This writer and now ‘aging’ psychiatrist finds this debate overdone and not very useful. In the last few years we of course as anyone would acknowledge, have had an epidemic it would seem, of mass shootings of all kinds. Many stories from many different viewpoints have tried to protect the mentally ill from the unavoidable but troubling intrusion into our views of our rapidly changing social matrices in this country, from being tagged almost reflexively and automatically with the reputation of being the single most associated group of persons responsible for mass shootings.
Story after story based on replicated and widely accepted research over the last few decades repeatedly shows that the chronically mentally ill are far more likely to be VICTIMS of crimes and violence than the perpetrators.
But it is equally if not increasingly hard to escape the avalanche of media stories the last few years reporting to us the mental states of more mass shooters that sound for all the world as disturbed in some manner or other. The two adolescents who perhaps are viewed by many in Aurora CO who shot up their own Columbine High School killing over a dozen persons certainly had some form of haywire thinking and disturbed dynamics. Truman Capote’s book that riveted this nation decades ago as he wrote of the pair who killed almost randomly for sport innocent persons, a family, in the Midwest comes to my mind as perhaps unwittingly having something to teach us about the two Columbine mass shooters. One in each pair was dominant and one was the follower. One of the Columbine pair has been called disturbed with various diagnostic attributions such narcissistic, paranoid, etc. Some historical and behavioral data had emerged in the months after their shooting of being loners, angry, odd, dressing in almost Goth black raincoat type clothing and such, but in many views, we really have not had enough reliable information to say much more than descriptive explanations.
An example of a very likely true, clearly psychotic mass shooter was Mr. Ferguson who shot and killed several people on I believe the Long Island RR line a number of years ago. There was great debate over his mental state as he tried to act as his own defense, was bizarre in the courtroom. His shooting act was chilling as he walked purposefully through the commuter train car or cars calmly methodically shooting persons with his pistol. He was still convicted and given multiple life sentences and likely was another example of a mentally ill person who committed such an egregiously horrific crime that the jury could not bring themselves to find him not guilty by reason of insanity and leave uncertain his lifetime fate, meaning leaving open the possibility that he would be able to released someday if he improved etc. It is still not appreciated by the public at large that NGRI persons are incredibly rarely EVER released as parole board members everywhere almost always never grant a release for fear of another heinous act occurring. One of “Manson’s girls,” who was terminally ill with brain cancer several years ago was denied parole in spite of her terminal condition and even John Hinckley who shot President Reagan outside the Washington DC Sheraton has not been parole (yet and it is not clear he will be) even though he has been granted passes outside the hospital with his long attentive parents.
Now with the recent tragic incident in Charlottesville earlier in this month of August 2017 at the protest rallies over the Confederate statue issues with Neo Nazis-white supremacists etc., and then the “Alt. Left” groups and other anti-Confederate/Nazi protest groups, the conversation may be starting to include the politically or “sociologically” motivated purveyors of violence as witnessed by the article, “Alt. Right Racists Mentally Ill? Some Psychiatrists Say Yes.” This is not a new line of conversation or speculation. We have been theorizing upon and trying to understand the motives of the new forms of mass violence and their practitioners, such as the self-immolation of the Tibetan monks protesting “Red China’s” forceful annexing of Tibet in the 1950’sthe waves of airplane bombings and mass killings and airjackings by the PLO in the 1970’s. Since those times, there have been many new forms of mass violence that were or felt new to us: an often forgotten phenomenon was the fedayeen who regularly tried to cross into Israel from surrounding then enemy Arab countries during the “Intifada.” This was collectively the three waves over nearly two decades of the uprisings of politically moivated Arab unaffiliated “soldiers” of the struggle agains the then labeled in the then current political jargon “Zionist occupiers” of Palestine, e.g., Israelis on the borders of the country.
Since then we have had other forms of mass violence and shootings, largely overshadowed in current times by the almost weekly incidents of bombing, well organized shootings in both unsettled and failed states such as Syria and Iraq, and western countries in Europe and our own 9/11 super tragedy 16 years ago with the airplanes crashing into the Twin Towers of New York City killing over 3,000 persons.
For instance, we had a very few isolated school ambush shootings by young students outside of their schools who shot students with rifles they purloined from home. These early teen boys always operated solo. Most were tried and juveniles and some as adults some under questionable criteria as far as age. Adam Lansky shot up dozens at the Sandy Hook elementary school was portrayed as an alienated loner,and speculation has included a number of possibly psychiatric diagnoses for him including Asperger’s Syndrome (formerly covering and meaning mild autistic spectrum disorder as it is semantically labelled now with the Fifth Edtion of the American Psychiatric Association’s Diagnostic and Statistical Manual, the longstanding compendium of American psychiatric diagnoses since the 1950’s; Europe, Britain and most other countries use the “ICD-10” compendium of diagnoses which also includes all diagnoses of the rest of all of the medical world of labels and not just psychiatric ones as the “DSM” does.
Another mass shooting phenomenon was the rash of post office shootings that took largely in the 1980’s in this country. The typical scenario was a postal worker would bring a rifle to work, enter the workplace and start shooting, though often trying to target resented supervisors and bosses. There were many social and labor law issues involved in many of those cases as post incident investigations revealed, or put more simply, on the job grudges and resentments, or, anger over being fired. Those adult readers old enough will remember the then current phrase applied to these incidents, “going postal.” Psychiatric issues and diagnoses were not trotted out much at all in those days.
There is yet another category of mass shootings which is still with us today and accounts for a sizeable number of smaller mass shootings nonetheless if three or four or more persons are killed (3 and 4 being the minimum numbers of fatalities required for a shooting to be defined as a mass shooting in the two schools of thought on the subject currently). This category is as good an example as any of the scientific differences of opinions that have appropriately occupied authorities of whether the shooters are mentally ill in the usual sense or not. These are the (almost always) male shooters who stalk, follow, seek out and eventually kill their estranged wives in public places which sadly takes the lives of others in the rampage. These men usually are found to fit the often very specific and eerily similar profiles of severely insecure, massively physically and emotionally abusive husbands, who stalk their wives, monitor their car mileage, often forbid them to work or function much at all outside the home, have independent friends even female but especially male, follow them even when the wives are on innocent errands such as shopping for groceries at the store and a myriad of other bizarre suspicious acts of over control. Some will examine their wives’ underwear, and nowadays for several years plant listening devices in their own homes or the wives’ cars, or install GPS devices to track their wives’ travels in the family or wife’s car. And even without ANY sign of infidelity at all, these men are usually so “delusional” (a symptomatic and even diagnostic term opening the door for the mentally ill debate) constantly accuse them of having affairs.
One of my now favored examples of the dilemmas of debating this mental illness issue with regard to someone showing kooky social behavior but with a gun and actively shooting and endangering lives, is the North Carolina man who some months ago travelled to Washington DC to spray a favored pizza place with bullets with an automatic military like rifle because he subscribed to the then “fake news” Internet circulated falsehood that Hillary Clinton was running a child sex trafficking ring in the basement of this long established pizza place favored by federal government workers. He received recently a prison sentence of around 4 years and apparently did express remorse and difference with his driving beliefs at the time of sentencing. Was he mentally ill at the time of the commission of his act or not? Was he treated before trial and regain his proper sense of reality. I do not know.
On a broader front, are all jihadists mentally ill? I doubt it. But they are committed to their beliefs for the most part. Some may be not so bright shills recruited by savvy terrorist operatives who know how to spot such individuals who are vulnerable. This is not a radical concept; pimps regularly know in the big city bus stations, for instance, how to spot naive girls to recruit into prostitution or so the social commentary has alleged backed up by law enforcement scholars who study such phenomena. And then there is the complicated touchy issues of strongly held religious beliefs. Are any such beliefs manifestations of types of widespread social mental illnesses? Were the rallying recruiting speeches of the Crusaders working up knights and serfs in Europe in the Middle Ages to march to the Holy Land and slaughter the Arab and Muslim peoples who lived there mentally ill? Are present day radical, minority Islamic beliefs of 72 virgins awaiting any male jihadist suicide bomber psychotic or just social belief systems?
Then we have our own oddball, weird and at times very bizarre religious cults who engage in mass murder or mass suicide that occasionally still manifest themselves, though this behavior seems to have decreased dramatically since James Jones’ mass preaching poisoning of hundreds of his followers in their isolated colony of Guyana a few decades ago. Were the Symbionese Liberation Army who provoked their deaths in their irrational suicidal standoff with the police in the 1970’s all psychotic. Were Charles Manson’s followers, especially the four women, all psychotic. We do know that Manson has been psychotic almost all his adult life but at least some of his followers were the typical, in a sense, weak followers, with no set identities or internal guiding principles of their own making them massively vulnerable to psychotic charismatic leaders like Manson.
Closer in our own social history as examples of hard to classify violent, aberrant “hate” groups of the past would be the anarchists of the early 1900’s, the Ku Klux Klan since its start in the years of Reconstruction in the South in the 1870’s by Nathan Bedford Forest the former Confederate, the American Nazi Party of the pre World War II years in this country, the very atypical religious or social isolationist groups such as the extreme fringe group of the two towns of polygamist non mainstream Mormons towns on the Arizona and Utah, Colorado City etc., Those groups have long been a question mark and in the last two decades as some women have left or escaped those colonies, it became clear the polygamy at least by the leader Warren Jetts was a stalking horse for sexual addiction and abuse of young women, even teenagers, for which he was convicted several years back. Are those folks all mentally ill in some ways that facilitate their adopting lifestyles so different and in some ways harmful to themselves and their children?
In any case, my point that I have belabored perhaps too much is that one can easily cite group and group, individual after individual who does “crazy” things and we cannot easily or cleanly decide if he/she/they are mentally ill or not.
The article cited above makes for interesting reading. It largely focuses on the question of whether ‘racists’ are mentally ill, more paranoid than anything else, and on the decades of controversy that has accompanied this kind of question. The author Jessica Firger from Newsweek magazine focuses well and appropriately on one of the leading authorities a black psychiatrist, Dr. Alvin Poussant of Harvard and his views, his experiences and lines of reasoning on this question. I will hasten to add that a white racist supremacist, hearing that Dr. Poussant is black, would immediately react, regard all this as black propaganda or worse and dismiss any of the issues that Dr. Poiussant and many others have raised since the 1960’s.
If I were to take the position that full mental illness that is biologically based brain disease and as such could be easily agreed upon by most as the “real thing,” then all these other categories are more social than biologically based. AT least insofar as the limits of our knowledge of these behavioral patterns and mental belief patterns permit us to diagnostically joust with them.
I am prepared to state that part of me would not be surprised at all that in decades to come, our brain research efforts find that the so similar wife abusing murdering husbands have a brain disorder. The behaviors appear at the time to be so similar, so predictable from one individual to another, that I feel it is very possible that this type of such similar behavior is brain disordered driven in a complicated biological manner we do not understand yet. If this was the case in a subset of such individuals, we theoretically in the footsteps of well mapped out and reliable paths of scientific investigation we have been so well served by for the last 200 years or so, identify the mechanisms of operation of aberrant brain processes, say involving one or more “rage centers” of the brain such as the amygdala and construct a blocking treatment that would act at the site of cellular or brain system dysfunction. But I really doubt even if this scenario were to be established and confirmed that it would account for more than a subset of such individuals. Many other developmental [“growing up” experiential] factors could easily account for and lay the groundwork for such malignant behaviors. Social factors, free will, making choices and all the other elements of personal governance of one’s emotions and behaviors in one’s everyday personal life, could count just as much if not more. Personal choice and responsibility still do and will count for something’ we are not brain-driven automatons. It will always be a complex mixture. Human nature I expect will always defy reductionism.
In closing, My other main thought is that much pathology is social. We seem to have forgotten this concept in the accelerating seductive world of biologically explained psychiatry and mental health sciences. Social diagnoses are tricky quagmires, with squishy, uncertain data as their underpinnings. Much of their analysis will likely have to remain as the level of social epidemiological quantification, counting how prevalent such and such condition of a pattern of behavior and what social factors, economics, widespread stressors, accelerated change and a myriad of other factors will have to comprise the meat of the measurement of these conditions. This is the area that Big Data, once it is understood better how to apply such new mathematical analysis to such multiply layered bodies of information, can be of help. This could help structure social policy of applied in a non-totalitarian manner, and perhaps lend some degree of social predictably. But more than that, I doubt may be possible. Much of it will be most successful as we already experience today, in the area of social behavior, measuring our ‘click through rates,’ on the Internet and helping to shape our human nature drive consumerism.
The scores of people carrying flaming torches and chanting “Jews will not replace us” last weekend in Charlottesville, Virginia, bore the message of the “alt-right,” the name given to the white supremacist movement dedicated to eradicating religious and ethnic minorities from America. This racist uprising will be followed by at least nine rallies this weekend—ostensibly dedicated to free speech but sure to broadcast messages of hate—across the U.S., held by members of the Ku Klux Klan, neo-Nazis, and other groups.
Many find the sight of hundreds of racists chanting their intentions for a so-called “ethno-state” and the forceful removal from America of anyone who isn’t white horrific. But others—namely, some psychiatrists—see these individuals as mentally ill. Which leads to a disturbing question: Are we seeing the emergence of a nationalist movement fueled by prejudice or a widespread personality disorder that requires psychiatric care? Answering that dredges up long-held notions about racism in America.
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In the 1960s, Alvin Poussaint, now a professor of psychiatry at Harvard Medical School, was providing medical and psychological care to civil rights activists in Jackson, Mississippi. As a black psychiatrist in the South, he often feared for his life. He witnessed many acts of violence, cared for victims of racist acts and had frequent run-ins with state troopers. Once, when he told an aggressive police officer that he was a doctor, the officer continued to call him “boy” with a hand on the gun in his holster. “I saw the malignancy of the racism much more clearly, and the genocidal element of the extreme racism where they wanted to kill you,” Poussaint tells Newsweek.
He wondered if that hatred was an actual sickness that could be diagnosed and potentially treated. When he was in his early 30s, and a prominent psychiatrist at Tufts Medical School, Poussaint and several other black psychiatrists approached the American Psychiatric Association (APA) with the idea that extreme racism wasn’t just a social problem or a cultural issue. To these professionals, extreme racism—the kind that leads to violence—was a mental illness.
Poussaint and his colleagues wanted the APA to include extreme racism in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a “delusional disorder.” The DSM is the definitive guideline used by mental health clinicians to diagnose patients.
The DSM is not infallible. Over the years, it has provided insights into the country’s ever-changing values and belief systems. Homosexuality, for example, wasn’t completely omitted from the DSM until the late 1980s. The last time the APA revised the DSM (in 2013) they declined the request by a group of psychiatrists to add pornography and sex addiction to the index. For psychiatrists updating the guide—a process that can take more than a decade—doing so means wrestling with the very nature of humanity, what is normal and abnormal when it comes to behavior and beliefs.
Poussaint wasn’t arguing about the relatively milder beliefs that cause a person to stereotype and classify groups of people negatively. Rather, he and the other psychiatrists were addressing the kind of racism that leads to violent behavior, like killing and injuring people by driving a car into a crowd, as happened in Charlottesville. That extreme form of racism, said Poussaint, could reasonably be classified as paranoid and delusional.
The APA was unreceptive. “There was a lot of resistance to the idea,” he says. The problem, Poussaint explains, was that those in charge saw racism as too ubiquitous to diagnose. “They felt racism was so embedded in culture, that it was almost normative, that you had to deal with all the cultural factors that lead to this behavior,”
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Members of the APA also argued that the extreme racism is a mental illness claim lacked hard science. That objection was weak, says Poussaint, because many mental health diagnoses listed in the DSM don’t have a solid scientific premise, including personality disorders. Some APA members said classifying extreme racism as an illness would excuse terrible beliefs and reprehensible behavior.
But Poussaint wasn’t interested in excusing or stigmatizing behavior; he wanted to help people he believed were sick. Inclusion in the DSM, he insisted, could allow individuals suffering from extreme racism to access services such as state-mandated psychiatric counseling, and therefore benefit society because, “it could protect people they might otherwise attack.”
Poussaint still believes extreme racism is a form of paranoia and should be treated that way. In therapy, a psychiatrist would help the patient understand the origins of their racism. “Like any psychotherapy or treatment you would try to tie it all together,” he says. “Other psychiatrists have testified and acknowledged such individuals may improve from treatment when they come to understand these beliefs and why they are projecting them onto other people and acting out.”
Racism as a Symptom
The question of whether extreme racism is a mental illness still haunts psychiatry. About 15 years ago, Carl Bell, a psychiatrist at Jackson Park Hospital Family Medicine Clinic and professor of clinical psychiatry at the University of Illinois at Chicago’s School of Medicine, resurrected Poussaint’s attempt to convince the APA to classify racism as a mental disorder. But Bell tried a different tack from Poussaint. He viewed extreme racism as a type of pathological bias that signaled an underlying personality disorder.
Bell proposed adding pathological bias to the DSM as a trait of personality disorder. With that addition, extreme bigotry would be a major criterion for the diagnosis. The broad term could also apply to individuals who direct violence and hatred toward other groups, such as gays or women.
But again, the APA said no. “When I raised this issue for the personality disorders working group they shut me down,” says Bell, “they were like, ‘Hell, no.’” As in decades past, the APA justified their objection on the grounds that racism is and always has been entrenched in society.
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“The difficulty is that if you are in a racist society, how do you tease that out from biology or personality?” says Bell, who could not even convince the APA to study why racist thoughts and action manifest in some people during manic episodes.
The Association did finally issue a statement in 2006 acknowledging that some psychiatric factors cause a person to become racist, although “further research would be needed to explore this hypothesis.” The group also noted that racist beliefs and behavior often cause depression and psychiatric illness in people who are subject to them. In a statement provided to Newsweek about its approach to prejudice-based violence, Saul Levin, CEO and Medical Director of the APA, said, “The APA has a longstanding policy noting the negative impact of racism and mental health. APA policy supports public education efforts and research on racism and its adverse impact on mental health.”
Bell and other experts continue to view some instances of racism as a symptom of other disorders. Racist thoughts and actions are often a manifestation of some other established and diagnosable mental disorder, says Bell. People with narcissistic personality disorder—a mental condition many experts have claimed Trump has —often have fixed values rooted in racism. Dylann Roof, the teen white supremacist convicted of killing nine black people at a church in Charleston, South Carolina, in 2015, had been diagnosed with schizoid personality disorder. People with conditions such as schizophrenia and bipolar disorder often experience extreme paranoia related to race or ethnicity, though not always violence.
There is also evidence that most of us harbor prejudices, leading some experts to believe we are hardwired to discriminate in some fashion (though not specifically against others). The Implicit Association test (IAT), a tool used to understand the roots and extent of bias, measures impulses of subconscious racism—for example, whether we associate certain types of people with negative or positive feelings. The test, which was developed by social psychologists at Harvard, the University of Virginia and the University of Washington more than two decades ago, has been taken by more than 17 million people. The results show that at least 90 percent of Americans are at least slightly biased against people unlike themselves. Psychologists remain split on where to draw the line, though. Some say discrimination requires a diagnosis when thoughts become actions. But others doubt whether acting on racist beliefs warrants a label of its own.
This Is Not Normal
The fact that many people who act on extreme racist beliefs lead high-functioning lives may also stand in the way of labeling this demographic as mentally ill. In the early 1960s, Jewish author and journalist Hannah Arendt covered the trials of Nazi war criminal Adolf Eichmann for the New Yorker. She was shocked that “half a dozen psychiatrists had certified Eichmann as ‘normal,’” despite the fact that he orchestrated the mass murder of millions of Jews. One psychiatrist described his familial relationships as not just normal but desirable.
In the decades following the Holocaust, the idea that someone who commits crimes against racial and ethnic minorities could still be considered sane by psychiatrists was unsettling, says James M. Thomas, an assistant professor of sociology at the University of Mississippi. “Many people turned to the explanation that there must be something wrong with the German psyche to have allowed this to happen.”
Social scientists knew that creating a clinical definition was critical. They understood that stigmatizing extreme racism could help society wake up to the abnormality of this pathology, and possibly prevent other genocidal acts. Three psychologists devised the California F-scale —F stands for fascist—a test used to evaluate a person for “authoritarian personality type.” They thought understanding how people were seduced by Adolf Hitler’s rhetoric could help prevent future such movements. Although the F-scale fell out of favor, it enabled psychologists to identify common traits of people who cling to dangerous ideologies. They included an inflexible outlook, strong allegiance to leadership, a tendency to scapegoat others and a willingness to lash out in anger and violence.
Sander Gilman, who teaches psychiatry at Emory University, and co-authored with Thomas the book Are Racists Crazy?, agrees that dangerous racists leading seemingly normal lives are hard to identify. “Racists, sadly, cope quite well with daily life,” says Gilman. “They have a take on the way the world should be, and that take functions in the world they live.”
Gilman does not favor a standalone diagnosis of extreme racism, and believes that attempts to categorize such people as mentally ill masks the greater problem of society allowing them to commit vengeful acts. “Those people are evil. They’ve made bad choices, but they’re not choices you can then attribute to mental illness,” says Gilman. “The minute you do that you let people off the hook.”