Microaggressions might be the consequence of intentional bias, but they can also reflect hidden biases. A person may deliver a microaggression without realising that their words or actions convey a discriminating viewpoint. According to new research, this covert type of prejudice has concrete harmful effects on the health of those who are subjected to it, just like more explicit forms of discrimination. Chronic exposure to microaggressions can have a direct and indirect influence on health when it occurs within a healthcare system.
The direct impact of microaggressions on health
When a person feels stressed, physiological responses such as high blood pressure, increased heart rate, and the secretion of hormones like cortisol might occur. Discrimination is a social stressor that has a similar effect on the body. A study on ethnic disparities in sleep indicated one effect of this enhanced stress response. Participants who reported higher discrimination had a lower rate of deep slow-wave sleep, a deep state of sleep linked with rest. Sleep is necessary for the body’s physiological functions, including the immune system, hormone systems, and brain function.
The link between perceived discrimination and a variety of medical illnesses was investigated in two distinct 2009 assessments of current research, one from the Journal of Behavioral Medicine and the other from the Psychological Bulletin. They both came to the same conclusion: discrimination is a stressor that has a negative influence on health and morbidity, especially hypertension and cardiovascular disease. Despite the expanding corpus of scientific literature on the links between discrimination and physical health outcomes, more research is needed to determine the true impact of various forms of discrimination and discriminatory aggression. Discrimination is linked to higher rates of mental illness, violence, poverty, and discrepancies in treatment and access to healthcare, all of which have negative consequences on one’s health. When there are so many co-factors at play, it’s difficult to isolate the direct physical impact of microaggressions. This is exacerbated by evidence that discrimination increases the likelihood of people participating in unhealthy activities like smoking, drinking, or overeating, which may function as a short-term stress reliever but are long-term high-risk factors for disease.
The effects of microaggressions on mental health are among the better-understood effects of microaggressions. A study of 405 students from racial and ethnic minorities at a large midwestern institution in 2015 looked at the link between microaggressions and suicidal thoughts. Along with answering questions about their mental health, participants rated the frequency with which they faced various sorts of microaggressions. For four of their six types of microaggressions, the data showed that the more often students faced microaggressions, the higher the rate of suicidal thoughts. Higher frequencies of racial microaggressions were a significant predictor of negative mental health among the participants, particularly depressive symptoms, anxiety, a negative view of the world, and a lack of behavioural control, according to a study conducted last year on a dataset of 506 adults from various racial groups.
Microaggressions in healthcare settings
Microaggressions are generally unintentional, but they reflect underlying biases that can affect how people are treated. Trust is necessary for a healthy relationship between a patient and a healthcare practitioner. When biases are exposed, the patient’s trust may be harmed, and the patient may develop a negative attitude toward obtaining medical care.
More than one-third of the survey’s 218 participants had experienced racial microaggressions from their healthcare providers, according to a 2015 study investigating the healthcare of American Indian patients with diabetes. They also rated the patients’ depressed symptoms, heart attack incidence, and hospitalizations in the previous year. Each of the study’s three health and well-being indicators showed a substantial positive association with the number of microaggressions faced.
One of the most prominent forms of microaggression in healthcare for LGBTQIA+ individuals is the assumption that they are heterosexual and cisgender. As a result of a higher frequency of discrimination, rejection, and violence, these communities are at much higher risk of tobacco, alcohol, and drug usage, sexually transmitted diseases, psychological distress, and suicide. Patients’ access to proper health services may be hampered if healthcare personnel make assumptions about their sexuality and gender. As a result, patients may be less likely to seek medical help. The same pattern can be seen in mental health settings. A 2014 study found that more than half of counselling clients from marginalised racial and ethnic backgrounds experienced microaggressions from their therapists. Their satisfaction with treatment and their relationship with their therapists were inversely connected with their perceptions of microaggressions.
Dr. Elinor Cleghorn, a medical humanities scholar and author of the book Unwell Women, which examines the history of gender bias in healthcare from Ancient Greece to the present, spoke with Medical News Today to discover more about how these biases develop. Dr. Cleghorn explained that we have a tendency to think about medicine through the lens of science, which elevates it to a level of neutrality and objectivity, but in reality, medicine’s roots are deeply rooted in society and culture, and because medicine deals with the most fundamental problems of life and death, it has absorbed and reflected society’s notions about who we are as people throughout its history. She added that medicine has only just become the science we know it to be — an evidence-based discipline but before that, practitioners of medicine had to rely on preconceptions about who individuals were, what their bodies did, and what they were for millennia.
Despite this, much of the status quo has persisted, resulting in systematic discrimination in hospital settings. Dr. Cleghorn explained that it made sense to Ancient Greeks that women lived only to produce, it was indisputable science to them, and they started to develop a medical discourse around women’s bodies oriented around these presumed realities that everything in their health rotated around their reproductive existence. She mentioned that this has been repeated again and over since medicine has historically been controlled by male practitioners who have tended, for the most part, to perpetuate these gender distinctions.
She went on to explain how this historical context might emerge in microaggressions in today’s healthcare setting. Microaggressions come in a variety of shapes and sizes, and they’re highly intersectional. Microaggressions that one might experience as an educated white woman may stem from a historical precedent those women who worry about their pains must be ‘hysterical’, whereas, for a woman of colour, the perception of her pain bears the burden of a different historical context, insofar as racialized microaggressions emerge through. She stated emphatically that the majority of doctors if confronted with this, would respond, ‘Of course, I don’t believe Black women are pain-free,’ but such ideas have influenced medical culture. It’s there because it went unchecked. After all, the mould in which science was built was not examined and remade.
Steps to mitigate the harmful effects of microaggressions
The Institute of Medicine recognises that implicit bias and stereotyping may play a role in health disparities among marginalised groups, and advises that recruiting more healthcare workers from underrepresented communities is one option for reducing their influence. Microaggressions, like any other kind of unconscious bias, necessitate critical self-reflection. Training that fosters inter-group contact and enhances awareness of one’s own biases can be a helpful technique in enhancing patient care. Providing such training also enhances the probability that employees will feel comfortable speaking openly about their sexuality and gender identity with their coworkers, allowing for more inter-group engagement.
Dr. Cleghorn underlined the importance of research when asked what she thought would help. She mentioned that one step is to use women’s and other marginalised people’s testimonies, voices, and experiences in a meaningful research setting. It’s the first time this topic has been explored from a social standpoint. Since the early 2000s, groundbreaking studies like The Girl Who Cried Pain have shown that statistically, when women report chronic pain, they are much more likely to be prescribed a sedative or antidepressant, whereas men are more likely to be prescribed an analgesic, and that women are much more likely to have the cause of pain diagnosed as psychological or emotional, whereas men are more likely to have it diagnosed as physical. She stated that studies like this revealed how pervasive the problem is, but they also showed how it can be researched. When we talk about things like microaggressions, it might feel a little hazy, but knowing there are tools through which we can critically examine these concerns is extremely crucial. She also mentioned that the study of The Girl Who Cried Pain was made up of patient testimonies as well as admission records. It was a thorough qualitative and quantitative study. Dr. Cleghorn declared that the more we look at this issue as something that can be researched objectively, the closer we will get to undo it.
She went on to explain how this historical context might emerge in microaggressions in today’s healthcare setting. Microaggressions come in a variety of shapes and sizes, and they’re highly intersectional. Microaggressions that one might experience as an educated white woman may stem from a historical precedent those women who worry about their pains must be ‘hysterical’, whereas, for a woman of colour, the perception of her pain bears the burden of a different historical context, insofar as racialized microaggressions emerge through. She stated emphatically that the majority of doctors if confronted with this, would respond, ‘Of course, I don’t believe Black women are pain-free,’ but such ideas have influenced medical culture. It’s there because it went unchecked. After all, the mould in which science was built was not examined and remade.
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