- Terms like "mass delusion" and "mass psychosis" are not appropriate terms to describe widespread false beliefs.
- Using such terms as pejoratives to describe ideological opposites unfairly stigmatizes those suffering from mental illness.
- Describing ideological opposites using terms like "mass psychosis" simply points away from the social causes of belief in misinformation.
As a psychiatrist whose academic work focuses on delusions and the delusion-like beliefs that lie in the grey area between psychopathology and normality, the most frequent question I’ve been asked over the past two years is if the large swaths of the public who have false beliefs related to COVID-19, QAnon, or the outcome of the 2020 presidential election are suffering from some kind of “mass delusion” or "mass psychosis." Whether I’m asked in the media, forensic consultation, or casual conversation, the answer—in a word—is “no.”
And yet, variants of the claim that our ideological opposites are “crazy” or impaired by some form of mental illness continue to be asserted to wide audiences on both sides of the political fence. On the left, The Atlantic has run two headlines in recent months claiming “mass psychosis” and “mass delusion” to account for the kind of false beliefs that motivated events like the Capitol insurrection of January 6, 2021. Meanwhile, on the right, the anti-vaccine physician Robert Malone appeared on the Joe Rogan Experience two weeks ago to liken vaccination efforts and vaccine mandates to Nazi Germany and attribute public support for them to “mass formation psychosis.”
“Psychosis” and “delusion” are psychiatric terms with medicolegal definitions. Delusions, one of the prototypical examples of psychosis, can be succinctly defined as fixed and false beliefs that are typically self-referential, idiosyncratic to the believer, and unshared. Although rare cases of shared delusion conceptualized as “folie-à-deux” and “shared psychotic disorder” have long been recognized in psychiatry, this diagnostic entity was all but removed from the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and in any case was never intended to describe “folie-à-mille” or the “craziness of a thousand.” “Mass psychogenic disorder” or “mass hysteria” are terms use to account for physical symptoms of illness that emerge within a population due to suggestibility as opposed to any identified medical cause, but are more applicable to “Havana syndrome” than anything related to QAnon, COVID-19, or current political affairs.
Invoking clinical terms to dismiss opponents hurts all of us
Although there’s a long history of misusing psychiatric terminology more loosely as a pejorative, this hardly justifies the act today in responsible journalism, politics, or civil public discourse. Besides being technically inaccurate, using terms like “delusion” and “psychosis” to “other” those whose beliefs we find objectionable or unfathomable unfairly stigmatizes those who suffer from actual mental illness. Furthermore, invoking clinical terms to dismiss our ideological opponents does us all a disservice by steering away from understanding and addressing the real root causes of false beliefs related to politics and scientific matters that have become politicized which are more appropriately categorized as conspiracy theories.
A better framework for understanding belief in conspiracy theories
The quotation “insanity is sometimes a sane response to an insane society”—variably attributed to the sociologist Emile Durkheim or to the psychiatrists R.D. Laing and Thomas Szasz—is a misinformed take on real mental illness, but it’s a fair account of the widespread belief in conspiracy theories that plagues us as a nation and as a world today. Polls have consistently demonstrated that over half of the population in the US as well as other countries around the globe believe in at least one conspiracy theory. While such beliefs can be partially attributed to a long list of “cognitive foibles” including psychological needs for certainty, control, and uniqueness; reliance on intuition over analytical thinking; scientific illiteracy; and even “bullsh*t receptivity,” these are quirks that we all possess in varying degrees. Conspiracy theory beliefs are often therefore better understood within a more normalizing socio-epistemic framework rather than in psychopathological terms.1
Widespread belief that the 2020 election was “stolen,” that vaccination either is or isn’t our best weapon to fight the COVID-19 pandemic, or for that matter that the Steele dossier wasn’t a fabricated political hit-piece shouldn’t therefore be swept under the othering rug of mass psychosis or delusion. Instead, vaccine hesitancy, claims of election tampering, belief in a Deep State, and the rise of other anti-establishment and populist ideals with their slippery slope to embrace of authoritarianism should be understood as byproducts of pervasive mistrust making all us vulnerable to misinformation along with the deliberate use of disinformation as political propaganda. This is much less evidence of psychopathology or “mass delusion” than it is partisan motivated reasoning and denial symptomatic of a sick society and a democracy in peril.
1. Pierre JM. Mistrust and misinformation: A two component, socio-epistemic model of belief in conspiracy theories. Journal of Social and Political Psychology 2020; 8:617-641.