Some of our members have suggested that racism is a form of psychiatric illness. They believe that failure to recognize it as a psychiatric disorder means that racist individuals will not receive the treatment they need to end their false beliefs. They have even suggested that racism should be included in the DSM. During the development of all recent versions of the DSM, psychiatric illnesses considered for inclusion were subjected to a rigorous search of the scientific literature, data analyses, field trials, multilevel reviews by more than 1,000 psychiatrists, and input from APA components and more than 60 outside organizations. In the past one of the DSM work groups seriously evaluated racism and concluded that it did not meet the criteria for a psychiatric illness.

I was reminded of this subject when I read the Los Angeles Times today and was struck by the juxtaposition of two stories on the front page. The first was about Auschwitz and the second about neo-Nazis in Idaho. Even though Nazis and neo-Nazis are clearly racists, it is hard to imagine that they all have the same psychiatric illness. On the other hand, I have no trouble believing that some racists have a serious psychiatric illness for which there is a diagnosis in our DSM.

Much has been written about groups following so-called charismatic leaders and the individuals in the groups allowing the leader’s commands to replace their own critical reasoning. Is it possible that all the members of all groups that follow strong or influential leaders have the same psychiatric illness? Does this include religious groups? If we agreed that some groups represent families that the individual participants longed for, does that mean all the individuals are mentally ill?

Brutal, violent hate crimes are usually committed by mean, not sick, individuals and groups. We must not provide the convenient excuse of mental illness for those who are not genuinely ill. In the instances in which an individual has a psychiatric illness, our criminal justice system makes a clear distinction between those whose illness prevents them from knowing right from wrong in contrast to those whose illness has little bearing on their criminal behavior. Should individuals with antisocial personality disorders and no other psychiatric illnesses be excused for their crimes because they are "mentally ill"? Of course not.

Although we have evidence of strong genetic influences for some psychiatric illnesses, there is none for what I see as a continuum in humans from nonjudgmental to racist attitudes. We do not come into this world possessing judgmental thoughts toward others. However, during our upbringing, we all develop preferences as to what is good or better. We may prefer to associate with some groups more than others and may even develop judgments that the group we prefer is better than other groups. These normal human tendencies are central to the development of prejudices. Preference becomes prejudice when we develop negative judgments toward groups of people who have done nothing to deserve our critical attitudes toward them. They are just different from us in some way—ethnic, cultural, religious, for example. Such attitudes may be shaped by environmental influences, social pressures, or our own insecurities. Prejudice is often accompanied by distrust and suspiciousness. The next step along this continuum may be dislike or even hatred toward others who belong to a particular group. In extreme cases, prejudice can lead to violence. Racism exists when one racial group is prejudiced toward and discriminates against another racial group. Extreme racism fosters violence toward members of another race.

Embracing our roots and feeling good about who we are is a part of healthy self-esteem. At times, feeling good about ourselves includes feeling superior in relationship to others. Recognition of such prejudicial tendencies in ourselves is essential in overcoming them. Introspection about these tendencies is important for individuals. As psychiatrists, it is imperative.