Projection Writ Large in American Politics.....

 

Recent events lead me to the conclusion that I should comment on them with the hope of breaking up the current pattern.  I see a lot of “hopes and prayers” commentary and “we need to unite like we did after 911” – but I don’t think that gets us very far.  What might help is recognizing the pattern, what it means, and using that knowledge to move ahead.    

Let’s start with the pattern.  To me it looks something like this. 

1:  Gun extremism for the past 20 years (as previously defined).  This results in no adaptive solutions for the problem for one of the major parties.

2:  Normalization of name-calling, blame, and rage by the President.  I don’t think any footnotes or references are needed at this point.  He posts something on almost a daily basis on his social media platform consistent with these activities. As Robert Jay Lifton said in 2017 commenting on the Trump Presidency as a descent into darkness “With Trump of course malignant normality becomes the rule because he’s President and what a President does tends to normalize potentially bad, evil, or destructive behavior.”

3:  Secondary spread of these patterns of behavior to everyone in his party – reinforced by mandatory compliance with his wishes using direct threats.

4:  Attributing all of the bad behavior to other people and another political party and acting as if that is true. 

In psychiatric parlance, 1 -> 4 above is referred to as projection.  I notice today that it is also used by commentators who are not psychiatric professionals.  A basic definition of projection is: ‘’Feelings and desires are not seen and admitted in oneself, but excluded from one’s experience and attributed to another.” (1)  In dealing with a person who uses that defense – it is common to feel like you are being blamed for something you are not responsible for and experience the associated anger.

But it can get even more complicated.  Kernberg writes:  “In contrast to higher levels of projection characterized by the patient’s attributing to the other an impulse he has repressed in himself, primitive forms of projection, particularly projective identification are characterized by: 1) the tendency to continue to experience the impulse that is simultaneously being projected onto the other person, 2) fear of the other person under that projected impulse, and 3) the need to control the other person under the influence of this mechanism.” (2)  In other words, the accuser in this case may be doing the same behaviors that he is accusing the other person of doing. In the cases I am referring to another party or member of another party is being accussed of radical politics that leads to political violence by a party or member of a party that has advocated and conducted radical and violent politics for years.

Before anyone invokes the Goldwater Rule here – let me say that I am not making any diagnosis of any individual.  I am simply observing patterns.  Observing patterns at a macro level is different from observing them in an individual patient in an intersubjective setting.  That field is profiling and it was invented by Jerrold Post, MD.  Post observes that in the case of paranoia projection distorts reality (3).  More specifically:  “Attempting to discredit Clinton’s popular victory in the 2016 election, he claimed massive voter fraud by illegal aliens.  As the 2018 midterms approached Trump expressed his concerns that the ‘Russians would be fighting very hard for a Clinton victory’.  So in his fevered imagination, there was a real basis for voter fraud.  And this suggests, given his reliance on the defense mechanism of projection that he would consider voter fraud.”  He subsequently refused to consider any polls that did not show him leading and called them fake news. (4).  Given his role in concessions to Putin and uniting China, Russia, and North Korea – the original suggestion of voter fraud was not consistent with reality.           

Sure you can say it’s just entertainment.  You can say like a recent District Court Judge that it is just rhetorical hyperbole that no reasonable person should take seriously.  You can say that Trump is “just joking” and that nobody takes him seriously but that misses two critical points.  First, this pattern of thought had to start somewhere.  Most of us are familiar with it from early to mid-adolescence when it is a developmental stage.  We can recall when it ended and we made a conscious decision to take responsibility rather than blaming other people for our problems.  Second, there are obviously many people who take this pattern of thought seriously and who can blame them?  I have seen trained mental health professionals fooled and reacting to it.

It is at the point where it cannot be ignored.  If you “do your own research” all the facts are out there. The current situation is the result of a decades long process that values gun extremism and political divisiveness – all leveraged by one party.  As long as you are caught up in that process – things will only get worse.  The results of future violence will be predictable and the soonest anyone can hope for change is 3 more years.  Stop the problem now by seeing this for what it is – a pattern of thought and behavior that most people grow out of.

Are there concrete steps you can take?  I suggest the following.  First, recognize what is going on. I am an old man and I have never seen a President behave like Donald Trump before.  All the projection going on needs to be ignored.  When you see news stations and social media sites trying to amplify his rage and name calling – just shut them off or ignore them.  You will not be missing a thing.  Think of the good old days when we had Presidents from both parties that did not demand our constant attention and outrage.  Presidents that acted in good faith for all of the people.  Presidents you could criticize and it would be taken seriously.  The government ran quietly in the background.  It was never perfect but it was a lot better than what we currently have.  Second, recognize that one of the provocative strategies associated with projection is to devalue some and overidealize others.  Civil servants, scientists, military officers, veterans, women, the disabled, low income people, and minorities have all been devalued while Confederate Generals, dictators, and white supremacists and neo-Nazis are praised and idealized.  It is a consistent dynamic over time.  Third, projection is a mechanism for producing bogeymen. One good example is the alleged left-wing organization Antifa.  Whenever I encounter that trope, I typically ask for evidence the organization exists and find none.  The Wikipedia page suggests there have been more hoaxes than action. For comparison, I was in college during the time of the Weather Underground and a collection of other radical underground left wing organizations were responsible for 2,500 domestic bombings in 1971 and 1972 (5).  That included attacks on universities and munitions plants. There is no possible way that any organizations like those exist today.  Fourth, recognize that the mechanisms I am referring to are intertwined with rhetoric and a distorted sense of reality. The best example I can think of is the constant accusation that you must hate a politician because you disagree with them. That is a recent development in the political landscape and it is a direct product of projection. You attribute hate to someone else if you really hate them and (per Kernberg) may experience it at the same time, fear the person you are projecting onto, and feel the need to control that person.  You also don’t have to think about it too long to see that the person(s) doing this has to see themselves as being extraordinarily important in your life.  That is also not consistent with reality.

There has never been a time in my life when ignoring rhetoric and focusing on reality has been more important.  I hope that I have provided a few pointers on how to get there and am confident that most mature adults in the country can do this.  When that happens it will be the unifying factor we are all looking for.  

 

George Dawson, MD, DFAPA

 

 

 

References:

1:  PDM Task Force.  Psychodynamic Diagnostic Manual.  Silver Springs, MD.  Alliance of Psychoanalytic Organizations. 1980:  p. 643.

2:  Kernberg OF.  Severe Personality Disorders: Psychotherapeutic Strategies. Yale University Press, New Haven.  1984: p. 16-17. 

3:  Post JM.  The Psychological Assessment of Political Leaders. University of Michigan Press.  Ann Arbor, MI. 2003: p. 96.

4:  Post JM, Douchette SR.  Dangerous Charisma: The Political Psychology of Donald Trump and His Followers.  Pegasus Books, New York. 2019: p. 222.

5:  Burrough B.  Days of Rage: America’s Radical Underground, The FBI, and the Forgotten Age of revolutionary Violence.  Penguin Press, New York. 2015

6:  Lifton RJ.  The Nazi Doctors.  Basic Books, New York.  1986.

The Current Moral Crisis In The United States

 

It is fashionable these days to talk about moral crises that really aren’t moral crises. The level of rhetoric is at the point where disagreements can be spun as moral crises, while people are dying in the streets. The best examples I can think of are the long-standing epidemics of gun violence and racism. New examples are cropping up every day. There are current trends in violence against Asian Americans and Jews against the backdrop of long-standing trends. Discrimination and violence against black Americans is finally acknowledged as being widespread and is the basis of an activist civil movement and hopefully systematic reforms.

All of the statistics to back up my statements in the first paragraph are easily available and I am not going to post all those references here. Since I started writing this blog one of my concerns has been gun violence and how to stop it given the level of interference with common sense gun law reforms by one of the major parties and major lobbying concerns. I saw the attempt to counter that political interference as being futile and focused more on public health interventions and possible psychiatric intervention. The latest good review of that approach is available in a review by Knoll and Pies (3).  For many years I have advocated that homicidal ideation should be seen as a public health intervention point and that it should be part of the strong public health message. To this day nothing has happened. Public health organizations do have research-based suggestions such as locking up firearms and common-sense gun laws like banning large capacity magazines, banning assault rifles, and universal background checks, but the general lack of progress in that area is not reassuring. There has been some movement in allowing more research on gun violence, an area that was previously blocked by gun lobbyists.

What is the connection between gun violence, racism, and violence toward our fellow Americans?  I think there are all based on the same interpersonal dynamic. That dynamic is seeing another person as being significantly different from you, attributing negative characteristics to them, and using both of those premises for treating them different from you up to and including perpetrating violence toward them.  In psychiatric jargon, we use the term projection to capture this process or in the extreme projective identification. These are not psychiatric diagnoses, but defense mechanisms that are distributed across the population even though they may be more likely in people with specific psychiatric diagnoses.

In my readings over the years I have been looking for a likely origin or at least first sign of this kind of thought pattern. In other words, have people been thinking like this since the beginning of recorded time, or is this a new phenomenon?  In the course of that reading, I came across a book written by the anthropologist Lawrence Keeley called War Before Civilization. In this book, Keeley explores the idea of the noble savage from prehistoric times.  In other words, were pre-historic people inherently peaceful as some had suggested or were there early signs of violence and aggression. A review of the evidence suggests that the majority of human prehistoric civilizations engaged in frequent warfare and total warfare – in other words attacks not limited to combatants and decimating the opposition’s infrastructure and ability to make war.  Keeley reviews the motivations and consequences of primitive warfare in great detail including tactics (surprise attacks, slaughter of noncombatants, and general massacres) and specific practices like mutilating dead bodies. There is clear evidence the latter functioned in part to dehumanize and humiliate the enemy and send a message to the survivors. These dynamics were not limited to prehistoric man and have continued through modern times and modern warfare.

A recent report referencing Keeley’s book appeared on Scientific Reports (2) this week.  It was a reanalysis of a Nile Valley burial site of 61 people from about 13,400 years ago. It is thought to be some of the earliest evidence of Homo sapiens interpersonal violence.  In that analysis over 100 lesions were identified in the skeletal remains from what appeared to be projectile weapons.  Examining the mortality curve of the individuals in the cemetery showed that it was consistent with multiple burials rather than a single event.   The stone artifacts examined were consistent with spear or arrow heads. Some we designed to kill by lacerating and causing blood loss. Some were discovered embedded in bones, but others were discovered within the area where the body was discovered and that was viewed as being consistent with the ability to penetrate the body.  The authors conclude that the majority of people in the cemetery died of blunt or sharp force trauma and that there were multiple episodes of interpersonal violence.  Some of the combatants had been wounded multiple times prior to death.  They also concluded that these episodes were most likely the result of “skirmishes, raids or ambushes” likely related to territorial disputes that may have been affected by the weather. (p. 9).

What can be inferred from this long history of human violence and aggression? First, groups of humans have been perpetrating violence against one another since prehistoric times. Second, during these episodes total warfare was very common and the human cost of war is always high. The estimated percentages of deaths in ancient society were generally higher than in modern society for a number of reasons. That was not a deterrent to ancient humans.  Third, the psychological states during these episodes of violence show a potentially broad range of thinking leading to aggression.  Very limited incidents such as the theft of livestock or a rumor of a sexual affair between members of different tribes or villages may be all that was required to start a series of retaliations leading to all out war.  Once a violent conflict ensued – there were thought patterns and rituals in place to justify the killing, prevent bad outcomes for the killers, humiliate the dead, and embarrass their families.

The current moral crisis in America seems to have a direct link with prehistoric behaviors. It is enacted by aggressive behavior that is described as racism, antisemitism, and gun violence, but the dynamic is the same one described in ancient man.  In other words, once a person can be seen and characterized as an enemy (for whatever reason),  it is very easy to vilify them, attribute the worst possible motivations to them, and use that as a basis for rationalizing aggressive behavior. In the past weeks, I saw two elderly Asian American women attacked at a bus stop by a man wielding a knife. The attack as so violent that the large blade of the weapon broke off inside the body of one of these women. In a more recent event, a heavily armed long time employee shot 9 of his coworkers and then killed himself when he was surrounded by police.  In both cases, the “motivation” for the violent behavior is unknown.  There is a suggestion of mental illness, but the majority of people with diagnosed mental illnesses and even the same diagnoses are not violent or aggressive. The sheer volume of mass shootings in the United States suggests it is more of a cultural phenomenon here than anywhere else but that is confounded by the easy availability of firearms.  The main difference between modern and ancient times is that we have a societal structure that is designed to contain violence and aggression and prevent larger outbreaks.  It is clearly ineffective at this point in preventing violence.

I am suggesting a common thought process here that does not require any psychiatric diagnosis and one that can be intervened upon and self-monitored.  In order to perpetrate discrimination, hate crimes, and even homicidal violence toward others 3 conditions have to exist.  First, the potential victims of violence need to be seen as sufficiently different from the perpetrator so that he can attribute unrealistic negative attributes to them and rationalize his aggressive action.  Second, the attacker can see himself as sufficiently different from the potential victims that he feels threatened by them and can rationalize attacking them for that reason alone.  A common example is that the attacker feels victimized by his coworkers and feels the need to strike out at them.  And finally, the attacker must have a plan to either seriously injure or kill the victim(s). All of these thought patterns can be considered derivative of thoughts present in ancient man leading to the wide ranging aggression and warfare described in the references.

I think there is much to be said for intervention based on the observations in this post.  For the time I have written this blog, I have advocated for intervention based on homicidal or aggressive behavior. When I worked as an acute care psychiatrist – treating violence and aggression was easily half of my job.  If we can suggest that persons with suicidal ideation or self-injurious behavior contact a crisis intervention service or hotline – why don’t we have a similar suggestion for people with homicidal thinking?  And further what about general education about the primitive origins of these thought patterns.  Just the other day I posted the following:

“Ridiculing people who died of C-19 and were antivaxxers and anti-maskers is bad form - plain and simple.

Bring civility back and restart civilization.

It starts with recognizing the value of a single human life.”

There was much agreement with the post, but also several people who suggested that I was naïve for not being able to recognize enemies or that I was a “better person” for being able to overlook the behaviors of a group of people who were potentially dangerous to others.  My post was not about moral superiority or not recognizing enemies – it is all about the fact that disagreement should not lead to enmity and beyond that we are all members of the same tribe.  We all came from Africa. And seeing differences between us that do not exist is probably ancient thinking that obscures the fact that we are all a lot more similar than we are different.  As I explained to some of the critics of my post, they seemed to be focused on the exceptions rather than the rule.  They also seemed to be making arbitrary exceptions based on seeing more differences than similarities. 

We are currently at a crossroads in this country.  People are making money and generating political capital by emphasizing differences and exploiting the primitive thinking that I have outlined in this post.  Much of the aggression plays out at a symbolic level in social media, but the Insurrection at the Capitol building and the increasing levels of physical violence illustrates that it is far from always symbolic. Americans have traditionally left ethics and morality up to religious institutions where it may be presented at an abstract level.   

It is time to get back to the basic premise of why every person is unique and needs to be treated with respect by virtue of being a member of the human race. It seems like an obvious but untested approach to reducing interpersonal violence at all levels in a society that is not currently equipped to prevent it.

 

George Dawson, MD, DFAPA

 

References:

1:  Lawrence H. Keeley. War Before Civilization. Oxford University Press, 1997.

2:  Crevecoeur I, Dias-Meirinho MH, Zazzo A, Antoine D, Bon F. New insights on interpersonal violence in the Late Pleistocene based on the Nile valley cemetery of Jebel Sahaba. Sci Rep. 2021 May 27;11(1):9991. doi: 10.1038/s41598-021-89386-y. PMID: 34045477 (Open Access).

3:  Knoll JD, Pies RW.  Moving Beyond "Motives" in Mass Shootings.  Psychiatric Times 36(1) Jan 13, 2019. Link

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Anger and Projection Are Not Political, Racial Or Gun Control Problems

Anger and projection are mental and public health problems.

The homicides of two young broadcast journalists yesterday continues to stimulate the same media response that it always does - mourning the victims, discussing the tragic aspects of the event, and doing a media profile of the perpetrator.  Anyone who has read this blog over the last three years knows my positions on this.  Lengthy posts and academic references don't seem to matter so I thought that I would keep this brief and reiterate the main points before it becomes the usual media circus about gun control and speculating about the perpetrator's mental state.   The most rational analysis considers the following points:

1.  This is first and foremost about the mental state of the perpetrator:

Without the perpetrator there is no tragedy.  Preliminary descriptions in his own words that he was a powder keg that was waiting to go off.  He had a pattern of angry conflicts with coworkers that severely complicated his life, led to job loss, and ongoing conflicts.  I heard a detailed analysis of an alleged pattern of behavior that results in this kind of homicide on the morning news today and it was too pat.   It sounded like the old "stages of grief" model that people used to adhere to.  I think there is a lot of confusion out there about what is normal anger and what kind of anger is pathological.  Anger is a socially and culturally difficult construct.  In many places like my home state of Minnesota it is generally unacceptable.  It is difficult to recognize when anger becomes a problem, if your reality excludes it as a possibility.

Anger is a problem when it is persistent and pervasive.  Normal anger is transient and does not persist for days, weeks or longer.  It is necessarily transient because it can activate physiological processes like hypertension that are not conducive to the health of the individual.  Persistent anger also gets in the way of normal social interactions that all people need in order to function properly.  Human beings are undeniably social animals and we do not function well if we are isolated or cut off from one another.  Anger tends to automatically focus people on an outside source for their problems and frustration while minimizing their own potential role in the process.  Persistent anger does not allow for the necessary productive interactions with family members, coworkers, or in many cases casual contacts in everyday life.

Projection is the attribution of a feeling state or problem to another person.  It is commonly experienced when observing a person blame other people or circumstances for problems they are having in life.  How rational that level of blame seems may be an indication of the severity of the problem.  In my years of treating people in inpatient psychiatric units, it was rare to encounter a person who did not see me as the root of their problem, even though I had barely met them, had nothing to do with why they were in the hospital, and was the person charged with helping them get out.  Some might think that was just a part of me representing an institution, but that goes out the window when the reasoning being given is that I am white or jewish or racist or I am physically attracted to the patient.  Those were typically the mildest accusations.  In many cases, this anger and projection was obvious to family members and coworkers for months or even years before the person was admitted to my unit.  Threats of physical violence or actual physical violence in these situations was common.

2.  This is a public health problem:

People with anger control problems and projection generally do not do well in life.  At the minimum these problems are significant obstacles to a successful career and social life.  One public mental health focus should be on optimizing the function of the population and preventing this social morbidity that is also associated with somatic morbidity and mortality.  In some cases, these mental states are also precursors to violence including suicide and homicide.  In some cases they have led to mass shootings.

There are very few people who talk about this kind of violence and the associated mental state as a preventable or treatable problem.  Part of the issue is that anger is socially unacceptable and it seems like a moral issue.  We should all learn how to control our tempers and keep ourselves in check.  If we don't, well that's on us and we should be punished for it.  Another part of the problem is that some people want to see it as a strictly mental health problem and turn it into a problem of prediction.  The argument then becomes the inability to predict who will "go off" and harm someone.  The additional issue that will heat up at some point is the gun control issue.  Any reasonable person will conclude that gun access in the US is too easy and the amount of firearm injuries and deaths are absurdly high for a sophisticated country.  That said, there appears to be no practical way to alter this problem within our current legislative system.  Even if all guns were removed, it would not stop the problem of people with anger control problems and projection from not doing well in life or harming innocent victims.

To address the problem, we need to take an approach that is similar to suicide prevention.  I am not talking about screening.  I am talking about identifying people at risk.  The best way to do that is to develop strategies to help them self-identify and request help or to help people in their lives assist them in getting help.  Typical ways this works in suicide prevention is public service announcements, volunteer hotlines, referrals through law enforcement and the court system, and referrals through the schools.  Suicide is also identified as a major public health issue and as such it is a focus of many organizations that do advocacy and intervention work in the area of mental health.  There are no similar resources for anger and violence prevention.

That is my basic message involving the most recent incident of preventable homicide in the United States.   I wanted to get this out after seeing just one broadcast on the issue and before I saw too many stories politicizing the incident.  I think that the factors that have resulted in lack of action in this area are obvious and several of them will be on display over the next few days.

As a psychiatrist who has worked in this area for nearly 30 years, I can say without a doubt that this unnecessary loss of life can be prevented and preventing it does not require psychiatric services, but it does require people who are willing and able to address the problem.

We just have to stop pretending that it can't be stopped.


George Dawson, MD, DFAPA



Supplementary:

1.  Previous violence prevention posts here.

2.  Previous homicide prevention posts here.