Conspiracy and Mental Health

It is finally over! After four terrible years for so many people in the United States and beyond, the Trump presidency has ended and Joe Biden has taken the reigns. Even from across the pond the world feels a little brighter today, and there is hope we could see some actual global leadership in tackling the pandemic, but also other significant issues of the day like climate change.

There will be a lot to unpack for people much more knowledgable on American politics than me in the coming weeks and months, specifically how such a dangerous individual ever managed to find themselves in a position of power, and how they managed to convince a sizeable portion of the American population, and a fair few supporters further afield as well, that they were the good guys, when almost everything they did was demonstrably terrible.

Even as the (muted) celebrations of Biden’s inauguration continue, the online world is abuzz with hypotheses and explanations for what the US has just experienced. Everything from education to the media has come under the magnifying glass as a potential contributor, and as with most things in life, the answer will probably be a combination of factors.

One issue that I have seen cropping up more and more from, for want of a better term, anti-Trumpers, is that of mental illness. The argument goes something along the lines of mental health care is poor in the US (undoubtably true, but certainly something you could say about much of the world), people are not receiving the care they need and so are finding themselves believing baseless conspiracy theories and nonsense which sees them supporting the likes of Trump. This idea has been particularly popular when thinking about the supporters of Qanon.

If you have never heard of Qanon, firstly lucky you. Secondly, Qanon is a collection of conspiracy theories related to an anonymous individual known as Q. They claim to have worked within the Trump Whitehouse, or within the military, and through anonymous posts on online message boards, they claim to be releasing information about a secret plan by Trump to drain the swamp and retain power. As far as I can tell the messages from Q have been relatively infrequent, and are often cryptic in nature, heavily influenced by ideas such as numerology, but they have led to a huge following online of people using this information and attempting to interpret Trump’s words and actions to understand his big plan. Q, if it is just one person, was likely a fantasist or prankster, but they garnered a loyal following, with people believing up until yesterday Trump would pull something out of the bag and stay in power. As you can imagine there are a fair few disappointed Qanon fans today.

As well as those in support of Qanon online, inevitably the detractors are there as well. For many it is simply another conspiracy theory to file away with people who believe the Moon landings are hoaxes or the Earth is flat, but for some people like the person who tweeted the image above, it is a sign of mental illness.

As you can see I have anonymised the posts above as I am not targeting that person individually for criticism, and they are certainly not the only person equating mental illness with Qanon conspiracies. This was the first hit which came up when I looked at Twitter, but there are plenty more.

Rather than targeting this person individually, I use them as an example of the kinds of negativity people with mental illness can be exposed to, even when well meaning, and to try and shift the conversation away from what I feel can be a harmful narrative. Crucially, given anti-Trumpers have spent much of the last four years accusing the other side of not living in a world of objective truth, it is important to make sure any criticism or explanation of the Trump phenomena has facts and reality as the starting point.

Some people with a mental illness believe in conspiracies, but not all conspiracy believers are mentally ill

I would hope this is not a controversial opinion, but it certainly does not seem to be the narrative pushed by some online. For some, the very fact people believe in out their conspiracies means they must have a mental illness, which if only better managed would mean they saw the light and no longer supported Trump.

When people speak about mental illness, I suspect they are talking about delusional beliefs which can be a part of a psychotic illness like schizophrenia. To a psychiatrist, a delusion has a specific meaning, namely;

A delusion is a fixed, false belief, which is held with certainty even when provided evidence to the contrary, and which is not in keeping with someone’s culture or religious beliefs

On the face of it, believing in a conspiracy theory such as Qanon could certainly fit this definition. It is a fixed belief, undoubtably false and is held by people even when they are provided evidence disproving their belief. You can even argue believing in Q is outside someone’s cultural norms as not every Trump supporter believes in Q.

But when we think about it just a little more, the idea a belief in a conspiracy alone means someone is mentally ill quickly unravels.

For a start, an isolated delusion alone does not meet the criteria for mental illness. Yes, someone with schizophrenia may have delusional beliefs, but you would also expect other symptoms such as voice hearing or muddled thoughts, and you would certainly want the symptoms to be having an impact on their life and functioning. Save those people who found themselves storming the US Capitol before being arrested, holding a belief in Q by itself does not meet the the criteria needed to diagnose a mental illness.

This is of course assuming you accept a belief in conspiracies as a delusion in the first place, which I do not believe is the case every time. For someone to be delusional, they need to be provided evidence to the contrary and still hold the false belief. For many people who believe in Q, and other conspiracies as well, I do not feel it is a mental illness which prevents them from accepting evidence to refute their claim, but rather an inability to evaluate evidence appropriately in the first place.

For many people, a YouTube video or website with an expert explaining in language they can understand can be very powerful, and once they throw in the odd bit of cherry-picked data or untested hypothesis, it can become appealing to believe the conspiracy. Learning to evaluate evidence and data and apply the proper weight to an argument depending on the reliability of the source is a difficult thing. I have received a world class medical education where evaluating evidence forms the core of practice, but even now I cannot help be pulled in from time to time by tempting claims, and can get lost in often contradictory data.

The world can be a complicated and confusing place, and sometimes a simple answer to complex questions is tempting. Believing that the guy you support has a plan and will win is a comforting thing, even when all the evidence is to the contrary. This does not make someone mentally ill, it is just a part of life. Challenging some of the false narratives people have fallen for over the last four years is a crucial part of moving forwards and repairing some of the damage done, but we need to do this from a position of understanding from the get go.

Yes, some people who supported Trump will have a mental illness, in much the same way some people who supported Biden will.

Yes, mental health care needs investment not just in the United States but across the world, and the world would be a much better place if this was done.

No, mental illness is not the answer to understanding Trump supporters and their beliefs, and continuing to do so risks not only preventing us reaching accurate conclusions on why people supported Trump, but also risks souring the debate which needs to be had on mental health care in the process. Let’s have the important debate about Trump and his followers, but let’s do it without causing harm in the process.