New Anxieties: The Fear of Being Cancelled

New Anxieties: The Fear of Being Cancelled Article from "Frontiers in Mental Health" Issue 2 By Dean McKay, PhD The following article appears in the second issue of “Frontiers in Mental Health,” journal of the Open Therapy Institute. Read the full issue here. Akyrono (ακυρώνω )—from Greek, meaning “to nullify” As society becomes increasingly polarized, people are being pressured to align themselves publicly with the currently accepted political narrative. It is not surprising that self-reported anxiety states are rising. In this essay, I will be arguing that these punishing social conditions are now in danger of generating new mental health disorders. In this essay, I argue that one particular anxiety disorder variant is becoming apparent, characterized by an irrational fear of being canceled. I am therefore naming this “akyró̱no̱phobia,” derived from the Greek meaning “to nullify.” Anxiety disorders are highly prevalent in the general public, with estimates suggesting that close to 20% of the public will have had serious anxiety within the past year and that just over 34% will experience it during their lifetimes (Szuhany & Simon, 2022). Although the current diagnostic manual lists obsessive-compulsive disorder (OCD) in a separate category, that condition is also marked by significant anxiety and afflicts around 2% of the population (Pampaloni et al., 2022). Collectively, this means that approximately 66 million Americans will suffer from an anxiety disorder or OCD in the next year. Experts in anxiety disorders and OCD have begun to recognize a specific manifestation, marked by intense and exaggerated fears of being canceled. I recently engaged colleagues on an expert network regarding how frequently they have treated individuals with fears of being canceled. This informal polling showed that of 187 colleagues, 147 reported anywhere from two cases to dozens who report this specific fear. The symptoms associated with this fear have included such diverse behaviors as avoiding social interactions and online conversations, destroying emails received from others if the individual remotely suspects it has upsetting content, and seeking reassurance from past consensual sexual partners that their intimacy was, in fact, appropriate. This is not an exhaustive list, but one common thread is that the sufferers generally possess personal qualities that make them particularly low risk for committing any act that might be deemed suitable for cancelation in the online social ecosystem. Specifically, most people with OCD typically have higher levels of neuroticism, a personality trait that makes people risk-averse (Barlow et al., 2014). The Nature of Akyró̱no̱phobia In proposing this phobia, it is reasonable to suggest it is characterized by two different patterns of psychopathology. One pattern may be obsessive-compulsive thoughts about the risk of cancelation and compulsive behaviors to ward off these risks. The other may be generalized anxiety, with worries about actions that might result in cancelation, with a dominant anxious mood and associated physical consequences (i.e., muscle tension or gastrointestinal distress). Considering the high-profile figures who have been canceled, it is little surprise that individuals prone to experiencing anxiety would suffer fears of it happening to them. To illustrate, if one were to simply Google the search term “people who were canceled,” it results in lists of public figures who were canceled stratified by year. It is such a pervasive social phenomenon that it is annually summarized. The manifestation of most anxiety conditions is embedded in the social context in which people live. The nature of akyró̱no̱phobia may be categorized into two different types. Obsessive-Compulsive Type Akyró̱no̱phobia Obsessions are characterized as intrusive and unwanted thoughts that the sufferer recognizes as irrational. These thoughts lead to considerable avoidance of situations that might provoke them and may or may not result in compulsive behaviors. Research has shown that OCD is highly heterogeneous, marked by subtypes (McKay et al., 2004; Wheaton et al., 2015). One facet of OCD that makes it a condition highly susceptible to akyró̱no̱phobia is that obsessions are typically a result of socially unacceptable ideas or situations that are widely held concerns by the public. To illustrate, whenever a serious illness gets media attention (such as COVID-19), individuals with OCD are more likely to express extreme concerns over contracting that condition (Sheu, McKay, & Storch, 2020). This means that the social milieu is ripe terrain for obsessional content. When public figures face cancelation, experts in OCD can (and do) expect to see clients reporting intrusive thoughts that the same fate may await them. These individuals suffer greatly, as the offenses that drive their obsessions are very minor and would not be considered offenses for most. For example, in my anecdotal poll of colleagues, one commented that it was not uncommon for clients they had treated to scrub their computers of any emails they received that they thought might contain slightly offensive content. Some severe cases have even involved avoiding people out of concern that they might have an offensive thought in their presence. All of these obsessions are for thoughts, with no intent to commit any even remotely offensive actions or to utter any offensive remarks. Generalized Anxiety Type Akyró̱no̱phobia While obsessions over the risk of acting on offensive and unwanted thoughts is a well-known variant of OCD, akyró̱no̱phobia can also prompt serious worries that are associated with generalized anxiety disorder (GAD). Unlike OCD, the concerns associated with akyró̱no̱phobia are marked by reviewing past statements, emails, social media posts, and other public comments for the slightest potential for offending content. As with any worries, a prevailing challenge for sufferers is intolerance of uncertainty (Jacoby, 2020). The pain of this variation of akyró̱no̱phobia is that individuals can point to specific acts that they interpret as potentially offensive, connect these to acts of other public figures, and claim that their offenses are on par with the ones that resulted in others being canceled. Treatment, Policy, and Politics The above illustrations of how cancel culture can result in significant OCD or GAD manifestations that I have termed akyró̱no̱phobia should be viewed as cautionary tales of how public discourse and mob-inspired desires for retribution can inflict pain and suffering indirectly on innocent individuals. It also should be considered an area where redress is possible. On a granular level, people with akyró̱no̱phobia can benefit from existing treatment approaches, so long as these are used with care. Exposure therapy is commonly prescribed for fears and OCD, and akyró̱no̱phobia would be no exception. It is essential that specific attention be given to social forces to ensure exposure is conducted not only ethically but also safely in the current social climate (as discussed in the context of COVID-19-related exposure in Sheu, McKay, & Storch, 2020). On a policy level, mental health professional organizations would do well to consider the extent to which their policies genuinely embrace pluralism. In my anecdotal poll of colleagues, several also cited prevailing attitudes among colleagues as potentially making clients feel less comfortable expressing putative offensive thoughts to their clinicians. Reorienting the profession to accept clients for the full range of ordinary human emotional and cognitive experiences will go a long way toward addressing this issue. As for politics, the mental health professions can do far better in embracing pluralism as well. This would mean endorsing a sense of fairness for all and setting aside some troubling movements that would allow clinicians to issue judgments about how clients may or may not receive care (McKay & White, in press; Strambler, in press). The mental health professions can and should do better to prevent unwanted and painful anxiety conditions. Addressing the illiberal excesses of cancel culture would be a significant public health benefit. A Look Ahead The public is generally unaware of this, but the mental health professions are collectively engaged in an internal struggle over how to address politics, both during within-session discussions with clients and concerning the policies they establish for professional conduct. The presence of akyró̱no̱phobia illustrates one of many places where clinicians lack clear guidance in how to best proceed, given the political focus within the profession. There is a growing recognition that political processes in the profession have been unrestrained and have lacked clear guidelines. For example, there have been increasing concerns that the politicization of the American Psychological Association has led professional members of the profession to hold anti-Semitic attitudes that emerge from anti-Zionist political viewpoints. There have been calls within some mental health professional communities to explicitly screen clients for political views and reject those who hold positions contrary to clinicians. These two examples only scratch the surface and represent ill-formed and heavy-handed attempts to integrate political processes into professional activities. This is hardly surprising since mental health professionals are not formally trained in political discourse. It is hoped that as the professions effectively address this challenge, there may correspondingly be attention paid to akyró̱no̱phobia in a non-judgmental manner, allowing clinicians to feel less constrained in addressing the individual needs of clients who report this problem. References Barlow, D.H., Sauer-Zavala, S., Carl, J.R., Bullis, J.R., & Ellard, K.K. (2014). The nature, diagnosis, and treatment of neuroticism: Back to the future. Clinical Psychological Science, 2, 344–365. https://doi.org/10.1177/2167702613505532 Jacoby, R.J. (2020). 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