Reconsidering the Clinical Utility of Bias as a Mental Health Problem: Intervention Strategies for Psychotherapy Practice.

Abstract

Pathological forms of bias, an area unaddressed by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), are considered in terms of diagnosis and treatment. Three clinical criteria of pathological bias are proposed: intrusive ideation, aversive arousal, and relationship-damaging behaviors in contexts of intergroup contact. A model of treatment is presented, encompassing dialogical, pharmacological, behavioral, and contextual interventions. Development of a research agenda addressing the clinical utility of pathological bias needs to examine the patient’s functional impairment, risk to commit bias-motivated aggression, and ability to benefit from treatment. Establishment of a reliable and valid methodology for psychotherapy research, as well as the legal and public health implications of viewing bias as a mental health problem, are discussed. Bias as a mental health problem has received very little attention over the past half-century. During this same time, discrimination and intergroup conflict have been recognized as a chronic social problem (Duckitt, 1992), a biological risk factor for the targets of biased behavior (Clark, Anderson, Clark, & Williams, 1999), and a legitimate civil rights issue in the courtroom (Griffith & Griffith, 1986). Racism, for example, may constitute a mental health problem for individuals who experience intense ego-dystonic affects concerning intergroup experiences (Frosh, 1989; Pinderhughes, 1989). Clinical problems of bias may include hostile racist behaviors, fearful preoccupation with cultural out-groups, or the commission of violent crimes that target members of a racial, ethnic, or sexual minority group. In this article, pathological bias is discussed in terms of current and future diagnostic decisions, as well as the multiple pathways for mental health treatment. There has been very little consideration in contemporary mental health literature concerning bias as a clinical problem. As a consequence, there is no standard of treatment for patients who demonstrate severe forms of racist beliefs and concerns. During the 1940s and 1950s, the study of intergroup problems was frequently explained in terms of psychodynamic models (Adorno, Frenkel-Brunswik, Levinson, & Sanford, 1950; Dollard, Doob, Miller, Mowrer, & Sears, 1939). Subsequent decades of social science research has demonstrated that these pathology-based explanations are inadequate to account for outgroup stereotyping and institutional forms of discrimination. Although this is certainly true, it will be argued that mental health problems related to out-group bias are inadequately represented by attitude research conducted with nonclinical samples. Rather, the study of pathological bias I would like to thank Drs. Carl Bell, Alice Chang, and Megan Sullaway for their encouragement in the preparation of this article. Correspondence regarding this article should be addressed to Edward Dunbar, EdD, Pacific Psychological Associates, 2221 Rosecrans Avenue, Suite 211, El Segundo, CA 90245. E-mail: edunbar@ucla.edu Psychotherapy: Theory, Research, Practice, Training Copyright 2004 by the Educational Publishing Foundation 2004, Vol. 41, No. 2, 97–111 0033-3204/04/$12.00 DOI 10.1037/0033-3204.41.2.97