When Frederick Douglass was born a slave in 1818, he entered a world of extreme poverty, devoid of educational opportunity, with no prospect of equal treatment under the law. By the time he died in 1895 at the age of 77, he had become perhaps the most widely traveled, most photographed, and most widely heard American of the 19th century, playing a transformative role in the abolition of slavery and the defense of human dignity [1]. His initial prospects for leading a life of influence were exceedingly poor, but he became one of the most prominent American leaders of the 19th century. And he did it all through the power of the spoken and written word.

At a time when information technology is fostering increased reliance on checkboxes, drop-down menus and reporting templates, Douglass — one of the great orators and writers of his age — reminds contemporary physicians of the perennial need to cultivate powers of creative self-expression. Patients, families and communities need advocates who can represent them effectively in the private and public squares. This means that pediatric radiologists need to help colleagues at all stages of professional development wield more effectively one of the profession’s most powerful resources — their voices.

Consider an example of Douglass’s immense rhetorical power, conveyed not in a great speech before an audience of thousands at a national convention but during an informal conversation with a group of schoolchildren at a school for Black children near the site of his birth:

I once knew a little colored boy whose mother and father died when he was but six years old. He was a slave and had no one to care for him. He slept on a dirt floor in a hovel, and in cold weather would crawl into a meal bag head foremost and leave his feet in the ashes to keep them warm. Often he would roast an ear of corn and eat it to satisfy his hunger, and many times has he crawled under the barn or stable and secured eggs, which he would roast in the fire and eat.

That boy did not wear pantaloons, as you do, but a tow linen shirt. Schools were unknown to him, and he learned to spell from an old Webster’s spelling book and to read and write from posters on cellar and barn doors, while boys and men would help him. He would then preach and speak, and soon became well known. He became a Presidential Elector, United States Marshal, United States Recorder, United States diplomat, and accumulated some wealth. He wore broadcloth and didn’t have to divide crumbs with the dogs under the table. That boy was Frederick Douglass.

What was possible for me is possible for you. Don’t think because you are colored you can’t accomplish anything. Strive earnestly to add to your knowledge. So long as you remain in ignorance, so long will you fail to command the respect of your fellowmen [2].

Douglass

Douglass was born in eastern Maryland, the property of a slave owner. He did not know his White father’s identity and saw his mother only rarely before she died during his childhood. Initially the wife of his owner began teaching him to read, but her husband eventually changed her mind, arguing that education was incompatible with slavery. As a teenager, Douglass was handed over to a slave-breaker, but he fought back and prevailed, putting an end to the abuse.

Falling in love with a free Black woman in Baltimore, Douglass escaped with her help to the North, where the two were married, living under an assumed name to avoid detection. While residing in Massachusetts, he became a devoted reader of The Liberator newspaper and regularly attended abolitionist meetings. Invited to speak at one such meeting, Douglass so impressed his audience that he was invited to travel the country and speak regularly against slavery.

In 1845, when Douglass was only 27 years old, he published the first of his three autobiographies, Narrative of the Life of Frederick Douglass, An American Slave. The book became a national and international bestseller and is still read by students around the world today. In it, Douglass courageously named names, raising fears about his recapture by bounty hunters. His friends advised him to travel to the British Isles, where for the first time he experienced a society devoid of racism. When he returned to the U.S. 2 years later, he did so a free man, because some of his supporters had purchased his freedom.

Douglass began publishing a newspaper, The North Star, whose motto was, “Right is of no sex — truth is of no color — God is the father of us all, and we are all brethren.” During the Civil War, he met President Abraham Lincoln, and Lincoln referred to him to as “my friend Douglass.” When the war was over Douglass’s advocacy helped secure passage of the 13th Amendment abolishing slavery; the 14th Amendment according all citizens, including former slaves, equal protection under the law; and the 15th Amendment, which prevented the denial of voting rights based on race or prior servitude.

Douglass remained active as a speaker and writer throughout his life. In fact, on the day he died at age 77, he was preparing to give a talk at a local African church and died just as the carriage that was to convey him arrived. Of the power of his rhetoric, a Douglass scholar has written:

From the outset, Douglass overwhelmed White audiences with his oratorical brilliance and his intellectual capacity. As he spoke at one antislavery meeting after another, his fame spread among abolitionists throughout the North. His reputation rested chiefly upon the passionate streams of rhetoric by which he gave vent to an unyielding hostility toward slavery and racial prejudice [3].

Character

Douglass’s own story was perhaps his greatest tool of persuasion. Abolitionists such as William Lloyd Garrison, one of Douglass’s earliest supporters, recognized that no argument could touch an audience as deeply as a first-person narrative of life under slavery. Douglass not only knew such a story, he had lived it, and over the years of sharing it in countless speeches and three autobiographies, he distilled and refined its essence. In his early days he began his addresses by showing the scars on his back, but soon he discovered that his words proved far more effective. Consider his account of how learning to read awakened his thirst for freedom:

I would at times feel that learning to read had been a curse rather than blessing. It had given me a view of my wretched condition, without the remedy. It opened my eyes to the horrible pit, but to no ladder upon which to get out. . . . [But] the silver trump of freedom had roused my soul to eternal wakefulness. Freedom now appeared, to disappear no more forever. It was heard in every sound and seen in every thing [4].

The deep connection between Douglass the man and Douglass the advocate is revealed by attempts to counteract the power of Douglass’s message. For example, his opponents attempted again and again to tarnish his reputation, suggesting that he was engaged in extramarital relationships, especially with White women. They believed that if they could shake the public’s faith in Douglass’s character, the foundation of his advocacy would be undermined.

Developing physician–advocates need to cultivate a deep understanding of their own stories. It is desirable to be able to cite robust evidence and fashion logically compelling arguments, but if physicians offer no account of the origins of their advocacy on behalf of the neglected and oppressed, their effectiveness is likely to be constrained. Listeners and readers want to know how and why a physician feels called to advocacy. If such an account evokes a high degree of engagement and enthusiasm, it can prove one of the most powerful resources of persuasion. In other words, in addition to learning to take the histories of patients, physician–advocates need to study their own.

Emotion

Douglass also knew how to reach the hearts of his audience through stories. He liked to say that women in slavery bore many children but none of them had a family. Men and women were often “bred” like cattle by their masters, and slaves could be moved around at their owners’ will. Douglass himself barely knew his mother and was raised by his grandmother until, as a young boy, he was taken by her and left with the master. Owners saw their slaves not as full human beings who should make their own decisions in life, but as tools to be wielded in whatever way seemed to maximize their value.

Douglass drew his audience into the perspective of a slave. He could ask adults to imagine themselves as children, torn away forever from their parents. He could ask women to imagine what it must be like to have your child taken away from you. He could challenge men to examine how they would feel if the woman they loved was sold to another owner. He could bring to life verbal abuse, beatings, rape and murder, all perpetrated in the name of slavery, and thereby evoke feelings of fear, horror and outrage in those who heard and read him.

Douglass describes the whipping of a female slave known as Aunt Hester, evoking its terrible effects not only on victims and witnesses but also on perpetrators themselves:

Her arms were stretched up at their full length, so that she stood upon the ends of her toes. . . . He commenced to lay on the heavy cowskin, and soon the warm, red blood (amid heart-rendering shrieks from her, and horrid oaths from him) came dripping to the floor. I was so terrified and horror-stricken at the sight, that I hid myself in a closet, and dared not venture out till long after the bloody transaction was over. I expected it would be my turn next. I had never seen any thing like that before. I had always lived with my grandmother on the outskirts of the plantation, where she was put to raise the children of the younger women. I had therefore been, until now, out of the way of the bloody scenes that often occurred on the plantation [4].

Physician–advocates might be tempted to confine themselves to empirical evidence, citing statistics such as the adverse effects of poverty, broken homes, and alcohol and drug use on human health. Yet studies with thousands or even millions of data points may lack the persuasive power of one good story that engages the emotions of those whom physicians are attempting to reach. An appeal to emotion is not necessarily an attempt to manipulate but often an appropriate and even necessary approach to engaging the whole human being. At the end of the day, a moving story often stays with audiences longest and exerts the most persuasive effect.

Reason

Douglass also appealed to his audiences’ power of reason. He addressed a wide range of topics — slavery, women’s suffrage, immigration and the rights of freed slaves, as well as more general themes such as education, freedom, equality and justice. For example, the fact that lack of learning was often used as an excuse to deny voting rights made Douglass a strong proponent of education. Yet he also insisted that the lack of education could have no bearing on a person’s citizenship. He expressed reservations about radical abolitionist John Brown’s violence while simultaneously praising his courage in promoting the cause of abolitionism.

The person of Douglass himself served as one of the most powerful possible refutations of the notion that Blacks were inherently intellectually inferior to Whites. Those with eyes to see and ears to listen had to admit that his reasoning skills were virtually unmatched. He based his arguments on the Bible, the Declaration of Independence and the Constitution, drawing his premises from their words and reaching conclusions that were nearly impossible to deny. For example, he quoted the Constitution’s first words, “We the people,” arguing that, once these apparently simple words are accepted, profound and unavoidable conclusions follow:

Consider the Constitution itself. Its language is "we the people"; not we the White people. Not even we the citizens, not we the privileged class, not we the high, not we the low, but we the people. Not we the horses, sheep, and swine, and wheel-barrows, but we the people, we the human inhabitants. If Negroes are people, they are included in the benefits for which the Constitution of America was ordained and established. But how dare any man who pretends to be a friend to the Negro thus gratuitously concede away what the Negro has a right to claim under the Constitution [5]?

Physician–advocates need to enhance their capacities to distinguish between good and bad arguments and to use reason effectively in what they say and write. Such capacities are not the same thing as recalling facts or being able to choose the one best answer from a variety of prompts on a multiple-choice examination. Crafting good arguments requires creativity and imagination. It also requires a well-developed capacity to see things from others’ perspectives and reach them there. To know is better than not to know, but to wield knowledge in a way that helps others see for themselves is better still.

Ripeness

Opponents and even friends regularly told Douglass that, whatever the merits of his arguments, the time was not right. In pressing the causes of abolitionism and human rights, they said he was failing to respect the limitations of human nature and culture, trying to move his audience too far and too fast. Wait for a more opportune moment, they urged, and slow down. But Douglass would have none of it. As opposed to the view that the time for change was not yet ripe, Douglass argued that it was long overdue. Injustice and cruelty were never timely, he argued, and those who would delay the establishment of a more just and kind community were merely prolonging unnecessary suffering.

Timing plays an important role in persuasion. For example, there are things that one can ask of an adult that one cannot ask of a child, and there are appeals that an alarmed audience might respond to that in times of complacency would fall on deaf ears. Douglass understood that a key part of his effectiveness lay in his ability to create a sense of urgency, convincing his audience that the time to act is now. For example, Douglass appealed to his fellow Blacks to enlist in the Union army in these terms:

The day dawns; the morning star is bright upon the horizon! The iron gate of our prison stands half open. One gallant rush from the North will fling it wide open, while four millions of our brothers and sisters shall march out into liberty. The chance is now given you to end in a day the bondage of centuries, and to rise in one bound from social degradation to the place of common equality with all other varieties of men [6].

Physician–advocates need to cultivate their capacity to recognize when the time is ripe and take the initiative. Such moments often soon pass, and the failure to promptly move or persuade others to move can allow a door to close. Many aspects of medical education can blunt this faculty. For example, the lives of physicians are often so programmed, and planned out so far in advance, that their faculty of recognizing the opportune moment may slacken. To call someone to action means knowing not only what call to deliver and how and why, but also when.

The power of words

In medicine, it is not enough to know. An effective physician needs to foster understanding in others — patients, family members, fellow health professionals, members of the community and so on. Physicians also need to be able to move others to action, whether in encouraging a patient to follow treatment recommendations, giving voice to a disadvantaged person or group of people, or persuading a health care organization or community to invest resources in a neglected area. Facing such challenges, the work and life of Frederick Douglass can provide deep insights into the nature of effective advocacy, educating and inspiring the physician–advocates of the future.