Psychiatry Ponders Whether Extreme Bias Can Be an Illness

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.

If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish “ordinary prejudice” from pathological bias.

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Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her — she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.

Another patient was a waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs.

A third patient was a Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them, Dunbar said.

“When I see someone who won’t see a physician because they’re Jewish, or who can’t sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, ‘This is not our problem,’ “ the psychologist said. “If it’s not our problem, whose problem is it?”

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Amid a profusion of recent studies into the nature of prejudice, researchers have found that biases are very common. Almost everyone harbors what might be termed “ordinary prejudice,” the research indicates.

Anthony Greenwald, a psychologist at the University of Washington in Seattle, and Mahzarin R. Banaji, a psychologist at Harvard, developed tests for such biases. By measuring the speed with which people make mental associations, the psychologists found that biases affect even those who actively resist them.

“When things are more strongly paired in our minds, we can respond to them more quickly,” Banaji said. “Large numbers of Americans cannot as swiftly make the association between ‘black’ and ‘good’ as they can between ‘white’ and ‘good.’”

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If biases are so common, many doctors ask, can racism really be a mental illness?

“I don’t think racism is a mental illness, and that’s because 100 percent of people are racist,” said Paul J. Fink, a former president of the American Psychiatric Association. “If you have a diagnostic category that fits 100 percent of people, it’s not a diagnostic category.”

But Poussaint said there is a difference between ordinary prejudice and pathological bias — the same distinction that psychiatrists make between sadness and depression. All people experience sadness, anxiety and fear, but extreme, disabling forms of these emotions are called disorders.

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The Washington Post reports that some psychiatrists are urging the creation of a new diagnosis that would cover people who display “extreme forms of racism, homophobia and other prejudice”:

“They are delusional,” said Alvin F. Poussaint, a professor of psychiatry at Harvard Medical School, who has long advocated such a diagnosis. “They imagine people are going to do all kinds of bad things and hurt them, and feel they have to do something to protect themselves.

“When they reach that stage, they are very impaired,” he said. “They can’t work and function; they can’t hold a job. They would benefit from treatment of some type, particularly medication.”

The Post gives several examples of people who might fit the diagnosis:

—A 48-year-old man who “blamed most of his personal, professional and emotional problems on the gay and lesbian movement.”

—A “young woman in Los Angeles who thought Jews were diseased and would infect her — she carried out compulsive cleansing rituals and hit her head to drive away her obsessions.”

—“A waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs.”

—“A Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them.”

What about black people who entertain paranoid conspiracy theories about white people? The Post doesn’t address this question, so we have to turn to an NBC report, in which our old friend Alvin Poussaint shows up singing a somewhat different tune:

Dyan French, also known as “Mama D,” is a New Orleans Citizen and Community Leader. She testified before the House Select Committee on Hurricane Katrina on Tuesday.

“I was on my front porch. I have witnesses that they bombed the walls of the levee, boom, boom!” Mama D said, holding her head. “Mister, I’ll never forget it.”

“Certainly appears to me to be an act of genocide and of ethnic cleansing,” Leah Hodges, another New Orleans citizen, told the committee. . .

Harvard’s Alvin Pouissant [sic] says such conspiracy theories are fueled by years of government neglect and discrimination against blacks: slavery, segregation and the Tuskegee experiments, during which poor blacks were used to test the effects of syphilis.

“If you’re angry and you’ve been discriminated against,” Pouissant says, “then your mind is open to many ideas about persecution, abandonment, feelings of rejection.”

Now, maybe there’s some subtlety here that doesn’t come across in the two quotes, but it certainly sounds as though Poussaint is saying behavior that is normal in blacks is a sign of mental illness in whites.