On The Oprah Winfrey Show in 1992, Jane Elliott, the educator known for teaching students about prejudice by biasing them against blue or brown eyes, came to an incisive conclusion about racism.
"What we're dealing with here is mental illness," she said. Members of the audience started clapping. "Racism is a mental illness. If you judge other people by the color of their skin, by the amount of a chemical in their skin, you have a mental problem. You are not dealing well with reality.”
This grainy television clip has been recirculating on social media due to the explosion of online advocacy from the current Black Lives Matter protests. Google searches for “racism is a mental illness” have spiked to a level unseen over the last 10 years, and on Twitter, many have declaratively shared the sentiment. The belief that someone isn't your equal because of the way they look must mean that person's brain isn't working correctly, these people are saying; they are ill.
But the comparison of racism to mental illness is a fraught one. Disability and mental health advocates push back strongly against the association, saying that racism is a choice, while mental disorders, like depression, anxiety, bipolar disorder, and schizophrenia are not. Calling racism a mental illness perpetuates the stigma around mental illnesses, and continues the practice of using mental health language in a derogatory way. (Think calling situations or people you don't like "crazy" or "insane.") The impulse to attribute racist acts and hate crimes to mental illness also conflates mental illness and violence, even though most mentally ill people do not engage in violent acts and are at most risk of harming themselves, not to others.
The push to define racism as a mental illness is decades old, though, and originally came from mental health providers. In 1969, a group of prominent Black psychiatrists petitioned the American Psychiatric Association (APA) to add extreme bigotry to The Diagnostic and Statistical Manual of Mental Disorders, or DSM, the handbook of mental disorders, now in its 5th edition. Their petition was rejected.
The APA's reason for rejection reveals something about the underlying desire for racism to be designated as a sickness. For something to be considered a mental illness, it must deviate from typical thinking or behavior, and cause disruption and distress to a person's life. The APA said that racism was, in contrast, so widespread that it was a cultural issue, not a psychopathology. Racism is too common, in other words, to be an illness.
Asking whether extreme racism is a mental illness often goes along with trying to understand extremely racist acts. How is anyone to make sense of white police officers tackling a 23-year-old Elijah McClain to the ground, putting him in a carotid hold, as he cried, vomited, said that he couldn't breathe, and pleaded to go to his home nearby? Or two white men in New Jersey, part of the All Lives Matter counter-movement to Black Lives Matter, re-enacting George Floyd's death with one pinning the other to the ground under his knee as Black Lives Matter protesters marched by? Or the nooses hung in trees and in the garage stall of Bubba Wallace, the only Black driver in NASCAR, at the Talladega Superspeedway?
By not calling racism a mental illness, does that mean we accept these acts of racism as normal human behavior? If racism is not a sickness, why is it so hard to get extremely racist people to change their minds? Doesn't their refusal mean that their beliefs are not opinions, but delusions?
These are complex questions. Racism exists on a spectrum, from extreme racist beliefs and hate crimes to the prejudices all white people have and need to reckon with. Delusions involving race can also be a symptom of other psychotic disorders; their placement in the DSM is not up for debate.
When asking whether racism should be considered a mental illness, it's worth asking another question: Would framing racism as such help us fight racism? One of the reasons we have diagnostic categories for mental illness is so that we can try to treat those illnesses. If racism was thought of as a mental illness, would it help efforts to make the world a less racist place, or make them harder?
In 1965, psychiatrist Alvin Poussaint went to Jackson, Mississippi to provide mental health treatment to civil rights workers and desegregate hospitals. While there, he said, he experienced the extreme racism that he would later try to have added to the DSM. "It was ever-present and it was a kind of state of terror," he said.
Even when talking to other doctors, trying to explain why hospitals should be desegregated, he encountered prejudice and bigotry. The white doctors would resist, saying they believed it was best if Black people remained segregated in the healthcare system and had separate facilities.
"I felt it was like a mental disturbance, because you couldn’t reason with people over it," Poussaint said. "I began to appreciate how deep it went, in terms of denying the humanity of Black people."
To him, this was reminiscent of a delusion. "No matter what you tell a person who is delusional—that their belief system makes no sense and is irrational—they still feel that Black people are inferior no matter what you show them," he said. "That's a delusion. That's a fixed belief system."
Poussaint has always made a distinction between everyday racism and extreme racism, the latter of which he thinks should be classified as a mental disorder. “Extreme racism is when someone gets genocidal and wants to kill. That’s beyond being normal,” he said. “Some of the people who object to it being called a mental disorder say, ‘Well, it's just learned behavior.' It's a learned behavior to want to exterminate people because of their skin color? Not to my way of thinking.”
He thinks cases like 21-year-old Dylann Roof, who killed nine people at Emanuel African Methodist Episcopal Church in Charleston, South Carolina, are in this category.
Psychiatrist Carl Bell, who died in 2019, also viewed racism as a mental illness, but more akin to a personality disorder. He thought people with narcissistic personality disorder might be more predisposed to racism than others. In 2004, he wrote that people with paranoid disorders or had trauma inflicted upon them by other groups could also have racist thoughts or behaviors that are explained by those psychological disruptions. “These are all legitimate scientific questions that we as psychiatrists should be willing to test and answer,” he wrote.
"They still feel that Black people are inferior no matter what you show them. That's a delusion."
If racism is a mental illness, it pushes the problem onto white people, Poussaint said. It acknowledges there’s something wrong in the way they’re thinking and feeling, and relieves Black people of the feeling that if they could act differently, then white people would stop being racist against them.
“Early in my career, even in college, I felt that if I was a perfect person, I could cure white people of their racism, and that's not where it's at,” Poussaint said. “It's not rational. You can’t undo it by being a good person and being intelligent and dressing properly. That's such a psychological burden on black people. It's part of the notion that racism is curable in that way. You can drive yourself nuts doing that.”
Although the APA never added racism to the DSM, people have continued giving racism clinical-sounding names, like prejudice personality, intolerant personality disorder, and pathological bias. And Poussaint has continued to advocate for thinking about racism as a mental illness since then, despite the APA's position.
“Right now, there is a normalcy to it," Poussaint said. "It's a disorder among many, many people indoctrinated with the culture of insanity of slavery and Jim Crow." He thinks classifying it as a mental illness would help to fix that. "Doing so says it's a disturbance that interferes with your well-being and is an impairment.”
Trying to understand racism as a mental illness goes back to the 1930s, when people tried to grapple with the extreme prejudices and behaviors of the Nazis, said James Thomas, an associate professor of sociology at the University of Mississippi and co-author of the book Are Racists Crazy? But a medical model of racism couldn't fully explain people's behaviors.
When covering the trials of the Nazis, Hannah Arendt wrote in The New Yorker about Adolf Eichmann, one of the top officials responsible for the concentration camps during the Holocaust. Arendt was unsettled to find that "half a dozen psychiatrists had certified Eichmann as ‘normal,’” she wrote. ‘“More normal, at any rate, than I am after having examined him,’ one of them was said to have exclaimed, while another had found that Eichmann’s whole psychological outlook, including his relationship with his wife and children, his mother and father, his brothers and sisters and friends, was ‘not only normal but most desirable.’”
Sander Gilman, a professor of psychiatry at Emory University and the other co-author of Are Racists Crazy?, said that the urge to deem racism a mental illness comes from a wish to place it outside the scope of typical human behavior, when it is not.
“It’s a beautiful argument," he said. "I wish it were true, because what it says is that normal people like you and me should never kill people in Auschwitz. The reality is normal people regularly killed people in Auschwitz. They had so dehumanized the people they were killing that they weren’t human beings anymore. That was not mental illness, that was evil, because people could make choices. When we start to talk about ‘normal’ activity, that includes bad acts."
In other words, normal is not a synonym for “good" or "just." “I wish it were,” he said. "But it's just not."
Gilman said that people who have serious mental illness sometimes incorporate racist tropes into their delusions because delusions can mirror or be similar to the societies that people live in. If a person with schizophrenia disorder is treated successfully, it can help get rid of paranoid delusions, including racist ones. To Gilman, that means that schizophrenia was the underlying condition, not racism.
The attempt to medicalize racism, Thomas said, can distract from the fact that racism is a systemic issue, not just an individual one. “It reflects a shift in thinking about racism as something that is interior to the self, compared to how we probably should think about racism as something that is structural and embedded.”
He drew an analogy to police reform in a 2016 Washington Post article. There are proposals to try and improve individual officers' prejudices through implicit bias training, for example. But this focusing on “treating” individuals ignores the larger, systemic issues that allow the police to act in racist ways overall, like “the increasing militarization of police departments, lack of oversight by law enforcement senior officials, and an approach to policing that often rewards unprovoked harassment rather than building community trust."
He worries that focusing too much on the individual can ignore the context in which that person exists, which has a huge impact. When Lindsey Graham defended the choice to fly the confederate flag in South Carolina, saying "It works here," critics said that it perpetuated the extreme beliefs of white supremacists, like Roof. Graham waved this off. “It’s him,” he said, referring to Roof. “Not the flag.”
In July 2011, Anders Breivik killed 77 people in Norway by detonating a car bomb that killed eight and then shooting 69 others. When he stood for an insanity trial, psychiatrists disagreed about whether or not he had mental illness-related delusions. In a manifesto, he had written that he believed himself to be a “Knight Templar” whose mission was to cleanse Norway of immigrants. But he didn't have hallucinations or impaired cognition—symptoms of schizophrenia and related disorders. The Norwegian court decided that since his extremist beliefs were shared by other right-wing groups in Norway, they were not delusions, and they didn't let him plead insanity.
This may be one way of understanding extreme racism, as both a psychological aberration, but not an official illness—as an “extreme overvalued belief.” This term is starting to be applied by some clinicians and forensic psychiatrists to extremist beliefs, like Breivik's, that are distinct from psychotic delusions or obsessions, and held by conspiracy theorists or religious cults.
According to the DSM-5, delusions are “fixed, false” beliefs, which are not shared with others. An overvalued idea is different because it is shared by others in someone's culture or subculture. Unlike obsessions, another form of delusional-seeming thoughts, people don’t resist or fight them off. They embrace them.
These rigidly held, non-delusional beliefs "are the motive behind most acts of terrorism and mass shootings,” wrote Washington University in St. Louis forensic psychiatrist Tahir Rahman in a 2018 paper. They are "often relished, amplified, and defended by the possessor of the belief," Rahman and his colleagues wrote in a paper from this year. "Over time, the belief grows more dominant, more refined, and more resistant to challenge."
Rahman compared it to acquiring a taste for food over the course of one's life. "How do you get to liking rare steak versus well done steak or medium steak?" he said. "You don't just wake up one morning and decide. These beliefs and behaviors are shaped slowly through time and through your encounters with the environment."
Such beliefs can take root in anyone, not just people with mental illnesses.
“Overvalued ideas” were first described by German neurologist Carl Wernicke in 1892. But one significant change since then is the access to online information that can easily expose a person to extremist information that agrees with their belief. It’s much easier now for fringe ideas to find company online, wrote Joe Pierre, a psychiatrist at the David Geffen School of Medicine at UCLA, in the Journal of the American Academy of Psychiatry and the Law.
Extreme overvalued ideas might be partially explained by cognitive distortions like “all-or-none thinking, overgeneralization, jumping to conclusions, magnification and minimization, and personalization,” Pierre wrote. Other cognitive biases like confirmation bias, where people only seek out information that confirms their beliefs, and the Dunning-Kruger effect, where people are overconfident in areas where they have the least expertise, can perpetuate and strengthen false, extreme beliefs.
Rahman called for more research on the non-delusional beliefs seen in cults, mass suicides, terrorism, and online radicalization, given that violence can often stem from them and that we don't yet know the best way to intervene. What is clear is that such beliefs can take root in anyone, not just people with mental illnesses.
"What on the surface appears to be a mental disorder from schizophrenia to bipolar disorder may actually be a shared belief which, which anyone can develop," Rahman said. "And that is the scary part to me."
The DSM has been criticized for being a collection of observed symptoms, and not effective and delineating and understanding the underlying disorders that cause those symptoms. What is the use of having such a manual, in which mental illnesses are distinguished from one another? It's so we can try to help the people with those illnesses, as crude as our diagnoses may be.
Calling racism a mental illness, and thereby treating it like one, is licensed social worker April Harter's approach. Her private practice is called the Racism Recovery Center. She said she’s seen the same psychological defenses crop up in people who are racist, and thinks that treating racism as narcissism and trauma can help to eradicate it.
“When you have individuals that struggle with narcissism and then they create laws and policies and educate and are in charge of school boards and they create these policies,” she said, “that's what institutional racism actually is.”
If people want to go to therapy for their racist attitudes, Thomas said, no one should stand in the way of them doing that. He thinks such therapy can help people think about what it means to be racist and live in a world where they benefit from privilege. “If we think that that is a policy intervention, that's where I have serious misgivings,” he said.
Danielle Jackson, a general psychiatry and behavioral health resident at Yale University specializing in structural racism and health equity, feels the opposite. “I’m of the camp of feeling very strongly that it should not be added to the DSM,” she said. “That is based on looking at the history of racism, and the effects of systemic racism that have been basically ingrained into the fabric of America since the beginning of the establishment of chattel slavery.”
If racism was officially designated as a mental illness, there could be other consequences too. "Could someone claim to be disabled from work because of racism and only be allowed to work in certain settings?" said Damon Tweedy, an associate professor of psychiatry at Duke University. "I don't think the system could contain a diagnosis of 'racism' in the way that its advocates would hope."
Jackson said that if racism was added to the DSM, she would be concerned that people would try to use their diagnosis as a legal defense when charged with hate crimes. Already, because of racism, mental illness is more likely to be given as an explanation for violence by white people than people of color. This might mean we need to be extra careful about allowing mental illness as a defense.
In 2015, researchers asked white Americans about two mass shootings: the Virginia Tech shooting, where the gunman was a South Korean immigrant, and Columbine, where the shooters were both white Americans. When asked about Columbine, the participants were more likely to attribute the shooting to mental illness. In contrast, when asked about Virginia Tech, people thought that the shooting was related to the shooter’s identity.
A formalized connection between racism and mental illness when convenient is easily exploited, as famous cases of celebrities show.
In 2006, the actor Michael Richards called hecklers “n------” while performing at a West Hollywood comedy club. His publicist said in a statement that Richards would seek “psychiatric help.” In June 2013, an NFL football player Riley Cooper, was caught on video saying “I will jump that fence and fight every n----- in here, bro!” Cooper's statement promised he would seek help from “a variety of professionals."
When Roseanne Barr tweeted a racist comment about Valerie Jarrett, an Obama administration advisor—leading ABC to cancel the reboot of her television show—Jimmy Kimmel also referred to Barr's mental health, writing in a tweet: "What [Roseanne] said is indefensible, but angrily attacking a woman who is obviously not well does no good for anyone. Please take a breath and remember that mental health issues are real. The Roseanne I know could probably use some compassion and help right now."
“I think that making racism a medical diagnosis would do nothing but provide a crutch to someone who had perpetrated a crime,” Jackson said. “So that people like the former officers who murdered George Floyd or the neighborhood vigilantes that murdered Ahmaud Arbery would then be able to look for something like that as part of their defense. And that to me is sickening.”
Extreme racist beliefs, while confusing, upsetting, and wrong, can't be understood only as mental illness. These beliefs come from a hodgepodge of societal influences, cultural reassurances, cognitive biases, and a strong motivational desire to keep things at the status quo.
There is one area, however, in which there is no debate on the relationship between racism and mental health—the detrimental health effects of racism on its victims. In a recent essay in Vogue, psychologist Samantha Rennalls wrote about how in light of the current protests, she has both been hopeful and also tired, reminded of the depth of the injustice she’s faced on a daily basis. "Racial trauma," she wrote, "takes its toll on the Black body and soul."
If calling racism a mental illness was helpful, Jackson said, she would feel differently. Instead she thinks it’s actively harmful, and gets in the way of the anti-racism work on a societal level that needs to be done—the work that will actually benefit the people who suffer from racism.
“I don’t think [calling racism a mental illness] gives you access to any more tools to becoming an anti-racist,” she said. “The work of being a racist, embracing anti-racism, and embracing social justice and equity for everyone in this country is hard individual work that folks have to do. But you also have to be committed to learning about the system in order to learn how to help do the system.”
Even Jane Elliott might agree. Despite her stance on racism as a mental illness, she was an advocate for early-intervention education on race, and believed that racism was far from being "normal"—that it was, instead, taught to us throughout our lives.
On the same Oprah segment that's recently gone viral, moments before her claim about mental illness, Elliott said, “I heard somebody in the break room say that racism is inbred. No, it is not. Racism is not part of the human condition. Racism is a learned response you have to be taught to be a racist you are not born racist. You are born into a racist society. And like anything else, if you can learn it, you can unlearn it.”
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