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        Scapegoating mentally ill people
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        Scapegoating mentally ill people
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Thank you for publishing the interesting debate on the ethics of diagnosing psychiatric disorders in public figures.1 Langford correctly draws attention to the inevitable stigmatisation of all those with mental illness which such public diagnoses would entail, but arguably a more pertinent issue here is that of scapegoating.

French intellectual Rene Girard (1923–2015) claimed that scapegoating, although eschewed by modern ethics, was an important adaptation in human evolution, inducing the unanimity of ‘all against one’, and thus strengthening group cohesion and curtailing internecine violence.2 Applying this Girardian anthropology, I have recently proposed the archetypal scapegoat hypothesis3 on the evolutionary origins of psychosis. This posits that psychosis emerged as an adaptation that provided early human groups with efficacious scapegoat victims, about whom unanimity was more likely. However, features of psychosis alone, as manifested in the ‘patient’, would have been insufficient for such an unanimity-inducing adaptation to function, as it would have been equally reliant on a corresponding tendency in the general population to both recognise the individual with psychosis in their midst, and to blame them for whatever adversity was at hand. I have thus argued that not only have we inherited a tendency to respond to crises by scapegoating, but we have also evolved a cognitive bias towards selectively scapegoating people who are mentally ill. In other words, our evolutionary origins make us prone to the fallacious conclusion that ‘If something is wrong, the madman must be responsible’.

Gartner's analysis of the current state of US politics seems to be based on a similar fallacy; ‘Something is wrong, therefore the man responsible must be mad’. Admittedly, his argument invokes narcissistic personality disorder rather than psychosis, but such diagnostic nuances are most likely lost on the general public. Ironically, Trump himself is probably one of the most high-profile contemporary exponents of the human propensity to scapegoat. However, labelling him as ‘mad’ merely reinforces, in the public mind, the myth of a strong link between mental illness and dangerousness.4 As psychiatrists, I believe that one of our duties is to de-mythologise mental illness, rather than to invite people to succumb to their innate propensity to scapegoat it.

1Gartner, J, Langford, A, O'Brien, A. It is ethical to diagnose a public figure one has not personally examined. Br J Psychiatry 2018; 213: 633–7.
2Girard, R, Oughourlian, JM, Lefort, G. Things Hidden since the Foundation of the World. Stanford University Press, 1987.
3Riordan, DV. Mimetic theory and the evolutionary paradox of schizophrenia: the archetypal scapegoat hypothesis. Med Hypotheses 2017; 108: 101–7.10.1016/j.mehy.2017.08.010
4Angermeyer, MC, Matschinger, H. Public beliefs about schizophrenia and depression: similarities and differences. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 526–34.