Sunday, December 11, 2005

Is Racism, Homophobia, or even Misogyny a Mental Illness?

Shankar Vedantam, one of my favorite science writers for the WaPo, just published this piece exploring the line between normal bias and pathological bias.

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."

Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.

Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.

Throughout the piece, Vendantam interviews psychiatrists who are both for and against classifying exreme bias as a mental illness. Among the arguments against putting pathological racist or homophobe in the Diagnostic and Statistic Manual on Mental Disorders (DSM), are:

1. Do we want to consider perpetrators of hate crimes as mentally ill?

2. Will the classification of this "syndrome" or "disorder" further compromise the integrity of the DSM?

I would note that what makes it into the DSM these days is also a good candidate for future psychopharmacological solutions.

Vendantam reports:

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."

Of course, I agree with Belkin that psychiatric disorders have social norms embedded in them. I think Belkin is also astute that classifying socially inappropriate behavior does not necessarily mean that we cannot or should not punish/sanction it. To further make his point, Belkin notes that clinical depression is a diagnosis the reflects social context as much as any diagnosis in the DSM.

We medicate regularly people diagnosed as depressed. Part of the reason why we can medicate these people is because they have a diagnosis, which then allows Big Pharma to make a compound that treats this diagnosis.

What I am wondering is: will we have anti-racist or anti-homophobe drugs one day? Apparently prisoners in Sacramento considered pathologically racist are already given anti-psychotics.

What might the Eli Lilly's or Pfizer's call anti-racist drugs?




Would we make anti-sexist drugs too?


I am having fun with this. Anyone else want to play along with naming anti-pathological bias drugs?

UPDATE: Shakes Sis has more on bigotry-as-mental illness here as well as John at Americablog here.