To the Editor: In the Taking Issue commentary in the December 2004 issue—"Racism: A Mental Illness?" —Carl Bell (1) challenges psychiatry to confront a difficult psychosocial problem. Should we define racism and other fixed beliefs as delusions or some other form of psychopathology? The definition of a delusion is a fixed belief that is not amenable to logic. Many beliefs, such as racism, would fit this definition but are accepted by a culture or a subculture and may not be viewed as delusional. Yet even if some of these beliefs are culturally accepted, they are destructive to individuals and society. So, how do psychiatrists view dangerous fixed beliefs that logic and reality do not appear to modify when the beliefs are accepted by a culture or subculture?
Racism is one form of a destructive fixed belief. There are many others. Anti-Semitism and homophobia are two other frequently encountered examples. If we look toward the Middle East and Africa, we find numerous other examples, such as female circumcision and honor killing. We can also cite the way that women are viewed in many societies in that part of the world.
As scientists and students of human relations, we should always be alert to false beliefs even if a majority of the culture in which we live accepts them. There are too many culturally accepted beliefs that destroy individuals and the fabric of a just society. Are these psychiatric problems, public health problems, or primarily moral and ethical problems, and can psychiatry find a way to deal with them without becoming the monitor of all human thought?
Perhaps research can show us a way. Research has found that gene-environmental interaction can lead to mental illness. A long-term epidemiologic study in New Zealand showed that genetically susceptible individuals are at higher risk of depression when exposed to environmental stress (2). Other studies, such as those of Mexican immigrants to the United States (3) and Oriental Jewish women in Israel (4), document that populations subjected to stress and discrimination have a higher risk of mental illness.
If we view racism as a form of stress, which is bad for everyone and also can lead to mental illness among susceptible individuals, we might view racism as a public health problem as well as a moral and ethical problem. Putting racism in the public health arena provides us with additional options for dealing with the problem. By including racism in the DSM we might classify it as a delusional disorder or a personality disorder among some individuals.
But what do we do about the culture or the subculture that harbors the virus of racism and prejudice? Research does not help us with this issue now but may do so in the future. It would involve psychiatry's taking a hard look at pathology in the society as a whole. Are racism and other forms of so-called cultural beliefs that harm others psychopathology? Is psychiatry prepared to confront this question? Maybe it is time that we did. When John Snow removed the handle of the Broad Street pump to stop the cholera epidemic he must have received much initial public criticism.
Dr. Leon is professor emeritus in the department of psychiatry at the University of Texas Health Science Center at San Antonio.