Unconscious Bias Is a Human Condition


Mihal Emberton, MD, MPH, MS1

Perm J 2021;25:20.199

E-pub: 03/03/2021

Editor’s note: Please also see: Learning in Humans versus Hierarchies and Etiology of Belief–behavior Systems and Hierarchies


The unconscious bias that plagues our police departments is the same unconscious bias that plagues business in the form of employee oppression and burnout, that plagues academia in the form of social promotion and fixed mindset, that plagues law in the form of poetic injustice and that plagues politics in the form of disenfranchisement and voter suppression. Each industry has also attempted to correct the negative effects of unconscious bias with leadership development in business, Montessori method and active learning in academia, restorative justice in law, and voter participation and town halls in politics. The reason that each of these efforts is still in its infancy is that our understanding of the rules of unconscious bias and the behaviors that stem from that unconscious bias have been incompletely understood until now. Good people like yourself and like me have unconscious bias; having unconscious bias is a human condition. But those of us who learn to recognize and overcome our unconscious bias become more impactful and powerful stewards of society.


This manuscript is the second in a 3-part series that begins with “Learning in Humans versus Hierarchies” and will conclude with “Etiology of Belief-Behavior Systems and Hierarchies.”


Human beings love to find patterns and identify the rules for those patterns to solve problems and puzzles.1,2 You can easily test this theory by observing the people around you. My child, for example, lights up when she recognizes the patterns and rules for defeating an opponent in games of strategy, and many physicians, for example, chose to study medicine because discovering the patterns and rules related to health and disease elicits excitement and meaning.

We use our ability to recognize patterns and to find rules for those patterns to also understand our social hierarchies to successfully interact with other people. For example, we often view a person wearing a metal band on their left ring finger as someone who is married because, based on our experience of this pattern, a ring being worn on this finger signifies marriage. In addition to our own experiences, we also learn about patterns from others. Many families, for example, teach their children to respect and defer to the insights and experiences of elders because, based on that family’s experience, people who are older generally have important knowledge, insights, and experience to impart. Therefore, we use our experiences of social patterns in combination with education from others about social patterns to figure out how to successfully navigate the social hierarchy.

Frank Abagnale, a consultant for the Federal Bureau of Investigation, a faculty member at The Department of Justice’s National Advocacy Center, and an expert on fraud prevention,3 recognized at an early age that people defer to patterns of authority. Mr Abagnale discovered that when he presented himself as a professional with a certain level of social status and authority, such as an airline pilot or physician, the people around him would defer to that position of power. I recently asked him if he ever found that despite wearing a uniform or nice suit, there were some people who were not inclined to assume that he was a professional. He responded, “No, absolutely not… When I had the uniform on, no one questioned me, not even other airline personnel” (FW Abagnale, personal communication, 2020 June).

Recognizing the patterns of social status and authority help us determine how to successfully relate to other people in our social hierarchy. In addition to generally deferring to those whom we interpret as having authority and/or social status, we may also recognize patterns that we interpret as placing us above another person in the social hierarchy. Encountering someone appearing homeless or encountering someone younger than ourselves may trigger this unconscious social calculation of presumed authority over others.

When we derive the correct rule for an observed pattern, it not only brings joy1,2 but also allows us to successfully relate to other people in our social hierarchy. However, sometimes we get the rule for the pattern wrong. A clear example of this occurred in June 2020 when a San Francisco white woman approached a person of color in her neighborhood who was writing “Black Lives Matter” on a retaining wall.4 This woman likely recognized a pattern that generally the people who live in her neighborhood are not people of color. However, she got the rule for the pattern wrong and mistakenly assumed that people of color never live in her neighborhood. Based on this miscalculated rule—an assumption that this person of color must be an outsider—, she accused him of defacing private property and called the police to report him as a criminal.4 It was her miscalculated rule, her unconscious bias, that caused her to mistakenly assume a position of authority over her neighbor, which resulted in a deleterious social interaction.

This type of unconscious bias is a human condition, not bounded by culture or place or time. Frank Abagnale highlights the universality of our unconscious bias when he states that, “Throughout my career, I’ve found that the power of image, whether in personal appearance, marketing materials, company correspondence, etc. has a tremendous influence and bias in the way people treat you, not only in this country but all over the world” (FW Abagnale, personal communication, 2020 June). The truth is, unfortunately, that we all carry the burden of possibly miscalculating the rules for the patterns we observe, the burden of unconscious bias.


While we seek out patterns to help identify rules1,2 that help us successfully interact within our social hierarchy, we all too often end up misidentifying a rule because we do not recognize that we have gaps in our knowledge about others. Other people are generally the experts of their own experience, and they will generally have more insight about their experiences than we will ever have about them. The San Francisco woman made a conclusion about the “Black Lives Matter” neighbor without recognizing that she did not know for a fact his neighborhood status. In Mr Abagnale’s experience, people always made a conclusion about his status and authority without recognizing that they did not really know for a fact if he was a pilot or physician (FW Abagnale, personal communication, 2020 June).

Making a decision or conclusion when a knowledge gap is present is the definition of bias, which I also call an autocratic belief-behavior system. Generally, when we are in our autocratic mindset, we are not aware that we are making decisions or conclusions despite having gaps in knowledge or experience; generally, by definition, our bias is unconscious.1


Unlike making a social calculation about a stranger and how that stranger relates to us in the social hierarchy, structured hierarchies such as academic institutions, businesses, and political systems, unfortunately incubate our unconscious bias. This occurs because the power differential in our structured hierarchies insulates and protects the unconscious bias of supervisors such that when a supervisor is in their autocratic mindset, they often misinterpret the clues and evidence of such as insurgency on the part of the subordinate. Autocratic supervisors will then tend to punish the subordinate for making the autocratic supervisor uncomfortable rather than recognize that it was the unconscious bias of the autocratic supervisor, driven by a knowledge gap, that created the discomfort in the first place.1

Einstein also recognized this pattern of unconscious bias, of supervisors unconsciously disregarding the knowledge, insights, and experiences of subordinates, when he advocated, “It is important for the common good to foster individuality [subordinate knowledge]: for only the individual can produce the new ideas which the community [hierarchy] needs for its continuous improvement and requirements – indeed, to avoid sterility and petrification.” 5

Because autocratic belief-behavior systems are a human condition, this pattern of unconscious bias can encumber any structured hierarchy.1 Carol Dweck, PhD, Stanford psychology professor, describes this pattern of unconscious bias in education in her description of fixed mindsets.2 Douglas McGregor, PhD, Massachusetts Institute of Technology management professor, described this pattern of unconscious bias in business in his description of Theory-X.6,7 Albert Eglash, psychologist, described this pattern of unconscious bias in law and outlined how to overcome this unconscious bias in law in his description of restorative justice.8,9 This pattern of unconscious bias within our political system, which has been present since the inception of our American Democracy in the 1700s, is often described as disenfranchisement and voter suppression. 10

The reason that our attempts to overcome this unconscious bias are still in their infancy is that we are only now understanding the rules for the patterns that cause and derive from our unconscious bias. The rules are that 1) we all can make conclusions despite having knowledge gaps, 2) we generally do not recognize when we have such knowledge gaps, and 3) we then often blame others for the discomfort of having such a knowledge gap. Generally, structured hierarchies allow autocratic supervisors to maintain autocratic belief-behavior systems because it can be nearly impossible for subordinates to teach autocratic supervisors that they are demonstrating unconscious bias. Additionally, subordinates are often punished for making autocratic supervisors feel uncomfortable. In order to overcome unconscious bias, supervisors themselves must discover their knowledge gaps by genuinely valuing and seeking out the knowledge, insights, and experiences of others, especially from those who are lower than them in the social or organizational hierarchy.1

An example of how unconscious bias can be protected in a hierarchy occurs very visibly in our political system. It is generally understood that our legislators spend 4-6 hours of their 9-10-hour day fundraising, leaving them very little time to seek out the knowledge, insights, and experiences of their constituents to better understand the social problems that the disenfranchised are experiencing.11 Ezra Klein, journalist, political commentator, and co-founder and editor-at-large for Vox, emphasizes that “congress could, if it wanted, move to a system of real public financing for elections [to give legislators more time to collaborate with constituents/disenfranchised]. They don’t, and the reason is simple: The money chase makes life miserable for incumbents, but it also makes it likelier that they remain incumbents. Even as it makes you worse at your job, it makes you better at keeping it.”11 In essence, our legislators have the power to change the system to allow them more time to seek out and fill in their knowledge gaps in order to create more just social policy, but instead legislators wield their power to maintain the status quo, which ends up insulating their knowledge gaps, perpetuating imperfect social policies, and keeping the disenfranchised oppressed.


While it is generally easier to spot the unconscious bias in others, it is often very difficult to recognize and spot it within ourselves. For example, a colleague recently shared their knowledge and experience that “systemic racism does not exist,” and, while I could easily recognize that this colleague had a gap in knowledge and experience, demonstrating unconscious bias, it took me a longer amount of time with much more effort to recognize the unconscious bias that I displayed toward this colleague in response. When I first encountered my colleague’s words, I initially felt vulnerable and threatened, thinking “this colleague has no idea what they are talking about and they are definitely not worth my time.” It took me a while to recognize that my initial feelings and thoughts were clues that I was in my autocratic mindset, demonstrating unconscious bias toward my colleague.1

In my effort to unravel my unconscious bias, I had to recognize 1) the pattern that I was interpreting as well as 2) the knowledge gap that was causing me to come up with the wrong rule for the pattern. The pattern that I was recognizing was that I had more knowledge and experience than my colleague about racism. However, I was misinterpreting my colleague’s proud display of their knowledge gap about racism, as evidence that my colleague did not offer me any other knowledge, insights, or experiences to learn from. This is, however, where I had a gap in knowledge; I assumed that my colleague did not offer any intellectual currency without really knowing for a fact that my colleague had nothing to teach me. The moment a person believes that they have nothing to learn from another is the moment they have closed themselves off to discovery.1

In order to truly collaborate with my colleague, I had to embrace my knowledge gap, remember that this colleague has something valuable to teach me, and use this insight to genuinely and respectfully engage with my colleague. Once I recognized that I had unconsciously devalued my colleague and unconsciously shut myself off to learning more about their journey, I was able to overcome my bias by reaching out to my colleague to fill in my knowledge gaps about their experiences and hopefully to help fill in their knowledge gaps about racism.

Since structured hierarchies tend to incubate our unconscious bias, it is even harder to seek out our knowledge and experience gaps when we become supervisors. Many organizations, for example, attempt 360 evaluations, where subordinates may “anonymously” provide feedback to their supervisor as a mechanism to identify the supervisor’s knowledge and performance gaps. How that supervisor uses and interprets that feedback, however, determines if they are willing to find and learn from their knowledge and performance gaps or not. If the supervisor is in their democratic mindset, they will seek out and embrace their knowledge and performance gaps in order to rectify them, but if the supervisor is in their autocratic mindset, they will instead look for evidence that they are already doing an adequate job, subsequently writing off minority “constructive” feedback as outliers. It is not the tool itself but rather how a supervisor uses that tool that determines if the supervisor is running a conformity process or a learning process.1

For example, an autocratic supervisor might ask that all subordinates complete a 360 evaluation of the supervisor in order to avoid getting only “super positive” and “super negative” reviews. Such an autocratic supervisor thinks that they are valuing all their subordinates’ knowledge and experience by asking for all their opinions. However, such an autocratic supervisor is really seeking a majority consensus that there are no gaps in knowledge or performance, a majority consensus that the status quo is acceptable. In essence, it is more comfortable to believe that we are functioning ideally, without knowledge gaps or performance gaps.

There are a few key insights about how hierarchies work that an autocratic supervisor often overlooks. First of all, just because there are only 1 or 2 people who take the time to comment on a knowledge gap or performance gap does not mean that the knowledge gap or performance gap does not exist or is not valid. Additionally, subordinates will often defer pointing out knowledge gaps or performance gaps in their supervisor because 1) subordinates may feel that speaking out will not change the current situation and/or 2) it is so much easier and safer for subordinates to just let a supervisor have a knowledge gap or performance gap.1 It is for exactly these reasons that finding those knowledge and performance gaps can be so difficult and elusive for supervisors.

Like many supervisors, I also receive annual 360 feedback evaluations from my subordinates, and, in order to overcome my unconscious bias, I intentionally embrace and apply all the “super negative” insights to my practice improvement. More specifically, I do not view the suggestions for growth as “super negative” but rather view the suggestions for growth as the very necessary keys to finding and addressing my knowledge and performance gaps. Additionally, I share my “super negative” feedback with my subordinates and then collaborate with my subordinates on how I can successfully address my knowledge and performance gaps. Consistently finding and addressing our knowledge gaps is the only way to overcome our unconscious biases, refine our leadership skills, and become more successful problem-solvers for the hierarchies we serve.

Good people, like yourself and like me, have unconscious bias; having unconscious bias is a human condition. But those of us who learn to recognize and overcome our unconscious bias become more impactful and powerful stewards of society.1

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Funding Sponsors or Financial Contributors



FBI, Federal Bureau of Investigation; NAC, National Advocacy Center.


Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

Author Affiliations

1Permanente Medical Group, Adult and Family Medicine, San Francisco, CA

Corresponding Author

Mihal Emberton, MD, MPH, MS, ()

Author Contributions

Emberton conceived and designed the analysis, collected and analyzed the data, copyrighted the belief-behavior systems archetype, and wrote the manuscript.


1. Emberton M. Learning in humans versus hierarchies. Perm J 2020;20:19.083. DOI: https://doi.org/10.7812/TPP/19.083

2. Brown PC, Roediger HL 3rd, McDaniel MA. Make it stick: The science of successful learning. Cambridge, MA: The Belknap Press of Harvard University Press; 2014. DOI: https://doi.org/10.4159/9780674419377

3. Abagnale FW. About Frank Abagnale. Frank W. Abagnale official website. Accessed September 16, 2020. https://www.abagnale.com/aboutfrank.htm

4. DiFeliciantonio C. Feud over Black Lives Matter stencil erupts in SF’s Pacific Heights. San Francisco Chronicle 2020 Jun 14; 2020. Accessed September 16, 2020. https://www.sfchronicle.com/bayarea/article/Feud-over-Black-Lives-Matter-stencil-erupts-in-15338715.php

5. Einstein A. The ultimate quotable Einstein. Princeton, NJ: Princeton University Press; 2010.

6. Prottas DJ, Nummelin MR. Theory X/Y in the health care setting: Employee perceptions, attitudes, and behaviors. Health Care Manag 2018 Apr/Jun;37(2):109-17. DOI: https://doi.org/10.1097/HCM.0000000000000210, PMID:29521893

7. Morse JJ, Lorsch JW. Beyond theory Y. Harvard Business Review May; 1970; 1970. Accessed September 20, 2020. https://hbr.org/1970/05/beyond-theory-y

8. Heath-Thornton D. Restorative justice. Encyclopædia Britannica, Inc. Accessed 26 Aug 2018. https://www.britannica.com/topic/restorative-justice

9. Maruna S. The role of wounded healing in restorative justice: An appreciation of Albert Eglash. Restorative Justice 2014 Apr;2(1):9-23. DOI: https://doi.org/10.5235/20504721.2.1.9

10. Carnegie Corporation of New York. Voting rights: A short history. New York: Carnegie Corporation of New York; 2019. Accessed September 19, 2020. https://www.carnegie.org/topics/topic-articles/voting-rights/voting-rights-timeline/?gclid=CjwKCAjw2Jb7BRBHEiwAXTR4jd-v0lCY-_zczp5BSbfNSJFBiVqY7OSeW_sdhjhX8j7iqqqbC90tZRoC-d0QAvD_BwE

11. Klein E. The most depressing graphic for members of Congress. The Washington Post 2013 Jan 14; 2013. Accessed September 22, 2020. https://www.washingtonpost.com/news/wonk/wp/2013/01/14/the-most-depressing-graphic-for-members-of-congress/

Keywords: burnout, engagement, organizational culture change, overcoming unconscious bias, social justice


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