THE SCORES of people carrying flaming torches and chanting “Jews will not replace us” in Charlottesville, Virginia, on August 12 bore the message of the so-called alt-right, the white supremacist movement dedicated to eradicating religious and ethnic minorities from America. This racist uprising was followed by several rallies 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 support for an “ethno-state” and the forceful removal from America of anyone who isn’t white horrific. But others—including some psychiatrists—see these individuals as mentally ill. Which leads to an intriguing but 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, witnessed many acts of violence, cared for victims of racist acts and had frequent run-ins with state troopers. “I saw the genocidal element of the extreme racism, where they wanted to kill you,” he says.
Poussaint wondered if that hatred was an actual sickness that could be diagnosed and 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 as a “delusional disorder.” The DSM is the definitive guide used by mental health clinicians to diagnose patients and is revised every several years through a long, arduous process. For psychiatrists updating the guide, doing so means wrestling with what is normal and abnormal when it comes to behavior and beliefs.
Poussaint wasn’t concerned with 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, says Poussaint, could reasonably be classified as paranoid and delusional.
The APA was unreceptive. “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 [it],” says Poussaint.
Members of the APA also argued that Poussaint’s 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 insisted that inclusion in the DSM could allow individuals suffering from extreme racism to access services such as state-mandated psychiatric counseling. Providing that help could benefit society because “it could protect people they might otherwise attack.”
RACISM AS A SYMPTOM
About 15 years ago, Carl Bell, professor of clinical psychiatry at the University of Illinois at Chicago School of Medicine, resurrected Poussaint’s attempt to convince the APA to classify racism as a mental disorder. But Bell tried a different tack. He saw extreme racism as a pathological bias that signaled an underlying personality disorder.
Bell proposed adding pathological bias to the DSM as a trait of personality disorder. That addition would make extreme bigotry 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 its 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 per- sonality?” 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, says, “The APA has a long-standing policy noting the negative impact of racism and mental health. APA policy supports public education efforts and research on racism and its adverse impact on mental health.”
THIS IS NOT NORMAL
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.”
Sander Gilman, who teaches psychiatry at Emory University and co-authored with Thomas the book Are Racists Crazy?, agrees that the notion of dangerous racists leading seemingly normal lives is disturbing. “Racists, sadly, cope quite well with daily life,” he says. “They have a take on the way the world should be, and that take functions in the world they live.”
But Gilman does not favor a stand-alone diagnosis of extreme racism and believes attempts to categorize such people as mentally ill disguise the greater problem of society allowing them to commit vengeful acts. Violent racists have made terrible 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.”
“I SAW THE GENOCIDAL ELEMENT OF THE EXTREME RACISM, WHERE THEY WANTED TO KILL YOU.”
RALLY CRIES: White nationalist Christopher Cantwell reacts after being hit with pepper spray when counterprotestors clashed with neoNazis and other white supremacist groups at the University of Virginia in August.