When Bigotry Becomes Madness Christian extremist Anders Behring Breivik has confessed to committing the recent Norway attacks. Did insanity or pure evil trigger his actions? Host Michel Martin and psychiatrist Dr. Carl Bell discuss whether there's a link between extreme racism and mental illness. Bell is among the authors of The Oxford Handbook of Personality Disorders.

When Bigotry Becomes Madness

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MICHEL MARTIN, host: Now to an issue that's been on many of our minds since that tragic attack in Norway last week. Anders Behring Breivik confessed to the attacks that left more than 70 people dead. He said that he believes Europe is at war with Islam and his actions were necessary. Breivik's lawyer, Geir Lippestad, spoke today at a press conference.


GEIR LIPPESTAD: This whole case has indicated that he's insane.

UNIDENTIFIED MAN: But does he say - have you asked him, are you insane? What does he say?

LIPPESTAD: He's in a war. And he says that the rest of the world, and especially the Western world don't understand his point of view.

MARTIN: Sadly, this is a question we have been forced to grapple with too often in recent years. But we are going to ask it again. What is the line between extreme views and mental illness? Our next guest has been researching this question for some time. Dr. Carl Bell is the co-author of a chapter on this subject for the forthcoming Oxford Handbook of Personality Disorders. He's a professor of psychiatry and public health at the University of Illinois.

He's been kind enough to speak to us from time to time on issues related to mental health. And he's with us once again from member station WBEZ in Chicago. Dr. Bell, welcome back to the program. Thanks so much for joining us.

CARL BELL: Thank you.

MARTIN: And I do want to clarify that you have not examined Mr. Breivik. So you don't have any firsthand knowledge of his mental state. To our knowledge he's not yet been examined by mental health professionals in his country. But just given your research on this question over the years, what is the line? The lawyer, his attorney seems to believe that his actions on its face indicate that they're mentally ill. Do you think that's true?

BELL: No, absolutely not. A lot of people do a lot of strange, hostile, negative behaviors to what they consider to be out groups. But that doesn't mean that they are legally insane, which means that they cannot tell the difference between right and wrong or they are suffering from some irresistible impulse which is forcing them to act. That's the legal criteria. So you can have a psychiatric disorder and not be insane.

MARTIN: Now, the American Psychiatric Association does not at this point recognize extreme racism as a mental disorder, does it?

BELL: No, it does not.

MARTIN: Do you think that it should?

BELL: Well, I think that I can't answer that because right now the science is not strong enough to say that it should or it shouldn't. However, the American Psychiatric Association did release a position statement, which said that this needs to be considered and they sort of outlined this notion that racist behavior or pathological bias is a concern for people's mental health and that it should be studied and that it's probably very likely a very complex issue.

You know, there's always nurture and nature as a cause for behavior. And so at least they went that far. But the hard science to say that we can tease out these issues is yet to be discovered.

MARTIN: How do you differentiate between what you call a pathological racist and somebody who has been, you know, taught to believe extreme - who just simply holds extreme views. I mean, we're not too far removed in this country from a time when people had very different views about the humanity and the basic dignity and worth of individuals of different races, particularly people who are of African descent, where it was just customary, if you part of a, you know, white majority to believe that persons of African descent were just lesser beings and therefore not worthy of the kind of human dignity that one would accord to members of the same group. And all kinds of behavior flowed from that.

BELL: Sure.

MARTIN: So how do you differentiate between kind of some pathological behavior and behavior that is part of the culture or...

BELL: Learned.

MARTIN: Or, yeah, learned. Part of the culture.

BELL: Yeah. Yeah. No, I mean, you know, you've got behavior, which is on the outside. And then you've got to look deeper inside to see if there is a psychopathological reason for that behavior, other than it's simply taught and adopted and learned.

So that, for example, if a person has a pervasive pattern of being just constantly thinking about out groups, constantly being negatively aroused with just the slightest little bit of out group contact, or who - it really gets into a lot of interpersonal difficulties with out group contact that's minimal. Then you have to wonder whether or not there's something a little deeper inside their personality or potentially that they could be psychotic, which would cause this extreme behavior.

MARTIN: Why don't you break it down for us. You mean somebody who recoils from the touch of a person who's of a different race, who just can't stand to be around people of a different race. Who feels that they would be harmed if somebody were to put change in their hand - something like that?

BELL: Something like that. Being generally afraid of - you know, you're in an office building downtown and a person of color gets on the elevator and you are fearful of your life or you get extremely hostile towards them. You become extraordinarily upset, start to have panic and anxiety 'cause they're on the elevator with you. I mean, that's a little bit extreme.

MARTIN: Could it go the other way? Could members of minority groups feels that way about members of the majority and that also be pathologically racist?

BELL: Well, I think that it could go to the other extreme in terms of any time you an in group, out group interface there's always the potential for anxiety, fear, concern, being on guard for very various subtle insults. Or to that matter, overt hostile behavior. I mean, come on. There's some neighborhoods in Chicago that I would not dare step foot in because I know better.

MARTIN: And Dr. Bell, there are those who just feel that this line of inquiry, conversation that we're having is - I don't want to say dangerous, but is something that takes away the moral responsibility for these kinds of acts. And I wonder whether you - would you address that point? There are some people who feel that we shouldn't even be having this kind of conversation around somebody who behaves in this way.

BELL: Yeah. No, I understand that because they're concerned that sort of a diagnosis of pathological bias or racism would remove the responsibility for somebody's behavior. But the reality is if you look at any court of law for people in, say, for example, murder, some people who are, say, classically schizophrenic will on occasion, rarely, though, murder somebody.

But that doesn't mean just because they have a diagnosis they do not - they can't tell the difference between right and wrong or that they're being driven by some irresistible impulse. And so you have to have a court proceeding regardless of whether somebody has a diagnosis or not to determine responsibility.

MARTIN: And, finally, Dr. Bell, you said that the science isn't there yet to really make that link definitely. How would one pursue this question? What kind of research would be helpful if we know to pin this down definitively. I mean, we've been thinking about this for an awfully long time.

BELL: Sure.

MARTIN: I mean, it seems to me at least since the Nazi era, people have been wondering, you know, why would people behave in that way? Who would do that?

BELL: Yeah. Well, the research that we've uncovered so far is that there are personality tests which indicates prejudice, which seems to have a pathological core. There's also some neuro imaging around brain - specifically the amygdala, which is the fear part of the brain. And when you show certain people out group photos that part of the brain lights up.

There's the Implicit Association Test, which you show pictures of out group people and then ask for words. And people come up with negative, hostile words. There's also hormonal stuff. You know, oxytocin is the bonding attachment hormone and there's been some evidence that people who are strongly bonded and attached to certain in groups because of this oxytocin are very hostile toward out groups.

So, again, you've got brain function, you've got personality tests, you've got hormonal stuff, you've got learned behavior. Behavior is multi-determined and if we can tease out the various aspects of these hostile, negative, extreme behaviors, maybe we can prevent some of them.

MARTIN: Dr. Carl Bell is a professor of psychiatry and public health at the University of Illinois. He co-authored a chapter in the forthcoming book, "The Oxford Handbook of Personality Disorders" on the possible connection between extreme racism and mental illness. And he was kind of join us from member station WBEZ in Chicago.

Dr. Bell, thank you so much for taking the time.

BELL: Thank you.

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