Racism is an Illness

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Psychology

Is Racism an Illness?

By Noliwe M. Rooks  May 04, 2012

 

 

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Members of the Ku Klux Klan burn a cross at a night rally in 1946.

Is racism an illness? Psychiatrists and psychologists are debating the issue. The forthcoming Oxford Handbook of Personality Disorders, due for publication in August 2012, will include a chapter on identifying and assessing pathological bias. This is the form of racism that could lead supremacists to violently and randomly maim or massacre those of another race. Meanwhile, a team of British psychologists recently announced they had stumbled upon a secondary use for Propranolol, a commonly prescribed medication for high blood pressure. They claim it could cure implicit bias, or the form of racism that can even occur in people “with a sincere belief in equality.” Scientists believe the discovery can be explained by the fact that implicit racism is fundamentally founded on fear, and the drug acts both on nerve circuits that govern automatic functions, such as heart rate, and the part of the brain involved in emotional responses.

Thinking of any form of racism as an illness is very troubling. Historically, psychiatrists, psychologists, the medical establishment and lay people have all agreed that the roots of racism are cultural or societal — a set of beliefs and behaviors that are learned and, as a result, can be unlearned. If it were to ever be declared an illness that can be treated, racists would no longer be legally or ethically responsible for their actions. Just imagine it: a medical justification for discriminating against, or even killing, those of another race.

(MORE: Inside the Racist Mind)

Dr. Carl C. Bell, the coauthor of the Oxford University Press chapter and a member of the APA is, nonetheless, convinced that some forms of racism are a mental illness. He notes that many of his colleagues are “concerned about having the conversation about racism and mental illness because, for them, it is akin to medicalizing a social problem.” He thinks there is some validity to those concerns but believes that while “95–98% of racist behavior is socially, culturally or politically determined, there is still a sliver of racist behavior that may be based on psychopathology.”

He might be right, but how would we differentiate between socially learned and the pathological forms of racism? Do they really present themselves in the world looking that different, one from the other? In addition to providing justification for behaviors currently deemed immoral, or even illegal, medicalizing racism also reduces the pressure to eliminate racist behavior by social and political means, a task at which we are not now excelling. For example, as sociologist Devah Pager’s work has made clear, in contemporary America, black men with no criminal records, solid work histories, and college degrees, fare no better on the job market than do white men with less education who have been newly released from prison. Does declaring racism an illness in any way remedy, address, or lead us toward a solution for this inequity?

(MORE: The Problem with the ‘Some of My Best Friends Are Black’ Defense)
Though it has been asked to consider the issue several times, the American Psychiatric Association has never recognized racism as a mental health problem. The issue was first raised in the mid 1960s by a group of black psychiatrists led by the Harvard professor Dr. Alvin Poussaint. After several race-based murders in Mississippi during the civil rights era, the group asked the APA to have racism entered into the Diagnostic and Statistical Manual of Mental Disorders (DSM-II.) The association rejected the recommendation, arguing that because so many Americans are racist, even extreme racism in this country is the norm — a problem for culture to solve, not medicine. In 2004, the organization again rejected a proposal to include extreme forms of pathological bias, such as racism, in the new edition of the DSM-5, due for publication next summer.

And of course, there are reasons to be suspicious of the racial and political consequences of medical and psychiatric diagnosis. In the 19th century, enslaved black people who escaped from their owners were diagnosed as having drapetomania, a disorder characterized by an irrational desire for freedom. The treatment involved beating the afflicted into submission. According to a 2010 book by psychiatrist Jonathan Metzel, The Protest Psychosis: How Schizophrenia Became a Black Disease, doctors began to diagnose black people involved in the civil rights movement as having a form of schizophrenia characterized by a desire to agitate for their rights. Those receiving this diagnosis were institutionalized.

(MORE: The Myth of Desegregation)

Race in and of itself does not dictate, or even explain behavior like running away from an owner, or protesting for civil rights. Humanity explains those behaviors. The same questionable thinking that led to the stigmatization of black people who desired freedom is at the heart of the decision to medicalize racism. It is clear that we as a society have a lot of work to do to end racism, and almost none of it will start in the lab.

MORE: The New Black Irony

Noliwe M. Rooks @nrookie

Rooks is an associate professor at Cornell University. The views expressed are solely her own.

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West J Med. 2002 January; 176(1): 4.

PMCID: PMC1071634

Is Extreme Racism a Mental Illness?

Yes

It can be a delusional symptom of psychotic disorders

 

 

Alvin F Poussaint, Professor of psychiatry¹

Author information ► Copyright and License information ►

 

The American Psychiatric Association has never officially recognized extreme racism (as opposed to ordinary prejudice) as a mental health problem, although the issue was raised more than 30 years ago. After several racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry classified as a mental disorder. The association's officials rejected the recommendation, arguing that because so many Americans are racist, even extreme racism in this country is normative—a cultural problem rather than an indication of psychopathology.

The psychiatric profession's primary index for diagnosing psychiatric symptoms, the Diagnostic and Statistical Manual of Mental Disorders (DSM), does not include racism, prejudice, or bigotry in its text or index.¹ Therefore, there is currently no support for including extreme racism under any diagnostic category. This leads psychiatrists to think that it cannot and should not be treated in their patients.

To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats a whole group of people and seeks to eliminate them to resolve his or her internal conflicts meets criteria for a delusional disorder, a major psychiatric illness.

Extreme racists' violence should be considered in the context of behavior described by Allport in The Nature of Prejudice.² Allport's 5-point scale categorizes increasingly dangerous acts. It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination against them, to physical attack, and finally to extermination (lynchings, massacres, genocide). That fifth point on the scale, the acting out of extermination fantasies, is readily classifiable as delusional behavior.

More recently, Sullaway and Dunbar used a prejudice rating scale to assess and describe levels of prejudice.³ They found associations between highly prejudiced people and other indicators of psychopathology. The subtype at the extreme end of their scale is a paranoid/delusional prejudice disorder.

Using the DSM's structure of diagnostic criteria for delusional disorder,^4(p329) I suggest the following subtype:

Prejudice type: A delusion whose theme is that a group of individuals, who share a defining characteristic, in one's environment have a particular and unusual significance. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. When these delusions are extreme, the person may act out by attempting to harm, and even murder, members of the despised group(s).

Extreme racist delusions can also occur as a major symptom in other psychotic disorders, such as schizophrenia and bipolar disorder. Persons suffering delusions usually have serious social dysfunction that impairs their ability to work with others and maintain employment.

As a clinical psychiatrist, I have treated several patients who projected their own unacceptable behavior and fears onto ethnic minorities, scapegoating them for society's problems. Their strong racist feelings, which were tied to fixed belief systems impervious to reality checks, were symptoms of serious mental dysfunction. When these patients became more aware of their own problems, they grew less paranoid—and less prejudiced.

It is time for the American Psychiatric Association to designate extreme racism as a mental health problem by recognizing it as a delusional psychotic symptom. Persons afflicted with such psychopathology represent an immediate danger to themselves and others. Clinicians need guidelines for recognizing delusional racism in all its forms so that they can provide appropriate treatment. 

Otherwise, extreme delusional racists will continue to fall through the cracks of the mental health system, and we can expect more of them to explode and act out their deadly delusions.

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Figure 1

Extreme racism indicates psychopathology

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Notes

Competing interests: None declared

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References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Press; 2000.

2. Allport G. The Nature of Prejudice. Reading, MA: Addison-Wesley; 1954.

3. Sullaway M, Dunbar E. Clinical manifestations of prejudice in psychotherapy: toward a strategy of assessment and treatment. Clin Psychol Sci Pract 1996;3: 296-309.

4. American Psychiatric Association. Diagnostic criteria for 297.1 delusional disorder. In: DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Press; 2000.

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