The Deadly Collision of Racism and Mental Illness
By Eyal Press
"Mr. Press is a writer and the author, most recently, of “Dirty Work: Essential Jobs and the Hidden Toll of Inequality in America.”
On April 29, 2021, around 3:45 p.m., Carl Chan, the president of the Oakland Chinatown Chamber of Commerce in Oakland, Calif., was walking along Eighth Street not far from the Chinatown district when a stranger struck him on the back of the head. The blow sent Mr. Chan, a slight man in his early 60s, tumbling onto the pavement. His glasses flew off his face and his left knee, which broke his fall, was scraped and bleeding. According to Mr. Chan, the stranger shouted an anti-Asian racial slur before ambushing him.
Less than an hour later, the Oakland police arrested Mr. Chan’s assailant, a 25-year-old man named James Lee Ramsey. Before the attack occurred, Mr. Ramsey had been in San Francisco, he told the officers who brought him into custody, where, according to the police report, he’d seen “crazy things,” such as “half-dog and half-humans and half-cats and half-humans.” Mr. Ramsey, who was homeless, had been diagnosed with bipolar disorder and schizophrenia, the officers who interrogated him learned, for which he’d been prescribed medication — medication he said he had stopped taking.
Since the start of the pandemic, a wave of violence against Asian Americans has swept across the country, brazen assaults in which victims were spat on, punched, shoved off subway platforms, fatally stabbed and shot. In a striking number of the attacks that have made the news, the individuals arrested have, like Mr. Ramsey, turned out to have severe mental health problems.
In New York City, a brutal string of attacks on Asian Americans took place in March 2021, among them a shocking incident near Times Square involving a Filipina woman who was repeatedly stomped on the head in broad daylight. Police and investigators reportedly believed that of the seven individuals arrested in these incidents, all of them had shown signs of being emotionally disturbed, prompting Tommy Ng, who was then the head of the New York’s Asian Hate Crimes Task Force, to describe mental illness as a “common denominator” in the spate of assaults.
Although hate crimes targeting Asians have declined in New York through the first half of this year, the overlap between bias attacks and mental illness has persisted. In May, the N.Y.P.D. announced that, of the 100 people arrested for hate crimes in the city through the first four months of 2022, nearly half had previously been designated as emotionally disturbed by the police.
Given this pattern, talking openly about the role that mental illness may play in racially motivated violence seems overdue and necessary. But there are reasons conversations on this subject are also dangerous and fraught. Some people may fear that having such discussions will reinforce negative stereotypes, in particular by playing into the widespread perception that the mentally ill are violent and dangerous. In reality, people who experience mental illness are far more likely to be the victims of violence than to carry it out, notes Carlos Cuevas, a clinical psychologist and professor at Northeastern University who studies hate crimes.
Another danger is that mental illness may be invoked to deflect attention from the rhetoric and ideas that inspire acts of violent extremism. Consider how quickly some influential figures on the right cited mental health to explain the conduct of Payton Gendron, an alleged white supremacist who has been charged with murdering 10 Black people at a Tops Friendly Market in Buffalo on May 14. (Mr. Grendon has pleaded not guilty.) Mr. Gendron is believed to have meticulously planned his attack and laid out his rationale in a 180-page racist and antisemitic manifesto that professed adherence to the “great replacement theory,” the conspiratorial notion that elites are trying to replace white Americans with nonwhite immigrants. This did not stop the Fox News host Tucker Carlson from rushing to label Mr. Gendron a “mental patient” whose “crazy” manifesto was not a political document but the product of a “diseased” mind. It was a convenient way for Mr. Carlson to explain away the murderous rampage that Mr. Gendron allegedly carried out and the racist ideas he seemed to espouse, some of which Mr. Carlson has popularized on his show.
The journalist Jeff Sharlet, who has written extensively about right-wing extremism, offered a different interpretation of Mr. Gendron’s manifesto. “Let there be no talk of ‘mental illness,’” he tweeted as he was reading the text online,. “This document is very cogent, articulate fascist hate, directly linked to fairly mainstream far-right ideas” — ideas that help explain why hate crimes targeting Latinos have escalated in recent years, as have attacks on Blacks, who are by far the largest victims of such violence. In the past, mental illness has also been invoked selectively, reserved for the members of some racial and religious groups far more often than others. “If you’re a white person and you kill a bunch of Muslims, you’re crazy,” said Stephen Hart, a professor of psychology at Simon Fraser University in Canada who studies violence risk among psychologically disordered individuals. “But if you’re a Muslim and you kill a bunch of white people, suddenly it’s terrorism.”
A decade ago, some Norwegians felt that the label of mental illness was mistakenly applied to Anders Breivik, a right-wing extremist who, on July 22, 2011, murdered 69 people at a youth camp run by the left-wing Labor Party after killing eight people in Oslo earlier that day. Like Mr. Gendron, whom he apparently inspired, Mr. Breivik explained his reasoning in a racist screed that called for deporting all Muslims from Norway and inveighed against “cultural genocide against the Indigenous peoples of Europe” (by which he meant white people like him). Afterward, he exhibited no remorse, as one might expect of a mission-driven zealot who saw it as his duty to kill leftists responsible for allowing Muslims into Europe.
But, as Asne Seierstad writes in “One of Us,” her book on Mr. Breivik, two court-appointed forensic psychiatrists interpreted his lack of empathy another way: as a symptom of paranoid schizophrenia, which in Norway meant Mr. Breivik would be sent to a psychiatric hospital rather than to prison. The diagnosis was made despite the fact that Mr. Breivik himself described the mass murder he committed as a political act, a deliberate slaughter he willfully executed in accordance with his beliefs. As in Mr. Gendron’s case, these beliefs were not Mr. Breivik’s alone. They were shared by some members of the Progress Party, an anti-Muslim party to which Mr. Breivik had belonged. (Its leaders condemned his actions.) A second psychiatric evaluation subsequently concluded that while Mr. Breivik exhibited signs of dissocial personality disorder and “narcissistic traits,” he was not psychotic, clearing the way for his trial and conviction.
As Mr. Breivik’s case shows, determining who should be classified as a mentally ill offender is not easy, not only for diagnostic reasons but also for moral and political ones. In his book “Hatred: The Psychological Descent Into Violence,” the psychiatrist Willard Gaylin argues that the ubiquity of psychodynamic interpretations of destructive violence risks trivializing it.
To illustrate the danger, Dr. Gaylin cited the response of Cardinal Bernard Francis Law, the archbishop of Boston, during the deposition for the trial of John J. Geoghan, a Catholic priest who was found guilty of groping a 10-year-old boy and accused of raping and molesting more than 130 children, abuses his superiors knew about for decades. “I viewed this as a pathology, as a psychological pathology, as an illness,” said Cardinal Law about such allegations. It was a striking departure from the kind of rhetoric the church typically used when condemning conduct it regarded as immoral, like homosexuality and abortion. It also underscored what can happen in a culture “where nothing is either wrong or right, only sick or healthy,” Dr. Gaylin contends, “where nothing is deemed punishable, only treatable.” To confront violent hatred, we need to be able to name and identify it as evil, Dr. Gaylin maintains, an imperative that therapeutic language can stunt. “If all aberrant behavior were sick, there would no longer be any room for judgment,” he argues.
But acknowledging the role that mental health problems can play in hate crimes does not require downplaying their perniciousness or diverting attention from the inflammatory language and ideas that can fuel their rise. Too often in America, there seems to exist a false binary: medical problems versus political ones. The truth is that it’s often impossible to disentangle the internal experience of mental illness from the external social and political forces shaping the world. And the mentally ill are no more immune to these forces than the rest of society. One reason the rhetoric of figures like Mr. Carlson is so dangerous is that it can seep into the culture and eventually help trigger an angry, mentally unstable individual to act violently. It may fuel stochastic terrorism — violence inspired by incendiary rhetoric whose eruption is predictable even if the specific details are not.
In 2019, a gunman in El Paso, Tex., opened fire at a Walmart, killing 23 people, many of them Latinos. The alleged perpetrator, a 21-year-old white man named Patrick Crusius, who has pleaded not guilty, is, according to his lawyers, psychotic, but his choice of targets hardly seemed random. Before committing the mass shooting, investigators believe he posted a manifesto on 8chan decrying the “Hispanic invasion” of America, a sentiment voiced by a growing chorus of xenophobic figures on the right in recent years, most notably Donald Trump.
Edward Dunbar, a professor of psychology at the University of California, Los Angeles, who researches bias-motivated crimes, does not find it surprising that during the pandemic, as anti-Asian rhetoric swirled through public discourse — not least thanks to Mr. Trump, who repeatedly referred to Covid-19 as the “Chinese virus” and “kung flu” — some people with mental health disorders acted on it. As Professor Dunbar noted, one thing that can cause hate crimes to surge is when public leaders demonize a group, effectively sending society a message that there will be no social cost to harming its members. No one should be shocked when individuals who are impulse disturbed or suffer from persecutory delusions end up lashing out, Professor Dunbar said, particularly when the demonized group is perceived to be successful — an assumption that has long been made about Asian Americans — by individuals whose mental health struggles may be compounded by homelessness or poverty. “As with previous waves of antisemitism, the resentment at Asians is directed toward those who’ve done well and are doing better than you,” Professor Dunbar explained.
In this respect, it’s worth noting that most of the mentally ill people who were arrested for assaulting Asians in New York City during the pandemic weren’t just emotionally disturbed. Many were also destitute — people like Martial Simon, a Haitian American with schizophrenia who in recent years had been spotted at a soup kitchen mumbling angrily to himself. Much of his fury was directed at doctors and the medical establishment, owing to the fact that, again and again, Mr. Simon had been hospitalized and then abruptly discharged before he felt stable.
Like thousands of mentally ill people in New York, Mr. Simon was repeatedly left to fend for himself on the streets, cycling through jails and hospitals for years without access to steady housing or remotely adequate psychiatric care. On one occasion in 2017, he apparently told a psychiatrist that he feared he would at some point push a woman off the subway tracks. The warning did not stop him from being released yet again. Some four years later, on Jan. 15, he shoved Michelle Alyssa Go, a 40-year-old Asian-American woman, in front of a southbound R train, killing her instantly. “Oh Lord, please,” Mr. Simon’s sister saidwhen she heard the news. “To know my brother cost somebody their life, not because he’s a bad person but because he didn’t get help? It’s unbearable.”
The way we talk about such crimes often plays into a false dichotomy, pitting victims against advocates for the mentally ill. This is what happened in Oakland after the attack on Carl Chan made the news and prompted Nancy O’Malley, the Alameda County district attorney, to charge Mr. Chan’s assailant, Mr. Ramsey, with two counts: “assault with force likely to produce great bodily injury” and a hate crime. That Mr. Chan was targeted because of his race seemed obvious enough to his supporters in the Asian American community. It seemed anything but obvious to some local activists, particularly as the severity of Mr. Ramsey’s mental health problems came to light and doubts were raised about whether animus towards Asians had motivated him. At a preliminary hearing, Mr. Ramsey’s public defender pointed out that Mr. Chan didn’t mention being called a racial slur when he first reported the assault to the police, leading some to question the veracity of this claim. (He did report the racial slur the next day.) “Mental Illness Is Not a Crime,” proclaimed a flier circulated by the Anti Police-Terror Project, a grass-roots organization that favors keeping mentally ill people out of the criminal justice system and that soon called for the charges against Mr. Ramsey to be dropped. (The hate crime charge against Mr. Ramsey was eventually dropped.) In the view of Cat Brooks, the group’s co-founder, what happened to Mr. Chan was not a bias attack but the predictable consequence of Mr. Ramsey’s mental illness, which she believes could just as easily have led him to attack a non-Asian person. “This just wasn’t a hate-based crime,” she told me.
Underlying this view is the belief that a person afflicted with severe mental health problems who engages in violence is too disconnected from reality to be aware of who they are attacking. In some cases, including that of Mr. Ramsey, this may be true. But in other cases, bias and mental illness, even severe mental illness, can coexist. This was true in the case of Patrick Crusius, the mentally disturbed, alleged white nationalist who is accused of killing scores of Latinos in El Paso in 2019. It was true as well of Arthur Martunovich, a construction worker who, that same year, allegedly stormed into the Seaport Buffet, a Chinese restaurant in Brooklyn, and bludgeoned three workers to death with a hammer. All three of the victims were Asian. Mr. Martunovich, who had a history of mental health problems, was reportedly inspired by a movie he’d watched that depicted Asian men as abusive to women and believed that he was acting as a savior. He spared the restaurant’s non-Asian workers. “This was a racial hate crime, plain and simple,” City Councilwoman Margaret Chin said after the gruesome details came to light. But this January, the Brooklyn Supreme Court judge Danny Chun ruledthat Martunovich had a “dangerous mental disorder” and was therefore “not responsible” for his conduct, sending him to a psychiatric facility rather than to prison. The ruling incensed the widows of the men who were killed. “I’m very upset, I’m outraged,” one of them said afterward. “I feel like there’s no justice here.”
If bias has played no role in the hundreds of attacks against Asian Americans carried out by people experiencing mental illness during the pandemic, why have people of Asian descent continued to be targeted?
We need to stop using mental illness to argue that attacks targeting the members of particular ethnic, racial or religious groups are not motivated by bias. But we also need to take mental illness into account when deciding how to respond to these crimes and how to treat the perpetrators in individual cases. It’s only by breaking down the binary between the medical and the political that we can begin to make sense of individuals’ actions — and to think about how to reform them. Even if definitive proof of bias had emerged, it’s worth asking whether a person as debilitated as Mr. Ramsey should ever be placed in the same legal and moral category as violent extremists like Mr. Gendron.
“The guy with a swastika who attends a weekly hate group meeting is likely much more culpable than the person who was off their meds, psychotic, and pushed somebody because they’ve been hearing all this rhetoric about Asians and the virus,” said Professor Cuevas, the clinical psychologist. “Is the person who was victimized still victimized? Yes, and that should not be minimized. But the culpability of the perpetrator and the mechanism by which the perpetrator got there is very different.”
To the targets of hate crimes, drawing such distinctions might seem like a way to downplay their suffering. But doing so could have the opposite effect, calling attention to the actual sources of hate, from online platforms and media personalities that inspire stochastic terrorism by popularizing ideas like the great replacement theory to the broken social safety net that fails people like Mr. Simon.
In the 1990s, a typology of hate crimes was introduced that sorted offenders into different categories based on their motivation, from those who saw it as their life’s mission to rid the world of the group they revile to those who did it for the thrill. Based on a detailed analysis of hundreds of cases, the typology, which has been used by law enforcement agencies across the country, makes no mention of mental illness, though not for lack of evidence of its existence. “It’s always been a part — maybe an unrecognized part — of many acts of hate-motivated violence,” said Jack McDevitt, a criminologist who helped develop the typology and now directs the Institute on Race and Justice at Northeastern University.
Brian Levin, director of the Center for the Study of Hate and Extremism at California State University, San Bernardino, has proposed creating a separate classification for offenders with mental illness, as a way of signaling that their cases are different. Doing so would have one immediate practical benefit, Mr. Levin said. “It would get these offenders treatment as opposed to putting them into a system of incarceration,” he said.
Imposing harsh criminal sanctions on such offenders is indeed likely to be ineffective. A better approach would be to invest resources in the broken mental health systems that leave so many highly unstable people with no access to long-term care. Addressing other social problems would also help: A growing body of research suggests that people with severe mental illnesses are more likely to engage in violence when exposed to other risk factors, from traumatic childhood experiences to financial precarity and living in high crime neighborhoods. Treatment alone won’t solve these problems, just as locking people up won’t make them go away.
Acknowledging the role of mental illness in such cases is particularly urgent in a society that has delegated the dirty work of warehousing the mentally ill to penal institutions — places like the Alameda County jail, where Mr. Ramsey was takenafter pleading no contest to assaulting Mr. Chan in exchange for having the hate crime charge dropped. In 2021, an investigation by the Justice Departmentconcluded that the mental health services at the jail were unconstitutional, violating the Eighth Amendment, which prohibits cruel and unusual punishment, and the 14th Amendment, which guarantees equal protection under the law. (The county said that it had already worked on improving the conditions raised by the Justice Department report but a subsequent grand jury investigation also foundmajor health and safety violations at the jail.) The harsh conditions that prevail in many prisons may fail to move people who have been victimized in bias attacks. But do the communities targeted by such violence really want to see it keep repeating itself? One of the most effective ways to prevent people with serious mental illnesses from engaging in violence is by ensuring they get treatment, research has shown, a luxury that incarcerated people are routinely denied. At many jails and prisons, perpetrators are often placed in solitary confinement, subjected to excessive force and inculcated in the very attitudes that fuel bigotry and violence. “Our prisons are some of the best incubators of hate in our country,” Mr. McDevitt noted.
When we spoke not long ago, Mr. Chan made it clear that he views punishment for bias attacks and for violent crime in general as a key deterrent needed to protect communities like his. “People should face consequences for harming others,” he said. But he went on to say that consequences “does not only mean going to jail”; it can also mean “getting access to proper treatment.” When it came to Mr. Ramsey, Mr. Chan said society needs to ensure that “he will get better and will not commit any type of incident again, harming others or himself.”
When I asked Mr. Chan where Mr. Ramsey was now, he said that he didn’t know. A few days later I spoke to Daniela Kantorova, a clinical psychologist in Oakland who coordinates Mental Health First, a program launched by the Anti-Police Terror Project to help people experiencing mental health crises get access to services before they end up having violent encounters with the police. Because he had already served over nine months before being sentenced, Mr. Ramsey was released from the Alameda County jail in February, Dr. Kantorova told me. She was there on the day he got out. He was dressed in a light gray tracksuit and orange flip-flops, she said. He also had a two-inch bump on his forehead, an injury he sustained after repeatedly banging his head against the wall of his cell.
In the weeks that followed, Dr. Kantorova tried to get Mr. Ramsey placed in a residential treatment facility because he was clearly psychotic and unable to care for himself. In some California counties, people released from custody who need mental health treatment may be placed into court-monitored programs to help them get the care they need. But the facilities Dr. Kantorova contacted kept finding reasons to reject him. “There was basically no place that was ready to take him,” she said. Members of the Anti Police-Terror Project had pooled together some resources to put Mr. Ramsey up in a hotel at the time of his release. Things did not go well, and after a while, the group was unable to keep up with the cost. Some time later, after missing a mandatory court session to ascertain his progress in the treatment program, a judge issued a warrant for Mr. Ramsey’s arrest. In August, he was back in jail.
Eyal Press (@EyalPress) is the author, most recently, of “Dirty Work: Essential Jobs and the Hidden Toll of Inequality in America.”