COMMENTARY

The Pandemic and America's Regressive National Psyche

Jeffrey A. Lieberman, MD

Disclosures

January 25, 2021

This transcript has been edited for clarity.

Hello. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. This video is inspired by observations and concerns about ongoing events that fly in the face of reason and knowledge, are unhealthy, and are possibly detrimental to our society. They pertain to mental health and the practice of psychiatry, mental illness and its associated stigma, and other topics.

It's increasingly important for psychiatrists to have a voice in the public arena about what is happening in our country. This is particularly true in recent years, as we've seen that we can't rely on government institutions to always protect us. As psychiatrists, we're uniquely qualified to recognize and call attention to pathologic behavior in our patients, but also in populations and societies.

If ever there was a time comparable to this past year, I don't know it. We've all worn out the hackneyed expressions about just how unprecedented this recent experience is, but it's important to remember that it's not just one crisis. Rather, we've gone through a series of crises, beginning with the COVID-19 pandemic but also including incidents of racial abuse and social unrest, continued economic disruptions, the contentious presidential election, and the symbolically poignant death of Ruth Bader Ginsburg.

Among the good things that recently occurred is the advent of the COVID-19 vaccines, which signaled a possible end to this dark period. However, rather than celebrating the arrival of the scientifically engineered solution to our problem, we're instead engaged in a battle for public opinion.

Since last March, we've been battling the COVID virus and its injurious and deadly effects. But we've also been fighting the pandemic's collateral effects, such as family members losing loved ones; stresses to overburdened healthcare workers; and social and economic disruption in the form of people's drastically changed lives, the closing of businesses, and resulting financial destitution. All of that is having a lasting impact on our population.

In addition to the pandemic and its disruptive effects rippling through our country, we have also become embroiled in a second conflict. It's characterized by civil strife over how we regard the pandemic, our methods for combating it, and the recently arrived vaccine. This has caused a two-front war in which we're battling not only the virus but also ourselves. It's not quite a circular firing squad, but it's a civil conflict, almost like the Civil War, where we're divided and opposing ourselves in terms of how we should deal with this national threat.

The intensely felt disagreements over how to cope with the problem are a demonstration of the political divide that we're riven by. This is reflected in the recent election and in its contentious aftermath. Now, I have to admit, I can't understand this and don't see a rational explanation. It appears to be a manifestation of some very pernicious dynamic that has invaded our national psyche.

On the basis of what we know from studying the psychiatric effects on people from past disasters, human-made or natural, we can estimate the increments in different mental health conditions that will develop as a result of this moment. We can predict the increases in population frequencies for such conditions as depression, anxiety, substance abuse, attempted suicide, and violence (domestic or criminal) within certain confidence intervals. Modeling could potentially allow us to enact public mental health initiatives to try to preempt or mitigate the sequelae of these conditions. We should be doing this, but we're not. Despite the consensus that there's going to be a considerable psychiatric aftermath to this pandemic, there's no action being taken to mitigate it.

What is this? People exercising their individual freedoms, their freedom of speech, their self-determination? Give me a break...

The other side of this war we're fighting is due to the fact that we have a population divide. On the one hand, the best and the brightest of our infectious disease and public health scientists and experts are telling us how to contain the virus, how long it's going to be with us, and when it will be eradicated by the vaccines, and we can plan to normalize. This is guidance from people whom we would ordinarily rely on, trust, and accept unquestionably, just as we would do if we went to the hospital for chest pain and were told we're having a heart attack, or if we had a lump identified as possibly being cancer, or if we fell and were told the pain in our leg was due to a broken bone.

But now, many are simply not following the expert advice on protective measures, such as wearing masks, social distancing, not congregating, proper disinfection. Some people are following this advice religiously, but amazingly large numbers are not only not following it, they're actively rebelling against it and encouraging others to do so as well.

What is this? People exercising their individual freedoms, their freedom of speech, their self-determination? Give me a break. The notion that people have freedoms that empower them to ignore the certainties of science and data, and in doing so, countermand the public good and national interest just to satisfy their own personal whims is complete crap.

Samuel Johnson said that patriotism is the last refuge of scoundrels. Well, in this case, we see large numbers of people using the American ethos of rugged individualism, self-determination, and "don't tread on me" to basically mean, "I'm going to do whatever I want and you can't tell me what to do, even if it's the right and necessary thing. Wearing a mask is bad. Don't tell me I can't eat inside a restaurant. Don't tell me I can't get together if I want to have a party."

This is nothing more than puerile narcissism. The COVID virus takes days to produce symptoms and does not severely incapacitate or kill everybody it infects. But I guarantee you that if instead this was Ebola, or nuclear fallout in the atmosphere causing everyone who went outside to immediately become sick or die, there wouldn't be any questioning expert advice. Nobody would be bitching. But because you can't see the effects immediately and instead need to use an intellectual process to understand and follow the advice of experts, and because at the same time people are being egged on by certain government officials and political elements, too many people are ignoring the advice. They think that if they can't see it and don't feel it, it's not real. And they're taking a contrarian position that's jeopardizing the nation's health and well-being.

That's just abominable, and it's unacceptable. All Americans have to be embarrassed by what's happening. Things were bad enough with the pandemic and the destruction that it's causing, and we're going to have to pick ourselves up in the aftermath. But we're prolonging the agony of this national nightmare by fighting amongst ourselves about how we should deal with it. And this is leading to a worsening of the problem. It's self-defeating. It defies reason.

From a macro clinical-psychological perspective, what is happening is a regression of our national psyche to a more primitive, childlike state. We're a young country compared to those in Europe and Asia, but in our approximately 250 years of existence, we have become a beacon of freedom and enlightenment to the rest of the world. What we've now done is reverse direction, devolving into a petulant, self-consumed adolescent mentality.

Continuing on this regressive trajectory would ensure a once-great civilization coming apart at the seams. But if this is a temporary blip from which we're going to recover, as I can only hope it is, the country can instead right itself and continue on a course that fulfills our great national destiny as the most successful country in the history of the world.

Winston Churchill, who has many quotable quotes, once said, "You can always count on the Americans to do the right thing after they've tried everything else." I pray that he was right in this case.

Thank you for listening. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

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