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 think our main difference is one of focus. You prefer to focus on the importance of investigating the possibility that mental illness exists in persons who express racist views when such expression is public and likely to get them into trouble--as occurred in the case of John Rocker. I prefer to focus on the danger of turning first to psychiatric explanations when such expressions are made.
Obviously, in any particular case, saying something unacceptable in a public way, when you should know it will get you into trouble, could indicate that you suffer from a mental illness that affects your ability to control your actions or your ability to understand reality. But it's simply all too common that, in our society, organizations turn to psychiatric explanations or excuses when they have to contend with moral transgressions. And they do it, almost automatically, for one of two reasons: 1) to find a medical explanation for an unacceptable action that will relieve the transgressor of responsibility and guilt, in the genuine belief that such an explanation must exist; or 2) to provide, for cynical reasons, a medical excuse that will get the transgressor off a legal hook.
So I grant you the possibility that, in the Rocker case, the baseball commissioner could have had a sound reason for calling for some kind of psychiatric evaluation. But calling for such evaluations is so often done in cases in which there is little or no basis for it that I think it's important to use the occasion of the Rocker case to reflect on the increasing tendency to turn to psychiatric evaluations in the face of social or legal problems. Neither of us knows the details of the Rocker case, of course, and for ethical reasons we obviously shouldn't speculate on them.
At the end of your message you ask several questions. Let me try to address each of them in turn.
1) Do I believe that there are instances when racism is a sign of mental illness?
I believe that some racists are mentally ill, but that the vast majority are not. Moreover, I doubt that the population of persons with various kinds of mental illnesses--which can be a substantial percentage of the general population, depending on which mental illnesses are included--contains significantly more racists, per capita, than the population as a whole.
An important question relates to violent racism, such as the killing of members of ethnic or religious groups other than one's own. Some of these killers may be mentally ill; most, I think, probably are not. They've got a different kind of problem--a social and moral one.
Cultural and historical context plays a big role. In some historical cases--Nazi Germany is the obvious and most extreme one--lots of otherwise ordinary people were involved in the mass murder of Jews. Most of the killers did their killing in the service of a state that was an immense and focused killing machine. But these people weren't programmed zombies; they knew what they were doing, and often did it with relish, in the full belief that what they were doing was not only acceptable but good. Very few of these people were mentally ill. On the other hand, in the cases of, say, white-supremacist individuals who are acting alone in their violent behavior, mental illness may play a more significant role. The two types of situations are different. The first involves membership in a large community--in this case, Nazi Germany--that extolled violent racism and reinforced behavior that conformed to the ethos of that community. The second situation involves persons with hatreds who may belong to small communities animated by an extreme racist ideology but who often act on their hatreds alone. To be sure, normal people can have extreme hatreds and act on them. But violent ideologies may attract persons whose extremism, and readiness to act on that extremism, may be a product of illness.
2) How do I deal with prejudice in my practice? Do I imagine that as a racially prejudiced patient improves he will have less need to blame alien groups, or do I think that such a patient would likely get better and still remain angrily prejudiced?
My obligation as a physician is to treat the patient and help him or her overcome illness. The patient's views and expressions about race, even about my own ethnic identity, shouldn't reduce my efforts to do all I can to help that patient, especially in a situation of acute illness. If, however, in a psychotherapeutic setting, those views, especially about my own ethnic identity, reduce the likelihood that the patient can work with me or that I can help him or her, it's in that patient's interest to be treated by another physician. At times, the therapist may find it difficult to work with a patient he or she considers racist--and should tell that to the patient and help him or her find another therapist. As it happens, I've never been in that position.
Might racism in a patient diminish if the patient gets, in psychiatric terms, better? In some patients, maybe yes; in some, maybe no. The roots of racism are many, and most of them are, I believe, social, cultural, and communal in nature. In the vast majority of cases of persons who are both mentally ill and racist, the two qualities are largely and fundamentally independent. Perhaps, when a patient becomes less symptomatic, his or her anger will diminish, and so, too, will his racist anger. But, as I think you well know, Prozac, or more likely some other medication or intervention, while diminishing such anger, is not likely to have any fundamental effect on long-formed opinions about other ethnic groups.
3) Do I have anything to say about racism as a force in international politics? Are we fated to see this millennium begin where the last ended, with a series of brutal ethnic conflicts?
I have a lot to say about these matters, but I don't think that, in this "Dialogue," we should stray so far from the issues related to psychiatry provoked by the Rocker case. I strongly feel that the most important of these issues is the widespread tendency to turn to psychiatry when dealing with moral transgressions. I believe that this tendency damages not only society but also psychiatry. People sometimes rush to psychiatric explanations because it's more satisfying to believe that a moral problem is really a psychiatric one, and can therefore be explained and cured. And they sometimes rush to diagnosis even though they don't really think the person is ill but hope that a diagnosis of illness will relieve the transgressor of responsibility and help him avoid punishment. In the latter situation, psychiatry is an especially big loser, since, if you can manipulate psychiatry in order to help someone, then psychiatry becomes all the more manipulable and therefore all the more likely to be manipulated by authorities--the state and its legal system--in order to harm someone. In short, psychiatry, one of the healing arts, could be transformed into an agent of social control and punishment. That's one of the reasons that the tragic experience of Soviet psychiatry, which was sometimes cynically manipulated to misdiagnose healthy political dissidents, is so cautionary a tale.
I certainly agree with you that persons with mental illness should be given every opportunity for treatment. But I think we have a joint interest in guarding against the manipulation of psychiatry--not only for social and moral reasons but also to protect our profession from abuse.
As ever,
Walter
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Highlights from the Fray (should be read after the final Thursday Dialogue entry):
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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