The Case for Treating Bigotry Like a Disease

If it’s both harmful and contagious, as research suggests, then a public health approach to the problem is warranted.

  • Some of the approaches taken toward controlling the spread of disease may be applicable to pathological bigotry.

Over a decade ago, I wrote a piece for a psychiatric journal entitled “Is Bigotry a Mental Illness?” At the time, some psychiatrists were advocating making “pathological bigotry” or pathological bias — essentially, bias so extreme it interferes with daily function and reaches near-delusional proportions — an official psychiatric diagnosis. For a variety of medical and scientific reasons, I wound up opposing that position.

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In brief, my reasoning was this: Some bigots suffer from mental illness, and some persons with mental illness exhibit bigotry — but that doesn’t mean that bigotry per se is an illness.

Yet in the past few weeks, in light of the hatred and bigotry the nation has witnessed, I have been reconsidering the matter. I’m still not convinced that bigotry is a discrete illness or disease, at least in the medical sense. But I do think there are good reasons to treat bigotry as a public health problem. This means that some of the approaches we take toward controlling the spread of disease may be applicable to pathological bigotry: for example, by promoting self-awareness of bigotry and its adverse health consequences.

In a recent piece in The New York Times, health care writer Kevin Sack referred to the “virulent anti-Semite” who carried out the horrific shootings at the Tree of Life synagogue in Pittsburgh on October 27, 2018.

It’s easy to dismiss the term “virulent” as merely metaphorical, but I think the issue is more complicated than that. In biology, “virulence” refers to the degree of pathology, or damage, caused by an organism. It differs from the term “contagious,” which refers to a disease’s communicability. But what if, in an important sense, bigotry is both virulent and contagious — that is, capable of both causing damage and spreading from person to person? Wouldn’t a public health approach to the problem make sense?

There is little question among mental health professionals that bigotry can do considerable harm to the targets of the bigotry. What is more surprising is the evidence showing that those who harbor bigotry are also at risk.

For example, research by psychologist Dr. Jordan B. Leitner has found a correlation between explicit racial bias among whites and rates of circulatory disease-related death. Explicit bias refers to consciously held prejudice that is sometimes overtly expressed; implicit bias is subconscious and detected only indirectly.

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In effect, Leitner’s data suggest that living in a racially hostile community is related to increased rates of cardiovascular death for both the group targeted by this bias — in this case blacks — as well as the group that harbors the bias.

Writing in the journal Psychological Science, Leitner and his colleagues at the University of California, Berkeley found that death rates from circulatory disease are more pronounced in communities where whites harbor more explicit racial bias. Both blacks and whites showed increased death rates, but the relationship was stronger for blacks. Although correlation does not prove causation, clinical psychology professor Vickie M. Mays and colleagues at UCLA have hypothesized that the experience of race-based discrimination may set in motion a chain of physiological events, such as elevated blood pressure and heart rate, that eventually increase the risk of death.

It’s unlikely that the adverse effects of discrimination and bigotry are limited to blacks and whites. For example, community health sciences professor Gilbert Gee and colleagues at UCLA have presented data showing that Asian-Americans who report discrimination are at elevated risk for poorer health, especially for mental health problems.

As the adverse health effects of bigotry have been increasingly recognized, awareness has grown that hateful behaviors and their harmful effects can spread. For example, public health specialist Dr. Izzeldin Abuelaish and family physician Dr. Neil Arya, in an article titled “Hatred — A Public Health Issue,” argue that “Hatred can be conceptualized as an infectious disease, leading to the spread of violence, fear, and ignorance. Hatred is contagious; it can cross barriers and borders.”

Similarly, communications professor Adam G. Klein has studied the “digital hate culture,” and has concluded that “The speed with which online hate travels is breathtaking.”

As an example, Klein recounted a chain of events in which an anti-Semitic story (“Jews Destroying Their Own Graveyards”) appeared in the Daily Stormer, and was quickly followed by a flurry of anti-Semitic conspiracy theories spread by white supremacist David Duke via his podcast.

Consistent with Klein’s work, the Anti-Defamation League recently released a report titled, “New Hate and Old: The Changing Face of American White Supremacy.” The report found that, “Despite the alt right’s move into the physical world, the internet remains its main propaganda vehicle. However, alt right internet propaganda involves more than just Twitter and websites. In 2018, podcasting plays a particularly outsized role in spreading alt right messages to the world.”

To be sure, tracking the spread of hatred is not like tracking the spread of, say, food-borne illness or the flu virus. After all, there is no laboratory test for the presence of hatred or bigotry.

Nevertheless, as a psychiatrist, I find the “hatred contagion hypothesis” entirely plausible. In my field, we see a similar phenomenon in so-called “copycat suicides,” whereby a highly publicized (and often glamorized) suicide appears to incite other vulnerable people to imitate the act.

If hatred and bigotry are indeed both harmful and contagious, how might a public health approach deal with this problem? Drs. Abuelaish and Arya suggest several “primary prevention” strategies, including promoting understanding of the adverse health consequences of hatred; developing emotional self-awareness and conflict resolution skills; creating “immunity” against provocative hate speech; and fostering an understanding of mutual respect and human rights.

In principle, these educational efforts could be incorporated into the curricula of elementary and middle schools. Indeed, the Anti-Defamation League already offers K-12 students in-person training and online resources to combat hatred, bullying, and bigotry. In addition, the Anti-Defamation League report urges an action plan that includes:

  • Enacting comprehensive hate crime laws in every state.
  • Improving the federal response to hate crimes.
  • Expanding training for university administrators, faculty, and staff.
  • Promoting community resilience programming, aimed at understanding and countering extremist hate.

Bigotry may not be a “disease” in the strict medical sense of that term, akin to conditions like AIDS, coronary artery disease, or polio. Yet, like alcoholism and substance use disorders, bigotry lends itself to a “disease model.” Indeed, to call bigotry a kind of disease is to invoke more than a metaphor. It is to assert that bigotry and other forms of hatred are correlated with adverse health consequences; and that hatred and bigotry can spread rapidly via social media, podcasts, and similar modes of dissemination.

A public health approach to problems such as smoking has shown demonstrable success; for example, anti-tobacco mass media campaigns were partly responsible for changing the American public’s mind about cigarette smoking. Similarly, a public health approach to bigotry, such as the measures recommended by Abuelaish and Arya, will not eliminate hatred, but may at least mitigate the damage hatred can inflict upon society.The Conversation

Ronald W. Pies is an emeritus professor of psychiatry, lecturer on bioethics and humanities at SUNY Upstate Medical University, and a clinical professor of psychiatry at Tufts University School of Medicine.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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5 comments / Join the Discussion

    @Ben Franklin, your comment is exactly what this article is about.
    Your presumption that “liberal socialists” “steal” your money borders on being comical to most people, yet you find it personally real and threatening.
    No one is out to get you. Yet you actually feel as though “those people” are committing a crime against you, and that makes you angry.
    Had you done the math, you’d learn that in order to steal $700 from each American, the total take would be around a quarter trillion dollars. That’s not what’s happening. But facts be damned. Facts don’t fit your prejudice. Reality just gets in your way.
    Yet you still feel threatened. Perhaps you should read this article again. It’s about you.
    Someone, somewhere, (often a parent) taught you how to hate complete strangers (no one is born hating people). I expect it gives you some twisted form of comfort, but you are misguided and will pay a price for your unwillingness to treat your neighbors as brothers rather than others.
    That’s what this article is about.

    Hi David, I think that strongly held opinions need to be expressed dispassionately corroborated with facts, research outcomes and statistics. Then the views cannot be labelled hate speech, however distasteful they are. Unfortunately some people don’t understand evidence, particularly when there is some evidence for both points of view.

    Hi, Mr. Leedom,

    Thank you for taking the time to comment. As the author of the essay under discussion, I appreciate the issues you are raising. Your “Where do you draw the line?” argument is certainly a conundrum for all manner of legal and ethical issues. For example, in legal parlance, “libel” requires that “a published false statement” be “damaging to a person’s reputation”–but who is to say, really, what is or is not “damaging” to someone’s reputation? For that matter, who is to say what is or is not “false”? We can paralyze ourselves in almost any sphere by positing borderline cases that defy easy classification. (A philosophy professor of mine once put it this way: “On a completely bald-headed man, it’s hard to tell where his forehead ends and the rest of his head begins. But that doesn’t mean we can’t define the word “forehead” for ordinary purposes.”)

    Yes, as you say: sometimes the line between “strong disagreement” and “hate speech” is hard to define, but–as I think you will agree–that doesn’t mean we should abandon efforts to do so, or that we can’t teach our children to recognize clear-cut instances of hate speech and bigotry. There is, after all, a difference between saying, “I strongly and fervently disagree with the policies of the Netanyahu administration, with respect to its treatment of the Palestinians” and saying, “The f—ing Jews are genocidal pigs!”. Surely we can agree on that? There will, of course, be “middle cases” that are not so easy to classify, but that doesn’t let us off the hook. We must try to sort these things out as best we can.

    As for comparing my proposal to “communist governments who put dissidents in hospitals”, I think this comparison goes far beyond anything remotely suggested in my essay. Nowhere do I even hint at forcibly confining anybody, any more than I would suggest forcibly quarantining smokers–yet smoking is a public health problem and merits a public health approach. In my view, bigotry may also be approached via a public health model, which involves voluntary education, increasing self-awareness, and encouraging ethnic and racial tolerance. This is a light-year away from involuntary confinement in mental hospitals. (And please note that I explicitly deny that bigotry is a “mental illness” in the first part of my essay).

    I am glad, Mr. Leedom, that we agree on the need “to educate people about the destructive nature of hatred.” In my view, we should not allow “Where do you draw the line?” arguments to discourage us from doing so. Again, thanks for contributing to this discussion.

    Best regards,
    Ronald W. Pies, MD

    OK. Then treat liberal socialism as a larceny crime. Misdeamanor if the theft is below $700, a felony ff the socialist streals more than $700 from a productive American citizen.

    A micro bio on me: I’m a mid 50s white guy. I’m not racist, or anti-Semitic. I am conservative, christian and am influenced by people like Ben Shapiro and Jordan Peterson.

    To keep things simple I see all physical violence as evil (except self defense). My concern is in hate speech. Where to draw the line between clearly hate speech and a strong disagreement. Threatening violence and calling people names is crossing the line. Blaming general groups of people on your specific misfortune in life or threat of misfortune is crossing the line. But what about having conversations about controversial issues like transgenderism, immigration, feminism, or abortion?

    When I hear you talk about treating hate as a public health issue I am reminded communist governments who put dissidents into mental hospitals. To say that a trans-women is still biologically male is a rational statement but will be seen as hate speech or even violence by some. A rational case can be made that mass immigration will have a negative effect on my life, but some will say that is racist hate speech.

    The real question is who decides what is hate speech? Advocating violence and verbal abuse clearly crosses the line, but where is the line…exactly. My contention is that it is not clear. We need do need to educate people about the destructive nature of hatred, but at the same time not to overreach and label strong disagreement as hate.

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