Thursday, 6 September 2012

Strange Fruit: Is Racism a Mental Illness?

The weakest link in every chain
I always want to find it
The strongest words in each belief
Find out what's behind it
Politics is pride too
Vagaries of science
She left because she understood
The value of defiance
Scritti Politti (The Sweetest Girl)

Recently I came across a, sadly, all too common newspaper article about racism in the UK - the story concerned a man (Mr Swift) found guilty of racially abusing staff at his local shop. The 32 year-old man racially abused two staff, made Nazi salutes, called a woman in the shop a "black ****" and said "go back to your country you bitch".

What made this story marginally more interesting was that the man's defendant Paul Morris said "Swift suffers from schizophrenia and part of his behaviour in recent years has been a direct result of the illness" - he claimed, or at least implied (given the way that Lawyers use language), that the racism was somehow linked to his schizophrenia

On reading the article, I tweeted “Astonishing – Defence claims schizophrenia caused man to be aggressive racist twat.” And within a couple of hours, I received a tweet from @JonesNev linking me to her interesting Ruminations on Madness blog, where she articulated a thought-provoking (albeit ambivalent) retort to my tweet - it is called 'Culture and Delusions'

In the blog, Nev says:
Although I’m not entirely comfortable with my apparent self-appointed role as apologist for (schizophrenic) mass shooters and racists, it seems necessary to underscore the extent to which severe psychosis in fact can and often does lead otherwise liberal, kind, non-racist people to become glaringly, bluntly racist, sexist, phobic, nymphomanic, hostile, anti-Semitic and so on. I struggle to articulate this in a way that does not directly equate psychosis with pathology, but it seems relatively unambiguous that, at least in some cases, the dynamic “re-mixing” of (emotionally charged) cultural motifs with personal (conscious and/or unconscious) fears and insecurities, profound experiential changes in the boundaries between self and other, disorganization and slippage of thought and memory, sometimes bizarre and frightening voices and visions, often very unsurprisingly leads to a kind of unwitting and strangely cultural “performance” of otherwise more broadly salient sociopolitical conflicts. (And what, of course, is more culturally salient than race?) One might also speculate that implicit racism (which virtually all of us tacitly endorse, as social psychologists have repeatedly demonstrated) simply boils to the surface in the cauldron of psychosis."

Could racism result from delusional thinking?
Nev's response got me thinking - could schizophrenia or a delusional state really cause a person, who was hitherto not racist... to become a violent or abusive racist?

Psychosis is associated with increased odds of violence (estimated at 49%–68%  in the meta-analysis of 204 studies by Douglas et al 2009); and other meta-analyses confirm that the key predisposing factor is comorbid substance abuse (Fazel et al 2009).

But I have worked for 20+ years with many deluded individuals - some claiming to be John Lennon, the Queen's son, or even Green Gartside, but unlike Nev I have yet to meet one who changed from being a non-racist to an aggressive racist following their 'illness'. I have, of course, encountered some expressing politically incorrect views, but none who radically changed! While psychosis can produce dramatic transformations large enough to impact personal identity, as far as I can determine empirical data are sadly lacking on radical transformation of sociopolitical beliefs in psychosis.

Jacques Derrida is in love with Green Gartside

Are we all racists under the surface?
What about the notion that racism is implicitly bubbling under the surface in most or all of us? Evidence used to underpin this idea comes from the Implicit Association Test - but I don't think it holds much water. I don't doubt that the IAT (test yourself here) reveals some associations may occur faster than others - what I object to is the notion that such associations signify racism (implicit or otherwise). Little or no evidence exists to document a link between IAT performance and overt discrimination. And a recent meta-analysis (Greenwald et al. 2009) found a very small association between performance on the Race (black-white) IAT and explicit (self-report) measures in 27 studies (with an r=.11). The bottom line is little or no evidence for a link between the IAT with overt racism; and of course, if most of use show implicit racism, why do only a fraction become overt racist? If only we could cure racism with propranolol...

Defining delusions
Could racist behaviour qualify as delusional? According to the DSM-IV-TR, a delusion is:
A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture.

Does racism meet the criteria for being a delusion? Yes...racism could be a false belief based on incorrect inference about external reality and one that is not one ordinarily accepted by other members of the person's culture.

In the case of Mr Swift, I think the correspondence may lack when we consider "firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary" Interestingly, in interview, Swift told police officers he remembered swearing and telling the shopkeepers to get out of his country, but he was not racist. Now, without being too picky (and leaving absurd "some of my best friends are black' reverse psychology nonsense), some might argue that his denial of being a racist undermines the claim about it being delusional. If only we could get deluded individuals to so readily give up their delusions (as perhaps a legal defence team), then I suspect we might dispense far less medication or psychological therapy!

As an aside, the person who thought they were Green Gartside looked nothing like him, being much heavier, shorter and with red hair  - when I pointed out the inconsistency, he informed me that the hospital had cut parts of his legs away and given him chemicals to change his hair colour and make him partly bald - invention and resistance are key to the survival of delusion!

If music could cure racists (a memory from my youth 30/4/1978)

Racism as a form of mental illness: Alvin Poussaint
Some within psychiatry, notably Harvard University psychiatrist Alvin Poussaint have argued that racism itself should be recognised as a mental illness. In a New York Times article entitled "They Hate. They Kill. Are they Insane?" in 1999, he argued that:
It is time for the American Psychiatric Association to designate extreme racism as a mental health problem. Clinicians need guidelines for recognizing delusional racism in all its stages so that they can provide treatment. Otherwise, racists will continue to fall through the cracks of the mental health system, and we can expect more of them to act out their deadly delusions
In another article entitled 'Is extreme racism a mental illness" Poussaint argues that:
To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats a whole group of people and seeks to eliminate them to resolve his or her internal conflicts meets criteria for a delusional disorder, a major psychiatric illness
However, he also claims that common or garden varieties of racism are treatable:
"...sometimes even lesser forms of racism are treatable because they have psychodynamics to them...They don't exist as a social problem, they … exist as psychological problems inside the individual."
In a piece in the Western Journal of Medicine Poussaint proposes specific modifications to the DSM’s diagnostic criteria for delusional disorder, suggesting the prejudice subtype:
A delusion whose theme is that a group of individuals, who share a defining characteristic, in one’s environment have a particular and unusual significance. 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).
Poussaint makes some valid arguments, but the dilemma we are faced with is...arent most violent hate crimes largely committed by people who are bad, not mad?

You needn't take it any further, sir. You've proved to me that all this ultraviolence and killing is wrong, wrong, and terribly wrong. I've learned me lesson, sir. I've seen now what I've never seen before. I'm cured! Praise Bog! I'm cured!
Alex (Clockwork Orange)
Despite some reservations, I do think this is an area requiring far greater empirical investigation. Future studies might also examine if the reverse occurs - could a racist become liberal-minded following psychosis? After all, why should any change inevitably run in a negative direction? Might we then also extend the notion to those who express other obnoxious views: sexists, homophobes (Oh... the irony of homophobes being mentally ill) and so on - could they be classified as forms of mental illness or delusional thinking and treatable?


Douglas, K., Guy, L., & Hart, S. (2009). Psychosis as a risk factor for violence to others: A meta analysis. Psychological Bulletin, 135, 679–706.

Fazel S, Gulati G, Linsell L, Geddes JR, Grann M (2009) Schizophrenia and violence: systematic review and metaanalysis. PLoS Med 6(8):1–15

Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using the Implicit Association Test: III. Meta–analysis of predictive validity. Journal of Personality and Social Psychology, 1, 17–41.


  1. I remember Chris Frith giving a talk about individuals who would feel the prick of a pin on the spot when the saw a photo of someone else being pricked. When this was investigated using a scanner the controls also showed activation on the part of the brain that corresponded the pictured prick, but only if the person in the picture was the same race as the subject or control. It appears that we do not "feel the pain" of someone of a different race as strongly as we politely pretend.

    I think that we use cognition to nullify the many deterministic differences that there are between us all. When cognition is broken in a mental illness, or discarded because it gets in the way, as in the army, people are forced to use a much rougher set of values.

    Robin Cousins

    1. Thanks Robin - I think it may be this very interesting paper "Do You Feel My Pain? Racial Group Membership Modulates
      Empathic Neural Responses" by Xu,Zuo, Wang,and Han (2009) which may be downloaded freely here

  2. Lots of interesting issues here. I agree that empirical investigations of the transformation of sociopolitical beliefs in psychosis would be fascinating (and important). Beyond my personal experience, I've certainly read case reports and qualitative studies noting paranoia specific to certain racial or ethnic minority groups (OR genders/sexual minority groups), but it's admittedly very rare for researchers to provide any information on the premorbid/morbid or episodic continuity or discontinuity of such "beliefs" or affects.

    With respect to the issue of implicit racism, I'd argue that the literature on implicit stigma/prejudice is quite robust and by no means exclusively dependent on IATs. There have been many psychophysiological studies (attesting to an implicit or automatic heightening of anxiety and negative affect) as well as some interesting recent neuroimaging work. And implicit prejudice researchers are certainly (at least in general) not making the claim that implicit racism correlates with overt racism--indeed many have specifically attempted to unpack the mechanisms & factors (sometimes relatively immediate) involved in the conscious or motivated suppression of initial implicit reactions. My original point was simply that in the chaos of psychosis it seems entirely plausible that many "implicit" or unconscious sociopolitical themes, perhaps shared by a broad swathe of the population, might play out (or "surface") in exaggerated ways.

    1. Thanks Nev and for sparking me to think more about this issue.
      The point about lack of premorbid (i.e. before 'illness') information is important - of course, we dont know who will develop psychosis in advance and so, cannot readily compare before and after psychosis. Its not unique to psychosis - the same problem exists in neurological disorders, but the focus is typically on the 'invariant' structure of mind (e.g. confabulation per se -independent of content). Interestingly the tradition within psychiatry has been to focus on delusional 'content' - to view the delusional content as 'meaningful'. Why does X show delusional misidentification (eg Capgras syndrome), Y paranoid content , and Z believe they are dead (Cotard delusion) and so on - rather than examining for similarity of delusional structure - we might ask whether different delusions do reflect important differences in meaning, obey different rules, or even reflect outputs from different brain areas, are differentially responsive to different treatments etc?

      Re your point, being that within "the chaos of psychosis it seems entirely plausible that many "implicit" or unconscious sociopolitical themes, perhaps shared by a broad swathe of the population, might play out (or "surface") in exaggerated ways" - I agree it is plausible...
      But I seriously doubt the notion that -contrary implicit sociopolitical themes -permeate the majority of individuals. Certainly as far as evidence from the IAT is concerned - I don’t consider the test to be measuring anything implicit in the sense of being 'outside of consciousness' or unconscious) - so I would be keen to hear about and take a look at any specific studies you have in mind.

  3. I see the connection between racism and mental illness.

    1. I look at things like racism from a perspective of learning and understanding, both of which can be impaired by mental illness. Ignorance and fear are not the purview of mental illness. I think that the relationship is more complex, but that there is an interplay between them all.

    2. Thanks Jason - I agree about learning and understanding; and being human, we show huge variability in both.
      I suppose I am asking whether a difference exists between a racist (with no diagnosis - although this doesnt mean they are without mental health problems) and a racist (with a mental health diagnosis)? and does it matter whether the latter was always a racist or could their illness be the sole cause? and should this make us view these cases differently. Some parallels might possibly exist with the recent Brevik case...

  4. Everybody is racist to one degree or another, if we see a difference in another person then it has an impact on our decision making process to one degree or another. Here's a perfectly legitimate (if slightly contrived) example:

    Person X walks into a cosmetics store and asks one of the assistants to recommend a blusher to match their skin tone. The assistant will (very legitimately and without any malice or ill-will) treat a black person differently to a white person.

    The problem arises when this inherent and completely normal form of racism leads to illogical or unfounded conclusions and/or actions.

    Even this line of argument is flawed if we consider "positive racism" - for example, having spent several months living in Nepal I would say that Nepalis are one of the friendliest and most welcoming people on the planet. This is clearly a racist view (directly equivalent to "I believe $racialGroup are dishonest" based on the same level information), but we don't see positive views like this as a problem.

    The most telling phrase in the article was the quoted "despite what almost everybody else believes". Racism is not considered a mental disorder within certain groups (eg the KKK or the BNP) because it is the norm. The ultimate upshot of this reasoning is the classification of mental illness by popular vote, a clearly absurd situation.

    Overt, negative racism isn't, in my opinion, a mental illness, but is quite possibly the result of one. Many homophobes base their views on religious teachings which also teach "love thy neighbour" or equivalent. The homophobia isn't a mental disorder in itself, it's a symptom of one, the inability to adopt a balanced view of the world based on the available information.

    1. Thanks Geoff 7 - Re delusions persisting "despite what almost everybody else believes" - and racism not being viewed as a mental disorder in BNP or KKK because it is the norm within the BNP or KKK. What you say is valid - but then arent mental illnesses decided by 'popular vote'? For example, how do diagnostic categories come and go in the DSM?

  5. As any black midwife will tell you, extreme physical or mental conditions, like childbirth or schizophrenia, can cause racist outbursts, it's territory-defending instinct at work in part, an attempt to counter a perceived threat. to refer to this mentally ill man as a "racist twat" is unethical in my view, we know nothing of the circumstances of his life and the experiences that led up to this outburst.

    1. Are you saying that childbirth also causes people to become racists (when they were not otherwise so inclined)? This is not an example I had ever considered...or would necessary believe at face value
      We do know about the man - he was found guilty of a racially aggravated crime - The issue is not what circumastance led to his being racist - but whether was he always a racist? or that his schizophrenia 'made' him a racist?
      I cant see what is 'unethical' in what I say - the man was clearly behaving in a racist manner! The court came to this conclusion, the poor recipients definitely saw and experienced this and even the man's lawyer conceded this fact!

  6. I've certainly seen people professionally with psychotic illnesses whose delusions have a component of race. For example (details changed) believing she has to kill Catholics for convoluted delusional reasons, and committing serious offences as a result. Or, in another case, believing there is a conspiracy (again details changed) of Mormons in Liverpool involving the judiciary. These beliefs developed in people who apparently had no pre-existing racist or other bigoted beliefs, and the ideas resolved with medication. Whether there were underlying racist attitudes which coloured the delusions which developed, is impossible to know, but nonetheless clearly delusional racist beliefs occurred as a result of psychosis.

    Conversely I've also seen racist attitudes in people where the racism appears unconnected to the delusional beliefs and didn't change with medication. And where the racist beliefs did not have the quality of delusional beliefs.

    Certainly though, in my experience, entrenched racist attitudes do not generally have the quality of delusional beliefs, although individual beliefs in individuals may, at times, be delusional.

    1. Thanks Gordon. Its an intruiging possibility that racist beliefs, formed by psychosis, are responsive to medication; while those believed to predate psychosis, are not responsive to medication.
      This would be a remarkable observation... if confirmed by some empirical evidence. Most of the time, we hear about the bluntness of antipsychotic meds. But this implies that antipsychotics might differentiate - what are essentially the same underlying (racist) beliefs - and target just those that predate psychosis!
      If true, however, it might limit any advances we might make in 'treating' or understanding common or garden varieties of racism by looking at psychosis.