Some mental health practitioners are seeking to study whether pathological bias, such as severe racism or homophobia, constitutes a mental illness. Such a decision would have far-ranging consequences both in mental health practice and the criminal justice system.
And in the California prison system, psychiatrists are already treating pathological bias with anti-psychotic drugs.
Consider the stories of these people from the Washington Post. The full article is worth a read, but here are some choice cuts.
The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement.
These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person.
“He had a fixed delusion about the world,” said Sondra E. Solomon, a psychologist at the University of Vermont who treated the man for two years. “He felt under attack, he felt threatened.” — Washington Post
But psychiatrists already know how to treat disorders where people believe things that aren’t true, raising the question of whether a new classification of mental illness is needed at all.
“If you are going to put racism into the next edition of DSM, you would have enormous criticism,” [Darrel A.] Regier [director of research for the American Psychological Association] said. Critics would ask, “‘Are you pathologizing all of life?’ You better be prepared to defend that classification.”
“I think it’s absurd,” said Sally Satel, a psychiatrist and the author of “PC, M.D.: How Political Correctness Is Corrupting Medicine.” Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. “You could use it as a defense.”
Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York’s Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted.
“Psychiatrists who are uneasy with including something like this in the Diagnostic and Statistical Manual need to get used to the fact that the whole manual reflects social context,” said Belkin, who is planning to launch a study on pathological bias among patients at his hospital. “That is true of depression on down. Pathological bias is no more or less scientific than major depression.” — Ibid.
And besides, most of the people psychiatrists see aren’t engaging in criminal behavior.
Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her — she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said [Edward] Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.
Another patient was a waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs.
A third patient was a Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them, Dunbar said.
“When I see someone who won’t see a physician because they’re Jewish, or who can’t sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, ‘This is not our problem,'” the psychologist said. “If it’s not our problem, whose problem is it?”
. . . But [Alvin F.] Poussaint [professor of psychiatry at Harvard Medical School] said there is a difference between ordinary prejudice and pathological bias — the same distinction that psychiatrists make between sadness and depression. All people experience sadness, anxiety and fear, but extreme, disabling forms of these emotions are called disorders.
While people with ordinary prejudice try very hard to conceal their biases, Solomon said, her homophobic patient had no embarrassment about his attitude toward gays. Dunbar said people with pathological prejudice often lack filtering capabilities. As a result, he said, they face problems at work and home.
“Everyone is inculcated with stereotypes and biases with cultural issues, but some individuals not only hold beliefs that are very rigid, but they are part of a psychological problem,” Dunbar said.
The psychologist said he has helped such patients with talk therapy, which encourages patients to question the basis for their beliefs, and by steering them toward medications such as antipsychotics.
The woman with the bias against Jews did not overcome her prejudice, Dunbar said, but she learned to control her fear response in social settings. The patient with hostility against African Americans realized his beliefs were “stupid.” — Ibid.
And in the California prison system, extreme racism or homophobia will get you medicated.
Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs.
“We treat racism and homophobia as delusional disorders,” said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. “Treatment with antipsychotics does work to reduce these prejudices.” — Ibid.
This is most certainly not my area of expertise. It seems reasonable to have people receive treatment if they are completely unable to function in society due to their racism or homophobia, but it doesn’t seem reasonable to call them mental illness. After all, everyone’s a little bit racist.