Unanswered Questions

From the Editor

Each year around Martin Luther King Day, there is a flurry of articles and media commentary addressing the continued existence of discrimination. Then, with the next wave of an increasingly short news cycle, the issue fades from public conversations. This year has been different, with the backdrop of Trayvon Martin’s death 2 years ago, and now in Ferguson, Staten Island, and elsewhere, the conversation has been lengthier, broader, and more emotional than usual.

And with the violent events in Paris last month and in almost every continent sometime in the past year, racial, religious, ethnic, and political intolerance have seemed to be increasing causes of violence. Martin Luther King Day this year celebrated his legacy of improving human rights as it should but also was marked by outrage at their erosion.

As a profession we’ve been far too silent on the issue of what I’m calling violent intolerance. Violent intolerance seems to be on the rise, and we must contribute more of our understanding about the origins of these problems, and to development of solutions to reverse these trends. I’m referring to acts by both those who perpetrate violence that is, or may appear to be, due to discrimination or intolerance, as well as those who state they are reacting to discrimination against themselves and/or a group to which they belong.

Psychiatrists’ first obligation is to the patients we serve. But, we also serve society, sanctioned by laws, to evaluate individuals who may pose an imminent risk to themselves or others and to reduce those risks by disclosing the threats and providing treatment when possible.

In addition, and of critical importance for this discussion, we have a public health responsibility to promote greater access to care; to develop more effective treatments; to provide public education; and to give support to government, business leaders, and other societal decision makers in the development of policies and programs to promote mental health, enhance prevention, and minimize the impact of psychiatric disturbances. It is especially in this advocacy role that we have been less effective in regard to violent intolerance.

We-and our colleagues in other mental health professions-benefitting from an increasingly diverse group of colleagues, know a good deal about human development and the deleterious effects of discrimination. The impact of discrimination on self-esteem and the role of the resulting humiliation on development, for example, have been studied for decades, and this knowledge informs our treatment. We need to apply this knowledge not only in our treatment of those patients who have been subject to violent intolerance and those at risk to act violently, but also to better inform the development of public policies and programs.

For example, the concerns about the role of discrimination in interactions of law enforcement officers with members of minority groups is nothing new-whether in the United States or in many other countries. To help address these concerns, and to help provide officers with the knowledge and tools to perform their duties more effectively, training programs led by mental health personnel, often involving psychiatrists in central roles, have been implemented around the country to provide education about psychiatric disorders and non-violent methods to engage with agitated, aggressive, or potentially violent individuals.

The success of these efforts has been demonstrated in reducing harm to both officers and the individuals who they have been called to assess. But, the resources devoted to such programs are sorely inadequate, and the educational component about discrimination and intolerance is highly variable. We haven’t needed the recent months’ news reports to tell us much more work must be done.

We’d also be able to better help our patients, contribute to critically important societal discussions, and influence policy decisions if we really made learning more about violent intolerance a more prominent aspect of our research, scholarship, teaching, and training. We need not only much more research and study, but even more importantly, we need the broader dissemination of what has been learned so that a better informed and broader group of people become involved.

For example, the Web site of the National Consortium for the Study of Terrorism and Responses to Terrorism (http://www.start.umd.edu) at the University of Maryland is such a resource; although, I think it’s little known in psychiatry. There is a compendium of research studies and an immense database of terrorist actions that are quantified in a number of ways. Their criteria include acts that are “aimed at attaining a political, economic, religious, or social goal” and that there should be “evidence of an intention to coerce, intimidate, or convey some other message to a larger audience (or audiences) than the immediate victims.”

Clearly, not only acts that are considered terrorism in common parlance, but also acts I am characterizing as violent intolerance are catalogued. This is the kind of information, and there is much more on the Web site and in other places as well, that psychiatrists should assess, digest, and use to better inform ourselves about what gaps in our knowledge exist regarding better understanding of the roots and remedies for violent intolerance in the clinical and public policy arenas.

It is clear to me that better understanding and more thoughtful discussion within our field and across all stakeholders is needed. Such discussions will help us with our patients and will start us on a path to overcoming our reticence to contribute to the public discussion about the violent intolerance that torments individuals and societies.

While I’ve given a few suggestions about areas of need for our profession, my main goal here is to stimulate a broader discussion within our field and across disciplines. I hope many of you will contribute to that discussion by sharing your thoughts on the subject on our Web site, www.psychiatrictimes.com.

Martin Luther King Day acknowledges his legacy in improving the human condition and of those who have taken steps, small or large, to making a positive change. No matter where we work or our specific responsibilities, let’s apply our understanding and healing powers to this dangerous pandemic of violent intolerance, whether, racial, ethnic, religious, or political. I know there’s much more we can do.