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Figure: misinformation, cults, COVID-19
FigureI have a friend whose marriage is failing because of an addiction to misinformation. She and her husband always had differing political views, but their yin and yang were endearing, intellectual fodder for respectful, playful debate. But things have dramatically changed in this new world we live in.
“If it were alcohol or drugs, I could stick it out and we could work on a solution together,” she told me. But what do you do when your spouse is addicted to murky news sources and the communities swirling around them?
Noel Brewer, PhD, a professor of public health at the University of North Carolina at Chapel Hill, specializes in studying why some people decline or oppose vaccinations. Even after two decades of researching this topic, today's environment is shocking to him. “Some people,” he told me, “have turned their love affair with misinformation into a defining personality trait. This is finally their chance to take a walk on the wild side.”
Prone to anxiety and depressive symptoms, my friend's husband Hank (not his real name) was hit hard by the pandemic. He is a stay-at-home dad with young children, and he had a lot to handle during COVID lockdowns and remote schooling with limited social outlets. A gaping void was left by the loss of normal school, sports, and play dates, and Hank's community started to revolve around social media and online committees. It began with a parenting group focused on wellness that somehow took a turn toward QAnon.
Hank became a vocal antimasker at school board meetings. Soon he was vaccine-bashing on social media and at the dinner table. A bitter argument ensued when two of the couple's children became eligible for the COVID-19 vaccine; they ultimately weren't vaccinated. Then he got sick. His symptoms progressed over two weeks, first a fever, then coughing and a sore chest. Next came bed-confining dizziness, which coincided with the mail delivery of a medication from India. My friend found the box; it was labeled “Covermectin.”
Through it all, Hank refused to get tested, not even before starting doses of ivermectin better suited to a large farm animal, not even before taking the kids to visit his parents, also vaccine skeptics, not even after his mother fell ill.
Cult-like Obsession
Dr. Brewer was selected for close study of two health behaviors that seemed to require complex decision-making, vaccination and disease screening, when he started his UNC career. He has since discovered that vaccination is driven by many environmental factors, and is actually often “not a decision in any routine sense of the word.” History, culture, and fear play a role in whether a community is likely to accept a vaccine. What seems to be new these days, he said, is the extent to which vaccine misinformation has become a cult-like obsession.
Misinformation, addiction, and cults all have something in common: A person's “vulnerability factors” can make him more susceptible to falling prey to the allure. Those with a history of anxiety or depression are more at risk for addiction and to join cults. Experts call the first step in cult commitment the narcissistic seduction. (Fournier A, Monroy M. [1999.] La dérive Sectaire [translation: Sectarian Drift]. Paris: Presses universitaires de France.)
The ego and its vulnerabilities are exploited by flattery and group think. Many new cult members seek refuge from addictions to other things or from family dynamics and find their new cult environment, at least initially, provides psychological relief. This honeymoon period can last for days, months, or years. (J Nerv Ment Dis. 1978;166[10]:685.)
The cult recruit is drawn away from his prior life during this time. Researchers found in a study of 31 former cult members that the repercussions of cult membership affected all areas of life—social, family, marital, professional, and financial. (Psychiatry Res. 2017;257:27; https://bit.ly/3uE8dQq.) The study also described the type of people drawn in by cults' narcissistic seduction, and they sound a lot like Hank. Most cult victims in the study were well-educated and had long-time partners and a history of anxiety. The ramifications of getting caught up in a cult reminded me of what happened with Hank. More than 50 percent of cult members reported a reduction in social life, and 45 percent experienced isolation from their family and spouse.
Our COVID era of uncertainty and isolation just doesn't seem to be going away. Rates of anxiety, depression, and substance use have skyrocketed. It's no surprise that cult mentality might be serving as a psychological safety blanket for many, like Hank. He has a community of like-minded people cheering him on as he fights with his family and community about masks, vaccines, and whether COVID even exists. Not even his own mother's illness swayed Hank; when he heard she was sick, he drove for half a day to deliver Covermectin. Despite sats in the low 80s, Hank's mother refused to go to the hospital, and Hank and his siblings didn't insist. They stayed instead to provide support. Maskless support.
My friend was at a complete loss about what to do. Unlike a substance use disorder, no intervention or program was available for her to lean on, no 12 steps, or Misinformation Anonymous. It's odd how little guidance is available on how to treat this scourge despite centuries upon centuries of misinformation of various incarnations (state-sponsored propaganda, false prophets, and Mad Men-style manipulative advertising) and despite the fact that being duped is a nearly universal human experience.
How can we help Hank and his family? If we view his situation as an addiction—an addiction to misinformation—we must ask: Can it be treated? How? Spoiler alert: The cure won't be easy. But consider several options borrowed from programs designed to treat other addictions:
A Different Obsession
The idea is to share scary information to change behavior. Every parent is familiar with this technique: “If you put your hand in the cage, the Gila monster will bite your finger off.” The fear communication might be around what Hank has to lose—his marriage, his children, the health of his family. The problem is, as we know, that fear often fades quickly. Even if such communication triggers a realization, that doesn't mean it will translate into action. Unfortunately, like with other addictions and behaviors such as substance use and driving after drinking, it's been shown that fear communication doesn't produce lasting change. Circling back to COVID, Dr. Brewer noted, “Fear communication doesn't increase vaccine uptake,” and it's “unlikely to do any better at breaking people's addiction to misinformation.”
Much like a recovering alcoholic becomes addicted to fitness, perhaps one obsession can be traded for another. “It may be unrealistic to treat misinformation addiction in the usual sense,” said Dr. Brewer. “Instead, we could encourage people to shift their attention to a new petty addiction, like baking bread, fantasy football, or Pokémon Go.” Unfortunately for Hank, his other obsessions were fitness, natural foods, and mindfulness, and those were his gateway into misinformation. Fantasy football and Pokémon Go are not likely to change this.
One path out of addiction is bottoming out. The weekend bender that results in the purchase of a Gila monster followed by the Chevy totaled in a ditch can be a transformative moment that purges demons, if it doesn't land the addict in the hospital or worse. In the best of cases, this is an organic moment, one that brings the risks into focus and motivates the addicted to move on.
Crisis of Faith
The most common reason people leave a cult (the average cult member spends almost nine years under the spell) is that they lose faith in the group's creeds. The provocation for this crisis of faith is often a family or social intervention.
This is where my friend was, planning an intervention. A rather simple one, actually, a part-time job, something that could get Hank out of the house and exposed to genuine, face-to-face social interactions. Employment, she thought, could get Hank out of the vacuum of exponential misinformation. She was making progress with this idea when Hank's crisis arrived. His brother, who had also rushed to help their mom when she was sick with (unspoken of) COVID, became ill. Unvaccinated and in denial, the brother went to bed early one night. He was found lifeless the next morning.
EPs see addicts all the time. There is no one answer to help them. They took many paths to become addicts, and a path out is never the same as someone else's. But roadmaps have worked for others, at least for drugs and alcohol. I believe misinformation is addictive, and Hank and, indeed, our nation need lifelines out. The sooner we admit that there's a new(ish) dangerous, habit-forming substance out there engaging the same neurotransmitters that feed substance use, gambling, and cult membership, and the sooner we name it misinformation addiction, the sooner we will be able to help Hank and countless others whose lives and families are being destroyed by a faceless, insidious threat.
Despite it all, last I heard Hank had yet to acknowledge or release his addiction, but he had agreed to apply for a job. Maybe this is step 1 in his 12 steps to freedom from misinformation.
Dr. Ballardis an emergency physician at San Rafael Kaiser, a past chair of the KP CREST Network, and the medical director for Marin County Emergency Medical Services. add after Services. Follow him on Twitter@dballard30. Read his past articles athttp://bit.ly/EMN-MedClear.
