Existential Threats....

 

Mapping Existential Threats in the Medical Literature

 

I heard President Trump and several right-wing politicians complaining about the term “existential threat” in the press the other day.  Some of the clips were a few months old but the overall message was first – “I didn’t know what it means”, second – the people using the term (in this case former President Biden discussing climate change) don’t know what it means, and third you are an elitist if you use the term because the average family in American does not use the term and you should learn to talk like them.  Like most statements uttered by the current President and his unquestioning party I found it rhetorical, not useful, and decided to see what the medical literature said.  This is what I found.

On PubMed, there are 248 references to the term dating back to 1979.  As seen in the table most of the scenarios listed like climate change, COVID and other pandemics (in this case HIV), diseases, antibiotic resistance, artificial intelligence, and other threats to life are the commonest threats listed in medical literature.  By definition, an existential threat puts the future of some group (humanity, specified individuals) or person at risk.  The worst-case scenario is an extinction event like the Cretaceous-Paleogene (K-Pg extinction) event that occurred 66 million years ago.  That was caused by an asteroid strike and it led to the extinction of non-avian dinosaurs and 75% of all plant and animal species. 

The tables contain existential threats to humanity, many subgroups including physicians and the afflicted, school and businesses, other animals, and plants, as well as ecosystems.  It also includes the psychological component where the perceived threat is experienced as a threat to existence, but more at a symbolic level.  Yalom’s text (1) on existential psychotherapy breaks those threats down to death anxiety, freedom, isolation, and meaninglessness.  Other psychoanalytical writers point out that existential crises are more likely to occur at various points in human development.  In psychiatric practice it is common to see people experiencing crises in these areas across all settings.  Existential crises can exist at the level of group or individual psychology depending on the nature and scope of the threat. Some scientists hypothesize that we are currently in the midst an extinction event.  They describe this as the sixth mass extinction event and verify it by estimating the number of vertebrate species that have gone extinct and compare it to previous mass extinctions (3).  Human culture is a critical factor in this extinction and the conclusion are a massive effort is needed to head off this event and much of that effort needs to be directed at reducing overconsumption, transitioning to environmentally friendly technologies, and an equitable path to those transitions (2).  These authors point out obstacles to these changes including most people being unaware of the changes required to prevent ecosystem damage by human culture, the scope of the problem, and the necessary solution of scaling back human impact – both the scale and processes.

The political use of the term “existential threat” has been applied to the Trump administration and this is probably why Trump himself is trying to spin the term in his favor. He is focused on blaming the opposition party, but at this point it goes far beyond the Democrats.  The non-partisan Bulletin of the Atomic Scientists has posted that the well know extreme budget cuts of the administration pose an existential threat to the next generation of scientists. Various publications around the world have written about Trump as an existential threat to democracy, the American economy, former American allies, Social Security, freedom, black Americans, American college and universities, public health, science, and critical international food and medical aid.  In many of these areas the facts are clear.  I can think of no better example than USAID and the PEPFAR program.  Just defunding those programs could lead to as many as 14 million deaths if none of these changes are reversed by the courts.  

Paranoid people do not do well with existential threats.  They lack the ability to assign probabilities. They cannot see a car on the street and just see it as another car.  They get the idea that all cars or all red cars are threats to them. The defined threat may be elaborated as surveillance by Homeland Security to being attacked by microwaves being transmitted from these cars.  In some cases, everything is seen as a threat.  The anxiety is real but the threat assessment is wrong.

If you do not know what an existential crisis is – you should.  Most students in the US start reading existential themed literature in middle school and early high school.  The average person needs to know at what level the threat exists (personal, group, civilization-wide) and what can be done about it.  That means that it makes sense to break down the specific threat, adequately assess it, and not leave it hanging there as ill-defined.  For example, nuclear war, a massive asteroid collision, and climate change threaten all human, animal, and plant life on the planet.  Not being able to get a job in an area where you were trained in college or losing your first significant relationship can be existential crises at an individual level.  That can be life changing at a personal level and the good news is most people find their way back on track with the help of family, friends, and the occasional therapist. 

The outcomes of existential threats can lead to unexpected action.  When I was in college, one of my jobs was working in the local public library.  It was a multi-county library and the main part of my work consisted of mailing out books and films to all the co-operating libraries. One day the chief librarian came in and told me it was now my job to dismantle the fall-out shelter in the basement.  The year was 1972 just 10 years after the Cuban Missile Crisis. The library had two Fallout Shelter signs like the one at the top of this post.  I went down into the basement and found about 100 steel drums.  They were all about 30-gallon capacity. According to the instructions on the side they were supposed to be used for water storage.  When empty they were supposed to be used as latrines.  None of them contained water.  I guess the planners thought there would be time after a nuclear attack to fill them all. When I asked my boss what I was supposed to do with the drums he said:” I don’t care just get them out of here.”  I took them back to my neighborhood and handed them out to anyone who wanted them.  Apart from the steel drums there was no food or medical supplies.  Just a very large room full of steel drums.

It took me a long time to figure out what happened to the fallout shelters and how they went from a national priority to complete disrepair and abandonment in a decade.  The only explanation is that the planners knew there would be no survivors. A few groups here and there would survive the blast and radiation but nobody would survive the nuclear winter.  Even a limited nuclear exchange kicks enough dust up into the atmosphere that makes food production impossible. That marks the end of humanity – the ultimate existential crisis.

Shouldn’t the man with the power to end civilization quickly or slowly know something about this?  Shouldn’t everyone know the real existential threats we are facing?

 

George Dawson, MD, DFAPA

 

References:

1:  Yalom ID.  Existential Psychotherapy.  Basic Books.  New York, 1980.

2:  Dirzo R, Ceballos G, Ehrlich PR. Circling the drain: the extinction crisis and the future of humanity. Philos Trans R Soc Lond B Biol Sci. 2022 Aug 15;377(1857):20210378. doi: 10.1098/rstb.2021.0378. Epub 2022 Jun 27. PMID: 35757873; PMCID: PMC9237743.

3: G. Ceballos, P. R. Ehrlich, A. D. Barnosky, A. García, R. M. Pringle, T. M. Palmer.  Accelerated modern human–induced species losses: Entering the sixth mass extinction. Sci. Adv. 1, e1400253 (2015).