PTSD expert Seth Norrholm: “George Santos likely has a disordered personality”

American society is very sick.

What public health experts have termed “the deaths of despair” have shortened the life spans of “working class” whites aged 45-54. Such a large decrease in lifespans for an entire demographic is relatively unique in the world. The American people – especially men – are experiencing very high levels of loneliness, disconnectedness and social atomization.

These problems are not separate or apart from Age of Trump.

In the most obvious example, more than 1 million people have died in America from the COVID pandemic – hundreds died just this week. The nation has not properly grieved such a massive loss. Part of that inability to properly grieve is a function of how the Trump regime and its agents have faced no serious criminal (or even civil) punishments for their role in what was a de facto act of democide.

Ultimately, however, Trumpism and other forms of fake populism are symptoms, not the cause of a deep societal rot that spans American society. When social deviance and other anti-social and anti-human behaviors are normalized entire cultures become pathological. This is one of the main lessons from the Age of Trump and in other countries where democracy and civil society have succumbed to authoritarianism, fascism, and other illiberal forces.

What would a healthy American society even look like? What would it require for America to confront its deep traumas and then find closure and healing?

In an effort to answer these questions I recently spoke with Dr. Seth D. Norrholm, a translational neuroscientist, psychologist, and one of the world’s leading experts on PTSD and fear. He is currently a scientific director at the Neuroscience Center for Anxiety, Stress, and Trauma (NeuroCAST) in the Department of Psychiatry and Behavioral Neurosciences at Wayne State University School of Medicine. Dr. Norrholm explores how America has been traumatized and is in the midst of a type of collective PTSD that the country’s leaders as well as everyday Americans are afraid to confront. The fact that Americans are overprescribed mood-altering drugs and are addicted to social media and other technology contributes to this denial and disengagement with reality. Of note: Americans are 4.4 percent of the world’s population but consume more than 80 percent of the opioids.

Ultimately, Dr. Norrholm is deeply concerned that today’s Republican Party (and by implication the larger “conservative” movement and white right) has become a vessel for pathological behavior where “personality disordered” individuals like Donald Trump, Marjorie Taylor Greene, George Santos, and others are elevated and given great power on a national and international stage.

This conversation has been edited for clarity and length.

---

Want a daily wrap-up of all the news and commentary Salon has to offer? Subscribe to our morning newsletter, Crash Course.

---

How are you feeling given the state of this country and world?

It’s day to day, it’s minute by minute depending on what is going on in my personal life and of course politics and current events too. I’m often accused of being too negative or spending too much time dwelling on the terrible or gut-wrenching news that comes at us in droves. But I’m actually an optimist and I believe that, on the whole, people are good and have good intentions. For many, it would seem easy to give up. The one true thing that keeps me from giving up is my optimism.

I tell many people, across areas of my life, “If you don’t believe that you can overcome something, then you’re probably not going to do it.”

But the truth is that there have been so many moments these last few years in America and other parts of the world where everything feels so hopeless and pointless. Sometimes in life when you feel like there’s no point, and the world is just caving in on you, THAT is when you have to fight the hardest. I often think of the analogy of these hard times being like leaving a bar and knowing that there is going to be a fight. You know it is not going to work out well. But you must have that mindset of, “Well, yeah, this is gonna be bad. I’m going to the hospital and at least one of them is going to the dentist, if not the hospital with me.”

My father taught me something similar. He would say they may beat me up or kill me, but they will know that they were in a fight for sure. They are going to remember me.

That’s the type of grit and resilience and perseverance you have to have in life, whether it’s dealing with the challenges we are facing as a society or our struggles and adversities on a personal level. You CAN be the effector of change. 

People who read my work or listen to my podcasts will often reach out to me and say things like, “Why are you so negative? Why are you so dark?” I am just trying to prepare the public for the reality of this American nightmare. I have been warning them for seven or so years and few want to listen. You must be prepared to confront evil. We are in a great moral crisis, one that we are not going to survive by denying reality and pretending it’s just going to magically disappear. That is not defeatism or “negativity”. It is the truth.

Sometimes when you are explaining a problem, people want to interpret it as you are excusing the problem. This is especially true when you are discussing the specific problems and challenges that are afflicting white men in American society right now.

The fact is, you cannot solve a problem that you do not understand. That is the rule and framework that I use across my life in all areas.

As a mental health professional, I have the ability to observe and analyze how the world impacts our individual and collective emotions and the larger world. When people have a framework for understanding all these changes and challenges in the world that are impacting them then there can be a calming effect. The worst type of stressor for us as human beings is unpredictable stress. This is due to our lack of a sense of control or disorientation. When you are disoriented, you need to first understand what is happening in order to orient yourself. From there we can find solutions.

Isn’t it better to deal with reality as it is instead of living in some type of fantasyland?

Trump’s presidency, and these two years afterward, have impacted people in different ways. There is the COVID pandemic, of course, and more than 1 million dead Americans and tens of millions affected in some way, psychologically, practically, or otherwise. Those people lucky enough to have been able to work from home the whole time, or come from a more secure economic background, or have other social capital and resources experienced the pandemic very differently from someone who works in the service industry and is poor or working class. If you’re living in a gated community, your perception and experience of the world likely haven’t necessarily changed a whole lot from before Trump to after Trump. In fact, in 2017, it may have even got better with a tax break. If you are someone with money it is much easier for you to stick your head in the sand when things get too stressful and to ignore the realities that are hurting other people.

Clinically speaking, I support the following advice about how to get through these last few years with everything that has been happening:

You do not have to spend eight or 10 hours a day watching cable TV or listening to political podcasts or whatever it may be. If doing that is causing you distress, then don’t do it. If it’s negatively impacting your relationships, if it’s creating a traumatic or extreme stress reaction, hurting your life and spirituality, if you’re having anxiety, if you’re depressed, then don’t do it. You can still be an informed citizen by not constantly monitoring the news and current events. If you need to disengage for your own health and well-being then do it.

There is so much denial and a type of amnesia about America’s many problems and character flaws — this is especially true among white Americans. Why are they at all surprised by the Age of Trump, the COVID disaster, police thuggery and brutality against Black and brown people, gays and lesbians and trans people? As I and others have often said, “white privilege is one hell of a drug”.

As human beings, we often struggle to step outside of our own subjective experiences. Empathy is literally the ability to put yourself in somebody else’s shoes. If our entire life has been more or less comfortable, and if we have not dealt with adversity until middle age for example, then we handle adversity very poorly. Yes, there are some people who have gone their whole lives without major traumatic or other adverse experiences. Such people usually handle adversity very poorly. Why? They have never had to face it. Conversely, if you’re somebody who dealt with childhood trauma, over time those experiences — or even one traumatic moment — may break you. But here is one of the “advantages” of having experienced trauma earlier in life: you can draw on those lessons and coping experiences as an adult. You are in a sense “inoculated” and can have confidence and life skills others may not.

On a national level, many, if not most Americans, believe in the myth of “American Exceptionalism” that fascism, authoritarianism, and other great disasters that happen in other countries somehow cannot happen here. That is the arrogance and narcissism of American Exceptionalism. But it almost happened here as we saw on January 6, 2021, with Trump’s coup attempt and the attack on the Capitol. It continues to be on display by sitting members of Congress.  

What happens on a cognitive level when a person is forced to confront reality and that their denial will not save them? 

People don’t want to accept bad news. Or to think about who is responsible or culpable. So we just wish it away and hope that it doesn’t happen. Many Americans have reached that point. I’ve written in the past about how the effect of chronic stress and chronic fear rewires the brain. That dynamic causes us to have a more intense reaction that, in turn, creates a fear response that lasts longer. In essence, we are in a state of hypervigilance that is akin to what someone who suffers from PTSD might experience.

The mainstream news media continues to follow the rule of “if it bleeds it leads.” Tucker Carlson, for example, is an expert at using (false) fear and terror to drive his ratings. He is always telling his audience that some “THEY” are “COMING AFTER YOU!” If a person hears that type of message over and over again it will change how their brain reacts to stress. There is an entire right-wing media machine dedicated to creating fear and terror and chaos on a massive level — and it spreads like a virus.

What is the clinical definition of trauma? What does it mean for a society to be traumatized?

Trauma is something adverse or tragic that happens to you that creates a deep emotional or psychological injury. American society is basically being caught in a trauma feedback loop. The media is exacerbating the trauma. People who have unresolved trauma in their lives are having those feelings amplified by how extremely dysfunctional and hyper-polarized American politics have become these last few years. Many Americans are ultimately trapped in a self-reinforcing feedback loop of trauma. Politics has unfortunately become a medium or theater of war where people unload all their trauma (or unresolved conflicts or perceived grievances) onto the people that they disagree with about politics or perhaps even hate. They should be in therapy or support groups instead. 

We have famously been described as a “Prozac Nation.” What do we know about this empirically?

In 2021, there were 337 million prescriptions written for antidepressants — we’re a country of 330 million people. And obviously, that’s not a one-for-one ratio, because some people may be getting multiple prescriptions filled throughout the year. The US has 5% of the world’s population, but we consume 50% of the world’s pharmaceuticals. We are a society that is overprescribed in terms of medication. Historically, human beings have relied on physical activity through our fight-or-flight instincts to mitigate and to deal with stress and fear. We encountered something that was stressful or fearful, we either fought like hell, or we ran like hell. Our bodies evolved to rely on those responses. However, because of technology, and especially automation, we’ve gotten to a point where we’re living highly sedentary lifestyles. It’s no coincidence that as obesity rates have climbed to about 70%, and as Type II Diabetes rates have climbed, we’re seeing exponential rates of depression and anxiety.

Don’t get me wrong, pharmacology absolutely has a place in mental health. But outside of a severe, debilitating, or incapacitating mental illness, there should be a progression of force, so to speak, going from the least invasive to most invasive, with pharmacology being at best, the fifth line of defense in dealing with mental health for most people struggling with depressive, anxious, or fearful signs and symptoms. The progress should be diet, it should be exercise, it should be sleep, and then it should be therapy. Only after you exhaust those options, do you then start to be open to a medication regimen.

Unfortunately, American society is typified by a get-rich-quick, path of least resistance, lottery ticket mentality. A person goes to the primary care doctor and tells them they are depressed and the doctor immediately gives them a prescription. From a mental health standpoint, we’re not taking the steps that we can do to try to maintain our mental health or to address it once it starts to regress a little bit. And then once it does regress, we’re to quit to look for the easy way out to try to address it.

You have written extensively about the meaning of masculinity in the Age of Trump and ascendant neofascism. What is the state of masculinity right now in America?

Fascists, authoritarians, and fake populists incite fear. In turn, that creates a moral authority and a justification to do anything required to defeat “evil” or “immoral enemies”. Once you create that as a backdrop, now you can excuse Trump’s or other right-wing leaders’ immorality or pathologies. One of the things that happens with authoritarians is that they want to create the perception of — or even actual — chaos and disorder. That scares people so that they will be willing to vote in or perhaps even install a strong man to restore order.

If you value your safety, if you value your family’s safety, if you value your way of life, then this is the tradeoff that we have to make in order to preserve that. What’s worse is that some of those with the most evil intent will (mis)align themselves with Christianity and the Bible to shore up a defense of their cause.

American society is one of spectacle and distraction. There are dream merchants in advertising, politics, technology, and across American life who are dedicated to selling fantasies and manipulating the public. How has that impacted the collective mental health of the American people and their ability to deal with personal and collective problems?

Let’s be clear here. There have always been lies and deception in American politics and government. It has occurred often in a “wink and nod” fashion where a political candidate says something to get elected but then acts differently once in office. But there was a long-standing, underlying assumption. That assumption being the politician might act in a way that I disagreed with and that might have had consequences for me or not (e.g., higher taxes, higher prices, longer processing times) but ultimately believed in democracy and didn’t want to actually hurt me/us. What we have now are elected officials who have torched that underlying understanding and aim to do real, significant, often malicious harm to those they now view as the enemy.

One inflection point in recent history that we can point to is the death of John McCain. That was one of the true points where Republican decency and its moral compass were shattered. So the spectacle has become more real and the collective anxiety felt in America is due to REAL threats (to Social Security, to alternative lifestyles, to women’s rights, to civil rights, to school safety, and to protection from being shot in public). 

George Santos and Donald Trump are more than fabulists. They appear to be pathological liars and malignant narcissists. But the more important fact is that such behavior is embraced by American society on so many levels. In fact, I would argue that they are able to get away with such behavior and profit from it encouraging that pathology and legitimizing it among the public at large. It is not a coincidence that both Santos and Trump are Republicans.  

Related to my point above, the destruction of the moral compass and avarice and cowardice in the Republican party has ushered in a new wave of candidates and politicians. What were once damning qualities or behaviors are now either swept aside or embraced. 

George Santos likely has a disordered personality characterized by pathological lying and lack of respect for others. He was just sworn into the U.S. House of Representatives. There was a time when Howard Dean’s candidacy for President was derailed because he once yelled too loud into a microphone at a campaign event. Jim Jordan covered up a university sexual assault scandal. Marjorie Taylor Greene cheered the 1/6 Insurrection. 147 Republicans voted to overturn the 2020 Presidential election. None were sanctioned, punished, or removed.

It is this lack of accountability coupled with the removal of the “conscience” of the GOP that has ushered in an era where it is not just lying that has been accepted but pathological lying and personality-disordered individuals who would be unfit for many jobs in the American workforce.

Does the average American want to be honest with themselves? What would that look like in practice? Moreover, what about a type of critical self-reflection and personal inventory on an individual and societal level? That would require that we look at the ugliness in the mirror. To do such a thing is terrifying for a culture and a people who are addicted to social media, the stupidity of the human zoo that is TikTok, obsessed with being “micro celebrities” on Twitter or Instagram, and the like. 

This is a great point. Psychologists have long known that we tend to have a public self and a private self. Before the age of social media, the coverage, influence, and impact of the public self was relatively limited. You could write an op-ed to the local newspaper, call into a radio show, or contact your member of Congress through a snail mail letter. Social media has pushed the public self beyond what was once envisioned. Tweets, Instas, Snaps, and Facebook posts can be “blown up” and go viral within seconds and minutes.

People who were once “on the fringe” have a louder voice and farther reach. Force multipliers like Fox News and other media outlets amplify messages that (1) never got very far and (2) were pretty easily dismissed. So, to answer your question, the amplification and distortion of the public self has pushed many people further away from self-reflection.

Those experience machines are a way of filling up one’s deep personal emptiness with dopamine hits from being “seen” and “acknowledged” by their so-called friends online. What of meaningful interpersonal human relationships? Loneliness and social atomization are a public health problem and a precondition and fuel for fascism and other anti-human politics. 

Technological advances, 24/7 at-the-fingertips access, and social media have greatly increased the size of the echo chambers within which the far right and extremists reside (and you could argue the far left as well). Through confirmation bias, an attentive audience, and a broad platform, people have a greater sense of seeing and being seen – even if it is in a fantasy world where elections are rigged, viruses are hoaxes, and immigrant invasion threatens our lives and property.

You are absolutely right that we know as neuroscientists that “likes”, “follows”, “retweets”, and other social media affirmations and validations increase dopamine like a rewarding drug, food, or sexual experience might. This fuels and reinforces the extreme behaviors and bolsters allegiance to false gods, golden calves, and their message.

If you were going to diagnose America collectively as a patient, what would your conclusion be?

The underlying problem in American society and politics right now is fear – both misplaced and well-placed. Even when otherwise good people are afraid — for their kids, families, or self-preservation — they will go to extreme lengths to protect themselves or to protect their families. Fear is a very effective political strategy. Remember also, it is not very hard for in-group/out-group, rivalry dynamics to take place with groups of people. Social psychology experiments have shown that simply identifying one group as “A” and another as “B,” it doesn’t take long for dislike, animosity, and eventually cruelty to leak out.

In addition, many people will compromise their values in order to support, defend, or even be a member of a tribe that is engaging in immoral or egregious or unethical actions. We will essentially defend the tribe that will defend us. This dynamic is almost a kind of authoritarian arms race. As a society, we are suffering from a Collective Generalized Anxiety Disorder. Depression as well. Anger is often a byproduct of depression. Men tend to express their emotions externally with violence. Women tend to internalize their fear and anger. Fear is underlying all of this. When people are scared, they get depressed; when people are scared they have anxiety; when people are scared they get pissed off. When they get pissed off, they often want to act.

What does it mean to be healthy in such an unhealthy society?

It’s difficult to be healthy if you don’t have healthy relationships. If you’re having issues with the people you love, it really doesn’t matter how well things are going at work, and how much money you’re making, it’s really difficult to feel healthy. There are a lot of good people in the world — and there are lots of bad people in the world too. Is hope a dangerous thing? In the end, it is all about how you use that hope. Action is what matters.