Are Antivaxxers Mentally Ill?

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I have writ­ten a book that explains why we use vac­cines to pre­vent dis­ease. I have also writ­ten a book about men­tal ill­ness­es: what they are and how they are clas­si­fied, diag­nosed, and treat­ed. So I am well pre­pared to answer a com­mon ques­tion: are the anti­vac­cine zealots out of their minds? The answer is “some­times”; that deter­mi­na­tion must be made on a case-by-case basis. Vac­ci­na­tion has long been the main­stay of pub­lic health efforts. Being vehe­ment­ly opposed to the main­stay of pub­lic health efforts is not, per se, a men­tal ill­ness. But nei­ther is it a sign of good men­tal health, espe­cial­ly not in an edu­cat­ed per­son. In fact, peo­ple who go to great lengths in their anti­vac­cine advo­ca­cy are more like­ly than the aver­age per­son to have a par­tic­u­lar kind of men­tal ill­ness: a per­son­al­i­ty dis­or­der.

What Is a Personality Disorder?

Psy­chi­a­trists are not sup­posed to give peo­ple a diag­no­sis of men­tal ill­ness just for hold­ing false beliefs. It is nor­mal for peo­ple to hold some false beliefs. Nor­mal peo­ple tend to hold the same false beliefs as their friends and rel­a­tives. Nev­er­the­less, the thought process­es that lead some­one to embrace and spread false­hoods are def­i­nite­ly faulty. If someone’s faulty thought pat­terns, ground­less fear, and dys­func­tion­al behav­ior are caus­ing dis­abil­i­ty and suf­fer­ing, they do con­sti­tute a men­tal ill­ness. If those thoughts, feel­ings, and behav­ior are dif­fer­ent from what one would expect for the per­son, giv­en that person’s social back­ground, they could even qual­i­fy for a diag­no­sis of a psy­chi­atric dis­or­der. If those dys­func­tion­al ways of think­ing and relat­ing to the world, and to the oth­er peo­ple in it, are long-stand­ing and per­vade many aspects of the person’s life, they may even qual­i­fy for a diag­no­sis of a kind of men­tal ill­ness called a per­son­al­i­ty dis­or­der.

How Mental Illnesses Are Classified

In my book Don’t Feed the Nar­cis­sists! The Mythol­o­gy and Sci­ence of Men­tal Health, I explain that a men­tal ill­ness can be any prob­lem in the realm of cog­ni­tion (which means per­cep­tion and thoughts), emo­tion, and/or action. Each men­tal ill­ness is like­ly to have some man­i­fes­ta­tions is all three areas. Psy­chi­a­trists clas­si­fy men­tal ill­ness­es accord­ing to the area in which the prob­lem is most obvi­ous. If the person’s most obvi­ous prob­lem in the realm of cog­ni­tion (per­cep­tions and thought pat­terns), the per­son is said to have a psy­chosis. If the most obvi­ous prob­lem is in the realm of emo­tions, the per­son is said to have a mood dis­or­der. If the most obvi­ous prob­lem is a long­stand­ing pat­tern of odd or bad behav­ior, the psy­chi­a­trist may con­sid­er the diag­no­sis of a per­son­al­i­ty dis­or­der. Peo­ple with per­son­al­i­ty dis­or­ders also have prob­lems with think­ing and mood. Those prob­lems may be seri­ous; how­ev­er, they are less obvi­ous than the person’s odd or bad behav­ior.

Cluster A, B, and C Personality Disorders

The Amer­i­can Psy­chi­atric Association’s Diag­nos­tic and Sta­tis­ti­cal Man­u­al pro­vides the diag­nos­tic cri­te­ria for many dif­fer­ent men­tal ill­ness­es. It defines ten per­son­al­i­ty dis­or­ders, which are divid­ed into three clus­ters: A, B, and C. The clus­ter A per­son­al­i­ty dis­or­ders involve prob­lems in how the per­son relates to real­i­ty. The clus­ter B per­son­al­i­ty dis­or­ders involve prob­lems in how the per­son relates to oth­er peo­ple. The clus­ter C per­son­al­i­ty dis­or­ders involve prob­lems in how the per­son deals with fear. The symp­toms of the dis­or­ders with­in a par­tic­u­lar clus­ter often over­lap. Also, a per­son can have a diag­no­sis from more than one clus­ter. Also, the prob­lems in one area can rein­force prob­lems in the oth­er area. Mood dis­or­ders and behav­ior dis­or­ders are often root­ed in prob­lems with log­i­cal rea­son­ing.

How Personality Disorders Shape Beliefs and Actions

The per­son­al­i­ty dis­or­ders can pro­vide a use­ful frame­work for under­stand­ing why some­one would become an anti­vac­ci­na­tion zealot. Like peo­ple with a clus­ter A per­son­al­i­ty dis­or­der, anti­vac­cine zealots have dif­fi­cul­ty in using evi­dence to eval­u­ate the sound­ness of their ideas, and they may have a deep-seat­ed irra­tional sus­pi­cion of oth­er people’s motives. Like peo­ple with a clus­ter B per­son­al­i­ty dis­or­der, many anti­vac­cine zealots like to cre­ate dra­ma and strife, to draw atten­tion to them­selves, to dom­i­nate oth­ers social­ly, or to exploit oth­ers per­son­al­ly and finan­cial­ly. Like peo­ple with a clus­ter C per­son­al­i­ty dis­or­der, espe­cial­ly obses­sive-com­pul­sive per­son­al­i­ty dis­or­der, many anti­vac­cine zealots have deep-seat­ed irra­tional fears of becom­ing con­t­a­m­i­nat­ed, and they may have a strong iner­tia bias: they would rather accept seri­ous risk by doing noth­ing, rather than assume a minor risk by tak­ing some sort of pos­i­tive action.

Disability and Suffering

A diag­no­sis of a per­son­al­i­ty dis­or­der is based pri­mar­i­ly on the person’s behav­ior. Their behav­ior must be not only unusu­al but dysfunctional—causing dis­abil­i­ty and/or suf­fer­ing for them­selves or suf­fer­ing for oth­er peo­ple. To qual­i­fy for a diag­no­sis of a per­son­al­i­ty dis­or­der, the per­son must have a his­to­ry of dys­func­tion­al behav­ior that start­ed ear­ly in life, that per­vades many areas of the person’s life, and that seems to be resis­tant to cor­rec­tion. The fact that the pat­tern of dys­func­tion­al behav­ior start­ed ear­ly, is per­va­sive, and is resis­tant to cor­rec­tion sug­gest that the under­ly­ing prob­lem in cas­es of per­son­al­i­ty dis­or­der is a fail­ure to grow up emotionally—especially since the behav­iors in ques­tion would often be per­fect­ly nor­mal for a much younger per­son. Just as the sto­ry­book char­ac­ter Peter Pan still had his baby teeth, peo­ple with per­son­al­i­ty dis­or­ders are try­ing to get through adult life with cop­ing skills that worked well when they were tod­dlers but are inap­pro­pri­ate for adults. By study­ing peo­ple with per­son­al­i­ty dis­or­ders, you can learn lessons about how to grow up your­self. Just get real­ly good at the things that peo­ple with per­son­al­i­ty dis­or­ders do poor­ly.

Worries About Vaccines

Many peo­ple are wor­ried about whether vac­cines are nec­es­sary and safe. This wor­ry is under­stand­able, giv­en the increas­ing­ly com­mer­cial nature of health­care in con­tem­po­rary cap­i­tal­ism. Yet for rea­son­able peo­ple, con­cerns about vac­ci­na­tion can be quick­ly and eas­i­ly dis­pelled through con­sumer edu­ca­tion. Yet for the die-hard anti­vax zealots, no attempt at per­sua­sion will work. At best, they will tell you that they have decid­ed to “agree to dis­agree.” At worst, they will become per­son­al­ly abu­sive to any­one who tries to rea­son with them.

How People Choose Their Talking Points

When you ask anti­vac­cine zealots why they are against vac­cines, they express con­cerns that fall neat­ly into the A, B, and C clus­ters and some­times align with a par­tic­u­lar per­son­al­i­ty dis­or­der. Express­ing one of these con­cerns does not mean that you have the cor­re­spond­ing per­son­al­i­ty dis­or­der. But if you do have a per­son­al­i­ty dis­or­der, you are like­ly to embrace the anti­vac­cine talk­ing points that align with your per­son­al­i­ty dis­or­der.

Cluster A personality disorders (problems in the relationship with reality)

  • A stat­ed pref­er­ence for some mys­ti­cal or mag­i­cal alter­na­tive, such as home­opa­thy or ener­gy heal­ing (schizo­typ­al per­son­al­i­ty dis­or­der).
  • Con­cern that an evil con­spir­a­cy is putting poi­sons in the vac­cines in order to ster­il­ize chil­dren or cause geno­cide or depop­u­la­tion (para­noid per­son­al­i­ty dis­or­der).
  • Belief that vac­cines are part of an attempt to exert mind con­trol on the pop­u­la­tion (para­noid per­son­al­i­ty dis­or­der).

Cluster B personality disorders (problems in relationships with other people)

  • The use of anti­vac­cine advo­ca­cy to seek atten­tion for its own sake (histri­on­ic per­son­al­i­ty dis­or­der).
  • The desire to por­tray one­self as supe­ri­or to med­ical doc­tors and the world’s top experts on biol­o­gy and med­i­cine and pub­lic health (nar­cis­sis­tic per­son­al­i­ty dis­or­der).
  • The belief that because of their close per­son­al rela­tion­ship with Jesus Christ, God would not allow any of their chil­dren to become sick (nar­cis­sis­tic per­son­al­i­ty dis­or­der).
  • Belief that vac­ci­na­tion would be unnec­es­sary because of one’s excep­tion­al par­ent­ing skills—breast-feeding, home cook­ing, etc. (nar­cis­sis­tic per­son­al­i­ty dis­or­der).
  • A desire to dis­cred­it real doc­tors and real med­i­cine in order to sell some bogus “alter­na­tive” prod­uct or ser­vice, such as natur­opa­thy, home­opa­thy, or herbal med­i­cine (anti­so­cial per­son­al­i­ty dis­or­der).
  • A need to cre­ate dra­ma in inter­per­son­al rela­tion­ships by argu­ing about non­sense (bor­der­line per­son­al­i­ty dis­or­der).

Cluster C personality disorders (problems with fear)

  • A desire to avoid doing any­thing that sounds even remote­ly risky (avoidant per­son­al­i­ty dis­or­der).
  • A desire to sub­mit to and obey some charis­mat­ic leader, such as a pas­tor or alter­na­tive health prac­ti­tion­er (depen­dent per­son­al­i­ty dis­or­der).
  • Fear of con­t­a­m­i­na­tion because of the scary-sound­ing ingre­di­ents or trace con­t­a­m­i­nants in vac­cines (obses­sive-com­pul­sive per­son­al­i­ty dis­or­der).

Psychosis or Personality Disorder?

Peo­ple with per­son­al­i­ty dis­or­ders have prob­lems with how they per­ceive the world and how they think, but those prob­lems are not severe enough for them to qual­i­fy for a diag­no­sis of a psy­chosis. Peo­ple with per­son­al­i­ty dis­or­ders tend to have unusu­al­ly poor judg­ment. They are poor judges of the truth of ideas. They are poor judges of oth­er peo­ple. They are poor judges of them­selves. If you try to rea­son with some­one with a per­son­al­i­ty dis­or­der about their anti­vac­ci­na­tion ide­ol­o­gy, you will run smack into their judg­ment prob­lem. Noth­ing you can say will make a dif­fer­ence, pre­cise­ly because their judge­ment is so poor that they do not real­ize that their judg­ment is poor. (In psy­chol­o­gy, this is called the Dun­ning-Kruger effect.)

Diagnosing Personality Disorder

How do psy­chi­a­trists decide if a patient has a per­son­al­i­ty dis­or­der? One of the biggest dif­fi­cul­ties in psy­chi­a­try is draw­ing the line between nor­mal and abnor­mal, and between healthy and ill. Those are actu­al­ly two sep­a­rate chal­lenges. Peo­ple who have abnor­mal­ly good skills in some area are, by def­i­n­i­tion, abnormal—but this depar­ture from nor­mal­i­ty does not mean that they are ill. Also, nor­mal­i­ty itself is not nec­es­sar­i­ly good. For exam­ple, in some social cir­cles, it is per­fect­ly nor­mal to embrace cer­tain irra­tional beliefs and to behave bad­ly. To qual­i­fy for a diag­no­sis of a per­son­al­i­ty dis­or­der from a psy­chi­a­trist, your cop­ing skills and behav­ior have to be more than just bad. They have to be remark­ably and con­sis­tent­ly bad, so much so that you are not func­tion­ing nor­mal­ly with­in your soci­ety.

The Cause of Personality Disorder

What caus­es per­son­al­i­ty dis­or­ders? Nobody real­ly knows. In the ear­ly 20th cen­tu­ry, Ger­man psy­chi­a­trist Emil Krae­pelin believed that the severe forms of men­tal ill­ness­es, includ­ing the psy­choses and the per­son­al­i­ty dis­or­ders, were prob­a­bly root­ed in dis­ease of the brain, which could some­times be genet­ic. (Of course, as soon as the med­ical cause of a par­tic­u­lar men­tal dis­or­der is dis­cov­ered, the dis­or­der gets reclas­si­fied, often as a neu­ro­log­ic dis­or­der as opposed to a psy­chi­atric dis­or­der.) At the same time, Sig­mund Freud was pop­u­lar­iz­ing psy­cho­analy­sis, which focused on the pre­sumed psy­cho­log­i­cal caus­es of men­tal ill­ness­es. Psy­cho­log­i­cal expla­na­tions are prob­a­bly ade­quate for most of the mild, com­mon prob­lems that can be solved through talk ther­a­py. Any giv­en case of men­tal ill­ness could have some com­bi­na­tion of med­ical and psy­cho­log­i­cal caus­es. The more severe the ill­ness is, the more like­ly it is that there is a med­ical com­po­nent. Yet even if there is a strong med­ical com­po­nent, the per­son may still ben­e­fit from talk ther­a­py, to help them learn to cope with or even com­pen­sate for their brain prob­lem.

How to Outgrow a Personality Disorder

Each of the three clus­ters of per­son­al­i­ty dis­or­ders rep­re­sents a fail­ure to meet a par­tic­u­lar kind of chal­lenge that adults are expect­ed to meet. Peo­ple with clus­ter A per­son­al­i­ty dis­or­ders engage in mag­i­cal think­ing because they lack mature skills in real­i­ty test­ing. Peo­ple with clus­ter B per­son­al­i­ty dis­or­ders don’t know how they fit into soci­ety. As a result, they behave like tod­dlers or teenagers instead of like adults. Peo­ple with clus­ter C per­son­al­i­ty dis­or­ders do not know how to man­age fear. As a result, they either become child­ish­ly depen­dent or go over­board in try­ing to con­trol things. Ide­al­ly, our edu­ca­tion­al sys­tem would help peo­ple devel­op the skills they need for adult life. Psy­chother­a­py could help them learn the lessons that they missed in school.

Cluster A Disorders and Reality Testing

Real­i­ty test­ing means “the objec­tive eval­u­a­tion of an emo­tion or thought against real life, as a fac­ul­ty present in nor­mal indi­vid­u­als but defec­tive in psy­chotics.” Of course, it is nat­ur­al and nor­mal to have mediocre skills at real­i­ty test­ing. That’s why super­sti­tions (false beliefs about cause and effect) are com­mon, espe­cial­ly among the poor­ly edu­cat­ed. Ide­al­ly, the pur­pose of a sci­ence edu­ca­tion would be to help peo­ple devel­op good skills in real­i­ty test­ing. Unfor­tu­nate­ly, sci­ence class­es are often focused exclu­sive­ly on get­ting stu­dents to cram a set of dis­con­nect­ed facts into their short-term mem­o­ry. As a result, the stu­dents do not devel­op the skills in real­i­ty test­ing that they will need in adult life. Nor do they even retain many of the facts that they were sup­posed to mem­o­rize. To improve your own skills in real­i­ty test­ing, read some books on log­ic and about the his­to­ry of sci­ence. Learn about how and why the cur­rent sci­en­tif­ic the­o­ries were devel­oped, and why the obso­lete ones were dis­card­ed.

Cluster B Disoders and Fitting Into Society

The Clus­ter B per­son­al­i­ty dis­or­ders are prob­lems in how peo­ple relate to oth­er peo­ple. Peo­ple with histri­on­ic per­son­al­i­ty dis­or­der use atten­tion-seek­ing as a way to solve prob­lems. Like a new­born, they cry for atten­tion, so that high­er-rank­ing peo­ple will solve their prob­lems for them. For histri­on­ic peo­ple, anti­vac­cine advo­ca­cy can be a way to seek atten­tion. Peo­ple with nar­cis­sis­tic per­son­al­i­ty dis­or­der try to use dom­i­nance as a way to solve prob­lems. They want to be regard­ed as the best and the bright­est, so that oth­er peo­ple will serve them. How­ev­er, oth­er peo­ple may not admire the nar­cis­sists as much as nar­cis­sists admire them­selves, and nar­cis­sists are try­ing to occu­py a high­er social posi­tion than they can han­dle respon­si­bly. Nar­cis­sists want to occu­py the role of wise elder, but they do not have the knowl­edge or judg­ment to ful­fill that role. For exam­ple, a nar­cis­sist may want to be regard­ed as an expert on all aspects of health, even if he or she has nev­er tak­en even an intro­duc­to­ry col­lege-lev­el course in biol­o­gy or nurs­ing. As a result, they often give fool­ish, dan­ger­ous advice. Peo­ple with anti­so­cial per­son­al­i­ty dis­or­der view oth­er peo­ple as objects to be used and exploit­ed, not as fel­low human beings whose joys and sor­rows are to be shared. These sociopaths may get involved in anti­vac­cine advo­ca­cy as a way to mar­ket use­less goods and ser­vices. Peo­ple with bor­der­line per­son­al­i­ty dis­or­der have prob­lems with reg­u­lat­ing their emo­tions. They des­per­ate­ly seek close rela­tion­ships but then delib­er­ate­ly do things that dri­ve peo­ple away. Argu­ing over things like vac­ci­na­tion would be a per­fect way to cre­ate this kind of dra­ma.

Cluster C disorders and Handling Fear

Fear is the prim­i­tive emo­tion that we feel when we think that our bod­ies or our feel­ings might get hurt. The nat­ur­al reac­tion to fear is avoid­ance. This is a major rea­son why peo­ple refuse vac­ci­na­tion. They are afraid of nee­dles, and they are afraid of the scary-sound­ing ingre­di­ents in the vac­cine. Any­thing that increas­es the person’s sense of fear could make them even more avoidant. That’s why attempts to edu­cate peo­ple about the dan­gers of the vac­cine-pre­ventable dis­eases can back­fire. By inten­si­fy­ing the person’s fear, you make them even more avoidant. They become so ter­ri­fied that they freeze in pan­ic. Ter­ri­fied peo­ple often refuse to take any action, even to run to safe­ty. For this rea­son, any pub­lic rela­tions cam­paign to pro­mote vac­ci­na­tion should be care­ful­ly test­ed, to make sure that it does not acci­den­tal­ly increase resis­tance to vac­ci­na­tion.

To Solve Vaccine Disputes, Eradicate the Diseases

The anti­vac­cine move­ment is cre­at­ing prob­lems on two time-scales. In the short run, it is lead­ing to out­breaks of seri­ous dis­eases, such as measles and per­tus­sis, as well as spo­radic cas­es of tetanus. In the long run, the anti­vac­cine move­ment is under­min­ing efforts to dri­ve some of the vac­cine-pre­ventable dis­eases into extinc­tion. A glob­al vac­ci­na­tion cam­paign drove small­pox into extinc­tion in the 1970s. A sim­i­lar cam­paign has already wiped out two of the three strains of wild poliovirus. Many of the oth­er vac­cine-pre­ventable dis­eases can also be erad­i­cat­ed because they occur only in human beings. And once a dis­ease is extinct, we can safe­ly stop vac­ci­nat­ing against it.

Why Do We Vaccinate?

Vac­cines are used to pre­vent dis­eases that are seri­ous because they are caused by germs that are good at get­ting past the body’s innate immune sys­tem but that can be con­trolled by the body’s adap­tive immune sys­tem. The innate immune sys­tem is the gen­er­al-pur­pose response to any infec­tion. In con­trast, the adap­tive immune response is a cus­tom-tai­lored response to a par­tic­u­lar infec­tion. We use vac­cines to pre­vent the dis­eases can cause seri­ous ill­ness, per­ma­nent dis­abil­i­ty, or even death before the body’s adap­tive immune sys­tem devel­ops the abil­i­ty to fight them. The pur­pose of vac­ci­na­tion is to give the adap­tive immune sys­tem a head start, so that it can rec­og­nize and fight the infec­tion before it takes hold. Many of the germs that are real­ly good at get­ting past the innate immune sys­tem are so high­ly adapt­ed to liv­ing in the human body that they are found nowhere else in nature. Once we stop those germs from cir­cu­lat­ing in the human pop­u­la­tion, they go extinct. At that point, we don’t need to vac­ci­nate any­one against them any­more.

Let’s Focus on Disease Eradication

The measles vac­cine was intro­duced in the 1960s, and the Unit­ed States elim­i­nat­ed measles in 2000. This meant that the measles virus was no longer cir­cu­lat­ing with­in the U.S. pop­u­la­tion. Yet we would still have a few cas­es every year, brought in by trav­el­ers who caught measles in areas where measles is still cir­cu­lat­ing. So to wipe out measles, we need to wipe it out world­wide. By focus­ing on dis­ease erad­i­ca­tion, we can make it clear that the pur­pose of vac­ci­na­tion is to pro­mote pub­lic health, not pri­vate prof­it. As soon as a dis­ease is erad­i­cat­ed, sales of the vac­cine to pre­vent it drop to zero and will remain zero for­ev­er. So dis­ease erad­i­ca­tion would be a bad invest­ment for a “phar­ma bro.” Dis­ease erad­i­ca­tion has anoth­er impor­tant ben­e­fit. Once a dis­ease is erad­i­cat­ed, we no longer have to frus­trat­ing con­ver­sa­tions about that dis­ease with ill-man­nered peo­ple who think that they know more than the experts.