Categories
Lessons Nonfiction Reading

How to Avoid Becoming an Agent of Social Control: Viktor Frankl

In our ongoing study in how governments have used psychiatrists as agents of social control (and how psychiatrists resisted these pressures), let’s learn about Viktor Frankl.


Viktor Frankl was an Austrian man who was Jewish. He worked as psychiatrist and is best known for his book, Man’s Search for Meaning. (It’s a slim book and worth a read.) In it he describes his experiences in Nazi concentration camps and the development of logotherapy.

Before the Nazis deported Frankl, he worked in the Neurological Department of the Rothschild Hospital in Vienna. His title was apparently “Jewish Specialist”; it was one of the last places Jews could work.

The Viktor Frankl Institute notes that, in 1940,

In spite of the danger to his own life he sabotages Nazi procedures by making false diagnoses to prevent the euthanasia of mentally ill patients.

though I am unable to find other evidence to support this.


There is more evidence that Frankl worked with people who had tried to kill themselves. Most of his Jewish patients attempted suicide because they had received deportation orders. Certain death was already awaiting them.

Frankl does not discuss in Man’s Search for Meaning how he tried to save these patients from suicide. Others do. Mikic writes:

Frankl tried to bring the suicidal patients back by injecting them with amphetamines, but it didn’t work.

And so, Frankl bored holes in the skulls of his Jewish patients, who had taken overdoses of pills in the hope of escaping their Nazi tormentors, and jolted their brains with Pervitin, an amphetamine popular in the Third Reich.

Pytell also comments:

… in the circumstances of Nazi oppression suicide was often considered a viable option if not a form of resistance, and [Frankl] was therefore undermining the choice of people who made such a difficult decision.

Frankl tried to protect the lives of Jewish people. The Nazis did not like this (or maybe they did?); they also did not like him.


In the preface to the 1992 edition of Man’s Search for Meaning, Frankl shares:

The reader may ask me why I did not try to escape what was in store for me after Hitler had occupied Austria. … Shortly before the United States entered World War II, I received an invitation to come to the American Consulate in Vienna to pick up my immigration visa. My old parents were overjoyed because they expected that I would soon be allowed to leave Austria. I suddenly hesitated, however. The question beset me: could I really afford to leave my parents alone to face their fate, to be sent, sooner or later, to a concentration camp, or even to a so-called extermination camp? Where did my responsibility lie?

Frankl writes that “this was the type of dilemma that made one wish for ‘a hint from Heaven’.” He describes the following as a sign:

… I noticed a piece of marble lying on a table at home. When I asked my father about it, he explained that he had found it on the site where the National Socialists had burned down the largest Viennese synagogue. He had taken the piece home because it was a part of the tablets on which the Ten Commandments were inscribed. One gilded Hebrew letter was engraved on the piece; my father explained that this letter stood for one of the Commandments. Eagerly, I asked, “Which one is it?” He answered, “Honor thy father and thy mother that thy days may be long upon the land.” At that moment I decided to stay with my father and my mother upon the land, and to let the American visa lapse.

Ultimately, his father, mother, and wife all perished. The Nazis killed them all in concentration camps.


From this, it seems that Viktor Frankl held fast to a set of values. We can never fully know all the intentions people hold in their hearts, but we can make educated guesses from their behaviors. He had an internal compass.

From his behaviors we can surmise the points of his internal compass:

Frankl valued the lives of his fellow Jewish people. If it is true that he made false diagnoses to prevent euthanasia, he used the power that he had to protect those who had less. One can argue that Frankl abandoned his professional duties by making diagnoses meaningless. However, the purpose of diagnosis is to guide treatment. If a government uses diagnosis to assign death, then the purpose of diagnosis has already been perverted.

Frankl had a clear vision of what medicine he should practice. If suicidal behavior was the enemy, Frankl used all the tools he had—including cranial surgery and stimulants!—to combat this. I don’t know what amount of amphetamines (or skull boring) can stop people from killing themselves. But if a government is going to execute you anyway for who you are, it seems like no amount will be enough.

Frankl valued his parents. He, his wife, and his parents, all Jewish, knew what the Nazis were doing. He could have escaped. He chose not to. It’s hard for any of us to understand what it means to die. Even if he only understood genocide as an abstraction, it was a consequence he was willing to accept. Being with his parents was a priority to him.


Perhaps the lesson we can learn from Viktor Frankl is to know what your values are. Understand what your priorities are and why. Once you have clarity on your values, then you will be less susceptible to corruption.

Those who live by cunning and duplicity may comment that integrity doesn’t matter if you are dead. Sure, but do you really want the alternative of an exhausting, joyless, and meaningless life?

Categories
Blogosphere Reading

Links Around the World Wide Web.

Some interesting items for your consideration:

Why are people poor? (short video) The intelligent and incisive Jamelle Bouie comments on the recent immoral fiasco surrounding SNAP benefits.

Zohran Mamdani Wants Civilians to Replace Cops. Will It Work?

Civilian alternative programs are controversial—a prominent police abolitionist has lauded Mamdani’s plan, while one retired NYPD sergeant called it “probably the worst idea I’ve heard of in a long time.” But most coverage has failed to ask: what do we actually know about what civilian alternative response does? Are they a brilliant intervention, or a disaster waiting to happen?

The author, Charles Fain Lehman, is a fellow at the conservative think tank Manhattan Institute. I recommend his Substack, The Causal Fallacy, where he consistently uses data in a good faith to make his arguments.

Full Days and the Long Walk. Craig Mod continues to walk many kilometers and notes,

The more people with control of their attention, the better our art, music, scientific research, political legislation, and, I believe, the more kindness and empathy in the world. Also, the more prepared you can be to fight. Without understanding and cultivating fullness, you lose sight of the battles worth fighting, and lack the energy to go after them.

And here’s an abrupt transition:

The Goon Squad: Loneliness, porn’s next frontier, and the dream of endless masturbation. A link to this was in Craig Mod’s essay above. Maybe don’t read this at work.

What are these gooners actually doing? Wasting hours each day consuming short-form video content. Chasing intensities of sensation across platforms. Parasocially fixating on microcelebrities who want their money. Broadcasting their love for those microcelebrities in public forums. Conducting bizarre self-experiments because someone on the internet told them to. In general, abjuring connective, other-directed pleasures for the comfort of staring at screens alone. Does any of this sound familiar?

The Map on the Wall. This essay now seems quaint given the drastic changes in the Department of Defense, but highlights the influence we each have as individuals.

But I can’t control what goes on “out there.” All I can do is try to foster a culture within my hangar — within our squadron — where we address things like race, gender, sexuality, and religious difference in a mature way that reinforces some very basic truths: we’re better because we’re different. We’re stronger because we come from everywhere. And, we’re much more dangerous to any potential adversary because we don’t all approach difficult problems the same way.

I Am a Drug Historian. Trump Is Wrong About Fentanyl in Almost Every Way. (gift link) The author gives a succinct summary of the history of drugs in America, then highlights why the federal government’s current approach (i.e., tariffs, threats of war, and extrajudicial murders) is wrong. He notes more effective strategies:

These successful policies all do one thing: They make drugs boring again. Drugs are not magic, they are not demonic, they are not fundamentally different from all the other problems society faces. They are highly desirable and highly dangerous consumer goods. They are not unique in that regard.

How to Be a Good Neighbor. This is from J Wortham’s Substack, where the writing is more casual and spiritual, though is just as thoughtful and genuine as their essays in the New York Times.

Good neighboring feels like an active term, and clearer to me than the vagaries of community, a noun that gets tossed around with such abandon that it has become semantically satiated and bleached of all intention and meaning. Good neighboring feels like tapping into the actual network of people and place that make up a shared ecology.

We Followed the Rules. ICE Jailed Us Anyway. (video, gift link) What ICE is doing across the nation is already horrifying in its own right. As someone who has worked as a psychiatrist in a county jail, I am sorry to say that the conditions of the detention facilities described in the video are far worse than anything I ever encountered. (To be clear, I’m not saying that it’s okay to detain people for no cause as long as they are held in more humane settings.)

Categories
Policy Reading

The Word “Mental” in Project 2025. (xiv + xv + xvi)

Guys, we’re getting to the end of this project! We’ve made it to the last three instances (14, 15, and 16) of the word “mental” in Project 2025. (I still need to return to the third instance; that will follow soon.) This will also be a short post because there’s not much to analyze in these last three instances.

The 14th instance of the word “mental” in Project 2025 is on page 879, in the closing section about the FTC:

Conservative approaches to antitrust and consumer protection continue to trust markets, not government, to give people what they want and provide the prosperity and material resources Americans need for flourishing, productive, and meaningful lives. At the same time, conservatives cannot be blind to certain developments in the American economy that appear to make government–private sector collusion more likely, threaten vital democratic institutions, such as free speech, and threaten the happiness and mental well-being of many Americans, particularly children. Many, but not all, conservatives believe that these developments may warrant the FTC’s making a careful recalibration of certain aspects of antitrust and consumer protection law and enforcement.

The 15th instance is a footnote at the end of the FTC chapter:

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is the authoritative publication of the American Psychiatric Association.

(Comment: Yes, the DSM-5-TR is an authoritative publication, though it’s not without problems.)

The 16th instance is also a footnote and contains a reference:

Allcott, supra note 19; see also Jean M. Twenge, Jonathan Haidt, Jimmy Lozano, and Kevin M. Cummins, “Specification Curve Analysis Shows that Social Media Use Is Linked to Poor Mental Health, Especially Among Girls,” Acta Psychologica, Vol. 224 (2022), p.103512, https://doi.org/10.1016/j.actpsy.2022.103512 (accessed March 23, 2023).

I don’t have anything more to add to what I noted earlier:

… there’s ambivalence in this chapter about the role of the FTC. Children’s mental health is used chiefly as a potential subject of regulation. Who is better poised to regulate social media and its effects on children? The government? Or parents? Surprisingly, this seems open to debate in this section.

The reference to the Acta Psychologica journal article (16th instance) is also interesting. We’ve discussed elsewhere in this series how the authors of Project 2025 have often ignored published data because it does not support their policy platform. We’ve also observed that this chapter on the FTC is notably less inflammatory than other chapters. Of all the articles they could have referenced that draws associations between social media and adverse mental health, they chose that one? (And only one?) Yours truly wasn’t put on retainer to find evidence to support that argument and found more than one robust and relevant resource to do so.

The Presidential inauguration is happening in less than one month. Thanks for reading along with me. We together can watch how the new administration implements policies from Project 2025 and uses “mental health” as the reason why. We will know if they are using data and evidence, or just making things up because they can. If you have found this series useful, please share with others what you’ve learned.

Categories
Funding Medicine Policy Reading

The Word “Mental” in Project 2025. (v)

The fifth instance of the word “mental” in Project 2025 is on page 518 in the section about the Health Resources and Services Administration (HRSA):

Withdraw Ryan White guidance allowing funds to pay for cross-sex transition support. HRSA should withdraw all guidance encouraging Ryan White HIV/AIDS Program service providers to provide controversial “gender transition” procedures or “gender-affirming care,” which cause irreversible physical and mental harm to those who receive them.

You can learn more about Ryan White, the person, here. (Learning both about him and how HIV is transmitted while in elementary school was revelatory for me. I learned how a disease can unfairly confer stigma onto people, even kids! More importantly, I learned that I could do something to reduce the stigma, like shake the hand of someone with HIV without fear.)

The Ryan White HIV/AIDS Program (RWHAP):

helps low-income people with HIV. We help them receive: 

  • Medical care  
  • Medications  
  • Essential support services to help them stay in care

More than 50% of people with diagnosed HIV – about a half million people – receive services through the RWHAP each year. 

We also help diagnose, treat, prevent, and respond to end the HIV epidemic in the U.S.

Notice how specific the target population is! The RWHAP provides more details as it relates to the Project 2025 recommendation:

Of the more than 561,000 people served by the RWHAP in 2020, 2.1 percent, approximately 11,600 were transgender. 

Thus, the Project 2025 recommendation is specifically aimed at these 11,600 people.

Are “gender transition” procedures or “gender-affirming care” controversial? Yes. Note that “controversial” does not mean “dangerous”. Pineapple on pizza is controversial. People have opinions.

Do “gender transition” procedures or “gender-affirming care” cause “irreversible… mental harm to those who receive them”?

Let’s see what the research says. The data to answer this question isn’t as robust as what is available for abortion. Because the study designs have weaknesses in them (e.g., not enough people enrolled; did not follow people over time; etc.), much of the research is classified as “low quality”. This is a fair evaluation.

Based on available data, the current consensus is that gender transition surgeries do not cause “irreversible… mental harm”. They rather seem to reduce distress, smoking, and suicidal ideation.

Only 15% of people who had gender transition surgeries about forty years ago responded to a survey. They reported high satisfaction, less negative moods, and reduced mental health issues. (What about the remaining 85%?)

If regret is considered “mental harm”, it also appears that the rate of regret following gender transition surgeries is less than 1%. This is far lower than regret following other surgeries that have nothing to do with gender transition (around 14%). (Again, there are challenges with this data: How does one accurately measure regret? When there is no agreement about which tool to use, or no tool yet exists, it’s hard to know if you’re measuring what you want to measure.)

Hormone treatment, which has been studied more than gender transition surgeries, also does not seem to cause “irreversible… mental harm”. It seems associated with increased quality of life, decreased depression, and decreased anxiety for most transgender people. How does this happen? One pathway seems to be through reducing gender dysphoria, body dissatisfaction, and uneasiness.

It looks like there isn’t enough data to state with confidence that either intervention — surgery or hormones — reduces death by suicide. (Suicide is a relatively rare event. However, transgender people are far more likely to think about suicide compared to cisgender people, gay or straight.)

We return again to an important caveat about scientific research: It looks at populations of people, not individuals. Are there people who underwent “gender transition” procedures or “gender-affirming care” and suffered “irreversible… mental harm”? There is probably at least one person who would say yes.

However, from what data is available, it looks like most people who undergo gender transition surgeries and hormone treatment do not experience mental harm and, in most cases, experience improvements in their mental health.

The phrasing “irreversible physical and mental harm to those who receive them”, troubles me, too. This makes it sound like people who undergo these interventions have no agency, that they have no say in what happens to them. People choose to take hormones or undergo surgery. There are gatekeepers to these interventions.

The strenuous objection that some have to the mere idea of “gender-affirming care” also puzzles me. People have preferences about their identities and they like receiving care that affirms these identities. For example:

  • If someone prefers to communicate in a language other than English, providing health care to them in their preferred language is affirming.
  • If someone prefers to work with a health care professional from a similar cultural background (and I’m not referring only to race or ethnicity — I’m including regional culture, age, communication styles, etc.), accommodating that preference is affirming and helps people feel more seen. (It’s often gratifying for the health care professional, too).
  • Heck, calling someone by their preferred name is affirming care. And while this can include pronouns, I’m actually thinking of all the Williams in the world who would prefer to be called Bill, the John Smiths who, upon greeting them as “Mr. Smith”, shoot back, “Mr. Smith is my dad! Call me John!”, and the people who prefer to be called by a nickname.

Going back to the original text, though:

First, RWHAP only pays for outpatient services. This means RWHAP funds could never be used for gender transition surgeries.

Second, Project 2025 authors may have included more recommendations elsewhere about prohibiting “gender transition” procedures or “gender-affirming care” for any resident of the US. (I can only tolerate reading this enormous document in small doses.) People who are eligible for RWHAP are, by definition, poor. Will the authors also oppose these interventions for rich people? (Does Project 2025 oppose the idea of transgender people only if public dollars are spent for their care? Or do they entirely oppose the idea of transgender people, even if they are millionaires or a billionaire?)

Third, we all, including the authors of Project 2025, must continually check our biases. All of us are prone to believe that “I make correct assessments“, when our assessments can be phenomenally wrong. Until there is more and better data, the assertion that “‘gender transition’ procedures or ‘gender-affirming care’… cause irreversible physical and mental harm to those who receive them” is false.

Categories
Policy Public health psychiatry Reading

The Word “Mental” in Project 2025. (ii)

The second instance of the word “mental” in Project 2025 is on page 6, just a few paragraphs after its first appearance in the foreword:

This resolve [“Every threat to family stability must be confronted”] should color each of our policies. Consider our approach to Big Tech. The worst of these companies prey on children, like drug dealers, to get them addicted to their mobile apps. Many Silicon Valley executives famously don’t let their own kids have smart phones. They nevertheless make billions of dollars addicting other people’s children to theirs. TikTok, Instagram, Facebook, Twitter, and other social media platforms are specifically designed to create the digital dependencies that fuel mental illness and anxiety, to fray children’s bonds with their parents and siblings. Federal policy cannot allow this industrial-scale child abuse to continue.

This 100-word paragraph features inflammatory language sure to capture a caring parent’s eye: drug dealers! addicting! child abuse! Let’s take a closer look:

Are social media companies preying on children like drug dealers? I don’t know the intentions of leadership at social media companies, but there is evidence that these companies make mega amounts of money from the attention of youth. One paper revealed that, in 2022, “advertising revenue from youth users ages 0–17 years [was] nearly $11 billion”.

Billion with a B! Let’s name names. According to the same paper:

The greatest advertising revenue profits derived children [sic] ages 0–12 years old was from YouTube ($959.1 million), followed by Instagram ($801.1 million) and Facebook ($137.2 million). Among youth ages 13–17 years old, the greatest estimated advertising revenue was generated on Instagram ($4 billion), TikTok ($2 billion), and YouTube ($1.2 billion).

(It’s true: Only old people use Facebook.)

How do these numbers compare to other businesses?

EntityRevenue (one year)
Los Angeles Dodgers$549 million
Taylor Swift$1.04 billion
Cannabis tax revenue$3 billion

Instagram made more money than Taylor Swift!

Is it true that “many Silicon Valley executives famously don’t let their own kids have smart phones”? It looks like the answer is yes, or at least they restrict their kids’ access to media.

Do social media platforms “create the digital dependencies that fuel mental illness and anxiety”? In short, the answer is yes, but not for every child and adolescent.

The excellent Surgeon General Vivek Murthy issued an advisory about the effects of social media on youth mental health:

Usage of social media can become harmful depending on the amount of time children spend on the platforms, the type of content they consume or are otherwise exposed to, and the degree to which it disrupts activities that are essential for health like sleep and physical activity. Importantly, different children are affected by social media in different ways, including based on cultural, historical, and socio-economic factors.

The American Academy of Pediatrics (AAP) has a Center of Excellence on Social Media and Youth Mental Health that includes a policy statement on the risks and benefits of social media use and how media can affect the development of young minds.

The American Psychological Association has shared information about relationships between the amount of time youth spend on social media and mental health outcomes (more time spent associated with worse outcomes), why young brains are especially vulnerable to social media, and called out social media companies to improve the safety of their products.

Does social media fray children’s bonds with their parents and siblings? The framing of their argument suggests that the fraying of bonds is entirely the fault of children using social media. Kids don’t have the money to buy phones and computers themselves. Humans learn through observing.

AAP correctly states:

Parents’ background television use distracts from parent–child interactions and child play. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children and may be associated with more parent-child conflict. Because parent media use is a strong predictor of child media habits, reducing parental media use and enhancing parent–child interactions may be an important area of behavior change.

This research paper about problematic media use in early childhood points out that “parent’s PMU [problematic media use] remained the strongest correlate of concurrent child PMU” and “parental warmth and responsiveness might be protective of the development of PMU among young children”.

In sum, the authors of Project 2025 have some legitimate and evidence-based concerns about the adverse effects of social media on kids.

So why do the authors of Project 2025, who have voiced support of the incoming President, seem to have no issue with his own social media platform (Truth Social)?

And why, after vilifying Silicon Valley executives, is there no outcry about Elon Musk, now an owner of a (financially failing) social media company, having a position in the federal government? (Also, is it efficient to have two leaders of the Department of Government Efficiency?)

And if the authors of Project 2025 want to change federal policy to prevent “industrial-scale child abuse”, then surely they want to prevent deaths of children. For [the] third straight year, firearms killed more children and teens, ages 1 to 17, than any other cause including car crashes and cancer. There are solutions to prevent guns from killing kids. Strange that there are absolutely no firearm policies in Project 2025!