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Bandy X. Lee M.D., M.Div.

Fascism or Not Fascism?

Fascism is a form of mental disorder at societal scale.

What we call it is unimportant, but it would be important to note what fascism is not: a political ideology. It would be more precise to call it a society-level mental disorder cloaked in political ideology.

According to American political historian Robert Paxton, fascism is a “form of political behavior marked by obsessive preoccupation with community decline, humiliation, or victimhood, and by compensatory cults of unity, energy, and purity, in which a mass-based party of committed nationalist militants, working in uneasy but effective collaboration with traditional elites, abandons democratic liberties and pursues with redemptive violence and without ethical or legal restraints goals of internal cleansing and external expansion” (Paxton, 2005).

The violence builds gradually, and thus to define it by immediate appearance or ideas would be incorrect—just like any syndrome that looks different at different stages. Disorders of the mind, furthermore, adapt to historical time and culture. Unprecedented spikes in hate crimes, a multiplying of white supremacist killings, widespread schoolyard bullying, the highest gun murder rates in 25 years, and a suicide epidemic, also the highest in decades (different forms of violence are interrelated, and each is an indicator of poor collective mental health) should raise alarms. These, in the context of the above psychological factors, should raise warnings against fascism.

Here, it is important to state that mental disorders, like physical ailments, happen in a vast array and are not all alike. This type of societal disorder, therefore, should not be conflated with what we ordinarily call mental illness, the kind that individuals suffer from, to add to the stigma and misunderstandings about the nature of mental illness. It is all the more reason to speak about it and to clarify the distinction between individual illness and disorders of society.

Mental illness is not uniform, and when there is a particular type that functions like an infectious disease and can infect whole populations, or at least large portions of populations, then there is a need to alert the public about the signs. It is important to discern a disorder as such when we see one, since a pathological drive, no matter how intentional, is destructive and distinct from healthy choice. For the health professional, it is the opposite of choice and works against the person “intending” it. Because mental disorder to varying degrees takes over thoughts, behavior, and personality, it is conflated with the person, but illness should be separated and the individual freed from illness, in ways a specialist would do.

A mental health professional’s job is to identify, to prevent, and to treat disorder. It would thus be important to view a societal disorder in the same manner: the society needs to be freed, to whatever degree possible, from its affliction. At the level of society, the intervention is legal or political. However, since most politicians, judges, or lawyers are not mental health professionals, and mental health professionals must extrapolate societal intervention from individual treatment, close collaboration is necessary. Therapeutic jurisprudence is a good example of how this happens at lesser scale (Wexler and Winick, 1991). Public health already engages in large-scale prevention (Rosen, 1959). However, as the great German physician Rudolph Virchow noted: “politics is … medicine on a large scale” (Virchow, 1848).

To deal with societal mental disorder, it is important first to identify and to recognize it. It follows certain patterns: when a disorder arises at societal scale, there are usually associated society-wide policies, but more dramatically, a mentally impaired leader. Removing the impaired leader is like removing a pathogen that is directly causing the illness and is an important first step to recovery. But then it is important to remove the conditions that predisposed the organism—in this case society—from the illness in the first place.

Until this becomes possible, or when it is not possible, education is necessary. Education campaigns are a large part of public health interventions. It is therefore not surprising that information is the first that is suppressed when a society-level disease is progressing. Journalists, if not jailed or killed, are intimidated and threatened into compliance. Critical information clearinghouses, such as those for medical knowledge (Editorial Board, 2018) and scientific studies on climate change (Davenport, 2018) that recently disappeared from White House web sites, may be abolished. As trivial as these may immediately appear, this lack of access to information is bound to translate into thousands if not millions of deaths, and in the case of global warming, may contribute to the demise of humankind itself.

It is therefore no coincidence that, with a mental health issue staring us in the face, that mental health professionals would be the first to be silenced—the first medical specialty and the first professionals to be “gagged” (Lee and Singer, 2018)—but there are sure to be others. This is what happened in Germany, when professional silence led to the medical crimes under Nazism that invoked the Declaration of Geneva (World Medical Association, 1948), a health professionals’ pledge to work for humanitarian goals—against any demands for participation or silence.

Currently, democracy, or societal mental health, is under threat in Europe and the U.S., and internal conflict is severe, in the same manner in which inner conflict plagues the individual who is in the process of falling ill. Individuals with highly pathological drives are capturing high-level positions: Viktor Orbán of Hungary, Recep Erdoğan of Turkey, and Jarosław Kaczyński of Poland are examples. Their actions are predictable, as is the characteristic of disorders: disorders are rigid, unlike healthy choice. And like all disorders, by definition, they lead to the inevitable ends of destruction and death. However, disease can be deceptive, becoming recognizable only when it is too late; in the case of mental disease, it can entice those who are predisposed into enthusiastic embracing.

Hence, as governments are curtailing civil liberties, removing the independence of the judiciary, and muzzling the press, it becomes an indispensable therapeutic intervention for mental health professionals to be a witness to what they observe. In the U.S., an antidemocratic wave has ushered in Donald Trump, transforming what used to be a battle of ideologies into a battle of sickness versus sanity, falsehoods versus facts, in the same way we observe psychopathology unfold as it takes over the individual. Is this proto-fascism? Whatever we call it, the pattern is distinctly recognizable.

Our nation was born in a revolt against the tyranny of King George III, and its Constitution designed to prevent tyranny through a system of checks and balances. We depend on the healthy element of our society to assert, as we did in the Declaration of Independence: “He [who] has refused his Assent to Laws, [stymied] the Laws for Naturalization of Foreigners;… obstructed the Administration of Justice; [and] has excited domestic insurrections amongst us…. A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people” (United States, 1776).

References

Davenport, C. (2018). How much has ‘climate change’ been scrubbed from federal websites? A lot. New York Times. Retrievable at: https://www.nytimes.com/2018/01/10/climate/climate-change-trump.html

Editorial Board (2018). Want reliable medical information? The Trump administration doesn’t. New York Times. Retrievable at: https://www.nytimes.com/2018/07/19/opinion/trump-medicine-data-hhs-ahrq…

Lee, B. X., and Singer, T. (2018). Why we must talk about Trump's mental health: Psychiatrists have a duty to educate the public. New York Daily News. Retrievable at: http://www.nydailynews.com/opinion/ny-oped-let-psychiatrists-diagnose-t…

Paxton, R. O. (2005). Anatomy of Fascism. New York, NY: Vintage Books.

Rosen, G. (1959). History of Public Health. New York, NY: Science.

United States (1776). Declaration of Independence. Philadelphia, PA: United States. Retrievable at: https://www.archives.gov/founding-docs/declaration-transcript

Virchow, R. (1848). Die Medizinische reform, 2.

Wexler, D. B., and Winick, B. J. (1991). Essays in Therapeutic Jurisprudence. Durham, NC: Carolina Academic Press.

World Medical Association (1948). International Code of Medical Ethics. Ferney-Voltaire, France: World Medical Association. Retrievable at: https://www.wma.net/wp-content/uploads/2018/07/Decl-of-Geneva-v1948-1.p…

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About the Author

Bandy Lee, M.D., is a forensic psychiatrist at Yale School of Medicine and project group leader for the World Health Organization Violence Prevention Alliance.  She also authored the textbook Violence.