A cautionary tale about how experts lose our trust
Self-delusion and self-righteousness make for a particularly dangerous combination.
In the early 1900s, a doctor named henry A. Cotton made a thrilling announcement: he had discovered the cure for psychosis.
Cotton was at the forefront of the thennascent field of bacteriology, and his groundbreaking methods stemmed from an epiphany as to the cause of insanity. Mental illness was rooted not in the brain, he said, but in a bacterial infection somewhere else in the body. Remove the septic tissue and the patient would be cured.
This treatment, for which Cotton claimed an astonishing success rate of 85 percent, was heralded as a new frontier in medicine and became standard in hospitals for the insane nationwide. In 1922, The New York Times applauded Cotton’s work as “the most searching, aggressive, and profound scientific investigation that has yet been made of the whole field of mental and nervous disorders.” The newspaper’s only criticism was that the doctor had not pushed his cures earlier and more aggressively. Patients clamored to be treated at the state-run asylum in New Jersey where Cotton was the medical director, or demanded that their own physicians adopt his methods. There was just one problem: Cotton’s theory of infection was nonsense. his groundbreaking methods didn’t replicate. And his miraculous cure for insanity, the one every
one wanted to try? It was pulling out his patients’ teeth.
All of them.
I have thought of Cotton often over the past year, and particularly in recent weeks. As bizarre and archaic as his methods were, the scandal that eventually surrounded them, and him, is eerily familiar in its contours: From leeches to lobotomies, multiple personalities to recovered memories, the path of progress is not always a straight line from ignorance to revelation. Sometimes it detours, weirdly. Sometimes it dead-ends in tragedy. And while the details of the individual scandals may vary, they often have one element in common: an expert class that has become so certain of its own infallibility, and so invested in its moral purity, that it closes ranks and quashes dissent at the precise moment when it should be asking questions. This is how the truth gets lost. It is how institutions fail.
It is also, perhaps most important, how trust is irrevocably broken.
A hundred years after Cotton claimed he could cure psychosis through teeth-pulling, we are living through a historic breakdown of social trust. The reasons for this are myriad, and in many cases technology-driven: a culture in which every person has an internet-connected video camera in their pocket quickly becomes a culture of surveillance, one in which every social error is liable to be filmed and broadcast for public consumption and in which teenagers preemptively store screenshots of one another’s offensive texts, a sort of mutually assured destruction for the digital age. But the most marked decline is not in our trust in one another but in our trust in our institutions. Americans have lost faith: in government, in public health, in higher education, and in the media tasked with holding our leaders accountable to the truth.
This was, to a certain extent, foreseeable. Ten years ago, in an essay (and later a book) titled “The Death of Expertise,” writer Tom Nichols warned readers of an impending implosion of trust between an institutionally backed elite class of highly educated experts and the hoi polloi: “a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers — in other words, between those of any achievement in an area and those with none at all.”
In Nichols’s view, the blame for this rested mainly with the layman, who was both generally deluded and wildly insecure about the merit of his terrible ideas: the living embodiment of the Dunning-Kruger effect, an idiot who is such an idiot that he can’t even recognize the limits of his own intellect. But as the saga of Henry A. Cotton illuminates, sometimes the death of expertise comes at the hands of the experts themselves. Highly educated people are not immune from intellectual wagon-circling when confronted by an inconvenient truth, nor from the same cult-like insularity, coupled with sneering contempt for the outgroup, that can lead a person to stop asking questions entirely lest he dislike the answers.
The ingredients of groupthink
It’s important to note that in his day, Cotton was renowned not just as a scientific authority but as a moral one — and with some justification. Most asylums at the time were run like prisons; Cotton believed they should be like hospitals, where patients were cared for instead of confined. At his own hospital, he insisted on a more compassionate standard of care, outlawing the use of mechanical restraints like straitjackets and hiring an all-female nursing staff (women, he believed, would be kinder to the patients).
So when doubts began to arise about whether Cotton’s madness cure was too good to be true, the scientific community — and particularly those who had staked their own integrity and reputation on the validity of his methods — immediately closed ranks. Adolf Meyer, a famous psychoanalyst and friend of Cotton’s who initially commissioned a report on his work at the asylum, had its findings suppressed in order to protect the embattled doctor’s reputation. An inquiry by the New Jersey state Senate into the conditions at Cotton’s hospital resulted in countless colleagues (many of whom had perhaps dabbled in curing insanity via dentistry themselves) rushing to his defense. The New York Times, which had glowingly reviewed Cotton the year before, now noted the testimony of “eminent physicians and surgeons” that the asylum “was the most progressive institution in the world for the care of the insane.”
The prevailing narrative, repeated by everyone from the press to the scientific community to the politicians investigating the hospital, was that there was nothing to see here. Cotton, meanwhile, claimed that the inquiry was causing him to have a nervous breakdown, further fueling the sense that his critics were anti-science hatemongers maliciously conspiring to persecute a brilliant man. Even the patients who died on his operating table became examples, in Cotton’s mind, of how well his methods worked. The failure in such cases, he said, was “that we have not been radical enough.”
This is the thing about expert consensus: It may be a reflection of what is true, but it may also be a reflection of what the experts wish were true or what they need other people to believe. The longer Cotton practiced medicine at the asylum in Trenton, the more deeply invested he and his supporters became in the validity of his methods, which by now had a body count in the hundreds. If a subject didn’t improve after he’d removed their teeth, Cotton would go hunting for sepsis elsewhere, removing stomachs, colons, sex organs, and more — and why not? Everyone agreed that this was the cutting edge of medicine!
These moments of lockstep ideological conformity among the sciences, the state, and the press are rare, but they are fertile ground for abuse of power by the people we trust to guide us.
During the satanic panic of the 1980s, experts testified — and journalists assured us — that secret cults of devil-worshippers were engaged in the sadistic serial torture of children all across America, right under our noses. During the COVID-19 pandemic, the expert class scolded us that masks were useless (until, suddenly, they were required by law), that the lab leak hypothesis was a racist conspiracy theory (until, suddenly, it was deemed likely to be true), and that any gathering of more than 10 people was an unconscionable risk (unless the gathering was a Black Lives Matter protest, in which case “the public health risks of not protesting to demand an end to systemic racism greatly exceed the harms of the virus,” as one public health expert put it). For the past few years, elementary school educators nationwide have been embroiled in a scandal over “whole language learning,” a literacy model that has been in use for decades despite its documented abysmal failure at actually teaching children to read. And just last month, a comprehensive review by British pediatrician Hilary Cass said that when it comes to gender-affirming medical care for children — whose efficacy countless people have been smeared as transphobic bigots for questioning — “we have no good evidence on the long-term outcomes.”
These very different cases have one crucial thing in common: A deliberate incuriousness spreads from the top down by experts who wield disproportionate influence over the national discourse and, by extension, people’s lives — influence that many believe it is their duty to exercise.
It’s not a coincidence that our current trust crisis corresponds with a growing belief among journalists that their job is not simply to report the news but to steer the moral compass of their audience. As memorably documented by NPR’s Uri Berliner in a recent piece for the Free Press, mistrust is a two-way street. The people who create our culture and lead our national conversations are suspicious at best and contemptuous at worst of ordinary people, who become distrustful in turn as they intuit, not incorrectly, that the folks in charge are not above trying to control their behavior. The result is something of a race to the bottom, as Berliner wryly notes in his description of the NPR newsroom celebrating its status as a more trusted outlet than CNN or The New York Times: “Only in a world where media credibility has completely imploded would a 3-in-10 trustworthy score be something to boast about.”
Today, the national discourse has begun to fracture along political lines into disparate information ecosystems, so that we are less and less likely to encounter stories or perspectives that challenge our prior beliefs — and less likely still to consider these things in good faith if they come from the “wrong” source. This new paradigm is intensely tribal, pathologically suspicious, and supported by a growing misinformation-detection complex that ranks the supposed trustworthiness of various news outlets. Advertisers are then algorithmically steered away from the ones deemed unreliable, starving those outlets of both revenue and visibility. If that sounds unobjectionable, consider that the founder of one such rankings system, the Global Disinformation Index, has said her algorithm flags not just untruths but “adversarial narratives,” which is to say, stories that are accurate but politically inexpedient. “Something can be factually accurate but still extremely harmful,” she has intoned. The whole thing is so Orwellian as to be laughable, until you realize that this company got some of its funding from the US State Department.
At the risk of stating the obvious, a world in which expressing doubt about supposedly settled truths is algorithmically suppressed as “fake news” has terrible implications for the national discourse, for a culture of free expression, and for people who deserve the chance to consider a diverse range of ideas and make up their own minds. But this is also an outright dangerous state of affairs for the members of the expert class who have the propensity to fall into line rather than pursue unpopular lines of inquiry.
John Stuart Mill once wrote, “He who knows only his own side of the case knows little of that.” But the ignorance of a person who does not trust himself to know the whole truth is uniquely poisonous. In 1925, the scientists who’d thrown in their lot with Cotton were deeply, reflexively hostile to any suggestion that they’d chosen poorly, and eagerly smeared the doctor’s critics as disgruntled and vengeful. This hostility will be familiar to anyone who has followed the contemporary debate over youth gender transition, as many supporters of these treatments have furiously attempted to discredit the findings of the Cass Review.
I sometimes try to imagine what it must have been like to be one of Henry Cotton’s former patients, or employees, watching as the scientific community circled the wagons around him; they must have felt as if they were losing their minds. But I can also imagine how Cotton’s supporters must have felt as those first terrible stories emerged of patients being dragged, screaming, into the operating theater where the doctor waited with scalpel in hand. There’s a famous quote by Upton Sinclair — “It’s difficult to get a man to understand something when his salary depends on not understanding it” — but the stakes in a moment like this are so much more than monetary. They are based in morality, identity, the certainty that you’ve chosen the right side in a battle between good and evil. For all that the decline of trust can fracture a society, to lose trust in your own judgment is even more shattering.
It is a hallmark of moments like this that some people, the key players, become trapped in a sort of ideological death spiral: They double and triple down, captive to the brutal sunk cost fallacy that writer Megan McArdle calls “the Oedipus trap.” The breach of trust that began with Cotton maiming and killing hundreds of patients ended with him pulling the wool over his own eyes: He died in 1933 convinced that he was the heroic victim of a hateful conspiracy. A true believer to the end, he had removed several of his own teeth as well as all the teeth of his wife and two sons.
Cotton’s obituary in The New York Times described him, in the most laudatory terms, as an “internationally known psychiatrist for his pioneer work in the treatment of the insane.” A hundred years later, if he’s remembered at all, he’s described as a sort of 20th-century Frankenstein, a crazed megalomaniac who went rogue. The complicity of his fellow physicians, politicians, and the press in selling him as a genius healer to an unsuspecting public went virtually unaddressed and was shortly forgotten — and behind the walls of the Trenton Psychiatric Hospital, Cotton’s methods remained in use for decades after his death.
These very different cases have one crucial thing in common: A deliberate incuriousness spreads from the top down.