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A Dark History, a Persistent Fear

Someone holding a sign: "Zero tolerance for antisemitism"

Antisemitism is on the rise and of concern to the College. Every one of us — Jewish or non-Jewish — has a role in eradicating this persistent form of hatred from our health care system.

Over the next several issues, eDialogue will explore the consequences of cultural discrimination and racism in the health care space. We begin by recognizing the upsurge in antisemitism and its effect on patients, practitioners and learners. In the following issue, we examine the toll Islamophobia continues to take on Muslim patients and doctors.

As a university student active in social justice causes in the late 1980s, Dr. Sharon Sharir took off her Star of David necklace, put it in a drawer and never wore it again. “I purposely took off the only identifying marker of me as a Jew and decided, for all intents and purposes, to live in the closet as a Jewish person in some parts of my life.”

It just seemed easier that way, she says. “Removing the necklace was a deliberate act, which allowed me to do my work without feeling like anyone was going to target me on the basis of being Jewish or Israeli. It made me think I could be more effective because I would not have to face the possibility of discrimination or rejection, even from people I had believed were allies.”

Dr. Sharir, now a urologist practising at Humber River Hospital in Toronto, says it was not hard to “pass” as a non-Jew. “I don’t look typically Jewish and do not wear religious-type clothing. Though I am originally from Israel, I came to Canada as a child and don’t have an accent. Even my last name — an Israeli name — is not recognizable as Jewish to most Canadians,” she said.

Her perceived “non-Jewishness,” she said, afforded her a glimpse into a world that may not be as welcoming to Jews who may be more easily identifiable as such. She remembers working at a clinic during her first medical elective. An outreach event was being planned to welcome potential patients from marginalized communities. On the list of attendees was a woman named “Libby.” The name gave one of the organizers pause. “We need to be careful here,” she told Dr. Sharir. “Libby can often be a Jewish name.”

For Dr. Sharir, the message was clear: Jews could only be perceived one way — as privileged, powerful and not deserving of assistance with issues of discrimination. “This was my first medical elective and I just kept my mouth shut, but I filed it in my brain,” she said. Over the years, she would see this antisemitic trope come into play with unfortunate regularity.

When she entered practice, things continued much the same. If someone asked her about her background, she would state truthfully that she was Jewish and Israeli, but she generally tried to avoid giving out that information. On those occasions that she did disclose, the reactions could sometimes be dismaying.

“I’ve had patients say, ‘It’s good that you don’t look Jewish.’ They say this while smiling, as though they have just given me a big compliment.”

A long-time patient, without knowing she was Jewish, told Dr. Sharir that Jews could not be trusted. “Here I was, his physician taking care of him for years on the presumption that he trusted me as I treated his cancer, and to hear that hateful message, it was incredibly hurtful.”

Dr. Sharir’s patient, unfortunately, is not unique in his animosity. Jews comprise only 1.25 percent of Canada’s population, but were targeted in 61 percent of all hate incidents against religious minorities that were reported to police in 2020, according to Statistics Canada.

The numbers have only gotten worse. In April 2022, B’nai Brith, a Jewish human rights organization, released a report that found 2,799 anti-Jewish hate crimes occurred in Canada in 2021, including beatings, vandalism of synagogues and swastikas in schools. Antisemitic incidents rose overall by seven percent from the year before, but the number of violent incidents increased by more than 700 percent, from nine in 2020 to 75 in 2021.

In the last few years, however, Dr. Sharir has begun to realize what being “hidden” has cost her. “As time has gone on, I have become more aware of the negative consequences. Just as those in the LGBTQ+ community know only too well, when you hide your true self, when you present yourself as something you are not and you are not being authentic, well, it’s problematic,” she said.

With the upsurge in antisemitism, she has decided to stop hiding. “I am not a public person, but here I am talking to the College’s publication about being Jewish and Israeli. And it feels very empowering. It’s come to the point where I can’t stay in my comfort zone. And if there are negative consequences from speaking out like this, so be it. I guess I am more willing to accept those at this point in my life.”

Taking a stand

Through policy, CPSO has made it clear that it condemns all forms of structural racism against religious, racialized and minority groups. Respect and courtesy, says CPSO President Dr. Janet van Vlymen, is a fundamental expectation of physicians in the workplace, the learning environment and, more recently, the digital space. She says the College is committed “to supporting physicians in creating an environment free of racism and other forms of discrimination, where people feel safe when receiving and accessing health care, and where providers feel safe and respected providing health care.”

CPSO’s new Social Media policy, for example, specifically identifies discriminatory comments as a form of disruptive behaviour that can have a chilling effect on colleagues and patients alike. Our Professional Responsibilities in Medical Education policy references how physicians must not engage in violence, harassment or discrimination against medical students and/or postgraduate trainees, and must take reasonable steps to stop it if they see it occurring in the learning environment. And our Physician Behaviour in the Professional Environment policy discusses responsibilities to ensure the safe, effective delivery of care and a healthy working environment, including working respectfully with other members of the care team. Currently out for consultation is a draft policy, Human Rights in the Provision of Health Services, which proposes new positive obligations for physicians to create and foster a safe, inclusive and accessible environment where patients’ needs are met by incorporating cultural humility, cultural safety, anti-racism and anti-oppression into physicians’ practices.

“The most important thing we have is the support we provide for each other”

“We cannot tolerate disrespectful or discriminatory behaviour,” said Dr. van Vlymen. “Aside from it just being plain wrong, it poses a huge threat to patients and clinical outcomes by inhibiting the collegiality and collaboration essential to teamwork, impeding communication, undermining morale and inhibiting the implementation of new practices. We ask physicians to be aware that unprofessional comments and behaviour have the potential to make others feel marginalized, and impact their feelings of safety and trust, and could impact patients’ willingness to access care.”

Antisemitism and health care — a long history, an ongoing issue

Some doctors still in practice today remember quota systems that restricted how many Jews were permitted to enroll in medical school. Mount Sinai Hospital in Toronto only came into being because at the time, no Toronto hospital was willing to bring Jewish doctors on staff.

In the 1930s, doctors in hospitals across Montreal walked off the job to protest the hiring of a Jewish senior intern, Dr. Samuel Rabinovitch. The strike only ended four days later when Dr. Rabinovitch resigned his position because he was worried about the effect on patient care. It was not until 1951 that the first Jewish doctor — Dr. Barnet Berris — was granted a full-time faculty position within the Department of Medicine at the University of Toronto.

Dr. Sandy Buchman, who is a Toronto palliative care physician, is keenly aware that antisemitism is not, however, a relic of the past. Earlier this year, he joined with other health care professionals in signing an open letter to Canadians, vowing not to let hate and violence intimidate them from fulfilling their commitment to providing quality care to patients.

Dr. Sandy Buchman
Dr. Sandy Buchman, a palliative care physician and past president of the Canadian Medical Association.

“We cannot and will not allow racism, antisemitism, homophobia, transphobia, ableism or any other form of hate or discrimination towards any person facing oppression in Canada stop us from doing our work,” the letter stated.

Signed by doctors, nurses, health care workers and public health scholars of different faiths, races, sexual and gender identities, and by health care professionals with disabilities, the letter is a “powerful example of inclusion and allyship,” said Dr. Buchman, who is Jewish and a past president of the Canadian Medical Association.

“Coming together with colleagues from different faiths, ethnicities and backgrounds, and having them acknowledge the existence of antisemitism among other forms of hatred and discrimination, and calling it out for what it is, is really, really important. The most important thing we have is the support we provide for each other,” said Dr. Buchman. In fact, he said, such demonstrations of support make all the difference.

“People look at me and see ‘a pale, stale, male’ and think what could I possibly bring to any conversation about EDI, what could I possibly know of discrimination?” said Dr. Buchman.

Jews have historically inclined to the role of ally, said Dr. Buchman. “Judaism and social justice are inseparable because of our history. Like many Jews, the importance of human rights was ingrained in me from early childhood and as I grew up, I learned about such issues, as did my Jewish friends.”

Antisemitism differs from other forms of racism in that it portrays Jews not only as ‘less than,’ but also as ‘more than’ — wrongfully portraying them as more privileged than they are, richer, more powerful, subversive and untrustworthy, self-serving, and unworthy of sympathy — and even falsely accusing them of pulling the strings of the world to control world governments and economies.

If you believe that, said Dr. Buchman, it would be hard to see Jews as a minority in need of any allies.

Jewish leaders suggest one of the problems in finding allies is that the general population may not recognize antisemitic violence when it does not have a swastika attached.

“One frequent misconception is that the problem is one of antisemites,” wrote David Feldman, director of the UK-based Birkbeck Institute for the Study of Antisemitism in The Guardian. “Of course, there are such people and some carry a violent threat — but they are a minority.”

He pointed out a study conducted by the Institute for Jewish Policy Research that found when presented with eight antisemitic statements, just 0.1 percent of those surveyed agreed with all eight.

“The problem is that antisemitism is a diffuse phenomenon,” wrote Feldman. “The same survey found that 30 percent of respondents agreed with at least one of the antisemitic statements. Antisemitism is part of the culture in which we all live and through which we make sense of the world. It is best conceived of as a reservoir of stereotypes and narratives, which accumulate over time and from which people draw with ease, whether they intend to or not.”

The University of Toronto’s Report of the Anti-Semitism Working Group, a group created to address forms of racism and discrimination faced by members of its community, describes some of the language used. “In the nineteenth century, the word ‘Rothschild’ was meant to stand for Jews in general; more recently, ‘Soros’ and some uses of the terms ‘globalist’ and ‘Zionist’ figure similarly as tropes in antisemitic stereotyping, as do images of Jews as powerful puppeteers controlling others,” stated the report.

And yet, conscious of perceived white privilege, some Jewish doctors have felt inhibited from bringing attention to antisemitism, said Dr. Buchman. “We have felt that way because we do recognize that the experiences of our Muslim colleagues, our Black colleagues and our Indigenous colleagues are different than ours.”

Dr. Buchman says he has received the occasional antisemitic comment from a patient or relatives of patients who did not want “a Jew doctor.” Still, Dr. Buchman, who graduated in 1981, says he personally did not face religious discrimination as a medical student, a resident or as a practising physician from any colleague or from the leadership of any organization in which he worked. Dealing with toxic hatred was not his daily reality. He recognizes that is not the experience of his colleagues of colour.

“Perhaps the physicians of my generation did live in a bit of a bubble, where we could imagine that antisemitism did not exist,” he says. “But was it an illusion? A moment in time? I don’t know.”

What he does know is that he is now feeling a growing uneasiness, the likes of which he is not sure he has ever felt before.

When it comes to antisemitism in the current climate, it’s not only the sheer number of incidents, but their virulence. In 2018, the U.S. saw the most lethal single attack on Jews in the nation’s history with the murder of 11 worshippers at the Tree of Life synagogue in Pittsburgh.

“I think we have finally come to grips with the fact that we do have something to say about what it feels like to be targeted and harassed just by virtue of belonging to a particular minority group,” Dr. Buchman said.

Jewish community holds vigil for victims of Pittsburgh synagogue shooting in Canada — 29 Oct 2018
Jewish community holds vigil for victims of Pittsburgh synagogue shooting in Canada — 29 Oct 2018

When the Canadian Medical Association came out with a statement last year denouncing antisemitism, it was a validation, he said.

The CMA’s statement, released in November 2021, noted “an alarming increase in online and in-person attacks against Canada’s Jewish community.”

To improve circumstances and opportunities for all, antisemitic behaviour must be called out, it stated. “We must take the necessary steps within health systems and learning environments to condemn and protect those who seek to learn, teach and care for others,” said Dr. Katharine Smart, then CMA President.

“When our professional association comes out and calls antisemitism out, it’s a huge boost for the profession and for students, and lets them know their experience is not false, is not made up and is not exaggerated,” said Dr. Buchman.

Medical education joins the fight against antisemitism

Eliminating racism and discrimination against Jewish people in the health system means starting these discussions early — i.e., while practitioners are still in training. The University of Toronto’s medical school has committed to fighting antisemitism by ensuring learners confront the practices and structures that have perpetuated harm through discrimination, bullying, inequitable care — and worse. As of 2020, U of T medical students have been formally examining the Holocaust and the role physicians willingly — even enthusiastically — played in the dehumanization of Jews, unethical medical experimentation, torture and mass murder.

“While this topic is deeply unsettling, we believe that understanding the darkest parts of the history of medicine — in all of its unsanitized, grotesque forms — is critical to developing moral courage and integrity as a physician,” wrote Dr. Trevor Young, Dean of the University of Toronto’s Faculty of Medicine in a public letter titled, “Cultivating Moral Courage.”

“There are many lessons for medicine in research ethics, resisting government practice, understanding intergenerational trauma and actively guarding against dehumanizing discourse. We know that disparaging words, often based on harmful stereotypes, are what begin to make it easier to treat people as less than human, or as undeserving of sympathy or basic human rights,” wrote Dr. Young.

The contemporary relevance for eliminating antisemitism is clear, wrote Dr. Richard Horton, editor of The Lancet, in a commentary titled, “Medicine and the Holocaust — It’s Time to Teach.” “And it goes beyond antisemitism too — promoting and embracing the needs of migrants and refugees, those with different cultural and ethnic backgrounds, the socially and economically dispossessed, and those living under occupation and in conflict. Teaching the Holocaust in medicine would be an act of resistance against depravity and discrimination.”

For her part, Dr. Sharir has been encouraged by a recent development within the University of Toronto’s Diversity Mentorship Program. The program connects U of T undergraduate medical students and first-year residents from minoritized or disadvantaged groups to faculty mentors who are able to support and assist them in their educational and professional growth and development. After becoming involved in the program two years ago, Dr. Sharir became a mentor to different students and enjoyed it. But she became dispirited by the fact that the program did not appear to apply to Jewish learners, despite students’ clear concerns about experiencing antisemitism. As a result, Dr. Sharir left the program. Recently, thanks to recommendations from the University of Toronto’s Report of the Anti-Semitism Working Group, the program began making outreach efforts to welcome Jewish students into the program.

“We believe that understanding the darkest parts of the history of medicine — in all of its unsanitized, grotesque forms — is critical to developing moral courage and integrity as a physician”

Dr. Sharir said she was astounded by the development. “It was the first time in my social activist life that I’ve ever seen this kind of recognition happen. I really give them kudos for doing this,” she said.

The decision encouraged her to sign up for the mentoring program once again. “I would mentor a Jewish student, a non-Jewish student. I am open to mentoring whoever needs it.”

Dr. Sharir says moves like this will hopefully illuminate the commonality of experience. “I’m an immigrant. I came to Canada not knowing English. Our family spoke a different language at home. I belong to an ethnoreligious minority with a history of persecution for over a millennium. I grew up feeling quite different from many of my peers as a result of this background. Yes, I have white skin, though there are Jews who do not. And while my own experience is not the same as the experiences of individuals who do not look white, I think we have a lot more in common than is often believed.”

Scapegoat

Antisemitism has often been called the world’s “oldest hatred” because it has existed in one form or another since antiquity, and as Jews are only too aware, it intensifies during periods of social disruption.

When Dr. Michael Warner advocated for public health measures regarding COVID, he was left shaken by the response. Dr. Warner, director of the Intensive Care Unit at Michael Garron Hospital in Toronto, was subjected to death threats, harassment, and coordinated attempts to discredit him through websites and videos. Much of the abuse was laced with antisemitic rhetoric.

“I have been told that I should be gassed in a gas chamber,” said Dr. Warner. On one of his worst days, his hospital received an envelope, addressed to him, filled with a white powder. The police were called and the HAZMAT unit was dispatched to ensure it was not anthrax.

“The degree of vitriol I receive is proportionate to how active I am on social media, particularly when I address the importance of vaccines,” he said. “I welcome debate. But because I can’t be taken down on the quality of my content, I am attacked personally — my appearance, the size of my nose, they target what they see as my Jewishness. I’ve been accused of being a political operative and of taking money from pharmaceutical companies. It is unrelenting. I have had many, many very dark days when I really wondered about the state of humanity.”

South of the border, antisemitism is the constant undercurrent in attacks on U.S. physicians who promote vaccines. During a recent webinar about disinformation held by the Anti-Defamation League, two Jewish doctors gave chilling accounts of the hate directed at them. Dr. Peter Hotez, Professor of Pediatrics and Molecular Virology at Baylor College of Medicine, said he has received Nazi imagery with the subtext, “Jews are doing this,” on his social media.

Dr. Gavin Yamey, Professor of Global Health and Public Policy at Duke University, has received similar messaging. Both Drs. Hotez and Yamey are related to Holocaust survivors and victims, and Dr. Yamey said, “The first time that as a Jewish physician you’re called a Nazi, it’s a real shock. It’s a punch to the gut.”

And happening simultaneously, if paradoxically, efforts have ben made to minimize the genocide and turn it into a political tool. Nazi imagery has been appropriated in an attempt to equate the experiences of anti-vaccine advocates with victims of the Holocaust. Protesters wearing yellow stars, like the ones Jews were forced to wear in Nazi-occupied Europe, have been seen at demonstrations across Canada.

Antisemitism hasn’t characterized all, or perhaps even most, of the abuse that Dr. Warner received. But it has not escaped any one’s notice that, in some circles, all aspects of the pandemic have been blamed on Jews.

Manhattan, NY — January 05: A marcher holds a sign that reads "Anti-Semitism = Anti-Human" as they walk across the Brooklyn Bridge.
Manhattan, NY — January 05: A marcher holds a sign that reads “Anti-Semitism = Anti-Human” as they walk across the Brooklyn Bridge.

Jews have been blamed for both the emergence of COVID and its restrictions, with Jewish physicians who promote public health measures singled out for particular vitriol. At least two Ontario hospitals had swastikas scrawled on their walls and placards with similar imagery placed on their grounds.

For those knowledgeable about Jewish history, the blame is all too familiar. For millennia, Jews have been blamed for failing economies and social downfalls. During the peak of the Bubonic Plague in Europe, from 1348 to 1351, more than 200 Jewish communities were annihilated, their inhabitants accused of spreading contagion or poisoning wells.

Intergenerational trauma

For children and grandchildren of Holocaust survivors who grew up listening to their ancestors’ harrowing stories about Jewish persecution, the upsurge in antisemitism may be more than unsettling. It could very well trigger a primordial fear of extinction.

“In some discussions of Jewish history and antisemitism, there’s an implication that Jewish safety is unstable and strictly time-limited,” wrote Rebecca Salzhauer in the publication, The Forward.

She says the magnitude of the Holocaust and the long history of pogroms have had an impact on the collective Jewish psyche, resulting in the development of an especially sensitive ear for impending danger.

“We talk about antisemitism not simply because hate and discrimination are bad, but because we fear it portends a looming existential threat… the pit that plunges deep into my stomach when an alarming headline pops up on my Facebook feed feels like the fear I felt as a child learning about the Holocaust and wondering who would hide my family if it happened again,” wrote Salzhauer.

In 1966, Canadian psychiatrist Dr. Vivian Rakoff began a study examining the high rates of psychological distress that had been observed in the children of Holocaust survivors. This study introduced the idea of intergenerational trauma — coping with trauma one has not directly experienced.

Dr. Lisa Andermann, a psychiatrist at Mount Sinai Hospital, says the anxiety is real. Her own parents and grandparents lived through the Holocaust in Europe, she urges health care professionals to be conscious that trauma can cast a long shadow over the descendants of survivors.

“Cultural safety is a term that gets used a lot, but it’s so important that physicians think about cultural safety, and what it means for people coming into any health encounter and feeling that they are in a safe space and able to receive trauma-centred care,” says Dr. Andermann, who worked for many years in Mount Sinai’s Psychological Trauma Clinic, and is also consultant psychiatrist for the Canadian Centre for Victims of Torture and the New Beginnings refugee clinic at CAMH.

Dr. Robert T. Muller, a Toronto psychologist, says given the increase in antisemitism, bringing an awareness of the Jewish experience to the medical care of [Jewish] patients is important.

“I think a lot of Jewish people who have suffered intergenerational trauma feel that they just can’t talk about it because it’s viewed by many people as something they need to get over and move past,” he said.

“When you have a group of people who absolutely identify as a targeted minority group who are told by some external force, that, in fact, that is not the case, well, it’s a fundamental invalidation. It’s a dismissal and disavowal of their cultural experience.” said Dr. Muller, author of the book, Trauma and the Struggle to Open Up.

He urges physicians to pay attention to the signs of post-traumatic stress disorder and make a referral for further mental health support, where necessary.

The toll

For patients, antisemitism can affect their health and well-being in many ways. The same is true for Jewish doctors.

When any racism or religious prejudice makes itself felt in a health care setting, it takes a toll on doctors and, ultimately, on those for which they care.

“If you can’t bring your true self to work, if you face hate, you’ll be burned out and won’t be as good a doctor,” said Dr. Ayelet Kuper, who, until recently, was Senior Advisor on Antisemitism at the Temerty Faculty of Medicine, University of Toronto.

Dr. Kuper has heard of antisemitic attacks from doctors themselves. She has known of colleagues who have made outrageous statements about Jewish people, casting aspersions on their integrity and honesty. It’s “antisemitic claptrap,” she says, but it is damaging.

Dr. van Vlymen says practising physicians, medical learners and faculty must be able to learn, teach and care for patients in a physically, psychologically and culturally safe environment, free of all forms of discrimination, including antisemitism.

A Jewish physician or medical student who experiences antisemitism, or who feels they cannot bring their full and authentic selves to their work due to unspoken antisemitism, may not be able to provide the best care they can to their patients, she said.

“There are so many causes of physician burnout in the health care system now,” said Dr. van Vlymen. “We can’t allow hatred, including antisemitism, to divide colleagues and escalate the already high levels of emotional exhaustion.”

She said the fight against antisemitism is an important part of the effort to improve patients’ experience and, ultimately, their health outcomes. “Every one of us — Jewish or non-Jewish — has a part to play in helping to eradicate this very old, but very persistent kind of hate from our health system,” said Dr. van Vlymen.