, if you don't expect certain things, then you're not
disappointed, okay? I don't expect to be president of the United States. I don't
expect to be Chairman of the Department of Psychiatry in a non-Black institution.
I don't expect certain things, and so I'm not disappointed. I'm not shattered.

Dr. Howard continued to explain that she really doesn’t have any complaints in
terms of “the real quality of my life and my enjoyment of it and my happiness,” that “I
don't have what, say, my classmates from [my elite private university] may have, but I
don't expect to have it, so I'm not pining about it.” She continued to say, “I'm not
unhappy and I'm not dissatisfied because I don't expect certain things. Those weren't my
goals. Yeah, and so, I'm okay with that. But there… definitely is racism, institutional
racism and personal prejudice, that continues to Blacks - including myself as a Black
woman physician - that are unmistakable and unavoidable.” Indeed, it seems never
having “greater expectations,” to use Dr. Howard’s words, acted as what Dr. Skillman
called a “self-protective mechanism.” Well aware that there are different rules,
standards, expectations of, and opportunities available to African Americans in this
country, many of the African American physicians I spoke with, shared this similar
preventative strategy of simply not allowing oneself to expect things that they knew that
probably would never have the opportunity of achieving due to the structural and
ideological barriers at play, and in doing so, Dr. Skillman says, “they reduce their
exposure rate to rejection. And that’s automatic.”
As Dr. Lee-Girard reasoned, “I think because it’s always been [this way], and I
realize in my mind it always will be…it’s not going to change.” Thus, to avoid the
disillusionment and disappointment that could result from knowing that you were
187
unfairly blocked from an opportunity that you pursued, “you set your focus” as Dr.
Skillman, said, and “[y]ou just haven’t looked out those windows,” meaning, you “adapt”
your goals and aspirations according to not what you might want and are personally
capable of achieving, but based on what you will be given the opportunity to pursue. As
Dr. James expressed,
[a]nd that just comes…you take it with the territory, so to speak. It's something
that you expect. You can fight to a certain extent, but that's a part of being, as we
put it, being black in America. And I think it always will - maybe not always will
be, but for the foreseeable future, I don't see that changing that much. Even with
Barack Obama being in the White House. I think that to some extent, things may
get a little worse because of that.

Additionally, some of the African American physicians also expressed that those
whose expectations may not match the opportunities realistically open to them as Black
Americans, often turn out to be the individuals who are most dismayed. Dr. Kingston is
well aware of the institutional inequalities and personal prejudice that others continue to
hold about African Americans. As such, he explained that he gets “validation from
friend, family, and patients,” and that he feels as though the people most affected by the
racial inequality that pervades their experiences, “are looking for validation in the wrong
places. You can't go to these…institutionally…have racism built into it and expect for
the institution to wrap their arms around you. You need to pick and choose who's
important to you and go from there.” Dr. Samuels echoed similar sentiments, saying,
“[t]here’s just so many different solutions to it that some of the most painful experiences,
disillusionment and things of that nature, so often folks with the highest expectations are
the ones that are the most disappointed.” Likewise, Dr. Howard feels that her husband
was so devastated by the mistreatment he endured as a junior associate at his law firm,
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culminating in his dismissal from the firm due to racial discrimination, “because he
expected it, [to be treated fairly].” She recalled that a psychiatrist who testified at his trial
spoke to this issue and said, "’In my generation, we knew that white folks would do it to
us, so we didn't put ourselves in a position to have that happen. These kids today,’ he
calls us kids, of course, but he was - he would now be 90 if he had lived, ’Y'know, these
kids today really believe that they can be the CEO. They don't understand that that's
never gonna happen.’" Indeed, the physicians feel very strongly that you have to know
where to look for validation and the limits of your expectations.

JAPANESE AMERICAN PHYSICIANS: THE AMBIGUITY OF BEING A PERPETUALLY
FOREIGN MODEL MINORITY

While the racial microaggressions that the African American physicians
encountered in the workplace environment mostly revolved around presumptions about
incompetence, the racial microaggressions that the Japanese American physicians
encountered mostly revolved around issues of citizenship or foreignness (Kim 1999). As
Dr. Itou put it “any disrespect I feel is not because of race;” yet, at the same time, she
explained, “[y]ou know, I don’t know the ones who didn’t pick me because my name is
Japanese, so I don’t have to deal with it.” Dr. Ando reiterated that any negative racial
attitudes he has picked up on come across in “subtle ways.” As Dr. Ando indicates,
“…frankly I never have a patient coming in and saying, ‘You know what, I can't deal
with you because of this reason.’” Rather, Dr. Ando feels that patients who feel unable to
work with a Japanese American physician “simply won't show up to see me, okay.
They'll make a judgment about that before they even walk in the door.” Indeed, in his
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experience, “most of the patients that I - everyone that I see - is willing to work with me,
you know to try. And they soon find out that, ‘Yeah, okay, I can work with this doctor.’”
Thus, in a way, Dr. Ando’s ethnically identifiable name shields him from patients who
may otherwise arrive for an appointment and express dissatisfaction about his ethnicity.
It seems most patients who see Dr. Ando do not feel uneasy about his racial background.
Given that Japanese American surnames have a distinct ethnic ring to them, it is possible
that patients can selectively opt out of any uncomfortable situations before they can even
arise, as Dr. Itou and Dr. Ando allude to. Similarly, as I mentioned earlier, Dr.
Henderson an African American surgeon created a website in part to inform patients
beforehand of his racial background.
Dr. Suzuki explained that patients “see you as Asian, [and] they’ll automatically
assume that you’re foreign-born and [a] foreign-trained doctor. And that’s not
necessarily true….But sometimes I’m taken aback by that because it’s like, I’m pretty
Westernized.” Dr. Kurniawan also shared that she has had one or two patients ask
whether she was “born here or trained here.” “But I think they don’t realize that I’m
speaking perfect English to them” she said. Just as it seems many African Americans
continue to withstand incessant and unrelenting skepticism about their abilities as
physicians regardless of their achievements, credentials, or how hard they work, Japanese
American physicians remain unable to adjust perceptions of them as foreign and
uncomfortably “different” regardless of how westernized or Americanized they appear
(Kim 1999).
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The racialization of Japanese Americans along this foreigner axis (Ancheta 1998)
introduces important considerations in the discussion about Japanese American
physicians, their patients, and preconceived attitudes about Asian Americans. First, it is
understandable that patients may feel concerned about how effectively their physician
can communicate in English. People need to feel safe and secure in their ability to
communicate with their physician about their medical needs and concerns. One Japanese
American physician explained that sometimes new patients will call and speak to the
receptionist about her (the physician’s) background, in particular, asking where she grew
up and where she went to school. Dr. Tano, expressed that, “I kind of get the feeling that
Caucasians are asking us, ‘am I going to have an accent or if my English is good.’” Dr.
Tano went on to talk about how on the flip side, Japanese (non-English speaking) patients
will ask if she speaks Japanese, which she doesn’t. Thus, in these situations, patients are
merely trying to ensure they find the most suitable medical care given their own needs
and positionalities.
However, as Dr. Kurniawan pointed out, patients will ask these sorts of questions
directly to her, despite the fact that she is speaking “perfect English” to them. Herein lies
the ambiguity and uncertainty about what the seemingly benign questions about one’s
language and national origin status really reflect. With the continuously running subtext
that portrays Asian Americans as the perpetual foreigner, it makes sense that Asian
Americans themselves are unsure what it means when someone asks how well they speak
English. On the one hand, the question seems completely reasonable in the context of a
patient simply being proactive in seeking out the most appropriate physician, while on the
191
other, one can’t help but wonder what other meanings or embedded assumptions are
attached to these sorts of questions, especially when inquiries about language abilities
occur even when Dr. Tano is speaking to them fluently in English. Further, it also speaks
to the unrelenting perception of Japanese Americans and other Asian Americans as other,
different and foreign, which ultimately reflects deeper issues of equality, Americanness
and relatability.
Another Japanese American physician explained how the assumption that he may
not be American affects him and his role as a practitioner.
But yeah, I've always felt that way, just in general because most of where I've
been, I've been a minority. It's assumptions. You know, they're assumptions.
You know, I mean professionally also. It's funny because when I came here into
this group and I'll just regress a bit. But when I first started here - this is largely a
non-Asian practice here. And I actually had patients express concern that I would
not be able to communicate with them. Yeah 'cause I took the place of someone
who was non-Asian. And so it just struck me. That's funny, but it takes you back
you know. It takes you back. It just reminds you that when someone hears a
name like mine, they will assume. They will assume that I don't speak English
and that, culturally, I'm very different from them.

Dr. Ando is a third generation American; yet, his non-white name alone signifies
foreignness, thereby eliciting feelings of dissimilarity and separateness in others. When I
asked Dr. Ando how he feels about this, he said,
In a strange way, you know, for a second, sometimes you permit yourself to feel
bad about it and to feel inferior. You know just for a second because, you know,
God, wouldn't that make anyone feel bad. And then you think about it and you're,
gosh, you know. I've lived that way now for 54 years, and people are not gonna
change in this country. And I know who I am. And you know if I do my best as a
physician here in this practice, everything's gonna be just fine. So you know, and
it's turned out that way. Everything's been fine so you just deal with it.

“…they think Asian doctors are smarter…”

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Some of the Japanese American physicians feels as though their ethnic
identifiably helps to weed out any potential patients who would feel uncomfortable
putting their medical care in the hands of a Japanese American physician. Additionally,
unlike African American physicians who encountered very clear doubt about their
qualifications on many different levels, a few of the Japanese American physicians stated
that their ancestry has “actually been an advantage” for them. Dr. Kondo continues to
share, “[y]ou know it is true that it’s helped me more than anything,” while Dr. Suzuki
shared that, “usually I feel that my ethnic background has probably helped patients’
acceptance of me.” Dr. Kondo has even had some patients tell him, “oh, I’m glad you’re
Japanese. I know that Japanese physicians work hard. They’re better skilled…” “…at
least that’s what their perception is,” Dr. Kondo, humorously shared. Interestingly,
however, Dr. Kondo specified, “it comes more from other ethnic groups like Russians
[rather] than Caucasian or American.” Dr. Satou also shared his own experiences in
working with African American patients who have conveyed a preference for Asian
doctors:
Dr. Satou: …what's interesting is that most people have…a generalization that all
Asian people are smart. [At] Kaiser, I worked in…Inglewood, okay- Black
people loved Asian doctors. They didn't even want a Black doctor. They want an
Asian doctor because they think the Asian doctors are smarter…they would
actually prefer an Asian doctor over anybody else, and also- they don't
particularly trust white people. So, they'll trust an Asian because they're not
white, and they think they're smarter…

Interviewer: Did people communicate that to you?
Dr. Satou: Oh, yeah, oh, yeah. They'd say, "Oh, yeah, yeah. We trust you. We
know you're smart." This is a funny story, but I have a few Black patients that get
on the bus, drive all the way, ride all the way across town [to Little Tokyo]…I
193
say, "You can go somewhere closer." They say, "I won't go anywhere closer,"
y'know?

Clearly, this experience differs drastically from the encounters of disrespect that
African American physicians shared with me. Dr. Satou’s example also touches upon the
ways in which racism gets internalized by African Americans; an issue that Dr. Kingston
pointed out earlier as a legacy and product of slavery. Yet, it is also interesting that the
patients who express preference for Asian physicians, at least with African American
patients, are people who feel subordinated and therefore mistrustful of white physicians.
While these positive stereotypes certainly are preferable to the negative ones thrust upon
African Americans, it also suggests that these physicians’ race or ethnicity is what is
valued, not their personal characteristics. In addition, empirical research suggests even
positive stereotypes communicated as other people’s high expectations can have negative
affects on performance (Cheryan and Bodenhausen 2000). For example, in their
experimental study of math performance among Asian American women, Cheryan and
Bodenhausen (2000) found that explicitly emphasizing racial identity (through priming, a
common tool in experimental research designs) prior to testing leads to reduced
performance, or “choking under pressure.”

Too Good for their own Good?

While the Japanese American physicians did not talk about the same sorts of
struggles at institutional levels like the African American physicians, they did convey
feeling a sense of resentment due to the high presence of Asian and Asian American
physicians. Thus, while African Americans struggle to achieve representation within the
194
field of medicine, alternatively, Asian American physicians perceive efforts to curtail the
over representation of Asian and Asian American physicians. Dr. Itou expressed that she
senses “a little resentment for some of the success” achieved by physicians of Asian
decent. Dr. Kondo relayed, “I've heard that they kind of discriminate against Asian
Americans because they do so well 'cause there are so many. So they feel that they're
getting more than their share of medical student spots. I don't know…that's what I've
heard that they try to limit the number of Orientals they accept 'cause they all do so
well…” The specific debates over quotas, enrollment preferences, and affirmative
action in higher education, including medical schools, is too large a topic to delve into
here. However, high levels of Asian American academic success, as Takagi (1998) has
written, has resulted in more restrictive admissions standards for Asian American
applicants, while it has also been a key issue neoconservatives have rallied around to
battle affirmative action programs of all sorts. In medical schools in particular, diversity
is a critical factor because they are training the pipeline of physicians who will provide
health care to racial and ethnic communities that need physicians of diverse backgrounds
to serve their needs (Bowen and Bok 1998; Smedley, Stith, and Nelson 2003).
Dr. Ando expressed that since “it was felt that [Asians] were overly
represented…in the medical field…this should be a good profession for me because it
should be relatively easy to access the profession and to climb up whatever ladder you
need, whether it's chief of staff at a hospital or something like that.” Yet, as Dr. Ando
finds, “you know, it isn’t really that way.” He continued to share that while “I don't want
to mention specifics or anything…there is, in certain places, an ethnic-based hierarchy in
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some of the older school hospitals, even in this area….” Thus, while Asian Americans
may find a good level of representation within the overall field of medicine, advancing
into leadership or administration positions continue to pose more of a challenge. Some
evidence supports this claim; for instance, Fang et al. (2000) found that Asian Americans
in academic medicine were less likely to be promoted above assistant professor than were
white assistant professors. In his experience, Dr. Ogawa finds that when attending more
‘exclusive’ meetings, “[i]t’s still actually white men” primarily in attendance. After
attending the NIH-National Institute of Health meeting, he reflected, “[i]n retrospect, I
sometimes wonder if I was chosen to go to some of these meetings because I was a
minority. ‘Cause I go…and see all white males, basically, and then me… So and then I
wonder if it’s because of my talent or because they needed some minorities.”
To many on the outside, it may seem that Asian Americans no longer encounter
issues of racial bias due to the clear presence of Asian American physicians. And,
compared to African Americans and other racial groups such as Latinos and Native
Americans, they do not grapple with the basic issue of gaining entrée into the field in
adequate numbers. Yet, their experience still instructs us about the presence and degree
of white male elitism that persists in the field of medicine and offers a window into the
future struggles that African American and other racial minorities may encounter if and
when they achieve equal representation. Again, the experience of the Japanese American
physicians speaks to this very ambiguous positionality in that they benefit from more
acceptance than their African American counterparts, yet continue to experience a degree
of separatism and unequal levels of acceptance and embeddedness as compared to their
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white colleagues. As Dr. Ando put it, “[s]o you know it's - if you open your eyes to that,
it's all there. It's all there, even in my field.”
Many of the Japanese American physicians did say that they feel as though
“we’ve made inroads.” It was not really that long ago that Japanese American physicians
in Los Angeles had to open their own hospital because they could not acquire the
privileges that allowed them to practice in other hospitals. Thus, we are not far removed
from a period of time where Japanese American doctors faced considerable levels of
exclusion. It is a bit premature to conclude that the significant gains and successes
achieved by Japanese Americans, signifies an overcoming of race to a so-called
“honorary white” status. One long-standing Los Angeles hospital was mentioned quite
frequently as an institution with a particularly troublesome racial past in terms of matters
of inclusivity and representation. Many physicians discussed problems at the hospital
ranging from gaining privileges, to inadequate referrals while on staff there, to more
informal slights from colleagues such as feeling invisible or just not being integrated into
the milieu of the hospital. Dr. Satou explained, “[t]hey didn't allow Japanese doctors in
there in the '70s. They didn't want any patients of any color... That was actually one of
the worst places to work.” A sign of the progress that many physicians touched up, is
that, at least according to Dr. Satou, “[t]here's not too many guys that are there that are
like that.” Yet, he shares that, “[b]ut I know, actually, the people on the Board of
Directors and they are like that still. That's really amazing, they're still like that.” Thus,
while some progress has been made, social change is a slow process and clearly the
entrenchment of white superiority in the higher ranks of medicine continues to impact the
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everyday lives of physicians of color trying to maneuver and negotiate their way through
the profession.
So far I have addressed the separate and distinct ways that race informs the work
lives of African American and Japanese American physician. I will now explore the
shared struggles these two communities face.

COMMON RACIAL REALITIES OF AFRICAN AMERICAN AND JAPANESE AMERICAN
PHYSICIANS

Referral Issues
Physicians utilize various methods to establish and build their medical practices
including recommendations and referrals from fellow physicians, which Dr. Kondo
explained is a “very informal” process. The process is so informal that the dynamics of
inter-physician referrals are nearly impossible to find in medical literature. Research on
specialist referrals focus on the characteristics of patients; for example, the way referral
processes affect patient care such as fewer referrals to cardiac specialists for Black
patients. However, as Dr. Kingston, an African American male plastic surgeon, stated,
“there’s a racial component that’s associated with it [the referral process].” Indeed, the
racialized nature of the referral process can put physicians of color at a serious
disadvantage; and it has been an ongoing problem for many decades. An African
American specialists in the early 1960s discussed some of the problems associated with
referrals and the need for African American doctors to work together to foster their
positive acceptance among physicians generally and their communities (Peyton 1963).
Yet these referral challenges, stemming from informal networks of physicians that send
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their patients to one another, persist. Dr. Kingston has practiced in Beverly Hills for
seventeen years, “so I’ve built a long track record in terms of my competency and
relationships that are there, but it takes a full, pretty much marketing effort for me to get
out and continue to get referrals from a wide variety of different people because race does
matter.” Dr. Gellings, an African American woman general surgeon also indicated that it
is likely her white colleagues would “refer to a white male before they will refer to me.”
Dr. Kondo, a Japanese American male general surgeon, shared that he feels very
fortunate that earlier in his career
16
he “joined a very successful general surgeon…whose
father was here [at the current hospital he has privileges at], whose grandfather was here.
So he…was really the leadership of this hospital so I was very fortunate to get involved
with him…I got a lot of referrals because I was his partner.” Dr. Kondo felt that his
relationship with his white partner, who was a third generation physician at the hospital,
“overrides that race problem because they’ll accept you because you’re the partner of,
you know, this doctor
17
.” However, Dr. Kondo also went on to share, “I think you know,
I’m always comfortable with referrals from Japanese physicians because I now that they
will always be there,” thereby exposing a sense of insecurity either in his relationship
with non-Japanese referring physicians with the insight that those relationships may not
feel as stable and permanent as his relationships with other Japanese American
physicians. And, understandably so when looking at some of Dr. Kondo’s early

16
This is not Dr. Kondo’s current partner, however.

17
I was interested in how Dr. Kondo came to be this multi-generational physician’s partner, so I asked how
his relationship with his white male partner came about. He explained, “what was interesting is he asked
three residents who were rotating through here who they would recommend in the graduating class at SC,
and they all – all three happened to be my friends. So he got the same name and goes, ‘boy, this guy must
be really good.’ But it was just luck. A lot of things in life are luck, as you know, more than skill.”
199
problems before he began practicing at his current hospital. Prior to his arrival where he
currently practices, he was on staff at a different hospital in Los Angeles, which seems to
have a reputation for being a racially exclusive hospital, and as he shared, “I hardly got
any referrals at all.” Dr. Kondo attributes the lack of referrals while on staff at that
hospital to “ethnic issues,” while he credits his ability to maintain a successful practice at
his current hospital to “leadership very early” which “really covered up” the racial
inequity inherent to the referral process as well as to the steady stream of referrals from
his Japanese colleagues. “Most – the reason my practice here has been successful is that
there are – there’s a group of Japanese physicians who have really supported me,” Dr.
Kondo explained.
Dr. Kondo also pointed out, “I still see definite racial patterns.” While
partnerships with his white male partner who was a third generation physician and was
“really the leadership” of the hospital, worked in Dr. Kondo’s favor, it seems as though
Dr. Kondo’s long-standing good reputation at the hospital has not provided the same
source of capital for his current colleague who is African American and is “not as busy as
I am,” according to Dr. Kondo. Dr. Kondo feels that his African American male
colleague is “the most outstanding colleague I’ve ever had, but as you know, he’s African
American.” Dr. Kondo went on to explain that he senses his African American male
colleague receives noticeably less referrals than himself.
Thus, the ethnic and racial bias found in the referral process does not occur just
from white physicians referring out to other white physicians. As Dr. Kondo described,
he senses the racial bias of some of his Japanese colleagues and/or their patients;
200
additionally, several of the physicians described the same ethnic referral patterns among
Korean doctors. Dr. Kondo shared, “there’s still a definite ethnic referral pattern. Like,
for example, the Korean physicians usually refer to the Korean physicians. They really
don’t refer outside.” Dr. Gellings, echoed, “[t]hat was one of the things I noticed here
when I opened my office in this particular area is that Korean doctors refer to Korean
doctors.” Dr. Gellings acknowledges that some of the ethnic bias among Korean
physician’s referrals “may be because of the language and whatnot, but you’ve [got] an
interpreter.” Thus, Dr. Gellings recognizes a language barrier may contribute to some of
the ethnic patterns she has observed in the referral process, but feels that interpreters can
also help ease that concern. Dr. Gellings also shared that she feels Latino patients “are at
a tremendous disadvantage” because “[t]here are so many of them and so many fewer
Hispanic doctors and whatnot.”
While research on physician-to-physician referral processes is lacking, the
conclusions these doctors draw are in line with survey research sampling physicians
themselves. One study found, for example, that Black and Asian American physicians,
unlike their white counterparts, report that race influences collegial relationships and that
they are under greater scrutiny due to their race/ethnicity (Nunez-Smith, Pilgrim, Wynia,
Desai, Jones, Bright, Krumholz, and Bradley 2009). One survey of African American
doctors found that the “referral practices of white colleagues” was by far the biggest
problem of discrimination they faced, with over 80 percent of Black doctors stating it
occurred to a “great degree” (Byrd, Clayton, Kichen, Richardson, Lawrence, Butcher,
and Davidson 1994). Experimental studies support these findings, with prominent
201
research by Dovidio (Dovidio and Gaertner 2002; Dovidio, Gaertner, Kawakami, and
Hodson 2002) finding that patterns of discrimination are very significant when decisions
people make are ambiguous, and there is no clear direction from our social norms. In
these ambiguous cases, but not in obvious, cognitive processes, we see African
Americans at a major disadvantage, with decisions emerging not from critical thought but
from unconscious processes where whites favor whites (Dovidio and Gaertner 2000).
This exact type of ambiguous circumstance exists with physician-to-physician referrals;
they are informal and made through channels of social networks, keeping in mind a
positive match between patient and doctor, not only based on skill but assumptions about
personal character.
Dr. Ando further pushed my understanding of the complexity of this issue,
especially for Asian American physicians who are not first generation and may not
benefit from the same ethnic affiliated ties of first generation Asians, while at the same
time sitting outside of the white-centered connections of ‘American’ colleagues. Dr.
Ando continued to elaborate on the multi-layered dynamics of this process of referring
and recommending one’s colleagues to their patients:
Well, it's a little awkward, and fortunately, I don't have to deal with a lot of that
because I'm a part of a medical group. And so I work with [my medical group]
and so I see patients, medical group patients. I do get referrals from outside from
time to time. But for the most part, I don't have to deal with that kind of
networking. It is difficult because my wife is second-generation Chinese. Her
parents were born in China, and so she's quite Americanized. She speaks
Mandarin, but not really well. Not fluently, but well enough. She's kind of like
on the border there, where she's not considered, you know, a non-Asian physician.
Yet, she's not considered a first-generation physician either. So she's in an
awkward position, probably even more awkward than I am because at least I've
declared myself as this. If I went out there to practice, I'm not a part of the Asian
network. I would have to grapple and deal with the non-Asian network, basically,
202
to a degree. I mean there are second and third-generation Chinese, Vietnamese
physicians out there who would probably refer to me because maybe they're not
as entrenched in their ethnicity. But you know, I think for the Asian national
physicians, it started out, really, largely as a means of survival because they were
at one time a minority in this community and they had to deal with that - with
being an outsider. And it's not all racist. Part of it is business. It's just pure
business. You come into a community, you know, you've got to somehow
integrate yourself. And granted, yes, if you're of a different ethnicity and race, it's
more difficult to integrate yourself into that flow of business. So yeah, granted,
you can't take that aspect of ethnicity and racism out of the picture. But at the
same time, part of it is just pure business dealings. If they don't know you, they
don't know how you practice, they're less likely to refer to you.

Thus, Dr. Ando feels grateful that he belongs to a medical group so that he doesn’t have
to grapple with the networking that is a part of the process of acquiring patients and thus,
more business. Indeed, Dr. Kondo counts himself very lucky that he can draw patients
from the group of Japanese physicians he met early in his career through the Japanese
hospital that still existed when he first began practicing (Japanese American physicians
were excluded from other hospitals so they created their own where they could practice
and send their patients, see (Rasmussen 1998; United Press International 1986) in
addition to the reputation he was able to build as a result of partnering up with a well
respected and well established white physician. Yet, without these sort of connections,
and with a referral process distinguished by definite ethnic and racial patterns, physicians
who do not have enough of “their own” physicians to network with, such as Asian
Americans who straddle two communities, Asian and American, but not completely
immersed or accepted in either, as well as African American and Latino physicians, can
not rely on this collegial referral process as securely as differently situated physicians.
Dr. Kobayashi shared his observations when out at lunch at his workplace that
illustrates the sorts of ethnic generational separation that exists despite the outward
203
appearance of an essentialized Asian network. According to Dr. Kobayashi, Asian ethnic
groups remain very separate and removed from each other. In talking about other Asian
colleagues, he feels, “[t]hey [are] obviously more comfortable talking amongst
themselves…and vice versa…Koreans with Koreans because I think they’re
uncomfortable talking to us. Chinese the same. I think they just feel comfortable
amongst themselves versus interacting with other ethnic groups.” This ethnic separation
between Asians “gets watered down a little bit as the generation goes down,” Dr.
Kobayashi explained. Thus, despite reaching such high levels of occupational success
and prestige, the lives of the physicians strongly mirror the same types of social
arrangements and hierarchies that circumscribe the rest of society. The same cultural
politics, same ideologies and the same pecking orders greatly inform the dynamics and
order of relations in the medical workplace.
Dr. Viola shared another way in which physicians of color acquire patients
through a pattern of racial bias.
…I also have, let's see, how do I say it, with the hospital, what I think comes up
as racist is that there is something called a "panel" doctor, so in hospitals where a
patient comes in through an emergency room and they don't have a doctor, then
there is a doctor that we call the "panel" doctor. They are assigned to that
doctor…Invariably, if there is an African-American doctor on the panel, we get
assigned the patient that has no insurance. The patient who has the PPO
insurance and is here, maybe on vacation, visiting daughters, will go to a white
doctor…[i]nvariably. There was a doctor…who I initially worked with; he just
fought for doctors of color, all doctors of color, because it happens with everyone,
not just the black physicians. At one point, and this had to be six years ago, he
would say, ‘Just walk through the emergency room and see who they're assigning
the outpatients to,’ because it was just so blatant. But the ER doctors are like,
‘Oh, no, it's not like that.’ But it was like that. It was like that…Supposedly, it's
suppose to be random, so it's supposed to be this doctor - I think there are three
names per day or something like that, who are supposed to be assigned one, two,
three as they come in, in order, but it just didn't happen that way. It didn't happen
204
that way. And any day varies, but most days there are probably about five or six
people who come in who don't have an assigned doctor. So that's how it was.
That was the randomization…and I’m to the point where I don’t do it anymore.”

One of the benefits of studying Blacks at high attainment levels is the ability to see that
the patterns of subtle bias remain major impediments to their livelihood and to their full
incorporation into workplaces and organizations. Dr. Gellings shared another example of
the racially segregated practice of referring patients to particular physicians: “when
people go to group health fairs or whatever, what they were doing was assigning, if it was
a black patient, they were assigned to the black doctor. The Asian patient, they were
assigned to the Asian doctor. It was also like, "Let's do a random thing here, because
what if no black patients come in? Then you don't suggest to me." Do you know what I
mean?” She also explained that she is on staff at a very prominent Los Angeles Hospital,
which also has a referral network, which sounds to be more formal than the informal
process of individual physicians referring to individual colleagues that they know. Even
in this situation Dr. Gellings indicated that, “I will get patients, every now and then, if
someone requests a Black physician.” Racial referral patterns are not a simple issue to
confront, they are subtle, rely on social networks and are highly ambiguous. Therefore,
the challenges these physicians reported in terms of breaking into these referral networks
are consistent with the patterns of racial discrimination is our colorblind era (Bobo and
Hutchings 1996).

PATIENT DEMOGRAPHICS AND THE EXTRA LABOR OF ADVOCACY FOR PATIENTS OF
COLOR

205
The referral process between physicians not only appears to be swayed by
racial/ethnic factors, physician-patient demographics also appear to fall along
racial/ethnic lines as well. For example, physicians of color are also more likely to see
patients of color, and particularly, patients who share their own ethnic/racial background
(Cooper-Patrick, Gallo, Gonzales, Vu, Powe, Nelson, and Ford 1999). One of the major
challenges facing the medical profession is getting enough African American and
Latina/o physicians to meet the needs of these communities (Smedley, Stith, and Nelson
2003). Dr. Viola, a Black woman physician who practices in Beverly Hills jokes, “I take
care of the people who work in Beverly Hills, not the folks who live here.” Fifty five
percent of Dr. Viola’s patients are African American, with “ten percent Asian, ten percent
Hispanic, and the rest…divided between white and [other].” Dr. Viola shared:
[w]hat I think is common is physicians do tend to have more patients within their
nationality or their ethnicity. That’s pretty common, unless they’re somewhere in
rural California with only one population. But that’s pretty common. We were
all kind of shocked doing the grant that I had such a vast majority of minority
patients. But again, I think it’s because I am minority. Again, most of my
referrals are coming from patients that I’ve seen already. So I think that’s largely
it.

Dr. Gellings, a Black woman general surgeon expressed that her “patient population
looks like LA.” “I would say,” Dr. Owen projects, “that forty percent of my patients,
fifty percent are Hispanic. Whatever the population ratio is among LA, that’s what my
population is.” Thus, while she stated that she doesn’t have “a predominantly Black
clientele,” it seems that based on her estimation of her patient population, she does serve
a primarily non-white demographic. Dr. Tano shared that “I probably do see more
Asians,” while Dr. Kondo also estimated that “maybe thirty percent” of his patients are
206
Japanese. While this sounds pretty high to me, he feels, “[i]t’s not that high; but that
thirty percent makes a big difference. It puts you into the success area as opposed to not
being successful because our overhead is so huge.”
Dr. Tanaka, a Japanese American male physicians who considers himself post-
racial explained that his staff thinks he serves more people of color, which he attributes to
the patients comfort level. Dr. Satou elaborated on this dynamic through a discussion of
the disproportionate amount of Japanese patients he sees.
If you really think about it, okay, the reason that I'm successful here is because
people of my parents' age were burned by camp and would never, ever trust a
white man again. They would never do it. They just don't trust white people, so
they will trust a Japanese doctor, and they will seek out a Japanese doctor, and
they will stay loyal to a Japanese doctor, y'know, through thick and thin because
of what happened to them before. They don't trust white people. They will never
trust white people and they haven't since then, so by doing that, that's what keeps
me busy. These people will never go anywhere else. They don't trust anybody,
and that allows me to practice because when I tell them something, they trust me
because they know I'm from the same community and I've been through that, and
my parents have been through all that stuff, so they trust me. But if they didn't
have camp, they - a lot of these people would care less whether they saw a
Japanese doctor or a white doctor, right? I mean, they would care less, but
because they were burned, they'll never do it again. I mean, Japanese people in
general don't trust other people. I mean, y'know, Japanese in Japan don't trust
other people. Y'know, so they always have that to begin with, but the camp really
solidified that because, see, I don't even speak that much Japanese. It's not a
language problem. They can - they can talk to American doctors, and - y'know,
granted, over time we're seeing that. The next generations - people don't have that
much loyalty. They'll go anywhere, which - I mean, that's fine. No big deal, but
the older ones that were in camp never go anywhere; but it's interesting. If it
wasn't for camp, I wouldn't be as busy as I am.

Thus, as Dr. Satou infers, patients of color may also prefer to see other physicians of
color or physicians with their same ethnic/racial background. He also stated at many
points that he feels a different level of trust coming from his Japanese patients. Dr.
Henderson, an African American male surgeon also shared that “from the start, I think
207
there’s more trust in African Americans, that they are willing to give me more trust at the
beginning, as opposed to kind of earning trust…” Dr. Grimes, reasoned that “[a]nd that’s
why women go to women. It’s why a Hispanic patient feels more comfortable with a
Hispanic doctor…There is a connection. There is a cultural connection, and even if they
don’t share everything similarly, they’ve got something there that they bond with.” Dr.
Itou identified this connection as a feeling of “kinship” with “this generation of largely
eighty-year-old Japanese American women that I see.” Dr. Kawaratani also shared that
one of the comments she has received from patient “is they feel much more comfortable
speaking about their medical problems in the shared context of nationality, race and
language.
18

Dr. Kingston further points out that there may also be certain cultural health needs
that particular physicians of color may be better prepared to handle due to their firsthand
experience and knowledge. For example, he explained, “…an African American patient
through just their experience knows that when you’re dealing with something like skin,
not dealing with a liver but dealing with skin, there’s different skin care products that you
have to use, there’s different issues that are there, and knowing whether or not someone
is sensitive, they may request [an African American physician].” Therefore, the shared
cultural histories, contexts, and lived experiences of similarly matched patients and

18
It is pretty interesting to note that the Japanese American physicians also encounter Japanese American
and other Asian American patients who express comfort in the shared context of race and nationality
because it speaks to the continued racialization that Japanese Americans and other Asian American
continue to perceive in their daily lives that it would factor into their decisions in picking a physician. This
is significant given the movement toward racializing Asian Americans as “honorary white” when clearly
racial and ethnic boundaries remain salient among these Asian ethnics.
208
physician may provide people of color with a greater sense of comfort and security, and
better outcomes overall (Cooper-Patrick et al. 1999).
Physicians of color are more likely to serve patients of color, in part due to an
uneven and racially charged referral process between colleagues as well as due to a self-
referral process among individuals, which may also fall along ethnic/racial lines of
friendships, and social networks. Further, patients of color may also feel more
comfortable and secure with a physician of similar cultural background
19
. Nonetheless,
as racial minorities, physicians of color also must negotiate and manage an entire extra
set of concerns that their white colleagues likely remain completely unaware of, the kind
of race work I discussed in chapter three. For example, Dr. Tanaka, a Japanese American
male physician shared that when he first arrived at his current practice, he spoke to the
office staff about how to properly pronounce the ethnic names of his patients, explaining
to them that it is actually an important consideration and a reflection of respect. Dr.
Viola discussed the difficulty she encounters when trying to talk to colleagues who are
unaware of the unique healthcare needs of African Americans. She shared, “I tried to
discuss that [health disparities within the African American community] with a few of
my colleagues who are like, ‘Oh my gosh. I just can’t believe it.’ Well, it’s in the New
England Journal of Medicine. So [that is] the racism that we see.” Indeed, African
Americans face the shortest life expectancy of any racial or ethnic group in the US, and

19
One physicians, Dr. Miyazawa, did not feel that ethnic or racial background was of importance any
longer. He feels that patients choose doctors more on “convenience and where you’re living and
reputation…but…the ethnic issue is not that major of an issue.” Dr. Miyazawa’s level of success is
extraordinary. He can boast of international recognition and has really been a pioneer in many respects.
He has a nine-month waiting list; thus, as a physician in exceptionally high demand, he does not have to
contend with some of the same racially informed issues other physicians of color may continue to
negotiate.
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more debilitating medical conditions in middle and old age than other groups (Hayward,
Miles, Crimmins, and Yang 2000). Hayward et al. (2000) concluded that most of these
differences in health outcomes related to social environmental conditions rather than
race-specific behaviors.]. Coming from these very communities, advocating on behalf of
and representing the health needs of African Americans in very important to the personal
and professional identities of Black physicians.
Discussing the importance of balance, Dr. Viola explained,
…ethnic physicians are a lot more interested in their ethnic communities. So even
though I practice in Beverly Hills, I think that’s why I do a lot of community
speaking. I think the majority of ethnic physicians do something for their
community. I think that’s common ground… I think it’s very important to have
balance. I think it’s important to be in your practice and up on the latest and
greatest, and it’s just as important to be part of your community politics on
healthcare policy. I think that is just as important as the practice…

Maintaining a balance of professional practice and commitment does not occur without
extra effort and sometimes personal sacrifice. Dr. Kingston, an African American male
plastic surgeon actually maintains two offices: one in Beverly Hills and one in South Los
Angeles. As Dr. Kingston explains, in Beverly Hills, he cares for “those who want”
while his practice in South Los Angeles serves patients “in need.” He shares that
[T]hese hours that I spend here [S. LA office] are hours that…could be spent
somewhere else making money. So there’s a choice and a trade-off. I do make
enough that allows me to be here so that my family doesn’t have to sacrifice and
my employees don’t have to sacrifice. But it is certainly a hardship on both the
staff and myself for us to maintain an office in the neighborhood.

Nonetheless, it is important to Dr. Kingston to give back to his community despite the
added labor and sacrifice because, as he explains, “I grew up in this area, and I also
believe in my oath to provide service to those in need.” The extra labor, cost and time of
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serving communities that are in more need is both rewarding and taxing. Indeed, as
Padilla (1994) finds, non-white professionals endure a “cultural taxation,” as additional
responsibilities fall on them due to their inadequate levels of representation and, in terms
of the medical profession specifically, African American physicians face more
demanding patient bases (e.g. patients requiring more demanding medical intervention)
(Glymour, Saha, and Bigby 2004).
Dr. Kingston and Dr. Parker also shared with me their commitment to mentoring
African American youth who otherwise may not realize their potential due to lack of role
models in their neighborhood communities. Dr. Kingston indicated that “I try to a
minimum of once a month of doing career days in school or going to talk to some type of
groups…So that ability for them to see, touch, feel, hear, and experience has a major
significance.” Thus, as physicians of color, and in particular, Black physicians, there is
extra labor that they exert. Dr. Parker, a successful Black male surgeon, who currently
lives just a mile away from where he grew up, explained, “[t]here’s a lot of work to be
done and sometimes, just the thought of that is overwhelming because there’s so much to
be done.” Further explaining his commitment to the community, Dr. Parker elaborated:
And I said, how do you help those kids learn because that impacts in terms of
society. I said, you know, you can’t turn your back on that. And that's to go
back, we talked about the community and that's one of the reasons why I never
wanted to leave the community because historically, in the days of segregation,
doctors, lawyers, everybody lived together because you couldn't live anywhere
else. You had a segregated community. So in a lot of ways, I think that helped
the younger generation because you had all these role models right here. You had
the professional people, everybody lived there. And they may have a bigger
house, but they all lived there. So, you saw the business people, you saw the
doctors you saw the lawyers because everybody was in the community; with
desegregation and increasing mobility people start moving out. So the more
successful, kind of the further you get away from the community the less visible
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you are so you lost a lot of that interaction. Because, those kids don't see that.
That's why I go to the career days. Because when I first started going, 15, 16
years ago, and you know, the teacher said, ‘they haven't ever seen a black doctor.’
And I'm stunned. I mean, in Los Angeles. Come on, are you kidding me? [The
teacher said,] ‘No, no it's really important for you to come.’ Cause I didn't want
to come because I didn't think I had anything to offer. I said, ‘what am I going to
tell these kids.’ [They] said, ‘just your presence.’ And I said, ‘really?’ And they
said, ‘yeah, just your presence.’

Dr. Parker’s experience volunteering, and his commitment to remain living in the
community he grew up in are, according to Wilson (1987), quite important for the
dynamism and potential of inner city Black neighborhoods. As he describes,
liberalization of housing resulted in many urban Black professionals leaving African
American neighborhoods, thereby creating a class rift that left these neighborhoods with
fewer successful role models, fewer social networks and overall more isolated (Wilson
1987). Thus, physicians of color, especially African American physicians bear an extra
responsibility that most white physicians do not have to fold into their daily work
routines. For African American physicians, not only do their careers often impart a
“racial fatigue” (Nunez-Smith et al. 2007:49), from daily encounters with subtle racial
subtexts which are unapproachable at work but their work often also requires a “cultural
taxation” (Padilla 1994), that can impede career pathways while costing time and
resources.

Better than the Rest: Giving 110%, Operating under Higher Standards and
Continually Performing Under the Microscope

In her comparative account of everyday racism, Essed reports that those facing
repeating patterns of discrimination begin to identify it, and therefore can predict what
their behaviors should be to minimize harm; “Given the ubiquity of racism and the often
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covert nature of its contemporary manifestations” (Essed 1991:126), this requires
extensive attention and energy. In environments where people of color are numerical
minorities or in precarious positions, race offers an additional hurdle that drives many of
the physicians I interviewed to see their efforts as needing to be greater, more focused
and leaving less room for error in their work and in their interpersonal communications.
Dr. Howard expressed that she feels Blacks continue to be held to different standards;
that it is not enough to accomplish, achieve, perform, etc. at the same level as non-Black
counterparts.
And it has always been the theory that the Talented Tenth have to be ten times
better than their peers, who were non-Black, in order to achieve the same thing,
and there remains still, in spite of that, a glass ceiling. So, you would commonly
have someone in a position that will have a non-Black brought in to be trained by
them to then become their supervisor, and that is a common thing that creates an
incredible amount of psychological distress. And I have experienced a lot of
people coming who have actually emotionally broken down around that just - just
egregious practice that occurs, but it's very, very common in corporate America.

Dr. Howard’s quote captures a major aspect of emotional labor that comes with working
in a predominantly white environment, and is common among members of the Black
middle class and Black professions (Feagin and Sikes 1994, esp. ch. 4). Indeed, having
to excel–achieving above and beyond in order to receive the same recognition that others
may gain almost effortlessly is a common circumstance–for African Americans, and
remains a problem shared by other racial minorities to a certain degree as well. The
physicians explained that the pressure to outperform, to exert 110 percent of oneself, was
even more pressing of an issue during medical school. According to Dr. Miyazawa, “it
was told to us by our parents and other people, ‘[b]ecause you’re Japanese, you’re a
minority, you can’t do 100 percent. You have to do 110 percent. And we did that.” The
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physicians were mostly at a point in their careers where they have established practices
and are no longer in the position of being compared to their peers. When in the position
though of having to demonstrate that they were “cut out” for the field of medicine, it
seems that as racial minorities, the physicians I spoke with had to prove and strive toward
to higher level of success in order to get the nod from their evaluators, who were mostly
white. Dr. Viola put it this way,
…I would say that probably happened more in medical school and residency.
That's where the 110 percent had to come in, where you definitely had to do
above and beyond the next person in order to be recognized. Whereas, I felt like
white students were recognized no matter what, but it didn't matter. But if I was
gonna be recognized, for that doctor [to] look me in the eye, I had to do
something above and beyond. So that was pretty much constant. That was
constant.

Dr. Johns-Washington further explained that, “…you had to be, like, the best one and you
had to prove that you were better than everybody else…so that nobody could question
what you were doing…question you academically and call you stupid, or all that kind of
stuff…” Thus, as non-white medical students, these physicians felt they had to
outperform the best because people were waiting for a mistake as proof of what they
were already expecting of them. Although Dr. Kobayashi feels that race matters less in
the workplace now than in the past, he still perceives a need for physicians of color to
outperform white students in matters of evaluation because, “[i]f you were equal in every
way, to say like a White applicant, you can bet, you are going to lose.” For example, he
explained, “[y]ou may not get, this is very competitive residency or a very competitive
fellowship, I think that you may not get quite the breaks that you should get.”
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An African American female obstetrician, Dr. Grimes shared a particularly
challenging case that she worked on, that in the end, enabled her to prove her
qualifications and abilities, but provides another example of the ways in which some
physicians of color, particularly African Americans, are held to a different standard or
have to work harder to ‘prove’ their merit and abilities. This particular case involved a
high-risk “forty-five years young” pregnant woman with at least two serious and chronic
medical conditions who did not realize she was pregnant until about six months along
ended up having a stroke and going into a coma. New problems continued to emerge
along the way as this patient was being managed from the ICU, but Dr. Grimes was still
able to get this patient up to thirty-five weeks of pregnancy at which point they had to
deliver the baby. The patient ended up rupturing her uterus, which they repaired and now
the baby is nine months old, “walking and talking [and the patient] is off walking and
talking.” This “was a case that was discussed amongst the staff at [the hospital],”
according to Dr. Grimes and it was the type of case where “you kinda feel like you had
your proving ground.” All the way up to this point, Dr. Grimes had dealt with other
challenging cases and feels that “[m]y patients always do well no matter what. Done,
done.” Yet, she describes a unique sort of experience as a physician of color when in
these sorts of high-pressure situations.
Dr. Grimes: You always feel like if you are a physician of color, then when
something happens to you everybody's looking at you with a microscope. It's not
fair; it's just how it is. It might happen to Sue down the street, but if it happens to
Sue, nobody screams. But if it happens to you, please understand they're gonna
be looking at you very carefully.

And I knew they were looking at me with that case. And she turned out and did
very well. But what it showed was that all the other cases prior to that time,
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anytime I'd ever have a challenging case, it wasn't a fluke that the patient did well,
that it really was that, ‘I think she knew what she was doing.’

Interviewer: You have qualifications, right.
Dr. Grimes: There you go. So you do have to work a little harder…So I know
I've proven it now, okay. That I've definitely proven it now, maybe nationally
now - Oprah listened. But that, you know, "Hey, she might be okay." And that's
a tremendous sense of, you feel like an accomplishment that you have the respect
of your peers.

And it doesn't matter that you're female; it doesn't matter that you're African-
American, but that you are right on par with everybody else or better. And that's
very nice to know. But there are also situations where there are physicians on
staff, who happen to be of color who run into problems where patients don't do
well. And you can't help but think that are they talking about them or bringing
them up in M&M or being extra harsh because they happen to be female or they
happen to be male. I've been there long enough to see that there are people
who've done some crazy stuff. I'm like, "You didn't scream at him like you're
screaming at this lady."

And I'm like, "She did the same thing, but she couldn't get away with it, but you
could." So you learn the dynamics and you learn the culture or politics at your
own hospital. But I think that's also a reflection of society, right. So it's reality.
But like I said, I don't think that there's - I don't think there's anything that a
woman can't do. Not - women of color too. You can do whatever it is you want
to do.

Here is another example where the physicians describe a reality of needing to go above
and beyond or outperform their peers or prove their qualifications in order to earn the
respect from colleagues, supervisors, etc. And as Dr. Grimes adds, when a particular
challenging case arises, it feels as though as a physician of color, and I would contend
that this is especially true for African American physicians more so than Asian American
physicians, you are being observed closely under a microscope; it is almost as if others
are waiting for a misstep almost as proof of what they may have expected all along.
Thus, this case allowed Dr. Grimes to prove that it doesn’t matter that she is a woman, or
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that she is a Black woman, but that she is qualified to be right where she is. Nonetheless,
Dr. Grimes maintains a very optimistic outlook, indicating that she feels as though people
of color can do “whatever it is [they] want to do.” Although she feels physicians of color
may travel a more arduous path, work harder and be held to different sorts of standards,
expectations and requirements, ultimately, she believes their goals can still be achieved.
Proving ones qualifications may not necessarily mean that the questioning and
scrutiny will end. Dr. Viola shared an opposite sort of reaction that she has experienced
which has left her with the sense that “[i]t’s better if they think you’re struggling.” She
explained that “…if you are doing what someone else thinks of as well, then why are you
doing that? Why are you better than me?…you must be doing something wrong.” Dr,
Viola relayed a situation that came about with a Korean American colleague and friend
who happens to have two practices: one at a prominent hospital and one in Koreatown
where she can serve her cultural community. According to Dr. Viola, “…when people
found out that she had these two practices, they actually sent—they do something called
‘proctoring.’ They wanted to proctor her chart from the hospital to see if she was doing
the right things.” Dr. Viola explained that learning of her Asian American colleague’s
two practices, might have led other physicians to question how she could maintain two
practices while they are struggling with their one practice, ultimately leaving them with
the impression that she must be doing something unsavory. As Dr. Viola pointed out, “I
think that’s racism…[i]f you’re doing well, you must be doing something wrong.”
The unfair application of ‘rules’ was also outlined by Dr. Kingston as a general
problem:
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That's where you run into a problem in that if you are an African American, the
slack, the tolerance, those two are going to be considerably less. There are rules
and there are rules. There are some rules where you can pretty much assume if
there's anything you've done that's been incorrect or wrong, that the letter of the
law in its harshest interpretation are the consequences that you're gonna receive.
Despite having numerous examples of others who have done the same thing, who
have gotten lesser punishment from the medical board, from whomever else for
doing the same type of thing, so I think that there's still a clear difference there.

Now, a racist can hide behind the fact of saying, "Oh, no we're just following
what the rules are." The issue isn't the rule. The issue is how it's applied and
what its interpretation is.

Dr. Kingston gave an example from his college experience to illustrate the heightened
level of scrutiny brought by race. He explained that out of 750 people in a chemistry
class, only four were African American, whom, all of which made it to the end very well.
These four African American students who made it through were accused of cheating
because their professors did not expect that, as African Americans, they could perform so
well.
we made it through and we all did very well, and then we were accused of
cheating… They just couldn't believe that [we did that] well. Well, the reason
why we did that well is because we had daily study sessions, we went to the
students learning center, we were behind the whole time and we diligently did
what we had to do. So that's just the reality of certain things. Not having the
intellectual or academic - we weren't expected to have the intellectual or academic
IQs to be able to do well. And it hasn't stopped yet. It's a continuous proving
ground. You never get to the point - most of us never get to the point where we
can have a blanket positive statement. It may be, "Doctor Kingston ___ really
knows that psoriasis, he's an expert on that. But he doesn't do such and such, and
such and such. Or so on and so forth." You aren't given full credit and allowed to
bask in your achievement. But that's just the way that it's gonna be, and I don't
spend any time worrying about it.

Doctor Kingston is his late fifties which means that this experience he shared with me
occurred during a different racial era than the colorblind frame that tends to define the
way people understand and communicate about race today. Thus, one may argue that if
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you talk to current medical students, you may find a very different type of experience and
that very well may be true. It could be that where hostility and aggression toward non-
Black students exists, it will get communicated in more subtle ways rather than the very
direct and overt expressions that Dr. Kingston shared from his days as a student.
African American physicians were more likely than Japanese American
physicians to discuss and provide examples where they or their colleagues perceived
unequal standards that required them to prove their capabilities and merit. This is not to
say that Japanese American physicians do not strive to give 110% or feel the need to; but
that racialized as a model minority with particular talents in the areas of math and
science, Japanese Americans automatically come across as potentially qualified experts
in the medical field. Dr. Fujimoto noted that in medicine, “there’s probably much, much,
much less emphasis upon some of the other issues and more emphasis upon, y’know your
abilities and what you can do…your skills.” He contends that “…your education, your
level of knowledge, your confidence,” are more important than other factors “because
medicine is much more technical.”
I argue that this is where the experience for Japanese American and African
American physicians separates. Japanese Americans are more likely to be perceived as
having a particular natural prowess (Aronson, Lustina, Good, Keough, Steele, and Brown
1999), talent, skill or ability in math and science, therefore, making them successful
physicians. African Americans are racialized on such a different scale that they are put
in a position where they must fight to prove what others automatically assume about
many, if not most, of their colleagues. As Dr. Johns-Washington shared, “…people will
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make assumptions based on what you look like as to how smart you are and things like
that. I think that still goes on.” She explained that especially in medical school “people’s
perception of you was that, you know, you were in school on financial aid
and…Affirmative Action.” As a result, colleagues “figured you got in easily and
so…you really weren’t as good enough as other doctors…” “Ultimately,” she feels, “that
plays into…your own feeling of self-worth. You know, people think that you’re not
going to be able to do stuff…I think you may think that more [about yourself].”

CONCLUSION

In this chapter, I examined the ways in which race continues to inform the work
lives of African American and Japanese American physicians in our current colorblind
times. The American medical institution has a very racially polarized past, and it does
not run as a system separate from the norms and racial ideologies that predominate in the
rest of society; thus, it is not surprising that upon inspection, I find that race indeed
continues to remain a salient part of the experience of being a physician. This pattern is
especially true for African Americans.
While some of the physicians reported that in looking at the racial representation
in medical programs today, they actually feel conditions have worsened as compared to
when they went to school (which may be attributable to the dismantling of Affirmative
Action legislation). Further, institutional issues pertaining to racial diversity and
representation lead to a very different experience for African American physicians. For
example, African American physicians report challenges that stem from the experience of
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being “the only one,” including inadequate mentorship and inadequate support and access
to information networks. While I did not interview white physicians, I would
hypothesize that this leads to a very different experience and career trajectory for African
American physicians, qualitatively speaking. Further, the African American physicians
also shared numerous accounts of disrespect, disregard and doubt about their abilities,
skills, and qualifications. For example, questions about grades and medical schools
attended represent one way that patients convey skepticism about their competence. An
important finding, again, is that the race related challenges that the physicians reported,
were typically conveyed in very unclear, opaque, subtle ways and sometimes seemingly
unrelated to race, making it very difficult to easily quantify and point out. Thus, I can not
prove that a patient’s inquiry alone, about a physician’s medical school and grades proves
hidden racist attitudes; however, I do contend that this type of questioning does reflect an
assumption that the physician needs to be questioned and it reveals an underlying doubt.
Further, it is not just this act of questioning alone that stands out significantly;
rather it is the cumulative and patterned context and a racially charged milieu that, when
put together, give each individual expression of skepticism, doubt, or disrespect meaning
and significance. For example, the numerous experiences of being mistaken for the
nurse, the orderly, the lab tech, the automatic assumptions that you are not a physician as
you attempt to park in the physician’s lot, the seeming disbelief that you are the
physician, etc. together constitute a racial context that convey preconceived assumptions
that reflect longstanding stereotypical misperceptions about the intelligence, skill and
competence of African Americans.
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The racial experiences of the Japanese American physicians differ in several
crucial aspects from those of the African American physicians I spoke with. While the
African American physicians I spoke with encountered many instances of uncertainty or
disbelief about their status as physicians, some of the Japanese American physicians
shared that they feel as though ethnicity has actually helped them gain acceptance from
their patients. Indeed, some patients have expressed feeling glad that they are Japanese
American because, according to the patients, Japanese Americans are smart, skilled and
work hard. This experience stands apart from those shared by the African American
physicians who get questioned about their credentials and challenged to prove that they
actually are indeed, a physician.
Yet, at the same time, some of the Japanese American physicians also conveyed
that they perceive resentment from other medical professionals of Asian success within
the field of medicine. Indeed, some of the physicians expressed that they suspect quotas
and a glass ceiling, where advancement is not as easy as anticipated. Overall, it seems a
white male elitism still remains, especially in the higher ranks of the field such as boards
of directors, at prestigious invited meetings and higher positions.
Further, although the Japanese American physicians did not report the same type
of questioning as the African American physicians, some of the Japanese American
physicians shared that they continue to face patients who automatically assume and
perceive them as foreign rather than the multi-generational Americans that they actually
are. Thus, I contend that a highly ambiguous and dubious positionality remains for
Japanese Americans. While structurally, clear successes have been achieved by Japanese
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Americans and the nature and depth of the closed-minded anti-Black xenophobia that
exist for African Americans, does not circumscribe the life choices and experiences for
Japanese Americans in the same way. However, they do still contend with perceptions
that deem them different, foreign and outside of a core group that generally receives
automatic recognition and acceptance as legitimate and American. Lacking this sort of
acceptance is troublesome because it constantly leaves one in a vulnerable and insecure
space where rights can be undermined, neglected and taken advantage of.
Together, both African American and Japanese American physicians experienced
challenges with the referral process- a highly informal process where physicians
recommend or refer patients to other physicians as the need arises. Survey research
(citation) and the physicians in their interviews with me, revealed an ethnic/racial bias
built into this process. This bias can occur at an institutional level within hospitals as
well as on a highly individualized level between private physicians. One Japanese
American physician was thankful for a group of Japanese physicians as well as
connection to a white partner that allowed him to build a successful patient load. This
issue of racial bias in patient referrals is particularly salient for African American
physicians who remain at the outside of numerous networks due to the under
representation of African American physicians. As one Japanese American physician
also expressed, this dynamic can also pose challenges for multi-generational Asian
American physicians who sit on the outside of white physicians networks as well as first
generation Asian networks.
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Somewhat related, the physicians of color I spoke with also expressed they are
more likely to treat more patients of color. African American physicians also discussed
an added aspect of labor that the Japanese American physicians did not share, which had
to do with serving their ethnic communities. While both groups discussed having
successful practices because of their ethnic/racial communities, the African American
physicians also shared a commitment and thus, an extra layer of labor, energy and
resources they must also exert through participation in community health fairs, mentoring
(career days), and making the choice to continue living and working in their
neighborhoods. Although, some of the Japanese American physicians expressed
gratitude toward their Japanese patients for helping them to maintain successful practices,
they did not talk about the importance or obligation of staying in the community due to
community need.
Working in a very traditionally hierarchical and status conscious field where
many entrenched norms about race and gender have endured, albeit to less of a degree,
complicates the work lives of physicians of color. Racialized experiences as reported by
the physicians of color I interviewed match other findings using a wide range of
methodologies, which report discrimination among medical professionals. Among
physicians of color, over 30 percent reported being treated with disrespect, ignored, held
to higher standards and having unequal benefits and/or pay (Coombs and King 2005).
Studies on multiple specialties have found divergent annual salaries among physicians,
with white men at the salary pinnacle often separated by a huge margin of difference
(Weeks and Kingston 2006a; Weeks and Kingston 2006b; Weeks and Kingston 2006c;
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Weeks and Kingston 2006d), especially for female physicians who are veterans in their
fields (Baker 1996).
20
Over 80 percent of African American and Asian American
physicians further felt that they were asked to take on greater responsibilities because of
their racial/ethnic background, and the majority thought they were under greater scrutiny
than their colleagues (Nunez-Smith et al. 2009). Among highly trained medical
professionals, challenges of equity continue to mirror those in the society at large. The
welcome shift that has opened avenues of advancement among physicians of color since
the civil rights era has left in its wake a black hole of racial misunderstanding and
continuing problems of advancement and fair treatment, even for those who have built
steps to the top professions.

20
Each of these studies is limited by small sample sizes of African American physicians, but the trend
appears clear.
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CHAPTER 5:
‘KNOW YOUR PLACE’:
THE CONFINEMENTS OF RACE AND GENDER FOR AFRICAN AMERICAN AND
JAPANESE AMERICAN FEMALE AND AFRICAN AMERICAN MALE PHYSICIANS

As institutionally embedded belief systems, white supremacy and patriarchy
structure, organize, and govern all facets of American life, which in turn immeasurably
constrain the everyday lives and identities of people of color (Almaguer 1994;
Carmichael and Hamilton 1967; Connell 2002; Feagin 2006). For example, where and
with whom one practices religion, where and at what time one shops, dressing, driving,
choosing doctors, going to new places, a person’s birth and death, and hundreds of other
activities of daily living are influenced by race, gender, and class status (Feagin 2001;
Glenn 2002; Lorde 1984). Simply put by Omi & Winant (1994:68), “…[r]ace is
gendered and gender is racialized.” In this chapter, I explore the ways that the social
constructions of race and gender mutually intersect and lead to very different experiences
and positionalities for African American and Japanese American women physicians as
well as for African American men, at home and in the workplace.

A BRIEF REVIEW OF INTERSECTIONALITY
Although not an integral part of the sociology of race literature, many gender
scholars have theoretically grappled with the complicated intersection between race,
gender, and class (Baca Zinn and Dill 1994a; Collins 2000a; Crenshaw, Gotanda, Peller,
and Thomas 1995; Espiritu 1997; Glenn 1985; Glenn 1986; Glenn 2002).
Intersectionality scholarship, which recognizes the simultaneity and multiplicity of large
226
structures of domination such as race, gender, and class, arose as a corrective to white
feminist scholarship and activism that essentialized the doubly and triply bound
experiences and realities of women of color under the falsely universalistic rubric of
womanhood (Collins 1999; King 1995). It treats race, gender, and class as socially
constructed structures, identities, ideologies, and realities which are interlocking,
historically and politically informed, and mutually constituted (Andersen and Collins
1992; Baca Zinn and Dill 2000; Collins 2000b; Collins 2004; Glenn 2002; Spelman
1988). Multiracial feminism not only calls attention to divergent experiences between
white women and women of color, but also recognizes that important differences exist
between women of color, emphasizing that people are located in multiple hierarchies at
once (Baca Zinn and Dill 1994a). Similarly, under the term, intersectionality Crenshaw
(1995b:358, 360) explains that “…the experiences of women of color are frequently the
product of intersecting patterns of racism and sexism…,” meaning that women of color
do not experience racism in the same way as men of color and they do not experience
sexism in the same way as white women. Building on Crenshaw’s notion of
intersectionality, Collins (2000a:18) uses the term matrix of domination to emphasize that
these intersecting oppressions are institutionally and historically embedded within power
structures and organized along four interconnected domains of power: structural,
disciplinary, hegemonic, and interpersonal.
According to Evelyn Nakano Glenn (1999), “[h]istorically, gender and race have
constituted separate fields of scholarly inquiry. By studying each in isolation, however,
each field marginalized major segments of the communities it claimed to represent.”
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This chapter strives to avoid this weakness. In this chapter, I begin to capture the
fluidity, simultaneity, and multiplicity of the race, gender, class nexus through an
empirical exploration of the ways in which the lives of the women of color physicians
and Black male physicians are constrained by their simultaneous location in multiple
hierarchies. “…[R]acism [and sexism] is structured into the rhythms of everyday life”
(Feagin 2001:2). Indeed, together, these ideological structures have created and
maintained unequal economic, political, and social conditions between men and women,
whites and non-whites. I find that enveloped in a matrix of domination, manipulated by
controlling images, women of color physicians (in particular African American and
Japanese American) and Black male physicians must negotiate daily their personal and
professional relationships and interactions in very different and unique ways in
comparison to their white counterparts.

The Intersection of Race and Gender: African American and Japanese American
Women Physicians’ Gendered Experiences with the Work/Family Balance

When talking about relationships between men and women, whether at home or in
the workplace, it is imperative to address the issue of patriarchy. Patriarchy is an
institutionalized system of unearned male privilege that is deeply embedded in every
structure, interaction, and cultural ideology in the U.S. According to Connell (1995:79),
the majority of men benefit from the “patriarchal dividend,” which is defined as “the
advantage men in general gain from the overall subordination of women.”
21
This overall

21
It is important to quickly point out that the power relations between men of color and women of color look
much different than the power relations between white men and white women. While it is true that men of
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subordination of women transpires everywhere: random public spaces, at the workplace,
and in the home. Speaking to physicians about their work and private lives offers an
opportunity to look into the work-life balance and how gender directly impacts the
careers, specialties, family responsibilities and relationships of these highly accomplished
professionals. Both the African American and Japanese American women physicians I
spoke with lent numerous insights into how gender continues to shape and constrain the
choices available to them in terms of their careers as well as their personal lives in the
home.

SEXISM AND PATRIARCHY IN THE FIELD OF MEDICINE
In the organization of medicine, as in society at large, gender is a major principle
affecting the hierarchies and interactions formed. While the number of women entering
the medical field is increasing, major challenges to women’s advancement in both
academic medicine (Nonnemaker 2000) and in terms of managing their proscribed
gender roles within a traditionally male-dominated and male-centered (clinical) career
remain (Bickel 2000). Choice of specialty appears to be affected by interest in style of
patient care (Behrend, Foster Thompson, Meade, Newton, and Grayson 2008), but a
major aspect of this choice is also due to the limits that social scripts of femininity place
upon women (Verlander 2004). Many female physicians describe responsibilities
attached to their status as women, which fall on their shoulders and limits career choices,
even among highly educated professional women (Menninger 1994; Verlander 2004).

color have certain patriarchal privileges, they do not necessarily benefit from patriarchy to the same degree as
white men.
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Burnout in physicians is a major problem, and women are at much higher risk
(McMurray, Linzer, Konrad, Douglas, Shugerman, and Nelson 2000).
Higher degrees of emotional labor in the workplace seem to play a role in the
higher burnout rates for women in medicine as it disproportionately impacts women in
various fields of work (Hochschild 1983). In the vein of Hochschild’s classic work on
the “second shift”(2003), increased emotional ties, and time spent with patients is not the
only downside to managing their careers; a danger that women’s extra family labor with
children will be unsupported by colleagues or family members increases burnout risk
(McMurray et al. 2000). Spouses play a crucial role in the ability of women physicians to
have active careers balanced with families (Ducker 1994); in other words, men and their
willingness or desire to share in the care of children are central to having sustainable
careers for women in medicine, as are the “gendered constructions of self” employed by
these women (Erickson 2005). The work-life balance of women physicians are so
crucially important and fragile that specific advice articles are published with the goal of
making motherhood sustainable with career (Bickel 2003; Blair and Files 2003). One
qualitative British study of medical students mirrored the results of my interviews, when
nearly one-third of respondents used the word “sacrifice” to describe the lives of female
physicians; nobody used that word to describe men and their medical careers (Lempp and
Seale 2006:21).
Dr. Viola, an African American woman who practices privately in Beverly Hills,
shared that her medical school experience was affected by the racism and sexism of her
professors. “As far as if I saw racism, oh, yes. Did I see sexism? I saw far more sexism
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than I did of racism in that medical school. It was subtle things…There was no eye
contact. I would get asked the super-hard questions. Males would get asked easy
questions with some prompting. Yeah, it was pretty obvious.” Dr. Viola attended
medical school many years ago; yet as a mentor to current women of color medical
students, she hears “the exact same complaints that we had when we sat around twenty
years ago.” Dr. Lee-Girard explained that as an African American woman she always
knew the racial hardships that many African Americans endure; yet, it was not until
entering the paid workforce that she realized the unrestricted gender bias that persists:
I've been black all my life, I've been female all my life, but it wasn't until
professionally that I really started seeing gender issues. …I mean there's always
an underlying [racial] thing. I mean there's always going to be people who have a
preconceived notion based on the color of your skin. That though has become so
subtle, you really don't know who those people are and you really don't know
what that is. I find that having gender discrimination is still somewhat accepted; I
mean it's okay. You could be in a mixed crowd and have those gender issues and
gender jokes, and men of any race can still have their biases based on gender. So
professionally I see more of a gender discrimination because it's just more
obvious.

Dr. Lee-Girard makes an important point here. So far, I have discussed at length the
subtlety with which racial intolerance now gets communicated to others. In this
colorblind age, racism or racially ignorant or intolerant beliefs tend to lurk behind the
scenes, disguised by very insidious and oftentimes unconscious expressions and actions.
Yet, as Dr. Lee-Girard contends, sexism still comes out in much more obvious or easier
to detect ways, existing in both overt hostile forms and subtle, ‘benevolent’ forms which
emphasize gender differences and a chivalrous ethic (Glick and Fiske 2001). Thus, other
than particular extremist type individuals and groups of individuals (KKK and other hate
groups), many have the sense that it is not okay to openly articulate beliefs that Blacks
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and whites have different abilities (Bobo, Kluegel, and Smith 1997); yet, cultural beliefs
about inherent biological sex-gender difference remain pretty deeply entrenched, which
ultimately restricts and compounds the workload both at home and at the office that
women are forced to juggle and balance (Verlander 2004).
Gender role norms permeate the social milieu effortlessly and pervasively. Dr.
Itou shared with me how she sort of “fell into” medicine as a career despite the very
gendered intentions she entered college with. Her story provides a good example of how
we often unknowingly maintain cultural gender ideologies that confine women’s roles
and aspirations, cheating them of the opportunity to develop and pursue their professional
and personal life trajectories with the same autonomy and relatively unbridled limits
afforded to white men.
Well, one thing for me, personally, you know - I mean I never intended to go to
medical school when I started in college. And a friend asked me and said - well, a
guy, actually, said, "Well, if you were a man, would you go into medicine." I'd
never thought about it. So, all of a sudden, I went, "I don't know." You know so
my sense was that I was going to college to be an educated mother, so kind of
finishing school of sorts. My brother had had a master's degree, and so I think my
parents presumed that they would offer me the same opportunity and weren't
counting on me to keep going for so long. So that was sort of striking to me that I
had, in a sense, put a lid on my considerations without even really knowing it, and
not that I was any shrinking violet ever, about going out and doing things. And
yet, I had somehow adopted that.

Old Boys Club

Dr. Itou spoke about the sense that there was a club of sorts that she was excluded
from. She explained, “…I really had the sense that there was still an old-boys' school,
that there was information and politics that were going on that we were not part of. And I
don't know whether that was my suspicion, but there really was kind of that whole
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sense…that there was one group that could still smoke cigars together as a whole.” Dr.
Suzuki echoed these sentiments, sharing, “[t]here were times when you did feel like [as a]
woman you were not part of the boys' club. You weren't in the men's locker room. Most
of the surgeons were male and so were the residents and sometimes they would have
interactions not formally on the floor, but in the locker room, that obviously we were not
privy to.”
Indeed, the women of color physicians I spoke with explained that the “old boys
network” in the field of medicine excludes women from equal participation while
providing their male colleagues with unequal advantages and resources. According to
Dr. Gellings, the old boys network in the field of medicine “is more inclusive than, say, it
was twenty years ago,” but she also points out that “even for young males there is an old
boy’s network.” Drawing on her own personal experience, Dr. Gellings continues to
clarify that “in terms of being respected as a colleague, I think I have that [even though
she isn’t apart of the boy’s club].” She explains, “[t]he key is… you know you’re
accepted when men will talk to you, men will refer [patients] to you because your work is
your credential.” Yet, she went on to share that she feels men (of all ethnic backgrounds)
will refer to other men first before referring patients to female physicians. Interestingly,
Dr. Gellings also feels as though male physicians will refer patients “to men outside their
race, and then they’ll refer to women.” When I inquired about how this affects her
referrals as an African American woman physician, she simply replied, “[w]ell, I think
that… they will refer to a white male before they will refer to me, sure.” The sexism here
is so evident; yet, in Dr. Gellings’ opinion, the old boy’s networking today is less limiting
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than it was in the past and she feels as though she has earned the respect of her colleagues
despite recognition that, generally speaking, she would not be among the first doctors that
some of her colleagues would refer their patients to simply due to her race and sex.
While the informal mechanisms that continue to push men forward in medicine are
declining, presumably in part due to the critical mass of women entering the field and
challenging this practice, this also speaks to the difficulties that earlier generations of
women physicians pushed up against as they challenged traditional gender prescriptions
(Davies-Netzley 1998).
So-called “old boy networks” have been challenged in many fields as women and
men of color have made strides to step outside of traditions of exclusivity to expand their
career options. While women represent over 40 percent of managerial workers in the US,
rising to the high ranks of management remains unusual in part due to gendered social
networks and institutional norms that favor men (Cotter, Hermsen, Ovadia, and
Vanneman 2001; Jackson 2001); this pattern has continued to a lesser degree in the new
high-technology sectors as well, in spite of their non-traditional reputations (Gamba and
Kleiner 2001). Medicine has had a similar, durable culture, driven not only by
exclusionary policies—which did exist—but also informal networks and comfort of white
male physicians mentoring young white men early in their careers (Gray and Smedstad
1986). More prestigious specialties, such as surgery, are often cited as places in the
medical training process where social networks are emphasized, and women are often
considered as mismatches for these challenging and time consuming specialties (Lempp
and Seale 2006).
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THE BALANCING ACT: THE TRADE OFFS AND DOUBLE SHIFTS
Many gender shifts have occurred in the past few decades; yet gender remains a
major organizing principle in society, instilled into our structures and institutions
(Connell 2002). The ‘choice’ of a career or a family has become less dichotomous, as
even a decade ago, women made up nearly half the paid labor force in the US (Jackson
2001). Yet, a major challenge exists in balancing work and family life, especially for
women physicians. Coltrane (2004) has concluded that elite professional couples, such
as doctors, have been slower to adapt to challenges in traditional family divisions of labor
than less elite career couples. This has left women in these professional careers with an
even larger share of this domestic burden even though their careers are quite time-
consuming, competitive and demanding. This family labor double-standard is not lost on
as many women who could be caught in this binding and stressful circumstance as in the
past.

Choosing Between Career and Family

For example, Dr. Suzuki, a surgeon explained that she was devoted to her career
and didn’t get married until she was in her mid-forties so she didn’t have to manage and
negotiate a balance between the two in the same way that many women today struggle
with. She shared that her mother told her that she had to decide to either, “’have a career
or have kids.’ She didn’t feel it was possible to do both.” As Dr. Viola, a Black woman
physician, reinforced, “… people in my generation, very few of us had kids. We married
late. You were caught up in this whole school thing, where young folks [today] wanna
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get married and have families. That is much more at the forefront as a priority. That's
good in a way, but that's why they're doing less group kinds of things.” As Dr. Viola
begins to point out, a tension between the personal lives and careers of women physicians
now complicates both their professional and personal lives as more women physicians are
choosing to have families. Where in the past many women felt they had to choose
between a career and children, loosening gender expectations and generational
differences today emphasize the ability to “have it all,” an idea that itself brings many
challenges as contemporary families try to put these ideas into practice (Machung 1989).
For physicians, achieving this work-life balance derails women. Among medical faculty
members, having children was a major career obstacle that differentiated women’s
productivity from men’s (Carr, Ash, Friedman, Scaramucci, Barnett, Szalacha, Palepu,
and Moskowitz 1998). Women and men without children showed no productivity
differences by gender; these differentials were only present when faculty members had
children (Carr et al. 1998).
Indeed, despite filling the same occupational shoes as their male colleagues,
women remain primarily responsible for matters in the domestic sphere. In Dr. Suzuki’s
words, “women may still be a little more challenged since they have childbirth, [a desire]
to move ahead in their career and still [have to] balance and have success at home.” As
the child bearer and through gender norms and roles that define women as natural
caregivers and nurturers, women are still forced to make difficult choices and decisions
between their careers and their children. As a mother myself, I am constantly working
against these competing interests. We live in a society where it is very difficult and
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sometimes unrealistic to enjoy both career, and children and family, fully and equally.
This is not to say that both cannot be achieved, but it is simply impossible to be a stay at
home mother and a working mother at the same time. Many times, choices have to be
made about what will get more time and attention; sometimes for financial reasons, the
choice is made for you. Women, unlike men, are in a very precarious situation because
the biological timeframe in which a woman can optimally have children is often at odds
with the timeframe in which she needs to devote her time and energy to developing a
career (Maines and Hardesty 1987), which forces many to have to pick and choose
between different aspects of both. Many of the women physicians I spoke with had to
make decisions about their careers based on the needs of their families, a trend that none
of the male physicians spoke of. Maines and Hardesty’s (1987) qualitative study of
young adults’ future career and family expectations reflects gender differences in terms
of career and family obligations. Women were aware of their status as primary family
caregivers, and men expressed preferences for and anticipation that future spouses would
either sacrifice or forego careers to accommodate childrearing (Maines and Hardesty
1987).

Choosing Specialty To Fit Family Needs

Even before their careers begin, women are making decisions about their families
or future families where men aren’t burdened by the expectations that these
responsibilities will be theirs to manage (Maines and Hardesty 1987). Even in cases
where men take on family labor that traditionally falls on women, men’s level of
responsibilities still do not match what women carry (Coltrane 1989). Dr. Ishii explained
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to me that “there’s lifestyle decisions in how people choose their areas,” meaning their
specialties. This issue of lifestyle and medical specialty came up frequently, mostly
when talking about or to the women physicians. Dr. Ojima shared that even before
attending medical school, she initially tried pharmacy school because she wanted to
respect her mother’s concern for “balancing professional and family life.” Pharmacy
didn’t feel like the right fit for her, so she decided on pursuing a career as a physician, but
stated,
…even going through medical school, it was important for me to find something
where I could balance both. So dermatology in particular, the schedule is pretty
flexible in terms of the hours that you can work and there's not a lot of overnight
in the hospital or calls during residency. Then once you're done with residency
then you're also - there aren't a lot of emergencies that you'd have to leave home
in the middle of the night for, et cetera.

In the choice of specialty, family obligations and planning was very important to Dr.
Ojima, including specifically, the time schedule and the need for after-hours work, which
presumably would interfere with parenting. One of Dr. Ojima’s mentors was a
dermatologist and she found dermatology interesting and “of course the lifestyle…really
manageable in terms of balancing professional and home life,” which she indicated, “is
important to me.” In hopes of maintaining a more even balance between the professional
and personal sides of her life, Dr. Ojima chose dermatology as her area of specialty. In
fact, according to Dr. Ojima, “a lot of the people who go into dermatology in general
choose it for lifestyle.” Dr. Ishii also expressed that the ability to “clock in and clock
out,” where work does not usually seep into the nights and weekends, provides a big
draw for physicians who want to maintain a fuller personal lifestyle.
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Likewise, some women avoid certain specialties for the same familial reasons.
For example, according to Dr. Ishii,
A lot of women think that's [OBGYN] a good women's field. It can be, but then
the flip side is that their night and weekend call is very tough, so that's why a lot
of women tend to go into professions that are not as demanding. It's not to say
that there aren't openings for women to be trauma surgeons or cardiothoracic
surgeons. There can be. It's just not the easiest lifestyle and it's not the easiest
environment to be in.

Interviewer: What's the environment like that makes it difficult?
Dr. Ishii: Oh, well, I would say, like, in surgical training programs, they tend to be
a little bit macho about who can stay up the longest. It's an indirect thing. I know
at UCSF, a lot of surgical residents wouldn't take their vacation because they
thought it reflected weakness, so it was just their way of showing their level of
intensity toward work. And it is true that the more cases that you do and see, the
better doctor you are, especially in the surgical field, but, y'know, this was
extreme stuff in my time. Now, that's changed ever since that whole - y'know, the
woman who died in New York, and they said that some residents can't be up
certain hours. Back when I was in school, y'know, some surgeons wouldn't leave
the hospital for an entire month. Y'know, they lived in the hospital. I mean, that
was normal. Or, some of the residents wouldn't sleep for 72 hours. That was just
how it was. Now, with the new rules, that's not permitted, but it was definitely
tough, even back for me in medical school. Surgical rotations were physically
brutal.

While Dr. Ishii discusses specialties in terms of “lifestyle” choices, this conversation
cannot be explicated without recognizing the important role of gender. To have a
semblance of balance, many women view their “lifestyles” as needing priority so they
can perform family obligations associated with motherhood. Such obligations do not
accompany fatherhood in the same way. Indeed, “lifestyle” choices are not as critical for
male physicians.
Dr. Tano, a female obstetrician echoed these sentiments, saying, “Timing. Time
is so precious in this specialty [OBGYN]…It would be very hard to juggle a family and
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have to be able to do this too.” Similarly, according to Dr. Gellings, a surgeon, many
women “don’t go into surgery because it’s demanding, time consuming, and from a
standpoint of a lot of women [who] still want to get married and have kids, it takes
away.” Not only have men been the vast majority of surgeons, but the culture of the
specialty is especially hegemonically masculine, exemplified by the macho performances
of staying up a great many hours and the sort of yardstick of one’s surgical prowess this
seems to reflect. Women who do go into surgery are demographically more likely to be
white, unmarried and without children than other women physician (Frank, Brownstein,
Ephgrave, and Neumayer 1998); and women are in a socially precarious position,
experiencing sanctions when displaying the types of dominant or aggressive behavior
male colleagues practice (Cassell 1997).
Nonetheless, unlike past generations of women physicians, more women today
pursue both career and family. As Dr. Tano, who does not have kids said, “…obviously
most of the doctors we work with you know, have families and everything.” Thus, I
don’t want to portray an inaccurate and unfair picture to the female physicians and
families who do find ways to make it possible to have a successful career as an
obstetrician and maintain a good family life as well. While women surgeons are more
likely to be unmarried, childless and delay childbearing, over 80 percent would choose
their profession again and the medical establishment is being pushed toward structural
changes in schedules, leave and child care to encourage retention (Troppmann, Palis,
Goodnight, Ho, and Troppmann 2009). Thus, many women do find ways to make their
careers in typically male dominated areas such as surgery, while also maintaining healthy
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and happy personal lives. To make this happen, these female physicians often rely on
various strategies including: creative juggling of their schedules, sharing workloads with
spouses or other women, and the use of outside domestic labor (usually supplied by other
women!) (Hondagneu-Sotelo 2001).

Making it Work

Well Developed Support Systems

Dr. Lee-Girard’s experience as an ER physician and a mother of three children,
illuminates how family needs and concerns factor into the decisions women make about
their professional lives throughout their career trajectories. Her story also sheds light on
how much personal labor in addition to a well-orchestrated support system is required in
order for women to enjoy both worlds. The type of lifestyle that emergency medicine
affords made a lasting impression on Dr. Lee-Girard. She described how she came to
choose this particular field as her own area of specialty.
The clincher for me was I was doing a rotation in the emergency department and
it was midweek and my team, the ER team said, ‘let's go skiing tomorrow.’ I
said, ‘skiing, we can go skiing on Wednesday?’ They were like, ‘yeah, we're off
for the next two and a half days,’ and that really intrigued me because I thought
wow, this is really cool. Because, first of all, they were a happy group of doctors.
They were typically into other things, they enjoyed outdoor activities and being
outside, and I'd just come off the surgical rotation where we were on call every
third night and the women especially were just miserable because they either
hadn't been able to see their families, or had no families. I just thought, gee, I
don't want to do that.

So emergency medicine just kind of fit my lifestyle at that time. I enjoyed skiing
and being outdoors and doing fun things, and I knew at that point I really didn't
want medicine to just completely absorb my life. So it seemed at that time that
emergency medicine was a great way to have the best of both worlds. So that's
how emergency medicine came about.
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It is clear that Dr. Lee-Girard’s desire to lead a life that allowed a balance between both
the personal and professional interests in her life led her to a career as an emergency
room physician. While the ability to engage in recreational activities and the fact that the
ER doctors seemed happy and living full lives attracted Dr. Lee-Girard to the subfield,
while the misery of the women in surgery who missed their families, if they had them,
also left a meaningful impression as Dr. Lee-Girard looked into her own future planning.
Thus, even before having children, the balance her career would allow was already on her
mind. This is not necessarily problematic in itself, but it does force us to look at how
certain pathways are closed to certain women simply because they force women to make
a difficult choice between prioritizing a career or children, and many women simply do
not want to have to be in the position to make that choice. Thus, while women’s career
and family decisions are often preplanned years ahead of time, men’s future career
objectives can afford not to consider children centrally because assumption exists that
family is a woman’s responsibility (Maines and Hardesty 1987) and because men do not
have to consider biological constraints related to reproduction and childbearing.
Dr. Lee-Girard shared that “emergency medicine worked wonderfully for me,
until my children got older.” She explained that, “[e]ven as a new mom, when they were
babies and infants, it was wonderful because I could, I didn't work every day and I could
have my mornings and I could just work in the evenings.” She went on to share that, “I
could do all of the mommy and me classes and all of the activities with them as children,
and then bring them home and they could get bathed and put them down about 6:30, 7:00,
and then I could leave to go to work.” However, as her children got older, the fit between
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her personal and familial needs declined with the structure of her emergency medicine
career.
There were a couple of things, I was younger at that time so I didn't need as much
sleep. I would sleep maybe an hour or so before my shift and come home, and
then sleep for a few hours that morning and I'd be at total recovery and could
continue on. As you get older, the needs of the children change and just my rest
requirement, my recovery time from working nights, all that became very
difficult.

Then in emergency medicine you do work weekends, you work nights, work
holidays. When your kids are little, if they're at my mom's house for Easter or
Thanksgiving, it's not such a major deal as if they're five or seven, and they
understand it's Thanksgiving and they understand my friend's party is today and I
can't go because you're working. So those things start playing a bigger role in
how it does not fit into your life.

As I listened to Dr. James describe how she juggled her work at home as a mom
and her paid work as a physician, it struck me just how much extra responsibility women
carry to make it all work. While differences in house and care work between men and
women in families have declined, multiple sources have noted that free time has now
emerged as a major site of gender difference, with families’ time binds impinging upon
down-time for women and revealing their ultimate responsibility for family and
childhood matters (Mattingly and Bianchi 2003; Sayer 2005). As a mom myself, I am
fully aware of the energy required to care for, nurture, and engage with one’s children.
As Dr. Lee-Girard indicated, eventually, her body could not withstand such a taxing
schedule and the needs of her children also changed. As children grow and age, their
needs also change. As infants, toddlers, and preschoolers, they are very needy and
dependent on their caregivers to keep them safe and occupied; as they grow into school
age, they need their caregivers in new ways. They continue to need attentive engagement
243
and active involvement, but they also begin to develop their own interests and
extracurricular activities in addition to increasing amounts of homework that at times
requires supervision, all of which demands a lot of time from their caregiver(s), making
that balance between career and family even more cumbersome. Thus, Dr. Lee-Girard’s
career choice did indeed allow her to enjoy full professional and personal lives when her
children were young. Yet, unanticipated needs of children as they age and one’s own
physical capabilities introduce new challenges to juggle that cannot be predicted and
factored in the years prior to even having children. With a disproportionate amount of
family responsibility continuing to fall on women and mothers, women will continue to
face this tension.
Listening to Dr. Lee-Girard describe how a couple of changes to their already
meticulous schedule threatened to disrupt the balance they achieved, I could see how
much time and energy goes into making both work and family coexist in one person’s
life:
It's a juggling act and you have to kind of get into your rhythm, and any one thing
can throw your rhythm off. For instance, my oldest daughter, last year she tested
really well on a math exam, so her principal said, "We want to send her to the
middle school for her math class this year." Now, this is my one year where they
were all three at one school, and I guess otherwise as a mommy you'd be really
happy and excited, thrilled that your daughter did really well on the exam, but my
first thought was okay, so I got to get her to the middle school every day? I'm
thinking this is just going to throw everything off.

Yeah, there's always variables. Like they were in gymnastics and their
gymnastics coach came and said, "These two we're going to put on teams." I'm
thinking, okay, I don't know what that means, but I'm sure somehow this is going
to throw me off. They're like, mom, we made teams, and I'm like... And they're
like aren't you happy? Yeah, great, I'm really happy, but how is this going to
affect my…balance that I've got.

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This time-crunch dilemma is an issue that affects many American families. And as will
become evident, Dr. William-Pascal and other women physicians (and their partners)
benefit from their class privilege. Physicians luckily make the kind of living that allows
them to rely on outside paid domestic labor to help them keep their homes and families
running. So, the challenges with balancing the schedule and making everything fit
together without shortchanging one end too much, require a lot of extra time and energy
and planning, for all families with two wage earners. However, the lower the family
income, the more other (family) needs can get shortchanged and put at risk because less
time can be taken off of work to attend to unforeseen family needs as they arise and
because outside childcare or other domestic work is not an option due to financial
limitations. Nonetheless, regardless of the fact that the women physicians I spoke with
do make an income that affords them certain domestic labor luxuries, it is clear that as
women, they are still put in a precarious position because the onus continues to fall on
them to make it all work. They, more often then their husbands, have to find ways to
make both their careers and their families possible. The underlying assumption still
seems to remain that the man in the family is the primary wage earner while the wife can
either figure out a way to make her career fit into the family’s schedule and family’s
needs or simply work less. While idealized family images favor more equality in
parenting and family labor, actual reality continues to burden women with these
responsibilities, especially with regard to emotional support and disciplining of children
(Milkie, Bianchi, Mattingly, and Robinson 2002).
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In order to make it all work, Dr. Lee-Girard described a well-developed support
system. She shared that without having “strong family support” from her mom and dad,
“I don’t think I could have ever been a full-time physician and a mom and a wife.” Her
parents provided tremendous support to her and her kids. Her father recently passed
away, but her mom continues to stay with her at times when she needs extra help. She
also explained that she has “a very supportive husband who also is a physician who
understands the demands that, as another physician, I would have. So he kicks in a lot in
being helpful.” Finally, Dr. Lee-Girard also relies on a live-in nanny, “someone who
lives in my home who helps.” Dr. Lee-Girard’s live-in nanny has been with her family
for many years, since her oldest daughter was young. Dr. Lee-Girard explained that her
nanny
has been through the pregnancies of the last two, so…their whole lives have been
with her. So she has really become like a grandmother kind of figure. So she
kind of keeps the house going. There are times I cook, but there are most times
that she cooks. If I cook it makes it easier because all the prep work and the clean
up, all that stuff which makes all that stuff very time consuming, she helps keep
all that going.

So it's like, I joke and I say I have a wife at home, but yet you need that kind of
support if you're going to work outside of the home.

It takes a full support system in order to maintain a full time career as a physician, while
also sharing a relationship with another person and caring for one’s children. Domestic
work and the reliance of middle-and upper-class parents on such labor has continued to
develop in an ambiguous, informal way even as more families are dependent upon it
(Hondagneu-Sotelo 2001). As another woman physician, Dr. Suzuki, who does not have
children and got married in her mid-forties, shared that unlike her generation of women
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physicians, younger generations of women are “finding more ways to do it,” meaning
they are finding more ways to make both career and family possible, in part because
“they have a career that affords them to hire a nanny or whatever.” Dr. Suzuki expressed
that women physicians who are also mothers need “some kind of support system to help
them.” “They won’t do very well if they don’t have that,” she said, or, as she went on to
speculate, “[t]hose who don’t have that are probably gonna have to make a different
choice.”

“We’re still the mom…There’s still the void of only things that I can do”

Even with the help of domestic labor to oversee the home front, whether it be in
the form of childcare, housecleaning, and/or cooking, women physicians remain at a
disadvantage in the workplace as it seems women ultimately often come back to making
a sacrifice of one sort or another. Dr. Ishii shared that, “it's hard if both spouses are
trying to have careers.” From her own experience, she knows some women physicians
whose spouses stayed home to raise the kids – “they were Mr. Mom,” to use Dr. Ishii’s
description- which worked well for them. The conflicts seem to arise when both partners
are trying to establish and develop their careers, and where even among feminist men and
women there is a breakdown between an idealized equal partnership and what actually
happens (Blaisure and Allen 1995). Dual-wage earning households can be especially
challenging to manage when children are involved, and the division of labor and work
hours are a frequent site of dissatisfaction (Paden and Buehler 1995; Philip and Wheatley
2011). One male physician, Dr. Ogawa explained that although he believes the gender
differential in the amount of childcare between men and women has “changed a lot over
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the last twenty years,” he sees that “[w]ell, it's harder for women to progress just because
they can have kids. And then they still take care of the kids more than the men do. And
then, that[leads to]… ‘you can't really work as hard as you may want to,’ or ‘you don't
work as hard as you want to.’”
Dr. Ojima explained that men may choose dermatology for lifestyle reasons,
similar to women, but, “I don't know if it's to the same extent as women in terms of - I
think even though we're in an age where there are more professional women and lots of
working moms and all that, we're still the moms.” An understanding of the reality that
women are going to be bearing primary responsibility for children and family labor is
taken-for-granted. Likewise, Dr. Lee-Girard described a very supportive husband who
understands her constraints as a physician because he is also a physician, yet clarified,
“[b]ut again, he's the dad and dad's just don't have the same role as moms do. So even
with a supportive, very involved husband, there's still that void of only things that I can
do.”
Dr. Ishii’s story illuminates the constant back and forth tug women physicians
who are mothers experience while caught in between doing what is best for their career
and caring for their children. Dr. Ishii explained that even though she has a full-time
housekeeper and family members nearby, “I can’t do everything.” Dr. Ishii described a
continuously morphing career, which eventually resulted in her working from home
more, an option available to her as a radiologist. She shared with me that, “…as a parent,
I finally gave in to the fact that it was better for my family for me to be around more.” I
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felt really sad and disappointed for Dr. Ishii as I listened to her share her story about her
developing, now somewhat stalled career. She described how
Up until now, I always had a hospital-based practice and I had a very academic-
practice career. So, all this time I've…done research, written articles, book
chapters, given lectures around the country. Yeah, I was president of a national
society a couple years ago, so I did a lot of other things that took up time. Right,
yeah. Those things really take up your time, y'know? Yeah, reviewing a journal
article is a lot of work, so I've had to really curtail those activities. You can't do
everything.

Dr. Ishii has two kids, one in the third grade and one in the fourth grade. She is
now divorced, but expressed that she “…had a working spouse who felt that his
profession was more important than mine, and really felt that childcare duties fell on me,
even though I worked harder, I made more money and I had a lot on my plate. It was still
the woman's duty to do all the - a lot of the childcare responsibility.” Dr. Ishii explained
that, “…someone has to be home to get their homework done,” so she, not her ex-
husband who made a lower income, had to shift her career in order to ensure her children
received the care they needed. In some situations, developing a career may not be as
important or appealing to some women, so rearranging their work schedule and long term
career trajectories does not feel like a loss. In other situations however, for women do
love their work, some are forced to shortchange their career because of unequal gender
role expectations that do not call for husbands and wives to share childcare evenly.
Indeed, Dr. Ishii continue to tell me that, “…it's a challenge and - y'know, a lot of
women just work part-time as physicians. Part-time physician, and then they do
childcare, and that's one way of still having a career and still caring for your kids, but if
you're working, y'know, more than - if you're working 40 hours a week or more, it's very
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hard to do that and also raise kids.” Choosing to work part-time in order to experience
both children and career is a great option if one finds that option appealing and suitable;
yet, as I will discuss shortly, some physicians explained that this arrangement can
foreclose on future career promotions, and ultimately result in less pay and greater
financial dependence on their husbands, which may or may not be problematic for some
women and in some families.
Further, in Dr. Fujimoto’s, a male physician, observations, [a]t the present time,
there is more of a predominance for female physicians to take time off for family
matters… as opposed to the male physicians, they don't do that, and so that is something
that can have an effect upon how the career advancing goes as well.” Dr Suzuki echoed a
similar sense, indicating, “…it's probably slowly changing, but for lifestyle issues and
family issues, you don't see as many women in leadership roles. They took time out to
have kids or kind of get off-track. But some have managed to do both, so I won't say
that's an excuse. It doesn't mean it can't be done.” In her opinion, “[i]f there is a glass
ceiling, it's higher. Not higher, but it's more breakable. So part of it may be personal
dedication to the job and how much a woman wants to take it.” The lives of women
physicians mirror the lives of other wage-working women in the labor market and the
experiences of families in balancing private and personal lives. The recognition that
women in higher education and the labor market are forging more career options for
women is well-know, but the role of gender in family lives hasn’t transitioned as quickly
(Blaisure and Allen 1995).
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I want to share a lengthier portion of my conversation with Dr. Ishii because it
captures this dilemma that women with children who work outside of the home often
face. Too often women and men do not equally share family responsibilities, causing
women to forgo their own professional aspirations, a process ultimately supported by
hegemonic constructions of gender.
Well, I was a - I started out as a neuro-interventional radiologist, which is kind of
a surgically based specialty. It's now called endovascular surgery, but it was
surgical treatments of people using a catheter rather than making an incision, and
so, that was very patient-based. And then I went from that in private practice to
focusing on spine interventions, and so, I had kind of a clinic of patients and a
very successful practice in that. But then, I got pregnant - I had kids. Very hard
to do - continue that practice because of the x-ray exposure during pregnancy. So,
I trained a partner and he kind of took over my practice for me.

So, that was a shame. I was sad to do that because it was hard to come back to
my practice. I mean, he did fine with it and I was happy to give it to him, but
that…was an impediment for me. So then, I went to another hospital with a
practice - a bigger hospital - and they had a shortage in mammographers. Their
mammographers quit, so they sent me there because I'm a woman. That was
okay. It was a great experience. I became an expert mammographer, and that is a
definite hands-on type of specialty, where you have a clinic of patients that come
in to be seen. Y'know, basically, it's like going from room to room, seeing these
women. So, that was very patient-based.

And then, since that time, I had to kind of make decisions for my family and
figure out how I could kind of maximize my career and my income while
maximizing the time I had for my family. So, I tried doing, like, night work - the
night shift - working midnight to 7:30 or, y'know, 8:00 p.m. to 2:00 a.m. I tried
different shifts like that and that is a great lifestyle for a woman with small kids
because that's when the kids are asleep…but it was - I didn't see it as a career, and
then I fell into this opportunity now with the practice where I'm doing a lot of my
own work from home, y'know? That's why it's working for me, but I'm sure that
in another year or two I'll get back to doing procedures, so…so I guess I've just
learned to morph myself a little bit to try and accommodate my personal situation,
but in another year or two - maybe a couple days a week - I could go back to
doing procedures because that's actually what I'm known for, is doing
intervention.

Interviewer: It sounds like that's sort of where your love of radiology is.
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Dr. Ishii: Yeah, that was my period that I focused a lot of my time on, but it's - it
was a - I guess, a conscious decision I had to make of - what was more important.

Interviewer: Right… Do you see men and women having to make these decisions
equally yet, or do these sort of decisions fall more heavily on women still?

Dr. Ishii: No, if I were a man, my career would have been totally different. I
have compromised my career a hundred times for my husband, and that's just how
I guess I chose to live, but most men will make their career decisions completely
based on their personal goals, not on the - necessarily, the interests of their spouse
or their children. Y'know, if they don't like their job and they see a better job,
they'll just say, "Hey, we're moving."

Y'know, "I'm the breadwinner and this is what I want to do for my career goals."

Or, maybe, they'll go take that job and commute. I mean - but most men won't
hold back on their career for their spouse or their family. Yeah, I mean, I have
regrets. I have regrets about that, so - no going back, right?

Dr. Ishii continued to share that some promising opportunities came her way, but she had
to pass on them because she “didn’t have that permission” to accept them. Dr. Ishii is
just one example of a very talented and bright woman with tremendous potential in her
career; yet ultimately, due to normative patriarchal societal ideologies, her own
aspirations were secondary to those of her husband, even though she had a higher income
to provide more financial support to her family than he did. In listening to her story, it is
amazing to see what lengths she went to, similar to Dr. Lee-Girard, in terms of taking
night shifts so she could work while her children slept, in her efforts to maintain a career
while still caring for her young children. Yet, despite having to bend her own
professional life in order to meet the needs of her family, Dr. Ishii continues to move
forward and hopes to get back to doing procedures when her private life allows. She is
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not deterred, but is just moving forward in spite of outside limitations placed on her
career, something women have been doing for a long time.
Kinship
While women oftentimes share an unequal amount of the domestic
responsibilities, this also carries over into the workplace. Dr. Viola remembered, “I had
two male partners. It was difficult for them to understand that I was taking a day off. ‘I
take a day off to do all those things that your wife does, like cleaning. I don’t have
anybody doing that for me.’” Further, Dr. Lee-Girard explained how as a mother, she
understands other women’s needs for flexibility while at work due to the various family
issues that may arise; a worry that their male counterparts often can not identify with. In
her words:
To go to my daughter’s ballet recital, now I as another mom get that. Whereas
my colleague, and she says my son is singing in a program at school. Sure, he’s
only four and it’s probably a horrible song, but she needs to be there to hear it,
and I get that. So I will make it happen such that I will cover for her so she can
go and then come back or something. Whereas the guys just, they don’t get that.
When your child is sick and you’ve been up all night and you come in and you’re
saying my daughter was vomiting all night, they don’t go through that because
often times they have wives at home that are doing all those things, and truly in
their minds they are thinking you need to-they just don’t get the concept. You’re
doing what I’m doing, yet you’re doing what my wife is doing as well. So they
don’t really-there’s that disconnect there.

Dr. Lee-Girard points to a sort of kinship arrangement where women are working
creatively together in order to make the balance of career and family more possible for
each other. Indeed, Dr. Viola attributes women physician’s abilities to maintain both
their professional and personal lives simultaneously to the strategy of “women getting
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together doing creative things” such as “women sharing practices,” and working part
time. She explained how sharing practices works:
So they may work part time. Somebody works Monday and Tuesday and half a
day Wednesday and someone picks up the other days. So there is a difference
with men and women with that. Men are gonna work until the last minute, until
midnight. They're gonna do that. There are a few women that do, but not the
majority. Women will work part time before doing that, which, in primary care,
part time is probably regular time for most folks. But they will. I've seen more of
them doing that.

Dr. Itou also shared that “I knew that I needed at least a group around me, that at some
point I really wanted to have a family.” Thus, she worked together with someone
“opposite of me who had kids and we were kind of a unit-for quite a few years we’d
kinda cross over, etc.” She now shares a practice comprised of all women- one Indian,
one Chinese, one Indonesian, one Jewish and her, Japanese American.
Although she does not have children, Dr. Suzuki can relate to this supportive
network of women working together and helping each other. She explained that she
“there was a kinship in medical school among the women.” She recalls that “as a
woman, I felt a lot of support from the nursing staff…a lot who were Filipina.” Thus,
both in the home and out of the home, these women physicians manage to carve out a
professional career while raising a family, largely due to the support and labor of other
women. Low-paid immigrant women have paved the way for high-earning professional
women to increase their hours at work and use more time away from childcare and
household labor (Cortés and Tessada 2011; Hondagneu-Sotelo 2001). Further, work
networks are extremely important, as in male-dominated professions women tend to be
more socially isolated, so finding support where they can is crucial (Taylor 2010).
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Evidence also shows that social support at work can decrease stress and reduce the risk of
serious medical conditions (Johnson and Hall 1988). While kinship networking between
women has allowed many women to get a taste of both worlds, it is important to also look
at what sort of playing field this leads to for male and female colleagues competing for
advancement and the same leadership positions. Kinship networking seems like a
valuable and vital resource for women who want to succeed in the workplace, while
maintaining a strong presence at home, but choosing a part time option can become
problematic for those who may want to move into leadership positions. To this end,
more structural support and change needs to occur.

Structural Changes
Just as Affirmative Action opened the doors in medicine for a period time to
heavily underrepresented racial groups, Dr. Samuels explained that “I think some of the
laws have really helped over time, where, you know, folks can't really be asked about
their plans for children and marriage, you know, and things of that nature.” Thus,
institutional changes made it more possible for women to pursue careers in medicine.
For example, Dr. Samuels explained that there are now laws that do no permit residents
to maintain excessive hours, which in the past made it “very difficult if you’re away from
husband, family every third night, every fourth night, very hard to do the traditional
cooking, cleaning. Kids are their own job.” It is notable that Dr. Samuels mentioned
“the traditional cooking, cleaning,” because it is this gendered cultural expectation that
must be overcome to increase the ability of women with families to participate in the paid
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labor force. Yet, just as with institutional policies directed at ameliorating racial
inequality in the workplace, the implementation of certain policy regulations and
guidelines aimed at promoting gender equality in the workplace fell short in achieving
the end goal.
As Dr. Samuels pointed out, “…in some specialties, I think when people are
honest job searching, they will say that they'll often take a man over a woman because of
the fear of loss of time with pregnancies and on and on since we cover, in some kinda
way, a 24-hour day.” Indeed, although it may no longer be legal to deny a woman a
position due to family plans, the cultural and ideological assumptions and expectations
about women’s roles in the family have not changed, leading to a persistent imbalance in
the workplace.
Dr. Ogawa, a male physician shared that
So it used to be a woman going into medicine actually had to act like a man. And
now, it's very acceptable for a woman in the middle of her residency to have a
couple of kids, to say, "Well, I have to go home now because my kids are sick."
Or, "I can't come in now because my kids are sick." And it's pretty much
accepted that you're gonna have to accommodate her, not the other way around.
So people cover them, and so it's people just make kinda - you know they do
cover each other. And they've changed the rules too. Like for residents, they
don't have to work so many hours. So there are a limited number of hours. So it's
become more, I guess, family friendly for women.

One other physician, a woman without children, Dr. Suzuki, expressed that she also feels
that “I am impacted by people with kids even though I don’t have kids because we’re
trying to help out a colleague.” Yet, she also sees that “the organization [of medicine] is
looking at a whole lot more flexibility” as more women enter the field of medicine and
may need to work part time as well as due to the changing expectations of men to move
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away from the traditional breadwinning role. She finds that men are also “having
challenges between home and work because the women expect them to do more at
home.” According to Dr. Suzuki, men take paternity leave and “[i]t isn’t all just up to the
woman anymore, especially if the woman works. So I think there’s a lot of cultural
changes in society that are actually affecting their medical career.” The US differs from
many European nations in that paternity leave has no guiding policy to endorse it, thus it
is left to individual workplaces and organizations to support. Paternity leave can be a
major intervention in terms of greater levels of father involvement in child care
(Nepomnyashy and Waldfogel 2007), which in turn provides women and mothers greater
flexibility in career choice.
Interestingly, Dr. Ogawa’s, a male physician, perspective and Dr. Suzuki’s, a
female surgeon without children, to a certain extent, differs from the perspective of the
women physicians I spoke with who have children. In these women’s perspective, their
male colleagues do not identify or understand with the double shifts they carry between
home and work, and it is really through their creative efforts together with other women,
that they make it all work-certainly not because anyone is accommodating their needs.
Nonetheless, it speaks to the need to rearrange the structure of work, specifically
medicine, to equitably accommodate the private lives of our physicians. Dr. Ogawa feels
that
even the men now, don't work as hard as they used to. So they just - if half the
people being women can take time off to do things, then the men just don't - you
know, they'll cover, but they're not going to do - to actually work as hard. 'Cause
you can't really expect them to work hard and the women not to work hard, so the
expectation is more or less that everyone doesn't work as hard.”

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Dr. Ogawa feels that a transition has taken place in medicine where more time flexibility
and a reduced workload is now a part of the profession for women and for men. Dr. Ishii
also described a similar shift:
Well, from what I've seen, at least in my specialty, is the doctors who are coming
out now do not want to work as hard. They didn't work as hard in their training
and they simply don't want to come out of school and work that hard. Most of
them. It was different back - for me, 20 years ago - because we all worked our
butts off, and then we came out in practice, and it was sort of like working your
way up to a partnership. You just knew you were going to work, y'know, long
days - y'know, 12, 15-hour days - and that was normal. Today, men and women
coming out of school have constraints, and the important thing for them for jobs
is, y'know, "Is it eight to five? Do they have the night service?" They don't want
to take too much night call, so - which is good. People coming out from school
today want to have a more balanced life.

The transition in the attitudes of younger physicians, as discussed among many
physicians I spoke to, appears to be notable. Nevertheless, structural changes to
accommodate this shift are slow; as with other professions, individual women and
families have made the adjustments that were needed—often at much strain—with rising
dual-earning families (Percheski 2008).
Dr. Viola shared her insights into how the desire among younger physicians to
lead a more balanced life is now affecting the structure of the organization.
Overall, younger people are not becoming part of a large group. The AMA has
less enrollment than ever before and they are saying that because younger people
want more family. And the other side of it is good, because people in my
generation, very few of us had kids. We married late. You were caught up in this
whole school thing, where young folks wanna get married and have families.
That is much more at the forefront as a priority.

Indeed, enrollment in the AMA declined over 5 percent from 2009 to 2010, with many
physicians joining smaller specialty organizations (Robeznieks 2011). Women make up
half of medical students and over 27 percent of physicians (AMA Women Physicians
258
Congress 2005). Many of those women will want to have a family and many more now
than in the past will expect their partners to share in the childcare responsibilities. Thus,
as Dr. Suzuki suggested, “I think that's where even we, as an organization, have to look at
more flexibility in work schedules - two people sharing a full-time job for example.
We're gonna see more and more of that. Maybe they're single fathers raising kids. They
need that flexibility in addition.” While structural pressures from strains between the
realms of work and family are pushing the medical professional workplace to adjust, in
surgery programs for instance (Troppmann et al. 2009), a decline in the traditional,
masculinist cultures of these institutions will likely be slower.
Dr. Pascal-James described one example of the slow-to-change nature of work
and the expectations that accompany workers when she shared her own family
experiences and the clash between her family versus work expectations.
Like tomorrow, I have a meeting tomorrow that I cannot get out of and even
though I scheduled not to work this week, I do have to go in. The teachers, my
youngest daughter's teacher sent an invitation home last week, Mother's Day tea.
Well, Thursday at 1:30, and I absolutely, as much as I've tried to [reschedule] I
just can't make it. So, because I'm not going to have my daughter there with no
mom, I've got to have somebody there. So I'm either going to have the nanny get
there, or my mom come, so that she can have some sort of mother figure there.

Families, children and parents, need to make schedules to manage the activities that are
important to them. In a work environment that was created to accommodate men’s career
advancement and not primarily the needs of families and children, a cultural canyon
remains between long-standing work expectations that career comes first, and these
newer family structures where women are not only primarily responsible domestic labor,
but also a career outside the home. Missing a daughter’s tea party at school where a day
259
off was scheduled, because the work schedule pushed in and took priority, is but one
example of the role strains that now confront women at work while they attempt to
manage family life. The emotional guilt and sadness Dr. Pascal-James showed as she
shared this experience seemed to carry so much weight—of a thousand other instances
like it perhaps—and it brought to life the interpersonal struggles and hardships that these
institutional incompatibilities create.
In her important study on Black teenage motherhood, Kaplan (1997:68) explains
how Russo’s conception “the motherhood mandate” links family structure to patriarchy
through gender norms that expect mothers, not fathers, to bear not only primary care-
taking duties, but also responsibility for ensuring their daughters develop moral character.
“In this society’s view women, not men, are charged with caring for others and for the
moral training of their children. Caring for others and teaching them social values are the
hallmarks of women’s mothering obligations…” (Kaplan 1997:67). Even in African
American and Asian American families, where women have been in the wage labor force
as long as their male counterparts, women have been expected to ensure that domestic
duties were done; patriarchal privilege freed men from these burdens (Harley 1997;
Higginbotham 1997).
Indeed, due to their long history in the paid labor force, African American and
Asian American women have been putting in a “double day” or “second shift” before
middle class white women began to fight for the right to participate in the public
workforce, representing one way in which patriarchy differentiates the racialized
experiences of African American and Asian American men and women (Dill 1994;
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Espiritu 1997; Hochschild and Machung 2003). Racial barriers in the labor market
required women of color to work in the paid labor force, ultimately transforming power
relations and gender roles between husbands and wives, as men were not always able to
fulfill the male “breadwinning” role. Decreased social status and lower earning power
created and introduced more tensions and conflicts between men and women, as men had
difficulty relinquishing patriarchal privilege (Espiritu 1997; Glenn 1992; Kingston 1995).
Yet, although power relations were undermined in these families, this did not shield
Asian American, or African American women, from the extra burden of responsibility for
all domestic duties.
Gender and race both inform the lives of the physicians I spoke with, and these
statuses intersect to create unique strains in terms of career advancement, acceptance and
everyday life experiences. As Feagin states, “…[R]acism [and sexism] is structured into
the rhythms of everyday life” (2001:2). Indeed, together, these ideological structures
have created and maintained unequal economic, political, and social conditions between
men and women, whites and non-whites. Enveloped in a matrix of domination,
manipulated by controlling images, women and men of color must negotiate daily their
relationships and interactions at home and in the workplace, which are constrained by this
nexus of race, gender, and class.

BULLYING BLACK MEN: THE PSYCHOSIS OF PROJECTING WHITE PRIVILEGE AND
POWER

While I was in the field work phase of this dissertation, I detected a significant
difference in the tone of the conversations I had with the African American male
261
physicians relative to my interviews with the African American women physicians and
the Japanese American physicians, both women and men. The primary point of
separation emerged out of the copious examples shared by the Black male physicians
beginning early in medical school and continuing all the way up to their current positions
as established physicians that indicated Black men had to suppress and swallow the racial
injustice they encounter in their personal and professional lives. The detail and memory
of racist encounters with non-Blacks stood out prominently as I listened to the African
American male physicians recall and generously share with me their blood-boiling,
emasculating, undermining, and unjust experiences with racist colleagues and patients, all
the while remaining in a powerfully oppressive position of not being able to say or do
anything about these unjust experiences for fear of being labeled and regarded as the
“angry Black male.” Indeed, this unique positionality seems deeply connected to cultural
sensibilities and fears about Black masculinity and the “threatened” loss of white
privilege. This is not to say that African American women physicians are not challenged
or undermined, but that their status is qualitatively different than Black men, and the
types of responses vary between Black men and Black women.
Controlling images of Black men in contemporary society are the most damaging
influence on the socialization experiences of African American men, according to
Franklin (1994), where mainstream society in general is a rather toxic environment. The
mundane, tiring threats of judgment and negative responses in public carry serious health
affects and play an important role in the heightened risk of high blood pressure among
Black males (Blascovich, Spencer, Quinn, and Steele 2001). Shifts in economic
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opportunities have left Black men behind at nearly every turn (Stewart 1994), and
evidence suggests equality in terms of career, pay and employment may be getting worse
(Moss and Tilly 1996).
In every arena of education we can see clear and disturbing examples of our
society’s malign neglect or hostility directed towards Black boys and men. Ferguson
(2000) has named a “hidden curriculum” that systematically places Black boys’ behavior
under a microscope, analyzed for imperfections which can be treated as confirmation of
looming deviance. On college campuses Black men are frequently regarded as unwanted
strangers in a social space that is not only unwelcoming but hostile (Smith, Allen, and
Danley 2007). While the troublesome contradictions of describing “Black masculinities”
are beyond the scope of these pages (see Messner 1997; Staples 1978; Kingston 1979).
Collins’ (2000a) matrix of domination provides a good theoretical model to describe the
unique character of experiences described by the African American physicians I spoke to.
The African American men I interviewed clearly seemed to experience their
status as African Americans in very different ways than African American. Likewise,
masculinity has its advantages, but for African American men, there are also clear
challenges and hazards that come from it. Of all the advantages in education, and
especially math and science, available to men, it is striking that the trend among African
Americans is unique, as shown in Table 1. Among medical school graduates in 2010,
1137 were Black, and among African American medical school graduates, 66 percent
were women, up from 63 percent in 2002, while 34 percent were men. Asian American
medical school graduates are split evenly, and among whites, men make up 54 percent of
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graduates while women follow behind at 46 percent. While women’s numbers relative to
men are increasing among all groups, African American women are now far more
frequent medical school graduates than African American men. This trend and the social
characteristics that help to produce it will be explored through the lives of the physicians
I interviewed, which provide clues to the strong undercurrent of raced and gendered ideas
that have conspired to pull down the social and employment opportunities of Black men.
Table 2: Medical School Graduates by Race and Gender, 2010

Num % Num % Num %
Black
women 751 66.1 White women 4908 46.0
Asian
women 1759 50.2
Black men 386 33.9 White men 5759 54.0 Asian men 1746 49.8
Total 1137 100.0 10667 100.0 3505 100.0
source: Association of American Medical Colleges

Dr. Viola pointed out that “[f]ewer and fewer black men are going into medicine
and I think that has to do with recruitment and knowing that there is an opportunity to do
that.” She further explained that she feels that, “overall, black men have lots of racial
struggles from the time they were in school. My friend has had to go to her son's fifth
grade class, you know, ‘Why do you never call on him? He's smart and gifted, and he
feels that.’ That's not a good thing when a child can recognize that. But I think that's part
of it.” Dr. Johns-Washington, another Black woman physicians, states that “[a]s a
doctor, I think probably I think that Black males have more problems. I think my
husband has probably had more problems; I think that it's been probably a little bit easier
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for me…” When I asked Dr. Johns-Washington why she feels that Black men may face
more challenges, she explained:
I think - again, I think that Black men are seen more as challenging. The
perception and perception of other groups, whereas I think it's probably this whole
- the Black image that's come down from slavery, kind of like this mother/nanny
kind of thing, that people are more likely to be comfortable with me taking care of
them and with me walking in the room because, I might look motherly or they
think of me in that kind of way; as opposed to having a Black man come into the
room, and they're like, "Oh, here comes a Black man," kind of thing. And so, I
think that's my thought, is that, probably it's easier for me.

Dr. Johns-Washington’s observation is a complex one: as a woman, and in particular, as a
Black woman, she certainly faces challenges to her career advancement and just everyday
interactions with colleagues and patients; yet she identifies a level of discomfort many
people show in their dealings with Black men, especially in a care-providing, doctor-
patient role that is aided by trust.
Dr. Kingston explained that, “…black males get bullied a lot and pushed into
situations where they are often challenged.” Several examples emerged out of my
interviews with the Black male physicians that exemplify this constant bullying of Black
males while at the same time they are held to standards that others, particularly whites are
not held to. Indeed, Black men are expected to walk and balance a very tenuous and thin
tightrope, forcing them to constrain, stonewall, suppress, and swallow the natural feelings
and emotions that arise out of injustice that others would be more freely entitled and
allowed to show and express if they were put in the same position.

“Take Low”
265
Dr. James, an extremely talented cardiologist and exceptional individual, shared a
concept called “take low” that his father shared with him as a strategy for getting through
life as a Black male in America, which exemplifies the constant tightrope African
American men constantly negotiate.
…my father recognized that I had this spirit in me that he felt might get me into
trouble if it weren't kept under control. And he said, ‘[b]oy, you've got -
sometimes you've got to make certain that you don't upset some of the people who
can harm you." And he used the expression of taking low. He said ‘you gotta
know when you have to take low. And that's for your protection.’ And I didn't
realize what he was saying at the time, and didn't really care too much about it.
But later, when I had a chance to look at Black history and about the way that
Blacks over the centuries have been able to survive, I realized that that was good
advice. Because if you were - for instance, during slavery if you were a slave and
you were insolent, you could be killed or at least maimed…And so anyway, I took
heed of his suggestions and recognized the fact that there were a lot of people
who were in control in the world who didn't care whether or not I succeeded.

An older African American colleague also extended the same kind of advice to Dr. James
before he began a post-graduate fellowship where he was the “first and only black post-
graduate student in the entire history of all of the hospitals of [an Ivy League Medical
School. And [the school] controlled 20 hospitals in [New England].” One of the faculty
warned Dr. James:
‘Now, look. Let me tell you something, young fellow.’ He said, ‘You're going
into an absolute cauldron. It's going to be very hot there. They're going to keep
the heat on you constantly. You're the first to do this, and you've got to be careful
not to make waves.’ I said, ‘Well, I've heard that before and I think that I'm up to
that task.’ He said, ‘I mean, you really have to be careful because there are
people who are going to just be lying in wait for you and waiting for you to make
a mistake. And even if you don't make a mistake, they're going to put the heat on
you. So I said, "Thanks very much.’ This is a black doctor.

Thus, taking low means that in the face of adversity, inequality, and disrespect, as an
African American male, one needs to not make waves by challenging or protesting the
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disparity. Taking low involves swallowing and suppressing all of the feelings and
responses that would naturally flow from these sorts of adversities. For example, in
college, Dr. Kingston remembers fellow students vandalizing his lab desk with the word
“nigger.” He explained that he never dared leave any experiments unattended because
“people would sabotage your experiments.” Yet in the face of these and other offenses,
the advice to “take low” outlines a path of survival in social circumstances that are often
hostile. I will now further explore what ‘taking low’ involves and looks like and feels
like for these African American male physicians.
Dr. Rider, a surgeon at a prominent university hospital in Southern California,
described an extremely troubling racist encounter with a colleague that transpired without
any repercussions to the offending party. Dr. Rider explained, “[w]e were in a
conference in a little meeting here amongst the faculty. And I was having a hard time
getting my point across. And one of the more, I guess pompous faculty members - he's
kind of an elitist - he leaned over to me and told me to go to the back of the bus.” Dr.
Rider explained that, “I just stayed quiet and…then later on, I had a lot of anger.” He
ended up filing a complaint and spoke with his chairman, but in the end, they “kind of
just did nothing,” so Dr. Rider said that he “pretty much just dropped it.”
Understandably, Dr. Rider expressed that he was pretty angry and did not speak to the
colleague for about a year. Yet, unable to seek recourse in the face of such inappropriate
and abusive racial hostility, a lot of personal energy, resources, and emotional labor must
be expended on reconciling the anger and other feelings that arise in response to these
sorts of oppressive situations. As Dr. Rider explained,
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Well, it's a fine line that you walk I think as an - especially an African American
male, because of the stereotypes out there about African American males that
have lingered for hundreds of years. Maybe more violent, more primitive, not as
good - not as in-depth thinkers. And so when something comes up like that, your
reaction would be to start yelling and hit the guy. But you can't do that in this
type of setting. But at the same time, you don't want to [not] do anything 'cause
then you just look like you're a marshmallow or a punk. So I tried to do what I
thought I could do, but after that if nothing is done, I'm not going to call the
NAACP or something and get Al Sharpton in here. I just have to kind of continue
to work and let the feelings go away. I guess it can be difficult. But I try not to
harbor anger because it comes out in other areas of your life that it shouldn't. So I
understand when other people have it because it would be very easy for me to still
have it. But I've taken efforts pretty consciously to make sure I get rid of it. And
I think a lot of it is gone. So as it comes up, I really - it festers for awhile and then
I really try to actively diffuse it and get rid of it…You can't hold onto those
things.

Dr. Rider credits his religious faith in Christianity as a significant source of solace that
allows him to work through and let go of the anger. Incidents like these are too
common still, but what might have allowed Dr. Rider to bring up this example with
minimal effort and background is the rather clear and obvious way it portrayed race. In
this example, race is stated, it is highlighted and acknowledged as important and
communicated as such. In most cases of discrimination, the communication is much
more confused, and the use of race subtle (Dovidio, Gaertner, Kawakami, and Hodson
2002). As sociologist Deirdre Royster (2003) explains, Americans often communicate
and talk about race without actually using the words, and this is the modern style of racial
meaning as portrayed through subtle meanings (Bonilla-Silva 2002; Bonilla-Silva and
Forman 2000). As Dr. Rider indicated, African Americans, and Black men in particular,
must walk a fine line, and it is a very fine line, with next to no room for any missteps.
This tightrope must be walked in a literal battlefield of racialized meanings that litter the
daily lives of Black doctors.
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As Dr. Rider indicated “there’s definitely stereotypes out there.” As I quoted him
earlier, Dr. Rider touched on a crucial aspect about attitudes toward Black men in
America; that there is this perception that African American are more primitive, prone to
violence, hyper-sexualized, and less intelligent. These racist depictions and
misperceptions about African Americans are deeply ingrained in the fabric of this country
as well as the mentality, mindset and way of thinking for many Americans, and can affect
their behaviors even when they consider themselves “colorblind” (Dovidio and Gaertner
2000). As Dr. Rider said, these attitudes have “lingered for hundreds of years.” As a
result, whites and others approach and interact with African Americans with these beliefs
in tow, thereby shaping and framing how they treat and disrespect them. Yet, due to the
gaping imbalance of power and the profound sense of fear and insecurity of others about
their own loss of power and privilege, Black men have almost no other recourse but to
take low, as Dr. James’ father advised.
Dr. Rider, expressed that, “…you can’t really do much to erase it because you
can’t get too angry about it.” Dr. James shared that
One of the things you learn to do is to…stonewall things. You put them off, you
put them behind a wall, so to speak. And try to forget about them. You suppress
them. If you’re going to go on, you can’t have things affect that actively on your
mind. And so you cover them up…And the other thing that you do is try to
develop some distractions, some things that allow you to…get your mind off of
all of those things.

Indeed, it seems whites are so sensitive and defensive to claims made against them
hinting at any sort of racist proclivity, that Black men and other people of color have to
tread carefully in making claims about racial intolerance. As I stated earlier, I was struck
(but not surprised) by the lengthy and clear memories the African American male
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physicians recounted about their experiences as Black men in America, and in the field of
medicine more specifically and the ways in which they had to ‘take low’ in order to keep
moving forward. I will continue to discuss a sample of the direct confrontational
challenges the Black male physicians encountered throughout their career trajectories and
the ways in which they took low in each situation.
Out of one hundred and fifty students in medical school, Dr. James was one of
three Black students when he attended decades ago. He explained that, “[m]edical school
is one of those situations where you simply must make sure that you don't upset the apple
cart or make waves or whatever. Don't want to call attention to yourself, and if you're
black you already have attention called to.” He went on to described a couple of
disheartening experiences that he encountered:
A couple of things happened there. I was on rounds one day when this resident -
the chief resident in fact - decided that he was going to I guess you might say take
issue with me. I was a young medical student. And it's not unusual for residents
to kind of lay it on the students. But he did it in an unusual way. He started
talking to me as though I were really an inferior and didn't have much
intelligence. And the ultimate thing that he did was he said, ‘I'd like to see what
your hair feels like.’ And he took his [hand out]. And I had to stand there and
take that. And there were all these other people standing around and everything.
And it was just him trying to humiliate me. And he was really waiting for me to
do something to get back at him, and I didn't. I mean I just - I knew what would
happen. I would really catch a lot of flak from that, and get written up.

As Dr. James instructs, the field of medicine is replete with robust hierarchies and, a
young medical student, of any race or gender, sits pretty low in those hierarchies. Yet, as
Dr. James also points out, other subordinating variables that stratify people in the broader
general population, such as race and gender, only intensify the deeply anchored
hierarchies in the medical field. Thus, as a young African American male medical
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student, Dr. James was subjected to brutally demeaning and humiliating vulgar racism.
With the understanding that as a young Black male medical student and further, as a
Black man in America, the chief resident had the power to command Dr. James to stand
there and endure humiliation and indignity while the institution of medicine as well as the
individuals who maintained the policies and practices of the structure, further uphold
white supremacy through these sorts of dynamics and interactions. Dr. James went on to
share more instances where he was required to take low in order to continue moving
forward toward his career goals.
I also had an instructor who was from South Africa, a white instructor who didn't
like the idea that there were any Blacks in the school. Of course, they had
apartheid there in South Africa. And he was a product of that. And I can
remember him very well, Dr. Wilde who tried to make my life miserable as much
as he possibly could. And again I had to, as my father said, take low. Don't make
any waves. Just go ahead and accept it. Your object is just to get through, and I
just kept that in mind. There were several other examples. One of the most
blatant ones was when a professor of gynecology came through from a southern
university, and he went to the grand rounds for the medical school. And I went to
the grand rounds. The grand rounds was on a subject called endometriosis. You
know about that? And he had been doing some studies on this disease. His
studies were very unusual. He - this was during a time when you didn't have to
have patient consent for patients to sign a human experimentation form or
anything of that sort for an IRB looking into the [study]. And so, he gave this
lecture on his experimental work with endometriosis, which involved taking black
women - and all of the subjects that he shared were black - and actually cutting a
hole in their abdomen - to reveal the uterus so that he could observe day by day
the changes that their uterus was going through with this disease. And just about
everybody in the audience was white. Nobody took issue with the fact that he
was doing these horrible experiments. And I sat there and was very, very tempted
to say something. But again, I knew that… [as a] medical student—I gotta keep
my eye on the prize, so to speak, and not make waves.

Dr. Parker shared his own experiences of taking low in response to various
instances of racial inequality as a way to keep moving toward his end goal of becoming a
physician, a goal that might have been impossible without the act of taking low. At a
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college orientation at a leading Southern California university, Dr. Parker recalled
hearing someone yell out a window, "Oh man, that sounds like a Negro." He described
how he was left just standing there asking himself, “what do I do with this?” In spite of
the stereotypes of Black men as unthinking and uncontrolled, Dr. Parker contemplated
the situation, decided there was nothing to do except swallow it, and walked on. Dr.
Parker described how, “we had friendly conversations all day and I said, wow, you never
really know what they're thinking. You really never know what their perception is, of
you.” Indeed, Dr. Parker highlighted the often insecure position African Americans can
find themselves in when coexisting in white dominated spaces—an ominous side of
integration and upward mobility (Willie 1978).
On the surface, some whites may appear accepting and tolerant, but the reality is
their positionality within racial structures and hierarchies affords them a powerful
standpoint that can lead to racist and judgmental perceptions and beliefs about non-
whites, putting African Americans and other racial minorities in a precarious space
because they face retaliation if they speak out against racial intolerance. Dr. Parker
recalled how angry he felt having heard that window assault, “Oh man, that sounds like a
Negro” echoing in his mind. He shared that he talked to his mom about it and that he
“wanted to kick this guy's ass. But again, we're [limited] because I knew [I had to show]
restraint because I knew that if I did that, something was going to happen to me and I'm
not going to be able to get from point A to point B.”
Dr. Kingston described one situation he encountered as a resident in Boston. He
explained that he was working on “a patient with a severe rheumatoid arthritis whose
272
hands were crippled.” Dr. Kingston continued to describe how this patient came in with
a very high temperature, which involved having to “take blood and run it through and
grow - do blood cultures and so on and so forth.” “And he comes” Dr. Kingston recalled,
“about 4:00 in the morning…I've been working on him for four or five hours getting his
temperature down, and he says come morning, ‘I don't want any shoe shine boys around
me.’ So, very much ingrained in Boston, and it still exists, the racism that is just
ubiquitous through the whole city.” Similarly, also as a resident, he had been working
with a particular patient at the hospital through the night. She came in very ill and
required a lot of intensive care. Dr. Kingston explained that after almost four hours of
working on and stabilizing the patient, “she sa[id], ‘I don’t want no niggers touching
me.’”
He continued to describe his reaction as well as that of his attending physician,
And I pretty much complied and so I told my professor about her or told the
attending physician, and his response to me was, ‘You'll never be a doctor if
you're gonna let something get under your skin like that.’ He had no sympathy
for the situation whatsoever, and this was a poor Irish Catholic out of South
Boston who made this statement. So, the next morning when we have the rounds
that we take…I'm talking to her, but…she won't respond or say anything to me.
She only talks with the attending physician, who was white, and so then she
concludes it with saying, "Tell the nigger to go get me some water." And he
actually requested me to go get her water without reprimanding her at all with
regard to her derogatory statement.

The racism expressed by these particular patients is beyond unnerving; yet even
more troubling is the smug, dismissive and insensitive reaction of the attending
physician, revealing his own racial entitlement as well as the oppressive “take low”
dynamic that Dr. Kingston had to and continues to negotiate as a Black male physician.
The attending physician’s reaction also exemplifies that even in the face of blatant and
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unmistakable racism, the white attending physician was unable to comprehend, or just
didn’t care, about the significance of the patient’s disrespect. This experience exposes
the foul and vulgar misconduct that both patients and colleagues and supervisors were
able to engage in at the African American physician’s expense. To reach his level of
achievement and then to be ordered, and condoned by his supervisor, as the “nigger,” to
go fetch some water, reveals how unjust and disempowering it feels as an African
American male physician. The injustice that flows from this inequality is summarized by
the simple yet sufficient statement by Grier and Cobbs, “[t]here are rules which regulate
black lives far more than the lives of white men” (1968:61). Taking low is an
understanding, a sense of “double consciousness,” as Du Bois called it, that these double
standards in behavioral expectations are ubiquitous.
Another situation that Dr. Rider experienced further exemplifies the internal
emotional management and negotiation of one’s feelings in the face of these racially
unjust realities. Dr. Rider explained that “he built up a surplus…of about sixty thousand
dollars” in his faculty account. It turns out that when he requested access to the funds, he
learned that the money had been used and no longer exists. Dr. Rider clarified that he
does not feel that his funds were used because he is Black, and that he thinks other
faculty members may be in the same situation as him, but the very apparent racially
uneven aspect of this situation clearly emerges out of how he can or can not handle his
own feelings and his public response. Again, as an African American man there are
unstated rules of conduct he must follow to maintain legitimacy.
And so what do I do? So then again, do I erupt violently and start cursing and
getting mad? Or do I just sit quietly and then they'll think that I'm an idiot
274
because I really didn't understand what happened. And so I'm just kind of - what
do I do with the anger and the frustration? Because that was my money. But who
can I trust to talk to about it? So that's kind of what you go through. And if you
have a couple other colleagues that you not only see here at work but maybe you
see at your kids' play and all those, then you develop and you build up that trust to
be able to discuss all those issues with. But right now I'm like, okay, who can I
really trust to talk about it with? And I know it probably happened to other
faculty members. And I don't think it happened to me because of race. So that's
eliminated. But how do you - what do you do? And so I just let my immediate
supervisor or chief know, and I let him know I was dissatisfied. But I couldn't
really show the emotion that I was feeling.

Dr. Rider explained that in one particular situation he did express his feelings, and as I
will discuss in the following section, this was used against him, perhaps as a way to
“keep him in line.” So, unable to express his feelings about this problematic and unfair
situation, Dr. Rider is left to only restrict his feelings and his only recourse seems to be to
contain and manage his feelings within himself and by himself, in isolation-at least in the
workplace. In Dr. Rider’s words
So now what do you do? Do you suppress and look like a mute? Somewhat of an
emotional dummy…what level of reaction can you have? And it's really difficult
to figure out. Because if you overreact, you're too volatile. And if you under
react, you look like you just don't know what's going on. And so yeah, that's
where having someone else very close would help to figure out how to navigate.
Right now for the money, I can't do anything. I'm just waiting to see what the
chief level does. I can't do anything. I do know that it happened to other people,
and they're upset. And I'm kind of learning from one other guy what to do. But
right now, yeah. You just have to let it go. Right now I'm working on, again,
getting rid of the anger.

Getting rid of that anger is challenging when there are no socially sanctioned
outlets for him to do so without his upset being viewed as an example of “angry Black
male” syndrome. Just listening to Dr. Rider’s description of this frustrating and
infuriating experience, I could myself feel a sense of suffocating helplessness. So few
“acceptable” options seem available to Dr. Rider; just as he described earlier, as an
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African American male he walks a very fine line that involves constant work within
himself to craft the least offensive response possible and to absolve the anger within
himself. As an outsider to this positionality, I myself felt enraged reflecting on all that
Dr. Rider had shared with me, from patients telling him that he looks like he should be a
basketball player; to telling others that he is a mechanic after growing tired of the
unending questioning that would ensue upon sharing his real occupation as a surgeon
(due to seeming disbelief that he, a Black man, could really reach such occupational
stature); to his feelings of loneliness and isolation, regretful that there is no one to eat
lunch with or confide in when difficulties arise; to disrespect from his colleagues. And,
in spite of all of this, Dr. Rider presented these situations so matter-of-factly; completely
opposite of the claims and complaints that people of color, especially African Americans
play the race card too often. And, in spite of these taxing recurrent negotiations, he has
managed to impressively move forward and continue on his way.
Dr. Parker elaborated on the restraint required when taking low in these racially
oppressive situations in order to avoid unbalanced punishment that could derail his career
plans. In one particular situation he recalled how he was taking more than the required
amount of classes at the Ivy League university he attended; yet the “dean wouldn't let me
drop a class and I knew I was in class with this girl and she dropped the class the day
before.” He explained how he was
taking five classes. And you only have to take four classes. Heavy load. I was
taking a heavy load and I said ‘man, I got to drop this class.’ And you had to get
a special dispensation. If you were going to go from four classes to three so you
had to get a make up. But I'm going from five to four. I'm only required four.
Wouldn't let me drop the class and I'm thinking, ‘hmmm, what could this be.’
276
And I'm sitting in the dean's office and they are here to help you. You know, this
is one of the things I said, ‘I thought you were here to help.’

Feeling as though he was being held to a different standard and pushed in a different way
then fellow students, Dr. Parker felt enraged, but could do very little to challenge the
Dean or his decision because, “I couldn't have gotten from point A to point B. That's just
it…” Yet, sometimes all of the injustice incurred throughout their lifetime can be
overwhelming and engulfing:
so a lot of times, like I said, a lot of it you hold within and some of the guys that I
grew up with couldn't and that's why they are either dead or in prison, because
there is this anger that you can’t always keep in your pocket. And you can’t
always… And I know several times I swallowed hard and I said, ‘oh, that's a pill.
I can’t respond to this and I cant do that.’ And you know, because my mom had
told me the same thing, ___ which I probably inherited from her. And she said,
‘you know, there are times that you are going to just have to learn to walk away.’
I think that's what I learned better than anything is that you just have to kind of
walk away from the situation and count to ten if it's not that important. It's one
thing to defend your life, but the situation where you are just upset and angry, you
just kind of walk away. And that's the same thing I told my kids. You know, you
can be upset about it, but an impulse, like I said, can affect your life forever. I
said, yeah, because I mean, there are people I could have killed. I was even
bigger then than I am now. Oh, yeah. I'm glad you brought that up because,
yeah, where do you put that? Where do you store that? I think I'm a pretty strong
person, but I know it has affected a lot of other people, physically and mentally
because there is just no place to put that and it just wears you down. It just wears
you down and beats you down.

Taking low, walking away, storing it in your pocket, are all similar terms for
strategies that African American male physicians have had to rely on throughout their
journeys to becoming physicians in America; and I’m sure they would contend that these
strategies not only apply to them as physicians, but to all African American men trying to
live out their lives in America. Yet, as Dr. Parker indicated, sometimes the strain of
taking low—swallowing, stonewalling and suppressing—racially hostile and
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unwelcoming situations is very taxing on a person’s emotional an physiological health.
Dr. James also indicated that “[e]very once and awhile, they will come out. It’s like you
have a blister or a pimple, so to speak. Something that’s there, but it’s being held down.
But eventually at some point or other, it kind of bubbles forth to the surface and gets out.
And that’s a good thing, because trying to hold all of that in constantly is not necessarily
good for you or for your psyche.” Indeed, emotional stress and exposure to
discrimination have damaging health affects for African Americans (James, Yan Yu,
Jackson, and Anderson 1997). For people of color encountering racism, peers are a very
valuable resource (see Lopez 2005), which can at times be troubling when such
colleagues do not exist to provide social support.’

The Penalties of Not Taking Low
At many different moments, and all throughout the range of their careers, the
African American male physicians I talked with endured many oppressive and
dehumanizing racist encounters with patients, colleagues and supervisors. As Dr.
Kingston explained, Black men are often bullied and challenged, through what I contend
is a display of white power and irrational projection of fear about the loss of power and
privilege which is visible in opinion polls regarding race relations (Gallup 2009). In each
of the situations I just discussed, the physicians were almost powerless in their abilities to
directly respond to the inappropriate and abusive demands put on them. It is as if there is
a constant testing ground for whites to see if they still maintain the upper hand and as a
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way to soothe their irrational fears about the loss of white power and privilege. As Dr.
James expressed,
And in fact, if I stepped out of line as they would put it, I needed to be pushed
back into line. I saw that kind of thing happen all through my career. Not just
when I was in high school and college, but in medical school and in my residency
training, specialty training - cardiology - and in my professional career and
practice. So it's been an underlying theme, so to speak. Just be careful if you're
Black. No matter how accomplished you become, there's always somebody who
is going to try to push you, so to speak, back into your place. And it's a matter of
how much of that you feel that you can accept. And it's just been something -
kind of an overriding part of being a Black medical professional in America. It
continues right to today, no question. Yeah. I mean, I could give you some
examples of in each stage of my career… There was always something that kind
of dragged me back to make me realize that the first thing was that I was Black.

Indeed, if these physicians did not take low, it is likely they would have faced
severe consequences. Taking low is a strategy that the physicians, and I am sure other
African American men, have learned they must constantly put into play just to “do life.”
If they step out of line, “there’s always somebody who is going to try to push you, so to
speak, back into your place,” as Dr. James expressed. For example, in sharing his
cautiously controlled response upon learning that his research funds had been used and
were no longer available, Dr. Rider recalled a previous situation where he did express his
anger, which was later used against him. He said,
I remember one time [a colleague] told me something and I kind of blew up and
used some expletives and walked out the door. And even though I thought that
was justified…my reaction; I maybe was too strong with it. But then what he said
was, ‘Well, next time we have an issue coming up, I would want to tell you about
it. But I don't want you to explode violently, so I don't know if I can tell you
because you react so strongly.’ So it's like wow. Now all of a sudden, my
reaction is being used against me.

Again pervasive stereotypes that depict Black men as angry, aggressive, and impulsive
likely informed how this person read Dr. Rider’s reaction. While Dr. Rider
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acknowledged that his reaction may have been too strong, his supervisor’s response also
comes across as punitive and subordinating, as if to whip Dr. Rider back into submission.
Dr. Higgens explained involvement in similar situations where “things were clearly
stretched well out of proportion,” making him wonder in comparison to others’ realities,
“why do I have to behave this particular way? And you know for a fact that others aren’t
necessarily having to behave a particular way, whether it’s getting their point across or
whether it’s actually just trying to do their job.”
For example, after one situation, Dr. Higgens’s supervisor reminded him that he
needed to be mindful of his physical stature when interacting with others in the
workplace. Dr. Higgens explained that he was talking with a group of people when
another colleague walked up to the group “and just starts talking and answering questions
without addressing anybody.” Feeling irritated, Dr. Higgens did not respond to this
person, so the colleague complained to their supervisor. The supervisor spoke with Dr.
Higgens explaining that, “so and so says that you looked at him.” When Dr. Higgens
asked, “And did what?” His supervisor responded by saying that the colleague claimed
that “…they came up to the group and they had a question and you just looked at them.”
Dr. Higgens explained his standpoint to me:
Okay. If you're talking about this particular circumstance, if you were talking to a
group of people and somebody comes up to the group of people and just starts
talking and answering questions without addressing anybody, what exact response
does that person deserve? Now, you could say I was being a little edgy, but the
reality is you don't just walk up to a group of people and just start [doing that].
And then to have a response to that as if I'm in the wrong.

It is almost laughable to think that someone would take such an insignificant slight
to a supervisor. Yet, given the nature and structure of racial hierarchies it is also
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worrisome, because if the person in the position of power is not opposed to misusing their
power or their decisions are influenced by whatever racial biases they have, the jobs and
lives of people such a Dr. Higgens could be easily jeopardized by an insignificant issue.
As an African American male himself, it seems his supervisor had insight on the dynamic
and process that was going on and cautioned Dr. Higgens (as opposed to warning or
reprimanding as a white or other non-Black supervisor may have done) by saying,
"’You're right…[b]ut Jeff, you're 6 feet tall. You're Black. You have this presence. It's
just going to be a response.’ And not that I was naïve to that, but it's like, wow. Wow.”
Thus, as an African American male, his supervisor understood the racialized perceptions
of the other colleague, and wanted to caution Dr. Higgens, and in doing so illuminated
how carefully Black men have to carry and conduct themselves. It seems there is little
room for expression of one’s realistic and suitable feelings; it is as though Black men
have very different rules they must follow in order to avoid retaliation, disciplinary
action, and punishment; these are some of the same findings Ferguson highlights in her
study of the school discipline of fifth and sixth-grade Black boys, who they were subject
to a “hidden curriculum” which served to trap them more easily than other students.
Related to that disconcerting similarity, Dr. Higgens said, “I mean at a certain point, as I
said, you reach a certain level of maturity that you really just need to get your life done.
You don't have time for dealing with their insecurities or their just nonsense.”
As I stated earlier, if the wrong person is in the position of power, the
consequences for the person who the complaint is made against, could be very costly.
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Dr. Howard shared an experience similar to that of Dr. Rider and Dr. Higgens, but with a
very tragic outcome for herself and her now-ex-husband:
My former spouse was a junior associate in a major law firm, and he got into a
dispute with a female adjuster in the insurance company who reported him and
misrepresented their conversation, not being aware that he had held the
conversation not in his private office, but in the secretarial bay. He happened to
pick up the phone there, and so the others in the office had heard his side of the
conversation and were able to [verify it]-- it got to the point where he was fired
precipitously, like, two weeks before Christmas. And we had, like, a one-and-a-
half year old and I was pregnant with the second child, and I had been in an auto
accident and I was unable to work, and so he got this - y'know, [boss] came in one
day and…said, "Here's your check, pack up your stuff and get out by 2:00."…
Just like that, after he had this argument. They insisted that he apologize and
made him travel - and he struggled with this for 24 hours about whether or not to
apologize. And he went down and he apologized for what he hadn't done, and the
person he apologized to, who was the supervisor of the woman, said, "Well, I
don't think his apology was sincere," so they fired him. He had not had any
negative work records or whatever. He sued them; he won… But it was an eight-
year process that absolutely devastated us and ultimately ended up in our
divorce…[I]t really broke him because he had gone to UCLA; he had gone to an
elite private university also; he was an attorney. And, y'know, and they just blew
him off because he raised his voice at a white woman, and she accused him of
cursing and all this stuff, which he had not done. He did raise his voice, but he
did not curse or anything; he just said - she said, "Well, I don't know," and he
said, "Well, you'd better find out." And because he said it with that tone, she
accused him of cursing at her and threatening her and -it got crazy. But, once you
sue, then you're seen as a trouble-maker, so he could not find a job after that. He
was hired by a security firm that he eventually had to leave because he found out
they were doing some shady stuff, but it really broke him and he had to start his
own practice, and he was really struggling. He was very, very bright, very hard-
working fellow, but, y'know, he became bitter. He was drinking, and, y'know…

After asking the physicians how they deal with living under these sorts of
constraints, the continual questioning and never-ending proving ground, Dr. Higgens
shared a concern with me, pointing to the death of Wayman Tisdale. Briefly a
professional basketball player and a musician, he died at the age of forty-four, right in Dr.
Higgens’s age range. Dr. Higgens shared:
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You wonder and you look at the numbers, and you hear about some of the
numbers, that not only - I don't know what the African-American numbers are,
but physician numbers, life expectancy to be in the mid 60s, [rather than] late 70s.
That's not comfortable. It's stressful. I mean, when you talk to the surgeons you
think about the stress or you wonder - I guess worth it is probably too strong of a
term. But if you're trying to balance getting a life done and all that that means for
your life and to have, on top of that, other things happen, you're like wow. This is
crazy. Is this crazy or what?

Indeed, life for anyone requires can require a lot of work and energy; but when you add
into that mix everything that African Americans, and in particular, the specific sorts of
restraints on Black men, it can start to feel “crazy.” The stress and emotional toll of that
stands out in the life expectancy rates of African American men (Sue, Capodilupo, and
Holder 2008). Dr. Parker adds that the emotional stress of the constant scrutiny and
bullying is…
probably why black people have hypertension, yeah. I think that's one of the
factors because in the intent that you experience this and there is this anger that's
inside, sometimes you just can’t get rid of because you associate, you go through
all of this and you can’t get respect. I mean, a guy answers his door in Inglewood
and the policeman shoots him. I mean, that kind of stuff, I mean, you want to go
outside and scream because it continues to happen over and over and over. The
innocent guy, no gun, gets shot. I mean, over and over and over. It's just very
frustrating, so yeah, it's very frustrating and you can’t seem to do anything about
that, yeah, because it's all a perception. You know, you are perceived as a threat,
so the first response to you is an aggressive response and I don't know how to fix
that. I mean that's a perception…

At the beginning of this chapter I quoted Dr. Kingston explaining that there are
rules and then there are rules that African Americans must follow. Beyond that, Black
males must follow a completely different set of rules and spend a lot of time “trying to
prepare [their Black male children] for the negotiation.” Dr. Parker adds, “[t]here is a
difference in how the justice system works, so one strike for somebody may be three
strikes for you and that's what you always have to be aware of. I said, maybe some of
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your friends can make that mistake, but you just can’t afford to. You just cant. And
that's the way I've always parented my kids. And most of us have.” If he were to have
boys, Dr. Rider stated that to help steer them in the right direction and to keep them out
of trouble, he would let them know that “there’s going to be certain things that are going
to come up. And, but you can’t get angry about it…. So that would probably be what I
would try to hammer home. And really, to try to make sure that they didn’t harbor any
anger… don’t let the anger build.” Thus, each of these physicians reveals what life is like
as a Black male, despite the achievement of high status and high paying occupations.
Black men constantly negotiate life within the constraints of a different, more disciplined
and more strict set of rules. They cannot do what their colleagues do and most
importantly, they can’t get angry about the inequity of their lives. They must take low,
not make wakes and be sure not to make the white folks around them feel uncomfortable.

CONCLUSION

In this chapter, I explored the ways that gender norms and ideologies complicate
the personal and professional lives of the physicians I interviewed. In particular, I
focused on the unique challenges that the African American and Japanese American
women physicians encountered due to gender differentials in the field of medicine as well
as at home. Additionally, I discussed the unique positionalities of Black male physicians.
While women have made inroads within the field of medicine, challenges remain.
For example, while some of the older women physicians expressed that in their time,
when they initially embarked on their medical careers, it was fairly common for women
to have to make a choice between career and family. Indeed, some of the older women
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physicians that I interviewed did make this choice for themselves and chose to focus on
developing their careers. Whereas, currently, more women are making the choice to find
ways to fit careers, children and families into their lives. This process is not easy or
uncomplicated and without compromise, however. While women today are less likely
than previous generations to choose one over the other, their choices are still constrained.
Now that they have careers, they face the challenge of how to balance both work and
home, with domestic responsibilities still falling primarily on their shoulders despite their
change in status as a family wage earner.
For example, many of the women discussed “lifestyle” choices that factor into
their decision when choosing their specialty. Those seeking to maintain a more even
balance may choose a “lifestyle specialty” such as dermatology, which due to more
family friendly hours and demands, makes a better fit for those wanting to enjoy both
career and family without too much compromise on either side. Likewise, surgical
specialties remain very difficult options for women wanting both equal professional and
personal lives. While many of the women physicians I spoke with discussed making
career choices and decisions based on children and family, none of the men of the men
spoke of this constraint. Further, it was expressed that men are more likely to make
career choices and decisions based on their own personal goals, while women are more
likely to make career choices based on a multitude of considerations, most prominently,
the needs of their children and partners.
In addition, to making pre-planned choices of specialty, sometimes prior to even
having children, women find it is necessary to have a very solid and well developed
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support system in place in order to make both career and family work. Support from
family members, such as one’s parents and partners as well as from paid domestic labor
sources such as nannies and housekeepers, is crucial to enabling women physicians to
maintain families alongside their careers.
Yet, it also seems that women find it necessary to curtail their work lives as family
demands present themselves, especially as their children’s needs grow. Some are forced
to accept that they can’t do everything and eventually bend their careers around the needs
of their families. For instance, some women end up choosing to work part-time while
others decrease productivity by forgoing things such as publishing, researching, and
lecturing at invited talks and conferences. These sorts of compromises in the end affect
promotions and opportunities for advancement. Finally, as women attempt to balance
their professional and personal lives, it struck me how support from other women
constitutes a key aspect of making it work. For example, while on the home-front, these
women physicians relied extensively on the domestic work of their nannies and/or
housekeeper (roles which tend to be filled by women) to care for their children when they
could not be there, to prepare their families meals or at least assist in this process and just
help to oversee the overall management of their homes. Similarly, on the work-front,
these women also explained how other women physicians worked together to help each
other out by developing creative strategies such as sharing practices with other women
and covering for each other so they could attend a child’s performance or school function
in order to maintain both parts of their lives. Thus, I was struck by the degree to which
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the physical labor as well as emotional support of women extended to other women made
careers and families possible.
Finally, it is clear that changes on a structural level as well as an ideological or
cultural level in terms of gender norms and expectations, need to occur before women
will be able to participate in the paid labor force in the same fashion that men carry out
their work lives. Paternity leave may be one step in the direction toward equalizing the
balance of paid and domestic labor between women and men.
The journey to becoming a physician is not only more challenging and
complicated for women of color, but also for African American male physicians, which
points to the highly complex ways that race and gender intersect and work together to
reproduce and maintain highly layered and sometimes ambiguous hierarchies. The
African American male physicians revealed deeply troubling, disturbing, sad and
tremendously unfair career trajectories wrought with clear and repeated experiences with
overt racism, in addition to the typical covert manifestations that I have addressed in
other parts of this dissertation.
In talking to the African American male physicians, it became evident just how
deep the double standard between Blacks and whites runs in the U.S. Indeed, African
Americans, and men in particular, are held to a standard that I did not hear the Japanese
American physicians having to negotiate. Dehumanizing stereotypes and controlling
images of Black masculinity, which describe Black men as violent, primitive, hyper-
sexualized, lazy, incompetent, impulsive and less intelligent confine Black men to an
extreme tightrope that they must constantly walk everyday in every aspect of their lives.
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In their efforts to become physicians and even as practicing physicians, African
American men have been bullied and have endured and continue to endure countless
indignities and injustices; yet, learned early on, that they must “take low” in order to
move forward in their careers and their lives.
“Take Low” is a term that one of the African American male physicians shared in
his interview, but is something that each of the African American male physicians
practiced at numerous point in their lives. Taking low involves, not making waves and
swallowing, stonewalling, and suppressing one’s natural feelings and responses to racial
adversity and racial injustice and it is a strategy that African American male physicians
are forced to use throughout all stages of their careers; not just as medical students when
they sit at the bottom of the medical field hierarchy.
With the exception of Dr. Henderson, each of the Black male physicians that I
spoke with shared many instances of open racial hostility communicated to them from
patients, colleagues and other personnel, ranging from subtle expressions of racial
stereotypes all the way to clear expressions of contempt for African Americans. Most
importantly for the purposes of this discussion, the experiences they shared with me
illustrate the ways in which, as Black men, they have to swallow, stonewall, and
suppress—or take low—when confronted with various instances of racial injustice. Dr.
Rider’s undermining experience with his colleague that instructed him to get to the back
of the bus provides one example of how, even as established physicians, efforts are still
made to “put Black men in their place.”
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Taking low is not only a strategy that African American men have utilized trying
to accomplish their goals and get through life; it really is a survival mechanism. Not
taking low can result in retaliation, punishment, disciplinary action, etc. Yet, at the same
time, it is likely that this highly constrained, disciplined and scrutinized life reality leads
to more health problems as well as lower life expectancy rates among Black men.
The work lives of physicians, just as the work lives of anyone, are built around
gender and racial classifications as central aspects of our identities. African American
men are declining in their representation among physicians, while women among all
racial and ethnic groups continue to increasingly pursue careers as physicians. The so-
called feminization of medicine, especially particular specialties such as obstetrics and
gynecology, and pediatrics has prodded changes in the systems of medical training and in
workplaces around the nation as women physicians bring their family obligations with
them. Men’s lives and careers, as women physicians described, have the freedom to be
relatively unencumbered by children or family obligations, even when they have children
and spouses, and when their spouses have demanding careers as well. The decline in
leisure time among women, but the formidable space men seem to keep around such time
reveals much about the continued inequity in parenting obligations and social
expectations surrounding the primacy of mothers.
The trend towards a decreasing presence of African American men in medicine
smacks colorblind logic upside its head. Claims that racial inequality are declining do
not ring true if we measure the daily life experiences of African American men, and view
the evidence that describes their continued struggles in the labor market and gaining
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upward mobility (Royster 2003). In a precarious position as Black men, they cannot
safely act as white men do, for instance, to defend themselves or show their upset. Yet
African American male physicians also risk internalizing their anger and frustrations
when they cannot show them in public for fear of being labeled as an “angry Black man.”
These gender and racial meanings we collectively grant so much meaning—to assign the
task of building family lives, or to hold angered emotions pent up—have life-changing
impacts on people’s lives. Women physicians whose male partners do not share family
responsibilities and labor bear a huge emotional and time burden, and can burn out much
more easily from the full needs of both career and family obligations. African American
men who feel obliged to “take low” and bottle up their emotions when confronted with
insults and treatment that devalues their existence are but some examples of the power
gender and race hold.
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CHAPTER 6:
CONCLUSION

There is a growing trend in public and academic circles to see racism as a
problem of the past. Colorblind ideology and increasing levels of success among various
ethnic/racial minority groups, have perpetuated the idea that race has lost its significance.
Indeed, people who see themselves as colorblind tend to claim that they only see people
for who they are rather than the color of their skin; therefore they couldn’t be racist,
because after all, they don’t even see color! Similarly, some claim that socioeconomic
success, such as the high level of educational, occupational and economic achievements
made by Asian Americans, represents an assimilation (which is often misinterpreted and
equated with racial equality and full acceptance or citizenship) into the mainstream. Or,
as Alba and Nee (Alba and Nee 2003) claim through the use of extensive quantitative
“evidence,” that some Asian American ethnic groups actually now help to define a
mainstream composite culture due to their statistical placement on measures such as out
marriage, language spoken at home, spatial patterns. Similar sorts of claims are being
made about African American women (Kaba 2008) and now, the election of a Black male
President, seemed to signify for many a true end to a very shameful racial past. Yet,
beneath this surface lies a confused notion of how to understand race and racism in the
contemporary US. How do we interpret the upward mobility of some people of color and
yet acknowledge that the picture is anything but clear? The experiences of high-earning,
high-status professionals of color provide insights into answering this question, and help
to make the picture more focused and complex.
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Through this dissertation, I critically engage with these sorts of racialized
narratives. Specifically, I show that first, racial dynamics are much more complex than
what socioeconomic measurements can capture. Individual stories of lived experience
regardless of income and educational level and occupational status reveal much more
about the qualitative process and reality of how race functions in one’s life that statistics
alone cannot address. Thus, through the lived experiences of physicians of color, I show
that despite successful careers and high incomes—the typical markers of “having made
it” that can be mistaken as an indication of an overcoming of racial problems—race and
racism remain salient and significant in these physicians’ lives.
Second, I show how race remains salient in American life by uncovering the
specific ways that race and racism continue to negatively impact everyday life for
African American and Japanese American physicians, personally and professionally. In
particular, I focus on the subtle micro-level interactive processes through which racial
dynamics and meaning are maintained. I show that race is still salient because it shapes
how others perceive and attach meanings to people of color. Further, I also contend that
the racial consciousness of the African American and Japanese American physicians,
exemplifies another way that race remains a core aspect of being American.
Third, I show the specific ways that gender intersects in a way that differentiates
the experiences of African American and Japanese American women from their male
colleagues as well as the unique life experiences of African American men.

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BRIEF CHAPTER OVERVIEW
Comprehensive summaries of the major findings follow the end of each empirical
chapter, but I will provide a brief overview of the primary findings of this dissertation
project. I discuss chapter two in slightly greater detail because lengthier discussion of the
major findings from chapters three, four and five will follow later.
In chapter two, I explored the tensions and gaps inherent in colorblind ideologies
and evidence-based explanations when trying to interpret and understand the character
and function of race and racism. I find that turning to tangible, overt and obvious barriers
(such as policies or practices with clear racial exclusions) as a way to demonstrate or
verify the presence or absence of racism or race related conflict could cause one to miss
the meaningful and significant ways that race actually does impact everyday life. Even
physicians who described barrier-free educational and occupational trajectories revealed,
upon close examination, life experiences where race or racial dynamics played a pretty
significant role in their personal friendships, social activities and the way they conducted
their professional lives.
For example, Dr. Ojima described a pretty smooth path in her efforts to obtain her
medical degree and establish herself as a physician and considers herself thankful to
previous generations of Japanese American physicians who paved the way for her so that
she did not have to battle or endure race related obstacles as she sough to establish her
own career. Thus, in a quantitative survey, I could imagine her checking a box that
would indicate no experience with racism because she seems to identify racism or race
related problems as a barrier that prevents one from achieving their goals. Yet, further
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exploration reveals that culture and race are actually very important to her; enough to
push her to make a conscious decision to prefer Asian American dating partners when she
was in high school. This may not necessarily indicate a distancing from whites due to
racial intolerance expressed to her, but at the very least, it demonstrates the extreme
importance of shared history and culture, which in part is due to racial meaning and racial
dynamics. It indicates a sense of comfort and understanding that Dr. Ojima feels with
other Asian Americans, which, in its subtlety speaks to a potential ongoing otherness that
makes race salient.
In chapter three, I continued the argument I began to lay out in chapter two.
While in chapter two, I began to argue that much more lurks beneath the surface of these
colorblind and evidence based understandings of race and racism by examining some of
the spots of tension between the physicians’ recollections of racial acceptance and the
ways that race, ethnicity and culture actually motivate important decisions they make and
how they feel about particular issues; in chapter three, I address the specific ways that
race remains a significant and salient feature of African American and Japanese
American physicians’ personal lives.
I find that African American and Japanese American physicians continue to
encounter racial microaggressions when they are in public spaces carrying out private
matters, including daily living activities such as shopping, eating out, taking walks,
attending community functions, traveling, driving, etc. Racial microaggressions directed
at them consist of subtle cues and messages that convey derogatory, insulting,
invalidating, undermining and other negative types of verbal or non-verbal
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communication (Sue 2005; Sue, Capodilupo, and Holder 2008). I also find that African
American and Japanese American physicians expend a great amount of emotional energy
through questioning themselves, second-guessing, and trying to decipher the cues and
coded messages of the racial microaggressions directed toward them. This captures one
way that race still carries a lot of meaning and impact, even though outsiders can rarely
see the unfolding of this very personal and internal process. Finally, I find that past
traumatic events within their racial communities, such as slavery and internment,
continue to shape and inform current life decisions they make and how they feel about
themselves even if they are not entirely conscious of the connection to the historical
traumas. Thus, in their private interactions with others, in the way they must maintain a
double consciousness, with awareness or not, and the continual presence of racial
legacies of the past that continue to haunt and intervene in their lives today; race remains
a highly salient feature of their private lives.
In chapter four I discuss the meaningful ways that race intervenes in their lives as
physicians. I find that race affects work-related matters in terms of the way patients,
colleagues and institutions relate to them as physicians. I also find that the experiences of
African American physicians vary significantly from the work lives of Japanese
American physicians. Further, gender intersects with race to produce a much different
career experience for African American men. I will discuss these issues later, so I only
briefly outline them here.
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In chapter five, I explore the ways that gender and racial ideologies intersect to
lead to very different personal and professional circumstances for African American
women and Japanese American women as well as African American men.

THE SALIENCE OF RACE
Looking Beneath the Surface: The Importance of Subtlety and Interaction

Many race theorists contend that we, as social scientists, need to formulate a more
complete framework for understanding race, racism, racial inequality and race relations
(Bonilla-Silva and Zuberi 2008; James 2008; Marks 2008; Winant 2000). In 1903
DuBois (1989 [1903]) noted that we are in need of a “convincing racial theory that
addresses the persistence of racial classification and stratification” (cited by Marks 2008).
Over a century later we find ourselves still without a full understanding of the myriad
ways (covert and overt) that race continues to structure and remain a fundamental
function of our life experiences. In fact, deeply concerned with current ineffective
sociological racial frameworks, Howard Winant (Winant 2000:169) has argued that
“sociology must develop more effective racial theory” while Bonilla-Silva and Baiocchi,
contend “that mainstream sociology has observed racial matters with an inadequate racial
theorization, and, hence, has not ‘seen’ the significance of racial stratification in
America” (2008:137). Along with West and Fenstermaker who contend, “race is not
simply an individual characteristic or trait but something that is accomplished in
interaction with others” (West and Fenstermaker 1995), Stewart argues that “racial
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inequality is created in countless social interactions taking place at various levels…and
locations in society” (Stewart 2008:113).
Thus, this dissertation sought to follow the lead of these scholars who emphasize
the importance of examining the interactive processes as the site where inequalities are
created and maintained; while drawing on the understanding that “any effective
sociological theory of race seems to require at a minimum, comparative historical and
political components, some sort of sociology of culture or knowledge, and an adequate
microsociological account” (Winant 2000:169) Indeed, my qualitative analysis of
African American and Japanese American physicians’ lives begins to uncover some of
the powerful and significant micro-level ways that race continues to organize the
“spectacular and mundane” interactive and relational aspects of our lives (James
2008:42).
The physicians’ life stories teach us that race operates in a much more
complicated way and with much more nuance and dynamism then some believe (Alba
and Nee 2003; D'Souza 1995; Thernstrom and Thernstrom 1997). Indeed, as the
physicians demonstrate, it is possible to be highly educated, have a high degree of
occupational prestige and be financially well off yet still encounter a considerable degree
of racism. At the very least, these physicians find that ethnic, racial and/or cultural
background remains a very significant and salient force in their lives in terms of the types
of decisions they make, personally and professionally, as well as level of connectedness.
I contend that examination of interpersonal interactions is key to developing a
fuller understanding of the complex and multi layered ways that race functions and
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maintains significance for Americans. Indeed, I find that racially intolerant messages and
attitudes are not conveyed through grandiose, out in the open gestures or exchanges;
rather racial microaggressions are communicated in very concealed, hidden, ubiquitous,
and disguised ways. It is only through the examination of interpersonal interactions that
the subtlety can be detected and made sense of.
These subtle racially antagonistic microaggressions can range from more concrete
sorts of problems such as exclusion from certain referral networks, to being harassed by
law enforcement to more seemingly mundane and innocuous sorts of interactions (Sue et
al. 2007), but over time accumulate and have significant meaning in one’s life. Dr.
Parker, a successful and reputable surgeon, shared an example of the type of mundane
and seemingly innocuous racialized interactions that typify covert colorblind racial
microaggressions (regardless of occupational prestige). Dr. Parker described how one
night while dining out with his wife, he was mistaken as the valet worker when another
patron of the restaurant handed him their car keys and requested he take care of his
vehicle. In other points of the interview, it was clear that this type of ‘misunderstanding’
happens quite frequently; such as when he is at work in the hospital that he has practiced
in for years, yet, he is still mistaken as the urine specimen collector or the attendant who
will wheel patients to their cars. While to some these may appear as harmless
misunderstandings, these sorts of insulting and invalidating interactions actually connote
deeply ingrained and embedded paternalistic, authoritative and biased racial sensibilities.

298
Internal Perceptions
Further, it is not the subtle insult alone that is significant. Rather, it is the target’s,
or in this case, Dr. Parker’s interpretation or perception of the insult or racial
microaggresion that is meaningful. Dr. Parker’s perception of this and numerous other
degrading insults like this, is really grounded in his own past and present lived
experiences as well the various racial ideological contexts that shift through time (Omi
and Winant 1994), as well as specific racial legacies that combine to constitute how Dr.
Parker will perceive these sorts of racial microaggressions, how he will understand and
make sense of them and the meanings he will arrive at. Thus, an important conclusion of
this dissertation is that racism should not just be studied as phenomenon between people
or directed toward people of color (although I am not saying that this isn’t important); but
it is also a highly internal process as well. Within oneself, a lot of hidden energy and
resources are expended on sorting through, trying to understand, manage and deal with
life taking into account a constantly running racial subtext and sometimes in the absence
of a directed insult. For example, just as a general rule of thumb, Dr. Kawaratani does
not attend activities or functions alone because she always wants to have an alibi should
anything problematic arise. This may sound like paranoia, but as I discussed earlier, this
concern appears to be deeply connected to the unjust WWII internment of Japanese
Americans. Thus, race and culture are likely pretty salient to the insecurity that Dr.
Kawaratani displays (although she may or may not directly interpret it this way or make
the connection herself); yet it is also solely through her own internal processes and
299
understandings that it comes to play a meaningful role. The internal work of race is just
one aspect of what maintains inequality.
Indeed, race continues to be relevant and important today, not solely because
racial differences inform and shape the way whites think about people of color and
consequentially treat them; but race continues to be an extremely salient, meaningful and
influential feature of American life because of the importance that it maintains for people
of color (not necessarily all), irrespective of white presence. I am not arguing that race is
some essential or defining trait of people of color. Rather, race as a socially constructed
signifying concept, in large degree, constitutes shared lived experiences and cultural
histories and personal and group identities for people of color, even if whites now acquire
a colorblind perspective and outlook. Indeed, as Stewart contends, social interactions are
“cumulative… related to characteristics, and prior conditions and reactions” (Stewart
2008:119, 126). Thus, race remains important regardless of what whites or others in
general think about it because of its subtle and cumulative weight and because it gains
meaning through its interactive and internal processes.

Micro/Macro Connections
Through this dissertation I sought to empirically connect micro level interactions
and implications of race and racism to the systemic racial ideologies that fuel these
relationships. I maintain that it is essential not to regard these interactive-level racial
microaggressions and race work that racial minorities carry out daily as random,
inconsequential, isolated and individualized circumstances. Rather, they are patterned,
300
commonplace, and diffuse, with powerful implications. They can be deleterious,
compromising and confining. Further, I find that these micro level racial processes are
connected and situated under one racial ideology, and as such, constitute constituents of
the overall structure of racial inequality just as other more dominant and validated
measures of racism such education, income, housing, outmarriage rates, etc (Stewart
2008). As Stewart asserts, “…racial ideology structures everyday social interactions
[and these interactions are] based on racial bias/nonbias…” (Stewart 2008:129).
Thus, as I stated earlier, Wellman (1993) describes a theoretical bifurcation in the
sociology of race literature, while Bonilla-Silva and Zuberi contend, “…White logic and
White methods shape the production of racial knowledge…” (Bonilla-Silva and Zuberi
2008:23). Similarly, Marks (2008:49) points out, “much about race remains
unexplained” in large part because “actual complexities of racial reality” does not “easily
lend itself to systematic analysis” (60). Therefore, through this dissertation, I tried to
demonstrate- through an exploration of the interactive processes that comprise the
African American and Japanese American physicians’ racial experiences, both externally
afflicted and internally driven- the nuanced, dynamic, and structural ways that race
remains highly salient in an age where color presumably no longer exists.

Through Different Lenses: The Unique Positionalities of African American and
Japanese American Physicians

The African American physicians I spoke with were almost always unwavering in
their sense that race still matters for African Americans in both the professional world of
medicine as well as in the public spaces where they carry out their private lives. In some
301
capacity, each of the African American physicians I interviewed expressed that race
continues to play an important and meaningful role in the lives of Black Americans of
every class strata. Thus, racism in America continues to pose challenges even to those
who have reached a professional status and who are seen has having attained that coveted
and elusive American Dream (Aguirre 2000; Fang, Moy, Colburn, and Hurley 2000;
Nunez-Smith et al. 2009). Indeed, several of the physicians talked about the challenges
that their African American patients continue to deal with due to class and racial biases
(cf. Saha, Taggart, Komaromy, and Bindman 2000), and many shared difficulties they
encountered throughout their personal lives as well as throughout their own career
trajectories and indicated that they feel disparities persist in the field of medicine (Nunez-
Smith, Curry, Berg, Krumholz, and Bradley 2008). Many, especially the African
American male physicians, retold story after story describing the ways race and racism
continues to play out in their personal lives.
The most startling, albeit not completely surprising, theme that emerged from my
conversations with the African American physicians was the degree to which, regardless
of their level of educational or occupational attainment, they continue to be regarded and
treated as racially inferior, unintelligent and unequal. While carrying out their private
lives and even in the workplace where they display the symbols- such as white coat,
scrubs, stethoscope around their neck- that denote their professional status, others seem
unable to comprehend and accept the reality of their capabilities and tremendous
accomplishments. It is remarkable that the African American physicians I spoke with
were able to attain the levels of accomplishment and success that they have. Educated in
302
some of the country’s most prestigious and elite universities; yet profoundly undermined,
disrespected and mistreated on so many different levels just speaks to the nature and
ability of racism to endure and cross class lines. I argue that the African American
physicians in this project got ahead in spite of the racial barriers–tangible and elusive–in
their lives, not because there were no barriers.
Significant differences emerged between the two groups- African American and
Japanese American- physicians that I interviewed. First, the majority of African
American physicians in my sample expressed a very clear sense and understanding of the
racialization and intolerance targeting African Americans in the U.S. Alternately, the
Japanese American physicians were more ambivalent or even contradictory in their
awareness and understanding of their own racial and ethnic experiences. While the
African American physicians were much more in tune or keen to the wide range of
expressions through which racial intolerance gets communicated, Japanese American
physicians were more likely to talk about racism in very concrete and tangible terms: as a
specific limitation, law, rule or behavior that acts as a barrier to achieving one’s goals and
which is intended at denying a racial group certain rights and privileges; the type of
racism that predominated prior to the contemporary era, according to Wilson (1980).
With this definition in mind, they were more likely to perceive a life free of racism and
were more likely to portray personal and professional trajectories free of overt barriers or
limitations grounded in racial intolerance compared to the African American physicians.
As one digs deeper though, some interesting contradictions pop out of the interviews with
the Japanese American physicians that force us to probe the hegemonic dynamics and
303
processes at work here, which I will address in greater detail shortly, as this dynamic is
very important to understanding all of the complexities of race.
The nature of racial microaggressions between the two groups represented another
difference between the African American and Japanese American physicians. The racial
microaggressions directed toward Japanese Americans tend to revolve around themes of
citizenship, unlike the theme of inferiority that is expressed toward African Americans. I
now want to address the ambiguity of Japanese American racialization because it adds to
our understanding of racial complexity.
Both in and out of the office, Japanese Americans report interactions, which
indicate that others still perceive Japanese Americans as foreign and unrelatably different.
Indeed, the Japanese American physicians describe encounters that imply they are not
‘real’ Americans despite the reality that they are actually multi-generational Americans.
Yet, the complicated racial dynamic for Japanese Americans lies in the contradiction
between these expressions of foreignness directed toward them juxtaposed against model
minority narratives. Drawing on these narratives, patients then also express satisfaction
that they have a Japanese physician because Japanese people “work hard” and “are
smart.” This positionality can be very complicated and confusing because, on the one
hand they are praised for intellect and work ethic (which though, still objectifies the
person); yet, on the other, they receive messages that in general, people still perceive you
to be foreign and uncomfortably different then them, you continue to perceive inequity at
the workplace as you speculate you may be excluded from some referral networks for
ethnic/racial reasons, you perceive resentment and backlash due to the high level of
304
success of Japanese and other Asian Americans, and you can see that promotions and
advancement don’t seem to happen as easily for Japanese Americans as one might expect
given the level of representation within the field of medicine. Thus, these highly
conflicting racial messages leave Japanese Americans in an uncertain space.
Further, when Japanese identity is at the center of how people define you, that
also puts you in a vulnerable, ambiguous and insecure position. For instance, while
Japanese Americans may be imbued with positive attributes now, which help to fuel
positive outcomes for them (such as patient satisfaction), if the tide changes, they are at
risk of attitudes toward them also shifting because these attributes emerge from group
identity, and not an individual’s personal characteristics. This ambiguity is reflected in
the way that the racial attitudes that the physicians conveyed to me often contradicted
their racialized feelings and actions. For instance, while Japanese American physicians
were more likely to describe lives free of racial problems than African Americans, they at
the same time displayed deeper ties to their ethnic heritage and community than you
would expect given current depictions that describe them as assimilated and even a part
of the renewed mainstream. I speculate that these contradictions reflect a place of racial
insecurity because others’ judgments of you can change at any moment. Whenever
you’re judged on an attribute that you have no control over, such as your racial and ethnic
appearance, you are completely at the mercy of those racial and ethnic definitions.
Therefore, Japanese Americans, although evaluated in many positive ways, also
face tremendous vulnerability due to their conditional and ambiguous status (Tuan 1998),
which help keep them tied to ethnic/racial identity that is distinctly Japanese/Asian
305
American, and not necessarily the composite culture that Alba and Nee imagine. Thus,
through the experiences and sometimes contradictory messages that emerge out of the
Japanese American physicians’ attitudes and actions, we learn that race and racism are so
much more complicated than simply where a group fits into various statistical and
demographic analyses. While how a group measures against other racial groups
socioeconomically is crucial to our understandings of race and racism in the U.S., it is
equally important to understand that a lot of the meaning and significance of race grows
from its nuance and dynamism. This is important to understand not just in regards to
Japanese or Asian American, but all people of color, especially when this subtle nuance is
a fundamental part of how African Americans remain at tremendous class disadvantage.

Race and Gender
Gender represents another major organizing principle of social life that intersects
with race to create new ways that race gains meaning. Again, the gendered experiences
of the physicians of color that I interviewed challenge essentialized understandings of
race. In particular, it is telling that although increasingly more women are entering
medical school and becoming physicians more frequently than any other time in the past
they still carry a disproportionate burden of the domestic labor in their private lives.
Indeed, the African American and Japanese American women physicians clearly revealed
their challenges and battles with patriarchy in the home and at the workplace.
I was struck by the sense of solidarity shared with other female colleagues,
regardless of racial background, as well as the deeply entrenched male elitism that
306
according to one physician, will cause some male physicians to refer patients to other
men regardless of racial background before they would refer to a woman physician. The
disparities are glaring and begin before women have even begun their careers as
physicians. All the way down to choosing their specialty in order to allow room for
domestic needs (their own desires as well), to structuring their careers, women are going
to great lengths and making numerous sacrifices to fit both career and family into their
lives. For example, some women physicians with families, will work only part time,
share practices and work night shifts when kids are sleeping so that they can be with them
in the day, while operating on just small amounts of sleep.
While these women are making immeasurable sacrifices, I also want to point out
that they do this because it is important, meaningful and valuable for them to do so. It is
not that their children and families are a burden to them; spending time with and being
available to their children is something that is deeply important and beneficial for them as
well, as was repeatedly communicated to me during this research. I point out these
patterns because the disparity in the level of ownership and engagement with family life
in terms of what men and women carry is so wide that it calls attention to the need to
shift more radically our perceptions of sex and gender roles. Children, women and men
lose a lot through such tight adherence to patriarchal ideals that assign all domestic life
matters to the ‘woman’s domain’. As some of the women physicians began speculating,
institutional and cultural shifts will need to occur in order to reconcile these tensions and
disparities. For example, by enacting more child and family centered policies, paternity
307
leave, strengthening maternity leave, among other considerations, ideological shifts may
follow.
Finally, my discussions with the African American male physicians provided
another very clear illustration of how race and gender intersect, ultimately leading to very
different life circumstances compared to other racial minorities. The number and detail
of the memories that the African American male physicians shared exposed deep the
hostility, resentment and fear that whites frequently convey towards them. As one
physician explained it, Black men get bullied a lot. While African American women and
men are subjected to the same types of racialization, such as stereotypes about their
supposed inferiority, primitiveness, lack intelligence, etc., these sensibilities also manifest
somewhat differently due to the ways gendered ideologies intersect with these racial
ideologies.
Indeed, a lot of irrational fear gets projected onto Black men. So many
caricatures depicting propensity toward criminality, impulsivity, and lack of control
abound about Black men; yet, it is really Black men who are the targets of these very
problems. The African American male physicians told story after story of dehumanizing
encounters, reflective of impulsivity and lack of control on the aggressor’s part, to a
criminal and abusive degree. The type of policing, surveillance, social control and
complete disrespect and racism that whites and others direct toward African American
men is where the true misconduct lies.
Despite deeply entrenched controlling images about the ‘angry Black male,’ I find
that, on the contrary, through ‘taking low,’ Black men actually swallow, suppress and
308
stonewall their rightful anger more than seems humanly possible, demonstrating
remarkable strength, control and perseverance. Thus, the benefits of patriarchy that some
groups enjoy are not equally open to Black men. In fact, stereotypes about Black
masculinity work against Black in ways that undermine some of the patriarchal dividends
that other men reap.

IN CONCLUSION
Through a tendency to see measurable, quantifiable and tangible conditions as
evidence, and consequentially, the most reliable measurement of inequality, we
inadvertently privilege a narrow way of thinking about race and racism (Bonilla-Silva
and Baiocchi 2001) as supposed “durable, coherent entities that constitute the legitimate
starting points” (Emirbayer 1997). Discomfort with micro-level dynamics and processes
due to fear of downplaying the structural nature and significance of race and racial
inequality also contributed to an incomplete theorization of race and racial intolerance.
According to the literature, and the physicians also support this, racial biases
continue to lurk beneath the surface in both individual and institutional spaces, despite
outward appearances of being “beyond race” (Bonilla-Silva 2003b; Picca and Feagin
2007; Winant 1998). While the framing of “race-talk” has evolved and become subtler,
we shouldn’t mistake the absence of outwardly clear racial ideology as the absence or
racial ideas altogether. While the frames of communication and social meanings have
changed (Goffman 1986 [1974]), meaning persists relative to race and ethnicity in our
contemporary society. If we accept this to be true, then one might next wonder, what
309
happens to these reframed, backstage or unconscious thoughts, feelings and ideas? Do
they get communicated and expressed to people of color? If so, what do those processes
and what do those interactions look like?
In this dissertation, through deep analysis of the ways that race is 1) a subtle,
interactive entity, 2) informed and given meaning through lived experience and history 3)
experienced differentially and 4) complicated by other ideological structures such as
gender, I show that race and racism are not static, essential traits or processes that can be
easily and neatly captured. Indeed, the bulk of racial meaning and significance lies
beneath the surface that sometimes is best captured through close examination and
detailed analysis of personal interactions and relationships. In this age of colorblindness,
it is important to capture the constantly shifting, nuanced and dynamic ways that race
maintains presence in everything that we do despite its purported absence.
The physicians that generously shared their time to talk about their life experiences and
personal perceptions teach us that race is still salient and integral to American life.
Indeed, race is still a central part of being American because of the assumptions and
beliefs that people attach to racialized bodies, despite outward claims of not seeing color.
Ultimately these stereotypical perceptions shape and inform relationships and interactions
that people of color experience and negotiate daily. Further, the internal state of mind, or
racial consciousness- formed through lived experiences, and other various contexts such
as community legacy- keeps race at the forefront of all daily and social life for many
people of color, which can come with a degree of unseen internal work. What these
physicians show is that they were able to create extremely successful lives,
310
socioeconomically speaking, and they were able to get ahead in spite of racial challenges.
This success should not be mistaken as a sign that race is no longer integral in America.
311
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Creator Fujiwara, Melissa Komeno (author)

Core Title The color of success: African American and Japanese American physicians in Los Angeles

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program Sociology

Publication Date 05/01/2013

Defense Date 02/13/2012

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag African Americans,colorblind racism,Inequality,intersectionality,Japanese Americans,OAI-PMH Harvest,physicians,Race

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Saito, Leland T. (committee chair), Messner, Michael A. (committee member), Sánchez, George J. (committee member)

Creator Email fujiwara@usc.edu,melissafujiwara@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-19552

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