Why Don't We Take Black People's Pain Seriously?

“Black people have thicker skin than white people” is a belief held by many white Americans. Such stereotypes lead to underestimating the pain level of Black people. At times, white Americans will fail to even recognize that a person of color is in pain and needs help.

A recent study asked participants to identify pain expressed in photos and found that white participants were better at recognizing pain expressed by white faces than Black ones (1). Failure at this primitive perceptual level would lead to depriving a Black person in pain from getting potentially life-saving help.

Furthermore, when white Americans recognize pain in a Black person, they believe that Black people experience pain differently. In one sobering study published by Proceedings of the National Academies of Science (PNAS), the authors asked white participants to evaluate the amount of pain they would feel across 18 scenarios, for example, “I slam my hand in the door” (2). Then, the same participants were asked to rate the pain of gender-matched Black or white targets across the same 18 scenarios. The participants also had to complete a 15-item measure about whether they endorsed beliefs about biological differences between Black people and white people. Here are some examples from the measure:

• Black people's nerve endings are less sensitive than white people's.
• Black people’s blood coagulates more quickly than white people's.
• Black people have stronger immune systems than white people.
• Black people's skin is thicker than white people's.
• Black couples are significantly more fertile than white couples.

Shockingly, 73% of participants endorsed at least one of the false beliefs about racially related biological differences. Furthermore, the results showed that the more false beliefs the white participants endorsed, the more they underestimated the pain of Black targets. In other words, if a white participant believes that there are indeed biological differences between white and Black people, they were likely to rate the Black people’s pain as less intense across exactly similar painful experiences.

Beliefs that Black people have thicker skin have existed for decades. For instance, Dr. Samuel Cartright (1793-1863) was a physician who was charged with proving that Black people were racially inferior to white people. His sensational report on his findings was presented on March 12, 1851 (3). He invented the psychological condition drapetomania. This madness occurred when a slave wanted to escape servitude and run away. The treatment he recommended was to whip the slave so they didn't run away. He strongly believed that Black people are “insensible to pain when subjected to punishment.”

White people who believed that Black people are insensitive to pain and injury felt justified in beating their Black slaves. Such attitudes were also endorsed by leaderships such as the military, which justified experimentation on Black soldiers. Some scientists also held similar attitudes and felt no remorse over infecting Black people with syphilis—the Tuskegee study. Doctors would deny Black people anesthesia before surgery because they also believed that Black people don’t feel pain.

The above-mentioned study was conducted on laypeople. But, how about people responsible for treating and managing pain: doctors? Medical students and residents were asked to read two mock medical cases about a Black and a white patient, rate their pain, and make medication recommendations. The participants also completed the same measure containing items about biological differences between Black people and white people. About half of these medical students and residents endorsed at least one false belief about Black people’s biology. Unfortunately, the consequences of these beliefs were far from benign. Similar to laypeople, participants who endorsed more false beliefs tended to underestimate Black patients’ pain. In other words, residents and to-be doctors exhibited racial bias in pain perception.

Did not taking Black people’s pain as seriously as white people's affect the medical students’ and residents’ treatment recommendations? Absolutely. Participants who endorsed more false beliefs were less accurate in their treatments of Black patients. So, medical students and residents also exhibited racial bias in treatment recommendations.

Beyond hypothetical mock cases, another study on actual patients with metastatic or recurrent cancer reported that only 35% of minority patients received the appropriate prescriptions as compared with 50% of nonminority patients — appropriate as recommended by the World Health Organization (4). Even children have not escaped this racial bias in pain perception and its treatment. In a study of nearly one million children diagnosed with appendicitis, Black patients were less likely than white ones to receive any pain medication for moderate pain (5).

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Why do these racial biases in pain perception and its treatment exist in many people including doctors? Some reasons for these biases may include: pain is complex and subjective, portrayals of Black Americans in movies, stereotypes about biological differences between Black people and white people. lingering attitudes from slavery and other factors. There is also the unsettling explanation that some racists believe that Black people are not entitled to certain emotional experiences such as pain. However, many of the people who endorse racial biases in pain perception are not explicitly and sometimes also not implicitly racist. Nonetheless, regardless of what causes these biases, whether they are explicit or implicit, they need to be abolished as soon as possible. These racial disparities in health and health care are literally killing Black people. It is reasonable to extrapolate from these studies that these biases extend to people with dark skin in general. These racial biases cause additional psychological pain.