The First Foothold of Tyranny

Posted Mar 13, 2018

Kristina Flour/Unsplash
Source: Kristina Flour/Unsplash

“All tyranny needs to gain a foothold is for people of good conscience to remain silent.” - Edmund Burke

Social and cultural norms are powerful shapers of human behavior.  They are specific to groups and are constantly being created, modified, and affirmed.  This is why, when tyranny takes hold with the quest for total control, it works aggressively to reshape these norms, in a way that comes to control the psyche of a society or a culture.  This does not mean that those who conform to these new norms—the hundreds or thousands or millions of the tyrant’s followers—suddenly each become diagnosable with a mental disorder.  Rather, the disorder is at the level of society; it is a consequence of the tyrant’s personal disorder playing out at large through her position of influence.

When the machinery of social and cultural norm conversion is set in motion, first with a redefinition of reality, it begins by fulfilling a vital psychological need: the need for group identity, a feeling of belonging, and guidelines on how to behave in the midst of ever-changing ambiguity.  The problem is that it fulfills these needs through pernicious means: through stoking and affirming fear to increase dependence, through a psychological conditioning that works to insulate individuals from facts, and through denouncing the free press or the rule of law that serves to check its actions.  By calling out the most isolated, disenfranchised, and marginalized individuals with a “quick fix” to their predicament, the enticement works much like a drug: addictions occur because drugs, rather than fixing the problem, short-circuit to the pleasure centers of the brain.  They do not fix the problems that led to the discontent in the first place but mire one further into problems that eventually destroy the individuals, their families, and communities.

Once followers are “hooked,” almost nothing the tyrant does will dissuade or diminish his followers’ belief in him.  The more she forces a rise in power, the power itself in turn provides legitimacy to her ways.  This is one of the reasons why the most potent weapon of the tyrant is the mind of the oppressed (Biko, 1978), and the mind tyranny’s battleground for power.

The voice of truth is the best antidote to this spread of sickness, in the same manner that reality checks help prevent the mind from coming unglued in crisis situations.  Thought reform, in defiance of truth, works first through the process of “milieu control,” or the control of information and communication in the environment (Lifton, 1961).  One role that mental health professionals have, as outlined in their ethical guidelines, is to contribute to public health through education.  What the American Psychiatric Association (APA) has done, in the face of an unprecedented number of mental health professionals speaking up in an unprecedented way in U.S. history, should come under scrutiny as a form of milieu control by imposing silence on them in the name of “ethics”.

Two months into the current administration, on March 16, 2017, the APA made the unprecedented move of expanding what is informally called “the Goldwater rule” into a prohibition against any form of commentary on public figures.  Briefly, the rule was established in 1973 following the circumstances during Barry Goldwater’s 1964 presidential campaign.  Fewer than ten percent of the 12,356 psychiatrists that a popular magazine surveyed made irresponsible conclusions, which were publicized in a way that resulted in a libel suit against the magazine and embarrassed the APA.  The rule never had a repeat case in court, and psychiatric practices have since drastically changed, going from intrapsychic, psychoanalytic assessments to diagnoses based purely on objectively observable behavior.  With the advent of telepsychiatry and the growing demand for forensic psychiatry, diagnoses are routinely made from afar or in the absence of a personal interview.  However, rather than abolish an obscure rule that scientific evidence no longer supports, or at the very least leave it alone, the APA decided to elevate the rule to a status where no previous ethical rule had gone: to the level of an absolute decree.

In fact, the original Goldwater rule almost does not matter, since the decree is a new one.  In the very context where mental health professionals may have been more attuned than the average citizen to dangerous patterns of behavior that indicated tyrannical tendencies, it has created a dangerous and unprecedented restriction on psychiatrists and, by extension, all mental health professionals.  A decree not only takes away an essential aspect of ethical deliberations—the agency capable of carefully weighing sometimes competing guidelines—but by creating a rule without limits or countervailing rule, regardless of the consequences to humanity, it has shaped discourse and silenced debate.  The timing and circumstances of this “gag order,” as many have called it, necessarily turns it into a political instrument.  Numerous members have resigned or have flooded the APA with letters calling for a vote, to which it has not responded, almost a year into the decree.

Tyranny at larger scale spawns micro-tyrannies, capable of engineering social and cultural norms by controlling the informational milieu: the public no longer expects to hear about mental health from mental health professionals the way they hear about politics from political scientists, about legal cases from legal experts, or even about nuclear weapons from nuclear physicists.  Mental health professionals have become remote figures they should not consult outside of personal meetings, in secret, and only for diagnosing mental illness, when this is just a small fraction of what they actually do.  Expanding the ethical rule to equate warnings about signs of danger with “diagnosis” increases stigma: it promulgates the popular misperception that danger is associated with the diagnosis of a mental disorder, when individuals with mental illness are no more dangerous than the general population.

Furthermore, while making the ethical rule more severe, the APA (2018) has enforced it unevenly: censuring those who are simply raising alarms, even though they are not diagnosing, but supporting those who actually violate the Goldwater rule and diagnose, provided they promote a sense of normalcy (Frances, quoted in Wilson, 2017; Lieberman, 2017).  This inconsistency has the effect of instructing what can and cannot be said, thus helping to “normalize” a malignant reality that accompanies the spread of tyranny.  By stifling discussions of concern, it has even limited what the New York Times would consider publishing, as it has so far printed op-ed articles only of the side that advocates silence (Friedman, 2017) while refusing dozens of articles that represent by all accounts the majority view.

Perverting ethical rules and what it means to politicize psychiatry (Tansey, 2018) has its consequences.  Reality is turned upside down, right is made wrong, and wrong made right in ways that create a society and culture ripe for tyrannical abuse.  It is therefore up to the healthy element of the population and its witnessing professionals to speak up and not to remain silent.

Disclaimer: The author was once a fellow of the American Psychiatric Association but resigned over a decade ago due to its growing ties with the pharmaceutical industry.


American Psychiatric Association (2018).  APA Calls for End to ‘Armchair’ Psychiatry.  Washington, DC: American Psychiatric Association.  Retrievable at:

Biko, S. (1978).  I Write What I Like.  Oxford, U.K.: Heinemann.

Friedman, R. A. (2017).  Is it time to call Trump mentally ill?  New York Times.  Retrievable at:

Lieberman, J. A. (2017).  Trump’s brain and the 25th Amendment.  Vice.  Retrievable at:

Lifton, R. J. (1961).  Thought Reform and the Psychology of Totalism: A Study of ‘Brainwashing’ in China.  London, U.K.: Victor Gollancz.

Tansey, M. J. (2018).  Part XVI. ‘This is not a drill’: Response to Jeffrey Lieberman.  Huffington Post.  Retrievable at:

Wilson, F. P. (2017).  Misdiagnosing Trump: Doc-to-doc with Allen Frances, MD.  MedPage Today.  Retrievable at: