Why bigotry may be a public health problem

People fly into the air as a vehicle drives into a group of protesters demonstrating against a white nationalist rally in Charlottesville, Va., Aug. 12, 2017 | Photo by Ryan M. Kelly/The Daily Progress via The Associated Press, St. George News

FEATURE (THE CONVERSATION) — 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 as a psychiatrist myself.

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 Oct. 27.

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?

The harm to victims and to haters

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.

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 Geeand 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.

But are hatred and bigotry contagious?

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 stated the following:

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.

A public health approach

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.

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.

Written by Ronald W. PiesTufts University.

This article is republished from The Conversation under a Creative Commons license. The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.

The Conversation

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Copyright 2018 The Conversation. All rights reserved. This material may only be published, broadcast or redistributed under The Conversation’s republishing guidelines.

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40 Comments

  • Kilroywashere December 10, 2018 at 1:12 pm

    Very very interesting article. Two things I would like to add. 1) it appears at least in the media from a race perspective white-caucasians are responsible and to blame for 90% of bigotry in this country. Logic dictates this is not the case. Bigotry runs the gamut of all racial lines, and as an example Don Lemon of CNN, (in my opinion) is an outright bigot, yet his actions are considered on a different scale, and tolerated with no recourse, while Megyn Kelly (white as opposed to black media personality) Is nationally castigated and loses her job. If bigotry is addressed as a white only problem then it will not work. Bigotry exists in the black community and Hispanic communities as well as white suburbia. It is simply less prominent in the public domain in certain communities, especially poorer ones. 2) This may sound out of left field, but the original series of Star Trek was responsible for breaking down racial barriers. When Captain Kirk kissed Uhuru (although it was forced to happen by the aliens) that was a first. Star Trek portrayed a future where Russians, Asians, African Americans , women, and even strange dorky aliens all got along and were equal. Our Media is the message. And until we recognize that, bigotry will continue to fester. We need a single standard, not multiple standards, based on different groups and racial lines. PLEASE ACCEPT MY APOLOGY IF I DIDNT SAY THIS RIGHT, as being honest these days gets you in trouble.

    • Comment December 10, 2018 at 1:47 pm

      I’ve experienced forms of racism from hispanics and blacks numerous times. Thankfully none of it involved violence.

      • KR567 December 11, 2018 at 3:49 am

        It’s called karma I hope you were upset about it you get what you give out

    • ladybugavenger December 10, 2018 at 3:47 pm

      I have experienced bigotry just for saying, I love Jesus. Got called delusional too (hi Theone, miss you!!! ❤)

      • KR567 December 11, 2018 at 3:51 am

        Yep …I’ve seen that right here on St George news by one of the commenters

      • theone December 11, 2018 at 11:24 am

        Hi bug! Love you too. Bigotry is hate, thinking it’s delusional to believe something is true when all you have is faith and no evidence is just a reality.

    • bikeandfish December 10, 2018 at 4:53 pm

      Those in the media may discuss racism and prejudice sloppily but its well established that individuals across races can definitely be bigoted and racist. What gets lost in translation is that pundits are often talking about institutional racism and bigotry which is almost exclusively the tool of the majority. But that is a population level issue and doesn’t mean white individuals are explicitly racist.

      It’s important to remember pushing for true equality and universal application of civil liberties is relatively new in the US and bound to be a sloppy ordeal. Expecting it to be succinctly applied in a way that makes the majority feel comfortable isn’t a reasonable expectation. Its uncomfortable to deal with our racist history and its deeply embedded roots in modern society.

  • Comment December 10, 2018 at 1:20 pm

    Is it really bigotry or is it a failure of the religion of fanatical “multi-culturalism”. The agenda being pushed by the “cultural marxists” seems to be failing miserably, and it seems to me they’re real butthurt about it. Humans are a very tribal animal. People prefer to associate with their own racial group. Forcing people together to make a “multi-cultural” or multi-racial society may work if it’s coerced or forced, but that doesn’t mean they want it or enjoy it. Can they change human nature with coercive political policy. I think not.

    • bikeandfish December 10, 2018 at 1:41 pm

      Sorry, but your comment ignores the prominent and longest portion of American history in which the white majority used coercion and political power to oppress minorities. But we are supposed to believe 30ish years of experimenting with protecting the liberties of every citizens is too much? Nice attempt at trying to pull that trick off.

      • Comment December 10, 2018 at 2:22 pm

        Nice try at deflecting, bike. The fact is “multiculturalism” isn’t working, and even you admit that that’s all it’s been is experimenting. It’s a failure. It doesn’t work. You butthurt about it also?

        • bikeandfish December 10, 2018 at 4:13 pm

          Butthurt? That wasn’t even a viable insult 15 years ago. Even John does better than that.

          And its not deflecting when the topic of the article is bigotry and most bigotry in the past and today is directed at minorities.

          Keep flinging useless insults though.

          • Comment December 10, 2018 at 5:53 pm

            Butthurt isn’t an insult, bike; don’t be so delicate. You leftists have been trying the same things over and over for the last 40 years and it’s failed at every step. What do you call that when the same thing is tried over and over and you expect a different result? The only thing we’ve seen with leftist cultural marxist policy is failure. All this leftist policy put in place and the cradle to prison pipeline for black men is flowing as strong as ever. Is that the fault of the racist white patriarchy? Are we not tolerant enough? What’s the solution, bike? I’d sure like to know. Let’s treat bigotry like an epidemic virus, huh? Sounds like insanity to me. More leftist loony fantasy crap.

          • tazzman December 10, 2018 at 6:08 pm

            This is one of the dumbest ideas I’ve ever read about. This is a prime example of what happens when the left runs out of ideas: nuttery.

          • bikeandfish December 10, 2018 at 6:50 pm

            Ha, now you are trying to spin butthurt as not being an insult? Seriously? That is a new level of ridiculous, Comment.

            Not sure you said leftist enough to disguise your illogical ideas. Maybe add a few more next time.

          • Comment December 10, 2018 at 7:11 pm

            Now you’ve reduced yourself to pettiness, bike. Fact is you don’t have anything to add to this discussion except the tired old leftist line of something like “wah wahhh, wahhhhhhh! the mean old white man has been opressing poor downtrodden minorities for 1000s of years!”. Come at it with some original thought and maybe you’ll be worth listening to. 😉

          • bikeandfish December 10, 2018 at 8:02 pm

            The irony is thick with you, comment.

        • bikeandfish December 10, 2018 at 4:57 pm

          PS…. everything social is an experiment, ie lacks any real certainty in outcome. Democracy is one of the biggest such experiments.

          • tazzman December 10, 2018 at 6:06 pm

            We’re not a democracy.

          • bikeandfish December 10, 2018 at 6:52 pm

            Didn’t say we were a pure democracy so I’m not sure of your point.

      • tazzman December 10, 2018 at 2:53 pm

        We haven’t been protecting the individual liberties of INDIVIDUAL citizens the last fifty years but protecting the ethnic and identity GROUPS comprised of individuals. Nice attempt at trying to pull that trick off. Nothing to do with individual liberties. Multi-culturalism breeds division and distinctions, not universal attributes of the pluralistic whole. The latter is a liberal value, the former, a new left radical notion of empowering ethnic and other identity groups and their distinctions and differences.

        • bikeandfish December 10, 2018 at 4:24 pm

          Except your zero sum clsims don’t hold up under scrutiny. Show me how us Caucasians have had our liberty infringed upon.

          And you mythologize our past if you think “universal liberal consensus …kept America tethered together as a nation for over two hundred years in spite of our differences.”. The white majority never protected or respected the liberal concept of individual liberty for all until it was forced by the courts. Are you kidding me with that quote? How is denying citizenship, franchise, bodily autonomy, etc an example of liberal consensus?

          I’m sorry but I’ll call that out for the BS it is every time. Those rose colored lenses don’t reflect the lived reality of minorities in this country for most of its history, including now.

          And the notion that extending those liberties to every citizen is somehow an affront to libersl governance is also BS. You’ll find when you read my comments that those liberties are what I speak to not your bogus boogeymen of “multi-culturalism” and “identity politics”. Speaking to the lived realities of racial, sexual and religious minorities doesn’t diminish the liberties of the majority in any fashion.

          • tazzman December 10, 2018 at 6:04 pm

            “Show me how us Caucasians have had our liberty infringed upon.”

            Strawman. I didn’t say we had our liberties infringed upon. I said you, with your university-tutored rhetoric drenched in racial-identity, and comment, with his own tribalism, focus on extending ethnic-multiculturalism on the left, or ethnic-nationalism on the right. You both are playing up differences based on race that divides people into groups, your faux paens to individual liberty aside.

            bikeandfish:
            “The white majority never protected or respected the liberal concept of individual liberty for all until it was forced by the courts.”

            Uh no, it was forced on less than half of the country by a majority with war, first, and secondly, through the courts, which were staffed completely with white men by the way.

          • Comment December 10, 2018 at 7:16 pm

            LOL. It’s not “my own tribalism”. Maybe we all just sit around the campfire smoking a blunt and sing Kum ba yah and all the races will live peacefully and happily forever after? lmao

          • bikeandfish December 10, 2018 at 8:00 pm

            Nice whitewashing, tazzman. Do you forget how many black lawyers the civil rights movement flooded the courts with to challenge segregation, disenfranchisement, etc? Thoroughgood Marshall argued on Brown v Board case. Its not like “courts” were only staffed by racially benevolent white men as you claim. Black judges existed at lower courts, until Marshall entered SCOTUS, and were a definitive part of civil rights in the judicial system. But the legal battles were (many) won because the Constitution was on their side despite the twisted logic of many who claimed the opposite. And I fully know how many white judges helped forward civil rights rulings;. Once again, there is a difference between speaking about population level issues and individual ones.

            And its another twisted rewriting to claim it was only an issue with “less than half the country” when it came to racial equality. Even if you are obliquely referencing the Civil War you have to understand even most in the “North” didn’t support full liberties for racial minorities.

            Sorry if my summarization of your comments were inaccurate. But you still aren’t being consistent. Explain to me how 50 years of civil rights law isn’t consistent with the founding liberal ideals of our country. How is providing equal rights and access to those its been denied to not in line with “universal attributes of the pluralistic whole”?

            You are completely strolling into lazy tropes and rhetoric about multiculturalism and identity politics without any supporting evidence, especially with your empty allegations against me. Talk about strawmen and red herrings. And its ironic given your retort.

            I love the notion that talking about race and its role in history divides our country. I love the notion that dealing with the unique realities that affect minorities in this country is what divides us. Those approaches are what defines real identity politics, not the boogeymen you stereotype. Your conclusion is an utter bastardization of the truth. To solve problems requires an honest accounting of the real nuances and contexts of the issue. To deal with disenfranchisement you had to talk about denying minorities the right to vote, poll taxes, the terror campaign of lynching etc. And doing so is actually ethically necessary if you believe in liberal ideals of equality and individual liberty. Anything else is empty rhetoric. Same goes with marriage equality, etc. What divides America is that many in the majority deny others life, liberty, and the pursuit of happiness because they have the convenience of political power.

            And PS….is multiculturalism now anything that respects individuals without regard to race, sex, creed, etc? If so, is that supposed to be a bad thing? And if thats not your working definition than you are misapplying it to me.

      • Craig December 10, 2018 at 9:12 pm

        Perhaps we need to live looking through the windshield instead of the rear view mirror.

        All people’s hsve this same type of history, so can we simply move on.

    • tazzman December 10, 2018 at 2:59 pm

      You and bikeandfish have more in common than you think. You both speak of tribalism based on ethnic and racial distinctions. You are just as multiculturalist as he is when you say “people prefer to associate with their own racial group”. Congrats on being a multiculturalist. The left’s identity politics enables and strengthens the right’s ethnic nationalism. Both are working at destroying the universal liberal consensus that kept America tethered together as a nation for over two hundred years in spite of our differences.

      • ladybugavenger December 10, 2018 at 3:50 pm

        I’m white and my husband is Native American. Maybe the hate I have received for all these years is because I’m in a interracial marriage. Jk. It’s because I love Jesus. 😍

        • Kilroywashere December 10, 2018 at 4:20 pm

          We have all experienced Bigotry, hatred, and shunning by others for being different. Some more than others no doubt Could boil down to the length of your hair or even how you dress -especially at a football game on rival turf . The point of the article is the solution. I get humans are tribal, I get the failures of force feeding multiculturalism, and I agree individual liberty cannot be ignored. With that being said, how do you get a solution that not only works for society, but is balanced & fair for all of us? That is the question Hamler or SG news think tank.

          • ladybugavenger December 10, 2018 at 4:49 pm

            One at a time. Be the light!

          • ladybugavenger December 10, 2018 at 5:24 pm

            One at a time. Be the light!
            Life will never be fair! Its right there in the Bible. All over the place. Here is an example: King James Bible
            “Think not that I am come to send peace on earth: I came not to send peace, but a sword.” Mathew 10:34
            “For I am come to set a man at variance against his father, and the daughter against her mother, and the daughter in law against her mother in law” Mathew 10:35
            ” a man’s foes shall be they of his own household” Mathew 10:36
            “He that loveth father or mother more than me is not worthy of me: and he that loveth son or daughter more than me is not worthy of me.” Mathew 10:37
            “He that taketh not his cross, and followeth after me, is not worthy of me.” Matthew 10:38
            “And he that findeth his life shall lose it: and he that loseth his life for my sake shall find it.” Matthew 10:39

            You can read the rest… you see, life will never be fair because not all choose Jesus.

            Just be the light in this dark world and make a difference in someone’s life.

            You know when my family was homeless, it was dark, and in 11 months of homelessness there were people that brought us light:

            One lady at the post office, said she would pray for us. The owner of a motel that protected us. The catholic church people that gave us a voucher for rooms. The homeless shelter workers were full of love. The soup kitchen workers that had a smile and just loved us and didnt look down on us. The church workers that gave us clothes. Congresswoman Linda Sanchez for meeting us and giving us Christmas gifts and got us in touch with Telecare in La County. The telecare workers. The food ministries. The Chalvary Chapel parishioners that fed us and befriended us. And the La Habra, Ca policeman who contacted the Chaplin and bought us a motel room (that was the last night we were ever a homeless family)

            Amongst the darkness there was some light. Be the light!

          • ladybugavenger December 10, 2018 at 7:26 pm

            And I also like to thank you personally, killroy. Maybe our paths crossed maybe they didn’t. And I would also like to thank all of you in St George. In St. George, we found refuge. Our lives turned around and i felt protected. My husband, on the other hand, felt discriminated against because hes Native American. Maybe, all you white people can work on that. But with no doubt, you have the best heart doctors and saved my husbands life when he had a heart attack and a quadrupal bypass. Forever, I will be grateful for that. But here we are in oklahoma where my husband was raised. I’m a white woman amongst a ton of Native Americans. I love them and they love me and maybe I’ve changed a perception in a persons life about white people. Idk. But I like to think I have. Forever grateful to the city of St George, it’s people and its employees and to St George News for giving me a place to share my life. Y’all have a Merry Christmas and a Happy New Year. May you all be blessed.

          • Craig December 10, 2018 at 9:17 pm

            We maintain the right of free speech, we stop trying to be offended by everything, we accept life is not fair, we work hard and make something of ourselves, and we look back at a life well-lived.

            It’s an individual choice.

    • KR567 December 11, 2018 at 3:55 am

      This article is right up alley ! racism. hatred . degrading people because they believe in religion oh yeah this is all about you…

  • bikeandfish December 10, 2018 at 4:42 pm

    The author provides a strong argument for approaching bigotry from a disease model perspective. We’ve known for decades that racial prejudice has significant health effects on minority populations and now the author highlights the damage hate plays on the oppressor.

    Implementing etfective and meaningful public health policy won’t be easy. If we approach it from a disease model than we view the issue at the population level. In that way society and culture are part of the body. And as we see in the other responses here, the immune system is kicking in. In this case it’s most like an autoimmune disorder. Something as foreign as targeting bigotry is to be attacked to protect society’s homeostasis. Sadly that strategy still lives minorities vulnerable.

  • Real Life December 10, 2018 at 4:44 pm

    Bigotry is indeed a health problem. And it’s not a one sided issue. Just like the KKK and “alt right” movement, Antifa and BLM should also be labeled what they are, hate groups.

  • Redbud December 10, 2018 at 5:52 pm

    I am against bigotry, which is why I voted for Trump! We should be thankful to have such a wonderful president!

  • bikeandfish December 10, 2018 at 8:07 pm

    So, Tazzman, add some substance to your claim that this is nuttery.

    Did you research any of the studies that prove bigotry and racism affect the health of both the person discriminating and the one discriminated against? If so, what about those findings is so absurd?

    If you agree with those findings, then why shouldn’t the issue be considered from the perspective of public health?

  • Red2Blue310 December 10, 2018 at 8:41 pm

    Figures so many bigoted comments from the most white audience in the US.

  • Craig December 10, 2018 at 9:18 pm

    We maintain the right of free speech, we stop trying to be offended by everything, we accept life is not fair, we work hard and make something of ourselves, and we look back at a life well-lived.

    It’s an individual choice. (And, we don’t need more excuses for bad behavior)

  • Happy Commenter December 13, 2018 at 2:33 pm

    B&F would also have you believe that if you hate sushi a law can force you to like it. Keep deflecting and chasing those rabbits b&f.

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