Mental Health Experts Warn of a Malignant Normality

In the context of Mental Health Awareness Month, authors of a book I edited, The Dangerous Case of Donald Trump, gathered in Washington, DC (Lee, 2018). A question that came up among the reporters regarded why there is such a lack of awareness and disinterest in the mental health aspects of this presidency.

For mental health professionals, this is often a signal that indicates how serious a mental health matter is. The very awareness of mental health issues is a part of good mental health (Jorm, 2011). The mind can only bear what it can bear, and the greater the likelihood of a serious problem in the mind, especially in someone who is supposed to be a leader and a protector, the more the populace will wish to avoid it.

Mental health professionals often deal with patients who are losing their state of health, and one of the first things to diminish is what is called insight, or the ability to recognize that something is wrong. Instead of addressing the multiple concerns others raise about one’s emotional and cognitive state, especially in a public office, a person might, for example, deflect and deny with a statement that one is a “very stable genius.” The inability to question but “doubling down” is the most concerning sign: Healthy individuals may deny but are usually able to leave a wedge of doubt, if not actively address, the concerns.

There is also the issue of education. We are not a culture that is particularly psychologically-minded, which makes us vulnerable to psychological manipulation and ill health. When signs of poor mental health arise, we do not recognize what is happening but are prone to interpreting it as something else, which allows for the disease to spread.

Many have bemoaned “the death of truth,” for instance, and have declared a post-truth era (Lewandowsky, Ecker, and Cook, 2017). This is not always a political strategy or an ideological preference, but can involve losing touch with reality, which for mental health practitioners is a cardinal sign of descent into illness.

Since human beings are complex, all kinds of defenses can arise, including loss of insight (“nothing can possibly be wrong with me”), cognitive distortions (“it must be true because I feel it is true”), gaslighting (“you are the one with a problem, not I”), or reaction formation (“I can’t stand feeling helpless, and so I’m going to believe I am omnipotent”), to name just a few.

This does not mean every individual who participates in delusions or conspiracy theories will be diagnosable with a mental disorder, but having someone in a power position who is unwell can result in a “shared psychosis” that brings about widespread damage to society. The analogy that many have made to fascism (Albright, 2018) may not be far off, since fascism is not an ideology or political strategy but a societal pathology. It is apparent in the accusation of mental health professionals who witness the dangers as “politicizing” psychiatry. The less we are even willing to consider the possibility, the closer we are to it: That is the nature of mental pathology.

Most people are not exposed to pathology on a daily basis, and so its manifestations can be bewildering. This is all the more reason for mental health professionals to speak up, no matter how “crazy” they themselves appear (this comes with the territory, since labeling the mental health professional as insane protects one from having to face the possibility oneself).

Accusations of partisanship will certainly come. But when health professionals are making a medical assessment, they are responding to outside natural phenomena, not subjective opinion, delusion, or preference. This is how we can have objective standards of care. There are even standards for including cultural aspects or using the “self” as an instrument of observation, to which professionals are trained, with empirical data to back up their approaches and, most importantly, which they do not change according to whom they treat (this is what we call “medical neutrality”). If they cannot adhere to this, they are also ethically required to refrain from giving treatment.

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A disorder at the societal level still has the same outcome as any unopposed disease: destruction and death. A mental health professional’s job is to tell apart that which is healthy decision-making from that which is maladaptive disease, no matter how tempting for the persons or societies involved (in disease, the insistence is even more irrationally adamant). No doubt, a mental health perspective will look like personal opinion from the outside. Without the training that standardizes observational skills and treatment modules across different clinicians, it will be hard to see how one arrives at a conclusion objectively, as well as why clinicians generally come to a consensus, provided enough information is available.

A medical perspective, including that of mental health, far from being irrelevant, is thus critical to bringing objective insight into what is happening. This holds especially true when a president is exhibiting an inability to perceive reality separately from his own thoughts, feelings, and needs; when his followers have taken on a level of dependency and symbiosis that they cannot do without each other; when enabling politicians see his mental weaknesses as an opportunity to advance corrupt policies that would never pass otherwise; and when foreign adversaries understand his pathology well enough to exploit them to their advantage.

Mental health professionals have ethical obligations to society. Leaving societal mental health problems to the society that is suffering from them is like asking a gravely ill individual to heal her own illness—that may be possible in the early stages, but not after a certain point. One cannot convince those who succumb to conspiracy theories and delusions through reason or facts, or even principles, because deep down they already know their beliefs are false—but they cannot accept reality or even allow themselves to become aware of it.

The input of mental health professionals is critical. However, the institutions that are the most cognizant of their power—which is the power of awareness—have done whatever they can to silence them in the public arena (APA, 2017; 2018; American Psychological Association, 2016). Silencing mental health professionals allows for a malignant normality to take hold, detached from reality checks, where factual reporting and rational discourse are no longer possible.

Further Reading:

Robert Jay Lifton

Judith L. Herman and Bandy X. Lee