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Ruth Bettelheim, Ph.D. Headshot

Anxiety in America: Behind the Health Care "Debate"

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Why do so many of our fellow citizens ignore the facts and actual issues in the current health care debate, and instead blindly insist that the health care reform proposals are a terrible danger to us all? At recent town halls and other meetings, the Democrats' bills have been described variously as "the systematic dismantling of this country," "trampling on our constitution," "communism," and "nothing short of evil." Protesters claim that "the government will choose to kill people instead of saving their lives" and "they have death panels that will kill the elderly and infirm." Interestingly, the protesters making these statements confirm that they or their family members are dependent on and happy with Medicare, even while they denounce the dangers of a health care proposal that would extend Medicare-like coverage to a small additional percentage of the US population.

Pundits, columnists and analysts remarking on this phenomenon have attributed it to stressors such as rapid social change, economic dislocation, and political and cultural shifts of major proportions. However, this does not explain why certain individuals persistently disregard the actual facts, proposals, and issues under discussion in favor of flagrantly false ideas and beliefs, from which they cannot be swayed by reason or evidence.

The underpinnings of such irrationality can be found in the psychology of anxiety. Anxiety is rooted in fear, and when we are afraid, our minds seek reasons for the fear. If we are extremely afraid, we believe that the danger we face is commensurately large -- even if this is not objectively true. Thus people who are very anxious believe that the dangers they are facing are global and extreme, regardless of reality.

If people who are already predisposed to anxiety are additionally stressed by ongoing life events (such as those noted above), their tendencies can bloom into what is called generalized anxiety disorder.

Generalized anxiety disorder is characterized by severe, uncontrollable, and often irrational worry about everyday things -- worry that is disproportionate to its actual source. People who have these excessive worries seek to rationalize the degree of their fear. Suggesting to them that the world is much less frightening than they imagine, for example by providing information about the actual content of the current health care proposals, does not alleviate their extreme sense of dread. To a person in this state of mind, the idea that the situation is not dangerous makes no sense at all. The only reasonable explanation for their fear is the presence of extreme danger. Thus, appeals by politicians or pundits for the protesters to be "reasonable" and pay attention to the actual facts fall on deaf ears. The only scenarios that seem plausible are those commensurate with their level of anxiety, such as an imminent threat of fascism, communism, or the end of the American way of life as we know it. The facts of the case simply have no resonance.

But while anxiety explains much of the rejection of rationality in the health care debate, it is not sufficient to cause the outbursts we see on the nightly news. Those who engage in extreme behavior, such as disrupting town hall meetings and threatening elected leaders, are doing what psychologists call acting out. In its technical sense, "acting out" means performing an action in response to an impulse instead of managing and controlling the impulse. These impulses are usually designed (often unconsciously or semi-consciously) to garner attention. In the case of the health care debate, the protesters' actions are both instigated and rewarded by the right-wing politicians, pundits, news services, and businesses whose interests are served by the drama, attention, and excitement of rowdy town hall meetings. These protesters receive not only an immediate audience but also frequently an invitation to follow-up interviews on Fox News or the like, and they relish the fleeting sense of power and fame that comes with it.

On an ordinary day, about 3.1% of Americans (approximately 6.8 million individuals) suffer from generalized anxiety disorder. In times of war, recession, and rapid and massive social change, the number increases. If even a few of these 6-8 million people start to "act out" and engage in outrageously disruptive, visually captivating behaviors, it can easily seem that a craze for shouting down elected leaders in front of TV cameras is sweeping the nation.

It is this combination of acting out with generalized anxiety disorder that explains much, if not most, of the behavior that seems to those of us who do not suffer from these problems, to be incomprehensible, unreasonable and unconscionable.

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