There are sentences that return to me long after they’ve been spoken, not because they are profound, but because they echo an entire landscape of quiet apathy. And what fantasies do I still need to sustain?
A General Practitioner in my class said one of those sentences this week. The prickly subjects for the white ear, of structural racism, of reconciliation, and she said, with an almost serene firmness, I will learn about difficult frameworks when I get there.
What struck me was not the content, but her ease.
There is no other area of medicine where postponement is tolerated. Breast cancer isn’t deferred. Menopause isn’t a someday project. Cardiology isn’t optional. Only racism gets treated as something you can study when the mood is right.
Only racism becomes optional. It is pushed to the margins, saved for later, a topic reserved for when one “gets there.” And “there,” in this formulation, is always imagined as elsewhere, never the racialised patient already in the room, already suffering in Fanon’s Zone of Non-Being.1 White innocence2 doesn’t need overt violence to function; postponement is enough.
Later that evening, after the muted antagonism of the Zoom calls, after the small, practised evasions of the white clinicians who spoke as if racism were an optional module in a distant semester, I sat at my desk with the windows half-open to the warm Brisbane air. I began reading a short case report in The Lancet.3 It described a 19-year-old man whose skin had been darkening for seven years before anyone understood what it meant. The house was quiet, but the detail refused to settle. For seven years, pigment gathered on his gums, his knuckles, the underside of his tongue, the single unmistakable sign of adrenal failure. And yet each clinician he saw passed over it with the composed confidence of someone who believes they already know the body in front of them.
His nausea, his fatigue, his weight loss, all seemed too ordinary to provoke alarm. They were symptoms that belong to the everyday, indistinguishable from the tiredness that so often circles a life. What stayed with me was not the illness itself but the space around it. The sign was present. It waited. It made itself known in the body. Yet it was never taken as knowledge.
I then turned to a German study by Bleicken et al.4, the pattern, more revealing. Even in a predominantly white population, where hyperpigmentation should have been recognised, diagnosis of adrenal insufficiency was delayed for years or missed entirely. Women waited longer than men. Many were given the familiar explanations that can be offered almost by reflex: depression, anxiety, psychosomatic complaints. These diagnoses provide a sense of closure without requiring anyone to see what is actually unfolding.
Even with every visual advantage, the disorder remained unseen. It lay in plain sight, patient and precise, but the gaze that met it was already reduced, already trimmed to a narrow aperture through which only familiar stories could pass.
Then came the South African data. The authors write the sentence with the kind of plainness that borders on brutal:
“Ethnicity influences the diagnosis of primary adrenal insufficiency.” (Ross et al.)5 Hyperpigmentation is harder to detect on darker skin, they note. Symptoms are easily folded into the familiar narratives of tuberculosis and HIV. Deaths from undiagnosed Addison’s still occur.
Here, the pattern reveals itself: The biology is constant. The visibility is not.
Medicine likes to insist that the body speaks universally. That the symptoms exist above history, above race, above culture. But these papers point to a truth many clinicians never learn because they believe they can wait: Addison’s disease depends on being seen. But the gaze is not neutral.6
If the diagnosis fails even in white bodies, what happens in bodies that medicine has never learned to read? What happens when the primary diagnostic sign is interpreted through narratives shaped by colonial history, economic precarity, or the casual misrecognition attached to darker skin?
When a GP says she will learn “difficult frameworks” when she gets around to it, I hear the deeper sentence beneath it: I will learn to see you later.
But later is when the damage has already been done. Later is the time of crisis.
Later is the moment of collapse. Hormones may be universal. Recognition is not.
And the cost of this delay is carried, as always, by the bodies that were never considered central to the story.
Thus, one day, everyone will have been against this.7
Fanon describes the “Zone of Non-Being” as the structural position imposed on the colonised/racialised subject, that is an ontological deprivation where one is not recognised as fully human within the colonial symbolic order (Fanon, 1952/2008). It is not simply an experience of oppression but a location outside the field of reciprocity, visibility, and full subjecthood.
Fanon, F. (2008). Black skin, white masks (R. Philcox, Trans.). Grove Press. (Original work published 1952)
Wekker (2016) uses “white innocence” to describe the affective and ideological formation that allows white subjects and institutions to imagine themselves as non-racial, benevolent, or untouched by colonial violence. Its power lies less in explicit denial and more in postponement, selective unknowing, and moral self-regard that displaces accountability into an indefinite future.
Wekker, G. (2016). White innocence: Paradoxes of colonialism and race. Duke University Press.
Freitas, PFS, Oliveira, JM & Kater, CE 2020, ‘Crisis? What crisis? Abdominal pain and darkening skin in Addison’s disease’, The Lancet (British Edition), vol. 396, no. 10249, pp. 498–498.
Bleicken B, Hahner S, Ventz M, Quinkler M. Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients. Am J Med Sci. 2010 Jun;339(6):525-31. doi: 10.1097/MAJ.0b013e3181db6b7a. PMID: 20400889.
Ross, IL, Levitt, NS, Schatz, DA & Johannsson, G 2013, ‘Ethnicity influences the diagnosis of primary adrenal insufficiency’, Clinical Endocrinology, vol. 78, no. 5, pp. 800–802.
Long before Sir Thomas Addison described adrenal failure in 1855, clinicians across Africa, Asia, and the Middle East recognised the syndrome: the wasting, the fainting, the darkened skin, the collapse of vitality. They didn’t have the anatomical concept of the adrenal gland, but they knew the pattern. Empire didn’t discover the disease; it consolidated and named it. The British physician is remembered; the global medical knowledge that preceded him is erased.
“One day, when it’s safe, when there’s no personal downside to calling a thing what it is, when it’s too late to hold anyone accountable, everyone will have always been against this.”
El Akkad, O. (2024). One day, everyone will have always been against this. Alfred A. Knopf.
