Our nation is on a suicidal path, both literally in terms of 1500 unnecessary Covid-19 deaths a day and figuratively in terms of destruction of democracy, and other countries continue to wonder if we have lost our minds. Would we know it if we had? Not necessarily, but there are clues. Above all, we have not addressed a president of the United States who is dangerously mentally unwell and incapable of leading. It is a difficult truth to absorb. Ordinarily, mental health professionals would be there to guide the public, naming the problem, explaining its nature, and recommending solutions. The conference I organized in 2017, inviting some of the most respected psychiatrists in the country to discuss how we might ethically go about this, many welcomed as an ice breaker. Ironically, the American Psychiatric Association played a pivotal role in shutting down discussion, facilitating denial, and preventing intervention until the problem became uncontainable.
Truncating discussion and making the messengers go away, instead of solving the problem, is what autocracies do. Not addressing mental problems in powerful leaders, much like not holding criminally accountable those in high offices, portends societal breakdown. Madeleine Albright recently said a phrase I often repeat: “Fascism is not a political ideology.” I usually add: “It is mental pathology writ large.” Pathology brings about disorder, damage, and death, unlike healthy choices, which are life-affirming.
When I introduced The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President three years ago, I emphasized that we were not interested in Trump as an individual and were not pretending to be his personal mental health providers. Rather, our profession’s societal responsibility compelled us to protect the public from a threat to its health and wellbeing. Society was our patient, as our own ethics code necessitates. The Trump presidency just happened to be a barometer that indicated a poor state of mental health in society, as well as a cause for greater “societal disorder” to spread.
Societies can become sick, just as individuals can. The distinction is not society versus individual or political office versus civilian status, but whether there are patterns and characteristics consistent with pathology. What are some of these patterns and characteristics? Here are four: 1) rigidity; 2) poor insight; 3) detachment from reality; and 4) destructiveness.
First, rigidity is important. Healthy individuals and societies are flexible, complex, and diverse. They can adapt to new circumstances, incorporate new knowledge or facts, and adjust to find the best solutions to problems. Sick individuals or societies, on the other hand, are rigid, often adhering to method more than the issue at hand, to rules over principles, reluctant to change, and afraid of the unknown. In situations of stress, they can exhibit “doubling down” (often mistaken for conviction or strength), scapegoating (a form of “doubling down” on prejudices over deciphering the actual problem), or inversion (finding comfort in conformity and familiarity over utility or benefit). Even chaos or impulsivity can be rigid when one refuses to find more life-affirming approaches or to pass on responsibilities in areas of deficiency.
The second is poor insight. Insight refers to the ability to recognize that something is wrong, especially in relation to oneself or one’s own society. Healthy individuals and societies are quick to examine themselves, to seek correction or improvement, and to solicit advice to that end. In clinical settings, we observe that the sicker the patients, the more they insist they are well and avoid evaluation and treatment at all costs. The same holds for expertise. In the words of my colleague, Dr. Edwin Fisher: “individuals who actually are high-achieving … don’t go down in flames trying to prove their prowess in areas in which they lack skill. Rather, they are quick to call on expertise to move their projects forward.”
The third is detachment from reality. Loss of touch with reality, also known as “psychosis”, is perhaps one of the most severe forms of mental compromise. One does not need to have a psychotic disorder such as schizophrenia to lose touch with reality. Detachment from reality can arise for various reasons, such as an urgent need under stress to protect a fragile sense of self, to defend a preferred version of reality, or to deny one’s incapacity to do a job. Conspiracy theories, magical or paranoid thinking, acceptance of propaganda as “news”, and rejection of science and facts can all be manifestations of detachment from reality. Certain conditions in society can facilitate this descent into unhealth: loose regulation of broadcast content so as to blur the distinction between entertainment and news; uninhibited use of psychological manipulation and misinformation in the political sphere; and the silencing of professionals who would use expertise for the betterment of society, instead of control and harm.
Finally, there is destructiveness. Disease is destructive to life by definition, which is why we treat it. For example, when a society refuses to engage in a collaborative effort to combat a deadly virus, it is self-destructive. When a nation “doubles down” on violence to fight the recognition of, rather than solve, systemic racism, it is ultimately self-defeating. When a species prefers to turn a blind eye to its potential extinction, either through the renewal of a nuclear arms race or through the insistence on destroying its own natural habitat, then it is suicidal. The driving force of pathology is emotional, not rational.
The job of health professionals is to be medically neutral; this means pinpointing the problem where it is, regardless of political inconvenience. But lethal levels of flagrant mental pathology have been “normalized” through the exclusion of mental health input, under the pretext that it was occurring in the political realm. Mental health professionals under this administration were told to diminish their sphere of professional activity—whether it be the role of treating only individuals and not society, of acting as mere technicians rather than as thinking intellectuals, or of obeying fiats over engaging in autonomous ethical deliberation. Mental pathology, however, knows no bounds, and shielding political agendas from professional input does not make the problem itself go away. Rather, it is a cardinal sign of fascism when journalists or intellectuals are targeted and silenced, and when professional organizations act as an arm of the government. When we stop misidentifying pathology as politics and adopt a more insightful approach to reality, open to flexible change, we may yet turn away from a course toward destruction.
About the contributor:
Dr. Bandy Lee, M.D., M.Div., is a forensic psychiatrist at Yale School of Medicine for 17 years who taught at Yale Law School 15 of those years, was a research fellow at the National Institute of Mental Health, and a consultant with the World Health Organization since 2002. She is author of the textbook, Violence (Wiley-Blackwell, 2019) and editor of The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President (Macmillan, 2017 and 2019). She is also president of the World Mental Health Coalition, which issued a “Prescription for Survival” and will collaborate on a podcast series with Bill Press featuring authors of The Dangerous Case. For donations to her organization, a tax-deductible 501(c)3, please go here. Dr. Lee is also a regular contributor to MeidasTouch.
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