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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.”


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.”


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.”


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.

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