Is extreme racism a form of mental disorder?

This question was recently sent to me via one of my psychology blogs:

Is extreme racism a form of mental disorder? 

My answer:
The American Psychological Association has never officially recognized extreme racism as a mental health problem, although the issue was raised more than 30 years ago. After several racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry classified as a mental disorder. At that time, the question was posed to the American Psychiatric Association, a related medical association that is separate from mental health counseling/psychology.

This professional association rejected the recommendation, arguing ‘that because so many Americans are racist, even extreme racism in this country is normative; a cultural problem rather than an indication of psychopathology’.

The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the Diagnostic and Statistical Manual of Mental Disorders (DSM), does not include racism, prejudice, or bigotry in its text or index.

Therefore, there is currently no statistical support for including extreme racism under any diagnostic category. This leads psychiatrists to think that it cannot and should not be treated in their patients.

Others in the profession have argued that to continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats whole groups of people and seeks to eliminate them to potentially resolve internal conflicts meets criteria for a delusional disorder, a major psychiatric symptom of illness.

Extreme racists’ violence could be examined in the context of behavior described by clinical psychologist Gordon Allport in the classic text, The Nature of Prejudice.

Allport’s 5-point scale categorizes increasingly dangerous acts: It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination including segregation, financial, and, social; to physical attack, and finally to extermination (lynchings, massacres, genocide).

Based on these theories, using the DSM’s structure of diagnostic criteria for a diagnosis of delusional disorder, the following subtype of delusional disorder has been suggested:

Delusional Disorder, Prejudice type: A delusion whose theme is that a group of individuals, who share a defining characteristic have a particular and unusual significance to the (psychiatric) patient. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. When these delusions are extreme, the person may act out by attempting to harm, and even murder, members of the despised group(s). Based on our Allport’s work, individuals suffering delusions usually also have overall serious social dysfunction that impairs their ability to work with others, have healthy interpersonal relationships, and maintain employment.

While psychiatric classification may be a useful tool, other researchers believe behaviors stemming from prejudice/hatred may not necessarily be pathological, and these acts are certainly not generic. Where is the line between societal ‘normal,’ and not? If racism has normative foundations, is it a disease, or an internalization of expectations? Is racism part of intergenerational trauma, as suggested by James Baldwin?

In my forensic work, intent, perceived goals, ability to understand right and wrong, cognitive ability, overall comprehension, and consequences, are all considered when somebody is deemed mentally incompetent. If somebody is aware of all of these factors and fully cognizant of their behavior, is it a mental illness?

We have a lot to study. And we must.

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