A Review of Race, Class, Region and Gender in Early Emory Medicine Yearbooks, by Moya Bailey.
Moya Bailey’s innovative dissertation, Race, Class, Region and Gender in Early Emory Medicine Yearbooks, is noteworthy for two reasons. Firstly, Bailey focuses on the yearbook, an under-critiqued site of regional and academic identity work. Her focus on Emory, a Southern school with an ongoing relationship with a large Black community, allows Bailey to highlight the ways in which the yearbook reveals, creates, and performs the identity of the ideal medical school student at the beginning of the twentieth century as a racialized and gendered concept. Secondly, Bailey augments her close reading of Emory’s yearbooks with Voyant, a digital text mining tool. By using Voyant, Bailey is able to interrogate the textual absence of black women as potential professional equals and sympathetic patients, even as she centers their constant rhetorical presence as objects of medical research, problems to be solved, and the butts of callous medical humor. Bailey’s use of Voyant further nuances her initial close reading of these yearbooks. Because of this methodological work, Bailey’s overall dissertation offers a nuanced analysis of the role of race and medical racism in creating and supporting the hidden curricula of medical school.
In “Chapter One: A Methodology for Analyzing Medical Media,” Bailey begins by offering a brief genealogy of the healthy body. She emphasizes that beauty, wellness, and health often blur together into one vision of the ideal healthy body. Because of this, ideas of wellness cannot be separated from the classed, raced, and gendered hierarchies of appearance created and encouraged by dominant culture. For Bailey, the images of healthy bodies presented in “didactic medical media” (18) are not, and can never be neutral. They are enmeshed in the same social and political contexts that create and foster environmental racism and institutional oppression. As Bailey presents the reader with a historiography of black women as patients and as sites of medical spectacle, she also neatly folds this historiography into an ongoing discussion of methodologies and archival research in academic institutions. Ultimately, Bailey develops an “archival triangulation method [that included] student representations, patient representations, and stock caricatures” (p. 24). Bailey incorporates the medical school yearbooks into her analysis of didactic medical media in order to how black women’s bodies become sites of experimentation even as they become invisible as patients and citizens. This “misogynoir” (26) becomes operationalized in medical schools as part of the process of professionalization for aspiring doctors.
In “Chapter Two: Framing and Background for a Medical School Portrait,” Bailey highlights how black women as an object of medical spectacle and a source of social pathology is foundational to the institutional processes that groom medical students into medical doctors. Her emphasis on yearbooks and the “hidden curriculum” of medical schools as institutions illustrate that medical racism, political racism, and political disenfranchisement act as mutually supportive social forces. Bailey borrows the term “hidden curriculum,” a concept that highlights “the informally conveyed messages that instruct students about how they should behave and who they will become” (24), from the work of Caroline Wachtler and Margareta Troein. Bailey’s analysis of racism and the hidden curriculum of medical school lays the groundwork for Bailey’s incisive discussion of the 1910 Flexner Report in “The Flexner Report: Standardizing Students and Study.” One of the foundational documents sketching out contemporary definitions for the ideal medical student, the 1910 Flexner Report created the Emory School of Medicine through advocating the closure of other medical schools and consecrated the modern idea of a (white, male, degree-holding) medical professional by professionalizing medical training and making it less accessible. Bailey’s analysis locates the ideal medical student in a specific time and place, as she makes explicit the role race, class, and gender played in both the concept of the ideal med school student and creation of the ideal med school. Bailey also uses this chapter to reflect on the role of modernity and masculinity in framing the hidden curriculum in medical training. Bailey’s attention to detail is particularly useful here, as she situates Emory’s institutional history in both national and regional histories riven by racial tensions. She also notes that the racial tensions surrounding the university were not included in the yearbooks themselves. She uses this absence to illustrate that nostalgia for the halcyon days of youth and study is part of the identity making process of medical school as students transition from farmers to physicians.
Bailey uses her discussion of the Flexner Report and the institutional culture of medical education to highlight that future physicians are educated into seeing black women as a particular kind of patient and object. She incorporates Paulo Freire, Henry Giroux, and other educational theorists in order to emphasize that medical school is both a place for education and socialization. In “Chapter Three: The Aesculapian: ‘fully represent[ing]’ the Institutional Culture of Medical Education,” Bailey emphasizes that future physicians are educated into believing the image of black women as bad patients, as less prestigious clients, as practice for “real” patients, as pathology, and that this education is part of becoming a professional within the field. In the yearbooks Bailey examines, black women are present as ignorant caricatures or as silent cadavers. By situating the yearbooks into larger regional and national histories, Bailey reveals the contemporary events framing the yearbooks’ editing. For example, Bailey describes the growing Black middle class in Atlanta. She writes, “The [caricatured] images help to ease the mounting social tensions of an advancing Southern Black population as well as assuage the fragile egos of subjugated students. Many of the images and representations follow the logics of minstrelsy. Black women are depicted alone and as mammies; Black children are orphaned, no mothers in sight…” (76). Bailey uses the larger histories of Emory and the city of Atlanta to illustrate the local politics that framed the yearbooks’ editing. She augments this historical context by including Voyant. Voyant is a “digital text mining tool” that Bailey uses “to create a digital “code book” that allowed [her] to easily visualize key words, map conspicuous absences, and most importantly, determine the frequency of these different attributes in each yearbook corpus” (34). Basically, Bailey is able to use Voyant to track contemporary references that ought to be in the yearbooks but aren’t. In “Chapter Four: The Yearbook: An ‘Algorithmic Criticism,’” Bailey uses Voyant to identify the ways in which race, gender, and region hide within the yearbooks. Bailey writes, “I found representations [of race] that were hidden in language and not visible to me in photographs” (134), in the ways in which the medical students’ identities as future doctors became a metonym for a white, moneyed, Christian identity. Whiteness, here, becomes conflated with both scientific knowledge and agency. This is in part why Bailey’s analysis of the roles black women play within the text is so powerful. By illustrating the ways in which black women appear within these yearbooks as patients, as stock caricature – Bailey is able to link the language used in these yearbooks to ongoing issues in patient access, the medicalization of race and disability, and the poor health outcomes of women of color in the US. For example, in her analysis of the 1913 yearbook, which includes the vignette A Patient, describes the invocation of black female incompetence as a way of reinforcing the sense of medical authority for which the students are striving. By invoking whiteness, the doctor-patient relationship, and the knowledge- and authority-based hierarchies implicit to that relationship, Bailey argues that A Patient addresses student anxieties about authority, power, and race “through the body of the Black woman patient; she is the marginal figure that exists at the lower end of the power dynamics at the intersection of race, gender, region and medical encounter” (137). By positioning black women as the ultimate patients, “unknowledgeable and passive” (158), Emory’s students were able to reassure themselves of their own knowledge, wisdom, and power.
Bailey’s use of Voyant is an example of using a digital tool to answer a cultural question, something that Bailey has challenged other digital humanists to do. Because of this, Bailey’s dissertation is not only an analysis of an under-researched aspect of American culture through her focus on the yearbook, it is also an interrogation of digital methodologies and their role in cultural studies research. By comparing trends in the language used, and situating the quantitative analysis Voyant provides with the use of qualitative analysis in interpreting the images, Bailey was able to discover references to race, region, and gender not immediately present in the images from the yearbooks themselves. In particular, Voyant contributed to Bailey’s analysis of gender. She writes, “Using Voyant helped me identify words that were germane to my analysis that I might have otherwise overlooked. For example, skirt is an appellation for women that would have escaped my attention without the use of Voyant… Digital text mining not only answered my initial questions, it prompted new ones, including questions about how certain types of content are more or less conducive for text mining projects” (155).
Bailey’s work in this dissertation is important because classroom-based medical training cannot address the overall climate of medical schools as institutions. By leaving the hidden curriculum of med school uninterrogated, med schools can appear to comply with diversity initiatives without actually producing doctors able to treat women of color as real patients deserving of respect and quality medical care. Bailey’s dissertation thus builds on the National Academies of Sciences, Engineering, and Medicine’s 2002 study, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” by arguing that both institutional culture and campus climate must change in order to address continued health care disparities. There has been no other research on medical yearbooks and their implications socially and politically as an “identity making process” (28) that produces medical professionals as an end-product. Further, Bailey demonstrates the same commitment to intellectual transparency that typifies her work with the Crunk Feminist Collective. She used the images scanned from the yearbooks to create an online archive that includes the data she developed using Voyant (http://moyabailey.com/exhibits/exhibits/show/aesculapian). She concludes by challenging readers to think critically about the ways in which black women’s bodies continue to be treated as grotesque pathology, using the media’s treatment of Caster Semanya and R. Kelly’s unnamed victim to describe the ways in which black women’s bodies remain sites of medical spectacle. In the case of Semenya, Bailey describes how the “unique synergy between socially constructed biases and medically derived standards” (161) led to a prolonged media frenzy surrounding Semanya’s gender identity, sex, and health. Bailey links this panicked interrogation of Semenya’s genitalia and sex to the ways in which medical training relies on the visual and the aesthetic. Bailey writes, “Within the realm of didactic medical media seeing becomes believing…To imagine that doctors are not coding for race and sex as they do their work is to miss the ways in which the visual plays a huge role in their training, as well as the hidden curriculum in which they come to understand themselves” (175). In her analysis of the R. Kelly trial, Bailey emphasizes that the trial hinged on the perceived age of the black sexual assault survivor. Using this case, Bailey illustrates how “observation becomes science and science becomes medicine that can be evaluated in a court of law” (176). Using an outdated and discredited scale for what childhood, pubescence, and adulthood ‘looks like,’ Kelly’s lawyers hinged their defense on the perception of the victim as a sexually mature adult, in spite of her chronological age. This scale primarily relies on measurements taken of white children in the 1960s. That this defense worked proves Bailey’s powerful point: the medicalization of marginal bodies, particularly those black women, is a social justice issue. Challenging the hidden curriculum of medical school and the biases of medical research is an intrinsic aspect of this social justice project.
Maria Velazquez, PhD
Emory University’s medical yearbook, The Aesculapian
The Flexner Report
Contemporary media coverage of Caster Semanya’s gender and R. Kelly’s assault trial
N.S. Patterson. Yearbook Planning, Editing, and Production. Ames: Iowa State University Press, 1976.
Atlanta Medical College records at the Manuscript, Archives, and Rare Book Library, Emory University
Emory University. 2013. 230 pp. Primary Advisor: Rosemarie Garland-Thomson.
Image: 1914 Emory School of Medicine Yearbook, Emory School of Medicine Archive, Stuart A. Rose Manuscript, Archives, and Rare Book Library, Emory University.