Just the Tip: Stigmatization and “Freaks of Nature”

February 22, 2022

Note: This blog was originally posted on my medium channel. I have since deleted my medium account and migrated all my blog posts to this website.

This is another of my notes processing a recent event on the simultaneous community center and cesspit that is MedTwitter. Specifically, I’m referencing Dr. Jeffrey Lieberman’s tweet referring to a beautiful dark-skinned woman as either a “work of art” or a “freak of nature”. See the screenshot below:

I had an extreme reaction to this tweet. To contextualize it, this is the Chair of Psychiatry at a top program who said, on this public, visible platform that a Black woman might be a “freak of nature”. The levels of inappropriateness are hard to itemize but I’ll do my best.
  1. The author said this from his public account, linked to his whole face with his profession and position clearly documented→that implies comfort with this sentiment, suggests that it is normal and reasonable to him, or at the very least, that he is indemnified from any possible consequence.
  2. The specific field of psychiatry is the steward of the mental health of the vulnerable. The field has failed as much or more often than it has succeeded in the past, but that is still ultimately the goal of the profession (I hope). There is so much work in disability studies and queer studies of how stigmatizing language like “freaks” can be (and also how these communities have reclaimed that language). But also, as a psychiatrist, it should be the bare minimum of your skills and orientation to have additional sensitivity around stigmatizing language and mitigating the impact of the harm of your words.
  3. This is a Black Woman. There is a history that dates back to the antebellum south of having fetishizing, hypersexualizing, and otherizing Black Women in freak shows and displays to media and even medical textbooks. Black women are consistently dehumanized in America. By using “freak of nature”, you separate Black women from the rest of human existence.

That’s just what’s wrapped in the tweet. To me, that alone is disqualifying of the position of Chair of Psychiatry. To be clear, I don’t think we can actually remove people from their jobs based on their political affiliations (Dr. Lieberman famously called a group of forensic psychiatrist unethical because they claimed that Trump was not fit to lead). However, regardless of your personal views, you should still be able to meet bare minimum requirements to perform your job without doing harm, especially in healthcare. Further, if you are in leadership within your profession, you should exceed those bare minimums and really be exceptional. I submit that being comfortable to say something so egregious on a platform like this is “just the tip”. What other normal extremes of human variation does he think of as “freaks”? Fat people? Trans people? We can’t conclude that he would say this exact same thing, but it is most certainly a reasonable extension of his publicly expressed sentiments in that single tweet. As a fat, Black, trans woman, I would not feel safe seeking his guidance. When you think about how societal oppression and discrimination, fatphobia, transphobia, etc, directly impact mental health outcomes, having a person with this social orientation and world view be in charge of the mental well-being of anyone exposes the most vulnerable to further injustice. Extend that to his role as chair and his impact is compounded; this man creates the environment in which future psychiatrists are trained. His reach is extensive and so are his harms.

Many people will argue that this is a “cancel culture” response. To that I’ll say, list 3 people who were successfully “cancelled”, who lost their ability to subsist in this world because they were held accountable. Most people who have been “cancelled”, are really just people who got their feelings hurt and had temporary restriction in access (Louis CK, that sexual harassing ED doc on med twitter y’all jump to defend every few months whose name I forgot, etc.). Weighing that discomfort against that potential (and almost certain) harm that a person in Dr. Lieberman’s position can cause is a no-brainer to me. This person needs immediate remediation on stigmatizing language, and anti-racist psychiatric practice before patients should be exposed to him AND he should be supervised with minoritized patients, particularly Black women. He also should be demoted. In his “nonapology” where he “apologized for any offense that was taken” rather than the content and harm of his actions, he said that he is still “living and learning”. At his big age of 73/74 I am thankful that he is still learning. I hope to be as well. But if your understanding of how you can cause harm with racism is at a 2nd grade level, then your learning practices have not been robust enough for you to be Chair of Psychiatry and you should not be able to shape future trainees, the culture of their department, or the environment that the patients they treat are cared for in.

And lastly, a note on accountability. At the time of this writing, Columbia Psychiatry has yet to publicly say anything about this on their twitter page (the same venue the harm of Dr. Lieberman was done). All that has happened is that Dr. Jeffrey Lieberman has deleted his twitter account. The distinction between cowardice and accountability is real simple. Have you demonstrated a deep understanding of how your actions were harmful, outlined a path for restitution, and described practices that ensure you won’t make the same mistake again? OR, have you hidden from the people holding you accountable, waiting it out by ignoring their voices and protecting your own feelings? Silence from the program is as harmful as the initial injury. Both the Chair and the department are moving similarly, and neither path is toward accountability and justice.