Surviving In The Society of Women

“Happy families are all alike; each unhappy family is unhappy in its own way.”

So begins the novel Anna Karenina. However, if Leo Tolstoy tagged along with me when I’m summoned to come rescue a clinic with troubles, he would doubtless come up with a similar observation about happy clinical staff and unhappy clinical staff.

In my role as a consultant – spending a relatively brief amount of time in a clinic to help it get on track and solve problems – I see troubled staff and administrators.  Unfortunately, I’m not called in to observe happy clinics and partake of celebrations of success.

Each clinic has its unique challenges and problems.  And although they ARE problems, it’s the unique part that intrigues me.  After all, the problems are severe enough that they are willing to pay me to come untangle the mess.

There are certain problems in common, whether in Massachusetts or California – too many patients, not enough time for each one, budget constraints.

The variations tend to be in the staff members.  Some are burned out, some impaired, some make me wonder how they slipped through graduation and licensing exams.  There are personality clashes and turf battles and power struggles and petty grievances blown up to world-class catastrophes.

One that sticks in my craw – I mean, my mind – was when I was caught up in the deadliest of all situations:  The Society Of Women.

From the moment I arrived, a blanket of negativity descended upon me and made me feel like I was swimming the English Channel while wearing galoshes.

The problems were subtle, but powerful.

Coming in as an outsider, a know-it-all and carrying some authority I hadn’t earned in the trenches (their trenches, at least), I was pre-judged, assailed by trivialities, forced into some kind of internecine warfare with people who had – and jealously guarded – inside knowledge that they confused with power, and placed in a position of false competition.

My very presence was an insult to some – a bureaucratic slap in the face telling certain staff that they weren’t doing their job well enough.  Therefore, I had to be put in my place.

Without certain information or instructions, there was always a situation where I could be made to look foolish – if not incompetent – and these situations were usually followed by a certain amount of gloating.

Of course, my superior medical knowledge and clinical experience wasn’t really at issue, when someone could point out that I didn’t really know the patients that had been in the system for many years, and thus could not foresee certain problems that arose.

Medical charts weren’t available in a timely manner, orders were “misplaced” and needed to be regenerated, practical advice was misconstrued in ways to ensure a negative outcome.

In other words, it was the “Passive-Aggressive Zone.”

I’ve seen it in lesser degrees elsewhere and heard of it the way a mariner hears of the dangers of the Bermuda Triangle – a frightening place one never wants to encounter.

It was a society of women, and it felts like high school.  Of course in high school, I was “hors concours,” as the French would say; “out of the contest.”  Titular nerd (my nickname was “the brain”) as well as the token Jew,  I neither sought nor received any popularity from my peers.  It was fine.  I didn’t much care.

But we weren’t in high school any more.  The stakes were higher now.  The outsider may not realize this, but psychiatry deals not only with nervous or sad patients, we deal with life or death situations.

The clinic needs a competent staff to get resources and provide services for the patients – nurses, therapists, case managers and the administrative people.

The psychiatrist is at the top of a pyramid and dependent upon these people.  If they decide to obstruct the process, the patient won’t get needed prescriptions, or medical referrals or tests or benefits to buy food or support children.

Worst of all, the clinic may not get paid by insurance or government.  And that is a real tragedy.

Yes, some staff people are so petty they will exercise their jealous nature against a psychiatrist by causing inconvenience or harm to someone in their care.

There is not one negative word on the internet that I can turn up about what happens when women work in groups. It seems, in general, to be politically correct to follow the norms of standup comedy; that is, I can be critical of my OWN “minority” (aren’t women 50% of the population?) only because I am part of it.

 In this institution there was only one male — the lowest-level employee in the place.  He would take the vital signs when patients arrived and pass the time of day with them, calming their nerves if needed, until they got to see the psychiatrist.

If that psychiatrist happened to be me, then it was possible that the staff wouldn’t alert me that a patient was waiting, and then act innocent when they realized my ESP was turned off and I couldn’t mystically divine that there was a patient in the waiting room.

I remember years ago working with a Menninger- trained classical analyst, who told me women would not only never work well together, but might never be able to form solid friendships, since they were inherently in competition for mates.

I never quite bought that one, for I remember telling him Freud at least admitted he did not know what women wanted.  And I admit that I was in denial at that stage, thinking we were all one big happy family of brothers and sisters.

I did remember in high school how female friendships were abandoned when a boyfriend came in the picture, or how gossip or innuendo could be used to bring people down.  In this clinic, clerical personnel wanted to be the ruling class. They whip-sawed the psychiatrists and therapists with their power over the scheduling.  They could book several patients to arrive at the same time, creating problems in the waiting room.  They could pretend they had notified the therapists of arrivals or cancellations.  They could “misplace” billing records and medical charts.  And best of all, they could talk about whomever wasn’t present and plant rumors and cause panic.

They were amateurs at the game.

When I was in the military, I had been sent to some kind of retreat in Maryland.  There was a delightful older woman psychoanalyst, Vienna-trained with the accent that Hollywood therapists always had in those 1940s movies, who was supposed to somehow analyze my behavior in groups.  I remember how it surprised me when she shook her head in sadness.

She told me that I am what is called a “receptacle” personality.  What it means is I have the knowledge and the drive and basically, I just get the job done, without much in the way of hangups.  But as a consequence, other people project their feelings onto me.

At its grossest oversimplification, she told me, this meant people who loved their mothers would love me, and people who hated their mothers would do horrible things to me.  I can tell you from experience that people in the Army who want to screw up your life are professionals – they play rough.

These wannabes at the clinic were light-weights and couldn’t ruffle my feathers.

I never asked the young woman who messed up most of my billing how she felt about her mother.  I never confronted the ones who scrambled the schedules if they still had unresolved Oedipal issues.

Personal confrontations weren’t the way to handle these people – it had to be done on a whole different level.  One they couldn’t imagine – much less see.

The way I handle these things – or how I handled this specific clinic – aren’t really the point of my story.  Of course, if you are curious, you can hire me to come straighten out YOUR situation.

But these anti-feminist feelings remain real and a force to be dealt with, even if they are obscured by the ideas of political correctness.  Workplaces face them all the time – in every field of endeavor.

How often I told myself sisterhood was powerful, only to find, especially when I was in high school, that gossip brought too-frequent tears.  It always felt stupid of me to cry.  My father of blessed memory often called me a crybaby, told me these things should be “like water on a duck’s back,” just roll off.  My husband explained to me, a while ago, that even though I am physiologically as heterosexual as a woman can be, I am “functionally” male.  I think he means I’m authoritative – bossy – and results-oriented.  He still thinks I’m cuddly and cute.

It is true that the medicine of my education and my specialty training was a male-dominated medicine, and I functioned well in it.  After one year of surgery in America, my preceptor told me that even though I seemed awkward at first, all of the surgeons “love you, to a man.”  I did not yell “sexist.”  It felt wonderful.  

To them I must have seemed disarmingly reasonable, like the famous Rex Harrison solo in “My Fair Lady”:

Why can’t a woman be more like a man?
Men are so honest, so thoroughly square;
Eternally noble, historic’ly fair;
Who, when you win, will always give your back a pat.
Well, why can’t a woman be like that?
Why does ev’ryone do what the others do?
Can’t a woman learn to use her head?
Why do they do ev’rything their mothers do?
Why don’t they grow up- well, like their father instead?
Why can’t a woman take after a man?
Men are so pleasant, so easy to please;
Whenever you are with them, you’re always at ease.

“Why can’t a woman/be more like a man,”  I was.

While making comparisons to Broadway plays, this clinic reminded me of “The Women” by Clare Booth Luc.

The talented woman who wrote this, and was also a member of congress and the ambassador to Italy, was apparently subject to jealousy for both her intelligence and her beauty.  The people at PBS call hers a “female Horatio Alger story.”  I am advanced enough in life and status and in a place where (surprise of surprises) people other than my husband actually think I am attractive.  Well, I may be, as a receptacle personality, slurping up some of the same forces that Ms. Luce describes.

Male competition is played out in sports or its analogues – such as politics or war — openly, aggressively, and unequivocally. Besides, even if other women invited me to a foot race or a bracing game of handball, I would lose.  That is not my preferred playing field. I have heard remarks from behind my back repeated to my face.

People resent the paycheck they imagine I make. They resent my clothes, which are more playful than expensive.

They resent this strange attractiveness which is, to me, make-up of increasing art on an aging face with furrows earned long ago during horrific nights on professional call. They resent my happiness, and the charming man who leaves me in the morning and finds me at night.  They do not have any better — that I know. What I know and they do not, is how their bitterness has driven these things away.

They tell me of the joys of hearth and home and watching children grow; all experiences which I knew I would not live as joys, but as onerous weights on my soul, so I eliminated them from my life.  I took control.  Any woman can, I think, and can get help if she needs it. Why competition, which I am fated to win?

I remember reading long ago how women in institutions would get on a sort of common menstrual cycle.  Not something I even want to check, but judging the communal mood of this place, it may be possible.  They want to talk about recipes and family and I am not in their place.  I give them medical facts and clinical opinions I remain convinced are for the good of the patient.  Sometimes I wonder if the patients will ever get what I think they need, because the control is not with me, the authority.

Power is in an informal structure, where people with incredible personal power and usually few credentials, seem to have a practical get-it-done attitude.  Even is such adversarial surroundings, there always seems to be an ally who helps me straighten out my billing, and seems to be able to get me what I need for my patients when nobody else can.  Usually, she is the one who actually runs the clinic.

There is no glass ceiling — rather, there are jagged shards that pierce like broken glass and can cut one down if progress is attempted.  The key is to find the informal power structure, to become friends with the precious person or people who act like the “underground” or the “resistance” in an occupied country. Using this resource I can often get my patients what they need, and — miracle of miracles – navigate the paperwork and bureacracy.

One must ignore those who are not supportive; even pay lip service to empty rituals just to get along, and pray that my sex — of which I am all too often ashamed — will abandon whatever behavior patterns seem to have been inherited by evolution and become, the way Rex Harrison wanted, “more like a man,” so we can eliminate the shards of the glass ceiling, and improve the world by towering toward the sky.