Just Read: Blindspot: Hidden Biases that shape, and could fix, society

Blindspot: Hidden Biases of Good People Mahzarin R. Banaji (@banaji) & Anthony G. Greenwald (via Amazon.com) | (Via your local library)

(The phrase “fix society” is a reference to the tragic death of Leelah Alcorn in 2014: Transgender teen who died of an apparent suicide: ‘Fix society. Please.’ – The Washington Post)

The topic of implicit or unconscious bias is integrated into a lot of the work I am doing today. I did a pretty exhaustive review of the research last year in preparation for this presentation (Presentation: Being a Transgender Ally and Unconscious Bias ). I am about to give a refreshed version of the presentation to fellow clinicians at Kaiser Permanente (which I’ll post here).

I figured it would be a good idea to read the book version of all the papers I read and the experts I spoke to last year (much of it chronicled here, many many posts…). This is that book.

I think this is a hard topic to grasp unless you dive in, but here’s a good overview:

Reflective or explicit attitudes are those that we are aware of having (for example, Mahzarin knows that she likes Star Trek, and Tony knows that he likes bebop), while automatic or implicit attitudes consist of associative knowledge for which we may lack awareness (for example, old = bad, shared by Tony, Mahzarin, and apparently 80 percent of everyone else). The two forms need not agree, which is a circumstance called dissociation . For example, explicit or reflective “I like elderly people” can exist in the same head with implicit old = bad.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 3074-3078). Random House Publishing Group. Kindle Edition.

The other important thing to know is that the study of implicit or “unconscious” bias is not a niche activity confined to doctors.


Even Eric knows it (View Source)

Actually it’s almost the opposite, with rich application in a wide variety of professional settings, most notably, the law, as well as the military. If anything, medicine, sadly, lags behind these other disciplines in applying knowledge about how the mind works.

For me, the book ended abruptly, as I had delved deeper into the topic last year (and did a follow-up review this year), and applied it in a place where it hasn’t previously been thought of, in the health of people who are lesbian, bisexual, gay, or transgender (or a combo).

However, if this is unfamiliar territory to you, start here, with this book.

What was helpful for me was the concept of identity. For the KP Lantern project, we recently did a group empathy exercise where we were asked a simple question:

How and when did you first know your gender identity?

…which really raises a lot of other questions, like where does a person’s identity come from in the first place? From the book:

…to the rapidly developing brain of the infant, which is acquiring new stores of knowledge at an exponential rate, each such interaction is a building block, reinforcing the foundation on which a more fully formed social being will one day stand. The name we give to this foundation is identity, and unique as each individual is, identity is deeply bound to the characteristics that are true of “us” as a group and differentiated from “them.”

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1953-1956). Random House Publishing Group. Kindle Edition.

Gender is a strong basis for identifying oneself as a member of a group, male and female being among the earliest social category distinctions that children make. At different points in development, a child comes to know that she is, for example, female, Irish, middle-class, brown-eyed, and athletic.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1977-1978). Random House Publishing Group. Kindle Edition.

The studies of infants and young children in the book are fascinating and adds layers and layers onto ideas about things that I formerly accepted as just a given in human development.

The cornerstone of measuring implicit attitudes is the Implicit Association Test (IAT) (@ProjectImplicit), which works in magical (based on science) ways by gently short circuiting the parts of your brain connected to your stereotypes and categories of things around you. If you don’t know where to start, start by taking one of the tests, you’ll see what I mean.

I recently posted my IAT results on this blog. It’s almost a certainty that if I repeated the tests, the results would be same (and I actually did repeat the gay/straight test, with the same result).

So a person is biased, so what?

Two answers to that question:

1. Yes, so what? That’s the nature of humanity & it’s boring (to paraphrase one of the experts I spoke to).
2. What’s exciting is what you do with that knowledge, and you can do things.

The book doesn’t delve into what can be done as much as a physician type might want to (we’re programmed/biased to look for the treatment plan), but things can be done.

From modifying our own biases, to the prize, modulating and eliminating them in society.

The benefit of that is huge – all of the behaviors modulated by our biases that we are unaware of can go from preventing human potential to promoting it.

Vivienne Ming, PhD (@NeuralTheory) and I will be discussing this very topic at the upcoming XX in Health event in New York. (@XXinHealth).

The first step is to know.  I’m glad I do.

Most people, we’ve discovered to our happy surprise, would rather know about the cracks in their own minds. In the same way that they would want to know about a high level of blood cholesterol so that they can take action against it, they wish to confront potentially harmful mental content.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 926-928). Random House Publishing Group. Kindle Edition.

“What good is intelligence if you cannot discover a useful melancholy?” the Japanese poet Ryūnosuke Akutagawa is said to have asked, by which he meant that knowledge that provokes a feeling of distress is only of value if it can be put to some use.

Banaji, Mahzarin R.; Greenwald, Anthony G. (2013-02-12). Blindspot: Hidden Biases of Good People (Kindle Locations 1076-1078). Random House Publishing Group. Kindle Edition.

Ted Eytan, MD