Peter D. Kramer practices psychiatry in Providence, R.I., where he is clinical professor of psychiatry at Brown University. He is the author of Listening to Prozac (click here to buy the book). Walter Reich, a psychiatrist, is the Yitzhak Rabin Memorial Professor of International Affairs, Ethics and Human Behavior at George Washington University and a former director of the U.S. Holocaust Memorial Museum.
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StumbleUponDear Peter,
I'm troubled by the news that Major League Baseball Commissioner Bud Selig ordered Atlanta Braves pitcher John Rocker to undergo psychological testing after Rocker expressed prejudiced views.Selig's assumption seems to be that, if the tests are said to reveal some kind of pathology, that will justify a lessening of the disciplinary action he or the Braves will take against Rocker. The idea, it seems, is that the tests might demonstrate that Rocker is, for psychological reasons, prone to holding certain views, or to expressing them, and that he therefore shouldn't be punished for them in the way that he'd be punished were he psychologically well. Instead of being dismissed from his team, for example, he might be given a lesser punishment, or none at all, and ordered to obtain psychological counseling.Neither of us knows anything about Rocker's psychological health--and, if we did, we, as psychiatrists, wouldn't be permitted, by the rules of medical ethics, to comment on it publicly. Nor should we speculate on the psychological health of people we don't know; lots of psychiatrists made fools of themselves, and abused their profession, when they issued psychiatric opinions about Barry Goldwater during the '60s.
So what I want to discuss with you is not Rocker but a practice that I'm reminded of by the Rocker story and that's all too common in America, the transformation of bad into mad.
One form of that transformation is the inclination to see bad behavior in pathological rather than moral terms and to respond to such behavior with prescriptions for psychological therapy. This inclination does a disservice to morality, to the concept of psychiatric illness, and to the enterprise of psychotherapy. And it allows us, in many cases, to avoid the unpleasant reality that people do bad things not because they're mad but because they're bad, that they should bear the responsibility for their actions, and that they should be punished if those actions cause harm.
Wanting to see bad as mad has a long history. A number of writers have speculated, for example, that Hitler was traumatized sexually as a child and never got over it, or that he began to hate Jews because of early family experiences, with the implication that one of these reasons, or some other, twisted Hitler psychologically and accounted, at least in part, for the Holocaust. Somehow it's satisfying to explain great evil, and even simple racism, using psychological formulations. But in Hitler's case, and in the cases of ordinary racists, racist feelings and expression are far more fundamentally rooted in social, cultural, and moral factors than they are in psychological ones. We're too inclined to look for the psychological factors--to assume, whenever we can, that if a person is racist or morally deficient in some way, he may not be normal--than to accept the idea that someone we know is, quite simply, morally flawed. And we're too inclined to assume that the solution for the problem is "counseling." Such an approach is satisfying not only because it explains unacceptable behavior but also because it offers the possibility of doing something about it.
Which brings up the issue of the effectiveness--and appropriateness--of attempting psychotherapy, or any other kind of psychiatric intervention, for what are really moral and social problems. I don't see it, Peter. You've written subtly and wonderfully about both psychotherapy and medication. Are you comfortable with the practice of sending a healthy miscreant for treatment rather than punishment?
Until now, I've been talking about the inclination we often have to really believe, because we want to believe, that mental illness is the cause of morally unacceptable behavior. But there are, of course, cases in which all persons involved in the situation--the misbehaving individual and the organization of which he's a part--don't believe that, but decide that a diagnosis of mental illness will, quite simply, get that individual off the hook. Such cynical use of psychiatric diagnosis is, I think, even worse than its naive, if equally incorrect, use. And sending such a person for counseling is truly absurd. The desire to apply a psychiatric diagnosis to someone who has committed a crime is, of course, not a new phenomenon: Lawyers have long sought to have clients declared not guilty by reason of insanity, whether they believe he's insane or not, in order to avoid a harsh prison sentence.
As you know, some years ago I studied the practice, in the old Soviet Union, of diagnosing healthy political dissidents as mentally ill. The idea was to discredit their views and to punish them by sending them to psychiatric hospitals. We seem to be encountering, in this country, an ironic twist on that theme. We're pronouncing unacceptable behavior to be the product of mental illness--not in order to discredit the behavior or the person carrying it out but because we've become inclined to genuinely see it as the product of such illness, or because we want to excuse it or to help him or her avoid responsibility and punishment for it. That may be good for the person. It's not good for society.
Best,
Walter
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The American Psychological Association has a very good pamphlet on the psychological dimensions of racism, including cause/effect, etc. No cure promised or suggested, but many good suggestions on how people can make common everyday responses to combat racism.
--J Wilkinson
(To reply, click here.)
This whole incident reminds me of the Fuhrman racism charges in the O.J. trial. For all Fuhrman's considerable racist talk, he was entirely innocent of ever being a racist in his activities a cop. Rocker has apparently roomed with people who were from the same groups of people he denounced, all without incident and seemingly with generosity.
What gives with this? The talk is ugly but illogical given each man's actions. What psychological condition would this be called? I do take offense at the notion that another indication of some sort of psychological problem is that Rocker said these things out loud and to a reporter. Does that mean a person who had these thoughts but knew enough not to say them is healthier?
--gmcgowan
(To reply, click here.)
John Rocker mouthed off to a man in a car. As yesterday's ESPN interview with him indicated, he's not a racist of the sort that this exchange is meant to describe--blacks and Hispanics have lived with him, he says, when they were playing minor league ball near his home. I grew up in Louisiana and met a number of people like Rocker--some are racists, in word and deed, while others mouth off and say hateful things because it's culturally sanctioned (or subculturally sanctioned). My Louisiana acquaintances of this type believe that New York is a sewer; although I don't share their opinion, it's not an uncommon one anywhere in the country, even up here in enlightened Minnesota, where I now live. In short: Rocker does not have my sympathy, but he was clearly victimized by a writer for Sports Illustrated.
--Alan Davis
(To reply, click here.)
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