The Social Psychology of Healthcare Reform

2021.10.01 Lembke - Lee

Summary:  Why hasn’t healthcare reform moved forward? Two psychiatrists dig deep beneath the systems issues, politics, and social polarization, and they find darker social-psychological forces at work — outrage addiction, and pathological social contagion. Too many of us have become addicted to outrage over our grievances, and too many have been infected with animosity toward others. These psychiatrists apply the principles of addictionology and psychiatry to prescribe how to fix our society, and this could fix healthcare along with it.

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Fixing U.S. Healthcare blog has made the case that healthcare reform is economically desirablesocietally compelling, and medically indispensable.   So, why hasn’t reform moved forward?

Two psychiatrists are giving us new answers to this baffling question, based on social psychology.

In search of the causes of inaction, previous posts on this blogsite have blamed healthcare corporations and political leaders for gaming the system to drive overconsumption well into the territory of diminishing marginal return. And for running up prices in the process.

But more recent posts on this blogsite have suggested that all Americans share in the blame. First, for acquiescing to the twin bugaboos undermining fair elections — manipulations that distort voting and too much campaign money.  These twin hitches derail democratic self-governance. And second, for isolating ourselves into tribes. Tribalism drains our collective civic power.

A further post has contended that beneath these defects lies a lack of empathy that turns away from the real harms of an inadequate healthcare system on real neighbors.

So, why this lack of empathy? Why this acquiescence to political dysfunction? Why this abandonment of civic cohesion? Psychiatrists Anna Lembke and Bandy X. Lee in their recent books probe deeper, down into our society’s collective psyche for basic and troubling explanations.

Their diagnosis is outrage addiction and social contagion. We will review these dark findings. We will discuss how they apply to healthcare reform. We’ll also look at their prescriptions for the healing needed before healthcare reform can happen.

Addiction to Outrage

We have all become addicted to outrage! Some more than others.

This is the claim of Stanford psychiatrist and addiction specialist Anna Lembke, M.D. She means this quite literally, not metaphorically.

As 21st century communications technology developed, tech entrepreneurs early on saw that our hand-held devices can act like Skinner boxes, doling out pleasurable rewards to users. And that those pleasures are intensified all the more by the “likes” from online “friends.”

Techs also rediscovered a dark side to social media psychology. Evolution has hard-wired us to discriminate our own tribe from others, and to react to outsiders with fear and outrage. So, fear and outrage, too, could be manipulated by algorithms, catharsed with hatred and cruelty, and magnified by online crowd psychology.

Dr. Lembke reports new research showing that dopamine, the brain’s pleasure chemical, is activated by outrage scrolling, pleasure-clicking, and cable news binge-watching. Dopamine is exactly the same chemical activated by cocaine or narcotics, although more intensely.

And just as addicted people’s brains become numbed over time to their drug of choice — requiring them to seek ever higher doses just to feel normal — so too we can all fall into a cycle of seeking ever more confirmation of our biases and seeking ever more targets for outrage. And sometimes, sadly, escalating into crowd-affirmed cruelty.

Many of us tap our devices for a social media jolt on first awakening or at every ping. We just can’t resist.

This is not a healthy situation, and is not a recipe for constructive self-governance! How can Americans work through the complexities of healthcare reform when our rational problem-solving brains are addicted to group-likes, outrage, and hatred?

Dr.  Lembke’s Prescription

Dr. Lembke is an addiction specialist, not a healthcare reform advocate.

But the remedy she prescribes for common addictions can be applied to healthcare reform – a 12-step reckoning modeled after Alcoholics Anonymous.

The First Step is admitting our powerlessness.  That is, seeing the addiction for what it is and breaking through our denial, excuses, and rationalizations. This is best accomplished by what Dr. Lembke calls “radical honesty” – not allowing ourselves even one “white lie” per day (the usual adult average).

The 12 Steps also call for a fearless inventory of harms caused by our addiction. In the case of healthcare, the truths we must face are that too many fellow Americans are harmed by lack of health insurance, and that our system is afflicted with high cost, corruption, and cronyism.

Dr. Lembke inserts an extra step of a “total fast” from the dopamine trigger for at least 4 weeks. This allows the brain’s chemistry to return to a balanced state. And it may actually open our eyes to what was clouded by the addiction. We must turn off our phone notifications or block breaking-news sites. We must seek out new people, places, and things that don’t simply confirm our biases and whip up outrage, but give us a new perspective on the issue.

The 12 Steps also recognize the need to cultivate empathy toward others. And they affirm that our human interconnections must be based on healthy psychological, social, and spiritual grounding.

Social Contagion

Outrage and tribalistic cruelty are not only addictive but are also contagious, spreading through our nation like an infection. So says Bandy X. Lee, M.D., M.Div. This is called “social contagion.” This phenomenon has been recognized for centuries. We are all aware how this contagion works for copycat violence, for trends in pop culture, and for good effects like “contagious kindness.“ No surprise, since humans are social creatures. Social contagion issues has been receiving growing media attention lately. Research shows that this social contagion model can be applied for understanding  current American politics.

Dr. Lee says that there are two components needed for social contagion. First are the “contagious” beliefs. And, second, are susceptible hosts to “catch” them.

In the case of healthcare reform, this blog suggests that the contagious false idea is that healthcare is a “discretionary commodity” that will be fairly distributed at a “fair-market” price.

This blog has demonstrated the hard truth that lack of universal healthcare sickens and kills individuals, constrains our economy, and weakens our social cohesion. That is, it’s an absolute necessity, not discretionary. Moreover, the so-called market has been deformed by the medical-industrial-political complex, so that it can no longer find the supply-demand price point, nor balance opportunity costs.

The susceptible hosts for these contagious ideas are large swaths of our nation, rendered vulnerable by tribalism, political paralysis, racism, poverty, and corrosion of the “social contract” for equal-opportunity.

Dr. Lee laments that many Americans have descended into cultic programming, “battered victim” entrapment, and shared mass delusional psychosis that detaches them from understanding reality. Again, quite literally, not metaphorically.

Like addiction, social contagion of false ideas creates an unhealthy situation, and is likewise not a recipe for constructive self-governance!

Dr. Lee’s Prescription

Dr. Lee applies the principles of psychiatric care to what she considers a full-blown “public mental-health crisis.” Healthcare cannot be healed until we heal our society. And paradoxically, ensuring healthcare for all must be an integral part of that healing of society.

So, a simultaneous, multi-pronged approach is needed at an individual level, system level, and societal level, including

  • Removing or containing toxic leaders, such as by elections, prosecutions, or impeachment
  • Strengthening ourselves as citizens with self-care, mutual support, and spiritual grounding
  • Demanding truth and justice, with non-violent public protests if necessary
  • Blunting cultic programming by limiting exposure, such as mitigating the spread of disinformation
  • Addressing underlying societal derangements – disparities in economic, educational, and healthcare opportunities
  • Strengthening unity in our diverse society
  • Investing in science, emotional growth, cultural activities, creativity.

Moving Toward Health and Healthcare Reform

Breaking our addiction to cruelty and indifference, and blocking the contagious spread of these corrosive patterns can move us all toward a more healthy society and toward a healthier healthcare system.

Raising awareness is a vital first step, one attempted by this post!

Take Action

Now, take action!

References:

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Image Credits

Title:  Anna Lembke, M.D., at Tanner Lectures Discussion Seminar, 2019

By:  Ethics in Society by Creative Commons CC-BY via Wikimedia Commons

URL: https://commons.wikimedia.org/wiki/File:Anna_Lembke_Tanner_Lectures_Discussion_Seminar.jpg

License: This file is licensed under the Creative Commons Attribution 3.0 Unported license.

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Title: Bandy X. Lee, M.D. (screenshot detail)

By:  WGBH Educational Foundation

URL: https://www.youtube.com/watch?v=Qh3tGShimi0

© 2020 WGBH Educational Foundation (Used under Terms of Use)

Note from the Blog Author:  I will be taking a break from blogging for several months in order to concentrate on a local civic project.

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