Fake News and the Landscape of Psychotherapy

Dr. Isaac Tylim

Fake news and the psychoanalytic frame. A singular clinical incident.


Fake connotes an object that is not genuine. A forgery or counterfeit watch or designer clothing, a made up declaration without evidence to sustain it, a plain lie. In other words, fake is equivalent to not true or real, a work of fiction with destructive potential. The contemporary ever-growing posting, and dissemination of fake news on social media appears to operate as an industry devoted to production of misinformation. Fake news have infiltrated the political and public health discourse in countries across the world.

The following vignette attempts to illustrate how the culture of fake news seems to have invaded the sanctity of the therapeutic setting. One may argue that the underlying motivations for this invasion is multi determined. No single interpretation could embrace what at first glance may be viewed as an acting out or an enactment. The case of E highlights the indestructibility of wishes underlying fake news, coupled with the permeability of the therapeutic frame.

A regular morning at the office during pre-pandemic times. The 10 am patient just left the waiting room. I have a brief break before the next appointment with E – a business woman who began treatment over a month ago. It crosses my mind that E has remained ambivalent about committing herself to her treatment. During the last session she has expressed skepticism about increasing the frequency as discussed on a previous occasion.

Closer to 11am, I pour myself a glass of water, anticipating the impending loud buzzer from the front door. The cellular phone exact clock indicates it is already 11:10 am. ‘She is not coming, I knew it’ – I mumble – ‘Acting out already’ I say to myself while engaging in an internal debate on how to proceed should she fail to notify me of the reasons for not making it to the session.

As with every new patient, I am aware of a veil of anxiety coloring my reflexions. Writing a few notes seems to ease the wait. 11: 20 am. The bell rings. I feel somewhat relief from her arrival, while pressing the front door buzzer. Shortly after, the second buzzer and the door to the waiting room opens up. Aware that the session would now be 20 minutes short, I move to invite E into the consulting room. Upon opening the door, to my surprise I am confronted with an unfamiliar face. A perfect stranger is standing next to the magazine rack. Confused and mildly disoriented, it takes me a few moments to recover. ‘Who is this woman? Have I mistakenly scheduled a new patient during E ’s time? Am I so much the prisoner of negative countertransference to a difficult patient that I would rather replace her with a less resistant one?’ At that moment the ability to discern what’s really going on eludes me. Yet, despite my unregulated state I manage to say ‘ May I help you?’

The perfect stranger replies ‘Aren’t you Dr. T ?

‘Yes, it’s me’ I declare.

The stranger standing now a few feet from me goes on: ‘E called me early this morning and told me that due to a work-related emergency she won’t be able to make today. Rather than wasting it she offered the hour to me. Here I am. I am very curious about therapy, and like to know how it works. A sample would help me decide one way or another.’

Explaining that I only see people by appointment, I rush to wishing the stranger good luck while retreating into the safety of my office.

As could have been predicted, the rest of the day I felt quite uneasy and irritated. E had used me, treated me like an object in her possession, replaced or disposed of me like a tool with limited value. E has attempted to control the therapeutic situation by exerting power over me. It triggers in me a sense of unreality, as if the brief exchange with the stranger was not a real encounter but rather a fictional one, a scene of a movie waiting to be produced.

The following session, E shows up on time. Overtly enraged, accused me of betraying what she called ‘the contract’. E brings up her own version of how we are supposed to work. She claims her hour belongs to her, and ‘who are you to take possession of it?’ E is convinced that an appointment is to be considered like theater tickets – if for any reason one can’t make the show, it is always possible to offer a friend the extra ticket. To E the no-show session was the equivalent to a voucher with no expiration date. She declares she knows that many practitioners she has been in contact with approve of, even welcome, the transfer of missing sessions to friends and relatives. My internal response is a phrase that is becoming popular on the national political stage: more FAKE NEWS.

E’s psychic reality was flooding the field. I felt gaslighted, and it crossed my mind that E and the stranger had plotted the scenario construction: a ‘home made’ conspiracy aimed at perverting the analytic setting and attacking the frame. Fake news provided E with a degree of comfort she couldn’t attain by distorting the frame that I so carefully discussed during the initial consultation. From my part, my countertransference resonated with E’s fake news, leading me to conjure up conspiracy theories. With hindsight I realized that speculating about the patient’s fake news led me to the creation of my own counter fake news – E and her friend having plotted an ‘insurrection’ to demote me from the analytic chair. The virus of lies had contaminated the treatment and the analyst’s function as well. A perverted transference rendered the frame fake, thus sterile. Has the political zeitgeist of lies and deception at the macro level exerted a ripple effect at the micro level? A splitting of the ego allows foreclosing aspects of reality. E’s fake frame may be viewed as one that subverts the established one which is thought to be limiting and restrictive.

Fake news generators assist cybernauts to create their own private, custom made fake news. At times they are benign pranks aimed at friends and relatives; at others they are at the service of aggression, inciting individuals or groups to violent actions. Were E’s intentions to make fun of the treatment, as a prank, or the ultimate attempt to defy reality in favor of gratification?

E perverted the frame, resulting in a kind of delusion / distortion. The therapeutic setting existed only as it related to herself. She rendered the landscape of therapy into a self-referential one. Consenting to work under the agreed analytic frame must have been experienced as an imposition of a reality that did not fit her quest for gratification. In order for E to get what she wanted, she needed to rely on psychic reality rather than on material reality. Creating a fake frame was E’s device, which heralded a wish that the persistence of primary process helped to sustain.

Mental functioning is ruled by a dynamic choreography of the two mental principles that govern mental life: the reality principle and the pleasure principle. While the pleasure principle aims at reducing tension to a minimum, the reality principle attempts to regulate and modify the demands of the pleasure principle.

Fake news represent the failure of the reality principle to exert its regulatory function. They run counter to the commands of external reality. Like wishes, fantasies, and irrational beliefs, fake news are signifiers of conscious or unconscious pulls, mobilized to foreclose what it is deemed to be unacceptable fact and fabricated evidence. Fake news seem never to go away, and like unconscious wishes they are indestructible. Under an umbrella of misinformation, secondary process is replaced by the logic of primary process. The logic of primary process is one that wants gratification without delay. Regarding fake news, secondary process fails to provide thinking, reasoning, and the postponing of gratification. In this manner, fake news serve as a buffer against narcissistic wounds. They by-pass a potential unbearable confrontation – the confrontation between external reality and the internal one. Limitations are thus denied, and perceptions became dominated by the comfort (pleasure) derived from the indestructibility of wishes.

Wikipedia defines fake news as ‘a false old misleading information presented as news. It often has the aim at damaging the reputation of a person or entity…the term doesn’t have a fixed definition, and has been applied more broadly to include any type of false information, including unintentional and unconscious mechanisms…’ Fake News are also defined as information pollution.

The quest for power is often at the root of fake news, as if holding on to power relies on the fabrication of a suitable narrative based on lies. To purge that which does not fit on a giving narrative, favors the creation of fake news.

Social media – Instagram, Facebook, WhatsApp – is nowadays a fertile soil for the growing of fake news; that is to say dissemination of information/pollution. Technology offers cost-effective tools for unchecked news to reach out to millions in a matter of minutes. Once posted, fake news seem to propagate as if having a life of their own. They operate like a virus capable of contaminating human endeavors, raging from the most personal and intimate domain of people’s private lives to the larger and multilayered ideological arena of political discourse. Across the world, cyber aficionados fail to sort out what is fake from what is not. Cybernauts are prone to embrace a reality defined by anonymous others who are masters in the field of selling seductive conspiracy theories.

Fake news are not a new phenomenon. Although the late twentieth century’s cyber-technological revolution made the spread of fake news easier and expedient, fake news have exerted powerful influence from the dawn of civilization. They were, and continue to be, faithful companion to changing ideological constructs. Fake news often evolve into elaborated conspiracy theories. Once posted, these conspiracies theories prove to be too difficult to eradicate. Like viruses who do not respond to treatment modalities, fake news mutate into variances that elude logic while strengthening their hold on entire populations. In the Middle Ages some Christians clung to a belief that Jews kill children to consume their blood during Passover. This centuries-old construction continues to thrive in the 21st century, albeit in different versions, i.e. the belief that the American election was stolen.

As stated above, fake news multiply at an unforeseen pace due to the dominance of digitality. Technology provides a vehicle for rapid transmission of fake news as never before in human civilization. Online communications have enriched consumers’ imaginations with mixed results. On one hand, creative enterprises have developed, contributing to economic and social advances, whilst on the other hand, allowing the proliferation of statements that attack truth and consensual reality.

Fake news are highly contagious. Their effect spreads across time and space in a world made flat by the internet. Online texts are like a double-edged sword: they facilitate connectivity, while being capable through false narratives to attack the same connectivity they promote, fostering hate and division. Indeed, the internet opens doors to psychological lands hitherto unvisited. Isolated cybernauts may find others who share similar views, and who trust the unifying mission of social media. Yet the internet also erects a forum for discharge of aggression disguised as fake news. The potential damaging, if not dangerous, outcomes of fake news are displayed almost daily on monitors. Roaming around cyberspace stimulate uncanny disinhibition offering a green light for hate to run amok under the shield of anonymity.

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