Harm

First, do no harm.

I think about that phrase a lot. It’s part of the foundation of Western medicine. It’s part of the foundation of the Western academy.

If you talk to me for any length of time you’ll find out that Feminist Standpoint Theory is my jam. I love it. I relate everything to it. I wanna talk about it all the time.

Feminist standpoint theory argues that your view of the world around you is dependent on how you’re positioned in the world. One of the contributions of feminist standpoint theory is that the view from the bottom looking up is more accurate than the view from the top looking down. In feminist standpoint theory, one of the arguments is that women know more about men’s lives than men know about women’s. This isn’t that women are necessarily smarter than men but that they need to understand men’s needs, moods, and lives to survive while men don’t need to know the same things about women. Some bitterly humorous evidence of this can be seen in the recent viral post showing that many men can’t recognize a speculum–a foundational piece of medical equipment for people with uteruses while everyone knows the traditional symptoms of a heart attack in men.

As someone who is a hardcore fan of Feminist Standpoint Theory, a scholar of women’s medical history, and someone with multiple chronic illnesses I have a conflicted relationship with, “First, do no harm.”

As the Harvard Health Blog has argued, to do no harm is not a particularly useful healing injunction. There are times when remedies carry harms of their own and one must weigh the relative costs of these harms because no harm is not a possible option.

Going deeper than that, however, I wonder who gets to determine what constitutes harm.

For instance, a lot of modern medical practice comes directly out of the suffering and death of women. For instance, J. Marion Sims, considered the “father of modern gynecology” practiced the techniques for which he became famous on black women without anesthesia under the belief that black people could not feel pain.

Take a moment and imagine, if you will, the mental barriers one has to erect to vivisect a live human being and convince yourself that they are not in pain. Imagine then, if you were the man who had successfully barricaded your mind against seeing clear evidence of harm, or even humanity, in your subjects how you would record your practice for others. You would not note, for instance, their screams of pain. You would, perhaps, write that the subjects you worked with are strangely reluctant to undergo medical procedures that directly benefit them. To be fair to Sims, we need to position him within the history of women’s health more broadly. For thousands of years what passed as official medical knowledge was the idea that women might not be fully human, with wandering organs that made them do crazy things. Medical practices known to benefit women by decreasing their death in childbirth were ignored for decades because male doctors didn’t think it was important. In other words, they didn’t see a harm there.

Defenders of Sims’ legacy have argued that, “To implicate him . . . is to implicate medicine in mid-19th century America.”

If you’ve stuck with me this far you might rightly be wondering, what does any of this have to do with getting a PhD or dissertation advisors?

To answer that question, let’s look at some of the similarities between the modern medical field and academia.

Both an MD/DO and PhD are terminal degrees. Trainees in each field are required to pay a huge opportunity cost through extended, expensive years in schooling while often paying a personal cost such as less time with family, chronic stress, or decreased health. The training for both professions (at least the Western incarnation of both professions) is rooted in an exclusive practice where male actors have, historically, gotten most of the credit and acclaim while the contributions of women and people of color have been overlooked. In both professions, you practice as a professional for years before being recognized by your community as a professional. The human cost of pursuing each degree is often written into a narrative of rigor–where the harsh conditions of the program theoretically weed out trainees who can’t “hack it.” After years of training and harsh conditions trainees finally earn the right to the title and, hopefully, a place in the profession.

Looking at both of these professions side-by-side, I would argue that what passes as “normal professionalization” in each field contains quite a bit of harm that participants at every level are trained to see as something other than what it clearly is.

All of this is not just a rambling diatribe (I mean, it is that, too), but a necessary prelude to understanding abusive advisors.

Abusive advisors are supposed to exist as a small minority in distinction to the vast majority of advisors who occupy a range between fine and great.

It’s hard to overestimate how important advisors are to whether or not a grad student successfully makes the journey from consumer of knowledge to producer of knowledge, from student to doctor, from temporary employment to permanent employment. In my MA program it was common practice to refer to your academic “family.” You advisor occupied the role of parent. The other students being overseen by your advisor were your academic siblings while your advisor’s advisor was your academic grandparent.

Personally, I tend to shy away from analogies that construct graduate students as children because those analogies are, of themselves, part of the toxic culture of graduate school in which the contributions of accomplished professionals are minimized until and unless they finish the degree. However, in terms of raw power, I don’t know if anything conveys the actual and perceived power that academic advisors have over their students than this analogy. Like a parent, your academic advisor has the power to make you part of a lineage or to exclude you from it. Like a family, your academic advisor and your fellow advisees shape a large part of who you become both professionally and personally.

There is one other way in which this troublesome analogy may be of use. The law recognizes that parents can abuse their children through neglect. In fact, we have laws on the books that protect children, the elderly, and the disabled from abuse via neglect. We even have a legal standard of “duty of care” that applies to corporations (a.k.a did the corporation take reasonable steps to protect a consumer from harm).

In other words, we, as a society, have enshrined in law the common-sense notion that there are cases where neglect, in and of itself, constitutes harm. In most of these cases, neglect constitutes harm because one part (the caregiver or the corporation) has significant power over the life and safety of the person they are serving.

Your academic advisor does not actually have control over your life and they rarely have control over your physical safety. However, they can have a great deal of influence over your mental health and your income–and all that is correlated with it.

Therefore, before we talk about abusive advisors we need to talk about the perpetuation of harm by well-intentioned actors.

I’ve come to believe that most advisors are harmful advisors.

This isn’t to say that most advisors are bad people. Just like the grad students they so consistently fail to serve, they are people caught in a bad system being asked to do ever more with less.

While there are, undoubtedly, bad actors who are malicious and harmful, the far larger problem comes back to who gets to define what counts as harm.

A while ago, I posted an image of an advisor’s time. I recently updated that image to make it easier to read and to better reflect reality:

This is what a normal advisor’s time would look like in the best case scenario. This isn’t a bad person. This is a bad system in which there is almost no option for your average academic advisor to give the necessary attention but given the power differential between a dissertation advisor and a PhD student this sort of necessary neglect constitutes a real harm to the graduate student.

It is not the harm of an outright abusive advisor, nor is it necessarily the harm of missed deadlines or poor feedback. One thing we know about graduate students is that over 50% of them won’t finish their PhD. Many of these students will make it through coursework but a few will drop out at the exam stage and far more will drop out as ABDs. In my conversations with grad students and faculty about why this is happening the answer I most commonly got is that graduate students languished, not knowing how to take the next step, without getting advice from their professors. Professors saw this happening but, with their own busy schedules and need for human things like sleep and families, didn’t have the time or energy to combat it.

The harm, I argue, consists in the opportunity cost these graduate students pay, the deep grief in losing a part of their identity when they unwillingly leave academia, the toll on their health from near-poverty level stipends, and the gap on their resume that they may struggle to explain to employers.

Even in the best cases, I have seen harried professors often give incomplete or contradictory advice to their equally harried grad students. These harms don’t even begin to touch on the missed opportunities for mentorship and sponsorship that we all go into graduate school hoping for.

“First, do no harm,” is an inadequate injunction for care. Our advisors, even all the good ones, are doing harm because they are trapped in a bad system that creates a monumental power difference and then necessitates neglect of the dependents all in the name of cheap labor and the life of the mind or some shit.

What we need, when we think about advisors, especially abusive advisors, is to recognize the ways in which the current incarnation of the system itself is abusive.

If you came to this series because you feel like you are being abused but you feel conflicted because your advisor is a genuinely kind, caring person who just doesn’t have enough time then don’t let anybody gaslight you.

Even if your advisor isn’t abusive the system is.

There are a lot of proposals on how to fix the system and I’ll let you google them when you can’t sleep because graduate school gave you anxiety which gave you insomnia. Someday, I’d like to be a part of those solutions.

However, if you are ABD right now and you want to get those other 3 letters one of the best things you can do for yourself is be honest about the system you’re in.

Let me be very clear: I’m not writing this piece to indict dissertation advisors. They are almost as trapped as their students, if not more so. (I mean, sure, they have a salary but they also have many more years invested in the system and a longer resume gap to explain if they want to leave.)

I’m writing this to indict the whole system.

If critiquing J. Marion Sims means critiquing the medical establishment since the 19th century then so be it and if critiquing dissertation advisors as dangerously neglectful of their PhD students means indicting the whole system then let’s burn this mother down.

First, though, let’s try and get everyone out of the building.