Is Extreme Hate a Mental Illness?

Since 1999, the total number of hate groups in the US had more than doubled. There are now more anti-Muslin, anti-immigrant, anti-LGBTQ, white nationalist, neo-Nazi, neo-confederate and black separatist organizations. Although still active, the number of Ku Klux Klan chapters, racist skinhead groups and anti-government militias and political groups have declined. According to the Southern Poverty Law Center, there are 917 hate groups currently operating in the US. What these groups have in common? They share a belief or practice that maligns an entire class of people, typically based on race, gender and religion. As a mental health counselor, I have to ask if extreme hate should be a diagnosable mental illness.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the psychiatric profession’s index for diagnosing psychiatric symptoms. It does not include racism, prejudice, or bigotry and there is no support for future revisions of the DSM to include it. However, there are associations of these beliefs and behaviors that may fall into other categories of mental illness. Some could make a case that extreme prejudice is a form of a delusional disorder, or is an aspect of a personality disorder. It could also indicate paranoid psychotic disorders such as schizophrenia and bipolar disorders. People with these delusions usually have a serious social dysfunction that impairs their relationships and ability to work. They pose a threat to themselves and others and need treatment.

Not every form of hate is problematic but in its extreme form, it poses a threat to the individual and others. There is a difference between ignorance and hostile aggression. For example, psychologist Gordon Allport, in The Nature of Prejudice, categorizes extreme racists’ violence on a five-point scale of 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).” Allport believes that the acting out of extermination fantasies is a classifiable delusional behavior.

Some might believe that because racism and other forms of extreme hate don’t fall into a clear diagnostic category that it cannot and should not be treated. There are differences of opinion among mental health providers about its classification in the DSM. But everyone agrees that it is a social and cultural problem. It is learned or acquired behavior that is expressed in one’s community and must be stopped. Extreme hatred causes extreme crime.

There are a number of conditions that are not specifically listed in the DSM that are nonetheless a focus of treatment. For example, sex addiction and domestic violence lack a diagnostic label, yet people who perceive themselves to be sex addicts and domestic violence perpetrators may be helped in treatment. The same may potentially be true of haters. We need to increase education in the US about this population. We need to address prevention and intervention strategies. One goal of treatment would be to help the person gain insight into their beliefs that support their hateful actions. The person’s healing could stop the cycle of violence. The Southern Poverty Law Center is a change agent dedicated to fighting hate, teaching tolerance, and seeking justice. They do this by using litigation, education and other forms of advocacy.

Perhaps a psychological diagnosis is not a useful way to view hatred. Some people resist calling it a psychological disorder for fear that it will absolve haters of blame for their hateful actions. They prefer to examine hate in a moral context and call it evil, rather than cloak it in a psychiatric term. Extreme hate can be seen through the lens of social psychology, psycho pathology or morality. In any case, I am comfortable naming it evil.

So what can you do? Start by examining your own prejudices. Take a look at where you fall on the Racism Scale at and examine your own biases. Extend this to examine your gender and religious bias. Next, have these conversations with your family and friends. Extreme hatred is a problem that can be seen as an infectious disease that is plaguing our nation. We need to identify the symptoms, name it, and prevent it from spreading.


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