Election Addiction Disorder: Mackey Rules!

November 3, 2016

“Election addiction disorder, undifferentiated, DSM-5A-177.6x” is characterized by an overwhelming need to watch anything and everything related to the current race for the White House, no matter how microscopic. Clinical details and prognosis are examined here.

COMMENTARY

Modern scientific exploration of group psychology debuted around the century’s turn with Gustave Le Bon’s The Crowd: A Study of the Popular Mind (1896). Parsing crowd behavior went on to be a cottage industry for sociologists. Psychologists of various persuasions were quick to weigh in. Freud’s contribution was his seminal Group Psychology and the Analysis of the Ego (1921).

A half century before Le Bon’s sober appraisal, Charles Mackey wrote Extraordinary Popular Delusions and the Madness of Crowds. Mackey was an intriguing character: a prolific Scottish journalist cum arm-chair philosopher, song-writer, and amateur entomologist. He was also a much admired and quoted raconteur, with a wry wit and keen eye for human folly. Kurt Vonnegut and Carl Sagan were ardent fans.

Mackey made no claims to clinical accuracy. Extraordinary Popular Delusions is rather an untheoretical inventory of collective lunacy throughout the ages. The author casts a wide net. Examples range from harmless to catastrophic, daffy to dire: inter alia, the Crusades, witch trials, adoration of charismatic criminals, and stock market bubbles. Mackey famously concluded that:

“It may be said that men . . . go mad in herds, while they only recover their senses slowly, and one by one . . .”

The public’s insatiable appetite for interminable network coverage of the 2016 presidential campaign bears the stigmata of a Mackey extraordinary popular delusion. The desperate craving for network election news during the just completed Presidential campaign has become serious enough to warrant clinical attention-and even intervention.

In aid of spreading the word, the DSM’s sachems put on their collective thinking caps, and have come up with “Election Addictive Disorder undifferentiated: 177.6X”-EAD. The new diagnosis will appear in the forthcoming supplementary DSM-5A. The following reprise of EAD will, it is hoped, spare busy practitioners from wading through the DSM’s usual turgid prose, as well as head off migraines.

Nosological considerations

Some experts object to the new entity’s classification as a “disorder,” preferring “Elective Addiction.” One acknowledges the DSM’s overwhelming yen, if not frank addiction, for disorders. But it’s bootless to complain: we will simply have to go along to get along, if only for the purpose of receiving adequate insurance reimbursement.

The salient features of EAD, like “Gambling Disorder” (formerly “Compulsive Gambling”), are closer to an addictive rather than an obsessional model. Hence the DSM-5a situates EAD-like Gambling Disorder-in the category of “Addictive Disorders Unrelated to Substance Abuse.”

ICD-10 wonks are still wrangling over whether a diagnosis corollary to EAD falls within their bailiwick, and what an appropriate F-code should be-again in aid of getting the biggest bang for the buck from insurance coverage.

Overview

Election Addictive Disorder (EAD) is characterized by an overwhelming need to watch anything and everything related to the all-too-recent race for the White House, no matter how microscopic. For most viewers, Fox News, CNN, and MSNBC channels have been preferred sites for devouring ceaseless campaign blather.

Fox News continues its 5-year run in first place, which progressives attribute to a political stance to the right of Metternich. Further discussion on this score lies beyond the author’s remit. MSNBC has renamed itself “The Place For Politics,” in aid of beating its chief competitor, CNN, in ratings and profitability. Which place it will now occupy after the election is a vexed question.

History

Archeological research indicates that EAD is not to be found during the Neanderthal and early Cro-Magnon non-electoral epochs, when leadership was solely based on who wielded the biggest club.

EAD commenced with the invention of elections in antiquity. The letters of Pliny the Elder to Pliny the Younger indicate EAD was common during the vicious political campaigning of the late republican era.

Classic Roman EAD often was spurred by the gladiatorial games sponsored by candidates for consulship such as Gaius Julius Caesar and Pompeius Magnus. Electoral success often depended upon the variety of animals assembled to dispose of criminals and religious dissidents in the Colosseum, as well as the number of miscreants gobbled up by the beasts.

The subsequent viral spread of EAD to everywhere in the globe where an election was held was facilitated by progress in communication technology-especially invention of the printing press and radio. Historians agree that TV was the real game changer in EAD’s proliferation, especially within the past decade.

Prevalence, incidence, epidemiology

Evidence-based research on EAD is unfortunately slim. The paucity of reliable EAD studies clearly stems from the disorder not being recognized by clinicians as such until the 2016 presidential campaign, despite ample historical evidence noted above. Cutbacks in NIH funding due to lobbying for other causes (eg, a bridge connecting Washington to Las Vegas) also have contributed to the shortfall.

Substantial anecdotal reports suggest that EAD, hiding in plain sight, afflicts subjects of any gender (or transgender); millennials, centennials, and perennials. EAD thrives in all states, blue or red; in the Big Enchilada as well as heartland hamlets. It also spread to US expats as the election neared, as well as the abundant population of American troops abroad.

EAD sprawls across the social spectrum, absent the poor and other subjects prevented from voting by whatever means that gets the job done.

Election-related anxiety and depression occasionally show up in foreign subjects. Symptoms are usually unrelated to EAD, but may constitute a rare form fruste. The disorder’s full-blown picture in Un-Americans is otherwise unusual, with the exception of terrified refugees seeking US asylum.

Family history

A family history of EAD is not uncommon, particularly when party zealots of any stripe have perched somewhere in the family tree.

Initial course

Approximately 35% of EAD patients in the meagre studies to date experience a prodromal stage hallmarked by gradually increasing interest in-and watching-early campaign coverage beginning with the primaries. One also sees early manifestation of world-destruction fantasies or rabid patriotic sentiments, depending upon the subject’s party preference. Talking back to the TV or TIVO also commences at this point.

The disorder may be highly contagious. Family study indicates that one member is typically infected, followed by rapid spread to others. Infants, toddlers, and early adolescents are not exempt. Contagion is accelerated by watching campaign news en famille. Relatives, neighbors, friends, and co-workers then quickly succumb. Public health officials point out that a similar pattern has previously been explored in Invasion of the Body Snatchers, Night of the Living Dead, and other low-budget vampire and zombie flicks.

Laboratory findings

Borderline elevation in fasting blood sugar, A1c, LDL, and other tests related to latent diabetes.

These findings are most likely related to the overconsumption of goodies and lack of exercise collateral to overconsumption of campaign coverage.

Neurochemistry and imaging

Preliminary neurochemical studies suggest findings similar to other addictions, particularly an increase in dopamine production. Imaging studies are no easy thing to pull off, given the average subject’s inability to keep still, accompanied by booing, cheering, etc. Early studies hint at suppression of frontal lobe activity involving judgment, articulated with heightened activity in backbrain centers related to joy or rage, again dependent upon which candidate is on screen.

Comorbidity

EAD is frequently accompanied by alcohol, nicotine, and caffeine disorders. EBTOD (election-based temporary obsessional disorder) is significantly higher in EAD subjects than normals. Comorbid anxiety and depressive disorders are not uncommon in terrified Mexicans and Muslims, as well as other immigrant populations, native born or illegal. Pre-existing PJD (Political Junkie Disorder) is frequently associated with EAD.

Differential diagnosis

A thin line exists between normal and pathological viewing. Normal subjects may temporarily experience EAD symptoms, especially during the occasional burst of real election news. Predisposed viewers, like compulsive gamblers, will shift back and forth between quotidian and pathological viewing. Inevitably, some slide down the slippery slope to EAD, and remain there in an end-stage state.

EAD is rarely a function of bipolar mania. Temporary exhilaration or despair during campaign coverage should not be confused with genuine bipolarity.

Etiology

Researchers believe that EAD arises from a frenzied cybernetic between network news producers and consumers, which proceeds to feed upon itself until the last vote is cast.

EAD has been primarily ascribed to the candidacy of a wily charismatic populist, with zip political experience, but with impressive celebrity status and television savvy. The mediameister’s impact cannot be ignored, but other powerful causes exist-some obvious, others beneath the radar:

• Impressive advances in television technology, which enhance the subject’s attraction to, and seduction by campaign coverage

• Over several decades, the increase in “special event” programming, eg, criminal trials, red-carpet award ceremonies, school and other public massacres, stellar sport events such as the recent Rio Olympics, etc. (In the so- called “society of the spectacle,” mega-coverage of a “‘special” event itself has become a special event. Network campaign coverage with celebrity anchors and commentators becomes more important than actual campaign news.)

• The birth and afterbirth of reality television-eg, The Apprentice and its iterations

• A daunting socio-economic climate, hallmarked by economic uncertainty and political unrest

• Sharply polarized views on national security, immigration, environmental degradation, race, crime, and any other relevant meat for the media grinder

The most important causal factor related to EAD generally resides beneath the public’s radar: the enormous profitability of incessant campaign coverage to the networks in general and corporate honchos in particular.

Outcome

Prognosis for complete recovery is deemed excellent. About 20% of subjects stop watching coverage before the election, usually within the concluding 2 months. Spontaneous pre-election recovery probably stems from supersaturation. In these cases, phobic avoidance of all TV programming is not uncommon. Nausea and other signs of withdrawal can occur upon abrupt termination. Convulsions have not been reported.

The presence and course of post-election symptomatology cannot yet be determined. It is conjectured that milder EAD symptoms will briefly continue and ultimately diminish.

Mutatis mutandis, a winner’s supporters with previous EAD may develop TASM (temporary acute situational mania), abetted by greater post-election coverage of their candidate until it too disappears.

In any case, one expects Mackey’s famous conclusion will hold true: those who were caught up in the hurly-burly of TV campaign coverage, addicted or otherwise, will now recover their wits slowly and singly.

Experts predict that about 10% of EAD patients who supported the loser will slip into chronic dysthymia. While persistent depression might stem from jangled biology, one theorizes their desolation chiefly stems from failure to successfully grieve their candidate’s defeat. It’s likely this cohort will be composed of “true believers.” The danger of the disgruntled and disaffected taking to the barricades must not be underestimated.

Treatment

To date, psychotropic medication of any sort (naltrexone included) has had little value. Bourbon, beer, or medical marijuana provides temporary relief, but symptoms may increase as a result of disinhibition.

Psychoanalysis takes too long, outlasting the syndrome.

Brief, analytically oriented therapy holds some promise, as does cognitive therapy. Cognitive procedures pitched at total abstinence demand exquisite attention, lest withdrawal symptoms occur.

Exciting work using a non-abstinent model is presently being conducted, based on Canadian studies that showed definite, if limited success in treating compulsive gamblers. EAD subjects in the new program agree to watch future election coverage no longer than 2 hours a day. The subject agrees to complete work-book assignments and attend lectures on EAD. Some gamblers in the Canadian study were actually unaware they were afflicted with the disorder until they completed the program, and actually stopped gambling altogether. Perhaps analogous EAD subjects will also cease pathological viewing behavior altogether.

An AA-based 12-step approach, combined with other therapies or as sole treatment, would seem to be ideal for EAD subjects. Unfortunately, few such programs exist at this time.

Concluding thoughts

It is said that those who do not remember the past are condemned to repeat it. Extraordinary popular delusions are chiefly remembered by academics, but public memory fades. Public health officials project another, even more serious outbreak of EAD in the next presidential election (should there be one).

A radical cutback in campaign coverage is needed to head off the potential catastrophe. But the network moguls won’t be policing themselves soon, given the stupendous amount of filthy lucre at stake. As for federal intervention, no joy. The new President who now sits in the big chair got there through the network’s hyperbolic hoopla, so why kill the golden goose?

Thus, a vaccine seems the only viable solution. Any takers, Big Pharma?

 

This article was originally posted on 10/18/2016 and has since been updated. It appeared in the November 2016 print issue (page 38) under the title "Election Addiction Disorder: Help for Your Patients Who Haven't Recovered." 

Disclosures:

Dr. Greenberg practices psychiatry in Manhattan, New York. Full bio.