Learning and unlearning about justice and injustice within the liminal space

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Javeed Sukhera, MD, PhD, FRCPC

By Javeed Sukhera

This is not about me.

This is about me.

Almost from the moment of my birth, I was always at war with myself. Growing up in Toronto, Canada, as the only child of immigrants from Pakistan, there was always something inside me that felt different from who I was supposed to be. A tiny ball of shame would swell within me when a glimpse of my Pakistani identity was revealed.  There were a million moments in my childhood where I remember wanting to disappear.

Reconciliation came with time and introspection. In choosing a career, I was drawn towards working in challenging settings. After several global health experiences as an undergraduate student, I challenged my comfort zone by studying medicine in Israel. As a medical student, I was a young brown Muslim male in a Jewish land where my existing identities were juxtaposed with intense political conflict, oppression, and injustice. I learned to become a physician in an environment where I feared becoming a victim of political violence while fearing that others would perceive me as a perpetrator of violence.

In Israel I began developing my nascent physician identity while reconciling the dimensions of my existing self. Living and learning in the midst of perennial conflict I struggled to find a balance between surviving and thriving. Every time I spoke, I felt I needed to censor an aspect of myself. I resisted being dichotomized in every way. At times it felt like I was building bridges. At other times, it felt like I was uniquely alone.

Learning to unlearn.

Unlearning to learn.

During psychiatry residency training I found myself “unlearning” the desire to fix patients and focusing on easing suffering and building trust. Once in practice, I began to appreciate that traditional approach to tackling injustice through medical education has been limited by a similar tension to my own personal narrative. Individuals who belong to one or another non-dominant group are often given responsibility for equity issues within an educational or healthcare organization. Only in a few instances are equity issues integrated into the core our organizations. Our trainees are taught cultural competence using discriminatory narratives that oversimplify and objectify non-dominant groups. Even as new concepts are being weaved into medical education, there is still a sense of “us versus them” and we are quick to deflect responsibility or accountability by pointing our finger at others.

Early in practice, I sought to build a bridge between the disparate interests in my academic and clinical life. The lived experience of witnessing injustice towards my patients led me towards medical education research. While I had worked extensively with underserved and marginalized populations that experienced discriminatory and prejudicial treatment, I came face to face with the struggle of a mental health system that is chronically underfunded and patients who experience labeling and stigmatization on a regular basis. I witnessed well-intentioned colleagues who consciously expressed egalitarian goals yet demonstrated stigmatizing attitudes and behaviours that dehumanized my patients.

I knew something had to be done, and I began researching how to have difficult conversations about stigma, equity, and bias. I knew our existing paradigm was flawed. I wanted to dig deeper into how we can advance our efforts to address injustice. The journey from an idea, to a grant, to a masters, to a PhD was challenging but rewarding.

This is not about me.

This is about me.

While my entire career has been associated with the idea of dominant versus non dominant identities, transitioning between my roles as a clinician/educator and scientist re-ignited issues related to my own identity and how I reconciled tensions. I sought to navigate the process through constant reflection and spending weekends marinating in writings by classic theorists, acquiring new skills and developing new ways of seeing the problems that informed my research questions.

During my PhD journey, a different but familiar tension re-emerged. Although I have been inspired by transformational thinkers such as Friere, Habermas, and Foucault, they were somewhat invisible in my work. If my work was about disruption, anti-racism, and anti-oppression, why was this not more explicit in my research? However, even asking this question felt like moving from solid footing to a more precarious, risky and dangerous position.

In preparation for my PhD defense, I reflected on how I would respond if asked about the tension between critical and constructivist thinking in my work. I realized that despite tremendous privilege, I remained consistently insecure within white spaces as a man of colour. My own lived experience also highlighted that there is rampant denial of privilege among those of us who speak up and call out injustice. I reflected on how emancipation may take multiple generations and is not something that can be accomplished through a course, a research study or a tweet.

This is not about you.

This is about you.

I have always asked myself: how I can balance my activism with my scholarship? How can I find comfort within discomfort? How can I find confidence in the midst of perpetual self-doubt? Is there an exit door from this perpetually liminal space? As I look around, I wonder if I am alone. I wonder if this rite of passage will ever feel complete.

Have we arrived?

Will we ever arrive?

Are you an oppressor or are you oppressed? Are you a victim, survivor, or perpetrator of injustice? What will you do in presence? What will you do in absence? What is your role in the poetry and myth of this moment?

There is no quick fix to injustice. There is no course, workshop, webinar or certificate. If there is no light at the end of this tunnel, where do we find the love and light we need for the journey?

As we look around, who is here with us? Who is us and who is them? Perhaps we are all bumbling through this dystopian moment one day at a time like everyone else. Perhaps the only light we need is already inside us. Perhaps this space is where we were meant to be. Where we were always meant to be.

 

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