Target gender moderates racial bias in pain perception as a function of prototypicality and context
Creators: name: Azaadeh Goharzad
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Psychology
subject: FOS: Psychology
subject: Social Psychology
subject: Social and Behavioral Sciences
subject: Cognitive Psychology
subject: Cognition and Perception
subject: Life Sciences
subject: Social Statistics
subject: Medicine and Health Sciences
subject: face
subject: treatment
subject: health
subject: perception
subject: emotion
subject: social cognition
subject: gender
subject: intersectionality
subject: prototypicality
subject: identity
subject: social category
subject: pain
subject: disparities
subject: race
subject: medicine

description: Recent work demonstrates that racial bias in pain care stems, at least in part, from a perceptual source (Mende-Siedlecki et al., 2019). Racial bias in pain perception cannot be explained by low-level stimulus features, persists even when identical expressions of pain are rendered on computer-generated targets, and facilitates biases in treatment above and beyond explicit stereotypes and prejudice. Critically, this bias in pain perception arises from disruptions in configural face processing (Exps. 3 &amp; 4, Mende-Siedlecki et al., 2019). Over two decades of research has documented consistent discrepancies in pain treatment across gender, such that women are prescribed pain medication less often and at lower doses than men with comparable conditions or presentation of symptoms (Breitbart et al., 1996; Calderone, 1990; Chen et al., 2008; Cleeland et al., 1994; Faherty &amp; Grier, 1984; Hoffman &amp; Tarzian, 2001; Leresche, 2011; McDonald &amp; Bridge, 1991; Vallerand &amp; Polomano, 2000). Given our own work suggesting that racial disparities in pain care are supported in part by gaps in visual perception of painful expressions (Mende-Siedlecki et al., 2019), it's possible that gender disparities in pain care stem from a similar source. However, work in social perception demonstrates that gender moderates the effects of target race on perception of emotion, and that typically, such effects are larger within male (versus female) targets. For example, while angry Black faces are remembered more accurately than angry white faces (e.g., Ackerman et al., 2006), Krumhuber &amp; Manstead (2011) later demonstrated that this effect held for male targets, but not for female targets. Similarly, while happy expressions are categorized faster on White (versus Black) faces (e.g., Hugenberg, 2005), this response latency advantage has been obtained when White male targets are presented in the context of Black male targets, but not amongst Black female or White female targets (Craig, Mallan, &amp; Lipp, 2012; Lipp, Craig, &amp; Dat, 2015; Craig, Koch, &amp; Lipp, 2017). We tested whether target gender shapes the effects of target race on pain perception across four behavioral experiments. Taken together, we observed an interaction between race and gender: racial bias in pain perception was larger within male versus female targets. That said, three of these experiments were somewhat underpowered due to an uptick in fraudulent responses on Mechanical Turk. The fourth study was conducted in-lab, and was the only study of the four not to yield a significant interaction between target race and gender. We then sought to conduct a well-powered final study in order to reach consensus as to the effects of target race and gender on pain perception and treatment. In that study, we once again observed a statistically significant interaction between race and gender in the same (and this time, preregistered) direction. In a posted pre-print, we have argued that this effect may be viewed as a consequence of differences in judgments of the racial prototypicality of Black women and Black men. For example, the categorization of Black male targets as male is facilitated while categorization of Black female targets as female is impaired (Johnson, Freeman, &amp; Pauker, 2012) due to shared stereotypes regarding strength and dominance between the race category Black and the gender category male (Galinsky, Hall, &amp; Cuddy, 2013; Goff et al., 2008). Similarly, the recognition of anger is facilitated on Black male faces (Smith, LaFrance, &amp; Dovidio, 2017; Hehman, Ingebretsen, &amp; Freeman, 2014) due to simultaneous stereotypes about aggression associated with both males and Black people (Stolier &amp; Freeman, 2016; Eberhardt, Goff, Purdie, &amp; Davies, 2004). Moreover, these associations bias emotion perception of non-prototypical category exemplars (e.g., Black women) to the extent that there is overlap in stereotypes between the emotion category (e.g., anger) and category prototype (e.g., Black men) (Stolier &amp; Freeman, 2016). Thus, the blunted perception of pain expression on Black male and female faces may depend on the strength of their association to their racial category. That said, in these previous investigations, we did not measure judgments of racial prototypicality at either the stimulus level (e.g., do participants rate Black male targets as looking more prototypically Black than Black female targets, and do individual differences in this tendency predict the interaction between target race and gender in pain perception thresholds?) or the group level (e.g., do participants represent Black women as being less similar to Black people than Black men, and does this tendency predict the interaction in the pain perception data?). The present investigation will allow us to close these gaps. Moreover, we note that in some subsequent studies where only female targets were presented, a robust racial bias in pain perception and treatment was observed—Black female targets’ pain was seen less readily and treated less aggressively than White female targets’ pain, and to an extent that is comparable to our previous studies with only male targets. One possibility is that context influences the perceived racial prototypicality of Black female targets, with consequences for the magnitude of this bias. When they appear in the context of Black men, they are seen as less racially prototypic, and thus, differences in pain outcomes between Black and White women are smaller in comparison to differences between Black and White men. The present study also contains a between-subjects manipulation of the race/gender distribution of targets that will allow for a direct test of this possibility.