The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides that a diagnosis of delusional disorder is made if a person has “non-bizarre” delusions (meaning things that could happen in real life, such as being stalked by someone, as opposed to, say, seeing flying elephants) for at least one month and does not have the characteristic symptoms of other psychotic disorders, such as schizophrenia. 

Recent polls showed that 52% of Republicans believe that Trump won the election and 56% of Republicans believe that the QAnon conspiracy theory is “mostly or partly true” (33% believe it is “mostly true”).     As a reminder, Forbes magazine described the QAnon thesis as follows:   “President Trump is defending the planet from a cabal of Satan-worshiping pedophiles (consisting mostly of Hollywood celebrities, liberal politicians and "deep-state" government officials) who are running a secret child sex-trafficking ring”  (the ever-sober Forbes omitted the more sensational non-core elements of QAnon belief, such as these same folks harvesting children’s blood).  

Both these delusions are not only unsupported by any evidence, but are easily disproven (and have been).   On their face, in the usually more restrained words of Forbes, they are “preposterous” and “outlandish.”   They are not opinions or beliefs, they are delusions.

With at least 245 million voting age Americans, 30% of whom most recently identified themselves as Republican, that means that about 38 million of our fellow citizens suffer from the delusion that Trump won and 24 million believe the QAnon conspiracy to be “mostly true.”

So as we enter 2021 America finds itself in the grip of two pandemics.  COVID has infected over 14 million Americans.   The 24-38 million delusional Republicans, most presumably being non-schizophrenic, and having persisted in these delusions for over a month, comprise a pandemic far more severe and perhaps more consequential than COVID: a pandemic of delusional disorder.  

While this disorder, unlike COVID, does not generally threaten the lives of the afflicted, it does make them vulnerable to mendacious politicians, con men, and hucksters of all kinds (the current President leading the way by conning mostly small donors, following the election, out of $200 million).   Most importantly, though, this second pandemic does threaten the life of the country.   Democratic government cannot be sustained with over half of one of our two political parties afflicted by a disabling delusion.   I say “disabling,” because you cannot freely exercise your rights as a voter when your judgment and discretion have been warped or coopted by a delusional conviction.    And the democratic system collapses when a critical mass of citizens no longer accepts elections as free and fair.

This second pandemic should be receiving equal time on the news feeds, nightly news, and front pages.   Psychologists, sociologists, and political scientists should help us understand the causes of this outbreak of mass hysterical delusion.  David Brooks argued that conspiracy theories take hold among “low status” groups that feel powerless; but within weeks acknowledged that this didn’t explain why “the neurosurgeon down the street” (neither low status nor powerless) believed that the election was fraudulent.  We have a strong grip on the causes and proper treatment of COVID-19.  But we don’t yet understand the delusional disorder pandemic, and until we understand it, we won’t know how to treat it.

Ultimately, this pandemic of delusion ­­– and not COVID ­– will present the knottiest challenge to the new Biden administration.  Left undiagnosed and untreated, it will power and sustain hyper-partisanship, political dysfunction, and the fracturing of the nation into irreconcilable camps through the Biden administration and beyond.