Climate change, psychiatry, and politics

One of our members, Dr. Michael Kalm, recently drew my attention to a review and an editorial published in Current Psychiatry: Climate Change and Mental Illness: What Psychiatrists can do; a Toxic and Fractured Political System can Breed Angst and PTSD; and to his letter to the editor (the second letter at this link) regarding these articles.

Access to those articles may require readers to be logged into an account with the publisher, but those articles, or portions of them are reproduced here, with permission from the publisher.

In Climate Change and Mental Illness: What Psychiatrists can do, the authors (Oliver Freudenreich, MD, FACLP; Katherine A. Koh, MD, MSc; and Elizabeth K. Haase, MD) begin my posing the question:

Why should psychiatrists care about climate change and try to mitigate its effects?"

They answer their question first by stating that we, as psychiatrists, are “tasked by society with managing the psychological and neuropsychiatric sequelae from disasters, which include climate change,” and reference the American Psychiatric Association’s position statement on climate change. The authors also assort that our moral obligation to do no harm requires us to look at the practices of the health care industry that contribute to climate change and take steps to manage them. Finally, the authors write, psychiatrists have skills that help them address fear, disagreement, and ambivalence around climate change and its associated harms. Psychiatrists, they say, can “help communities not only endure the emotional impact of climate change but become more psychologically resilient.”

The authors discuss the impact of climate change on human health, and divide their discussion between the direct impacts (e.g., air pollutions, heat, infections, and hunger) and indirect impacts (e.g., increased stress from living through disasters, loss of friends and family members, and being displaced from homes and communities), which are often intertwined. The authors discuss the research associating these changes with specific anatomical and physiological changes in animal and human study populations and associated health outcomes, including increased associations with depression, suicide, anxiety, psychotic disorders, increasing transmission of infectious disease, agriculture and associated hunger. Including the striking statistic that “each degree Celsius increase in ambient temperature may increase suicide rates by approximately 1%.” If climate change (or other stimuli) drive large-scale migrations, there are concerns related to the loss of support and resources that come along with being displaced from one’s home and community and from the strain on the communities that receive large numbers of immigrants. The authors also discuss the evolving language around distress related to climate change, including with terms such as “ecoanxiety”, “ecogrief”, “solastalgia”, and “terrafuria” or “ecorage”, and discuss the nihilism and pessimism about the future that may accompany individuals’ consideration of the future.

The article relates that individuals with severe mental illness are particularly vulnerable to many of these concerns due to decreased physical and emotional resiliency, more limited socioeconomic means, and limited social support. The authors use impaired heat regulation due to medications, mental illness and its sequelae as an example of one concern psychiatrists should keep in mind. The coronavirus pandemic highlighted many ways that our conventional systems of care needed to adapt to keep patients engaged in care.

The authors propose “three Ps” of taking climate action as they apply to psychiatrists. Psychiatrists can take Personal action by “overcoming paralysis from the enormity of the problem,” shifting away from an “expanding consumption” model to a a more environmentally sustainable model. Psychiatrists can also learn how to discuss these issues effectively in both their professional and personal lives by pairing “constructive hope” and “constructive doubt” to motivate people to action. They point out that well-meaning campaigns to change behavior can fail if not communicated with skill. Good messages, they authors write, “are targeted to a concrete concern and where action would pay off now and not in some distant future.” This is all in addition to the obvious personal steps of moving toward carbon neutrality and learning about disaster preparedness and crisis communication. Psychiatrists may take Patient-oriented steps by helping patients understand their own climate-related anxieties around uncertain futures, identify barriers in their own lives to taking climate action, and emphasizing the immediate health benefits to them and their communities from taking climate action. Patient-oriented actions also including developing disaster plans to prevent disruption of psychiatric care that includes the provision of medications. Finally, supporting refugees by connecting them to services and providing appropriate trauma-informed care. Psychiatrists may take Politically-oriented action by advocating for changes within the health care system, joining climate and other relevant committees of special interest groups in their professional organizations, promoting psychiatric voices in these public forums.

The authors emphasize planning for the future, recognizing our duty and opportunity to create and maintain a health care system that addresses the needs of our patients and their communities. They say, “We must grapple wit ha sense of an ‘extended period of insecurity and instability’ (permacrisis) and must better prepare for and prevent the polycrisis (many simultaneous crises) or the metacrisis of our ‘age of turmoil’ in which we must limit global warming, mitigate its damage, and increase community resilience to adapt… it may be better for both our world and a clinician’s own sanity to be engaged in professional and private hopeful action to address climate change. Without ecological or planetary health, there can be no mental health.”

Dr. Nasrallah, in his editorial, wrote (quoted in its entirety)

As psychiatrists know, many of our severely traumatized adult patients were victims of abuse during childhood. We routinely ask every new patient about physical, emotional, or sexual abuse when they were growing up because of the well-established, serious neurobiological and mental repercussions.1,2

Perhaps one of the worst experiences for a child is to witness bitterly adversarial parents (their vital role models) who argue viciously, despise each other, and hurl insults (and even punches) at each other. Such a chronically and emotionally traumatic upbringing can haunt kids well into adulthood, disrupting their hypothalamic-pituitary-adrenal axis and triggering anxiety, depression, and even psychosis due to epigenetic changes that ultimately lead to abnormal brain development.3

It often feels that the governance of our country, or the national “political family,” is seriously fractured like a hopelessly dysfunctional family. Could that be negatively impacting the mental health of the citizenry? Having 2 antagonistic political parties expressing visceral hatred and undisguised contempt for each other 24/7 (thanks to the enabling era of cable TV, the internet, and social media) has transformed each party’s fanatic followers from fellow citizens to ideological combatants. In this poisonous societal zeitgeist of bidirectional acrimony and mutual detestation, the opposing parties and their “intellectual militias” label each other as “extremists” or “radicals.” They become completely blind to any redeeming social value in the ideas or principles of their political opponents. They spend enormous time and energy on undermining each other instead of attending to the myriad vital issues involved in the governance of a massive and complex country.

Winston Churchill said, “Democracy is the worst form of government, except for all the others that have been tried.”4 The current toxic cloud of intense “hyperpartisanship” is emblematic of the dark Machiavellian side of democracy. But those who lament the current distorted version of democracy should contemplate living in a dictatorship or totalitarian regime, where a despot would execute any dissenter or invade and destroy an adjacent country at a whim.

Churchill made that statement in 1947. The internet, social media, and smartphones were science fiction back then. Those technological advances have added fuel to the political process and significantly stoked the flames of hyperpartisanship. It’s now democracy on steroids, where freedom of expression goes to extremes, highlighting the warts and pitfalls of the democratic system. Political rivals can now communicate their ferocious disagreements to millions of their disciples instantaneously, triggering immediate rebuttals and counterattacks by their adversaries. This “virtual guerilla warfare” is mentally and emotionally exhausting to all involved, especially to the subset of neutral bystanders who are unaffiliated with either political party, which, due to the “religification” of politics, have become like secular religions.5 Chronic, unremitting, inescapable stress is a sure pathway for anxiety, depression, posttraumatic stress disorder, and even brain atrophy.

Optimists may point out that the United States has weathered and emerged stronger from many serious traumas, including the Civil War (with its lethal divisiveness), World War I, the deadly 1918 influenza pandemic, the Great Depression, Pearl Harbor, World War II, the Cold War, the Vietnam War, the Watergate political scandal, the 9/11 terrorist attacks, the banking collapse and recession, and most recently the COVID-19 pandemic, which brought society to a standstill and induced so much anxiety and uncertainty.

On the other hand, pessimists would insist those sequential crises left indelible scars that cumulatively altered the mindset of political rivals, predisposing them to extreme views of each other. Alienation inevitably leads to fanaticism. It’s perplexing but fascinating how the fierce bidirectional missives of weaponized ideas can be as virulent and destructive as a traditional physical war. Perhaps in this era, the pen is mightier than the sword after all.

From a psychiatric perspective, the intransigent groupthink of political partisanship eerily resembles folie en masse, a psychiatric syndrome for which there is no established treatment. It has become a serious threat to our modern democracy. So I decided to ask the “know-it-all” artificial intelligence ChatGPT, whom I previously had “invited” to write a “guest editorial” about myths surrounding psychiatry,6 to answer 3 burning questions:

1. Is there toxic hyperpartisanship in the USA today?

ChatGPT’s response: Yes, there is toxic hyperpartisanship in the United States today. Political polarization has been on the rise for several decades, and in recent years, it has become increasingly toxic and divisive. This toxic hyperpartisanship has contributed to a breakdown in civil discourse and a lack of cooperation and compromise in government.

The toxic hyperpartisanship is evident in many aspects of American society, including politics, media, and social media. Political leaders often engage in divisive rhetoric and focus on winning at all costs, rather than working towards solutions that benefit the country as a whole. Media outlets often present news in a partisan manner, further fueling political polarization. Social media platforms have also played a role in exacerbating toxic hyperpartisanship by allowing the spread of misinformation and creating echo chambers where people are only exposed to like-minded viewpoints.

The consequences of toxic hyperpartisanship are significant, as it can hinder progress on important issues and erode trust in institutions and government. It also makes it difficult for people to engage in productive dialogue and find common ground, leading to a lack of cooperation and compromise.

It is important for individuals to be aware of the impact of toxic hyperpartisanship and work towards finding ways to bridge the political divide and engage in constructive dialogue.

2. How can severe hyperpartisanship be corrected?

ChatGPT’s response: Severe hyperpartisanship, characterized by intense and entrenched divisions between political parties, can be a challenging issue to address, but there are several steps that can be taken to work towards correcting it. Here are some potential approaches:

1. Promote civil discourse: Encourage respectful and constructive conversations between individuals with differing political views. This can be achieved through education programs, media campaigns, and initiatives to foster open dialogue.

2. Electoral reforms: Consider implementing electoral reforms that can reduce the influence of extreme partisanship. For example, ranked-choice voting or nonpartisan primaries may encourage candidates to appeal to a broader base of voters rather than just their party’s base.

3. Campaign finance reform: Limit the influence of money in politics, as it can exacerbate hyperpartisanship by allowing wealthy donors to have undue influence over candidates and parties.

4. Independent redistricting: Ensure that electoral district boundaries are drawn in a fair and nonpartisan manner. Gerrymandering, the manipulation of district lines to favor one party, can contribute to hyperpartisanship by creating “safe” districts where extreme candidates are more likely to be elected.

5. Promote media literacy: Encourage media literacy education to help citizens critically evaluate information sources and avoid echo chambers. A well-informed electorate is less susceptible to extreme partisanship.

6. Encourage bipartisan collaboration: Highlight and support instances of successful bipartisan collaboration. Elected officials who work across the aisle can serve as positive examples and encourage others to follow suit.

7. Address economic inequality: Tackling economic disparities can alleviate some of the underlying factors that contribute to polarization. When people feel economically secure, they may be more willing to seek common ground.

8. Civics education: Improve civics education in schools to foster a deeper understanding of democratic values, the political process, and the importance of civic engagement.

9. Leadership example: Encourage political leaders to model cooperation and compromise rather than relying on divisive rhetoric. Voters often take cues from their leaders’ behavior.

10. Promote third parties: Support and encourage the emergence of viable thirdparty candidates. A more diverse political landscape can provide alternatives to extreme partisanship.

11. Focus on common ground: Identify and prioritize issues where there is potential for bipartisan consensus and progress. Building success on these issues can create momentum for further cooperation.

12. Encourage grassroots activism: Support grassroots movements that seek to bridge divides and foster understanding between individuals and communities with different political perspectives.

It’s essential to recognize that addressing severe hyperpartisanship is a complex and long-term process that requires collective effort from citizens, political leaders, educators, and institutions. It won’t be achieved overnight, but through sustained and committed actions, progress can be made toward a more collaborative and less divisive political climate.

3. What can cause the collapse of a democracy?

ChatGPT’s response: The collapse of a democracy can be a complex and multifaceted process, influenced by various factors and circumstances. Some of the common causes that can lead to the erosion or breakdown of a democratic system include:

1. Authoritarianism and power concentration: When leaders or institutions become increasingly authoritarian, centralizing power and weakening checks and balances, it can undermine democratic principles.

2. Corruption and lack of accountability: Rampant corruption among political leaders and institutions can erode public trust in the democratic system, leading to disillusionment and disengagement.

3. Economic instability: Prolonged economic crises or severe inequality can lead to social unrest, increasing the appeal of populist or extremist movements that may challenge democratic norms.

4. Weakening of rule of law: If the rule of law is weakened, and there is a lack of respect for judicial independence and constitutional principles, democratic institutions can become vulnerable to manipulation.

5. Erosion of civil liberties: Suppression of freedom of speech, media, assembly, and association can limit citizens’ ability to express their opinions and participate in the democratic process.

6. Polarization and divisive politics: Extreme political polarization and a breakdown of civil discourse can hinder cooperation and compromise essential for a functioning democracy.

7. External interference: Foreign intervention, propaganda, or cyberattacks can influence electoral processes and undermine democratic institutions.

8. Rise of populism and nationalism: Populist movements that challenge democratic norms, demonize minorities, or advocate for a strongman leadership can pose a threat to democracy.

9. Demographic and social shifts: Demographic changes and social tensions can exacerbate political divisions and weaken the fabric of democratic societies.

10. Lack of civic education and participation: A lack of civic education and low voter turnout can lead to reduced civic engagement and undermine the democratic process.

It is crucial to understand that no democracy is immune to these challenges, and the strength of a democratic system depends on the vigilance and engagement of its citizens, the integrity of its institutions, and the commitment to upholding democratic values. Safeguarding and strengthening democracy requires ongoing efforts to address these issues and protect the principles that underpin democratic governance.

Judge for yourself, but I believe the ChatGPT responses were spot-on.

The articles address difficult topics and phenomena about which there are a broad variety of opinions among the general public and among psychiatrists. Dr. Kalm writes:

I want to send my appreciation for publishing in the same issue your editorial “A toxic and fractured political system can breed angst and PTSD” and the article “Climate change and mental illness: What psychiatrists can do.” I believe the issues addressed are important and belong in the mainstream of current psychiatric discussion.

Regarding the differing views of optimists and pessimists, I agree that narrative is bound for destruction. Because of that, several months ago I decided to deliberately cultivate and maintain a sense of optimism while knowing the facts! I believe that stance is the only one that strategically can lead towards progress.

I also want to comment on the “religification” of politics. While I believe secular religions exist, I also believe what we are currently seeing in the United States is not the rise of secular religions, but instead an attempt to insert extreme religious beliefs into politics while using language to create the illusion that the Constitution’s barrier against the merging of church and state is not being breached. I don’t think we are seeing secular religion, but God-based religion masking as secular religion.

For those interested in more information, and more of the discourse, the relevant article sources are linked above.