Dehumanization and mental health

Abstract

Dehumanization is a fearsome word, calling to mind the gravest atrocities of the past and present. People seen as less than human have suffered and suffer violence, deprivation, exclusion and dispossession, and that suffering has been and is routinely ignored or minimized. However, although dehumanization is usually understood as an extreme phenomenon confined to wars, genocides and conquests, it falls on a spectrum. Two decades of social psychological research have shown that it has significant repercussions in everyday life1. The burgeoning literature on dehumanization offers three key insights. First, dehumanization ranges from blatant and verbalized to subtle and unconscious: people can be explicitly likened to animals, but also implicitly denied fundamental human qualities such as rationality, self-control and complex emotions. Second, dehumanization takes varied forms, from seeing others as bestial or robotic, to rejecting their individuality or agency, to failing to spontaneously grant them minds. Third, although dehumanization often accompanies negative views of others, it is psychologically and even neurally distinct from prejudice. Seeing people as less than fully human is not the same as disliking them. We can dehumanize those about whom we are indifferent, not only those we hate. Indeed, studies of close relationships show that we can subtly dehumanize those we love. The vast literature on stigma reveals how people with mental illness are often viewed negatively by the general public, pictured as dangerous, blameworthy and shameful, with adverse implications for equity, well-being and recovery. It has recently become clear that, in addition to these negative perceptions, they are often also denied humanity. People are seen as less human when they receive mental rather than physical illness labels, and people with mental illnesses – especially schizophrenia and addictions – are even more blatantly dehumanized than some vilified ethnic or religious minorities2. Dehumanizing attitudes to the mentally ill are not confined to the public, but can also be held by mental health professionals. Researchers have begun to document the causes and consequences of these attitudes. One contributing factor is emotional self-preservation: professionals may dehumanize patients as a way to protect themselves against emotional exhaustion and distress3. The anticipation of emotional demands may motivate professionals to deny humanity to others and result in the withholding of empathy and care. Studies like these shine a new light on burnout, one of whose primary manifestations is the loss of empathy for others. In clinical settings, this dehumanization-like tendency may lead professionals to disengage from patients, failing to appreciate their emotional experience and reducing them to their diagnosis. Adverse working conditions that foster burnout, such as excessive workloads and organizations that treat employees as interchangeable cogs in an industrial machine, can lead mental health professionals to dehumanize patients, with the adverse effects on clinical care that burnout researchers have documented. One study found that psychiatric nurses who felt unsupported by their organizational superiors were more likely to experience burnout and depression as well as to dehumanize their patients (e.g., showing a greater willingness to bypass their consent)4. People who seek mental health treatment need not be denied humanity on the basis of their illness to suffer the impacts of dehumanization. Dehumanizing perceptions of racial minorities might contribute to racial disparities in mental health diagnosis and treatment, such as significantly elevated rates of chemical sedation in African American patients presenting to emergency departments with psychiatric disorders5, just as race-based dehumanization contributes to harsh discipline in criminal justice and educational settings. People who believe they are being denied humanity by others typi