The temperature of the electorate has officially reached a boiling point on both sides of the aisle. Biological relatives can't even make it through Thanksgiving or the Fourth of July without exhibiting some level of vitriol related to politics. Most of America chalks this up to the age of Trump. Trump confabulates, and America conflagrates. Many politicians have questioned his mental fitness, and several psychiatrists have diagnosed him with multiple disorders in spite of the American Psychiatric Association's Goldwater Rule.
Everyone is worried about what happened to Trump's brain, but no one seems to be particularly worried about what's happening to ours. The Russians hacked the election, but it's Trump who has hacked our minds. In fact, Trump has instead turned the tables and coined a new diagnosis in a tweet: "Some people HATE the fact that I got along well with President Putin of Russia. They would rather go to war than see this. It's called Trump Derangement Syndrome!"
Trump Derangement Syndrome (TDS) is ostensibly a mental condition in which persons have been driven effectively "insane" due to their dislike of Donald Trump to the point at which they abandon all logic and reason.
The question is: Is this a real diagnosis or just the latest meme? If not a diagnosis, does it reflect a bonafide physiologic phenomenon?
Many have remarked that Trump operates out of his "lizard brain". Rather, I would argue that Trump has turned our brains reptilian. The two emotions that belie this effect -- greed and fear -- are the same two emotions that govern Wall Street's behavior. No surprise.
Greed drives dopamine action in the nucleus accumbens (NAc), the reward center deep within the limbic system, the emotional part of the brain (Freud called it our id). Appealing to our avarice with promises of "good jobs" and "healthcare for everyone" and "tariffs on our competitors" and "better trade deals" and "tax breaks", Trump jacks up our dopamine the same way a roller coaster does. Thrills in both directions, up and down. When the NAc goes into hyperdrive, it translates into "I want more." The problem with the dopamine response is it's a bell-shaped curve -- there is an optimum below which people are lethargic and above which they become irritable. Finding and maintaining the "sweet spot" on the curve is complex, as dopamine is a minute-to-minute neurotransmitter. Chronic overstimulation drives severe irritability, as chronic cocaine users can attest to.
In contrast, fear activates the amygdala, which sends corticotropin-releasing hormone (CRH) signals throughout the CNS. CRH drives cortisol, which stymies our prefrontal cortex (PFC) the executive function center (Freud's superego), which sits just above the eyes and serves as our internal compass. Normally, the PFC makes you behave and keeps you from doing stupid things you'll later regret, and acts as the "brake" on the NAc. Unfortunately, the PFC is a highly vulnerable structure. Chronic stress and cortisol kill neurons in the PFC, as is seen in people who were victims of child abuse or other adverse experiences like war. What's the quickest way to short-circuit the PFC? Multitasking. Even pilots, the ultimate multitaskers, experience inhibition of their PFC with enough stress.
So, what do you think Trump's 3 a.m. non-stop Twitter feed combined with a 24-hour media cycle is doing to you? The next quickest way to inactivate the PFC? Xenophobia. Build that wall. Banish that Muslim. Nuke North Korea. A dysfunctional PFC inhibits cognitive processing, restricts long-term planning, and translates into "I don't care about the consequences."
These two neurophysiologic phenomena have conspired to change human behavior throughout the millennia, and have previously been harnessed by demagogues in the name of populism. The difference now is that the message can be "weaponized" by the digital targeting of those who are most likely to respond to manipulation. In fact, these two phenomena are now at work on both sides of the aisle.
After the harvesting of data from 270,000 Facebook users in 2013, Alexandr Kogan and Joseph Chancellor of Cambridge University Predicted "likes" and "dislikes" based on a personality questionnaire called "thisisyourdigitallife." From there, the researchers accessed 87 million "friends" data, including 1 million U.K. records. Utilizing two algorithms similar to what Netflix uses to predict movie choices called "singular value decomposition" and "multi-step co-occurrence" they exhibited 95% confidence in distinguishing black from white, 93% confidence in distinguishing men from women, 88% in distinguishing gay from straight, 85% distinguishing Democrats from Republicans, and 70%-80% distinguishing five personality traits to target with social media. From there, the Canadian consultancy AggregateIQ used these data to create the Ripon platform to activate dopamine and cortisol to influence voters to sway the Brexit referendum on June 23, 2016. They then sold the dataset to Cambridge Analytica to influence specific voters in the American election on November 8, 2016, to increase their dopamine and cortisol to get them irritable enough so that they would vote, and couldn't necessarily foresee the consequences of their actions. Furthermore, Trump continues to feed their dopamine with his tax cuts and deregulations.
More recently, Trump has ramped up dopamine and cortisol in the opposite voter swath. The fear and animus generated by racism, misogyny, and security concerns has overcome another sizeable sector of the electorate. The cortisol/PFC response on dopaminergic activity is enough to alter human behavior in predictable, if socially undesirable, ways. Witness the episode of "The View" last week when Whoopi Goldberg popped off at Judge Jeanine Pirro.
In other words, many of us have now become Trump. The more dopamine and cortisol, the more we lose our ability to discern truth from post-truth, the more irritable we become, and the more we abandon our cognitive control and with little regard for the consequences.
This phenomenon of individual TDS is also recapitulated at the societal level. There is an institutional analogy leading to dopamine and cortisol, to the NA and the PFC, and it's also under attack by Trump and constitutes its own form of "derangement". American society built administrative agencies as checks and balances against unbridled reward (read: money). For instance, President T. Roosevelt instituted the FDA to ensure a safe food supply, Wilson the FTC to protect consumers, F. Roosevelt chartered the SEC to regulate the banks, and Nixon established OSHA to improve working conditions and the EPA to prevent pollution of our water and air. Aren't these governmental agencies supposed to monitor corporations and punish them when they lie? Yet each of these agencies has failed us because of corporations' abilities to propagate their propaganda. What is the difference between marketing and propaganda? Marketing is using information to advance your point of view. Propaganda is using disinformation to advance your point of view. The difference is the truth. What does propaganda do to the mind? Dopamine and cortisol, the one-two punch to rational thought. Trump has rolled back EPA, FDA, and USDA policies to make sure that corporations continue to rule. Corporations are now in charge, and Trump is their CEO.
The question is, what drives you? Trump has capitalized on the "vicious" cycle between dopamine and cortisol, between the NAc and the PFC, between greed and fear, between avarice and xenophobia, between corporations and deregulation, between truth and post-truth. It may not be a clinical "diagnosis" yet, but it is a well-documented phenomenon, backed up by hard neuroscience, endocrinology, and history.
Robert H. Lustig, MD, MSL, is emeritus professor of pediatric endocrinology and member of the Institute for Health Policy Studies at the University of California San Francisco. Follow him on Twitter, Facebook, or robertlustig.com.