Karen Johnson, M.D.
From Radiance Spring 1992
Karen Johnson's photograph on the front cover of her book Trusting Ourselves: The Complete Guide to Emotional Well-Being for Women, didn't prepare me for meeting the woman. The book jacket shows a seated figure with auburn hair, fair complexion, and placid smile, looking, well, petite. I'd read Johnson's chapter on size acceptance and wondered how a small woman-perhaps a trim five-foot-fourish-could have such insight into this subject.
With this picture of Johnson in my mind, I knock on the white wood of her door and turn to admire the view of San Francisco from the stoop. When the door opens I find myself-just shy of six feet tall-looking up at Karen Johnson. She is not what I expected.
Johnson invites me in, picks up her cat of considerable poundage and personality, and, drawing her long legs under her, sits in a stuffed chair in the corner of the room. Her voice is soft, friendly. She is gently stroking the cat when, very early in our conversation, she says that she is an angry woman. I confuse her tranquil tone and the lulling rhythm of her hand stroking the cat with her words and assume she is being facetious. "No," she corrects me quietly, "I am an extremely angry woman."
Why? Why should this woman be angry, and how could she announce it so calmly? Here is a successful author whose first book has just gone into a second printing and whose second book is in the works, a speaker who "won't travel more than once a month and tries to keep it to every other month," a teacher, a psychiatrist. She lives in an innovative showplace of a house. We are seated on the main level of her home, which has no walls save those protecting the privacy of the bathroom. An impressive run of large plated windows reveals a southern view of the downtown skyscrapers. Greenery thrives in large urns and planters. Johnson has mentioned Michael, who is working on his computer on the lower level, and her happy relationship with him. She has this great cat. Angry? Again, not what I expected.
Maybe her anger started with her mother. I don't think she is angry at her mother, but for her mother. Mother, who has always been quite heavy and has struggled with that. Mother, who just recently survived yet another round with Weight Watchers. Mother, who can't take her daughter's advice to "relax and enjoy that she is a beautiful, wonderful woman with a contagious laugh." An episode Johnson experienced in college as a premed undergraduate might have fueled her anger. In 1967 she met with an administrator from a medical school she was interested in attending. He told Johnson, right to her face, that he would take fifty men before he'd take her, no matter what her grades were. "I was furious," she confirms.
After that roadblock, Johnson switched her major and graduated in 1969 with an undergraduate degree in speech communication. Out in the field of TV reporting and journalism she discovered that women's progress was also being thwarted. "Women had few opportunities in broadcasting. Remember, it wasn't until 1972 that a woman reporter was allowed on the floor of the Democratic convention."
In fact, 1972, says Johnson, "was a watershed year for women. With Title IX, doors were opened for women. It changed the world around. A man working for a medical school could no longer look at a woman and tell her he'd take fifty men before her." Johnson applied to the medical school at Michigan State University. "It was new and unconventional. The dean of the medical school believed it was the responsibility of the doctor to educate. Michigan State had no university hospital, so students were trained in the community. We were distributed among community hospitals and placed under the tutelage of practicing doctors."
As part of her medical training, Johnson found herself in the Porcupine Mountains in Northern Michigan, apprenticed to a family physician whose patients were "very rural and very poor." While working there, she lived with the doctor and his wife. The wife, Johnson says, "changed my life. She was in her sixties. She was, and is, a remarkable woman. She was a peace activist. She had marched with Martin Luther King. And she was a feminist. She was extremely outspoken. She raised my consciousness about women. Most women live in abysmal situations. She brought that home to me."
Johnson pauses, remembering this influential woman, and the silence punctuates her last statement. I begin to see that the undercurrent of Johnson's frustration and anger is a wide one.
During her medical residency at Michigan State, Johnson made another important discovery: she didn't particularly like to take care of people's bodies. "I often had to inflict pain. Once I had to drive a steel rod into a man's sternum to take a sample of bone. It was hard for me to do. It was impossible for me to do." Knowing that she enjoyed communication and that the business of psychiatry was communication, she decided to specialize in psychiatry and health care for women.
This required additional work at the medical school, and Johnson created her own curriculum. Just as geriatrics encompasses many specialties as they relate to the elderly, Johnson proposed a multidisciplinary specialization in women's health that would include gynecology, endocrinology, nutrition, and psychology, among other disciplines.
Following the completion of her psychiatric residency, Johnson applied to the National Fund for Education and received a research fellowship to study the experiences of women medical students. Previous studies of medical students had focused only on men. Johnson's voice catches sharply when she explains that the study "was funded for only one year. The second year wasn't funded because it 'did not have enough merit,' but the money was there."
Without a fellowship and finished with school, Johnson looked for employment. She found no positions that would allow her to continue her work with women. Finally, in 1982, Johnson heard about a new health center in Chicago, a women's health center, and she called the woman in charge. Johnson convinced her the center needed a psychiatrist whose specialty was women.
In Chicago, Johnson conducted a series of seminars on topics for women, including discussions of self-esteem, anxiety, and alcohol. Johnson laughs and says with some pride that "250 women would show up and actually enjoy a two-hour seminar on depression." The success of Johnson's seminars provided the impetus for her book, Trusting Ourselves.
In 1985 Mt. Zion Hospital in San Francisco recruited Johnson to duplicate the Chicago Women's Heath Center. Part of the lure of San Francisco was Mt. Zion's promise that Johnson's center would have strong ties with the University of California at San Francisco and would help train medical students and physicians about providing health care for women. "That," Johnson says in a flat voice that admits to her disappointment, "didn't happen."
But she continues in an optimistic spirit. "Over time, we will create centers for training students." Now in solo practice and no longer affiliated with Mt. Zion's center, Johnson finally does have a hand in educating medical students. Every winter quarter at UCSF, Johnson coteaches a course for medical students and graduate nurses about feminist issues in psychiatry.
"In part of the course we question the conventional wisdom that fat is bad. If a woman is obese-and we talk about how charged that word is-doctors instruct her to lose weight. But 98 percent of the people who lose weight regain it in two years, and they usually gain back more than they lost. So we ask, Is this an effective treatment plan? If the assumed treatment plan is a diet, a diet with a 98 percent failure rate, then that prescription is a debatable medical practice. We discuss the research that strongly suggests that genetics programs us to be a certain size and shape, that our bodies have a setpoint, and that only through tremendous physical effort or fundamental deprivation can we change this. These are hot class meetings. The literature we offer from fat liberation runs counter to everything medical students and nurses are taught. We ask them to question the assumption that being fat is a medical problem."
Most of Johnson's professional life revolves around her psychiatric practice, established in 1989. Although most of her patients are women, 15 percent are men who chose Johnson because she is a feminist. Her patients are anywhere from twenty-four years old to seventy-two, but Johnson notes that "most patients seek therapists approximately their own age, so most of mine range from their early thirties to late forties."
During our interview, the phone rings. At the other end is a woman whose friend has recommended Johnson as a therapist. Often patients are referred to Johnson by another physician, or they call because they've heard Johnson speak or have read her book.
After deciding from an initial conversation that she can help the caller, Johnson schedules a consultation and conducts a "bio-psycho-social assessment." Next she creates a plan for each of those areas-biological, psychological, and social. She helps each patient understand the reasons for her distress, and she lays out a course of action. "If the patient decides to accept the plan, I become her consultant. She may make the decision to start therapy, make a life change, jettison a relationship, begin medication, or any combination of these."
The most common issue? "For most women, it's something to do with relationships," answers Johnson. About half of Johnson's patients are in relationships that are not going well. The other half are without a primary relationship and want one.
Johnson also reports that most women, regardless of their shapes, are preoccupied with their bodies. "Very few women don't have issues about their bodies. They're too big and should be smaller. Their breasts are too big or too small. Their faces aren't quite right. They're too short. They're too tall." Johnson is clear about her position on body issues: "I'm a bad person to come to see if a woman is obsessed about dieting. I tell her upfront, 'Understand, I'm not in favor of dieting.'"
Johnson explains how she works with her patients. "We might take six months and work through a problem," says Johnson, "but the patients won't want to terminate our association. So they take a 'leave of absence' when they finish their work, and they can always come back when they have a problem or want to do another piece of work."
Johnson gladly returns to the topic of anger that initially puzzled me. "Any group with less power than another group is angry about it," she says. "Men have more power than women. But women live in a world that discourages them from valuing their own feeling of anger. Women have a right to be angry. Obstacles are placed in their paths. They deserve full representation, full access to opportunities. To be seen as an angry woman is bad; it's a negative label. But I love anger. Anger should be embraced: it's a fuel, a resource for challenging those who want you to stay in your place.
"I think about anger a lot. We need to figure out ways to use it effectively. I work with anger in therapy and in my own life. I want to redefine the notion of female to include anger."
Asked what she would create if she could wave a magic wand, Johnson describes "a big, open field on a warm summer day with women joyfully dancing in beautifully colored garments, women of all sizes, shapes, and colors. Incredible joy, freedom, pleasure. The world would be safe, peaceful-without violence. We could enjoy ourselves just as we are; we would be valued in all our diversity." She stops, lost in a bit of sorrow, and confides, "I'm pessimistic about this happening in our lifetime." I look up from my hurried notes and see her wipe away a tear. I scramble for something clever to say to ease her discomfort but find nothing. Then Johnson rallies and adds, "But the Berlin Wall did come down."
As I leave Karen Johnson and drive east, back to my own life, I keep coming back to the issue of anger. What's wrong with being angry? Why do I work to avoid it? Then it hits me: because angry is ugly. The word evokes images of faces contorted with rage; obscenities belched from unruly mobs; stiff-limbed, rank emotion. I have always thought of anger as disfiguring, and I don't want to be branded as angry because I don't want people to think of me as ugly.
But Karen Johnson wasn't ugly-angry. I liked talking with her; I liked her. I liked what she had to say about anger. I drove to San Francisco to talk about her, and she made me think about myself. And that's not what I expected. �
Johnson entitled her book Trusting Ourselves for two reasons. First, Johnson encourages women to trust themselves, their feelings and gut reactions, despite what "professionals" might say. These professionals and their advice are the product of schools and research that have largely ignored women, their bodies, and their special needs. Second, Johnson hopes the book's title will suggest that her work is similar in spirit to Our Bodies, Ourselves, the renowned medical reference book created for women by laywomen in Boston. "I don't pretend that my book is the landmark book that Our Bodies, Ourselves was," Johnson says, "but I would be pleased if Trusting Ourselves came to be viewed as a companion piece to Our Bodies, Ourselves."
Excerpts from Trusting Ourselves
From Chapter 11: "Body Image and Eating Disorders"
"The arbitrary standard for what constitutes an attractive female body has changed. But body size and shape are not altered as easily as hemlines. Asking women to adjust, rearrange, and accommodate to a new standard of attractiveness every decade or so ties up energy and time that could go elsewhere."
"Media images and cultural pressures have less impact if family and friends like us as we are. You couldn't pick your family, but you can pick your friends and lovers. Why bother with any who do not appreciate your natural size and shape?"
From Chapter 10: "Alcohol"
"With heavy drinking, ovulation and menstrual flow become irregular and hormone output decreases. Birth-control pills cause the body to metabolize alcohol more slowly, and a woman stays intoxicated longer on her usual number of drinks. It appears that as little as three drinks a week may increase a woman's risk of breast cancer by 50 percent, but we do not yet know why."
From Chapter 5: "Creating Healthy Intimate Relationships"
"No woman can safely entrust her heart and well-being to a man who does not live by these beliefs. Genuine intimacy is impossible in any relationship unless each partner feels equally important and equally valuable. But even when a couple creates a companionship relationship and shares power, they will still experience conflict."
"When you are ready for a new relationship, finding a potential partner takes a combination of imagination, planning, thought, the willingness to extend yourself, and good luck. You cannot count on stumbling onto opportunities-you have to help create them. You can take three good steps toward choosing a new partner: define the kind of potential partners who interest you, figure out where they are likely to spend their time, and arrange to be there to meet them."
"Women who have no trouble finding a decent, if not exciting, job often seem to be completely inept when it comes to recruiting an acceptable partner into their life. Yet the skills are quite similar. Setting goals, going on interviews, reviewing job descriptions, investigating benefits, and selecting among employment alternatives is a familiar process to anyone who has changed jobs." �
SUSAN LAWRENCE RICH, from Oakdale, California, scurries between her high school classroom, her new Mac computer, and her family.
From Radiance Spring 1992
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