The president convinced many voters that his response to the pandemic was not a disaster. The psychology of medical fraud is simple, timeless, and tragic. JAMES HAMBLINNOVEMBER 10, 2020
At some basic level, Americans do seem to agree that the coronavirus is a major threat. Despite attempts to politicize and divide us on the pandemic, we are at least united in anxiety. In September, a survey of almost 4,000 Americans found that only 12 percent disagreed with requiring masks in public. Fully 70 percent wanted the government to do more to protect people, and only 8 percent wanted it to do less.
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Since then, though, the government under President Donald Trump has done less. The U.S. has suffered the most documented coronavirus deaths in the world, by far. The Trump administration has continued to downplay and ignore the virus as its spread has accelerated in almost every region of the country. On Wednesday, the U.S. shattered the world record for daily coronavirus cases by topping 100,000 for the first time—only to break the record again each subsequent day until a Saturday high of 128,000. Field hospitals and makeshift morgues are appearing around the country. Daily death counts have risen to more than 1,000.
It may have been reasonable to expect, then, that the leadership vacuum at the core of these numbers would decide the presidential election. Polling indicated extensive support for former Vice President Joe Biden, which buoyed speculation that the vote tallies might amount to a decisive repudiation of Trump’s disastrous handling of the coronavirus. The president has variously lied by his own admission, denied the severity of the disease, and promised false cures, all as the death toll shot into the hundreds of thousands.
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Yet no repudiation came. Biden won decisively, but more than 70 million Americans still voted for Trump. That’s more than those who voted for him in the 2016 election, and roughly seven people for every person who has been infected by the coronavirus that Trump has repeatedly said would disappear. Most Americans are undoubtedly aware of the pandemic. One exit poll found that the virus was the most important issue guiding more than 40 percent of voters. But somehow, 80 percent of Republican voters said they believe that the virus is at least “somewhat under control” in the same week that cases reached record numbers. The virus alone clearly did not scare an overwhelming number of people away from voting for Trump.
Deciphering what happened in this election will surely involve a grueling postmortem within the Democratic Party. Trump’s enduring popularity clearly has much to do with factors beyond the pandemic. Much of what he said and did as president was thinly veiled white supremacy, misogyny, race-baiting, and class warfare. But Trump’s vacuous promises about the virus were more than self-serving, disingenuous, and deadly; they were also convincing and appealing to many people. Understanding why will be crucial to America’s pandemic response even after Trump is out of office.
The narratives and tactics Trump used to persuade people to trust him as a sole beacon of truth—amid a sea of corrupt, lying scientists and doctors—draw on those of cult leaders, self-proclaimed healers, and wellness charlatans as much as those of authoritarian demagogues. They have proved effective over centuries. In 1927, the British physician A. J. Clark lamented the proliferation of “quackery” in the medical profession. The term was once simply synonymous with fraud. “The fact that this term has come to signify, in popular usage, a pretender to medical knowledge indicates very clearly that there is something about the cure of disease that particularly attracts both delusion and imposture,” Clark wrote. That is, when we are sick or threatened by disease, we seem to be uniquely susceptible to scams.
At the time, scientists and engineers had just begun to apply the discovery of electrons to medicine. Some researchers expanded on the recent, accidental invention of the medical X-ray image, working to make the process safe and accurate. Medical imaging would steadily revolutionize the practice of medicine. But opportunists like the physician Albert Abrams jumped to capitalize on the hype. Abrams claimed that realigning electrons could cure almost any ailment. He began selling expensive electrical inverter devices—with names like the “Radioclast,” “Dynomizer,” and “Oscilloclast”—to sick people. He promised that by shocking the body or running radio waves through it, his devices could treat people without the need for other doctors. He alone could diagnose disease using only one drop of blood.
Abrams fooled intelligent, otherwise skeptical people. Among them, the journalist Upton Sinclair wrote with apparent earnestness about Abrams’s unique ability to diagnose and cure people of “bovine syphilis.” Though his claims were decried by scientists like Clark, to the sick and desperate, the appeal of an oddly named electron-altering device came more from a survival instinct than a rational thought process. If anything, Abrams’s outsider status gave his claims a certain allure. As Clark wrote, the quintessential quack starts as a “renegade against authority” and often ends up “establishing a dogmatic faith even more absurd than the orthodox traditions he tried to explode.” The quack is nothing if not a prophet: He promises access to a truth that no one else has. Unlike all the slow, doom-and-gloom scientists, he can make your problem go away now.
The psychology of this appeal is just as pertinent today as it was a century ago. Beyond the continued sale of electron-realignment devices, a booming wellness industry runs on the same premise of antiestablishment hope combined with soaring promises. Sellers depend on information asymmetry, wherein it’s hard for consumers to know if a product is effective, but very easy to believe that it is. If someone tries to sell you a car that doesn’t have wheels, you know it. If someone tries to sell you a secret vitamin that’s going to prolong your life, you just have to trust him (or not).
The same holds if someone tells you that an invisible virus is going to disappear. Trump’s primary approach to the pandemic has been to tell people what they would like to be true. He has promised, repeatedly: Everything will go back to normal; everyone will have amazing treatments; there will be a vaccine very soon; the disease isn’t that serious, anyway. The fact that these are conflicting claims—not to mention patently false—can only partly detract from their allure. To avoid scrutiny, quacks use misdirection. In textbook form, Trump consistently pointed to another threat that, by comparison, made the actual threat (the virus) seem smaller: Stopping the coronavirus would kill jobs. This is a false dichotomy. The two issues are conjoined. Economies collapse when going outside is dangerous; they thrive when people not only feel safe, but actually are safe.
Like any competent quack, Trump focuses on a winning vibe, not a factual case. He positions himself as an alternative to “the scientists” and “the doctors” such that followers have to choose between trusting them or him. This process, in extreme forms, leads to what some psychologists refer to as identity fusion. William Swann, a professor at the University of Texas at Austin, coined the term in 2009 while studying theories of individual identity. Once fused with a group or leader, he noticed, followers seem tied to them in such a way that things are true because the leader said them. Dystopian as that may seem, it can be a coping mechanism: Orienting your sense of truth around a person can be more comforting than doing so around a nebulous, uncertain, or otherwise threatening reality. Fusion is not appealing because it makes sense; it is appealing because it alleviates the cognitive and emotional burden of thinking.
The phenomenon transcends ideological bounds. We all fuse our identities in some ways. If you are a diehard Red Sox fan, you are almost certainly going to stay a fan, even as the roster completely turns over. The stakes escalate with political allegiances, and can lead people to vote against their own interests. When Americans are polled about individual elements of the Affordable Care Act, the health-care law put in place by President Barack Obama, for example, they approve of them. Medicare, which the law slightly expanded, is one of the most highly favorable programs among people of both parties. Yet Trump campaigned on repealing the ACA.
The freedom from scrutiny Trump now enjoys from many of his followers is reflected in an ignorance even of where he stands on the pandemic. In the survey of 4,000 Americans, 81 percent of Trump voters who believed that masks should be required also believed that Trump agrees. He has not supported a mask mandate, and has barely even endorsed their voluntary use.
Nothing is novel about the effectiveness of Trump’s approach. Scrutinizing and understanding its universal elements may help mitigate its damage as the pandemic continues. People’s needs for support and stability are real, and for many voters, Biden apparently failed to offer a meaningful way to meet those needs. While campaigning, he promised interventions like mask mandates and pledged to “follow the science,” while telling people we’ll need to hunker down for a brutal winter. All of this is true and sound. If Biden follows through on this, he will save many thousands of lives. But even A. J. Clark would have been unsurprised that so many people chose the charlatan. Biden promised rigor, perseverance, and a triumph of reason. When opting to follow a quack, though, as Clark wrote, “Reason is not involved in the process.” The draw is the personality of the healer, and “subsequent success is ensured by mass suggestion.”
If the nation’s public-health and scientific communities assume that the appeal of a quack was some transient aberration—something that will end when Trump is out of office, and that can be remedied with yet more facts—then the Biden administration will fail to reach millions of Americans, no matter how soundly it recites statistics. Its warnings and mandates will go unheeded and become fodder for charismatic outsiders who tell people what they want to hear.
There are ways to serve as a confident, optimistic leader without making up nonsensical promises. Hope can be conferred with promises to take care of people, and to be there for them. Reassurance can be offered by guaranteeing that no one will go into debt because they had to go to the hospital, and that people will have paid sick leave and job security so they can stay at home when necessary. If the public-health community does not do more to give people hope and reassurance in the face of this disaster, it will see people defect to those who will—even when they know the promises are too good to be true.