Sometimes, when psychoanalysts begin treatment with a new patient, they quickly find themselves feeling that they can't make sense of what is going on. The patient's statements and behavior simply don't add up, and the flurry of dissociated statements and actions can quickly begin to produce something like a disorienting fog.
Most seasoned clinicians will have learned that they shouldn't attribute this confusion, which is typically accompanied by a distinct form of anxiety, to their lack of skill. Instead, adept clinicians take the experience itself and the accompanying anxiety as significant data, indicating that they are dealing with, if not psychosis in the strict diagnostic sense, at the very least something in the vicinity of psychotic-like phenomena.
Freud distinguished between neurosis and psychosis by arguing that while the former is psychically localized, the latter is relatively global. In neurosis, individuals break with a portion of reality that they find intolerable. As a result, their overall relation to reality remains more or less intact, but becomes impaired in one aspect of their personality. In contrast, because psychotic individuals tend to find reality as a whole too painful to bear, they break with it globally, and construct an alternative, delusional, "magical" reality of their own. This alternate relation to reality, manifesting itself in the initial meetings with the patient, is at the root of the clinician's confusion.
Now many of us throughout American society at large, after an interminable electoral campaign and transitional phase into the presidency of Donald J. Trump, have experienced a form of disorientation and anxiety that bears a striking resemblance to the clinical situation I have described. And recent events indicate that this feeling is not going to abate any time soon.
Of course, a clinical psychoanalytic experience and general social experience are not strictly analogous. But a comparison of them can prove illuminating. Just as disorientation and bewilderment tell analysts something significant about what they are experiencing in the clinical setting, so too our confusion and anxiety in the face of Trumpism can tell us something important about ours. I am suggesting, in other words, that Trumpism as a social experience can be understood as a psychotic-like phenomenon.
This is not a question of Donald Trump's personal psychopathology, alarming as that question may be. The point is, rather, that Trumpism as a social-psychological phenomenon has aspects reminiscent of psychosis, in that it entails a systematic - and it seems likely intentional - attack on our relation to reality. Much has been written about "post-truth" politics in the context of the recent presidential election, and rightly so, as Trump's relationship with the truth is not the same old conservative legerdemain. Every weekday, get thought-provoking commentary from Op-Ed columnists, the Times editorial board and contributing writers from around the world.
But in an important sense, anti-fact campaigns, such as the effort led by archconservatives like the Koch brothers to discredit scientific research on climate change, remained within the register of truth. They were forced to act as if facts and reality were still in place, even if only to subvert them. For example, when they attempted to undermine the findings of legitimate scientists, they often utilized rational arguments concerning certainty, probability and proof. The collective social experience of this propaganda may have led to greater ignorance about the science of climate change, but it didn't substantially alter our experience of truth as such.
But Donald Trump and his operatives are up to something qualitatively different. Armed with the weaponized resources of social media, Trump has radicalized this strategy in a way that aims to subvert our relation to reality in general. To assert that there are "alternative facts," as his adviser Kellyanne Conway did, is to assert that there is an alternative, delusional, reality in which those "facts" and opinions most convenient in supporting Trump's policies and worldview hold sway. Whether we accept the reality that Trump and his supporters seek to impose on us, or reject it, it is an important and ever-present source of the specific confusion and anxiety that Trumpism evokes.
Donald Trump's relation to Vladimir Putin is one area where our sense of bewilderment is particularly pronounced. Whatever may or may not be going on between the two authoritarian leaders, similarities in their style are striking. A recent BBC documentary, "HyperNormaliza-tion," by Adam Curtis - who is often as over-the-top as he is insightful - is suggestive in this context. Curtis calls our attention to Vladislav Surkov, whose official title is "the vice head of the presidential administration" and has been referred to as the "puppet master" of Putin's Russia. Surkov has a background in avant-garde theater and is a devotee of postmodern culture, and has adopted theatrical and artistic techniques of "subversion" to unleash a full frontal attack on Russian society's sense of reality. According to Curtis, Trump has taken his stratagems for spreading pandemonium from Surkov's playbook, with Steve Bannon - a product of Hollywood and Goldman Sachs who now sits on the National Security Council's Principals Committee - acting as Trump's Surkov.
By continually contradicting himself and not seeming to care, Trump generates confusion in the members of the media and political opposition that has often rendered them ineffectual, especially in speaking to those outside the liberal base. They were slow to realize that he was playing by a different set of rules. This is why they, like Hillary Clinton before them, have had such difficulty gaining traction against him via appeals to facts and other cherished norms of liberal democracy. He has proved adept at deflecting well-intentioned fact-checking, regardless of how often it has caught him in a contradiction, and rational counterarguments, which can bounce off him like rubber. As long as Steve Bannon and his colleagues continue to destabilize our sense of reality, and their opponents fail to recognize how these techniques work, those who oppose him will continue to stumble.
In the psychiatric setting, it only becomes possible to treat a patient in the psychotic range of the diagnostic spectrum when an analyst does not focus on the "manifest content" - on what actually happens on the surface - but finds a way to address the underlying dynamics in order to work them through and establish, first in the analytic setting, and then hopefully in the patient's life, a less compromised relation to reality.
On the hopeful side, there has recently been a robust and energetic attempt not only by members of the press, but also of the legal profession and by average citizens to call out and counter Trumpism's attack on reality. But on the less encouraging side, clinical experience teaches us that work with more disturbed patients can be time-consuming, exhausting and has been known to lead to burnout. The fear here is that if the 45th president can maintain this manic pace, he may wear down the resistance and Trump-exhaustion will set in, causing the disoriented experience of reality he has created to grow ever stronger and more insidious. The writer is the director of the Psychoanalytic Studies Program at Columbia University
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