This post is dedicated to the brave women physicians who have come forward to share their stories of gender-based harassment and discrimination. With you, I stand in solidarity.
{Mandatory preamble: As with all of my blog posts, the views espoused herein are mine alone and should be construed as neither shared nor endorsed by any organization with which I have an affiliation.}
Trigger warning: gender-based violence; gender-based harassment and discrimination; sexual violence; trauma.
This post is about a strategy I call “The Playbook”. Before we dive into the nuts and bolts of who exercises this strategy and for what purpose, we need to arrive at a common understanding of trauma. So, a few facts:
- Trauma that occurs at the hands of another human being should not have happened.
- Although there are stereotypical trauma response patterns, how one adapts, copes, and survives trauma is highly individualized. There is no “correct” or “preferred” way to do this.
- Trauma cannot be processed while it is occurring. Processing and – for some – eventual recovery, may take decades. Survivors should not and do not need to conform to others’ expectations about the nature and evolution of trauma processing and recovery. Statute of limitation laws are finally catching up to this notion.
- Trauma bleeds across generations. A quote by William Faulkner: “The past is never dead. It’s not even past.”
As a bibliophile who has read a lot about trauma, I highly recommend the following resources if you are interested in expanding your awareness of trauma discourse and paradigms, particularly those that relate to gender-based violence, harassment, and discrimination:
- The Body Keeps the Score – Dr. Bessel van der Kolk
- The Unexpected Gift of Trauma – Dr. Edith Shiro
- What is a Girl Worth? – Rachael Denhollander
- Nobody’s Girl – Virginia Roberts Guiffre
- Not That Bad – Dr. Roxane Gay
- My Brother Moochie – Isaac J. Bailey
- Fire Shut Up in My Bones – Charles M. Blow
- Unbound – Tarana Burke
- My Parent the Peacock – Kathleen Saxton
- Toufah – Toufah Jallow
- Hollywood Ending – Ken Auletta
- She Said – Jodi Kantor and Megan Twohey
- Catch and Kill – Ronan Farrow
- Weathering – Dr. Arline T. Geronimus
- Heavy – Kiese Laymon
- Mad Wife – Kate Hamilton
- Raised by Narcissists – Dr. Sarah Davies
- Takedown – Laila Mickelwait
- A Well-Trained Wife – Tia Levings
- The Beauty in Breaking – Dr. Michele Harper
Now, back to “The Playbook”. I began to really think of The Playbook years ago as an adaptive strategy deployed by “mediocre” academics to get what they want by predatory means. However, by expanding the aperture through which I was envisioning The Playbook, I realized that it’s an unfortunately common element of the narcissist’s toolbox, in general. Whether in media or entertainment or finance or medicine or academia, the steps by which narcissists – mediocre by definition because how can one ever rise above mediocrity when one believes one is always right? – manifest a desired outcome are common across sectors. While narcissistic predation clearly exists on a spectrum, as I’ll illuminate below through exemplar cases, a highly stylized version of The Playbook as it relates to gender-based violence, harassment, and discrimination is:
|
Man wants what woman has |
→→→ |
She says No |
→→→ |
He has a prolonged (sometimes violent) tantrum enabled by leaders and colluders |
→→→ |
Woman breaks and he gets the prize |
The first actual step in The Playbook is Entitlement. The narcissist in your midst will believe that they are entitled to what they desire owing to their: intelligence, class, race, religion, good fortune, aptitudes, skill set, some perceived good deed for which they are owed, genetic superiority, institutional superiority, unqualified superiority, etc, etc. Whether what he desires is actually on the table – or even contractually promised to someone else – is immaterial. Jeffrey Epstein felt entitled to be serviced by those he trafficked and enslaved three times per day! Harvey Weinstein felt entitled to answer the door nude save for an open bathrobe when meeting female actors whom he had invited over for business related discussions.
After entitlement with implicit or explicit declarations of his wishes comes Step 2: pressure. This may take the form of beseeching, cajoling, or gaslighting directly, or may enlist the bevy of allies at his disposal. Harvey Weinstein reportedly wore actresses down with his tactics, like a lion pursuing an antelope on the Serengeti. Jeffrey Epstein promised the teens he trafficked opportunities for growth and education in exchange for their loyalty and fealty. In academic medicine, pressure comes from allies with power: Directors, Chairs, Deans, Physicians- and Surgeons-in-Chief, etc. A minute amount of force applied consistently over time can steer the Titanic off course. And this is what he does: chronic, unyielding pressure to cede whatever territory of yours – whether it be physical, digital, relational, or occupational – he seeks to colonize.
Step 3 marks the transition from asking nicely (i.e., direct or indirect pressure) to outright threats and intimidation. In the worlds of Jeffrey Epstein and Harvey Weinstein, this stage reportedly included but was not limited to:
- Verbal threats of career annihilation
- Implied or stated threats to women’s family members
- Threats of extended litigation and bankruptcy
- Physical overpowerment and violence
- Covert surveillance and audio recording
- Thundering escalation and the booming theatrics befitting the man child that each of them was/is
- Blackmail, extortion and bribery
Harvey Weinstein reportedly went so far as to hire ex-Mossad agents to intimidate his women victims.
In academic medicine, the players are ostensibly less brutish; as mentioned, predation exists on a spectrum. However, it bears mentioning that Virginia Guiffre was trafficked as a teenager by Jeffrey Epstein to several prominent academic males at institutions as reputable as MIT. Les Wexner’s name remains all over OSU. From what I’ve read or heard about other women’s experiences, academic men who rely on The Playbook use forms of threats and intimidation that occur more by proxy: that is, they mostly (but not invariably) outsource their threats via weaponization of disciplinary structures. The University or Hospital ombudsperson. Formal and informal complaint channels. 360 reviews. External reviews. HR. The “quick chat” with your boss’s boss. And on and on and on. The message: “You are not safe here”. When women are minimized, disbelieved, and gaslit by the proxies, the corrective and remediation plans proposed are absolutely a threat to her livelihood and most likely a threat to her sense of self, purpose, and value. She’s been DARVOed and dehumanized and acts accordingly. “You are not safe” plays on repeat in her mind. Jeffrey Epstein also outsourced aspects of Step 3 to Ghislaine Maxwell. And this is why she is incarcerated.
Step 4 constitutes the smear campaign of defamation: libelous written commentary and slanderous spoken words. Creation of a false narrative that relies heavily on pre-poisoning, gossip, and confirmation bias. Harvey Weinstein planted negative stories in the tabloids and spoke to other Hollywood elites about “difficult” actresses. Justin Baldoni received written confirmation from his crisis PR manager, Melissa Nathan, that she could “bury anyone”. Gideon Koren gave false testimony about Nancy Olivieri to external investigators brought in to adjudicate the debacle that he himself set in motion.
Running concurrently with Steps 1 through 4, like background software on your hard drive, are Steps 5 and 6: virtue washing and collusion.
Jeffrey Epstein was a master of virtue washing; just look at the photos! He was everywhere all at once in the upper echelons of cultural elitism. Naomi Campbell’s birthday party in St. Tropez! Gmax was a guest a Chelsea Clinton’s wedding! The producer of The Simpsons flew on his private jet! Prince Andrew for the love of God. Epstein was a benefactor of the sciences and fancied himself a genius. Harvey Weinstein also ran in elite circles of glitterati and politicians. Justin Baldoni is reportedly a self-branded feminist? How could a misogynist be so virtuous? In academia, virtue washing often occurs via male adjacency to women who are used as ‘proximity shields’. Hey! Look at me! I can’t be a dickhead! I publish with women trainees! I helped her land a fellowship! I’m just a big, lovable goof! A teddy bear, actually, who just wants to save lives! That’s really all that matters to me! And advancing women, of course.
Step 6 is collusion, and also rides shotgun with steps 1 through 4 the entire time. As Ken Auletta aptly named the phenomenon, it’s “an architecture of collusion”. For Harvey Weinstein, his brother, paid allies, and the legal bubble of Miramax were major participants here. NDAs are part of the architecture since women who are contracted to silence have an extraordinarily difficult time speaking up. For Jeffrey Epstein it was Gmax and countless other men and women including the former prosecutor, Alex Acosta, and the entire JP Morgan bank!?!
The four highly public cases of Canadian women doctors who have been reportedly harassed, threatened, discriminated against, publicly maligned, and demoted or fired – Drs. Nancy Olivieri, Irene Cybulsky, Teresa Kieser, and Marisa Azad – all appear to have fallen victim to what reads as corrosively inept divisional, departmental, and Faculty-level leadership colluding with or at least breathing oxygen into their harassers’ campaigns against them.
Dr. Nancy Olivieri, a pediatric hematologist who – in her attempts to raise serious concerns about patient safety during a drug trial – was targeted not just by Gideon Koren, but also his allies. Koren was reprimanded by the College for unprofessional conduct and harassment of Dr. Olivieri, and after other serious breaches of professionalism and ethics related to his leadership of Motherisk, was stripped of his license after which he left the country. However, on the long tedious road to vindication, Dr. Olivieri – as noted in the CAUT’s investigator report – endured untold personal and professional hardship including punitive treatment by her own institutions as they bought the narrative of Koren hook, line, and sinker. The CAUT investigation determined – among many, many other findings – that:
- “HSC Pediatrician-in-Chief Dr. O’Brodovich put forward incorrect allegations and testimony, in addition to seriously incomplete testimony, against Dr. Olivieri to the Naimark Review and to the Medical Advisory Committee. In this he used information from Dr. Koren and cooperated with Dr. Koren. Dr. O’Brodovich was seriously neglectful in not checking the validity, or ensuring the completeness, of his testimony.”
- “Dr. Koren attempted to discredit Dr. Olivieri by dishonest means: He was the author of anonymous letters to the press and others against Dr. Olivieri and her supporters, for which he denied responsibility for many months. He put forward false allegations and testimony again st Dr. Olivieri to the Naimark Review, and to the MAC inquiry that followed.”
- “Dr. Koren lied persistently for many months about his responsibility for the anonymous letters, and did not admit responsibility until after he had been identified by DNA evidence.”
- “Neither the University nor the Hospital has properly addressed the conduct of Dr. Koren in putting forward false allegations and testimony against Dr. Olivieri to the Naimark Review and to the MAC, or taken any action to correct the resulting situation.”
- “The misconduct by Dr. Koren in putting forward false and seriously neglectful testimony against Dr. Olivieri to the Naimark Review and the Medical Advisory Committee, and the uncritical acceptance of his testimony, are significant factors in the L1 controversy being prolonged and widened.”
Dr. Irene Cybulsky was the first woman Head of Cardiac Surgery at an academic centre in all of Canada before she was removed from her position at Hamilton Health Sciences, owing to a biased and discriminatory process that was underpinned, again, by factually inaccurate testimony of surgery bros unhappy with her leadership. During the process of her pursuit of justice – since she no longer had Cardiovascular Surgery privileges – she trained as a lawyer and represented herself at the Ontario Human Rights Tribunal. The OHRT ruled that Cybulsky’s rights as a woman were breached throughout and that her “dignity and self-worth were undermined, and those consequences are directly connected to the fact that the applicant is a woman”.
Similarly, Dr. Teresa Kieser filed a complaint with the Alberta Human Rights Tribunal alleging gender-based harassment and discrimination in the same heavily male-dominated field of Cardiovascular Surgery. Similarities between Kieser’s and Cybulsky’s reported experiences include leadership of a group of male colleagues who expressed dissatisfaction at the women’s leadership to superiors, who in turn, conducted lengthy and punitive ‘investigations’, which were both personally and professionally damaging. While the ultimate disposition of Dr. Kieser’s pursuit of justice remains unresolved, the AHRT – in a recent decision – failed to consider her case due to its purported lack of jurisdiction over “contractors” rather than employees.
Dr. Marisa Azad, the most junior of the four female physicians described here, is an Infectious Diseases physician in Ottawa who is an innovator in the application of phage therapy for prosthetic joint infections. Dr. Azad’s civil Statement of Claim describes a workplace allegedly influenced by a group of disgruntled male surgeons who ostracized her out of her own clinical leadership space, a process that was – through alleged acts of commission and omission reported in the Claim – aided by hospital leadership. In their letter to Dr. Azad, the Ottawa Hospital apologized “after an independent investigation confirmed she had been the victim of a campaign of bullying and harassment by two male physicians as well as sexual harassment by one of them”.
Across all four of these highly public cases of determined or alleged gender-based harassment and discrimination of Canadian women physicians, the “architecture of collusion” was multilevel, multipronged and reportedly gave life to a group of male colleagues’ false narratives reliant on all six steps of The Playbook as amply outlined in the public record and media reports. Every single case is a masterclass in entitlement, sustained pressure, intimidation, false accusations, virtue washing, and institutional enablement.
I hope that the parallels across sectors are obvious, but if not, please consider reading the aforementioned literature if for nothing else than to be a better human! If you’re taking the time to read this then you’re likely open to learning. As for me, I continue to learn in the trauma space every single day.
The 7th and final step – the one that near-inevitably leads to her utter depletion and possible exit is the glacial pace at which justice is wrought. Whether justice takes the form of an out-of-court settlement, a public apology, internal reconciliation, or an actual trial, the speed at which these things happen engenders nothing but hopelessness. Can something really be “in progress” if it’s already taken a decade? How long does one wait for things to get better? While limping along the slow road to repair, her reputation, her health, her finances continue to take a beating. And for what? Someone to finally say “Oops, we goofed up! Sorry we violated your rights”? “Congratulations on working so hard and surviving!”? Women – across all disciplines and workplaces – need capital A accountability. If she tells decision-makers what it will take to make her “whole again”, they need to just bloody well listen to her and get it done! Give her the time and space and resources she needs to heal from the institutional trauma she’s endured. Institutions, don’t be the enabler. Don’t profiteer from the harassers’ misdeeds. Because guess what? In the words of William Wilberforce (circa 1789), “You may choose to look the other way but you can never again say you did not know.” When institutions refuse to see, refuse to acknowledge, refuse to change, refuse to publicly apologize, they might as well have unleashed The Playbook all by themselves. Every success earned by the oppressors, the harassers – whether it’s their wealth or VIP network or promotions or publications in Nature or their Nobel prize – every single success occurred by stepping on the back of the harassed. And that success is so tainted forever it’s actually worthless.
