Microaggressions are one of the main ways racism and prejudice persist, even in health care. But what exactly are microaggressions? Benji Mathews, MD, joins hosts Kari Haley, MD, and Steven Jackson, MD, to talk about the subtle (and not-so-subtle) ways discrimination can influence the world around us. They also discuss everyday ways we can recognize and counteract unconscious bias — in both ourselves and others.
Microaggressions are one of the main ways racism and prejudice persist, even in health care. But what exactly are microaggressions? Benji Mathews, MD, joins hosts Kari Haley, MD, and Steven Jackson, MD, to talk about the subtle (and not-so-subtle) ways discrimination can influence the world around us. They also discuss everyday ways we can recognize and counteract unconscious bias — in both ourselves and others.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Benji Mathews, MD
Dr. Mathews on Twitter: @MDbenji
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to the show. In this episode, we had a conversation with Dr. Benji Mathews, internal medicine physician here at HealthPartners.
Kari Haley:
Our conversation surrounded microaggressions and what it means to be a bystander versus an upstander.
Steven Jackson:
In the many conversations I've had with people over say, the last year or so, I'm surprised to hear how many people do not know what a microaggression is, and Dr. Mathews did a great job of explaining it and was highlighting the fact there's nothing micro about a microaggression.
Benji Mathews:
I think in its aggression, I don't think there's anything micro about it, but people may feel micro by it. Simply put, microaggressions, it's a type of an insult that's really rooted in a backdrop of a stereotype. It's directed at someone or at a group, because of a particular membership in that group. So, because they're rooted in stereotype, it leads to the difficulty in seeing people as true people or humans or individuals. The term actually was coined back, I think it was 1970s, by a guy named Chester from Harvard, and he really coined the term originally for people of color, particularly our Black people group. Now it's been expanded. I would say, our BIPOC (Black, Indigenous, and people of color), women, all people of color, disabilities, elderly are included.
Benji Mathews:
The key takeaway I say, for microaggression, microaggressions wound people. Imagine a paper cut, Steven and Kari, I think you've probably had a paper cut in the last year, I'm sure. One it's probably painful, it's probably a nuisance. One is manageable to an extent. Now, imagine getting paper cuts all over your body. Sounds a little gory, maybe not too gory for Dr. Haley there in ER (emergency room), but it's that accumulation of paper cuts or comments in the personal and professional settings, that really begin to take a toll on. That's what really, microaggressions are.
Kari Haley:
I think another thing that, the paper cut analogy, is that the paper cuts really don't go away. You get one paper cut and normally it heals within a day or two maybe, but those accumulation of paper cuts that he's talking about, the microaggressions, that maybe they don't actually fully heal ever. It's really that cumulative effect that he's talking about that I think really hit home for me.
Steven Jackson:
Let's get into it.
Benji Mathews:
Some may wonder, ah, is this the right term? I really get at impact exploration. Is there, look at not only intention of what's being stated, but what I'm going to say, how is that going to impact the person? Does that help? I think there's a way to kind of delve into this more and I think it's pushing people to, and I'll maybe I'll go into that, Steve, but I think there's, after our last conversation in the larger meeting, a set of people had questions, and I think some of them were around, "I think we're going too far here," or claims of political correctness or claims of playing the race card. I think these are games of verbal jujitsu, and I think these are meant to provide cover for the people to live within their biases, implicit biases, and often quote unquote bigotry. I say that with all grace as much as possible. It's trying to flip the script and avoid that uncomfortable conversation, which we're having right now.
Steven Jackson:
I have found it to be true that many folks feel uncomfortable talking about race. Some of you out there might be saying, "Duh," but in reality, many people don't like to talk about race, and then when you bring up something like microaggressions, it's "Well, what is that?" and "Is that even real? Is that a thing now? Is that what they're talking about?" and maybe it's just another way to play the race card, and I just think Benji did a really good job of really just dissecting that a little bit for us.
Kari Haley:
I think he did a really great job of really summarizing that defensive mechanism that we all have when we are talking about something that's uncomfortable or that we might not a hundred percent understand or agree with, and that really just getting down to it, it is that verbal jujitsu that we do in our mind or that we play it out, when we just know the truth. We know the truth that maybe this is wrong. Maybe this is bad, but we just don't fully understand it, and we're afraid to ask those questions.
Benji Mathews:
I tend to go at different types of onions on this topic of political incorrectness, and you'll get this a lot, and I think it's worthwhile on this show to just talk through the layers of it. If someone were to say, "Oh boy, why are we bringing this up? Is this such a big deal?" The first layer is, the person that is talking through it, they have a fear that what they say or do not say will appear racist. Sometimes they go through this phenomenon called rhetorical incoherence. They stammer, they stutter, they wax philosophically. They're so abstract to a point, you don't even know by the end of that dialogue, what are we even talking about? And that has happened many times, and Steve's laughing. Kari's laughing as well, but it's a defensive posture. They're just responding to that and you're like, what did we just talk about for the last 45 minutes to an hour?
Benji Mathews:
If you get past that, and if they acknowledge that, the next layer is they're harboring some biases and prejudices, and that's hard. Their goal is, that goes against their identity. That goes against their belief that they're good, they're moral people, and if we get past that, if we actually get deeper to the third layer of the onion, and this is the professor Sue, I may be butchering the third piece, but it's something that... The fact that if they get to the point that they are advantaged. They understand that they're advantaged, that they have a systemic benefited white skin privilege or gender based piece, that their hard work alone did not get to where they got, that's a big onion to open up. Sometimes it's that Molly Evans quote that says, "People got to, they were born at third base, some people." Something to that effect.
Benji Mathews:
I think, "Some people are born on third base and thought they hit a triple." I forget if I butchered that up, but that's the invisibility of this type of privilege. What is failed to recognize is that Dr. Haley, as a woman, Dr. Jackson, as a person of color, maybe they've worked equally hard, if not harder, equally skilled, if not more skilled, and some people in our communities don't even make it to the batter's box, and that's the painful hit of it. If they get to that level and acknowledge that, the fourth level is, I acknowledge my privilege. I acknowledge my biases. I acknowledge that I may say something racist. I acknowledge my privilege, yet I do nothing about it. That's hard. This is when, at least acknowledging that as a conversation piece, we can move towards tackling it and build those relationships.
Steven Jackson:
We've already kind of acknowledged that having conversations about race and bias and those kinds of things are uncomfortable for many. I think it's just important for us to understand that in order to get to that point of comfort, or at least more comfort with having these tough discussions and conversations, it arts with looking in the mirror and being honest with oneself and saying, "Hey, perhaps I do have biases, and perhaps my biases affect the way I give care or how I relate to the next person in the checkout aisle," or etc. I think Benji did a great job of really highlighting that.
Kari Haley:
I really like Benji's point, too, that when you're talking about these really hard subjects, that people think that there is an insult to their own moral integrity. I really like that point because I think part of taking that step back and taking that look in the mirror, being acknowledging that I am biased, I do have biases and they affect the way that I go about my life, but not feeling morally injured by that, potentially can be that new opening space where you can accept the conversations and you can be open to new ideas and people's experiences.
Steven Jackson:
I think the concept of intent versus impact came up in good fashion in this conversation, and I think the importance of looking from another person's perspective would help people to be more sensitive to what they say and how they said it, and how it may have impacted the person they said it to. This was highlighted very nicely.
Benji Mathews:
If we have a lens and try to sit in other people's shoes, we can probably understand that impact better. Again, the power of these microaggressions is their invisibility to the recipient or the perpetrator. Some examples that I think I may have shared with Steve, a lot of these, a patient to a health care worker, we had a situation come up relatively recently, where someone had asked around... Oh, I'll go a little further back. This is our Ramadan, and someone had asked, "What's with this fast?" to one of our health care workers, who's celebrating the Ramadan. "Why don't you eat all day long? Wait, wait, I don't really get it." If it's coming from a colleague to this person as well, that it's also happened, if there's a way that we can understand and get in their shoes to appreciate, "Hey, tell me more about the Ramadan. I'm excited that you're celebrating or is that even the right word?" It's okay to misstep into some of this, but acknowledge that discomfort and say, "I want to learn, I want to grow, and get to Know you," giving credence for that other side.
Benji Mathews:
I often get, "Where are you originally from?" or "You speak English so well," which I actually take as a good credit because I struggle in my language and I worry that I misstep a lot. The theme is that, you're an alien in your own land. That's the theme around when someone asks, "Where are you originally from? You speak English so well." I go back to my green card when I had resident alien written all over it, and the message to me is, I am a foreigner in this land, and there's a Hindi proverb or a statement, I may butcher it, that says, " [spoken in Hindi 00:10:35]."
Benji Mathews:
It means a foreign bird with a local walk. I think I've always felt that as an immigrant into the middle east, with my heritage from India, but I never was an Arab necessarily, but then immigrating here to the U.S. and in a city or town called White Bear Lake, that white was definitely in there. I was one of the few people of color in that whole educational... I had a wonderful education, wonderful groups of friends, but I think that city 10 miles away from twin cities, it was noticeable for its lack of people of color, particularly immigrants in the 1990s. Navigating that world helped me understand these pieces. My hope is just to improve lenses by really understanding the other side.
Steven Jackson:
Just the other day, when my son was walking the dog, one of our neighbors who we didn't see very often said, "Wow, you talk very proper," and my son said he was pretty speechless. He didn't really know how to respond, and I wish he had listened in on what Benji said about how to respond to microaggressions when they occur.
Kari Haley:
I think he gave a great summary of some really great techniques people can use and take away from.
Benji Mathews:
The 4D model is, you can be direct, you can be distracting, you can be delegating, you can be delaying, or you can display discomfort. The easiest one, which is courtesy of Dr. Manning at Emory, you can display discomfort. If someone shows some indifference or some, "Oh, I don't know about what they just said." That'll cue the other people in the room to say, "Hey, that was not right. Let's just make sure we follow up on that comment or statement." You could be more direct and for some, again, this may not fit. This is the, I statements. I feel like this crossed a line, or I felt like that that comment may not been intended that way, was it? Or you could distract, you could change a subject. You could delegate. Have someone else in that room, maybe with more influence or authority talk into it. You could delay. All these kind of things are the different D's.
Steven Jackson:
I think Benji challenges us to speak up or if you see something, say something, and he really does a nice job of explaining and really educating me about the difference between a bystander and an upstander.
Benji Mathews:
A bystander by definition, again, it's a chance spectator. It's someone who's at an event, going to Twin Cities marathon, and you're just there. You're not part partaking in that race, you're just watching those marathoners run by and cheering them on maybe, and you're just there for a little bit. I think a bystander is a, in this context, I would say at most, it is a not racist stance. It's a non-racist stance. It is definitely not anti-racist. It is a non-racist stance. Maybe I'll dig deeper and say, why does it even occur? The researchers really have gone through a couple different buckets, and I may miss a couple of these, but it's diffusion of responsibility. It's that more people are present. If I see a microaggression occur, someone else will take care of it.
Benji Mathews:
This analogy of my home front, I have four kids, so if I tell, "Hey, got to take out the trash, got to do the Saturday morning chores. Someone go take out the dog." Our little dog, Buddy, 2-year-old puppy still, someone thinks it's someone else's responsibility or someone more experienced in that room can take care of it. And so, no one gets it done and it's noon, and we have to go eat lunch, and no one's done anything all day long. Welcome to my home. Sometimes it's on me, too. I'm supposed to walk the dog and I assume it's someone else. So, that's diffusion of responsibility. Second thing is, perceived cost. I think that's the language around it. It recognizing that there's sometimes hierarchy when we're in a system that can muzzle us from speaking up.
Benji Mathews:
It's the fear of having judgment when we do something. It's particularly trainees, non physicians, other staff, so I applaud a speak up culture that we have building in at HealthPartners and the culture we built here, and hopefully that'll continue forward on that perceived cost. The last couple things with ambiguity, was that even insensitive. So, you're a bystander because, did I hear that right? Probably not a big deal. Maybe I'm the only one who heard it. I'm not going to speak up here, and so situation's important, social influence, confirmation bias, all those things can happen, and a lot of this happens because of the lenses we built in. Bystander is definitely a passive.
Kari Haley:
I think that having that distinction is really important as well, because I think it's really easy for us to fall back into being a bystander, but to actually have a word and something to grab onto in being an upstander might remind us that, wait, I shouldn't sit back. I should say something. I should do something because you can actually think of that word and have that comparison in your brain.
Steven Jackson:
If you find yourself having difficulty speaking up, then maybe this conversation will help you. Let's take a listen.
Benji Mathews:
The upstander, on the other side, is an active posture. It's an anti-racist stance. It's, I hear something. That was uncomfortable. I need to move into the discomfort here and I would like to speak up.
Steven Jackson:
Dr. Mathews did a great job of really defining some of the specific terms related to microaggressions, and I felt like my brain sort of expanded during this portion of the conversation, but something that really stood out to me was how we may judge others by their impact of what's said to us, but we judge ourselves by our intent of what we said, and that really convicted me personally.
Kari Haley:
I think it's like how there's a new teaching out there about thinking about the flipped classroom. We need to flip ourselves in our conversation, so really applying similar things that people know about and are well aware of a lot of in the educational space, but really using those tools to think about it. Racism with ourselves.
Steven Jackson:
Let's get educated.
Benji Mathews:
Microassaults are one of them. They are the overt, deliberate, or conscious. It's telling a racist joke and saying, "Hey, I was just joking," but I think, especially in this current climate, especially at the end of 2021, end of 2020 into 2021, we've seen a large increase in microassaults. That's a type of microaggressions. The second one, I cover these with an intent, if we understand these definitions better, we can maybe get at who would possibly be hurting, and how do we mitigate that? Micro insults are number two. Not only microassaults, micro insults. This is the comment of being unintentionally discriminatory. This could be someone saying to me as a middle Eastern or Asian doctor, "Your people must be so proud of you." Well, is that helpful or not?
Benji Mathews:
The third one would be micro invalidation. That's when you invalidate or undermine an existence of a group of people. Telling a Black patient or person, racism doesn't exist in today's society. We've kind of eradicated it, and we may laugh at it on this podcast to an extent, but just acknowledging that can be a challenge. When you get at your question of how do we actually counter this, you have to identify it first. I tend to judge myself based on the intent of what I share. I judge others on the impact of what they're sharing. We rarely tend to judge ourselves on the impact of our statements.
Benji Mathews:
It's really getting at the lens correction early on. The power of these microaggressions are really, they're so invisible to the perpetrator and often, sometimes the recipient. The question is, whose reality are we trying to correct here? Social psychologists really have gone to the point and I tend to align with them that the reality of people who are most hurt or the most under-resourced, some may use the word, marginalized or repressed, are the lens and the reality that should be the most accurate here. Really need to consider who is being impacted.
Kari Haley:
Moving on beyond, into the macro stage, so he talked something about the social contagion of ethnic hostility, which really I think is very relevant to our world today.
Benji Mathews:
These are hard questions for a reason, and I think several changes have occurred in the last decade, especially in the last year that have maybe led to where we are. There's a complexion of the society with more brown and Black immigrant populations. There's an aging of the nation. There's growing women in the workforce. Groups are starting to feel threatened by this, and you can get sexism, ageism, you can get antisemitism, you can have all the other isms and schisms, because of this. A number of researchers in think Australia, New Zealand, they label this as an ethnic hostility contagion. That is when you witness overt acts of bias and bigotry, and it has an impact on other people and they start mimicking it, too. There's an upsurge, as you've seen, the recent administration, there's an upsurge in overt bias, overt bigotry, coupled by a contagious nature of it, and people who feel threatened by the changing demographics and complexion society is starting to move towards a poster action.
Benji Mathews:
Can it be mitigated ever, is a good topic, and several camps are on this topic. I'll give you my cards, but I think racism has been with us ever since the early history of mankind. Martin Luther King Jr. took a stance that it can be diminished and ended, and I love that hopeful approach, but in some sense, I think it'll continue into the future and why? It's just our human nature to kind of one up each other, and the flattening hierarchy is going to take maybe, I would even say supernatural beyond this, to even move beyond it, but then the why. Why do we do this conversation? If we were to have that kind of hopeless attitude, Benji, why do we want to even do this conversation? It's because I think the doing is as important as the outcome. Here that out. The battle, the struggle is as important as outcome.
Kari Haley:
You can follow Dr. Mathews on Twitter @MDBenji.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers, and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.