PSYCHIATRIC VIEWS ON THE NEWS
In his wonderful year-end summary, “Hot Topics of 2016: In and Around Psychiatry,” Psychiatric Times' Editor in Chief, Allan Tasman, MD, made the case for the bio-psycho-social model. He also provided hope for future treatment advances, even though innovations in new medications and psychotherapeutic techniques have remained stagnant in recent years. I would like to add 2 additional topics to Dr. Tasman’s list—the escalating threat of climate change and the epidemic of physician burnout.
Why we in American psychiatry have continued to ignore the worldwide problems of burnout and climate change is open to interpretation. Physician burnout is higher than in any other profession and has indirect detrimental effects on patients. In a recent survey, 40% of US psychiatrists reported experiencing burnout (defined as “a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment”). Some say that we are too busy and stressed in our day-to-day work and others say these challenges are not important and do not compromise patient care.
Although we are experts in addressing trauma of all kinds, the psychological toll of climate-related events will require a different paradigm for approaches to disaster psychiatry. In terms of ethical priorities, taking care of ourselves is secondary to taking care of patients, even though our own well-being correlates with quality of care.
We are up against powerful corporate players. Fossil fuel companies (in the case of climate change) and insurance companies (in the case of physician burnout) have developed strategies to deny the responsibility for—and even existence of—these problems.
Is there something that ties the rising heat of “global warming” with the decreasing passion of physicians? Certainly, in an ethical sense there is. Section 7 in the American Medical Association Principles of Medical Ethics, adapted by the American Psychiatric Association, states, "A physician shall recognize a responsibility to participate in activities contributing to an improved community." [PDF]
In my first blog for Psychiatric Times, “Why Psychiatrists Should Go Green,” I wrote about climate change, and I have continued to do so periodically since then. Burnout came to my attention after I retired from clinical work in July 2012, and, with the help of a retired emergency physician, I came to realize that I had been burned out without realizing it.
In the past year, signs have emerged that the tide is turning:
• A growing group of psychiatrists, tentatively called The Climate Psychiatry Alliance, is lobbying the American Psychiatric Association to address physical and mental health concerns associated with climate change
• Another think-tank in psychiatry, the Group for the Advancement of Psychiatry (GAP), has added a new committee related to climate change
• There was a pop-up session on climate change at the October 2016 APA-IPS meeting
• At the same meeting, I gave 3 presentations on burnout, and the topic was included in my acceptance speech for the Administrative Psychiatry Award
The grave irony in the relative absence of psychiatrists from these social challenges is that our special expertise could contribute much to the solutions. We are uniquely qualified to know how denial, disavowing, fear of change, misinformation, narcissism, learned helplessness, greed, and guilt, among other defense mechanisms, often unconsciously prevent us from accepting reality—that human behaviors contribute to climate change.
We know, too, that these and other psychological processes—such as a counter-phobic response to fulfill our calling adequately—prevent physicians from recognizing the development of burnout within themselves and allows a continuing false sense of work satisfaction. How to better solve these problems requires us to understand ways to connect with those whose perspectives are different from ours and how to neutralize aggression.
Like all resolutions, it will be important for me to continue to write about these topics in 2017. If more psychiatrists join me in one way or another, perhaps by the end of the year, both topics will be addressed.