Entering a second national lockdown in the space of a year can be very anxiety-inducing. But for ethnic minorities, in particular, lockdown anxieties concern not only restrictions on our everyday movements but also having to trust a government that has consistently failed to safeguard us.
In England and Wales, males of Black African descent are 2.7 times more likely to die of COVID-19 than males of a white ethnic background, and Caribbean females are almost three times as likely in comparison to females of white ethnic background.
As a Nigerian-Jamaican woman born and bred in the UK, this makes relying on some sort of national consciousness to regulate a fatal disease terrifying. Having to trust the government to make choices that protect me and healthcare institutions to administer fair treatment when entering these spaces is an unnerving feeling.
The relationship between race and healthcare is an intersection often overlooked; but in times like this, ignoring it is an injustice.
What is iatrophobia?
Iatrophobia is the abnormal or irrational fear of going to the doctor. Research highlights that there are several ways that this phobia arises: ranging from fear of the unknown, to hypochondria, to hatred of both drawing blood and injections.
Iatrophobia rears its head in a particular way for Black people because many acute versions of this fear are based on atrocities that the bodies of people of colour have been subjected to at the hands of healthcare institutions. Harriet A. Washington defines Black iatrophobia as “the fear of medicine present in the Black community as a result of a long history of involuntary, unethical and non-therapeutic treatment by medical professionals and institutions”. Given the historical treatment of ethnic minorities in healthcare, this supposed ‘irrational’ deep-rooted wariness actually seems quite justified.
We have never been afforded the same type of treatment as white people when it comes to healthcare. The treatment of Black people in relation to hospitalisation, medicine, and surgery is foundational to how modern medicine has developed, and iatrophobia is merely a reaction to this. It is the result of the trauma consequential to the treatment of Black people at the hands of such institutions that has, time and time again, left us more vulnerable than we were previously.
Just because hospitals have their own rules of operation and areas of speciality, does not mean they exist in a vacuum. Despite claims that medical institutions are governed by the common goal of ‘wellness’, the same ideas that mediate how we interact outside of a hospital exists within their four walls. The wealth of socio-historic trauma and concealed discrimination that are heavily present in other spaces – e.g. legal institutions and the media – exist heavily in medicinal practices.
How racism and iatrophobia come together
Before we get to how iatrophobia has occurred we must deal with the why. Why some people are subjected to intense unethical medical attention and others are not is based on racialisation. The process of why some natural bodies are negatively ‘racialised’ while others are not is intricate and extensive, so I will focus on one arena that encapsulates both racial principles and medicinal practices, that of Social Darwinism.
Social Darwinism argues that evolution has made some humans innately more developed than others, thus better suited for survival in modern society. This is code for white– and has been used to rationalise horrific regimes such as mass genocide and eugenics (to name a few). For Black people, Social Darwinism was used to justify slavery. It was claimed that the natural composition of the ‘Negro’ made them more prone to crime, less evolved, more sexually illicit, and thus completely inferior. It was once thought that Black people were so socially and intellectually rudimentary, they would become extinct as a part of the natural order of evolution.
The [pseudo] science of Social Darwinism hypothesises that physical features ordinary of African bodies were actually imperfections and explained why Black people were more prone to certain diseases and had lower life expectancies. Wide nasal apertures, protruding jaws and receding chins were all labelled as physical defects to highlight that Black people were undeveloped ‘savages’ that could be used for scientific experiments.
The disturbing history of medical experimentation
There are hundreds of accounts of highly respected Social Darwinist doctors using Black people as test dummies for surgery, mainly to explore their fascination with Black bodies. Famously, Georges Cuvier dissected the body of Sarah Baartman post-death (a South African slave woman who was put in freak-shows across Europe) to probe her perceived underdevelopment. Baartman’s dissected body was put on display in France from the 1800’s to 1974, only to be buried in South Africa in 2002.
This example is only a mild version of its extremities. Let’s take the legacy of Dr. James Marion Sims, also widely celebrated as the ‘father of gynaecology’. He did several intrusive vaginal experiments and surgeries on fully conscious non-consenting slave women, often getting them to hold down each other whilst these were taking place. That general anaesthesia was already in common use, but he decided against using it for these women, makes this case all the more harrowing. Additionally, he also operated on several Black children, claiming that rearranging their skulls would treat tetany conditions (a completely unfounded claim).
This use of Black people as material for experimentation is not as far in the past as one might think; 1932-1972 featured the Tuskegee Syphilis study on 600 unsuspecting Black men by the American Public Health service and Orlando Andy (who is still very highly respected) was performing lobotomies on young black boys to solve their ‘behaviour problems’ as recent as the ‘60s and ’70s.
If the performance of these acts weren’t distressing enough, it is the neglect of humane medical procedures during these studies that heightens fears. The men who were part of the Tuskegee Syphilis atrocity were never given penicillin to cure their disease despite healthcare professionals knowing full well that this would cure it. The same as the withholding of anaesthesia from Sim’s hostages. This all has its roots in Social Darwinist principles of racism. Either we can ‘handle’ maltreatment because we are not fully human, or it doesn’t even matter whether we can – for the very same reason.
Luckily, there are more precautions that are put in place to monitor unethical practices within hospitals, but this does not dilute fears over how Black people will be treated when admitted into hospitals.
Even Serena Williams, a multimillionaire athlete, experienced this. Similar to the men of Tuskegee and Sim’s victims, she experienced an incident of withholding life-saving cures during the birth of her daughter. Doctors failed to pay attention to her long history with blood clots and its effect on her birthing experience- resulting in her insistence, mid-labour, on getting a heparin drip and CT scan when she realised something was wrong. This was a plea that saved her life.
The lower standard of care that has historically plagued Black patients makes placing faith in medical institutions to have your best interests at heart very hard – even in a society that has a national healthcare service. Race relations still heavily mediate arenas that are rarely discussed such as medicalisation and hospitalisation, and during a pandemic these fears are only inflated.
Iatrophobia for ethnic minorities is not an ‘irrational fear’ – it is active distrust, based on past treatment of people who look just like you.
Graphic courtesy of Abigail Takahashi (@takahaae)