This is an excerpt from Athletic Training and Therapy With HKPropel Access by Leamor Kahanov & Ellen K. Payne.
By Marsha Grant-Ford, ATC, PhD, and Leamor Kahanov, EdD, ATC, LAT
Privilege is unearned social and cultural advantages or entitlements that are awarded to a majority group based on the qualities valued by the dominant culture. It benefits the dominant group and marginalizes minority groups (table 4.7). Someone can be both privileged by virtue of membership in a majority group and oppressed as a result of membership in a minority group.58,59 The concept of privilege is not meant to suggest that someone has not struggled or is not conscientious. Nor is privilege a reflection on one’s character or integrity. It is not uncommon for privileged people to be unaware of or disregard their privilege; many are also unaware that privilege has been a long-standing component of marginalization of minority groups.41 Identity, marginalization, and privilege affect the lives of people on a daily basis.41 Privilege and oppression change over time and with respect to one’s experience and the context.6
Microaggressions are a form of discrimination in which verbal, nonverbal, intentional, unintentional, or environmental insults are made to or about marginalized societal groups (table 4.8).57 Microaggressions were first described in 1970 as racial transgressions directed toward Black Americans; however, research since then has uncovered that microaggressions occur with similar negative consequences toward all marginalized societal groups.60-62 Micro refers to the size of the transgression, not the magnitude of the harm.60
Microaggressions are not simply acts of political incorrectness, as is often suggested.63 They are derogatory assaults directed at one’s gender, ethnicity, or socioeconomic status.63 People in marginalized societal groups may experience a significant cumulative effect of receiving multiple microaggressions over the course of a day from the media, strangers, colleagues, and even family members.
Discrimination reinforces the power and privilege discrepancies that perpetuate the cycle.64,65 The psychological and physical consequences of microaggression are harsh and so pervasive that they are often taken for granted.65 These include depression, anxiety, anger, somatic symptoms, blaming or distancing, migraines, heart disease, and autoimmune disorders. Microaggressions are a barrier to optimal interactions with patients.60,62,66-69
The three types of microaggression are microinsults, microassaults, and microinvalidations (table 4.9).65,72,73
- Microinsults: These are insensitive or rude remarks that convey contempt for the target. The transgressor may be unaware of the offensive nature of her comments and may believe she is paying the person a compliment.72-76
- Microassaults: These behaviors are most closely aligned with isms like sexism or racism. Assaults can be verbal, nonverbal, implicit, or explicit (i.e., intentional) discriminatory behavior. Avoidance behavior is also a microassault.77,78
- Microinvalidations: These comments are dismissive of the feelings or experiences of the person being addressed or denying one’s own (possibly unconscious) biases toward a social group.62,64,77,78
We all have unconscious biases and we all are responsible for the effect our actions have on others, especially when it comes to interactions with our patients.63 Athletic trainers may unknowingly commit microaggressions and negatively affect the patient–clinician relationship.65 Social responsibility and respect are core values explicitly delineated for most health care professionals licensed in the United States. Ideally, those who embrace their professional values change behaviors that are harmful to patients through educative correction, or embracing ideals, information, and socialization as part of the professional education process.