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Hello Charlie,I am a pediatric cancer doctor and I study communication and ethical decision making in medicine. Yesterday, I realized that a central concept from my field can help to explain why so many appear to accept the president's lies: mutual pretense. The president has a relationship with his base in which he lies, he knows he lies, they know he lies, but none of them acknowledge the lie, because the lie provides them with stability and comfort. Recognizing mutual pretense matters, because attempts to shine light on the deception often lead to resentment towards the person shining the light. Mutual pretense was first discovered by Glaser and Strauss, two anthropologists who observed conversations between doctors and patients with cancer in the the VA in the 1960s.(Their first paper showed a breathtaking lack of bedside manner - see attached) In the 1970s, Myra Bluebond-Langner found the same thing in a pediatric cancer ward. (see her book, "The Private Worlds of Dying Children") For some parents and children, this mutual pretense was central to their relationship. It allowed each of them to protect the other and avoid a difficult truth. Most importantly, attempts to force the families to address hard truths often backfired on the physician, leading to decreased trust and greater frustration. I have known about this literature for years, but a recent encounter with a loved one suggested that a similar phenomenon is happening with some of the president's most fervent supporters.Last week, I was talking with a loved one about COVID-19 and the real challenges we face as a country. As she laid out hopeful statements (hydroxychloroquine will prevent the disease, we will have a vaccine in the next few months, scientists will find a preventive medication soon), I continued to highlight the impediments to each of these hopes (hydroxychloroquine is a dud, vaccines take a long time to develop and often fail, preventive medication for 100 million people is hard to imagine). I also explained that the president is lying and failing to show leadership. My loved one did not agree (to say the least). After arguing back and forth for a few minutes, she raised her voice and nearly yelled, "Don't you think I know how bad things are? Don't you think I understand that we have a lot of problems? Don't you think I know all of this? I can't focus on these negatives all the time because I have to live somehow." Then it struck me - she knows the same things I know. She knows that that we are in a tough spot. She knows that hydroxycloroquine probably won't work. She knows that preventive medicine is probably a fantasy for the general population. She knows that the president is not being honest with her - but she accepts this deception because it helps her to cope. When I forced her to acknowledge these truths, her faith in the president did not waiver. Her relationship with me, however, was strained. If many of the president's faithful maintain mutual pretense with him, then how do we address his lies? While highlighting the falsehoods can help those willing to be convinced, this might actually drive the president's base closer to him. Perhaps the answer is framing the difficult news as reason for hope. Rather than focusing on the failure of hydroxychloroquine, focus on the multiple clinical trials that are a real source of hope. Instead of saying, "The president is lying about hydroxychloroquine," perhaps we can say, "I really wish the president would not focus on hydroxychloroquine, because it is distracting from other really promising clinical trials." We can frame his lie as an assault on a greater hope, a hope that acknowledges the harsh reality but promises to push toward better days. We never would have made it to the moon if we didn't realize how hard it would be. This approach might allow individuals to re-calibrate their goals and hopes. Whether this works is an empirical question, but nothing else has helped... Maybe it's worth a shot.Thanks for your time.Best,Bryan Sisk, MD, MSCI