Sunday, January 10, 2021

The Insurrection


This has been an historic week in the United States. On January 6, 2021, President Donald Trump and several of his supporters incited a large group to attack and invade the Capitol Building as Congress was in the process of certifying the electoral college vote – the last official but routine step for Joe Biden to become the duly elected President of the United States.  During the riot, Capitol police were assaulted and one of them was killed. A rioter was shot and killed.  Three people died of medical emergencies due to poor access at the scene. There were scores of people injured, many serious.

Police and the National Guard eventually regained control and Congress was able to reconvene and certify the electoral college vote.  The challenges to the votes in several states were overwhelmingly rejected.  The President had also suggested that the Vice President Mike Pence could decide to not accept the votes and nullify the election, but the Vice President was very explicit about his Constitutional duties and knew that was outside of his scope of power. He kept the process going and brought it to appropriate closure declaring that Biden-Harris were the winners.

The aftermath of this event has produced a little certainty but not much.  As I write this late on a Saturday night, all that we know for sure is that Joe Biden is the certified winner of the election and that he will be inaugurated on January 20th.  President Trump’s supporters from the recertification debacle are in disarray.  Press reports quote them as lashing out at the expected fall out from their efforts and the insurrection at the Capitol. At least one has lost a book deal and in other cases constituents are calling for their resignation.  Since the official vote was preceded by the insurrection and violence, some of the people who were expected to object to the certifications from specific states did not. Other Republicans were outspoken against the process from the outset since it was clear that the President had repeatedly lied about the election being stolen and there was no factual basis for any objections. Republicans adopting those positions were subjected to derision and threats from Republicans who supported Trump.

On the night of the insurrection, there were rumors that Trump’s cabinet may be considering invoking the 25th Amendment and removing the President from power based on his incapacity to do the job. Inciting an insurrection against the government and Constitution that he was sworn to uphold would seem like a sure way to get anyone fired.  The other logical question is, if a person can make such a drastic error in judgment – does it imply that they will continue to make further drastic errors?  In other words is their judgment compromised even beyond the crisis they have created?  I am not talking about a diagnosis of mental illness. I am an adherent of the Goldwater Rule and don’t believe that psychiatrists should speculate about the mental health of a public figure without doing a thorough personal assessment and then disclosing the result of that assessment only with the consent of that individual.

That does not mean that professional organizations should abdicate their roles in advocating for science, social justice and correcting disparities related issues, and most of all advocating for a practice environment that allows physicians to provide high quality health care to our patients who need it the most. Health care professional organizations have not done a very good job on these issues largely because they have been completely ineffective against the business takeover of health care. 

With the recent events the American Psychiatric Association cam out with a statement on January 7, 2021 entitled: APA Statement on Yesterday’s Violence in Washington.  It seemed to be overly reactive to me and it carried the usual generic conclusions – if you are having problems see someone. It would have more authority if there had been statements at every stage of the President’s escalating rhetoric.  Where was the APA for example when the President attacked science, the CDC and its scientists, and Dr. Fauci?  Where was the APA when the President attacked Black Lives Matter and showed support for white supremacists? Where was the APA when the President trivialized the COVID-19 epidemic, politicized the treatment and endangered lives, and spread misinformation about the origins of the virus and how it spreads. There is no authority when you sweep in at the very end when conditions are dire and seek to correct what you did not comment on in the previous 10 months. Real time commentary on political action that is detrimental to the social fabric of the country is necessary from professional organizations, especially one whose members assess the impact of that social fabric on every patient they see.

But there is more blame to go around – especially when it comes to social media companies.  Facebook, Twitter, and Google all seem to be very confused about how they are used for propaganda purposes. Misinformation is a euphemism for propaganda these days and there has never been a more powerful amplifier of propaganda than American social media. To be clear, propaganda is an intentional lie that is repeated over and over again until a certain segment believes it to be true and starts to react emotionally to it. This behavior was clearly visible from people at the Trump rally and people who invaded the Capitol building. People clearly agitated about the election being “stolen”, socialists taking over, the country turning to socialism, personal freedoms being impinged upon.  Image after image of people in the media who were obvious Trump supporters who were agitated about what are essentially non-issues. The clearest non-issue was the election being stolen.  Trump himself keeps repeating this despite the clear facts that the elections are much more well run that when Al Gore was defeated by hanging cardboard chads in the 2000 election that was decided by a Supreme Court decision and a 271 to 267 electoral college vote. In fact, the score card about election fraud shows that there is a complete lack of evidence of significant “fraud” or stolen elections.  The major social media players finally came around and banned Trump and his accounts, but even as I type this he is vowing to get more media access and continue his divisive propaganda campaign.

In the big picture, the Trump propaganda is much more than a curiosity at this point.  In addition to the insurrection at the Capitol, Trump followers have threatened violence against the families of both Democrat and Republican elected officials largely as a way to support Trump.  These coercive tactics have no place in a functional democracy and at the individual level should be considered terroristic threats by local police. The insurrection has provided a blueprint for both foreign and domestic enemies of the United States who seek to disrupt the functions of our government and the security of our citizens. The disruptive effect that the Trump administration has had on our military, intelligence community, allies and leadership role in the world adds greatly to the insecurity of the republic. President Trump and his administration should be considered a case study of incompetent leadership and suggest pathways to competency that future leaders should be assessed by.

I started to write this with some suggestions about what needs to happen over the next 10 days to get the country back on track and correct some of the current glaring deficits:

1:  President Trump: the people on the ground specifically his Cabinet and leaders in Congress need to make an assessment acutely about whether he lacks the current capacity to function in his role as President. The insurrection is strong evidence.  His lack of commentary of a major Russian government hack that has been occurring for months (the extent of which is not currently known) is another.  There is speculation that some of his cabinet members are contemplating this but there have been resignations and temporary appointments.  There is a question about how fragmented the Cabinet is and whether that would hinder the process.  Members of Congress are apparently considering impeachment, but that is a long process.  There are platitudes about how impeachment would not “heal the divisiveness” that are more than a little ironic considering the people making these statements. I have heard that two impeachments of any President rules out any future candidacy and if that is true – it is a very good reason for proceeding with impeachment.

There are still some mental health professionals out there who think a psychiatric emergency is a better response. I routinely did psychiatric emergencies for 22 years and I can say without a doubt that there is no court judge that I know of who would detain President Trump on an emergency basis for hearing or schedule a hearing for guardianship or conservatorship on the basis of a mental illness. Media reports are full armchair diagnoses of narcissistic personality disorder or malignant narcissism (not an actual diagnosis) and even if these diagnoses were accurate – they are not diagnoses that result in court action.  Those diagnoses are typically statutorily defined severe mental illness.  The legal criteria in the 25th Amendment is much clearer: unable to discharge the powers and duties of his office. The only problem is that it is interpreted by lawyers and politicians and not everyone will agree with that interpretation.

Another feature of the legal versus psychiatric intervention is that the decisions can be made right now, by people who have been working with the President in some cases for 4 years.  That constitutes a larger amount of information and a much shorter timeline for action than is possible in any psychiatric scenario. 

2:  The security issue:  The Capitol and any place there are elected officials doing the work of the US Government needs to be very secure. That means there needs to be an adequate force and clear rules of engagement.  Right now there are people threatening the inauguration process and there must be very thorough plans to prevent that from happening.  The FBI is apparently trying to identify as many people as possible from the original insurrection and the message is out there that they will be prosecuted.

The larger security issue is starting to counteract the propaganda about stolen elections, fake pandemics, fake news, and freedom being under attack. I am confident that clearer messaging from the White House and members of Congress will be useful as well as integration back into the international community.

3:  The potential for Civil War:  Not my idea.  About 3-4 months ago I was contacted by people who knew that I was a bit of a survivalist.  Their concerns ranged from civil unrest disrupting the food and power supply as well as access to medical treatment to outright armed conflict between warring factions  Their specific questions were about what they should acquire now to protect themselves and their family if the Trump induced negative reverberations through society continue and worsen.  I am not a historian and wonder if an attempted coup by an autocrat who refuses to accept or even acknowledge 200 years of democracy qualifies as a civil war?  The autocracies in my lifetime including Hitler, Stalin, Mussolini, Pol Pot and many others extending right up to modern times do not seem to be the products of civil war.  Many occurred as the result of internal political turmoil often fomented by propaganda.  Many of these propaganda techniques were codified by the Nazis such as the Big Lie propaganda technique.  

The transition from ordered to disordered society is never clear. No American anticipated the rise of a disruptive autocrat and the impact that he could have on ordinary citizens.  In many ways it reminds me of Robert J. Lifton's interviews in The Nazi Doctors and how the transition to state sanctioned medical killing occurred during the Holocaust.  On page 13 he quotes a French speaking eastern European physician on whether what happened can be understood from a psychology viewpoint:

"The professor would like to understand what is not understandable. We ourselves who were there, and who have always asked ourselves the question and will ask it to the end of our lives , we will never understand it because it cannot be understood."    

I think there may be some insights from the anthropology of warfare.  Keeley gathered anthropological evidence of ancient conflicts between tribes, towns, and eventually cities.  He concluded that there were no peaceful primitive people. The settlement of disputes between neighboring tribes or city states have always been violent with a significant toll on the losing population.  That theme is obviously extended to current times where there is an uneasy peace based on nuclear deterrence but a quarter million people lose their lives each year due to small arms fire.  Peace does not seem to be the interest of many nations even though there are clear cut advantages.  The human propensity for violent dispute resolution is not reassuring in a heavily armed nation and an angry faction who show up on government property holding assault rifles.  Interestingly one of the features of society that Keeley considered protective against war was an active trading and economic relationship with rivals.  That is another area where President Trump has not done well. 

4:  The propaganda at the individual level:  Many people ask me why so many people buy into obvious propaganda like the stolen election lie.  It turns out this recipe for influencing large groups of people politically has been around for decades.  The general message is to keep repeating the lie and at some point people start to emotionally react to it and that reinforces it.  From a neuroscience perspective there have been some imaging studies that claim to be able to detect Democrats from Republicans but I question those results.  Some suggest the problem is a lack of critical thinking, but I know a lot of professionals who have accepted Trump’s stolen election lie as a fact and their critical reasoning capabilities in all other areas seem to be intact.  One of my colleagues proposed an evolutionary social theory that seems to have some plausibility – as humans we are socialized to follow charismatic leaders whether they are right or wrong.  There seems to be a lot of historical data to back that up.

I would suggest a complementary hypothesis and that is the emotional inputs for day-today decision making.  Some time ago on this blog I discussed some of the groundbreaking work of Antoine Bechara, MD, PhD and his work on why emotional input is critical for human decision making. He demonstrated that without it – subject with normal intelligence is unable to function.  We also know that an excess of emotion can adversely affect decision making and lead to errors both acutely and on an ongoing basis.

Propaganda has both a cognitive component (the lie) and a strong associated emotional component.  Supporters of the stolen election lie are clearly angry about getting a raw deal, about their rights being impinged up, about needing to take the law into their own hands, about someone treating them (or their candidate) unfairly, the list is quite lengthy but the emotion is always anger.

I don’t claim to know how to reverse that process.  I did take a course in how to deprogram cult members at one point and the main intervention was to get them away from the people influencing them.  Removing the continuous inaccurate social media messaging may be useful in that regard. An improvement in the general tone of the media may also be helpful.  Since the insurrection, the mainstream media seems a lot more willing to make determinations of what is accurate and what is a lie.  One lesson appears to be that even if the propaganda lie is labeled as misinformation that is probably not enough.  It will still be altered in a positive way and propagated for propaganda use.  Propaganda needs to be eliminated when there is obvious overwhelming evidence against it.

There also have to be organizations that are willing to step up and make a stand for accuracy to correct political misinformation.  Both Science and Nature the major general scientific publications have been doing that on an increasing basis.

And finally, there is the appeal to the individual. In some of my earlier writing on this blog about firearm violence I suggested that people self-monitor for violent or aggressive thinking and seek out help if they noticed this. My thoughts related this insurrection are no different.  Nobody should be thinking that American elections are rigged or that they need to take the country back from someone.  We all know how this democracy works and it has been working well for 200+ years.  It works well because of the concept of peaceful transfer of power and the associated traditions. In other words, it is about what is good for the country and its people and not an individual official.  The President is the President for all of the people and not half of the people and he or she serves at the will of the majority.

Let that sink in……

 

 George Dawson, MD, DFAPA



Supplementary 1:  A poster on Twitter pointed out the rationale for the suspension of Trump's account.  The rationale is listed in this blog post.  Pay particular attention to the last 5 bullet points, especially bullet point 5:

"Plans for future armed protests have already begun proliferating on and off-Twitter, including a proposed secondary attack on the US Capitol and state capitol buildings on January 17, 2021."

I am hoping that there will be more than a few hundred National Guard troops present at the Inauguration and that Governors take these threats seriously, especially in states where gun advocates have succeeded in getting laws passed to carry firearms on state government property. I would suggest going as far as a temporary order to suspend firearms in proximity to the state capitols in addition to an adequate show of force to deter further antigovernment activity. 


Supplementary 2:  For anyone confused about what happened at the Capitol building it comes down to this:





References:

1:  Lawrence H. Keeley.  War Before Civilization. Oxford University Press, New York 1996.

2:  Robert Jay Lifton.  The Nazi Doctors. Basic Books, New York 1986: p 13.


Image Credit:  This is an image from the Capitol Building on Jan 6, 2021 from Shutterstock per their standard agreement.

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