In the mass-media response to the killings of nine churchgoers in Charleston, South Carolina, many of the talking heads presented an either-or controversy: was the killer mentally ill or was he a racist?

The mentally-ill argument came mostly from conservatives. The Wall Street Journal editorialized that racism could not explain the murders because “systemic racism no longer exists in the South” and the cause is a “problem that defies explanation beyond the reality that evil still stalks humanity. It is no small solace that in committing such an act today, he stands alone.” Rudy Giuliani said “We don’t know the motivation of the person who did it.” Donald Trump called the crime “incomprehensible.” Rick Santorum and Lindsay Graham called it an “attack on Christians” and a sign of how religion is under attack in the US. Rick Perry said it was caused by drugs.

The alleged choice between mental-illness and racist-context explanations is false—the two are often fused. The panicky conservative attempts to avoid acknowledging the obvious racism of this act of terrorism are missing an important fact: that the forms mental illness takes are shaped by the environment in which mentally ill people live.  Mentally ill people are no more immune to the ideologies surrounding them than are sane people. Over the past few decades, psychiatrists, psychologists and anthropologists have shown, for example, that when schizophrenics hear voices, or when other psychotics have hallucinations, the content of their delusions is determined by the culture. These deluded thoughts and voices seem real, one of the many tricks that our complex brains can manufacture. They are often directive, ordering the hearer to take actions. But what actions they are told to take varies from one society to another.

Mental illness is everywhere but its content is shaped by the context.  One study compared schizophrenics in San Mateo, California; Accra, Ghana; and Chennai, India.  The African and Indian subjects mainly heard positive instructions.  Indians often heard the voice of family members, typically playful and entertaining, often speaking as elders advising younger people, but rarely threatening.  In India and Africa the voices often aroused sexual feelings.  American schizophrenics, by contrast, were far more likely to hear violent voices; they reported being ordered to torture people, to take out someone’s eye with a fork, cut their head off and drink their blood. In India and Ghana, the hearers were not troubled by their voices, while in the US schizophrenics experience their voices as bombardment. A study of Swiss psychotics showed that those who are religious are likely to hear the voices of demons; some have taken violent actions directly from the Bible, feeling compelled to pluck out offending eyes or cut off offending body parts, and their fears of the antichrist have led to violent behaviours. Another study compared Korean and Chinese schizophrenics.  The Koreans mainly heard family voices discussing love, religious, economic, and business matters. The Chinese were more fearful, hearing about bloodsucking and poisoning. Saudi Arabian patients showed the importance of racism in their delusions.  Those who felt persecuted because of their racial/ethnic religious identity—for example, reporting that the voices “always say to me you are a black guy and you should not eat with us,” or “go out of our country; you are not Saudi, go to your country … and we hate you, they said we are not the same,” reported two schizophrenics from Jeddah.  Those with such hate and persecution delusions were more likely to commit violence.

In short, the context determines the content of psychoses.

Perhaps anyone who kills nine people is mentally disturbed, if not actually ill.  But it is the social and political context that makes killers act as they do.  The nature of the new media is itself a contributor, because users surround themselves with sources that reinforce what they already believe and rarely encounter dissenting views. The Charleston killer was surrounded by racism, and it filled his unconscious as well as his conscious mind.

Do not imagine that taking down the Confederate flag will solve the problem.  True, that symbol is a daily insult to African Americans but so too are many other daily aggressions, such as being the first to be suspected of everything from shop-lifting to drug use to rape.  To understand the killer’s mindset, we need to register how daily life can send consistently false messages to white people.  Unless white people can hear–from sources they consider authoritative– accurate accounts of the how American racism works, they will assume that blacks occupy the worst neighborhoods and the worst jobs because they belong there.  Anyone who watches Fox news might think that blacks are the most arrested because they are the greatest threats, when it has been repeatedly proven that this is not the case.  Racists regularly charge that African Americans get the most benefits from government programs, when most government hand-outs go to corporations and the middle class.

Combine this racism with American gun culture—by which I mean not only the proliferation of guns but the cultural celebration of violence and military might—and you get what the Charleston killer became: a mentally deranged racist murderer.

*If readers would like a version of this piece with citations, write to lg48@nyu.edu

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