Microaggressions: How Subconscious Biases Affect Recovery

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Microaggressions: How Subconscious Biases Affect Recovery

By Jesse Beach 08/20/18

An example of a microaggression in the recovery universe: someone from NA asks someone who's considering Suboxone: "Are you in denial? A drug is a drug is a drug." No malicious intent is involved, but the fellow member is left feeling disparaged.

Image: 
Group of angry people with drawn megaphones yelling at each other.
"Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships."

Politics and Religion: we’re encouraged to avoid these conversations, socially. Conviction can escalate to hostility, hurt feelings and polarization, turning a fun-loving conversation into… “Awkward.”

Has anyone noticed polarization-creep migrating from political intercourse into our addiction/recovery discussion? A diversifying recovery community means different tribes and subcultures with differing views on recovery and addiction. Many Fix readers are members of a mutual-aid group that gives a sense of identity and belonging. Being tribal is human nature; so, what’s the problem? Maybe it’s a hangover from the current political climate but I’m feeling a little microaggression-fatigue. It’s great to cheer hard for the home-team; but does that mean diminishing the other(s)?

“We tribal humans have a ‘dark side,’ ironically also related to our social relationships: We are as belligerent and brutal as any other animal species,” says author and UC San Diego Professor Emeritus Saul Levine, MD, in “Belonging Is Our Blessing, Tribalism Is Our Burden.” “Our species, homo sapiens, is indeed creative and loving, but it is also destructive and hostile.”

Levine cautions that for all the psychological good that belonging offers us, “Dangers lurk when there is an absence of Benevolence. Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships. Estrangement can easily beget prejudice, nativism, and extremism. These are the very hallmarks of zealous tribalism which has fueled bloodshed and wars over the millennia.”

How does “zealous tribalism” present in the recovery community? Abstinence-focused tribes have dearly held views that differ from our harm-reduction fellows. Inside the abstinence-model tribe, it’s not all Kum Ba Yah, either. Refuge Recovery clans, SMART Recovery, Women for Recovery and the 12-step advocates may feel a superiority/inferiority thing that comes out in how we talk about each other. SMART followers may look down on 12-stepping as stubbornly old-fashioned. 12-steppers might see Life Ring or other new tribes as acting overtly precious with their dismissal of tried-and-true methods. Focusing in even more, we see NAs, CAs and AAs each rolling their eyes at each other’s rituals or slogans. In AA, secular members and “our more religious members” finger point at each other about who’s being too rigid and who’s watering down the message. These are examples of what Levine calls “belonging without the benevolence.” Finding “our people” is great. Part of what makes us feel included might also over-emphasize the narcissism of small differences.

“Meeting makers make it!”
“That’s not sober; that’s dry. The solution is clearly laid out in the 12 steps—not meetings!”
“AA’s a cult that harms more people than it helps!”

These are tribal battle cries—sincerely held feeling based in part on our unique lived experience and in part on an ignorance we’re not conscious of.

If you love the fight and you don’t care what others think of you, this article might not hold your attention. We’re going to talk about how to get along better. On the other hand, if you see yourself as empathetic and regret falling prey to us vs. them conflicts, let’s talk about cause and corrective measures.

Recovery professionals curb their own biases through professional practices; we can borrow their best practices to avoid getting defensive or dismissive with people who hold divergent worldviews. If our goal is to connect with others, an increasingly diverse world of others presents challenges.

“In my early career, I was adamant about abstinence as the only viable solution to alcohol and other drug problems,” recalls William White, author of Recovery Rising: A Retrospective of Addiction Treatment and Recovery. As a historian and treatment mentor, White learned from lived-experience, clinical practice, study and research. His 2017 book advocates for treatment professionals to exercise “professional humility and holding all of our opinions on probation pending new discoveries in the field and new learning experiences. Many parties can be harmed when we mistake a part of the truth for the whole truth.”

If 100% of my knowledge about harm reduction is from harm reduction failures who tell their story of decline in a 12-step meeting, I could “mistake a part of the truth for the whole truth.” What would I know about harm reduction success stories if I only go to 12-step rooms?

Treatment professionals are adapting to cultural diversity in their practices. Bound by a Code of Ethics, NAADAC (the Association for Addiction Professionals) has embraced the concept of “cultural humility.” Cultural humility is a fiduciary duty for professionals to be sensitive to client race, creed, sexual orientation, gender identity and physical/mental characteristics when providing healthcare.

“Cultural humility is other-oriented. Cultural humility is to maintain a willingness to suspend what you know or what you think you know based on generalizations about the client’s culture. Power imbalance between counselor and client have no place in cultural humility. There is an expectation that you understand the population you’re serving and that you take the time to understand them better,” explains Mita Johnson, the Ethics Chair for NAADAC, who teaches cultural humility to addiction/treatment professionals. Dr. Johnson says, “Addiction professionals and providers, bound by ethical practice standards, shall develop an understanding of their own personal, professional and cultural values and beliefs. Providers shall seek supervision and/or consultation to decrease bias, judgement and microaggressions. Microaggressions are often below our level of awareness. We don’t always know we are doing it.”

Microaggression—today’s buzzword—google it. In The Atlantic’s “Microaggression Matters,” Simba Runyowa elaborates on the insidiousness of this behavior: “Microaggressions are behaviors or statements that do not necessarily reflect malicious intent, but which nevertheless can inflict insult or injury. … microaggressions point out cultural difference in ways that put the recipient’s non-conformity into sharp relief, often causing anxiety and crises of belonging on the part of minorities.”

Here’s how that might look in our recovery universe: someone from NA, a complete abstinence-based fellowship, asks someone who’s thinking about medication-assisted treatment with Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved but the fellow member is left feeling disparaged. Maybe the well-intended NA had a negative experience with medically assisted treatment (MAT) and has a visceral feeling about it, “Taking drugs to stop drugs isn’t clean.” But NA doesn’t work for everyone. Yours or my anecdotal experience will bias us. Maybe expressing my own personal experience, or just listening without commenting, would be more culturally humble.

The same is true of the MAT fan who says, “12-steppers are deluded by a faith-healing 80-year-old modality; only five-percent of people get helped from the 12 steps.” These types of arguments are not other-oriented. This is tribalism. 

A simplistic solution to avoiding lane-drift is to listen more and share in first person. Prescriptive communicating—as opposed to a descriptive narrative—will, inadvertently, engage us in microaggression.

Just when “Why can’t we all just get along” seemed hard enough, there’s more than one subconscious microaggression we need to be aware of. Derald W. Sue, Ph.D., a psychology professor at Columbia University, describes three microaggressions: micro–assaults, micro–insults and micro–invalidations.

Micro–assaults are most akin to conventional discrimination. They are explicit derogatory actions, intended to hurt. Here’s an AA example: disparaging a humanist AA in a meeting by quoting Dr. Bob’s 1930s view, “If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you.” No one feels “sorry for” their equal. Inferiority is implied.

“A micro–insult is an unconscious communication that demeans a person from a minority group,” Dr. Sue reports. Using another 12-step creed-based example, “CA includes everyone; it’s ‘God as you understand Him.” Who is likely to feel demeaned by Judeo/Christian-normative language?

We could rightfully credit 1930s middle-America Alcoholics Anonymous founders for their progressive—always inclusive, never exclusive—posture; “everybody” in 1939 America meant Protestants, Catholics and Jews. The AA of the 1930s was culturally humble. Today, inadvertently, this same language is less effective at gateway-widening. Today, just 33% of earthlings embrace this interventionist higher power of the early 12-step narrative. According to the Washington Times, globally, 16% of people have no religion and 51% have a non-theistic, polytheistic faith. Sikhs or Muslims may share monotheism, but they worship a genderless deity; no room for “Him” of any understanding. Cultural humility accommodates all worldviews, without asking others to speak in the language of the majority.

“Minimizing or disregarding the thoughts, feelings or experiences of a person of color is referred to as micro–invalidation.” This is how the American Psychiatric Association rounds out Dr. Sue’s three types of microaggression. “A white person asserting to minorities that ‘They don’t see color’ or that ‘We are all human beings’ are examples.”

Disregarding or minimizing in our community might be telling someone: “You can participate in your online groups if you like but don’t treat InTheRooms.com like real meetings. Face-to-face is the only way to connect with real people.” If expressed in first person, instead of disregarding the other, the message could relate a personal experience and an informed belief. Have we learned everything about the person we’re talking to? Social anxiety disorder or a dependent partner, parent or child at home could be reasons why the online meeting is the superior option for them.

To William White’s point, what do I really know about the comparative benefits of online community vs. traditional meetings? Maybe I could consider his informed advice of “holding all of our opinions on probation pending new discoveries in the field and new learning experiences.”

Mita Johnson identifies a challenge with microaggression—it’s subconscious. How do we correct subconscious behaviors? Dr. Sue authored a couple of books to help combat microaggression at an individual, institutional and societal level: Microaggressions in Everyday Life: Race, Gender and Sexual Orientation and Microaggressions and Marginality. Sue offers five steps to help connect us with more varieties of addicts/alcoholics. “Microaggressions are unconscious manifestations of a worldview of inclusion, exclusion, superiority, inferiority; thus, our main task is to make the invisible, visible.” Here are Dr. Sue’s five practices:

  1. Learn from constant vigilance of your own biases and fears.
  2. Experiential reality is important in interacting with people who differ from you in terms of race, culture, ethnicity.
  3. Don’t be defensive.
  4. Be open to discussing your own attitudes and biases and how they might have hurt others or revealed bias on your part.
  5. Be an ally. Stand personally against all forms of bias and discrimination.

I gave it a try. Taking inventory—in these five ways—of my prejudices and preconceived ideas helps identify my insensitivities. It helps thinking/acting more other-oriented. Secondly, more than ever, it’s a good time for more active listening and less instruction. Getting defensive, even to microaggression coming my way, escalates the divides. Admitting my assumptions and the faulty conclusions is a version of “promptly admit it” that is so familiar. Finally, how can I “Be an ally?” It’s not hard, today, to stand up for myself when I’m being disrespected. Now will I say something when someone else is being invalidated, insulted or dismissed? Yes, there’s a time to mind my own business but if I’m committed to “be an ally,” can I stay silent when another is being ganged up on by the tyranny of the majority?

When I’m tempted to be tribal when confronted with other individuals or recovery groups, I try to remember that all people who suffer from process or substance use disorder have been subjected to microaggressions. William White identifies a few of the more cliché slights we all face:

  • “Portrayals of the cause of substance use disorders as personal culpability (bad character) rather than biological, psychological, or environmental vulnerability.
  • Imposed shame, e.g., being explicitly prohibited by one’s supervisor from disclosing one’s recovery status out of the fear it would harm the reputation of the company.
  • Misinterpretation of normal stress responses as signs of impending relapse.”

In this regard there is no us vs. them. Just “us.”

Not everyone believes that shining a light on microaggression will solve hostilities towards each other. “There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory,” Althea Nagai argues in “The Pseudo-Science of Microaggressions.” Nagai identifies confirmation bias found in almost all focus groups and the problem of unintended consequences when institutionalizing anti-microaggression policy.

Nagai’s National Association of Scholars article continues, “There is nothing in the current research to show that such programs work. I suspect most fail to create greater feelings of inclusion. Research suggests they create more alienation and sense of apartness. The recent large-scale quantitative studies suggest that increased focus on ethnic/racial identity exacerbates the problems they are supposed to address. In other words, ‘social justice’ and diversity programs may actually backfire, creating less inclusion, more polarization.”

Dr. Sue cautions us about weaponizing microaggression; other-oriented cultural humility is to take inventory of my microaggressions—not to fault-find other’s behaviors. Social psychologist Lee Jussim in Psychology Today says keep it personal—not global: “To understand how we can all unintentionally give offense through our own ignorance or insensitivity—thereby increasing our ability to make the same points without being hurtful.”

“I’d rather step on your toes than walk on your grave,” is a rationalization we hear in the rooms. How do I neither pussy-foot around and avoid being a dick? Beyond intellectualizing, cultural humility is introspective. In “Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes,” cues from professionals show me how to re-frame how I interact with others: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique to redressing the power imbalance in the patient-physician dynamic and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and the defined population.”

For me, this nails how to stay other-focused: Professionals (or anyone who wants to relate to others better) should “relinquish the role of expert and become the student of the patient with a conviction and explicit expression of the patient’s potential to be a capable and full partner in the therapeutic alliance.”

I don’t need a course or a degree to “become the student” of others. Instead of acting like I know what’s best for others, I can be a fellow traveler; think about other-focused approaches globally; but act locally.

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