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Location: Kansas City, Missouri, United States

Doing my part to irritate Republicans, fundamentalists, bigots and other lower life forms.

Saturday, December 10, 2005

Finding the line between bias and mental illness

Few things would give me greater pleasure then seeing Fred Phelps and his clan of followers placed into straightjackets and loaded onto a bus to transport them to the nearest psychiatric facility. Or the thought of Jerry Falwell twitching and jerking while undergoing electro-convulsive therapy. Or maybe Pat Robertson channeling his inner Blanche DuBois from the final scene of "A Streetcar Named Desire" and whimpering how he's "always depended on the kindness of strangers" as men in white coats lead him out of his television studio.

Maybe someday we'll be treated to just such scenes if the field of psychiatry decides to include extreme bias in its listing of psychiatric diagnoses.

According to a Washington Post article, a California psychiatrist named Edward Dunbar has proposed writing new guidelines for the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the hefty book that defines a variety of mental disorders. Dunbar's guidelines, which haven't officially been submitted to the APA yet, describe people whose daily functioning is paralyzed by persistent fears and worries about other groups.

The article cites a number of examples: a waiter who lost numerous jobs because he refused to provide service to black customers; a Viet Nam veteran who feared going anywhere Asians might be; a woman in Los Angeles so convinced that Jews carried diseases that she went through elaborate cleansing rituals. And then there's this one:

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 E. Solomon, a psychologist at the University of Vermont who treated the man for two years. "He felt under attack, he felt threatened."

Wow! If that kind of behavior was suddenly considered a mental illness, the ranks of fun-D'uh-Mentalist churches and right-wing politicians would shrink drastically.

My first impulse was to cheer the APA for considering making extreme bias a new form of pathology. That's because I saw how easily we could use it as a tool to silence the opposition. As much as I'd like to see folks like Phelps and Falwell and Robertson (and a list of several hundred more that I could name off the top of my head) silenced, such a tool could easily become a two-edged sword.

It's only been a little over three decades ago that simply being gay was considered a "mental illness." We were victims of a patholgy at best and crazed, deviant monsters at worst, in the eyes of the field of psychiatry. We were treated with hormones. We were strapped to chairs with electrodes attached to our genitals to provide a shock if we started to become aroused when shown photos of naked men. We were injected with serums made from goat glands. We were lobotomized. We were castrated. All because we were "sick" according to a definition in a manual.

As tempting as it is to wish to avenge those dark years by painting our opponents with the same "mentally ill" brush that was once used on us, there are compelling reasons why we shouldn't.

First, creating a new category of mental illness to describe extreme bigotry would risk setting free those who commit hate crimes. Imagine if such a category of mental illness had been available when the two cretins who murdered Matthew Shepard were on trial. Would they still have been convicted and given life in prison? Or would the diagnosis of extreme bias have provided them with an instant insanity defense?

Second, when a person's prejudices become so severe they create problems with his or her job and social life, there are existing diagnoses that can provide the same treatment without creating a whole new type of mental illness. The article notes that anti-psychotic drugs have been used to successfully treat prison inmates who exhibited high levels of prejudice toward other groups. These same drugs treatments might be useful in dealing with persons who exhibit the delusional belief that a particular group is taking over or out to get him. Why create a whole new category to describe something that already exists like paranoid delusions?

Finally, there's just something a little creepy about using psychiatry to enforce social norms. Some might envision a brave new world free from prejudice, but I shudder at the idea it's not too many steps from copying the Joseph Stalin's style of silencing dissident voices. Stalin claimed the state existed to "protect the people." Therefore, if a person sopke out against the Soviet Union, they were acting against their own best interest and could rightly be judged "insane" and sent for "rehabilitation" to some Siberian gulag.

That's were the two-edged sword comes in. The progress we have made toward LGBT rights is tenuous at best, especially under the current political climate. What gains we have made can be lost and we can once again be judged to be on the wrong side of mental health.

It's important for all of us to talk about racism and sexism and homophobia and all sorts of prejudices. It's also important for groups like the APA to examine what effect biases have on society. There may well turn out to be a good reason to list extreme bias as a mental disorder ... but to set forth a new definition before we've studied the issue in depth could turn out to be a very dangerous proposition.