It’s been said that QAnon is the mother of all conspiracy theories. Since its modest beginnings with Pizzagate in 2016, QAnon has grown from a fringe movement to a seemingly all-inclusive convergence of multiple right-wing conspiracy theories related to COVID-19, vaccines, 5G networks, Bill Gates, Donald Trump, and a “Deep State” cabal that harvests adrenochrome from children. Some have gone so far as to claim that QAnon has become a new American religion.

By the end of 2020, an NPR/Ipsos poll confirmed broad support for some of the beliefs falling underneath the wide QAnon umbrella. Nearly 40 per cent of Americans endorsed belief that the “Deep State” was working to undermine President Trump and as many as 1 in 3 believed that voter fraud helped Joe Biden win the presidential election. The claim that “a group of Satan-worshipping elites who run a child sex ring are trying to control our politics and media” was rated as false by a mere 47 per cent of respondents. But ironically, 83 per cent voiced concern about the spread of false information.

How can we explain why so many people believe in things not supported by empirical evidence? How did people come to believe in Pizzagate, the conspiracy theory that Hilary Clinton was running a child pornography ring out of the basement of a pizzeria that actually had no basement? How did people believe something as obscure and lacking in evidence as “Frazzledrip,” another conspiracy theory claim that Clinton was filmed tearing off the face of a child, wearing it as a mask, and then drinking the child’s blood?

Although a common temptation is to invoke mental illness or delusional thinking as an explanation, such accounts mostly fall flat. For one thing, surveys have consistently shown that about half of the population believes in at least one conspiracy theory. So conspiracy theory beliefs, like religious beliefs, are normal, unless we want to start proposing that half the population has a psychotic disorder.

Although psychology research has found some support for a kind of subclinical paranoia being related to conspiracy theory belief, most findings indicate that it is a matter of more quantitative differences in certain subtle ‘cognitive quirks’ that we all tend to have to some degree. For example, greater needs for closure, certainty, and control could explain why some tend to embrace conspiracy theories during times of crisis and chaos.

Psychological needs for uniqueness can explain how belief in conspiracy theories are often rewarding, based on believers’ fantasy of “seeing the light” in a way that “uncritical sheep” do not. Lack of analytical thinking and ‘bullshit receptivity’ have also been implicated in conspiracy theory belief, but these are also widespread liabilities of normal human brains and results of poor education, not deficits of psychopathology per se.

A more convincing account of QAnon conspiracy theories like Pizzagate and Frazzledrip lies at the level of social interaction and information science as opposed to psychiatric disorder. Conspiracy theories involve a negation of conventional explanations in favour of an alternative account featuring shadowy forces with malevolent intent. Therefore, mistrust—not clinical paranoia—is often the central feature of conspiracy theory belief.

QAnon conspiracy theories that, at their core, demonise left-wing liberals and “globalists” were born out of an emerging right-wing American populism and have come to be widely adopted within the Republican party. Appearing around the time of Clinton’s campaign against Donald Trump during the 2016 Presidential race, conspiracy theories like Pizzagate and Frazzledrip that maligned her were embraced because many viewed her as a literal enemy, just as the so-called “birthers” endorsed conspiracy theories about Barack Obama’s citizenship 8 years before. While mistrust can be earned, when it underlies conspiracy theory belief, it’s often fueled by prejudices of “othering” in the form of hyper-partisanship, racism, or misogyny.

Mistrust of others, and especially of authoritative sources of information, results in a vulnerability to misinformation that is widely available within today’s media landscape. When Edgar Maddison Welch decided to “self-investigate” Pizzagate armed with a rifle, he was misinformed by sources like Reddit and InfoWars that had presented the supposed “evidence” of Clinton’s guilt. Only later, when Welch was arrested, did he concede that “the intel on this wasn’t 100%.” Likewise, the purported “evidence” for Frazzledrip was widely claimed within YouTube videos back in 2018, despite the fact that no actual video of Clinton cutting off a child’s face ever existed.

The democratisation of knowledge in the modern era of online media has resulted in a ‘post-truth’ world in which ‘fake news’ has become a household word, but no one can agree on which information sources are to be trusted. Consequently, trust has largely become a matter of confirmation bias and motivated reasoning aligned with partisan identities, with little agreement about what constitutes objective evidence anymore.

Human beings are fond of myths that revere our heroes and demonise our enemies. We’re also fond of the self-deception that we think rationally and are always right. The reality is that we come to hold beliefs based on intuition, subjective experience, and faith in trusted sources of transmitted information, independent of veracity. It’s no coincidence that Pizzagate, Frazzledrip, and QAnon have been largely online phenomena that have flourished in an era of hyper-partisanship where the other side is regarded as a mortal enemy and existential threat. So long as that continues, conspiracy theories will continue to flourish.

Joseph Pierre, MD is a Health Sciences Clinical Professor in the Department of Psychiatry and Biobehavioural Sciences, David Geffen School of Medicine at UCLA and the Acting Chief of Mental Health Community Care Systems at the VA Greater Los Angeles Healthcare System. His column titled Psych Unseen and published in Psychology Today draws from the perspectives of psychiatry, neuroscience, psychology, and evidence-based medicine to address timely topics related to mental illness, human behaviour, and how we come to hold popular and not-so-popular beliefs.