The ungodly massacre of nine black worshippers at a church in Charleston, S.C., reignites the question: Is extreme racism a mental illness? The prime murder suspect, a young white man, allegedly hated black people and hoped to incite a race war. Media outlets categorized the alleged perpetrator as deranged, demented, and delusional. Nevertheless, mental health professionals are reluctant to classify racial terrorists as mentally ill.
The American Psychiatric Association contests extreme racism (as opposed to ordinary prejudice) as a mental health problem. The psychodynamics of extreme racism were all but ignored until the 1960s. After multiple racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry – not ordinary bigotry – defined as a mental disorder. The association’s officials rebuffed the recommendation, arguing that so many Americans are racist that even extreme racism is normative and better thought of as a social aberration than an indication of individual psychopathology.
Some felt that a mental illness diagnosis would serve as an excuse and absolve perpetrators of personal responsibility for their gruesome acts. Others believed a psychiatric diagnosis would open doors to an insanity defense plea that might lead to exoneration. However, such fears do not hinder diagnosing mental disorders in other capital murder defendants. Raising these extraneous issues evades the point.
Similar questions have arisen with regard to genocide. Whether individual Nazis exterminating Jews were insane or merely acting out the extremes of a pathologic society is an ongoing debate. Describing these killers as evil falls far short of a psychological evaluation. Reports document that Hitler suffered from diagnosable paranoia. Were his followers ill as well? There is a point at which the cultural norms with regard to racism clearly separate from extreme racism, a manifestation of serious individual psychopathology. Societal racism facilitates incorporating bigotry into a person’s racist psychotic and antisocial dysfunction. Many murderous paranoid schizophrenics have had racial targets at the core of their psychotic delusions. The criminal justice system (perhaps a step ahead of psychiatry) now refers to such violence as hate crimes – but that tells us little about the offender’s psychological state.
Not everyone professing a prejudiced belief about a particular group is mentally ill. On the contrary, most racism is learned behavior. Racism in a broad sense may be adaptive human behavior; homo sapiens are hard wired with a tendency to fear strangers and protect their own turf to foster their survival.
Racist attitudes that interfere with an individual’s ability to work with people from a particular group should not in itself be considered mental illness. However, if that person believes he has to kill black people, such ideation must be examined as an expression of a mental disorder. Acting out extermination fantasies is readily classifiable as a delusional and a psychotic disorder. To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy.
The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the DSM-5, does not include racism, prejudice, or bigotry in its text or index. There is no support for including racism (affecting perpetrators or victims) under any diagnostic category. Unfortunately, too many psychiatrists believe that extreme racism cannot and should not be recognized as a potentially treatable symptom of mental dysfunction.
Anecdotally, I have known psychiatrists who treated patients who projected their own unacceptable behavior and fears onto ethnic minorities as scapegoats. Often, their strong racist feelings were tied to fixed belief systems impervious to reality checks, reflecting symptoms of mental dysfunction. These colleagues have told me that as their patients became more aware of their own problems, they grew less paranoid – and less prejudiced. Community and family members should know that they can seek professional help for individuals who exhibit violent racist thinking.
It’s time for mental health professionals to examine their resistance to accepting extreme racism as a symptom of serious mental illness. Such a focus in the future may prevent tragedies like the Charleston massacre.
Dr. Poussaint is professor of psychiatry at Harvard Medical School, Boston.