(This article was first published in Lifelines for Health, Fall, 2022)
We are hearing a lot about unconscious bias these days. Along with many examples of what unconscious bias looks like, how it affects the ways in which we communicate, how it harms those who are the victims of unconscious bias. We hear about it in the media, of course. We see examples of it in our own lives, at school, at work, in our communities. And in the offices of healthcare providers.
What about you? Have you had unconscious bias directed toward you or your child? Or have you unintentionally directed it toward someone else?
So Just What is Unconscious Bias?
Basically, unconscious bias is made up of thoughts or feelings that you may not be aware of, but yet have an influence on judgments you make. Unconscious biases come from your preferences for or against something, and these preferences may lead you to have a positive or a negative bias.
For example, you may find yourself assuming that people from certain cities are naturally rude. You meet someone from that city, and you find yourself expecting them to behave in a rude manner, you haven’t actually taken the time to get to know them yet, you just “naturally” expect them to be rude.
Or consider this example: You are walking down the sidewalk late at night and you see someone coming toward you, mumbling, and yelling with a brown paper bag in their hand, asking you for money. Most likely, you don’t take the time to think about what they are doing and how you are feeling. Instead, you would pop into a store or a restaurant that is still open, or cross to the other side of the street.
We are constantly bombarded with information. Unconscious bias helps us to organize information and make shortcut decisions. As humans, we are hardwired for unconscious bias, for better or worse.
As humans, we are a collection of life experiences. These experiences, including the families and communities we grew up in, have a major impact on the unconscious bias we have incorporated.
Is unconscious bias a good thing or a bad thing? First it is human. It is automatic. That part of our brain that makes quick judgements in a potentially dangerous situation can also, unfortunately, cause us to make judgments that are unfair and potentially damaging to another person or, on the other hand, to have those unfair judgments directed toward us.
Unconscious Bias at Your Healthcare Provider’s Office
First, allow me to emphasize that my intention in the words that follow is not to accuse your healthcare provider of being biased toward you. As I hope I made clear in the previous paragraphs, unconscious bias is “hardwired” and often unintentional.
However, that doesn’t mean that even unintended unconscious bias is not harmful when it is directed toward you. I will give you some ideas about how to advocate for yourself when you are in this situation.
But first, here are some of the forms of unconscious bias:
Let’s start with an example. A mother who is Latinx has a conversation with her physician’s nurse about her 12 year-old daughter. Her daughter is refusing to eat dinner with the family and instead comes into the kitchen later in the evening and picks from the refrigerator.
The nurse informs her that “Kids at that age are very weight conscious. I am sure you’re a great cook. But maybe she is tired of all the fried food and rice and beans.”
Do you see what just happened here? The nurse made a comment that reflected an unconscious bias, based on her own limited exposure to members of the Latinx community and most likely her own experiences and assumptions, starting in childhood.
Her comment, however unintended, was experienced as a microagression. This mother may have felt disrespected and devalued. If not embarrassed and ashamed, having been made to feel by someone she is seeking advice from that she is giving her children unhealthy food without having had the benefit of being asked what she serves her family.
Furthermore, by making this assumption, the healthcare provider has potentially stopped a conversation that might have led to an important discussion about what kind of help this 12 year-old needs.
Consider this: A wife accompanies her husband to an appointment with his physician. Her husband has been experiencing unrelenting pain. After exploring her husband’s symptoms, the physician announces: “Well, when a man finally complains about pain, I know the pain must be real.”
The woman in this situation most likely experienced this as a microinsult. The physician, by saying that men only complain when they have real pain, is also implying that women whine and complain about pain that isn’t worth taking the physician’s time. By encouraging her husband to talk about his pain, he insulted his wife.
Hopefully, this won’t discourage her from reaching out for help the next time she experiences pain. But it could.
Microinvalidation is a topic that I frequently discuss with my clients. Here are a couple of examples for you to consider:
A parent meets with her daughter’s teacher to talk about the way in which the teacher treated her. Her daughter has a chronic condition. She had missed two days of school and was late with an assignment as a result of having struggled to complete it as soon as she could. The teacher had scolded her in front of other students for not completing it on time and emailing it to her.
When her mother tried to explain to the teacher that she had completed it as soon as she could, the teacher interrupted her. “Research has shown that kids with chronic conditions learn to play the victim and manipulate adults.”
After 4 major abdominal surgeries in a 5-year span to remove large, blood-filled endometriomas and 5 pregnancies that never came to term, I had a total hysterectomy. Removing all my female reproductive organs. I was 29 and a half years old and devastated. I began bleeding elsewhere. Especially in my kidneys, gastrointestinal system, and some joints. My muscles continued to be swollen and sore. I was told I had fibromyalgia, was a klutz, and worst of all, one doc even accused me of “liking the attention” I received from going in and out of the hospital.
Microinvalidation is communicating in a way that excludes or discounts another person’s thoughts, feelings or experiences. For example, implying that they are being dramatic, making symptoms up, or attempting to gain attention. To be honest, I hear versions of this story frequently, from adult patients and from parents of children with chronic conditions like bleeding disorders.
The teacher may think she is using a teachable moment to educate a parent, but the parent is being made to feel like she is all too often made to feel when attempting to advocate for her daughter. Like her child is being viewed as an annoyance, as well as judged.
The physician may feel they are being straightforward, even showing “tough love,” but they are doing emotional damage to their patient, who is left feeling that she is not being heard by the individuals who are responsible for her health care. Leaving her at risk of not receiving the health care she needs.
Microinvalidation has impacts the emotional and potentially the physical wellness of the person to whom this is being directed The result of microinvalidation? Feeling misunderstood. Disrespected. In a word: Invalidated.
So What Do I Do When I am Experiencing Unconscious Bias
Again, unconscious bias if often unintended. But let’s face it, unconscious bias can also be expressed in a very direct and intentional way. We see examples of this in the media. You may experience this in your own life.
Here are some ideas to help you to cope, and advocate for yourself, when you experience unconscious bias:
First, feelings are not always reliable. The experience of unconscious bias can bring up really strong feelings – anger, sadness, frustration – depending on the situation and our own past experiences. Keep in mind that the first rush of emotions can lead to actions that you may later regret. So, take a deep breath. Evaluate the situation. Ask yourself if your emotions are in proportion to what just occurred.
Consider intentionality. Is it clear that the other person is intending to cause emotional harm to your or your child? Are they demonstrating their own ignorance? Or are they just in a hurry or stressed and not thinking about their words? I am not saying you should make excuses for other people and let them mistreat you. But I am saying that at times giving someone the benefit of a doubt can keep a situation from getting out of control.
Identify the unconscious bias. I live in New York City, and in our subway system, we have signs that say, “If you see something, say something.” By identifying situations where we feel unconscious bias, we can help educate the other person and potentially help protect other people from having the same experience. This begins with simply letting them know how you feel and why. Here are a couple of examples:
“I don’t want to sound like I am attacking you or that I don’t respect you. But when you said __________, I felt marginalized/overlooked/disrespected/invalidated. I don’t think you meant it that way, but I have to let you know how I feel.”
“I wish other people understood what it is like to live with this condition. When you said this about my child, I felt like _____________________.
“I am not sure what your experience has been with members of my community, but we actually don’t ________________. We _______________.”
The point here is to clearly identify what was said that you experienced as unconscious bias and how you were emotionally impacted. Don’t accuse. Use I-statements. Focus on what was said and your reaction. Be a “patient” educator.
Keep your expectations realistic. I constantly remind myself, and my clients, that we can’t control how other people, think, feel, and behave. On one hand, pointing out an unconscious bias may be an eye-opening teachable moment that results in an apology and needed change on their part. On the other hand, the other person may not see a problem on their side and toss it back on you (that’s call gaslighting). Be aware of your options in this situation, especially if this is a professional working with you or your child. If you see something, say something. Know when it’s also time to do something.
How Do I Help My Child?
Here is one last example of unconscious bias. It is based on many conversations I have had with parents over the years:
A high school student living with a chronic condition reports to his father that his gym teacher told him to sit on the bench and observe other students doing rigorous calisthenics. The teacher told him, “I don’t know if you should be doing this and the school doesn’t need any liability issues.”
The young man felt deeply humiliated, and a few of the other students made fun of him later. His father is outraged; his son begs him not to make an issue out if for fear of retaliation.
If you are a parent, you may have similar stories. Here are a few ideas for parents:
Help your children to develop a sense of their own self-worth. Set an example of open-mindedness and compassion. Insist that healthcare providers and education professionals, and anyone else who has contact with your children, treat them with respect. Identify unconscious bias when you see it. Advocate for your children.
Create a safe space for emotions. Make your home a place where it is okay to talk about feelings, “good” feelings and “bad” feelings. Set an example by talking about your own feelings. Ask questions: What’s going on with you today? How can I help? How can I help you to feel safe?
Get involved in advocacy organizations. From a healthcare perspective, join an organization that supports families living with a chronic condition. Fortunately, the bleeding disorder community has amazing local and national advocacy resources. Get your children involved in meeting other children who share their condition and get to know other parents. But also get involved in your own communities, help your children to be aware of other forms of unconscious bias, be a family that embraces diversity in all forms.
Let’s Watch Out for Each Other
Look for signs of stress in your family members, your friends, your co-workers, your neighbors. Keep in mind that stress can be the result of being exposed to unconscious bias. Reaching out is a simple as asking “How can I help?’ Helping begins with just providing a listening ear and listening with an open and non-judgmental mind. By offering another person the opportunity to talk about what they’re experiencing, they can better frame out the situation in their own minds in the process of helping us to understand.
And if you are experiencing unconscious bias, you might also want to consider speaking with a mental health professional. We can help you to gain perspective, to validate your emotional reactions, to identify your strengths, and share some coping techniques. We’re pretty good at being objective listeners. Don’t go through this alone!
As we’ve been saying a lot during the past two years, we’re all in this together.
Gary McClain, PhD, is a therapist, patient advocate, and educator, specializing in helping clients deal with the emotional impact of chronic and life-threatening health conditions, as well as their families and professional caregivers. He works with them to understand and cope with their emotions, to learn about their lifestyle and treatment options, to maintain compliance with medical regimens, to communicate effectively with each other and healthcare professionals, and to listen to their own inner voice as they make decisions about the future. His website is JustGotDiagnosed.com.