Does “mass formation psychosis” really exist?

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Source: US National Archives and DVIDS/Public Domain

“Mass psychosis”, “mass delusion”, “mass formation psychosis” and “mass delusional psychosis” are terms that have been used a lot lately to describe our ideological opposites. This is a pejorative and inappropriate use of psychiatric terminology. Here are some thoughts that came up on the subject in a recent discussion I had.

Is there something like “shared delusion” or “mass psychosis”? And are there any real ones that have been documented?

Psychiatry has always been careful not to label culturally sanctioned beliefs – like religious beliefs – as delusions. Accordingly, delusions are defined as fixed, false beliefs that are idiosyncratic to the believer and not shared within a culture or subculture. That said, it has long been recognized that delusions are sometimes shared between people. This traditionally occurs within a dyad such as a parent and child where one person is delusional and the other is impressionable – this has been called “double madness” or the “double madness”. Shared psychosis, or shared delusion, has sometimes been applied to a handful of people who share a delusional belief, but the term was never intended to describe what journalist Charles Mackay called “Popular delusions and the madness of crowds” in 1841. But groupthink, whether in religion or politics, is not a matter of delusional thought, psychosis or mental illness and it is doing a disservice to those with mental illness to pretend that it is. It is also a disservice to ourselves, as it distracts us from the real social forces that lead to widespread false beliefs.

Physician Robert Malone has claimed that getting vaccinated or taking other COVID precautions can be explained by “mass forming psychosis”. Why is this not correct?

An illusion is a belief, not a behavior. The question we should ask ourselves is: what are the beliefs that lead people to get vaccinated or not? If they get vaccinated because they think the advice of public health scientists and epidemiologists is sound, or that following the evidence of research studies supporting the effectiveness of vaccines or wearing masks makes sense, this is obviously not an illusion. But not believing scientists, nor Dr. Fauci and the CDC, nor research studies and instead following the advice of Robert Malone is not an illusion either. The end result may be a fixed and false belief, but it is not the product of mental illness, it is the product of a pervasive distrust of authoritative sources of information, resulting in vulnerability to misinformation and disinformation that exists in the world.1 It reflects a kind of social evil of society, not the mental illness of individuals en masse.

Mass delusional thinking or mass psychosis has been used at both ends of the political spectrum. Why are these constructs so easily co-opted and applied?

What’s happening right now is kind of a tit-for-tat. Conservatives and anti-vaxxers like Robert Malone say following the scientific evidence on the pandemic and backing vaccination mandates can be explained by a “mass forming psychosis”. Meanwhile, articles in a liberal magazine like Atlantic used terms like “mass delusion” and “mass psychosis” to describe the type of conspiracy theories that motivated the Capitol insurgents. These are just pejorative slurs from our ideological opposites on both sides of the political fence. This is not an appropriate or responsible use of psychiatric terminology. It’s also the equivalent of Hillary Clinton’s “basket of deplorables” gaffe: calling our ideological opposites “crazy” only further alienates people and worsens political polarization rather than bringing us closer to the type of collaborative work we need to do to pull ourselves out of the pandemic. as a nation and as a world.

How to distinguish between extreme belief and mental illness?

Most things in nature can be conceptualized on a continuum. We recognize that there is a color called “red”, but the reality is that “red” represents a spectrum or range of wavelength intensity and the sort where red ends and orange begins is “blurry”. It’s the same thing when we talk about delusions and what psychiatry sometimes calls “overstated beliefs” and what some have recently called “extremely overstated beliefs”.2 It’s often a matter of degree, where degree depends on cognitive dimensions like ‘belief’ (how strongly we believe something) and concern (how long we spend thinking about it).

Beyond the continuum, the categorical guidelines for separating delusions from non-delusions are quite straightforward. Illusions are fixed and false, but for the most part they are not shared beliefs. They are idiosyncratic and self-referential, meaning they are often about the believer rather than beliefs about the world. It is relatively easy to find others who share the belief that there will be a second coming of the Messiah. But it’s not as easy to find people who agree that you are the Messiah. Nor are delusions usually based on information or misinformation that one encounters in the world. If someone believes something because they’ve “done their research” and found “evidence” somewhere on the internet, that’s not what psychiatrists are talking about when we talk about delusions.

The answer to Malone’s statement is that “mass forming psychosis” simply does not exist. Is this a helpful answer? People can see online that there have been studies of phenomena similar to what he is talking about.

“Mass-forming psychosis” does not exist as a recognized psychiatric diagnosis, so it is a misuse – and arguably a deliberate misuse – of psychiatric terminology. But then Malone doesn’t really claim it’s a psychiatric diagnosis and “mass forming psychosis” isn’t even his idea – he borrowed the term from a Belgian psychologist named Matthias Desmit (though Desmit says he only refers to “mass training” without “psychosis”) as well as psychiatrist Mark MacDonald (whose book uses the term “mass delusional psychosis”). Mental health professionals should know not to throw around such stigmatizing terms, but we’ve also had psychiatrists try to tell the American public that Donald Trump is mentally unfit to be president because he suffers from mental illness. a psychiatric disorder. Unfortunately, we have mental health professionals on both sides of the political fence who use psychiatric terms irresponsibly to advance political views.

When psychiatrists and psychologists say “mass forming psychosis” does not exist, we mean that what Desmit and MacDonald describe is not psychosis or a symptom of mental illness. But despite their poor choice of words, they’re not really claiming that people who support vaccination and vaccination mandates are actually delusional or mentally ill. Instead, they use “psychosis” as a pejorative to claim that people are misinformed because they are victims of fear and other social forces in today’s world. But meanwhile, MacDonald is promoting ivermectin to treat COVID-19 and acting as an adviser to Ronald DeSantis, the governor of a state near the peak of COVID-19 cases per capita here in the United States. United. Desmit and MacDonald are right that fear can cause us to overestimate the risk and take excessive precautions – like what we’ve endured when boarding a plane since 9/11 – but there have been nearly 850,000 deaths in the United States from COVID-19 since the start of the pandemic and an average of 1,600 deaths per day this week during Omicron’s peak.

Based on these realities, is the fear of contracting COVID-19 irrational or intelligent? This is the wrong question to ask. The right question is how best to prevent morbidity and mortality from COVID-19 and how to protect the most vulnerable people in our country, like our parents and grandparents who are most at risk. When we face a global pandemic, the evidence-based response is herd immunity, which is most reliably and reliably achieved through vaccination and behavioral measures such as masking and social distancing to prevent the spread. It would be great if we could achieve this without a warrant, but here we are.

Essential readings on psychosis

Although we Americans are proud of our individualism and like to talk about “not giving up our freedoms,” we really could use more altruism for the greater good right now. There’s nothing delusional or psychotic about it.

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