Racial Microaggression: Stress and Health Effects of Subtle Interpersonal Violence in Narratives of African American Adults

Background: African Americans (AA) have comparatively earlier onset, later diagnosis and under-treatment of illness. The association between discrimination and negative health effects is well-established, yet the specific mechanisms are not well-understood.  Interpersonal racism is a form of violence that can be overt, such as name calling and bullying. More often in contemporary social environments, however, it occurs in subtle and oblique forms, expressed toward the target person insidiously through language and nonverbal behavior of white people. Dovidio and Gaertner discuss subtle racism as aversive racism, referring to subconscious negative tendencies toward POC that occur even in white people who consider themselves fair and nonbiased regarding race. The subtle forms of racism are largely communicated through racial microaggressions, defined by Sue as “brief and commonplace daily verbal, behavioral and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group.” Arguably, accumulated distress of such interactions increases allostatic load, reaching a threshold and causing diverse, serious illnesses.

Methods: Our narrative study, framed by Critical Race Theory, entailed face-to-face, semi-structured in-depth interviews with ten African American adults in a southeastern US city, (m=4, f=6). In 90 min interviews participants recalled their experiences with 13 common types of microaggressions (e.g. ascriptions of intelligence, over-identification, infantilizing, ignoring, stereotyping, colorblindness, assumptions of criminality, denial of racism). Participants reported what happened in these interactions with white people, how they responded if at all, thoughts and feelings that resulted. They were also were prompted to talk about perceived associated negative stress, and any attributions of health effects.

Results: Narrative thematic analysis revealed stress-involved problems, including musculoskeletal pain, sensing “blood pressure going up,” anger, depression, anxiety, gastroesophageal reflux disease, insomnia, hypervigilance, hopelessness, and traumatic stress, attributed to microaggressions. Subjective interpretations were diverse, and overtly racist incidents were also described. Most incidents occurred at work, but consequences and reactions affected home, family, and social relationships, with much time spent in ruminating on the events. Coping strategies included giving white people (WP) “a pass,” social avoidance, explaining to WP, laughter and direct confrontation. Participants described having been parented protectively, with warnings that such interactions with Euroamericans are inevitable.

Implications: This study somewhat unravels the subjective link between subtle racism and attributed physiologic changes explored as a socio-psycho-biological “link” between interpersonal microaggressions and health damage that may contribute to persistent health disparities. The consequences of subtle racism are underestimated. If they occur in health and behavioral health contexts, avoidance, non-adherence and distrust may result. Participants provided information on ways they strategize to avoid or counter the negative effects of these interactions that offer important insights for prevention and intervention.