Introduction

Definition of hatred

According to Merriam-Webster hatred is defined as “extreme dislike or disgust... ill will or resentment that is usually mutual… prejudiced hostility or animosity”. The etymology of the word is “Middle Englishhatred, fromhate +-rede,suffix denoting state or quality, going back to Old English-rǣden”

Rationale of this study

We see various manifestations of hatred around us daily, namely, hate-speech, hate-crime, hate-mail, acts of terrorism, genocide, discrimination, stigmatisation and online displays of hatred on social media platforms. Another is self-hatred which can lead to self-harm and even suicide. The negativity and damage caused by these manifestations raises the question of whether medical researchers offer solutions to addressing hatred. Mental health and forensic professionals observe and encounter hatred in their day-to-day practice dealing with client groups that require psychological formulations aimed at understanding the predisposition, presentation, precipitation, and perpetuation of various hateful activities and behaviours. They are expected to identify protective factors that can help understanding and stop development of hatred. Hatred can manifest in the form of certain psychological and psychiatric conditions such as depression, psychosis, eating disorders, phobias, or PTSD.Medical researchers are therefore interested in finding ways of addressing it.

Aims and objectives

To carry out systematic literature search on an international medical database; to find studies that offer information on how hatred could be addressed; and to analyse the relevant data to learn which themes emerge from studies that aim to address hatred

METHODS

Systematic review of literature was carried out utilising the following search strategy:

Literature search strategy

We used the following search terms: hate [Title/Abstract]) OR (hatred [Title/Abstract])) OR (hateful [Title/Abstract]) OR (hating [Title/Abstract].

Eligibility criteria

This included all relevant medical studies that were available on PubMed database on National Library of Medicine (National Centre of Biotechnology Information, NCIB) on 19^th August 2024.

Inclusion criteria

Articles contained either of the four words hate/hatred/hating/hateful in their titles or abstracts and were published on PubMed in 2015 onwards.

Exclusion criteria

This was done in two steps. First, after removing duplicates, all studies meeting the inclusion criteria above were longlisted. In step twothe titles and abstracts of each study were reviewed and categorised according to the aim and objective of each study and labelled carefully by the main researcher. Only those studies that qualified under the category of ‘addressing hatred’ were included. There were nine excluded categories, namely: studies discussing detection and/or assessment of hatred; discussing generation of hatred; if words hate/hatred are used in the context of medical and psychiatric conditions described as a symptom; if words are used in their literal meanings; studies discussing manifestation and/or the impact of hatred; studies discussing hatred as a topic of a piece of writing; studies that used the words in unique meanings that do not match the overall aim of the study or do not relate to addressing hatred in any way; or studies in which the words were used in the keywords section but not in the title or abstract of the study.

Paper selection strategy

On 19^th August 2024, the total number of eligible studies as appearing in PubMed, NCIB (National Centre for Biotechnology Information) library was 1226. After removing duplicates and applying the above exclusion criteria, the total number of selected studies that aimed to address hatred were 87.

Data extraction

Relevant information, addressing hatred from the identified 87 studies, was imported to NVivo (qualitative data analysis software) version-13 for data interpretation. An endnote diary of references was kept.

Data items and synthesis of results

With the intention to carry out a thematic analysis aimed at understanding how hatred can be addressed, each of the 87 studies was given a code. The common codes were combined under one theme, and common themes were combined under a meta-theme.

Thematic analysis

Braun and Clarke (2006) describe thematic analysis as one that can be used for identification, analysis and reporting of themes within a dataset. According to Braun and Clarke, a theme captures and describes something important in relation to the research question. Furthermore, they state that authors should clarify the main aim of the thematic analysis and how conclusions were reached based on the analysis. It is a matter of common observation that “Thematizing Meanings” is one of the few shared core generic skills that a qualitative researcher needs to develop, no matter what kind of methodology is being adopted whilst interpreting qualitative data (Holloway et al, 2003). Boyatzis et al (1998) suggest that it may delve deeper and, in an attempt, to interpret multiple aspects of the topic being researched. According to Braun and Clarke (2006, p 82), “A theme captures something important about the data in relation to the research question and represents some level of patterned response or meaning within a data set”. Identification of themes can be either inductive (bottom up) or deductive (top down). Whilst carrying out any qualitative analysis, including thematic analysis, the researcher may encounter common questions involving the process of qualitative research (ibid). Understanding the relationship between these questions is helpful to the researcher: firstly, an initial primary research question that led to the development of the project; secondly, there would be questions that guide the coding and analysis process (ibid). Although the researcher would benefit from being mindful of these big questions and the relationship between them, though not essential, it is desirable for the reader’s comprehension. All in all, the thematic analysis aims to find the repeated pattern of themes that can be clustered together, and the final product must contain an account of what was done and why (ibid).

Figure1.Prisma flow diagram

Data extraction

Data was extracted from 87 studies after a full text review. The data extracted from each article comprised information that addressed different forms and manifestations of hatred. In addition, several articles containing the researchers’ personal opinions regarding hatred were identified. Information regarding addressing various forms and manifestations of hatred from personal opinions or scholarly discussions was extracted from those articles. Data from each of the 87 studies was given a code which related to a theme, and these were reviewed. Naming of meta-themes was carried out after identification.

Data items and synthesis of results

After summarisation of the extracted data, each excerpt was given a descriptive title and a code, keeping in mind one or more unique factors of the study. Once all data was summarised in the form of the codes, we tried to pick out the themes each code expressed. Whilst deriving the themes we were mindful of the primary research question i.e. what information is available in medical literature with regards to addressing hatred in its various manifestations and forms. All codes with similar themes were put under a common heading, thus theming them. Next, all the themes were further collected under three broader meta-themes. Further details of emerging themes and meta-themes are discussed in the relevant sections below.

Table 1 contains details of the information acquired from experimental studies and Table 2 contains details of the relevant information acquired from studies that were scholarly discussions or personal opinions of the writers.

Table 1 comprises of six columns and Table 2 of five. For all studies the information regarding addressing hatred is extracted under the column titled ‘Information offered on addressing hatred’. The details of the information acquired from and of knowledge synthesized from individual themes is described in the results section of this article.

RESULTS

The results reinforce the findings from previous studies that the word `hatred´ is used in medical literature in a multiplicity of meanings that range from using it to describe a subtle attitude such as a phobia-philia relationship (literal sense), to describing a unique outcome that is generated as an interplay of several different kinds of psychological, emotional and social factors (Shafiq, 2023). The word ‘addressing’ used in the title of this study and during initial categorisation of the collected data loosely denotes any attempts by the medical researchers aimed at understanding and finding solutions of various forms, manifestations and expressions of hatred. The major criterion for inclusion of relevant studies in this systematic review was the use of any of the following words: ‘hate’, ‘hatred’, ‘hating’ or ‘hateful’. In the studies included in the review, the authors have used one of these four words whilst discussing their efforts to ‘address’ several different kinds and manifestations of hatred. As hatred varied in its manifestations and presentation, so have the attempts made and ways offered to address these by medical researchers varied significantly. The following addresses the meta-themes that emerged on combining the themes.

Meta theme one: Addressing hatred by appreciating the need of…

One of the emerging themes from the interpretation of collected data is that medical researchers prompt us to ‘appreciate the need of’. This raises the obvious question: to appreciate the need of what? There are several needs identified by medical researchers. In an editorial that is published in The Lancet titled ‘A call for education against hatred’ the authors highlight the importance of need to understand how we engage with feelings of hatred (Launer and Jameel, 2024). These authors describe how it sometimes appears as if each and every Palestinian and Muslim person must be held to account for the violence of Oct 7, 2023, while every Israeli and Jewish person is at fault for the destruction in Gaza. They further explain that holding on to notions of complexity—the idea that individuals on both sides are caught up in a maelstrom where there may be a wide range of different, contradictory, and negotiable attitudes—seems to have become almost impossible. The authors state that there is a word for this process and the emotions connected with it: it is hatred. In addition, they state that hatred does not happen in a vacuum but against a historical background where it has often been cultivated for political, economic, or cultural purposes. Antisemitism occurs against a millennial background of persecution and genocide against Jewish people. Islamophobia has its roots in western hatred going back to the Crusades. Prejudice against people of colour is part of a history that includes conquest, colonisation, enslavement, and extermination of Indigenous peoples (Launer and Jameel, 2024). The authors propose three general principles that might guide colleagues in medical education to go beyond essential but basic efforts to address the manifestations of prejudice. Firstly, the authors suggests that spaces where issues of equality and diversity are discussed allow opportunities for people to speak of their personal and family experiences of discrimination, displacement, persecution, and trauma. Thus, participants can understand how hatred is experienced and how it affects perceptions of the world. Secondly, medical educators should be aware that there are many training approaches to facilitating discussion in the presence of disagreement and conflict, whether expressed or unexpressed. Thirdly, they believe that a commitment to equality, diversity, and inclusion through mutual understanding should be embedded into the definition of medical professionalism. Hence, they call for medical education against hatred in the context of a divisive issue that is currently evoking hate in many people.

Three other papers highlight that antisemitism is on the rise and needs addressing. One paper prompts doctors to accept the responsibility to keep medical literature racism-free stating that ‘hatred has no place in medicine’ (Adler and Grant-Kells, 2023). Another one offers strategies that social work educators, practitioners and researchers can adapt to create a socially just society for the Jewish community in the United States. For example, one of the strategies include social workers seeking to address spiritual microaggressions aimed at members of the Jewish community (Hodge and Stephanie, 2021). By doing this, social workers might help create a culture that respects religious freedom, a fundamental human right, and advocate for equitable portrayals of Jewish people and perspectives in diverse media. The third article calls for the American Psychological Association to proactively include the elimination of antisemitism or prejudice against Jewish people in its current mission to disassemble racism in society (Walker et al, 2024).

One article highlights the need to appreciate that Islamophobia levels have heightened following the rise of radicalisation, the ‘demonisation’ of Muslims in the media and the immigration crisis in Europe (Hankir, 2017). The author of this article aims to challenge the stigma attached to Muslims by providing information to educate people about Islam, debunk myths, challenge negative stereotypes and by utilising the power of storytelling to engage readers and to equip them with facts and the necessary skills to combat Islamophobia.

Whilst the above articles highlight the need to appreciate and address religious prejudice, another set of articles highlight the need to appreciate and address various forms of hatred that manifested during the COVID-19 pandemic like racism, stigmatisation and discrimination. One article highlights that since anti-Asian hatred was high at the time of the pandemic, steps needed to be taken for the reopening of schools ensuring that this goes safely and smoothly for students of Asian descent (Akiba, 2020). Another described the need to address dehumanisation resulting from the pandemic, by highlighting that governments have a vital role to play in setting national directions to tackle racist violence and making hate crime laws (Collard, 2023). One author stated that verbal harassment and physical assault led to the start of the nationwide #StopAsianHate movement in the USA and drew a parallel to the Black Lives Matter movement that was aimed at addressing racism towards black people (Liu, 2022). Another author observes that the COVID pandemic sparked a rise in misinformation from various media sources, which contributed to the heightened severity of hate speech. This author explored the current effects of hate speech and why hate speech should be widely recognized as a public health issue (Nguyen, 2021). Another researcher noticed that, on one hand, the pandemic had a disastrous effect on public health and economy, and, on the other hand, it highlighted the importance of the emotion of love and how it can be used to address hatred. The author asks whether there is a need for the explicit inclusion of the emotion of love in policy formulation (Sur, 2020).

Whilst the above articles discussed the need to appreciate and address racism in the context of the COVID pandemic, others discussed the need for addressing racism regardless of any specific context. One set of authors carried out a data analysis of tweets on the social media platform Twitter (now named X) when US President Joe Biden signed the COVID-19 Hate Crimes Act on 20^th May 2021. They found five themes all highlighting the need to address racism: “Asian hate is not new”; “Address the harm of racism”; “Get involved in #StopAsianHate”; “Appreciate the Asian American and Pacific Islander (AAPI) community’s culture, history, and contributions”; and “Increase the visibility of the AAPI community.” (Cao et al, 2022 ).

Six authors highlight the need to appreciate the negative impact of, and therefore the need to address, hate speech. One highlights the complexities associated with positions supporting free speech and those protesting hate speech. These authors suggest that ensuring vigorous freedom of expression within the context of an inclusive, diverse community, can be a way forward to addressing hate-speech in academic institutes (Ceci and Wendy, 2018). Another author reviewed arguments favouring bans on problematic speech (e.g. hate speech) on a university campus. Contrasting the calls for top-down regulation, the author highlights the need and potential for a “bottom-up approach” to campus speech governance (Chamlee, 2018). One author suggests that internet service providers (ISPs) and web-hosting services (WHs) need to accept responsibility for restricting and addressing hate speech as they are the gatekeepers and they need to be far more proactive than they are (Cohen-Almagor, 2017). Another author in his paper talks about the situation generated by conflicting values and highlights the need to protect the value of free-speech whilst making efforts to restrict hate-speech (Parekh, 2017). One article aims to draw attention to the computer science community to focus less on automated hate detection methods and appreciate the need to start thinking about it as something that demands solutions. The author identifies urgent steps that need to be taken to incorporate computational researchers into a single, coherent, multistakeholder community that is working towards civil discourse online (Parker and Ruth, 2023). Another paper describes the need to appreciate addressing digital hatred across all age groups. The authors highlight the theoretical and empirical distinction between personal and vicarious victims and provides insight into the effects on the well-being of a population (elderly) largely unexplored in terms of age and national representativeness (Stahel and Baier, 2023).

In addition to prejudice, racism and hate speech, medical researchers point out the need to address hatred committed in the form of crime and violence. Three articles draw readers’ attention towards this need from different but overlapping perspectives. One article stresses that hatred manifests as extreme violence towards transgender people. The authors call to action for countries to urgently address these violations of human rights (Divan et al, 2016). Another article emphasizes the importance of protection against hate crime that intellectually disabled people experience on the streets (McClimens and Brewster (2017). The third article pinpoints the need to appreciate that LGBTQ plus communities are more prone to violence at the hands of gender majority, based on the research conducted on LGBTQ plus communities and on violence (McKay et al, 2017).

On the note of hatred, violence and aggression towards LGBTQ plus communities, one author emphasizes the need for what is called, ‘Pink washing’, meaning, the production and mobilization of an exceptional discourse of gay-friendly and post-homophobic Britain (Wahab, 2021).

Some authors highlight the usefulness of understanding certain aspects relevant to hatred in order to address it. One article suggests that the more we understand hate speech the more we are able to address it and argue against it (Ancell, 2022). Another article points out that hatred can be understood by learning about online hatred, and this can be done by defining it and distinguishing it from other similar online phenomena such as trolling and cyberstalking etc (Malecki, 2021). One author highlights the usefulness of understanding online hatred by learning about the mind set of perpetrators of hatred. The author states that research on the perpetrators indicates positive emotions and specific gratifications resulting from their behaviour, in particular when it is fully consistent with their ideologies. Uncovering these gratifications-and the positive effects dark-participation may have on perpetrators’ well-being, could be the key to a better understanding of the dark side of social media (Quandt et al, 2021). One article emphasizes that to address hatred, it is helpful to understand how haters left their hate groups and developed antihate activists’ identities (Liguori, 2022). Another one highlights the importance of understanding coping strategies against racialised stressors like racial-ethnic discrimination, so that this kind of hatred can be addressed (Martin, 2021). Another article gives insight into the importance of understanding radicalisation by exploring the association between sociodemographic characteristics and sympathy for violent radicalisation (Rousseau, 2020). One group of authors state that hatred of terrorists is an obstacle to the implementation of effective counterterrorism policies: it invites indiscriminate retaliation, whereas many of the greatest successes in counterterrorism have come from understanding terrorists’ personal and political motivations. Hence, these aspects need to be understood in depth to address hatred (Theriault, 2021). One article highlights the importance of understanding how hate-speech can be countered by optimising classroom climate, empathising with victims of hate speech and self-efficacy towards intervention (Wachs, 2023). One study shows evidence in favour of a prevention program using a trauma-informed race equity lens to better understand methods to reduce Teen Dating Violence among ethnically and economically diverse populations (Guillot-Wright, 2021). One author shares evidence that online hatred can be addressed through the introduction of empathy-based counter speech (Hangartner, 2021).

Meta theme two: Highlighting the need to approach addressing hatred from different angles utilising various tools and methods

Medical researchers have pointed out the usefulness of various methods, tools, techniques and means that can be adapted and utilised to address hatred as well as what is unhelpful.

Several medical researchers address online hatred highlighting the usefulness of creating a safer digital environment to address cyberbullying (Adeeba, 2024). Data analysis data led to the conclusion that online hate speech can be addressed by taking measures to detect it and counter it with what they call ‘hope-speech’ (Chakravarthi, 2022). With regards to addressing online racism, the use of online anti-racism advocacy is suggested (Keum, 2023). Windisch (2022) described a lack of experimental (random assignment) and quasi-experimental evaluations of online hate speech/cyberhate interventions; addressing the creation and/or consumption of hate speech as opposed to the accuracy of detection/classification software; and assessing heterogeneity among subjects by including both extremist and non-extremist individuals in future intervention studies. The author suggests it would be useful if medical researchers remain mindful of this gap and incorporate this in future research.

One article highlights the usefulness of computer/mobile Apps to seek guidance and support to address various forms of hatred in virtual or real world (Malta, 2023).

Some medical researchers interested in how various forms of racism can be addressed, suggest various approaches: the usefulness of evidence-based intervention and policy strategies (Cao, 2022); the use of poetry (Choudhury, 2022); of psychoanalysis (Heyer, 2022 and Holmes, 2021); and of green-space environments (Hoffman, 2020). They also highlight the usefulness of dual identification to address the gateway group effect that leads to racism (Levy, 2023 ).

One article highlights the usefulness of psychoanalysis to address self-hatred (Austin, 2016). Other states that more can be learnt about hatred through understanding the nature of delusions in psychoanalysis (Bronstein, 2018). One author stresses the importance of reflecting on personal experience and engaging in group psychotherapy to address hatred (Levine, 2023). With regards to the usefulness of psychotherapeutic approaches on addressing hatred, one author suggests that this can be done through analysing work of psychoanalysts and philosophers, noting the importance of love within their work (Stromberg, 2018).

Medical researchers also emphasise the usefulness of religion and religious practices to address hatred. One article highlights the role that religious leaders can play to address hatred against LGBTQ plus individuals and communities (Gichuru, 2018). Another article highlights the importance of understanding collective recovery and stepping up against religiously motivated hatred (Levin, 2020). Litvak et al. (2024) share the outcomes of a systematic literature search that was aimed at finding out how the hatred in the name of religion (religious-hatred) be addressed. The article describes how hate crime victimisation is targeting the victim’s religious identity posing a serious problem for individuals, communities, and societies. The authors describe countermeasures to such victimisation, aiming for broad descriptive inclusion by canvassing personal adaptations, collective programs, and institutional-governmental policies. The most salient personal adaptations included camouflage-type blending in to avoid victimisation, using religion as a source of resilience, and changing routines to deflect risk. At the collective level, mobilising community resilience, stereotype reduction, and place-based solutions were often researched. Another article highlights the importance of understanding the role of religious zeal as an affective phenomenon to address hatred. These authors state that religious zeal can be presented and interpreted as both, a love-like passion and an anger-like emotion. As an anger-like emotion, religious zeal is an occurrent affective state of mind that is intentionally directed towards a specific (immanent) object, characteristically a person or group of persons. To address hatred, love-like passion could be useful (Tietjen, 2021).

Another area of interest to medical researchers is how hate speech can be addressed and free-speech be promoted to address hatred. One article suggests that hate speech can be countered by facilitating free speech and vigorous freedom of expression on a university campus (Ceci, 2018). Another article highlights the importance of learning about human language to counter hate-speech. These authors describe how humans use language towards hateful ends, inciting violence and genocide, and intimidating and denigrating others based on their identity. Despite efforts to better address the language of hate in the public sphere, the psychological processes involved in hateful language remain unclear and need to be better understood (Kennedy, 2023). One study, (Sahu, 2023), evaluates the usefulness of an hour-long webinar discussing the ethics of working with veterans who use hate speech, motivations and intentions of hate speech, and guidance on how to respond. Participants were clinicians who completed the evaluation for the training. They reported that they were highly satisfied with the training and would recommend it to others. They also reported the intention to talk with co-workers and trainees about responding to hate speech and requested additional training. They, therefore, highlight the importance of formal training in the form of webinars to address hatred.

Medical researchers highlight the need to appreciate that LGBTQ plus communities are more prone to being on the receiving end of hatred and violence by the gender majority. McKay et al (2017) offer a solution to this through reviewing literature on hatred and making recommendations to address it. Authors found no data to support the idea (widespread in popular discourse) that those in the sexual or gender majority require protection from sexual or gender minority individuals. Contradicting the image of hate crimes as perpetrated by strangers or acquaintances, authors found that bias-related verbal abuse, physical, and sexual assault by close family members contribute heavily to observed victimisation rates. Another paper points out the importance of addressing hatred through visual arts as a response to hate crime that is manifested in visual artwork of an activist fighting for rights of LGBTQ plus communities (Imma, 2016).

A couple of articles emphasise the usefulness of generating and sharing a hatred counternarrative. One author notes that ever since the global spread of the COVID-19 pandemic in 2020, East Asians across the globe have been ostracised, othered, pathologized, and subjected to numerous anti-Asian hate crimes. Drawing theoretical insights from Alexandre White’s “epidemic orientalism” and Priscilla Wald’s “medicalised nativism,” the author investigates how these chosen comics function as counternarratives through first-person storytelling. In so doing, these comics, while reinstating the dignity of East Asians, also challenge and resist the naturalised methods of seeing that justify violence and dehumanisation (Venkatesan, 2024). Another group of authors highlight the importance of reclaiming the narrative against harmful populist rhetoric in politics and fake news. These authors set out 6 principles for public health professionals faced with these situations including the suggestion that they can reclaim the narrative, rejecting hatred and division, to promote social solidarity (McKee and Martin, 2017).

In addition to above, medical researchers point out the usefulness of ‘Respect’ (Arshad et al, 2023), addressing dehumanisation by recognising the role of governments to set national directions to achieve re-humanisation (Collard, 2023), and ‘Identification with Humanity’ that reduced hate crime and dehumanisation (Hamer et al, 2021). One author advises making use of ‘Forgiveness’ to avoid ruminative thoughts that reinforce hatred (Kioulus, 2017). Another one addresses the problem of pressure on a person to forgive that often makes forgiveness impossible or superficial. The author proposes that within a psychotherapeutic setting, the clients who are unwilling or unable to forgive can still be encouraged to let go of interpersonal hatred because it is psychologically harmful to them (Vitz, 2018). One article suggest that the Chinese notion of ‘Ren’ (meaning benevolence) can be used to negate the stigma of racial discrimination among Asian people. The Filipino notion of ‘Kapwa’ or “shared self” can be utilised as an equivalent socio-normative ideal fostering deep communal and group solidarity among people, regardless of race, colour and ethnicity (Macaraan, 2021). Another article states that hatred can be addressed through an Indonesian motto of ‘Bhinneka Tunggal Ika’ (meaning: “It is different, [yet] it is one”) that helped the people of Indonesia fight COVID-19 pandemic together, ignoring their differences (Situmorang, 2021).

Medical researchers emphasise the unhelpfulness of certain things that led to difficulties in addressing hatred. One researcher highlights that online hate, and extremist narratives have been linked to abhorrent real-world events, including a current surge in hate crimes and an alarming increase in youth suicides that result from social media vitriol. Examples include: inciting mass shootings such as the 2019 attack in Christchurch, stabbings and bombings; recruitment of extremists, including entrapment and sex-trafficking of girls as fighter brides; threats against public figures, including the 2019 verbal attack against an anti-Brexit politician, and hybrid (racist-anti-women-anti-immigrant) hate threats against a US member of the British royal family; and renewed anti-western hate in the 2019 post-ISIS landscape associated with support for Osama Bin Laden’s son and Al Qaeda. Social media platforms seem to be losing the battle against online hate and urgently need new insights (Johnson, 2019). Another group of researchers highlight that collectively blaming groups for the actions of individuals can license vicarious retribution leading to hatred. Acts of terrorism by Muslim extremists against innocents, and the spikes in anti-Muslim hate crimes against innocent Muslims that follow, suggest that reciprocal bouts of collective blame can spark cycles of violence (Bruneau, 2018). One group of researchers share their experience while researching hate and gaining media attention, beginning in 2018, when they incurred a good deal of hate towards them and their research in the form of online comments and direct correspondence. Though it was initially perceived as a very unhelpful response and rather unpleasant experience, they collected and analysed the texts to better understand the beliefs, perceptions, and arguments of those that rejected their efforts toward gaining knowledge on geographical hate trends (Medina, 2021).

Meta theme three: Highlighting a need for and importance of active interventions aimed at addressing hatred

Medical researchers suggest making use of several interventions to address various forms and manifestations of hatred. This includes use of artificial intelligence that can be used to induce norms and empathy (Bilewicz, 2021). To address self-hatred researchers share evidence through interventional studies, confirming the usefulness of various psychotherapeutic approaches including: Cognitive Behavioural Therapy (CBT) (Dobias, 2021); a single-session structured psychological intervention (called project SAVE) (Dobias, 2021); Cognitive Analytic therapy in which the patient explores abandonment dynamics and their self-to-self relationship improves (Kellett, 2021); and of a psychoeducational method that was found useful in addressing self-blame and self-hate (Melin, 2018).

One study discusses the evidence-based efficacy of a bio-psycho-social approach for addressing hatred as a symptom of Post-Traumatic Stress Disorder. (Wang, 2017).

Other active interventions featured by medical researchers to address hatred include: use of a hatred prevention programme aimed at optimising classroom climate; empathising with victims of hate speech and self-efficacy towards intervention (Wachs, 2023); using photos as a means to counter hate speech (Mamary, 2022); keeping places of worship (synagogues) safe by securitisation that according to them should be considered as a white-noise (Samson, 2021); tackling online hatred by removing leadership of online hate organisations and hate-network disruptions (Thomas, 2023); and through introducing meta-humanisation that reduced prejudice and addresses dehumanisation and hostility (Pavetich, 2021).

One researcher’s findings from interventional studies confirm that hatred towards sexual and gender minorities can be addressed through a computer App used as a mental health intervention (Malta, 2023). Two other articles share the evidence in favour of interventions that aim to address hatred towards LGBTQ plus communities. One of them concludes that this can be achieved by compassion and overcoming bystander apathy (Owuamalam, 2020) Another provides evidence in favour of utilising the framework of gender performativity to reduce hatred towards transgender people (Tsang, 2021).

DISCUSSION

The findings of the current literature search are aimed at understanding how hatred can be addressed. Table one covers the details of experimental interventions done by medical researchers and table two covers the details of personal opinions and of non-experimental interventions that researchers have adapted, to address hatred. Analysis of collected data suggests that Hatred has varied manifestations and, therefore, it is impossible to find a general solution. Analysis of data also suggests that medical researchers broadly take three types of approaches to address hatred that are manifested in the titles of the meta-themes that emerged on interpretation of data. These include appreciating a need to understand various aspects related to hatred to find ways to address it; appreciating the usefulness of and unhelpfulness of various tools, methods or means; and utilising various interventions.

An awareness of something needing attention

To find ways to address hatred, medical researchers are highlighting the need of appreciation of various aspects related to it. These are summarised above under meta theme one titled, ‘addressing hatred by appreciating the need of’. The overall interpretation of data highlights some choices and trends exhibited by medical researchers that are worth reflecting upon. It appears that medical researchers are sometimes interested in exploring quite core and general aspects: for example, trying to define what hatred is and the feelings it generates in us. If we can recognise this then we can try to understand how to manage and tackle those feelings that are generated in us because of hatred (Launer and Jameel 2024). Other times, researchers are noted to be highlighting quite specific and specialised aspects that need our attention: for example, aspects related to religious hatred, online hatred, LGBTQ+ hatred, hate-speech and racism etc. By way of understanding some manifestations, the medical researchers highlight the need to understand manifestations like shame, stigma, radicalisation and terrorism, among others, as all of them can lead to hatred in their own unique ways. Overall, one collective emerging message appears to be: all these various kinds of phenomena, occurrences and manifestations around us continue to seek our attention towards the need to note them and find ways to understand them in depth thus leading to an appreciation of ways to address them. All in all, it requires mindfulness and active effort from us all.

What is useful when it comes to addressing hatred?

The details of these have been discussed under the second meta-theme and are not repeated here. Once a need for addressing hatred is appreciated then medical researchers try several different kinds of tools, methods and means to address hatred. Their efforts to find ways to address it reveal what is useful and, on the other hand, what adds up to hatred. From the overall interpretation of data, it appears that researchers are interested in finding usefulness of methods at different levels, namely, individual, group as well as country and government. Individuals can develop hatred towards others and towards themselves. Medical researchers are keen to find usefulness of tools that address self-hatred improving the relationship of the individual with his own self (Kellett et al, 2021). They found psychotherapeutic approaches useful in achieving this. Some researchers advocate in favour of group psychotherapy to address hatred (Levine, 2023). Some problems affect countries and sometimes the entire world. Such issues, if stressful, lead to the manifestation of various forms of hatred and provide medical researchers an opportunity to find methods and tools useful to addressing hatred on a large scale. The data collected for this systematic literature review covers a period when the world went through the COVID-19 pandemic. Stress generated by the pandemic increased the personal and social pressures that led to an unprecedented rise in frequency and severity of hateful activities. For example, anti-Asian and anti-Chinese sentiments increased all over the world just because COVID-19 originated in China. The pandemic caused a shrinkage in available resources and increased competition in accessing these. The medical researchers on appreciating the situation highlight the usefulness of utilising the Chinese notion of ‘Ren’, the Filipino notion of ‘Kapwa’, the Indonesian notion of ‘Bhinneka Tunggal Ika’, and incorporating love into official policymaking to address hatred at nationwide and worldwide levels. These suggestions appear to have something in common and that is the advice to connect with our non-discriminatory core human-values and transcending any personal or selfish identities held.

We need to find ways to intervene to address hatred

Medical researchers also try to find which interventions are useful when addressing various forms and manifestations of hatred. This is the subject of meta-theme three above. Medical researchers share the outcomes of their experiments on individuals and communities alike to find evidence-based interventions to support vulnerable groups including LGBTQ+, immigrants, those experiencing religious hatred, those facing online hatred and those experiencing self-hatred. Overall, it appears that medical researchers are keen to explore, introduce and improvise methods, tools and strategies that enable them to tackle various forms and manifestations of hatred.

Contributions of current study

This study highlights that the systematic review of medical literature could be a good source to understanding how various kinds of hateful mind sets could be addressed. With the backdrop of existing knowledge, the current study brings in several approaches and opinions together, suggesting that medical researchers are keen to understand and address ‘hatred’ from different perspectives and points of view.

Conclusions

Medical researchers have highlighted that hatred exists and there are several aspects relating to it that need our attention to address it. Researchers offer details of several tools, methods, means and strategies that are useful and may help us tackle numerous forms and manifestations of hatred. The evidence in favour of several interventions that they found helpful in addressing hatred is shared. Keeping in mind the primary research question, from a psychological and psychotherapeutic point of view, it appears that at an individual level the choice to hate someone/something (including ourselves) is the product of an active decision-making process. To reduce the manifestation and expression of hatred it would be reasonable to understand various factors that contribute towards this decision making and to remain mindful of breaking the process of its generation where possible. The researchers also highlight the importance of our core human identity that we are born with and the importance of our core human ability to love and accept others. These core human abilities and values might have different names and terms across different cultures, but the underlying message is the same which is to connect with our inner sources of love and humanity. The findings of the review suggest that as there are several different forms and manifestations of hatred, addressing them also requires understanding each one of them separately in their unique background and context. Once we can understand the individualities of each manifestation, we are in a better position to address them. Whatever the approach, it appears that it requires some personal effort by individuals, by greater groups, by organisations, by countries and by governments alike to address hatred.

Limitations

This literature review took a cross-sectional approach for data collection at a specific point in time. Most of the papers in the review are scholarly articles. The reason for this seems to be that given the nature of the topic of ‘addressing hatred’ medical researchers seem to be more interested in discussing the issue in scholarly discussions rather through experimental designs.

DECLARATIONS

Acknowledgement

My thanks to Numair Kaukab from the National University of Computer and Emerging Sciences, Faisalabad, Pakistan for help during some stages of data collection.

My thanks to Prof. Dr. Reinhard Heun of ‘Global Psychiatry Archives’ for his general guidance and support during the writing of this paper and to Ms Rahina Q. Røst for proofreading.

My thanks to Ms. Sue Clark, Ms. Katie Roper and all the staff members at Gosall library, Lantern Centre at Lancashire, and South Cumbria Foundation NHS Trust (LSCFT), Preston, UK for support finding some of the full text articles.

Motivation and Dedication

This study is dedicated to all the authors past and present who have taken the opportunity and accepted the responsibility to address hatred with their pens and keyboards. To the parents who taught their children the notions of ‘Ren (Chinese word meaning benevolence)’, ‘Kapwa (Pilipino word meaning fellow humans), Bhinneka Tunggal Ika (Indonesian word meaning unity in diversity), Sab di khair, sab da bhala (Punjabi phrase meaning welfare for all and blessings for everyone).

Ethical approval

The research process did not involve any direct engagement with clients, hence, it did not require formal ethical approval.

Funding

No financial support of any sort was sought throughout this research project.

Informed consent

Informed consent not required.

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