Chet hunches forward rubbing his temples, as though trying to anesthetize the pain in his head. His 56th birthday is less than two months away, and it looks like he’ll be dead before it arrives.
“Sometimes I wonder if I should have listened to Sandy,” he says mournfully, “and tried radiation or something. But I was scared of what they’d do to me.”
For months he’d ignored a stubborn cough. When he started getting winded climbing stairs or working in the yard, he ignored these symptoms as well. By the time he started losing weight, the pressure to go to urgent care was becoming intense from Sandy, his wife. When he had a respiratory crisis one night, Chet allowed her to call 911.
“She’d have shot me if I didn’t go to the emergency department,” he recalled. “So I figured the worst that could happen was the medical buzzards would kill me too.”
It was the first time in his adult life that he’d seen a doctor. He’d been near panic while sitting in the waiting room, his eyes scanning constantly for danger. After assessing Chet’s symptoms and learning that he was a smoker, the doctor recommended an MRI scan of his chest. Chet refused. The doctor rattled off a list of alternatives to screen for lung cancer: CT scan? X-ray? PET scan?
Chet’s responses were “no,” “no” and “hell no.”
He was ready to hit the door when Sandy talked him into an ultrasound. The results showed some kind of mass in his lungs. Getting an accurate diagnosis would require additional tests.
“He never followed up,” Sandy recalled sadly. “All he did was spout off about how doctors all work for some kind of deep state cartel and actually give people cancer in order to make money and to get rid of people who are onto them.”
Whenever Sandy urged him to seek treatment for what she assumed was lung cancer, he’d go off on more tirades, claiming an all-encompassing “surveillance state” was implanting everyone who received medical care with microscopic tracking devices.
When COVID-19 hit, he believed it had been engineered by a syndicate of “global elites” hellbent on “population control.” When the vaccines rolled out, he was convinced they were filled with microchips that, when activated, would turn recipients into “sheep ready for the slaughter.”
Chet started spitting up blood. Afraid of conventional medical care, he searched the internet and listened to YouTubers and podcasters who confirmed his suspicions about the “medical-industrial complex.” Many were happy to sell him “alternative” treatments or access to “important inside information.”
He tried everything from nutritional supplements to freezing showers. He shelled out money for a boxlike contraption that he was convinced would balance his bioenergy. He made concoctions from recipes pulled off websites long on claims but short on evidence.
Another acute respiratory crisis landed Chet back in the emergency department, where he refused admission. He did, however, agree to hospice care after learning a team would visit him at home and work to keep him out of the hospital.
As his hospice social worker, I steered clear of Chet’s conspiracy theories after he’d ended a visit with a nurse by screaming at her to get the hell out of his house and never come back. Her offense had been attempting to speak to him about the safety of COVID vaccines.
“He really melted down,” Sandy recalled. “But from his point of view, the nurse was talking down to him.”
After Sandy filled me in on Chet’s conspiracy beliefs, we used our time to reflect on his life and what he hoped would be his legacy. He said he wanted to be remembered as a good husband who’d worked hard to make an honest living and who’d always stood up for anyone being pushed around.
I learned that his life had been laced with trauma and adversity. He’d grown up being bounced around in the foster care system before “aging out.” With nowhere to go, he’d joined the military just in time for a combat tour in the Middle East. He’d struggled with alcohol, a quick temper and a painfully thin skin, often taking offense at the slightest perceived gesture of disrespect.
Prior to meeting patients like Chet, I had a smug stereotype that people who believed conspiracy theories were impressionable and easily manipulated. But Chet, like others, was smart, genuine, kind and well intentioned. He had an insightful sense of humor and was, in most respects, a more-or-less conventional guy.
As a clinical social worker trained in recognizing post-traumatic stress, however, it was clear to me that he had undiagnosed PTSD.
Research has linked conspiracy beliefs like Chet’s with various mental disorders and personality traits such as paranoia, anxiety, narcissism and psychopathy. They’ve also been associated with cognitive tendencies such as seeing seemingly meaningless statements as profound, inferring meaning and motives where others do not, and believing there are patterns in events or objects that others regard as random.
“Prior to meeting patients like Chet, I had a smug stereotype that people who believed conspiracy theories were impressionable and easily manipulated. But Chet, like others, was smart, genuine and well intentioned.”
Rarely is post-traumatic stress disorder considered as a factor that may increase susceptibility to conspiratorial beliefs. Yet I’ve found that patients with underlying post-traumatic stress often appear more likely to believe one or more conspiracy theories.
In fact, research has correlated belief in conspiracy theories with some common effects of PTSD such as suspicious thinking, low trust in others, a belief that the world is a dangerous place, social avoidance and emotions like fear or anger.
An article in the journal Current Opinion in Psychology suggests groups that have been collectively traumatized may be more susceptible to conspiracy theories due to stigma, a loss of status, a sense of being victimized and feelings of powerlessness.
It’s easy to see how groups that have been targeted for unfair treatment might turn to conspiracies to explain such dynamics. On an individual level, though, powerlessness, feeling stigmatized and a sense of being under threat are also common in those who have PTSD.
People with PTSD often, consciously or not, live with a heightened sense of fear. The world can seem like an unsafe place in which others, particularly strangers or large systems, are untrustworthy and their motives are suspect.
Chronic fear can impair one’s ability to regulate emotions and critically assess information. It can reinforce negative, black-and-white thinking and hinder someone from taking in information that clashes with core beliefs.
Psychological trauma rewires a person’s nervous system into an elevated state of threat preparedness. This creates a tendency to exaggerate, overgeneralize and overreact to perceived dangers.
Consider some common features of PTSD that reinforced Chet’s conspiratorial beliefs: hypervigilance, hyperreactivity, negative thoughts and beliefs, avoidance, anxiety, fear, distrust, viewing the world as a dangerous place, worst-case-scenario thinking, intense emotional reactions, and feelings of vulnerability and a loss of control. It’s easy to see how these potential effects of post-traumatic stress could cause or reinforce conspiratorial narratives and worldviews.
For someone with post-traumatic stress, a set of ideas that seems to provide answers and special knowledge against the world’s dangers might be seductive. The perceived protection of an inside group of like-minded individuals might feel reassuring. Unfortunately, such groups often fall into the trap of vilifying people skeptical of their views — those whom Chet dismissed as “sheeple.”
I’m not claiming that everyone with PTSD is more susceptible to conspiracy theories or that PTSD always energizes conspiratorial beliefs. There are many reasons someone might find such ideas attractive or credible. But PTSD may be one factor that has typically been overlooked.
Many assume PTSD only affects combat veterans or those who have survived interpersonal violence, but exposure to potentially traumatic events is widespread. These include things like automobile accidents, invasive medical care, emotional or psychological abuse, and the unexpected death of a loved one.
Chet isn’t the first patient I’ve known with PTSD who wound up dying because they refused medical treatment. The medical system can be frightening and dehumanizing. Invasive tests and procedures, a loss of control and violations of personal space can be terrifying for someone who’s been traumatized.
In Chet’s case, these fears were inflamed by conspiratorial beliefs that ultimately proved lethal when they led him to resist standard medical care.
Looking at the current research on conspiracy theories, it would be easy to use stigmatizing labels when talking about people like Chet. But in my experience, such labels are not helpful for understanding an individual’s viewpoint and treating them with respect, much less offering a different perspective.
Understanding the impact of PTSD deepens empathy for those who’ve survived traumatizing events. Empathy can help us understand how such events might sometimes lead to beliefs that, though we may find them far-fetched, actually make sense from the perspectives of those who hold them.
This is not to gloss over the fact that some conspiracy theories promote outrageous lies and even advocate or justify violence. Empathy and understanding do not absolve others of responsibility or accountability for their actions. But they open a window into underlying struggles that may be at play. They help us better connect with those entranced by conspiracies rather than patronizing or ridiculing them.
Empathy also helps me reflect on my own tendency to see conspiracies. I confess that after decades of working in health care, there’s a part of me that agrees with Chet. We have created a monstrous system that can seem more interested in profit than compassionate care ― a system in which I have literally seen people die because they had no insurance or could not afford obscenely high drug prices set by corporations grasping at every last penny.
Sometimes I wonder what forces are benefiting from the fear, distrust and division created by those pushing the kinds of conspiracies Chet endorsed. Who’s making money? Who’s gaining power and influence? What are we being distracted from? Who’s using people like Chet, and for what ends?
There are those making money hand over fist by promoting conspiratorial beliefs. Some become “influencers” or social media “personalities.” Conspiracies about vaccines and COVID have lined many pockets. And the events of Jan. 6, 2021, made clear that some will use conspiratorial thinking to gain or cling to power by inciting people to violence.
Maybe, to some extent, most of us have tendencies toward seeing conspiracies. Maybe what differentiates those of us who get sucked down the rabbit hole has less to do with labels like “psychopathy” or “narcissism” and more to do with how high the volume goes on the fear and vulnerability we all feel in one form or another, and whether our support systems and experiences suggest that the world is a safe or a dangerous place.
It’s important to be sensitive to the possibility that those espousing such beliefs may have underlying traumatic wounds and, at a deeper level, may be trying to feel safer and better protected.
“Maybe what differentiates those of us who get sucked down the rabbit hole has less to do with labels like 'psychopathy' or 'narcissism' and more to do with how high the volume goes on the fear and vulnerability we all feel in one form or another.”
One afternoon, Chet says to me, “Do you think I’m a fool, Scott?”
“Why do you ask that?” I respond.
“I’m not stupid, man. I know people think I’m nuts not agreeing to those so-called treatments.”
“No, I don’t think you’re nuts,” I tell him. “You made the best decision you could, based on what thought was right. What do you think?”
He shakes his head. “I’m sure they would have killed me,” he says. “But if I’d known I was going to die anyway, maybe I’d have rolled the dice.”
“You didn’t know,” I offer.
He looks toward the kitchen, where Sandy has been pretending to stay busy so we can talk.
“She’ll never forgive me,” he whispers.
“Why don’t we call her in here, Chet?” I suggest, motioning toward the kitchen. “Let’s ask her what she thinks instead of making assumptions.”
He shakes his head again. “Leave it, man.”
After a long silence, he says softly, “We’re a hell of a show down here, aren’t we?”
“What’re you talking about?” I ask.
“Humans. God must have a head injury or something.”
I explode into laughter. Chet does too. Sandy comes in wondering why the two of us have been “cackling like a barnyard full a hens.”
He looks at her with love. She swallows hard, tears welling in her eyes.
It’s a tender moment. They fumble for what to say. I put a hand on my chest and ask, “Chet, what does your heart want Sandy to know?”
He breaks into sobs. I move so Sandy can sit beside him and put her arms around his shoulders. After a while, he looked up and says: “I’m sorry, babe. I don’t know why I’ve been so scared all these years. All I ever wanted was to be here for you.”
Sandy manages to respond through sobs of her own: “I’m scared too, Chet. Maybe we’re all scared.”
As I witness this, I think about the unspeakable trauma, betrayal and grief Chet has survived, and his quiet strength. He has been through hell.
I think about the support I’ve received in my life when I’ve been afraid, the friends and family who accepted me and kept me safe when I felt vulnerable ― as well as the experiences that helped me trust, despite appearances, that the world is not inherently dangerous and people are basically good. Until he met Sandy, Chet had none of that. Now, he’s gone.
The fact that I don’t live in a nightmare world where doctors intentionally kill their patients and the rich engineer a virus to rub out half the world’s population has nothing to do with being smarter, wiser or more psychologically healthy than Chet. It has to do with luck.
Note: Names and some identifying characteristics have been changed to protect the privacy of individuals mentioned in this essay.
Scott Janssen is a hospice social worker and writer. He has written extensively about providing trauma-informed care for patients who are terminally ill and has spoken about ways to better support veterans who are nearing the end of their lives. His work has appeared in dozens of publications, including Social Work Today, Psychotherapy Networker, American Journal of Nursing, Reader’s Digest and The Washington Post. His novel “Light Keepers” is about the transformational power of kindness and love when the world appears lost in anger, conflict and fear.
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.