Is Extreme Racism a Mental Illness?: Yes


It can be a delusional symptom of psychotic disorders

Alvin F Poussaint, Professor of psychiatry1

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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.

To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats a whole group of people and seeks to eliminate them to resolve his or her internal conflicts meets criteria for a delusional disorder, a major psychiatric illness.

Extreme racists’ violence should be considered in the context of behavior described by Allport in The Nature of Prejudice.2 Allport’s 5-point scale categorizes increasingly dangerous acts. It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination against them, to physical attack, and finally to extermination (lynchings, massacres, genocide). That fifth point on the scale, the acting out of extermination fantasies, is readily classifiable as delusional behavior.

More recently, Sullaway and Dunbar used a prejudice rating scale to assess and describe levels of prejudice.3 They found associations between highly prejudiced people and other indicators of psychopathology. The subtype at the extreme end of their scale is a paranoid/delusional prejudice disorder.

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).

Extreme racist delusions can also occur as a major symptom in other psychotic disorders, such as schizophrenia and bipolar disorder. Persons suffering delusions usually have serious social dysfunction that impairs their ability to work with others and maintain employment.

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.

It is time for the American Psychiatric Association to designate extreme racism as a mental health problem by recognizing it as a delusional psychotic symptom. Persons afflicted with such psychopathology represent an immediate danger to themselves and others. Clinicians need guidelines for recognizing delusional racism in all its forms so that they can provide appropriate treatment. Otherwise, extreme delusional racists will continue to fall through the cracks of the mental health system, and we can expect more of them to explode and act out their deadly delusions.

Figure 1

Figure 1

Extreme racism indicates psychopathology

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Competing interests: None declared

Go to:


1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Press; 2000.

2. Allport G. The Nature of Prejudice. Reading, MA: Addison-Wesley; 1954.

3. Sullaway M, Dunbar E. Clinical manifestations of prejudice in psychotherapy: toward a strategy of assessment and treatment. Clin Psychol Sci Pract 1996;3: 296-309.

4. American Psychiatric Association. Diagnostic criteria for 297.1 delusional disorder. In: DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Press; 2000.

Articles from The Western Journal of Medicine are provided here courtesy of BMJ Group


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One thought on “Is Extreme Racism a Mental Illness?: Yes

  1. Don’t you think it should be understandable why the national organizations of psychiatrists really can never look at racism as ‘mental illness’, since recognition of such would put them at odds with those associated with the historical actions of conquering and colonizing relatively peaceful peoples, and their (then) working civilizations; those folks known as the last millenia’s original architects of ‘the conquering process’.

    Such recognition would mean that all the techniques and attitudes written about “racism” as a mental illness, would have to be superimposed onto ‘the original mentally ill’, who inflicted the same techniques and attitudes (now known as ‘racism’) upon the lesser classes of old Europe (who were the first people to be colonized by ‘the process’); after all, who would ever believe that the old families of Europe’s upper class would allow their actions to be called “mentally ill”, even though the reference would be to their ancestors of semi-ancient times.

    As it stands now, the descendants of the then existing upper class, who benefited most from the advent of the renaissance, remain in positions of (old money) power; those who used to be ‘the serfdom class’ are now the real middle class of the world and are partially in charge of setting up, disguising and maintaining the buffer between (and on behalf of) the originally ‘mentally ill machinery’ and those who presently reflect ‘the effects’ from that original mental illness, now known as “racism”. And so, to define the practice of “racism” as a ‘mental illness’, is to allow the worlds scientists of psychological arts to begin to research and find solutions to counter the old and still powerful ruling classes ‘conquering process’. the beat goes on, though there is much less left for the machinery of that process to conquer; somewhere, ‘the process’ must exist as a written codified system of operation, for how else could the results from its effects be so consistently repeated for such a long time (centuries).

    A system could be a ‘crazy maker’ without the developers of it being crazy at all; they only need to be inhumane. And as history consistently points out, the inhumane that are intelligent and powerful enough to write history in there favor and from their perspective, are designated as “great” and “worthy of emulation”. So what chance is there of ‘racism as a mental illness’ to be established and acted upon? Of course, non-establishment and inaction doesn’t remove it from the reality of being ‘mental illness’.

    But shouldn’t we all understand why they haven’t declared it as such and why they, possibly, won’t ever declare it as such? And if this is so, isn’t an eventual sanction by them, only a waste of time that will just result in them systematizing such a declaration into another diversion away from real healing?

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