Clinical and Moral Language: Personality, Character, and Psychopathology

 A talk given at Boston College, 4/23/23, at The Spring Meeting of the Society for Theoretical and Philosophical Psychology

 

The personality disorders create conceptual problems of social, cultural, and political relevance where clinical and moral concerns uncomfortably dovetail. In the older literature “personality” and “character” are used interchangeably as if having, essentially, the same meaning. They shouldn't and they don't. In an informal semantic differential I’ve asked, and let me ask you, in ordinary conversation do the two words carry the same moral implication? Invariably the answer is that personality is morally neutral whereas character clearly has a moral feel to it.  

 

More narrowly, I want to consider the ambiguous overlap of the moral, pathological, and social meaning of narcissism, particularly the moral and clinical dimensions of the Narcissistic Personality Disorders (NPD), especially when the subject turns to Kernberg’s 'Malignant Narcissism'.

 

In the Diagnostic and Statistical Manuals, here’s how we establish a diagnosis for NPD: A person shows at least five of these nine:

 

• A grandiose sense of self-importance
• With preoccupations and fantasies of unlimited success, power, brilliance, beauty, and/or ideal love
• A belief that one is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
• A need for excessive admiration
• A sense of entitlement
• Interpersonally exploitive behavior
• A lack of empathy
• Envy of others or a belief that others are envious of oneself
• A demonstration of arrogant and haughty behaviors or attitudes

 

What brings people with these attributes into my office?  If they show up alone, it’s because they have failed to achieve what they believe they deserve and are depressed, anxious, panicked, and/or isolated. Or if they show up as a couple, one of them is more than a bit fed up with the other’s entitlement, lack of understanding and compassion, or pissed off due to an absence of gratifying compliance. 

 

Add to this package Malignant Narcissism’s paradigmatic core of antisocial behavior, ego-syntonic sadism, and paranoid orientation and you have a formula for someone’s misery. I’m going to focus on the problem of when they get away with it.

 

A recent American Psychologist essay “It’s time to replace the personality disorders with the interpersonal disorders" (Wright, et al) spelled out some of this: the fundamental problem of social engagement apart from personal distress.  

 

This is deeply personal given my profession as an academic clinical psychologist and practicing psychoanalyst, committed to citizenship in our fragile multicultural cosmopolitan society –– under obvious siege –– held together by attempts at maintaining often conflicting democratic norms of justice as fairness.

 

Some background.  This became a preoccupation in 2015/16 as I taught, supervised, and needed to validate the distress of my students in clinical seminar. My observations echoed during Editorial Board meetings of The American Journal of Psychotherapy. I wrote an essay for the Journal addressing some of these concerns: “Politics and Religion: Revisiting Psychotherapy’s Third Rail”. I started with:

 

“My clinical psychology trainees rarely have trouble asking their clients to explore something problematic. The point, explicitly stated or not, is to increase understanding and free up consideration of whether something might be done differently. Such inquiry is not always welcome. Questioning implies a judgment that something is questionable.  We all know this. This is why when therapy touches politics or religion, trainees are awkward and uncertain about what they should appropriately ask.  I suspect this holds true for most of my colleagues.” 

 

The case in question was a composite of a supervision of a therapist working with a racist Trump supporter.

 

Let’s take this outside the consulting room.

 

I’m going to talk about Trump, MAGA, the Goldwater Rule, and the confounding amplifications of grievance brought on during Covid isolation. Trump rallies and the Covid pandemic set my stage. Hannah Arendt, reminds us in The Origins of Totalitarianism: Totalitarian movements are simply "mass organizations of atomized, isolated individuals." As does Robert Putman in Bowling Alone: The Collapse and Revival of American Community writing, “People divorced from community, occupation, and association are first and foremost among the supporters of extremism.”

 

Regarding Covid time: 35.7 million Americans live alone. Now consider being subjected to Fox Media and clickbait fueled by algorithms governed by the psychological truism that attention gathers around feelings of vulnerability, grievance, and if encouraged, hostility to those assigned the status of problematic other. 

Isolation is a hotbed of misogyny, racism, antisemitism, and anti-intellectualism. Covid Culture constantly offered reminders of contamination: the themes of Mary Douglas’s “Purity and Danger” morphing to a primitive torch parade chanting “Blood and Soil”. 

 

Not terrified enough, in 2016 I wrote "A Note on American Reactionary Politics:

Sanctioned Transgression and Uncanny Dread." Something from that posting:

 

"Here's my un-nuanced sense of the abused and aggrieved core of the GOP, a group of maybe 20-25% of the overall electorate. Not enough to win the presidency without additional support, but more than enough to make national life ugly. What turns white conservatives, reactionary? Their perception that too many nonwhites are getting a piece of their pie. This is the heart of Trump's base. What makes religious conservatives reactionary? An uncanny and confused confrontation with the sanctioned transgression of enfranchised gays, uppity women, and gender benders feeling it's time to come out of the shadows. Cruz country. Trump and Cruz's core supporters overlap and share a hyper-defensive us violated by them. They finally chose Trump, the bigger bully, the entertaining clown, who encouraged impotent whites to share his narcissistic desire to tower. They're going to get screwed again, but more organized and rankled with neo-fascist frustration, entitlement, and aggression. We're in for a very dark rough ride."

About Sanctioned Transgression: 

 

"Sex, gender, race, and family relations have always been subject to religion and state attempts to limit what people are permitted to feel and do. Sanctioned transgression concerns enhanced social or legal protection for behaviors and relationships a dominant group has previously kept forbidden. When legal protection is sought or offered for these "transgressions", taboos are less hidden, even celebrated. This doesn't sit well with the deeply defensive. It is especially problematic when it evokes a person's suppressed urges now openly exhibited in others. Freud called this the return of the repressed. It should come as no surprise that anxious dread surfaces in people unprepared to manage these feelings; nor is it a surprise these feelings are treated as provocation to assault the source of threat. So why Trump over Cruz? I suspect it's because Trump encourages attack, a position of strength that feels better than Cruz's creepy discomfort." 

 

Trump’s MAGA rally provided unity and celebration; and thanks to Hilary Clinton, an identity politics of “Deplorable Pride”. And along with these poorly educated aggrieved whites, the Nazi scum and Nazi curious were invited to slither out from under the rocks. 

 

None of this bodes well for a citizen wanting vibrant democratic cosmopolitan communities. 

 

What does this have to do with the clinical encounter, diagnosis, moral dialog, and the Goldwater Rule? Do you remember the Goldwater slogan “In your heart you know he’s right”, and the wry response, “In your guts you know he’s nuts”? Whether nuts or not, his platform invited psychiatric critique and the American Psychiatric Association's reaction in the form of a rule that, “a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

 

In 2016 and 2017 various psychiatrists and psychologists publicly ignored this claiming Trump displayed "an assortment of personality disorders marked by a lack of empathy, grandiosity, exploitive behavior, and malignant narcissism.” 

 

Defending their public diagnosis as a duty to warn, they followed with the claim of an ethical responsibility to alert the public about Donald Trump's “dangerous mental illness”.

 

Let’s return to NPD and Malignant Narcissism. Think about the meaning and semantic differential of the word, "malignant".  Malignant breaks into two domains, social and medical.

1. The Social: Malevolent, spiteful, hostile, malicious, malign, evil-intentioned.

2. The Medical: highly virulent or infectious, invasive, lethal.

 

The social use of malignant is medically evocative of cancer’s invasive infiltration of the Body Politic. 

 

Otto Kernberg described Malignant Narcissism as a component of a narcissistic personality disorder in people with sadistic dispositions. Kernberg employs "malignant narcissism" and psychopathy interchangeably. The malignant narcissist wantonly disregards the rights of others by endorsing violence with an absence of remorse, coupled with chronic lying, disregard of law, and the like. 

 

Notice I just shifted from the clinical diagnostic NPD to “the malignant narcissist”, moving from clinical language to the moral language of indignation and condemnation. This is the public polemic the ethnomethodologist Harold Garfinkel described as essential in Degradation Ceremonies: public rituals that removes or restricts a person’s standing in community. 

 

A key feature of moral condemnation in classical Degradation Ceremonies is the act of identifying the foundational values a community member failed or betrayed, denouncing them publicly as having acted in true character, and in so doing, effecting a judgment that the person in question is no longer fully one of us. They are not one of us now and perhaps never were. Harsh and punitive. Here the language points its finger at bad character. Depraved whether or not deprived.

 

Let me ask: What can the professionally informed clinician/citizen do when encountering people whose interests and power directly threaten the integrity and survival of the communities they most value? (The question that plagued my students and supervisees).

 

Now back to clinical and moral language. Let’s turn to the different intent in clinical and moral appraisals starting with something from Philip Cushman’s “Psychotherapy as Moral Discourse”.

 

“Because the therapist's professional identity and economic livelihood

are contingent upon being viewed as a neutral observer, putatively cut loose from or at most minimally influenced by moral allegiances and the corruption of politics, therapists are uncomfortable with conceiving of their work as a discourse about the definition of the good and the determination of what is proper or improper behavior. Yet when one studies the history of various schools of psychotherapy with a hermeneutic eye, the moral frameworks and political consequences of these theories seem obvious. The self and its ills, the healers, and their technologies, are historically contingent, socially constructed, politically active, and morally constituted.”

 

Clinical language generally concerns the dynamics of the individual especially in reference to their symptoms, deficits, and suffering.  Medicalized, “nonjudgmental”, and morally neutral, when correctly employed has the noble aim of avoiding a clinical encounter from becoming a Degradation Ceremony. Consistent with compassion and care, psychotherapeutic engagement attempts affirmation and empathy, a stance of I to Thou. Clinical language and practice provide, at least temporarily, the patient-client with the breathing space of being off the hook. Apart from whether this respects the person as agent, when should the hook be applied?

 

Moral language's foundation is the engagement with others; how the other suffers or is damaged, enhanced, protected, and so on. Moral language involves the Utilitarian's greater social good and happiness along with the Deontological “oughts”, the choices morally required, forbidden, or permitted. The Deontological and the Utilitarian can clash. The oughts good for the goose might make the gander unhappy. Sometimes it matters which side you are on.

 

We might offer corrective empathy, we can care for the narcissistically disappointed struggling with depression, panic, and envy. We can be compassionate. But what should we do when they inflict harm? Worse, far worse, what of the privileged narcissist: successful, charismatic, in a position of power, who gets away with it by appealing to the envy, grievance, and pain of the vulnerable?  And in doing so creates a political community defined by a cultivated hatred of the people and norms of the cosmopolitan society I embrace and defend. 

 

We don’t need clinical language when the cause of alarm is the open celebration of a charismatic and malignant narcissist; a destructive, entitled asshole deserving degradation.  And as psychologist and citizen, I've an obligation to point this malignancy out. I don’t need to diagnose psychopathology. Instead, I can rail against an evil character; not an illness deserving healing and compassion, but a vileness requiring removal. 

Arendt, H. (2017). The origins of totalitarianism. Penguin Classics.

Kernberg, O  Malignant Narcissism and Large Group Regression, The Psychoanalytic Quarterly, 2020, 89:1, 1-24

Putnam, R. (2001). Bowling alone. Simon & Schuster.

Douglas, M. (1966). Purity and Danger. London: Routledge and Kegan Paul. 

Schwartz W. Politics and Religion: Revisiting Psychotherapy's Third Rail. Am J Psychother. 2022 Dec 1;75(4):177-180

Wright AGC, Ringwald WR, Hopwood CJ, Pincus AL. It's time to replace the personality disorders with the interpersonal disorders. Am Psychol. 2022 Dec;77(9):1085-1099. 

 

 

Abortion, Personhood, and the Control of Women: An American Dilemma

The question of whom or what  is included as a person is central to legal, moral, and religious stances regarding abortion. There is something sinister obscured by this question. Over the years I’ve written papers on possible persons, published a book on the Person Concept, and developed a Paradigm Case Formulation (PCF) that offers a reasonable set of characteristics that should provide agreement that, when present, we are observing a person. Paradigm Case Formulations are employed when ordinary definitions can’t establish general agreement. A PCF offers a set of characteristics, a sort of “if there was ever a case of X, this is clearly an example of what we treat as X”.  The word "persons" clearly involves the difficulty of a shared definition. 

Here's a PCF: A person involves an individual, in our case a human, able to engage in deliberate action in a dramaturgical pattern. A person is an individual that can cognizantly make choices from their perspective of what that individual actually values. The pattern of significant choices unfolds like a narrative or drama intelligibly "in-character" to a careful observer. This concept rests on a set of inter-dependent concepts that include the individual person, intentional action, verbal behavior, culture, and world.

 

When we observe all that, there should be no reason to doubt a person is present. Here is where it gets interesting and problematic. We can remove or add characteristics to the formulation. This allows for a gradualist approach to the moral/ethical status of the not yet born. With each addition or deletion, we may find ourselves agreeing or disagreeing that our re-formulation is still what we mean by a person. But at least we can see where we agree or disagree. My brother who just sent and described photos from his trip to the Amazon is no doubt a person. But what about his two-week-old granddaughter? She doesn’t speak yet, although I am quite sure she will very soon.  And what about when she was a fetus, an embryo, a blastocyst, a zygote, or an egg and sperm?  When did she become a person or achieve the status where her potential as one of us matters? We tend to disagree about this.

 

Our disagreements follow from where we conceptually draw the line on what collection of attributes need to be present, and empirically, whether those characteristics are present. We can doubt the need for the “full” PCF, and we can doubt the empirical presence of the characteristics that fall within our conceptualization. 

 

The PCF formulation of a person is neutral regarding where we place our doubt. It can be a starting point for talking about non-human persons, as well as potential, nascent, and former persons. Actual, potential, nascent, and former persons are the relevant cases for debating the ethics and morality of abortion.

 

In informing abortion legislation and the courts, who is primarily concerned with the personhood question: Theocrats with their commitments to souls? The informed gradualist worried about fetal anguish and viability?  Other than pregnant women and their physicians, who is worried about the morality, ethics, and well-being of pregnancy?

 

I think it is unfortunate the theocrats have any say in this, but given their world view, some of them are acting in good faith. But hiding behind the authentic theocrats are a large constituency that controls the politics, legislation, and judgment: a voting bloc of the aggrieved, mostly men, who don’t care about theology but are preoccupied with the control of women. 

 

Ask yourself who is celebrating the fall of Roe v. Wade. For the sake of argument, take theology and the morality of the destruction of a potential person out. Who is left celebrating?  What drives glee in controlling a woman's sexuality: men insecure about theirs. I have no doubt there are men with no authentic interest in 14th Century doctrine, men darkly governed by fears of sexual inadequacy, who are gladdened. You don't need to be Freudian to know this. The theocratic court has provided them compensatory relief when it should have provided them silence. 

My friend and colleague Joe Jeffrey summed it up this way:

Who is interested in using the power of the State to restrict women's choices about the potential person in their bodies?

1. Theocrats, who claim the right to impose their religious doctrine (a doctrine that is in fact that of the minority of the country) on everyone.

2. Moralists with a radical claim that "all life is sacred", a disguised religious doctrine masquerading as a moral claim, one with no justification, a bare philosophical claim to the moral high ground with nothing behind it but the feeling of the believers.

3. A voting bloc of the aggrieved, mostly men, who don’t care about theology but are preoccupied with the control of women.  

More like Joyce, less like Proust: The Pandemic’s Signal to Noise Paradox.

 

 

It’s June. In the Northeast where I live, the pandemic is over. Here, Covid is a medical management problem and not a public health emergency. I hope it stays this way. I hope this is a cautionary remembrance of things past. 

 

Since a year ago March, when I moved my teaching and practice entirely online, I’ve logged more weekly hours than any time in my career. That’s come with benefits and costs. This is about some of the costs. 

In my consulting and clinical practice, I’d been hearing that production is high, but initiative, improvisation, and creativity are low and nearly everyone complains about Zoom fatigue.  That matched my state of mind.  That, and how many of us felt a bit like Billy Pilgrim, unstuck in time, not clear what day followed the one before.

 

Mid-May, grumpy, spent, I escaped to Provincetown. Immediately I felt much better. I think I’ve learned some lessons. First, maybe foremost, is when to play hooky. 

Provincetown in May 2021 was my second escape from Covid culture. The first, back in October, was the woods and beaches of Chappaquiddick Island.  Then, during one of our Friday conversations, I told Michael Kubovy how different I was feeling from the previous seven months and how this fit with what I’d observed about my clients and students.  I was relaxed and open, my mounting doldrums vanished. Helping me understand my changed state, Michael suggested that except for far less talent, we are generally more like James Joyce than Marcel Proust. We do better when spending our day strolling the streets of Dublin than in bed with shades drawn in a cork lined room.

By now, mid June, the pandemic has lasted long enough to change society, fostering a Covid culture that, while intent on protection, took a toll on those never infected and who did not share the pain or suffer the loss of someone who was. 

 

Some costs are moral and psychological. The pandemic left many in states of languish, and some, victims of acedia, its depressive variant. Other costs were political: hostile splits over adherence and resistance to political “biopower” [1]. The public discourse, the rancor on mandated shutdowns and masks that quickly devolved into ‘which side are you on?’.  The incompetent, odious, absurd utterances of Trump that met an under-examined counter to “follow the science”; too often an incoherent collection of methodologies and data promoted by different communities of interest: medical, economic, and academic. Policy and implementation did not fare well. Nor did we. 

 

Social distance and masking took a toll, and there's Zoom. Online, work from home did not happen on a level playing field. Many parents try to restrict their children’s screen time and want them to spend more time playing outside. I’ve come to see the value of that for all of us. 

This is about the condition of folk like me. I don’t have the numbers, but it’s a safe bet I’m not in a minority. So before you roll your eyes, I didn’t have it that bad, not at all; my life and livelihood was never threatened. Knock on wood, I was never sick, not broke, and in a stable relationship. I’m one of the privileged: a senior academic clinical psychologist, mostly home with wife and dogs, with fast reliable ethernet, and no children needing to be home schooled. My concerns are trivial compared to the endangered front-line workers, the truly isolated and impoverished, and those overwhelmed by grief, work, or worry.

Here’s some of the circumstances many of my ilk lived with: 

1) Stuck at home, more or less isolated with restricted encounters apart from our affinity groups. 

2) Engaged without handshakes. No collegial pats on the back.  Working, schooling, and shopping online. Living with less surprise and fewer random encounters.  

3) While productive  –– scheduling was easy, the commute gone, people knew where to find us –– we experienced Zoom fatigue: a consequence, I think, of a diminished and restricted ‘sensory ecology’ of a less varied, less novel sensory stimulation that undermined multimodal perception, ‘inter-affectivity’, and empathy.  Facing each other on screen, our engagement was less informed, less moved, by the rhythms of gesture and speech, the ‘dance’ that naturally and ordinarily is part of being in the physical proximity of others [3]. Dancing in harmony invigorates; being held in place, missing the beat, is tiresome.

4) Masks and social distancing are problematic. When we ventured out and tried to connect, but avoided physical closeness with faces masked, our full expression was muffled; was less intimate and empathetic. From trivial inconvenience to severe handicap, verbal behavior is enhanced not only by clear speech but by simultaneous lip reading [4]. Talking together, relaxed and spontaneous, was below par at best.

5) And while out, leaving home, affinity group, and pod behind, we feared contagion and suffered an uncertainty of whether it would ever end [5].

With all this in mind, I think I can throw light on why many of us have been both productive and stuck in a funk.  Why we started cozy but ended irritated in our cocoons. 

 

In a nutshell, here is my premise: To thrive, to experience comfort, satisfaction, and vigor; to improvise, create, and initiate, we need all our senses frequently engaged. We need random, unexpected encounters with the natural, architectural, and social worlds. And here’s the kicker: We need distraction. We need shiny objects pulling our attention away from the task at hand. Keep in mind that what distracts us, what catches our attention, interests us. What actually interests us, what doesn’t go against our grain becomes available for consideration. And that availability might come in handy.

 

Distraction is important, not because we acquire the discipline to ignore it, but in the sense of a metaphorical signal to noise paradox, where the noise enhances the signal by offering additional content and context. (Unless, of course, it is merely distraction. Naps help sort it out.)

 

In particular, akin to a seed crystal, unexpected encounters and distractions are idea nodes: Cognitive and emotional behavior potential that can provide associational connection to the task at hand; something novel we might recognize as significant and decide to pursue. (Of course, we might not. It helps to have the breathing space to think about what we've been thinking about.) I am taking issue with ‘necessity is the mother of invention’ when necessity comes from adversity. Adversity rarely makes us stronger or creative. Mostly it makes us mean, defensive, and closed off.  

Seeking safety in social distance and masks, living our lives on Zoom, the pandemic diminished our encounter with the complexity and nuance of strangers, companions, and our worlds [2].  Our bodies less involved, our empathy strained, we ended up more worn than usual. We could produce but did not thrive. 

 

My remedy is unexpected encounters and distraction coupled with a strong dose of whatever fully engages the senses. And naps. 

 

 

My friend and esteemed colleague Mark Greenberg alerted me to the Japanese therapeutic practice of Shinrin-yoku (taking in the forest atmosphere or forest bathing) "for the restorative impact of multi-sensory, natural stimuli."  "The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan" Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y.,  Environ Health Prev Med. 2010;15(1):18-26. doi:10.1007/s12199-009-0086-9

Also consider this study on The Effect of Movement on Cognitive Performance.

From the 6/12/22 NY Times: Why Strangers Are Good for Us

 

[1] Michel Foucault’s term for "an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations” (The History of Sexuality 1976, Vol. 1 p. 140).

[2] The Black Lives Matter protests following the constantly televised police murder of George Floyd was a galvanizing distraction for white Americans not accustomed to being victim of police violence.  For many, a wake up significantly informing awareness.  

[3] Concerning difficulties maintaining empathy while employing Zoom, see “Embodied Affectivity: on moving and being moved” Fuchs & Koch (2014) Frontiers in Psychology. 

[4] See for example, Altieri, N. A., Pisoni, D. B., & Townsend, J. T. (2011). Some normative data on lip-reading skills (L). The Journal of the Acoustical Society of America, 130(1), 1–4. https://doi.org/10.1121/1.3593376.

 [5] I’d like to believe I’ve overstated the problem in a blog posting The Affinity Group, the Mask, and the Counter-Progressive Politics of Suffering Alone (Some Reminders from Harry Stack Sullivan).

 

 

 

 

The Affinity Group, the Mask, and the Counter-Progressive Politics of Suffering Alone (Some Reminders from Harry Stack Sullivan)

Totalitarian movements are simply "mass organizations of atomized, isolated individuals." Hannah Arendt, The Origins of Totalitarianism, 1951.

People divorced from community, occupation, and association are first and foremost among the supporters of extremism. Robert D. Putnam, Bowling Alone: The Collapse and Revival of American Community, 2000.

The confined affinity group and the mask should be left behind if we desire a vibrant cosmopolitan society. With the advent of successful vaccines, coronavirus should become a problem requiring medical management and not a public health emergency.  We'll eventually leave the confinement of our bubble and pod affinity groups, but if masking remains an ordinary part of life, I fear 'same-as-us' identity politics will intensify, inadvertently inviting a dystopian future.  The personal and social costs of the pandemic should not be borne when the crisis is past.

By now we should be familiar with the tragic condition of the quarantined elderly and the hidden agony of the isolated and lonely. We are less familiar with the counter-progressive consequence of segregating the otherwise healthy, maskless only under a shared roof of kin and friends. What happens when they venture out masked and encounter others behind theirs? 

Trump encouraged a virulent populism. But after the crisis passes, will virtue-driven normalization of masking facilitate another version of tribal hostility? From the start of the pandemic to the present, the masked versus the unmasked triggered rancor.

I don’t want to be misunderstood. Masks, pods and bubbles are vital components for managing a pandemic. But donning the mask and disdain for those who refuse has become, apart from actual health concerns, a badge of the progressive and anti-Trump. I am both.  There are problems lurking here. To the extent masks become a cultural norm, liberal cosmopolitan democracy can be undermined by life less informed by inclusiveness and diversity. When I wonder aloud about this, my well-traveled peers mention the extensive masking in Japan and the alien status of the gaijin. 

The liberal and progressive ideal of tolerant cosmopolitan community requires understanding and getting along with those different from one’s friends and kin. The liberal ideal requires loosening the natural tribalism of ‘us and them’ and resisting the tendency of ‘us versus them’. Facilitating engagement with people different from ourselves allows this to happen. But when huddled together, without mask only within home and pod –– avoiding the other as contagion –– tribal pathologies of blood and soil, of purity and danger, too easily come out of hiding; are too easily projected onto the mask of the stranger. It doesn’t take a sociologist to point out that our households and pods are generally inhabited by people very similar to ourselves. Folks with our complexion. 

Here’s a darker worry. For many of the financially secure and socially well connected, the lockdowns offered a cozy respite, marred by the annoyance of titrating a comfortable distance from those too much around. In contrast, the lockdowns have been awful for the isolated and lonely. We don’t hear much from them. Today, 35.7 million Americans live alone.   How do you think they are doing? Although we might like to believe adversity brings out the best in us, mostly it makes us mean.

For many people who live alone, the loneliness manageable during ordinary times is now intolerable. When they leave their homes, masked faces make it worse. Harry Stack Sullivan’s observations from 1940’s and 50’s are relevant. In the seminal volume, The Interpersonal Theory of Psychiatry, he wrote, “There are good many situations in which lonely people literally lack any experience with things they encounter…. loneliness in itself is more terrible than anxiety.” 

We rely on the acknowledgment of others, from the beloved to the stranger, to cure an otherwise empty heart. Without empathic responsiveness, we become aliens in a world without compassion.  Some need a responsive face more frequently than others. But we all need it. When significantly absent, when hope is replaced by demoralization, our demons and pathologies erupt. The prolonged demoralization of knowing there is no one nearby who truly cares, no one who has your back or understands how you feel can foment depression, rage, and suicide.  In such a world, the most terrible thoughts are not intimately expressed, soothed, or corrected.

Severe loneliness, Sullivan observed, deprived people of the companions needed to “integrate experience” creating defects in the ability to adequately appraise situations apart from wanting relief. It is unsurprising this breeds resentment toward whomever or whatever is held as cause. The masked face is a blank screen where resentment, fear, and anger are easily projected. 

Public masking has gone on for a very long time. When the pandemic began my socially conscious neighbors and most everyone else in my neighborhood wore masks and zigzagged as we crossed paths. We feared contact and avoided lingering and gesturing. I was lonely walking the dogs. But then something happened. A few weeks in, late March early April, I noticed I was deliberately smiling with my eyes, nodding when my sunglasses covered them, and saw my neighbors do the same.  We expressed solidarity as best we could.  But by late October, with the fall and no end in sight, these gestures mostly faded except among those already committed to each other. The sidewalk, crowded or not, became empty. 

I want to be clear.  I have little sympathy for those who feel the mask is a violation of their self-entitlement, an insult provoking “don’t tread on me”, an expression of indifference to the concern of others.  But ask, how do people eventually behave when they’ve been secluded, uncertain, anxious, and nursing whatever prejudice is consistent with what they blame for being locked out of life? And when the time comes, how do they vote?

February 6, 2022

Was it worth it?

A Literature Review and Meta-Analysis of the 

Effects of Lockdowns on COVID-19 Mortality 

By Jonas Herby, Lars Jonung, and Steve H. Hanke 

SAE./No.200/January 2022

A LITERATURE REVIEW AND META-ANALYSIS OF THE EFFECTS OF LOCKDOWNS ON COVID-19 MORTALITY

Abstract

This systematic review and meta-analysis are designed to determine whether there is empirical evidence to support the belief that “lockdowns” reduce COVID-19 mortality. Lockdowns are defined as the imposition of at least one compulsory, non-pharmaceutical intervention (NPI). NPIs are any government mandate that directly restrict peoples’ possibilities, such as policies that limit internal movement, close schools and businesses, and ban international travel. This study employed a systematic search and screening procedure in which 18,590 studies are identified that could potentially address the belief posed. After three levels of screening, 34 studies ultimately qualified. Of those 34 eligible studies, 24 qualified for inclusion in the meta-analysis. They were separated into three groups: lockdown stringency index studies, shelter-in-place-order (SIPO) studies, and specific NPI studies. An analysis of each of these three groups support the conclusion that lockdowns have had little to no effect on COVID-19 mortality. More specifically, stringency index studies find that lockdowns in Europe and the United States only reduced COVID-19 mortality by 0.2% on average. SIPOs were also ineffective, only reducing COVID-19 mortality by 2.9% on average. Specific NPI studies also find no broad-based evidence of noticeable effects on COVID-19 mortality.

While this meta-analysis concludes that lockdowns have had little to no public health effects, they have imposed enormous economic and social costs where they have been adopted. In consequence, lockdown policies are ill-founded and should be rejected as a pandemic policy instrument.

JANUARY 26, 2022, From The Atlantic

The Case Against Masks at School

March 10, 2025  Five Years later from The Boston Globe: 

‘The lockdowns were never really effective’: New research shows COVID stay-at-home orders did more harm than good.