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).
