The American Psychiatric Association has never officially recognized extreme racism (as opposed to ordinary prejudice) 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. The association's officials 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.1 Therefore, there is currently no 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.
Using the DSM's structure of diagnostic criteria for delusional disorder,4(p329) I suggest the following subtype:
Prejudice type: 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).
As a clinical psychiatrist, I have treated several patients who projected their own unacceptable behavior and fears onto ethnic minorities, scapegoating them for society's problems. Their strong racist feelings, which were tied to fixed belief systems impervious to reality checks, were symptoms of serious mental dysfunction. When these patients became more aware of their own problems, they grew less paranoid—and less prejudiced.
To read more of the National Institutes of Health's post from the Western Journal of Medicine, please click here.
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