What have we learned—and what do we need to know—about the mental health implications of organizational and governmental dictatorships?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Recently, former federal House of Representative Liz Cheney conveyed her concern about a future presidential dictatorship, and one in which there might not be a term limit. That got me wondering about the likely mental health implications in living under a dictatorship and, goodness knows, the world has had plenty of them.
On the one hand, it might seem obvious that there are adverse mental health repercussions, but on other hand, maybe not. Perhaps the dictatorship even absorbs or covers some mental health vulnerabilities. For instance, there may be large numbers of followers of a dictator who have deficits in self-esteem or societal obstacles to their mental well-being who come to feel, perhaps deceptively and naively, better and more optimistic with a new dictator. The dictator is their savior.
Finding sufficient research is a challenge, though. By its very nature, like many other things, dictators may not want their effects on mental health examined. One overview from about 20 years ago concluded that the effect tyranny has on mental health is not fully understood.1 Although an authoritarian system is likely to result in an impaired sense of personal responsibility, that is not necessarily distressing. However, such totalitarian regimes do tend to destroy trust between citizens by rewarding informers. There also are many examples of dictatorships corrupting the ethical norms of psychiatrists and other physicians by using them to hospitalize political dissidents and support torture. Once upon a time, we psychiatrists successfully fought against that in the old Soviet Union.
When there is state violence and repression, the trauma inevitably leads to increased posttraumatic stress disorders. That, in turn, can tend to lead to intergenerational transmission of trauma unless it is treated along the way, although that is unlikely as long as the dictatorship is present.
A much more recent review concluded that internalized oppression is common from dictatorships. That internalization results in incorrectly believing in one’s own inferiority, as well as mistrusting one’s own thinking and intelligence.2
There are various degrees of severity and intensity of dictatorships, but even with limited research, the risks to mental health seem obvious. Early warning signs may include increasing societal conflict, cultish thinking, arbitrary changes, and unrealistic or inappropriate promises or demands from potential leaders.
Governments are not the only ones susceptible to dictator leadership. Authoritarian leadership can also happen in organizations, including those in educational and medical systems. For-profit managed care can be said to have been an example, with the ensuing burnout epidemic of physicians as the fallout.3
Although we receive important federal funding, it behooves psychiatry to monitor and educate the public about the risks of authoritarian governments in the future of the United States. Historically, the field didn’t do a good enough job of doing so in Nazi Germany, let alone many other countries.
Dr Moffic (he/himhis) is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry, and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.
1. Abed RT. Tyranny and mental health. Br Med Bull. 2005;72:1-13.
2. Hagan E. What can we learn from the mass trauma of dictatorships? The Society for the Psychological Study of Social Issues. February 22, 2023. Accessed December 7, 2023. https://www.psychologytoday.com/us/blog/sound-science-sound-policy/202302/what-can-we-learn-from-the-mass-trauma-of-dictatorships
3. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.