News:
Psychiatry ponders whether extreme biases are illnesses
By Shankar VedantamWashington Post
WASHINGTON – The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement.
These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person.
“He had a fixed delusion about the world,” said Sondra Solomon, a psychologist at the University of Vermont who treated the man for two years. “He felt under attack, he felt threatened.”
Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are seriously impaired by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.
Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.
If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish “ordinary prejudice” from pathological bias.
Several experts said they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agreed that psychiatry has been inattentive to the effects of prejudice on mental health and illness.
“Has anyone done a word search for ‘racism’ in DSM-IV? It doesn’t exist,” said Carl Bell, a Chicago psychiatrist, referring to psychiatry’s manual of mental disorders. “Has anyone asked, ‘If you have paranoia, do you project your ” hostility toward other groups?’ The answer is ‘Hell, no!’
The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, or DSM; advocates are mostly seeking support for systematic study.
Darrel A. Regier, director of research at the psychiatric association, said he supports research into whether pathological bias is a disorder. But he said the jury is out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs.
“If you are going to put racism into the next edition of DSM, you would have ‘Are you pathologizing enormous criticism,” Regier said. Critics would ask, “ all of life?’ You better be prepared to defend that classification.”
“I think it’s absurd,” said Sally Satel, a psychiatrist and the author of “PC, M.D.: How Political Correctness Is Corrupting Medicine.” Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. “You could use it as a defense.”
Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York’s Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted.
Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her – she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.
“When I see someone who won’t see a physician because they’re Jewish, or who can’t sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, ‘This is not ” Dunbar said. “If it’s not our problem, whose problem is it?” our problem,’
Opponents say making pathological bias a diagnosis raises the specter of social engineering – brainwashing individuals who do not fit society’s norms. But Dunbar and others say patients with disabling levels of prejudice should be treated for the same reason as are patients with any other disorder: They would feel, live and function better.
Chicago psychiatrist Bell said he has not made up his mind on whether bias can be pathological. But in proposing a research agenda for the next edition of psychiatry’s DSM of mental disorders, Bell and researchers from the Mayo Clinic, McGill University, the University of California at Los Angeles and other academic institutions wrote: “Clinical experience informs us that racism may be a manifestation of a delusional process, a consequence of anxiety, or a feature of an individual’s personality dynamics.”
The psychiatrists said their profession has neglected the issue: “One solution would be to encourage research that seeks to delineate the validity and reliability of racism as a symptom and to investigate the possibility of including it in some diagnostic criteria sets in future editions of DSM.”
By Shankar VedantamWashington Post
WASHINGTON – The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement.
These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person.
“He had a fixed delusion about the world,” said Sondra Solomon, a psychologist at the University of Vermont who treated the man for two years. “He felt under attack, he felt threatened.”
Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are seriously impaired by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.
Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.
If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish “ordinary prejudice” from pathological bias.
Several experts said they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agreed that psychiatry has been inattentive to the effects of prejudice on mental health and illness.
“Has anyone done a word search for ‘racism’ in DSM-IV? It doesn’t exist,” said Carl Bell, a Chicago psychiatrist, referring to psychiatry’s manual of mental disorders. “Has anyone asked, ‘If you have paranoia, do you project your ” hostility toward other groups?’ The answer is ‘Hell, no!’
The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, or DSM; advocates are mostly seeking support for systematic study.
Darrel A. Regier, director of research at the psychiatric association, said he supports research into whether pathological bias is a disorder. But he said the jury is out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs.
“If you are going to put racism into the next edition of DSM, you would have ‘Are you pathologizing enormous criticism,” Regier said. Critics would ask, “ all of life?’ You better be prepared to defend that classification.”
“I think it’s absurd,” said Sally Satel, a psychiatrist and the author of “PC, M.D.: How Political Correctness Is Corrupting Medicine.” Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. “You could use it as a defense.”
Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York’s Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted.
Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her – she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.
“When I see someone who won’t see a physician because they’re Jewish, or who can’t sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, ‘This is not ” Dunbar said. “If it’s not our problem, whose problem is it?” our problem,’
Opponents say making pathological bias a diagnosis raises the specter of social engineering – brainwashing individuals who do not fit society’s norms. But Dunbar and others say patients with disabling levels of prejudice should be treated for the same reason as are patients with any other disorder: They would feel, live and function better.
Chicago psychiatrist Bell said he has not made up his mind on whether bias can be pathological. But in proposing a research agenda for the next edition of psychiatry’s DSM of mental disorders, Bell and researchers from the Mayo Clinic, McGill University, the University of California at Los Angeles and other academic institutions wrote: “Clinical experience informs us that racism may be a manifestation of a delusional process, a consequence of anxiety, or a feature of an individual’s personality dynamics.”
The psychiatrists said their profession has neglected the issue: “One solution would be to encourage research that seeks to delineate the validity and reliability of racism as a symptom and to investigate the possibility of including it in some diagnostic criteria sets in future editions of DSM.”
posted by John Q. Public esq. at 2:49 AM
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