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Alt-Right: Are Racists Mentally Ill? Some Psychiatrists Say Yes

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The 'Unite the Right' rally in Charlottesville, VA, where white supremacists march with tiki torchs through the University of Virginia campus. Getty Images/Zach D. Roberts

The scores of people carrying flaming torches and chanting “Jews will not replace us” last weekend in Charlottesville, Virginia, bore the message of the “alt-right,” the name given to the white supremacist movement dedicated to eradicating religious and ethnic minorities from America. This racist uprising will be followed by at least nine rallies this weekend—ostensibly dedicated to free speech but sure to broadcast messages of hate—across the U.S., held by members of the Ku Klux Klan, neo-Nazis, and other groups.

Many find the sight of hundreds of racists chanting their intentions for a so-called "ethno-state" and the forceful removal from America of anyone who isn't white horrific. But others—namely, some psychiatrists—see these individuals as mentally ill. Which leads to a disturbing question: Are we seeing the emergence of a nationalist movement fueled by prejudice or a widespread personality disorder that requires psychiatric care? Answering that dredges up long-held notions about racism in America.

In the 1960s, Alvin Poussaint, now a professor of psychiatry at Harvard Medical School, was providing medical and psychological care to civil rights activists in Jackson, Mississippi. As a black psychiatrist in the South, he often feared for his life. He witnessed many acts of violence, cared for victims of racist acts and had frequent run-ins with state troopers. Once, when he told an aggressive police officer that he was a doctor, the officer continued to call him “boy” with a hand on the gun in his holster.  “I saw the malignancy of the racism much more clearly, and the genocidal element of the extreme racism where they wanted to kill you,” Poussaint tells Newsweek.

He wondered if that hatred was an actual sickness that could be diagnosed and potentially treated. When he was in his early 30s, and a prominent psychiatrist at Tufts Medical School, Poussaint and several other black psychiatrists approached the American Psychiatric Association (APA) with the idea that extreme racism wasn’t just a social problem or a cultural issue. To these professionals, extreme racism—the kind that leads to violence—was a mental illness.

Poussaint and his colleagues wanted the APA to include extreme racism in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a “delusional disorder.” The DSM is the definitive guideline used by mental health clinicians to diagnose patients.

The DSM is not infallible. Over the years, it has provided insights into the country’s ever-changing values and belief systems. Homosexuality, for example, wasn’t completely omitted from the DSM until the late 1980s. The APA now has a new system for continuous updates, but last time the APA revised the DSM (in 2013) they declined the request by a group of psychiatrists to add pornography and sex addiction to the index. For psychiatrists updating the guide—a process that in the past might take more than a decade—doing so means wrestling with the very nature of humanity, what is normal and abnormal when it comes to behavior and beliefs.

Poussaint wasn’t arguing about the relatively milder beliefs that cause a person to stereotype and classify groups of people negatively. Rather, he and the other psychiatrists were addressing the kind of racism that leads to violent behavior, like killing and injuring people by driving a car into a crowd, as happened in Charlottesville. That extreme form of racism, said Poussaint, could reasonably be classified as paranoid and delusional.

GettyImages-810888668 In July 2017, Ku Klux Klan protests planned removal of General Lee statue from park in Charlottesville, Virginia. Chet Strange/Getty Images

The APA was unreceptive. “There was a lot of resistance to the idea,” he says. The problem, Poussaint explains, was that those in charge saw racism as too ubiquitous to diagnose. “They felt racism was so embedded in culture, that it was almost normative, that you had to deal with all the cultural factors that lead to this behavior,”

Members of the APA also argued that the extreme racism is a mental illness claim lacked hard science. That objection was weak, says Poussaint, because many mental health diagnoses  listed in the DSM don't have a solid scientific premise, including personality disorders. Some APA members said classifying extreme racism as an illness would excuse terrible beliefs and reprehensible behavior.

But Poussaint wasn’t interested in excusing or stigmatizing behavior; he wanted to help people he believed were sick. Inclusion in the DSM, he insisted, could allow individuals suffering from extreme racism to access services such as state-mandated psychiatric counseling, and therefore benefit society because, “it could protect people they might otherwise attack.”

Poussaint still believes extreme racism is a form of paranoia and should be treated that way. In therapy, a psychiatrist would help the patient understand the origins of their racism. “Like any psychotherapy or treatment you would try to tie it all together,” he says. “Other psychiatrists have testified and acknowledged such individuals may improve from treatment when they come to understand these beliefs and why they are projecting them onto other people and acting out.”

Racism as a Symptom

The question of whether extreme racism is a mental illness still haunts psychiatry. About 15 years ago, Carl Bell, a psychiatrist at Jackson Park Hospital Family Medicine Clinic and professor of clinical psychiatry at the University of Illinois at Chicago’s School of Medicine, resurrected Poussaint’s attempt to convince the APA to classify racism as a mental disorder. But Bell tried a different tack from Poussaint. He viewed extreme racism as a type of pathological bias that signaled an underlying personality disorder.

Bell proposed adding pathological bias to the DSM as a trait of personality disorder. With that addition, extreme bigotry would be a major criterion for the diagnosis. The broad term could also apply to individuals who direct violence and hatred toward other groups, such as gays or women.

But again, the APA said no. “When I raised this issue for the personality disorders working group they shut me down,” says Bell, “they were like, ‘Hell, no.’” As in decades past, the APA justified their objection on the grounds that racism is and always has been entrenched in society.

“The difficulty is that if you are in a racist society, how do you tease that out from biology or personality?” says Bell, who could not even convince the APA to study why racist thoughts and action manifest in some people during manic episodes.

The Association did finally issue a statement in 2006 acknowledging that some psychiatric factors cause a person to become racist, although “further research would be needed to explore this hypothesis.” The group also noted that racist beliefs and behavior often cause depression and psychiatric illness in people who are subject to them. In a statement provided to Newsweek about its approach to prejudice-based violence, Saul Levin, CEO and Medical Director of the APA, said, "The APA has a longstanding policy noting the negative impact of racism on mental health. APA policy supports public education efforts and research on racism and its adverse impact on mental health."

Bell and other experts continue to view some instances of racism as a symptom of other disorders. Racist thoughts and actions are often a manifestation of some other established and diagnosable mental disorder, says Bell. People with narcissistic personality disorder—a mental condition many experts have claimed Trump has —often have fixed values rooted in racism. Dylann Roof, the teen white supremacist convicted of killing nine black people at a church in Charleston, South Carolina, in 2015, had been diagnosed with schizoid personality disorder. People with conditions such as schizophrenia and bipolar disorder often experience extreme paranoia related to race or ethnicity, though not always violence.

GettyImages-831328974 Outside the court hearing for James Alex Fields, the suspect who drove his car into a crowd in Charlottesville, Virginia, Matthew Heinbach, of the white nationalist Traditionalist Workers Party, shouts at journalists. Chip Somodevilla/Getty Images

There is also evidence that most of us harbor prejudices, leading some experts to believe we are hardwired to discriminate in some fashion (though not specifically against others). The Implicit Association test (IAT), a tool used to understand the roots and extent of bias, measures impulses of subconscious racism—for example, whether we associate certain types of people with negative or positive feelings. The test, which was developed by social psychologists at Harvard, the University of Virginia and the University of Washington more than two decades ago, has been taken by more than 17 million people. The results show that at least 90 percent of Americans are at least slightly biased against people unlike themselves. Psychologists remain split on where to draw the line, though. Some say discrimination requires a diagnosis when thoughts become actions. But others doubt whether acting on racist beliefs warrants a label of its own. 

This Is Not Normal

The fact that many people who act on extreme racist beliefs lead high-functioning lives may also stand in the way of labeling this demographic as mentally ill. In the early 1960s, Jewish author and journalist Hannah Arendt covered the trials of Nazi war criminal Adolf Eichmann for the New Yorker. She was shocked that “half a dozen psychiatrists had certified Eichmann as ‘normal,’” despite the fact that he orchestrated the mass murder of millions of Jews. One psychiatrist described his familial relationships as not just normal but desirable.

In the decades following the Holocaust, the idea that someone who commits crimes against racial and ethnic minorities could still be considered sane by psychiatrists was unsettling, says James M. Thomas, an assistant professor of sociology at the University of Mississippi. “Many people turned to the explanation that there must be something wrong with the German psyche to have allowed this to happen.”

Social scientists knew that creating a clinical definition was critical. They understood that stigmatizing extreme racism could help society wake up to the abnormality of this pathology, and possibly prevent other genocidal acts. Three psychologists devised the California F-scale —F stands for fascist—a test used to evaluate a person for “authoritarian personality type.” They thought  understanding how people were seduced by Adolf Hitler’s rhetoric could help prevent future such movements. Although the F-scale fell out of favor, it enabled psychologists to identify common traits of people who cling to dangerous ideologies. They included an inflexible outlook, strong allegiance to leadership, a tendency to scapegoat others and a willingness to lash out in anger and violence.

GettyImages-810865732 In Charlottesville, Virginia, on July 8, 2017, members of the Ku Klux Klan gesture during a rally calling for the protection of Southern Confederate monuments. Andrew Caballero-Reynolds/AFP/Getty Images

Sander Gilman, who teaches psychiatry at Emory University, and co-authored with Thomas the book Are Racists Crazy?, agrees that dangerous racists leading seemingly normal lives are hard to identify. “Racists, sadly, cope quite well with daily life,” says Gilman. “They have a take on the way the world should be, and that take functions in the world they live.”

Gilman does not favor a standalone diagnosis of extreme racism, and believes that attempts to categorize such people as mentally ill masks the greater problem of society allowing them to commit vengeful acts. “Those people are evil. They’ve made bad choices, but they’re not choices you can then attribute to mental illness,” says Gilman. “The minute you do that you let people off the hook.”

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