As an American therapist, it’s hard for me not to try and diagnose en masse. I become so familiar with individual problems that I start to see them playing out in society at large, and the sociological implications of this fascinate me. For example, as individual human beings have trauma, can we conceptualize a society to have collective trauma? Would war, inequality, corruption, and oppression be symptoms of this? More specifically, could the paranoia that we see fueling American politics be a symptom of some collective dysfunction? It becomes more and more difficult to avoid feeling a responsibility to address it the more I see how paranoid delusion affects political discourse in this country and how it has to a large extent gone “mainstream.” I, like many other Americans, am horrified and morbidly fascinated that our discourse has made a place at the table for extremely racist, xenophobic, homophobic, and transphobic vitriol as well as the surreal accoutrements of such belief systems. I’m referring primarily to the influence of the Q Anon conspiracy movement both in America and across the world, but I’m also thinking about 9/11 “truther” movements, Flat Earthers, and a host of anti-Semitic myths in various degrees of disguise.

In Richard Hofstedter’s classic essay, “The Paranoid Style in American Politics,” he identifies a strain of thought that has only become more and more relevant in defining political discourse in America. Though written in 1964, its discussion of how feelings of dispossession lead to conspiratorial thought are oddly prescient. Despite oftentimes being privileged members of a first-world nation that lead comfortable lives, individuals who craft and adhere to stories like these are possessed by a notion that they are being attacked, eradicated, or undermined; usually by a shadowy cabal operating in secret. This can manifest in the overtly racist myth of “White replacement” or the more socially acceptable fear that foreign elements will somehow compromise the integrity of American culture.

Hofstadter also speaks of how paranoia leads people to “emulate the enemy” even when the enemy is imagined, echoing Freud’s classic defense mechanism of identification with the aggressor as well as Jung’s concept of The Shadow. Hofstadter says “It is hard to resist the conclusion that this enemy is on many counts the projection of the self; both the ideal and the unacceptable aspects of the self are attributed to him.” So if one is insecure about one’s education or influence in society, then “The Other” is seen as a group of highly educated and highly powerful people. Oddly, the more energy one puts into opposing such an enemy, the more one begins to resemble them. This becomes especially dangerous when the belief systems allege that the rich and powerful are hurting children (as in the case of Q Anon). Suddenly, the stakes are so high that violence may be easily justified in the face of such an enemy. And here we see a mass of new irrational beliefs interacting with one of the oldest irrational beliefs of humanity: that “it’s okay to hurt people if they’re hurting people.”

This is all to say that such paranoid delusions have demonstrably done a lot of harm in America and have the capacity to do far more. One doesn’t have to be a student of history to recognize the role of conspiracy theories in the authoritarian propaganda of totalitarian states. And this capacity to do harm qualifies paranoid delusions as clinically significant. But the question becomes: what does it mean to talk about a society with a mental illness rather than an individual?

I believe that anyone conversant with the paranoid strains of thought in American culture right now has to come to a very odd conclusion. That being; groups of human beings are capable of holding on to very bizarre delusions while not meeting clinical criteria for individual disorders. In other words, we’ve come to a point where we have to admit that not every person who believes the Earth is flat or that the world is run by Satanic pedophiles who consume blood in order to stay young meets clinical criteria for a delusional disorder. This is a strange admission to make, given the bizarre content of the delusions we see gripping the American psyche. And this is where the more amorphous and less often studied concept of mass delusion comes in. The world of psychology has addressed this clinically to some extent with the “shared delusional disorder” or folie a deux of the DSM5, but this phenomenon is usually only applied to small groups. If there is a systemic and informed approach to even conceptualize, let alone treat, mass disorder like this, then I haven’t heard of it. And when I think about mass delusion on a societal level, this lack of a form of treatment is the biggest problem. I can barely describe what diagnosis would look like, and I have no idea what treatment would look like. In my own biased opinion, if everyone went to therapy individually then the world would be a better place, but I’m not sure that individual treatment is the best course of action for such a collective problem. What does therapy look like for an entire culture? For a society, For a nation? I have no idea. And although it’s scary to admit it, it may also be an indication that both therapists and American citizens are responsible for supplying some form of help for the illness that we see in our country. I try to have faith that we can develop something soon.