Mental(izing) Health
Newsletter, #58
In and out of sessions, people are talking about the election. Most of the people I interact with are mystified about how anyone could vote for Trump or even imagine him as a qualified president, and they are also worried about the results of the election—both if Trump wins, and if he loses. I am not having conversations with Trump supporters or undecided voters; dialogue with the former seems unlikely; dialogue with the latter is crucial at this moment, and anyone who is making that effort deserves our appreciation and gratitude.
It is hard not to feel that something has profoundly changed in American politics, exemplified by the diminished relevance of the mainstream media, the absence of primaries, and the way that both candidates have been anointed, rather than being vetted through the usual channels. Moreover, the viciousness of Trump’s rhetoric has escalated beyond (or should I say “below”) the level of any previous presidential candidates. What is especially concerning, too, is that regardless of the outcome, we must reckon with the probability that roughly 50 per cent of Americans will have voted for a proud authoritarian.
It is, indeed, shocking to realize that in less than a week’s time, we could have confirmation of the end or at least serious compromising of our democracy.[i] There is now an intense, and luminous sense of dread hanging over us— that something bad is about to happen. Yet, just like Winnicott’s astute argument in Fear of a Breakdown, perhaps our dread is about what has already happened, not just what might happen.[ii]
Several contributions about the election in the November 7, 2024 issue of The New York Review of Books (NYRB) make the case that our country has been floundering for some time, and that Trump represents a culmination of ideas and policies that have existed at least from the Bush-era, beginning with the false claim about Iraq having weapons of mass destruction and the torture program, and possibly before.[iii] One can discern the origins of Trump’s “philosophy” in Reagan’s simplistic, jingoistic nationalism, although Reagan was a passionate anti-communist and cold-war warrior for whom the bad guys were the Russian empire. As we know, Trump has a strong affection for Putin, and although less ideologically driven than Reagan, he is unpredictable and more pernicious.
In his piece in NYRB, Pankaj Mishra takes up a perspective that Americans too often lack: how we are seen by others. He maintains that respect for the United States has hugely decreased from the fruitless wars in Iraq and Afghanistan, and from the “sinister regression” that we are currently witnessing. He sees the entire spectrum of American politics as having shifted to the right, which is hard to dispute, given, for example, the strong embrace of the military by the democratic ticket. Jacqueline Rose is also skeptical of the democratic ticket for their posturing with the emotion of joy, given the precarious state of the world, with calamitous wars in the Ukraine, Israel/Palestine, and the Sudan.
Marilynne Robinson reminds us that Poe, Twain and Melville discerned a certain attraction to hucksters that runs through American history. She moves on to a surprisingly optimistic conclusion based upon her sense that Americans are open-minded, optimistic, and believe in mutual respect. Does Robinson believe that we still possess these virtues? Polarization has certainly diminished our open-mindedness. I am not sure how to square optimism with the dread that has descended upon us. Moreover, I don’t agree that mutual respect is evident as part of the American character. One could only defend that perspective by minimizing the history of slavery and enduring racism.
Jonathan Lethem heeds the theme of racism, tracing the dog whistle politics that Nixon used, followed by Reagan and the Bushes, and now Trump. He rightly points out, though, that Trump’s racism is different in being overt and unapologetic. He is less optimistic than Robinson, observing how challenging it is to keep in mind both the idea that Harris must win and the idea that everything needs to change.
In another piece in the same issue of NYRB, Mark Danner reflects on attending a Trump rally in Las Vegas, where he is struck by the “lurid dystopia” depicted by Trump, and the fact that his showmanship is organized around fear. As he eloquently notes: “Fear, the most lucrative political emotion, is Trump’s superpower.” Fear is a healthy emotion that protects us from harm; yet, it can be manipulated to disguise the object of threat or to exaggerate it with ulterior motives. Trump’s fearmongering is dangerous because he is adept at such orchestration, burying his primary concern, his own self-interest.
Another danger of such fearmongering is how it incapacitates our ability to think. Danner documents that Trump’s response to criticism of his claim about illegal Haitian immigrants devouring cats and dogs in Springfield, Ohio, was to say: “the people on television say my dog was taken and used for food.” Television, as Danner notes, is invoked as evidence of truth and granted the status of being “ironclad, immune from fact-checking, impervious to correction.”
In her piece in NYRB, Anne Enright also weighs in about the lack of interest in argument or evidence among Trump and his supporters, and their “denial, blinded by their inability to see.” She is astounded by a man who becomes irate in response to the suggestion that Trump ought to reveal specifics about his “concept of a plan” regarding healthcare. She also cites an undecided voter who seemed to be swayed by Harris because of how she approached Trump to shake his hand in the debate. Americans seem childish in her account, unable to rise to the occasion of articulating or defending their beliefs in a way that might enable a dialogue.
In a recent podcast sponsored by the psychiatry department at Weill-Cornell Medicine, Daniel Knoepflmacher interviews Richard Friedman about the polarization in the country and how the election is negatively impacting people who are anxious and depressed (as well as people who have been targeted, such as black and brown immigrants).[iv] To their credit, the two psychiatrists also attempt to move beyond our alarming situation to entertains steps that might help us to cope and move forward.
Knoepflmacher introduces the importance of empathy and equates it with mentalization; Friedman takes this in the direction of trying to understand others in their own terms, making sure to avoid judging their opinions. Both are modelling what could be adapted for the social environment based upon the obligation that a clinician has in understanding a patient.
The dialogue between Knoepflmacher and Friedman is fruitful, but it left me pondering whether dialogue is possible where one party values it and the other does not. In other words, what happens if I have empathy for you, but you are unwilling to have empathy for me? What happens if you feel you are right without qualification, whereas I am open to modifying my beliefs based upon arguments and evidence? Perhaps, an argument can be made that conveying empathy for the other induces empathy in return. Let us hope that that is the case.
The relation between empathy and mentalization merits further consideration. I am inclined to distinguish between them: that empathy is a necessary but insufficient for mentalization. However, this does depend upon how one construes empathy—for some, it is a pure emotion; for others, it entails cognition as well. So-called “cognitive empathy” would come close to mentalization. As I see it, though, mentalization differs from thinking in aspiring toward an integration of cognition and emotion. Mentalization is an appropriate term to characterize the investment that humans have in each other, where we begin with an acceptance that your point of view matters, not just my own. Furthermore, mentalization means that I am open to revise what I believe and am modest about not presuming that I possess the truth.
Let’s return to the intriguing but difficult situation, where one seeks to mentalize the other but the other is not motivated to return the favor. It seems to me that there are two alternative responses: keeping on keeping on or giving up. If you give up, you must face that you are abandoning your commitment to mentalizing. If you go this route, then it seems tantamount to giving up hope. What happens then?
If you decide to keep trying, you might be heading to having mounting frustration, and you might even feel that the other is using the opportunity to take advantage of you. That does not sound so appealing. However, since it is consistent with mentalizing to know that you do not know, it must be possible that you win the other over to participate in a dialogue. Arguably, evolution has equipped us with the capacity to mentalize, so this would mean that we would be restoring what once existed.
The patient-waiting option is better as assurance that you remain consistent with your values. There is still a legitimate concern, though, if we imagine a situation of brewing political violence. It would not make sense to attempt to engage January 6 insurrectionists in dialogue, when they are aroused and/or while acting.
So, dialogue is not always possible. What then: another civil war? No sane person could dispute that this would be the most likely way to accelerate the decline of our country. It is, indeed, sad to contemplate the proliferation of divisions, not just in the US, but across the globe. Do we even remember when globalization seemed like a promising development? What has happened to diplomacy, the political sphere that depends upon mentalizing skills? Try out this thought experiment: one fine day, strange aliens descend upon earth for a visit. Wouldn’t this evaporate our divisions and prompt us to realize how much we have in common as humans on this planet?
It is imperative to defeat Trump’s destructiveness, cynicism and cruelty. His dystopian vision of America, a mixture hyperbolic dangers and magical solutions, obscures the issues that we need to confront. His followers, having drunk the Kool-Aid, seemingly will follow him to any destination. But we should not deceive ourselves that electing Harris will make democracy safe. Democracy is threatened on a global level, and as the political theorist Wendy Brown reminds us, Trump is a symptom of the crisis of democracy, not its cause.
The dread that I invoked earlier is a species of anxiety infused with depression and/or variable mood states. A Harris victory will minimize this feeling, but it will not resolve it. We will still have a challenge of redressing the damage already done to our democracy and recreating it for a new era. As mental health professionals, we can expect that such concerns will manifest themselves in our offices. It is likely that we will be dealing with a greater number of individuals alienated from friends and families as well as families split apart from the sequelae of the election.
Rather than despair, we will need to look toward new models for sustaining or reinstituting democracy. One such model is Wendy Brown’s notion of reparative democracy, which proposes a transformation of democracy to face our current reality: preserving collective self-rule but aiming to address our dire environmental circumstances and disturbing human inequities.[v] Less than a week out from the election, the opportunity to work on democracy represents a ray of hope amidst the gathering storm clouds around us.
[i] For anyone who remains unconcerned about Trump’s attitude to democracy, see Leonhardt’s article from the New York Times: https://www.nytimes.com/2024/10/30/briefing/trump-democracy-2024-election.html
[ii] D.W. Winnicott (1974). Fear of a Breakdown. Intl. Rev. Psycho-Analysis. 1: 103-107.
[iii] See under: Election 2024, A Symposium: https://www.nybooks.com/for the individual pieces.
[iv] https://support.doctorpodcasting.com/client/weillcornellrehab/item/65270-on-election-year-stress-is-american-politics-hurting-our-mental-health#
[v] https://www.bostonreview.net/articles/the-violent-exhaustion-of-liberal-democracy/utm_source=Boston+Review+Email+Subscribers&utm_campaign=1abd20c9d1-reading_list_10_27_2024&utm_medium=email&utm_term=0_2cb428c5ad-1abd20c9d1-41179525&mc_cid=1abd20c9d1&mc_eid=13ca2371c7