Al Jazeera - Greta Moran
A growing network of psychiatrists is tackling a mental health crisis spurred by climate change.
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Lisa Van Susteren (centre) and activists with Beyond Extreme Energy. [Photo courtesy of Beyond Extreme Energy]
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Psychiatrist
Dr Lise Van Susteren did not expect to be allowed into a public hearing
of the Federal Energy Regulatory Commission (FERC), the agency
responsible for regulating interstate energy transmission across the
United States.
She had interrupted a FERC meeting before, which typically results in
being barred from entering again. But to her surprise, she was allowed
into the late February hearing, along with activists from Beyond Extreme
Energy, a collective fighting fossil fuel extraction and calling for an
overhaul of FERC to enable the quick transition to renewable energy
sources.
Van Susteren had nothing prepared, but she knew the drill: she found a
seat in the middle of a packed row so it would take longer for security
to get to her. "Like a crowded aeroplane, the more people that are on
either side of you, the more time you have," she explained.
The commission was in the middle of considering a proposal for a
liquefied natural gas (LNG) terminal and 230-mile (370-km) pipeline in
southwest Oregon - until it was interrupted. Following six other
activists, Van Susteren stood up to speak about climate change's
far-ranging harm to mental health, including the patients who turn up at
her office in Washington, DC, struggling to cope with a quickly warming
world.
Van Susteren warned the commissioners that by approving the
construction of the sprawling pipeline, they were fuelling this mental
health crisis.
It is an issue that she has been studying for more than a decade now.
In 2012, she co-authored one of the earliest major reports (
PDF) on climate change and mental health, published by the National Wildlife Federation.
"We
may not currently be thinking about how heavy the toll on our psyche
will be, but, before long, we will know only too well," she wrote in the
report.
Yet this evidence-backed warning has gone largely unheeded,
especially by those controlling the world's energy future, which is why
Van Susteren is still fighting for it to be heard.
It did not take too long - about a minute, Van Susteren estimated -
for the security guards to press through the crowded row and escort her
from the room. "Talk about surreal," Van Susteren said, recalling the
experience. "You can hardly believe that you are there, right at the
confrontation between good and evil. And I don't mean 'good' in a
self-serving sense. I mean, in the sense of life versus our demise."
The commissioners did not listen to the warnings of Van Susteren and
other activists: in March, FERC approved the pipeline and LNG facility, a
decision that will allow more greenhouse gases to be emitted into a
world overwhelmed by enormous wildfires, prolonged stretches of drought,
relentless hurricanes, thinning permafrost and the current global
pandemic - a world unprepared for even more unscalable loss of life.
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Members of the Chesapeake Climate Action Network picket outside of the Federal Energy Regulatory Commission in Washington, DC to protest against fracked gas exports and the liquified natural gas export facility at Cove Point in Maryland in 2014. [File: Bill Clark/CQ Roll Call]
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Mobilising psychiatrists
Van Susteren is far from the only psychiatrist warning of the anxiety
and suffering resulting from living on an Earth that is being
destroyed. She is a founding member of a nonprofit and all-volunteer
network of psychiatrists, known as the Climate Psychiatry Alliance
(CPA), which share a common goal, Van Susteren explained, of "pointing
out the mental health tragedy that awaits as a result of climate
disruption and how to build resilience".
In 2014, Van Susteren was searching for other mental health
professionals who were strategising around the climate crisis, but could
not find any groups dedicated to this in the US. So, she went to
England and met with members of the Climate Psychology Alliance in the
United Kingdom, which left her determined to try to form a similar group
back in the US.
"I came back and was continuing to look for allies here and they started popping up kind of randomly," she explained.
A web of climate-focused psychiatrists was beginning to come
together, many having already met through professional affiliations. So,
in early 2017, they decided to have an initial phone call to work out
how they could organise for broader change, particularly within their
own field.
In just a few years, the handful of psychiatrists ballooned to more
than 400 across the US. Every two weeks, they conduct a meeting by
phone, which begins with a meditation, prayer, or thought to establish a
sense of community and trust.
The network is premised on the idea that psychiatrists can play a
unique role in helping people emotionally navigate the climate crisis,
while also communicating its health risks, Van Susteren explained.
"We're good at talking people off the ledge who are very anxious. We're
also good at finding a silver lining. Even when things are dark, we
understand science and urgency."
Along with mobilising psychiatrists to address climate change, the
CPA has been pushing the American Psychiatric Association (APA), the
largest professional body of psychiatrists, to take a stronger stance on
the climate crisis.
'A race against time'
But there is still a long way to go. Many psychiatrists remain
untrained in how to talk about climate change, recognise its
far-reaching, ongoing devastation, and prepare for a growing surge of
people in need of their services.
"It's
really a race against time to get psychiatry where it needs to be,"
said Dr Elizabeth Haase, a founding member of the CPA and a Nevada-based
psychiatrist. "No one is really prepared for the magnitude that is
predicted to occur, and with things going much faster than we thought
they were going to go, that impact is coming much sooner than we
thought."
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Dr Elizabeth Haase and Dr Jack Gorman consider the direction climate psychiatry should go in during a meeting of the Association for the Advancement of Psychodynamic Psychiatry in 2014. [Photo courtesy of Climate Psychiatry Alliance]
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It can be hard to recognise the scope of this tragedy, explained
Haase, because the mental health effects of climate change show up in so
many different layers of a person's life. Rising temperatures and
heatwaves can be devastating, including being linked to increased rates
of
suicide and violence.
The social and economic upheaval of climate change can also cause a
range of psychological harm, from acute stress to more chronic responses
to trauma.
"Because we're having more extreme weather, more people are living in
areas with food scarcity, more people are homeless, more people are
financially struggling," said Haase.
Climate disasters, like intensified hurricanes and wildfires, can
lead to mental health consequences that linger for years. As parts of
the world become nearly uninhabitable, more people will become climate
refugees, forced to migrate and experience the pain of leaving one's
home.
Communities 'on edge'
An emotional response to the climate crisis can permeate whole communities.
Dr Robin Cooper, another founding member of the CPA and an assistant
professor of clinical psychiatry at the University of California San
Francisco, described the emotional distress felt in her community from
the wildfires of recent years.
"The
community was just on edge," said Cooper, recalling the screen of smoke
that fell over the Bay Area during the wildfires in 2018. "Those are
the moments where the absolute anxiety of what we are doing to the world
just emerges."
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A San Francisco firefighter uses an axe to dismantle a burned mobile home as he searches for human remains at a mobile home park that was destroyed by the Camp Fire on November 14, 2018 in Paradise, California. [File: Justin Sullivan/Getty Images]
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Cooper recalls one patient who came into her office in an extreme state of anxiety.
"[She was] breathing heavily, hyperventilating, agitated, her thought
patterns were scattered and talking about how we had destroyed the
Earth," said Cooper. In a matter of minutes, she began asking "Where can
I go?" until it dawned on her that there was no place she could move
that would fully solve the continuing, worsening threat of climate
change. "In a moment of extraordinary grief and powerlessness, she wept
and said, 'I should never have had my son,'" said Cooper.
Such an emotional response to the climate crisis should not be
pathologised, Cooper explained, given that it is a normal reaction to a
profoundly disturbed planet - and one that is becoming more common.
As more disruptive weather patterns intensify, this grieving, anxiety
and suffering is expected to worsen. The immediate future is already
looking grim: the oceans, which are now at the warmest temperature on
record, are predicted to spur a year of colossal hurricanes and
wildfires.
Not only does the CPA aim to help people face this complex reality,
but also to have the courage to build a new, better long-term reality.
"We
can positively frame this crisis," reads a statement from the CPA. "The
antidote to hopelessness, cynicism and magical thinking is awareness of
our responsibility and active engagement in this crucial work with
others at this crucial time."
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Six-year-old King Bass (left) sits and watches the Holy Fire burn from on top of his parents' car as his five-year-old sister Princess rests her head on his shoulder on August 9, 2018 in Lake Elsinore, California. [File: Patrick Record/AP Photo]
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'First do no harm'
Early on, the CPA decided to take on a goal that could create a
ripple effect through its field: encouraging the American Psychiatric
Association (APA), which has 38,800 members, to divest its investment
portfolio from fossil fuels. By cutting off the APA's most direct
contributions to the climate crisis, it would send a strong message to
many psychiatrists.
"The APA has a wide membership," said Cooper. "So, it is the most powerful way we can influence and educate psychiatrists."
Fossil fuel divestment was a tall demand, especially considering it
took the APA until 2017 to publicly acknowledge the threat the climate
crisis poses to mental health. Yet there was precedent for it: the
British Medical Association, the Canadian Medical Association, the World
Health Organization and the American Medical Association had all
adopted policies to divest.
So, the CPA reached out to Dr Todd Sack, who drafted the American
Medical Association's resolution to divest from fossil fuels, and asked
him for advice on how they could follow suit. This effort soon resulted
in an action paper that clearly laid out why the APA has a
responsibility to divest. The paper points to the fact that the "health
and mental health impacts of climate change fall disproportionately upon
the mentally ill". Citing the Hippocratic oath to "first do no harm,"
the paper argues that psychiatrists have a responsibility to "minimise
fossil fuel consumption and strive to influence the healthcare
institutions in which we practise," to curb this worsening mental health
crisis.
In early November 2018, Dr James Fleming, a Missouri-based
psychiatrist, representative to the APA, and founding member of the CPA,
stood before the assembly of the APA and urged it to divest. He read a
plea written by Van Susteren. "Folks, we cannot mess this up. We do not
have time. Be under no illusions, the climate-aware generation of kids
are beside themselves - scared, angry, grief-stricken," said Fleming.
"They are experiencing inaction as assault."
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A swimmer explores the waves during high tide as Hurricane Dorian churns offshore on September 3, 2019 in Indialantic, Florida. [File: Scott Olson/Getty Images]
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Just a month before, the Intergovernmental Panel on Climate Change released a
groundbreaking report,
warning of ecosystems collapsing, the disruption of food systems,
population displacement and a rising death toll from extreme weather
that can only be averted through "rapid and unprecedented action". This
timing may have made the assembly particularly receptive to divestment,
but in any case, the action paper passed with a 61 percent majority,
which Cooper described in the Psychiatric Times as "a result stunning
for both the margin of victory and speed with which it moved through the
Assembly's usually slow process".
In October 2019, the APA's Board of Trustees took the first step of
enacting the paper's goal by blocking all future direct investments in
fossil fuels. The APA's Investment Oversight Committee decided to
regularly review the APA's investment portfolio to screen for ways to
completely divest from fossil fuels. Currently, less than five percent
of its investment portfolio is in companies that derive most of their
incomes from fossil fuels, according to Fleming.
Shifting attitudes
The divestment effort also helps spread awareness to all of the APA's
members on the mental health effects of climate change, connecting to a
broader CPA aim of communicating this ever-present connection.
"By articulating the connection between health and climate, it gets
more people motivated to recognise that they individually and, more
importantly, collectively need to do something," said Dr David Pollack, a
community-focused psychiatrist based in Oregon and another founding
member of the CPA.
To this end, the CPA members also frequently give presentations on
the mental health dimensions of climate change at APA meetings and write
about the topic in popular trade journals, like The Psychiatric Times.
They have been the driving force behind other APA action papers related
to the climate crisis, including a resolution to distribute curricula on
mental health and climate change in medical schools, universities, and
fellowships. This will build on a growing push for medical schools to
integrate climate change into the curriculum.
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Partially submerged cars are seen in Hurricane Isaac's flood waters on August 31, 2012 in Plaquemines Parish, Louisiana. [File: Mario Tama/Getty Images]
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There is already a noticeable shift in psychiatrists' attitudes.
"When we first started psychiatrists would say, 'Climate change is a big
issue, but it really doesn't affect us. It's not in our domain,'" said
Cooper. "Now that has completely changed."
Recently,
the CPA has been working on making this knowledge more widely
accessible. It has joined forces with the Climate Psychology Alliance in
the UK and the Climate Psychology Alliance North America, which Van
Susteren also helped establish, to develop training on mental health and
climate change. Modelled on Al Gore's The Climate Reality Project
training, it will involve a set of slideshows that can be accessed from
anywhere and intended for a variety of uses, from how to bring an
awareness of climate change into a clinical setting to engaging with
lawmakers in pushing for mental health policies.
Climate-aware psychiatry
For mental health professionals already schooled in climate change,
the CPA and Climate Psychology Alliance North America have developed a
shared referral list so patients can more easily locate a therapist with this background.
So, what makes a climate-aware therapist?
One of the first steps any mental health professional can take is
just being aware of the mental health risks of climate change. This way,
they can better inform their patients of any interventions to take,
such as in the event of a heatwave.
"I think it's incumbent upon us to say before summer season, 'you
know we are having more and more periods of extreme heat and there are
ways that you need to know how to protect yourself and be aware of early
signs of trouble,'" said Cooper.
Therapists should also really grapple with this crisis themselves,
explained Dr Janet Lewis, a psychiatrist in New York and another
founding member of the CPA. "It really has to be personally digested in
order to be able to help others with it," said Lewis. "It's the
experience of mental health professionals in general that patients tend
to talk about what the therapist is ready to hear."
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A firefighter keeps watch on flames that could jump the Angeles Crest Highway at the Bobcat Fire in the Angeles National Forest on September 11, 2020 north of Monrovia, California. [David McNew/Getty Images]
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There
are patterns in which "climate anxiety," an umbrella term used to
describe a range of psychological responses to the climate crisis, shows
up clinically. For instance, Lewis explained, as patients grapple with
the climate crisis, they often vacillate between poles of emotions and
thought, such as between extreme hope and despair. A therapist can help
patients navigate these extremes to find ways to move forward and
meaningfully live with the reality of climate change.
Unlike many forms of psychological harm, the threat of climate crisis
does not disappear. This can produce in patients "continuous traumatic
stress," a term that Van Susteren coined to describe a psychological
response that mirrors post-traumatic stress in many ways, but the
primary preoccupation is with the future. It is a response that has also
been observed in nurses and doctors treating patients infected with
COVID-19.
In the longer-term, therapists may be able to help patients
experience "post-traumatic growth". This can happen, Haase explained,
when "through a profitable, deep reflection and grief about what has
been lost, people choose to make some meaningful changes and become
typically more connected to other people". She pointed to how
reconnecting with the natural world can be a way to facilitate this
growth, particularly when the source of trauma comes from nature.
Systemic oppression
Dr Carissa Caban-Aleman, a Miami-based psychiatrist and founding
member of the CPA, believes psychiatrists also need to recognise how the
consequences of systemic oppression make people more vulnerable to
climate change. For example, in Puerto Rico, the effects of Hurricane
Maria were compounded by what Caban-Aleman described as "the chronic
aggression of colonialism and a lot of economic and political factors,"
such as laws imposed on Puerto Rico by the US that made the island
particularly vulnerable to corporate profiteers swooping in after the
storm.
While Puerto Rico's recovery has been rocky and slow, Caban-Aleman
also points to ways the community has come together to build
long-lasting resilience, such as through solar and agricultural
cooperatives. "It's really an option to see in real life how
transformational and social resilience can work," she said.
Therapists can support these recovery efforts by first building trust
within a community. In her work with the nonprofit mental health
organisation CrearConSalud, Caban-Aleman led community-based mental
health workshops. At first, this involved "just giving emotional support
to people, but more than anything, it was helping them with their basic
needs," said Caban-Aleman.
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The nonprofit CrearConSalud provided free mental health workshops in the wake of Hurricane Maria. [Photo courtesy of Carissa Caban-Aleman]
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Caban-Aleman
also frequently engages in environmental justice activism in Miami,
which helps her better understand and provide for the mental health
needs of that community. "The best way that I get to thoroughly insert
myself in an environmental justice effort is by being part of it," she
explained. "If you are trying to help from the point of view of being in
the faculty of a university or in a clinic as a medical provider, but
you're not really visible in the community that you're trying to impact,
it's really hard to get far with that effort."
Long-term resilience to the climate crisis might look like
therapists, patients and activists all working together to address the
climate crisis. This engagement in collective action, while at times
exhausting, can also be profoundly healing. "As we confront climate
change, just like with the coronavirus pandemic," said Dr Janet Lewis,
"we have to shift to an appreciation of this whole realm of collective
action and responsibility."
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