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Protecting Yourself From COVID Isn’t a Sign of Mental Illness

By calling people getting their COVID vaccines “mass formation psychosis,” anti-vax doctor Robert Malone misused language from group psychology and psychiatry on a recent interview with Joe Rogan. Here’s what it really means.

In 1895, Gustav Le Bon wrote The Crowd: A Study of the Popular Mind, which argued that something nefarious happens when people gather together: A crowd develops a psychology of its own that usurps the individual. This psychology is impulsive, irrational, and resistant to reason. 

“A crowd is not merely impulsive and mobile,” Le Bon wrote. “Like a savage, it is not prepared to admit that anything can come between its desire and the realization of its desire.”

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Earlier this year on the Joe Rogan podcast, anti-vaccine physician Robert Malone made a similar declaration. Malone was involved in early mRNA research and claims to have “invented” mRNA vaccines, but he’s been banned from several social media platforms for spreading misinformation about the vaccines’ efficacy and safety. Referencing the ideas of University of Ghent psychologist Mattias Desmet, Malone told Rogan that the decision by millions to get a COVID-19 vaccine amounted to “mass formation psychosis,” a kind of “hypnosis” in which people blindly follow orders. 

“A third of the population [is] basically being hypnotized and totally wrapped up in whatever Tony Fauci in the mainstream media feeds them," Malone told Rogan. True to the anti-vaxxers’ urge to compare the pandemic to the Holocaust, Malone said this was the same process that occurred in Nazi Germany during Hitler’s rise to power: “In the 20s and 30s [in Germany]...[there was a] very intelligent highly educated population and they went barking mad. And how did that happen? The answer is mass formation psychosis,” he said. 

The episode was removed from YouTube for violating its COVID-19 misinformation policies, and media outlets quickly countered Malone’s claims by saying that “mass formation psychosis” does not exist, even as Texas congressman Troy Nehls entered the transcript into the Congressional Record.

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“An anti-vaxx scientist said 'mass formation psychosis' caused people to follow COVID-19 measures. Psychologists say there's no such thing,” wrote Business Insider. The AP called the theory “unfounded” and reported that “there is no support for the ‘psychosis’ theory described by Malone.” “The term does not exist in the psychology literature, nor does it appear in the American Psychological Association Dictionary of Psychology or its PsycNet database,” wrote MedPage Today. 

To be clear, “mass formation psychosis” is not a phrase that has been used, except by Malone, to describe the behavior of groups or of psychotic illness. But the problem with saying that mass formation psychosis doesn’t exist at all is that it’s easy to go online and find decades of literature on phenomena that sounds a lot like it: social identity theory, group think, delusional thinking, folie à deux, and mass psychogenic illness. 

When reached for comment, Desmet said that he “never used the term ‘psychosis’” and doesn’t endorse using that word; his theory is called only “mass formation.”  When asked about multiple podcast episodes and interviews with him that are titled “mass formation psychosis” and where the hosts refer to mass formation as “mass formation psychosis,” Desmet said, “The hosts of podcasts use that term because it leads to more views. If you listen to the podcasts/interviews, you will hear that I often say that I refuse to use the term ‘psychosis.’” Malone did not respond to requests for comment. 

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But mass formation psychosis has entered the lexicon: Reuters reported that online searches for “mass formation psychosis” spiked this month, and that “as of Jan. 3, the term has gathered more than 100,000 interactions (likes, comments and shares) on public Facebook pages, groups and verified profiles, according to social media monitoring tool CrowdTangle.” 

Part of the power of misinformation is its ability to misrepresent; it embeds kernels of truth into claims so that the totality of an argument sounds convincing. This is exactly what Malone did in a Substack post where he “rebutted” fact-checkers by providing a litany of citations from the field of group psychology. 

“Some of these scholars did explicitly use the term mass-formation, others didn’t,” Malone quoted Desmet as saying. “But what they studied was basically the same: the way in which an individual’s mental state is influenced by their tendency to conform to group thinking.”

In cases like this, when misinformation borrows from complex and real phenomena, it’s not helpful to just brush it off entirely. Rather than saying that nothing like mass formation psychosis has ever been studied, it’s more useful to explain exactly how our identities are shaped by others; how it is tricky, but not impossible, to distinguish between extreme beliefs and delusions; and why the application of all of these concepts to getting vaccinated is a misapplication, not a figment of imagination altogether.

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Jessica Malaty Rivera, an epidemiologist who debunks health misinformation on Instagram, was “horrified to discover” that several people she thought to be “‘quite wise and discerning,’ were hoodwinked by Malone’s patina of academic credibility,” as she told Rolling Stone.

“One of the ways most misinformation and fake news travels is it has true facts embedded within it,” said Jay Van Bavel, a psychologist at New York University. 

Van Bavel was quoted in Business Insider saying, "To my knowledge, there's no evidence whatsoever for this concept.” Van Bavel confirmed that while there’s nothing specifically called “mass formation psychosis,” social identity theory certainly does exist. He’s spent his career studying it and just co-wrote a book on it called The Power of Us.

According to social identity theory, we all have a sense of self, and that sense of self is not just who we are as individuals; it’s defined by the groups we belong to. Our in-groups have sway over us. We’re more likely to pay attention to people who share our identity groups, more likely to trust them and to cooperate with them.

“Social identity theory is arguably one of the most important theories in the entirety of social sciences,” Van Bavel said. There is a robust body of evidence to support it, not just conceptual papers but experimental ones, too. Many studies on “minimal groups” have showed that when you assign people to one of two groups, even just by flipping a coin, people will quickly start discriminating in favor of their own group. 

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These are important biases to be aware of, but, crucially, these identities are flexible, and we all have many of them. If you watch the Olympics, you might identify as an American if that’s where you live. Visiting your parents over the holiday, you might identify as a son or daughter. Going to work, you identify as a colleague and a member of your chosen profession. 

It’s also highly dependent on context. In one classic study, the psychologist Solomon Asch showed that people would incorrectly say that one line was longer than another, even when it clearly was not, if they heard other people say that line was shorter first. 

But this experiment, which has been shared online recently as proof of mass formation psychosis, didn't show how people could permanently and irrevocably be duped. As Van Bavel pointed out on Twitter, “people sharing it don't appear to understand what's happening psychologically. All it takes is a single dissenter and about 95% of people will no longer conform with the majority.”

According to Desmet, whose published papers center on psychotherapy, not group psychology, mass formation occurs when many people in a society feel isolated and lack meaning, and there are high levels of “free floating” negative emotions, like anxiety and anger. Then, when a narrative—like COVID prevention measures—is disseminated, people have an outlet for their negative emotions, gain social bonds and meaning from the narrative, and are willing to adhere to a narrative at any cost.

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It’s true that group dynamics, like social identity theory, play a role in all of our lives. Implying that it’s the only motivating factor behind precautionary behaviors takes it too far. Van Bavel has done research that showed that when people are lonely, they are more likely to look to in-group members to resolve those feelings. It’s like showing up to a party and feeling anxious until you see someone you know. But Van Bavel said that Desmet’s point about “free floating anxiety” is misunderstanding people’s negative emotions. People don’t have “free-floating anxiety,” they’re anxious about getting COVID because of the threat it may pose to their own health, the health of others in their family or social networks, or their ability to go to work and earn money.

“The pandemic brings a number of sources of legitimate real-world anxiety, things that have been studied hundreds of times, like people's anxiety about losing a job,” Van Bavel said. “People have anxiety about economics, people have anxiety about getting sick. People have anxiety about their kids' school.” 

In response, Desmet told Motherboard “Group dynamics do play a role in this crisis, at several levels: information gathering, selection of research, etc. There is not one ‘evidence-based theory’ on vaccines, mask wearing, efficacy of lockdowns.” When asked if he disagreed that vaccines provide protection from severe illness and death, or that wearing masks in indoor spaces can prevent the spread of the virus, Desmet replied, “I don’t give an opinion on the vaccine efficacy and the wearing of masks, simply because it’s not my field of expertise. In my opinion, as a layman, we lack an open and honest academic debate. People who are critical are easily stigmatized and expelled from public debate.” 

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What social identity theory actually reveals is how adhering to the norms of a group is hardly psychotic, but, instead, the norm.  “Is standing for the national anthem at a sporting event ‘mass formation psychosis’?” said Thomas Costello, a Ph.D. candidate at Emory University who studies the psychological factors of authoritarianism. “If not, then neither is sticking to public health guidelines.”

According to the DSM-5, delusions are “fixed, false” beliefs that are not shared with others, meaning that those beliefs are considered implausible by nearly everyone in a person’s social circle. Just like social identity theory is a real thing, psychosis and delusions are real, and can be shared. This rare occurrence is called “folie à deux." It often takes place between people who live together and are isolated from the outside world. 

“The person with psychosis might believe that their skin is infected or infested with parasites, and the person who catches the delusion literally catches the parasites, even though no parasite actually exists,” explained Phillip Corlett, a cognitive neuroscientist and psychiatrist at Yale University who studies psychosis. 

Other similar-sounding phrases like "mass psychogenic disorder" and "mass hysteria" describe "physical symptoms of illness that emerge within a population due to suggestibility as opposed to any identified medical cause, but are more applicable to ‘Havana syndrome’ than anything related to QAnon, COVID-19, or current political affairs,” wrote Joseph Pierre in Psychology Today

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Pierre is a psychiatrist at UCLA who studies delusions and delusion-like beliefs, who said that “the most frequent question” he’s been asked over the past two years is whether people are mentally ill who hold extreme beliefs about the pandemic, QAnon, or the veracity of election results. “The answer—in a word—is ‘no,’” he wrote.

Delusions are beliefs, not behaviors, Pierre explained to Motherboard. When people get vaccinated, they do so based on the belief that the advice of scientists and public health epidemiologists is sound, or that the studies on vaccine efficacy are legitimate. Notably, shared psychosis is not what’s happening when people get vaccinated. 

“Beliefs about the efficacy of COVID vaccines or the necessity of precautions against COVID do not really match the definition of delusions in psychosis,” said Lisa Bortolotti, a philosopher of cognitive science at the University of Birmingham. “Even if one considers them false and resistant to counterevidence, they are obviously shared by many.” 

Again, there’s a real debate that this is tapping into: It is difficult in the realm of psychiatry to distinguish between an extreme belief and a mental illness. This has been deliberated about long before the pandemic. Certain conspiracy theories like the sovereign citizen movement have given rise to questions about where the line is, and the question of whether  extreme racism constitutes enough of an aberration of thoughts to be considered a disorder has even been posed. The term “extreme overvalued belief” has started to be used by clinicians to describe extreme beliefs that are different from psychosis and delusions, though Pierre pointed out there's likely a continuum between such beliefs and delusions that are a symptom of psychosis. 

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There are other symptoms that come with psychotic conditions, like hallucinations, having problems with motivation and social engagement, and difficulty with self-care. In-group and out-group psychology is not the same as delusional thinking, psychosis, or mental illness. 

“It’s a disservice to those who have mental illness to claim it is,” Pierre said. “It’s also a disservice to ourselves because it distracts us from the real social forces that lead to widespread false belief.”

There is a tendency to pathologize the behavior of people who think differently than we do, Bortolotti said. Besides being incorrect, this practice perpetuates the stigmatization of mental illness by using it as an insult. 

“I find pathologization misleading and objectionable on several fronts,” Bortolotti said. When we label other people as “crazy” or “out of their mind,” we lose any incentive to exchange ideas with them, she said, because we assume they can’t participate in rational arguments. 

“We shouldn't call our opponents psychotic,” Corlett agreed.

Yet, the impulse to do so is increasing. Before the pandemic and before Trump's presidency, Corlett had an alert set up on Twitter so he could see when people were tweeting about delusions or hallucinations—his field of research. Since 2015, it’s been completely overwhelmed by political arguments, and he's had to turn that alert off.

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“This is just pejorative name-calling of our ideological opposites on both sides of the political fence,” Pierre said. “It’s not a proper or responsible use of psychiatric terminology.”

Ironically, social identity theory or overvalued beliefs can be useful lenses through which to view the very groups who are accusing others of mass psychosis. 

“Characterizing people who have made a decision you disagree with as psychotic or 'hypnotized' mirrors the sorts of black-and-white, complexity-averse, us vs. them thinking that is indicative of political extremism and authoritarianism,” Costello said. 

Desmet agreed, saying, “I think group dynamics such as mass formation play on both sides, both in the corona-believers and the corona-skeptics.” 

In studies, Van Bavel and his colleagues have found through smartphone data that the biggest predictor of who engaged in social distancing was whether you were in a county that voted for Trump. The same goes for vaccination: The biggest predictor overall in not getting vaccinated is whether someone voted for Trump. 

“If there is a real identity story here, it's around Republican identity, specifically the Trump-supporting wing of the party,” Van Bavel said.

Corlett said that Desmet’s theories about “free floating anxiety” and lack of meaning sound similar to his own theories about paranoia, but with one major difference: The search for meaning, and an increase in anxiety and uncertainty, can push people toward not adhering to vaccination guidelines. In Nature Human Behavior, Corlett and his colleagues showed that people who experience lots of uncertainty are in fact more hesitant about COVID vaccines, mask-wearing, and all of the other public health measures taken in response to the pandemic. 

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“Ironically, in a really weird way, it sort of explains a lot of the behaviors and beliefs of the people who are drawn to this idea,” Corlett said. 

Still, this doesn’t mean Malone, or those who agree with Malone, are the victims of “mass formation psychosis” either. “The end result may be fixed, false belief, but that’s not a product of mental illness; it’s a product of pervasive mistrust in authoritative sources of information resulting in vulnerability to misinformation and disinformation that’s out there in the world,” Pierre said. “That reflects a kind of social ill of society, not the mental illness of individuals en masse.”

Bortolotti and her colleagues have found that some irrational beliefs, like the ones that support conspiracy theories, work in the opposite way: They attempt to protect mental health by “responding to the human need for control, understanding, and belonging.” 

Conspiracy theories are appealing because they provide a reason behind why something is happening. “In a pandemic scenario, the explanation may be filling a gap caused by doubt and division among experts,” Bortolotti and her colleague wrote recently in The Conversation. “Seeing the event as planned rather than accidental allows people to maintain a sense of control over a reality that is confusing and unpredictable.” 

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Costello, who has studied the underlying psychology of extreme political belief and behaviors, said that these attitudes are associated with an aversion to complexity and uncertainty, difficulty with nuanced information, and antagonism toward perceived political enemies.

“Extremists tend to see the world in clear, certain terms and believe there are obvious, simple answers to the world's problems,” Costello said. “COVID is a problem with complex, rather than simple, solutions.”

As a guest on the podcast Social Science Bites, Stephen Reicher, professor of social psychology at the University of St Andrews, said the idea that permeates out of the literature is that all groups are bad: “Groups take rational individuals, they take moral individuals, and they turn them into immoral idiots.” He’s been trying to push back against that idea.

Let's return to Le Bon’s book The Crowd, which Malone and many others are now referencing. It was published in the 19th century during the Third Republic in France, during an explosion of collective movement from “populism, religious movements, above all trade union movements, and crowd psychology grew up as a defense of the status quo,” Reicher explained. There was a motive there. “It was an attempt to say these people are mad, what they’re doing is illegitimate. It was precisely because of the power of crowds, that the powerful were afraid of crowds, and thought to pathologize them, so there’s clear politics to this anti-collectivism, a clear conservative, elitist politics.”

Reicher said that Le Bon’s book was cited by Mussolini and that Mein Kampf “has been called a poor person’s The Crowd.” 

“What he was doing was belittling the masses when they were not happy with the structure of society,” Van Bavel said. “It's a really useful tool for pathologizing large groups of people who disagree with you.”

Crowds certainly aren’t always a good thing, and there are warnings to be heeded from the kinds of biases that social identity theory can bring about. But it’s not the crowd itself that is dangerous; it’s the ideas within a crowd. The power of groups can also be used for good. “It might be that group processes lead to racism, but it’s through group processes, it’s through the civil rights movement, that you challenge racism,” Reicher said. Or, when group adherence to public health measures can protect those who are vulnerable against disease. 

As for the rise of authoritarianism, which is what Desmet claims is the end result of mass formation, Costello said that changing norms and increased threats can “both render authoritarianism more acceptable to the broader public and exacerbate latent authoritarian tendencies in certain people.” That doesn’t mean that the people participating in it are mentally ill. 

“I find this fact considerably more troublesome than the possibility of ‘mass psychosis,’” Costello said. “The Nazis and Soviets were clear-eyed and cognizant as they killed untold millions. We don't have to worry about unusual or rare psychological phenomena to explain authoritarianism—whether that's past or present. We have to worry about people—including our neighbors and friends—who are drawn to simple solutions to complex problems. People who ignore the suffering of others. Nuance, empathy, and openness to information we disagree with are the enemies of authoritarianism.”

Part of the United States’ struggle in this pandemic is the difficulty in seeing beyond individual welfare, and taking actions that, even if they don’t benefit you, may protect others. Individuality at all costs is reinforced by a book like The Crowd, which states that we are only in control, and living in a “sane” reality, when we are following our own individual thoughts and not behaving collectively. 

“Although we Americans take pride in our individualism and like to talk about 'not giving up our freedoms,' we could really use more altruism right now for the greater good," Pierre said. "There’s nothing delusional or psychotic about that."

Follow Shayla Love on Twitter.