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The American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and Children’s Hospital Association have declared a national emergency for children and adolescent mental health. Children and families in the United States have experienced “enormous adversity and disruption,” which was only exacerbated by the COVID-19 pandemic.

worsening crisis in child and adolescent mental health

 is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020. Rates of childhood mental health concerns and suicide rose steadily between 2010 and 2020 and by 2018 suicide was the second leading cause of death for youth ages 10-24. The pandemic has intensified this crisis,” the groups wrote.

The groups went on to call for government and advocate intervention for the following 10 items:

1. Increased federal funding for evidence-based mental health screening, diagnosis, and treatment, particularly for underprivileged populations.

2. Improved access to technology to maintain availability of telemedicine.

3. Sustained funding for effective school-based mental health care.

4. Adoption of effective and financially sustainable integrated mental health care in primary care pediatrics.

5. Strengthened suicide prevention programs in schools, primary care, and community response teams.

6. Address challenges of acute care needs for children and young adults, like the shortage of beds and emergency room boarding.

7. Creation of fully funded community-based systems of care that can connect families with the programs they need.

8.Support family resilience through trauma-informed care services.

9. Address longstanding workforce challenges, including intensified efforts to recruit and support underrepresented populations into mental health professions.

10. Enforce mental health parity laws through advanced policies.

“We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and 

 that will have lasting impacts on them, their families, and their communities. We must identify strategies to meet these challenges through innovation and action, using state, local and national approaches to improve the access to and quality of care across the continuum of mental health promotion, prevention, and treatment,” wrote the groups.

, many youth have been socially isolated. They have been attending school virtually, have not been able to see their friends, and have not been able to participate in extracurricular activities. Most of my patients have struggled academically with the changes and are having difficulty catching up. Although the majority of my patients have returned to in-person school, many have fewer social opportunities,” said Ann Childress, MD, a psychiatrist with a subspecialty in child and adolescent psychiatry, and president of the Center for Psychiatry and Behavioral Medicine in Las Vegas.

Childress also recommends encouraging patients to get the vaccine: “In addition to providing usual care, I have found that a short discussion of the vaccine science in a supportive way has been helpful. Several of my hesitant patients have gotten the vaccine after an appointment or allowed their teens to get vaccinated.”

What measures have you taken to support child and adolescent mental health during the pandemic? Write us at 

1. American Academy of Pediatrics. AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. October 19, 2021. Accessed October 21, 2021. 

https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/

Three leading groups in child and adolescent mental health have declared a state of emergency for the nation’s youth. 

Child and Adolescent Mental Health: A National Emergency 

Americans are being bombarded with all kinds of information about the

. As we can see every day, this information can be partial, fragmented, conflicting, inaccurate, or downright wrong. Information can be distorted by politics or religion or conspiracy theories. What is needed—and has been sorely missing—is critical thinking by all Americans. And until we apply critical thinking to the issue of vaccines, our nation will continue to flail and remain on its deadly course.

It does not have to be this way. All mental health professionals should be voicing their opinions about the vital role of critical thinking in individuals’ lives.

Critical thinking refers to the objective analysis and evaluation of an issue. It requires 5 central steps: identification of an issue; open-mindedness in bringing to light all sides of the issue; evaluation of the factualness of each piece of information; synthesizing the best facts into a cohesive whole; and formulating superior conclusions.

Historically, schools have done a terrible job of teaching us critical thinking. Most of us had classes where information was provided to us, we memorized it, and then we recited it back on exams. High grades reflected strong memorization. But the ability to think critically was seldom taught, even in high schools.

Colleges and universities have made critical thinking a priority in their classrooms. But, of course, only 42% of Americans have a college education. That means the vast majority of citizens have not had the opportunity to learn critical thinking.

Thus, we are inept at conquering complicated—and potentially deadly—national problems.

Let us apply critical thinking to the COVID-19 vaccines. If we do, here is what we know for certain: vaccines are effective and safe; upward of 90% of Americans must be vaccinated or have had the coronavirus for the pandemic to be soundly defeated; our national history of vaccinations has been extremely impressive; and decisions about vaccines must be based on medical and scientific evidence.

Our country is founded on the ideals of freedom and individual liberties. No one wants to take those away. But at this moment, when 

is running wild, critical thinking must be far more salient in our decision-making than individual wishes, desires, politics, or religion. Critical thinking can debunk lies, conspiracy theories, and misinformation. It can lead us to the truth.

Until critical thinking is widely accepted about vaccines, thousands of Americans will continue to die each week. This is profoundly sad and tragic since these deaths are almost totally preventable.

All Americans must be vaccinated as soon as possible. It is the vehicle by which we can defeat this deadly pandemic. This is a certainty. This is the truth. Critical thinking can save lives. We just need to use it. Mental health professionals can be a role model for its use.



is a clinical psychologist in private practice in Birmingham, Alabama.

Critical thinking is sorely missing in our decision-making about the COVID vaccines—and it is having tragic results.

Critical Thinking, COVID-19 Vaccines, and Deadly Consequences

The news just emerged from his family that Colin Powell died at the age of 84. Certainly, he was one of our well-known public figures and, as such, the American Psychiatric Association’s Goldwater Rule suggests not saying much about him personally. Yet, there are principles that can continue to guide us.

One is COVID-19 vaccination, especially since the family conveyed that he was “fully vaccinated,” but died of COVID-related complications. For those in our country that want an excuse to not be vaccinated, this might be one. Yet, as it turns out, he had high vulnerability to be among the very rare people who die despite vaccination. He was not only elderly, but he was fighting the disease multiple myeloma, which increases his vulnerability in 2 ways: the illness itself and the treatment which further compromises his immune system. On the contrary, perhaps the vaccination helped him to live a bit longer. In addition, we do not whether it was someone unvaccinated who infected him.

Second was his struggle against racism. From being unable to get housing at Fort Benning when he first joined the Army due to his skin color to becoming our first Black Secretary of State was an extraordinary accomplishment, and models what can be done.

Third is his preference for coalitions over confrontations. Whereas he was talking about international conflict, he could just as well been talking about the divisiveness in our society. I quoted the journalist Brian Stelter in 

 about how dangerous the “self-censorship” is that is being triggered “by small but vocal groups and powerful but cowardly leaders.”

 Instead, Colin Powell was usually called courageous.

Given the evolving news on his death, I apologize in advance for any factual mistakes.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

1. Stetler B. Bari Weiss’ next act: a Substack newsletter that serves as ‘the newspaper for the 21st centur.’ CNN Business. Updated October 17, 2021. Accessed October 18, 2021. 

https://www.cnn.com/2021/10/17/media/bari-weiss-newsletter/index.html

It was recently announced that Colin Powell has died at the age of 84 from COVID-complications. 

What Colin Powell’s Life and Death Can Teach Us about Vaccination, Racism, and Coalitions 

Welcome to America, a year and a half into the COVID-19 pandemic. Emergency departments and hospitals are swamped with COVID-19 patients. Patients with possible heart attacks and strokes are being 

 Medical staff are feeling overwhelmed and burned out in the face of patients who have 

 Tragically, nearly 9 months after the first safe and effective vaccine became available in the US, only about 54.7% of Americans are fully 

 The situation has been rightly characterized as “a pandemic of the unvaccinated.”

 columnist David Brooks wrote, “We Americans enter the July 4 weekend of 2020 humiliated as almost never before. We had one collective project this year and that was to crush COVID-19, and we failed.”

It is extraordinary—and far more humiliating—that at this advanced stage of the pandemic, we are still far from containing, much less crushing, a contagion that has now killed more Americans than 

What accounts for this massive societal failure in one of the world’s most scientifically advanced countries? What accounts for the resistance to vaccination among a substantial percentage of the US population? As psychiatrists, we are accustomed to exploring resistance on an individual level, usually in the context of psychotherapy. But societies and their subcultures may also manifest resistance to public health measures.

 In my view, answers to these questions require a deep dive into the realm of social psychiatry, which Eugenio M. Rothe, MD, has 

as follows: “Social Psychiatry is a paradigm that combines medical training with the perspectives of social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to the human condition and to mental distress and disorder.”

In this essay, I want to argue that our failure to contain the COVID-19 pandemic—and in particular, our inability to overcome public resistance to vaccination—stems from the convergence of 3 sociocultural forces: 1) systemic deficiencies in science education in the US; 2) the failure of American civics education to inculcate a sophisticated understanding of individual rights; and 3) the deterioration, over the past few decades, of community and communitarian values in American culture. The confluence of these forces has amounted to a perfect storm, in which the entire nation has become a casualty.

Worse still, these forces have been amplified and strengthened by massive amounts of misinformation regarding vaccination against COVID-19, promulgated by 

; several prominent politicians; and, alas, even by some irresponsible physicians.

I hasten to add that I am considering those forces that foster a deliberate decision to refuse vaccination, not to situations in which access to COVID vaccines is 

—a significant problem in some minority communities.

 I am also omitting discussion of individuals who have documented medical contraindications to receiving the vaccine; or those who claim—controversially—that they are opposed to vaccination for religious reasons.

Consider this plaintive question: how on earth do we educate the general public regarding m-RNA vaccines, in a country where 42% of Americans believe that ghosts really exist; 29% believe in astrology; 21% believe the government is hiding space aliens; and 14% of Americans believe in Bigfoot?

I wish I were making up these figures, but reliable surveys support those 

 I think it fair to say that suboptimal science education in the US bears at least some of the blame for these beliefs—or at least, blame attaches to our country’s failure to support optimal science education. It is telling, for example, that less than one-third of California students met or exceeded standards on a new science test developed by the California Department of Education.

American Association for the Advancement of Science (AAAS)

scientific achievements in the US are the best in the world (45%), or above average (47%), 

they are far less sanguine about science education in this country. Fully 75% of 

AAAS scientists say too little STEM (science, technology, engineering, and math) education for grades K-12 is a major factor in the public’s limited knowledge about science.

Given this backdrop, it is not hard to understand the difficulty of explaining the nuances of COVID vaccines to the general public—or reassuring individuals that approved vaccines are safe and effective, notwithstanding some rare but serious side effects.

Deficiencies in American Civics Education

If we can point wistfully to the woeful state of science education in the US, we can justify even more gloom regarding civics education in this country. 

, to be clear, refers to “the study or science of the privileges and obligations of citizens.”

 Unfortunately, there is evidence that, in the US, “…Civic[s] knowledge and public engagement is at an all-time low.”

 For example, a 2016 survey by the Annenberg Public Policy Center found that only 26% of Americans can name all 3 branches of government, which was a 

 According to the (nominally nonpartisan but left-leaning) Center for American Progress, “Most states have dedicated insufficient class time to understanding the basic functions of government at the expense of other courses.”

In my view, one consequence of inadequate civics education in the US is a widespread misconception of what constitutes an individual 

. This has played out during the COVID pandemic in ways that put the public’s health in grave jeopardy. Thus, many vaccine refusers or anti-vax activists argue that vaccine refusal is an 

But legal scholars hotly dispute this claim. For example, law professor Mark Hall, JD, director of the Health Law and Policy program at Wake Forest University, argues that, “Because one person’s choice affects the health of other people and the public at large, people do not have a fundamental right to refuse vaccination.”

This position was affirmed by the US Supreme Court in the famous 1905 case, 

 to mandate vaccinations for smallpox. That same principle was likely applied when associate justice Amy Coney Barrett, JD, left standing Indiana University’s COVID vaccine mandate.

The Deterioration of American Communitarian Values

And finally, the third force in the triadic perfect storm: the gradual erosion of community and communitarian values in the US. As philosopher Aeon Skoble, PhD, has noted, the term 

 refers broadly to the concept that: “…the community can be thought of as a bearer of rights, or at least as the holder of interests, to which an individual’s interests may have to be subordinated in some cases.”

David Brooks has fleshed out this concept, arguing that American society in recent years has lost: “…a civic consciousness, a sense that we live life embedded in community and nation, that we owe a debt to community and nation, and that the essence of the admirable life is community before self.”

Perhaps the communitarian ideal is most strikingly illustrated when we meet up with its polar opposite—what 

 as a puerile sense of personal entitlement, acted out as passive-aggressive behavior.

 In my view, this attitude was forcefully illustrated by one congressman from Ohio, who commented in May 2020, “I will not wear a mask . . . quite frankly, everyone else’s freedom ends at the tip of my nose. You’re not going to tell me what to do...”

As the writer Damon Linker, PhD, expressed the problem in this country

…individualism, cultural libertarianism, atomism, selfishness, lack of social trust, suspicion of authority…it takes a multitude of forms. But whatever we call it, it amounts to a refusal on the part of lots of Americans to think in terms of the social whole—of what’s best for the community, of the common or public good. Each of us thinks we know what’s best for ourselves. We resent being told what to do. If wearing a mask is unpleasant, we don’t want to be forced to do it. In fact, a governing authority—or really, anyone, even fellow customers at a grocery store—reprimanding us for failing to do our part for public health is enough to make us dig in our heels and stubbornly refuse to go along.

The Israeli diplomat Abba Eban (1915-2002) once quipped that, “Men and nations behave wisely when they have exhausted all other resources.”

 It is painful to contemplate how many more resources—human, material, and spiritual—some of our fellow citizens will exhaust before behaving wisely during the COVID-19 pandemic. As psychiatric physicians, we may well encounter patients who refuse to take even basic health precautions during the pandemic, including availing themselves of the approved vaccines. While we owe these individuals respectful listening and empathic understanding (a tall order, given the harm they inflict on society) we are surely under no obligation to condone their behavior.

Furthermore, as guardians of the public health, we need to adopt a social psychiatry perspective in order to understand the sociocultural forces at work in this pandemic, particularly those that have created a perfect storm of civic irresponsibility. Finally, as physicians and concerned citizens, we must work to strengthen science education; improve civics education; and mend the fraying fabric that knits us together as a human community.

is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Editor in Chief emeritus of

1. Radcliffe S. Why rising COVID-19 hospitalizations are a risk to everyone’s health. 

. August 30, 2021. Accessed September 30, 2021.

2. Facher L. ‘It’s soul-draining’: Health workers deployed to Covid hot zones are overwhelmed by deaths among the unvaccinated. 

. August 18, 2021. Accessed September 30, 2021.

3. At least 214 million people have received one or both doses of the vaccine in the U.S. 

4. Kalter L, Ellis R. CDC: COVID-19 Is a 'Pandemic of the Unvaccinated.' 

. July 16, 2021. Accessed September 30, 2021. 

5. Brooks D. The national humiliation we need. 

. July 2, 2020. Accessed September 30, 2021. 

6. Yan H. The US death toll from Covid-19 just surpassed that of the 1918 flu pandemic. CNN Health. September 20, 2021. Accessed September 30, 2021. 

8. Rothe EM. What is social psychiatry? American Association for Social Psychiatry. Accessed September 30, 2021. 

9. Jimenez D. Covid-19 vaccines: the role of social media in disinformation. 

. June 4, 2021. Accessed September 30, 2021.

10. Brumfiel G. This doctor spread false information about COVID. She still kept her medical license. 

. September 14, 2021. Accessed September 30, 2021.

11. Feldman N. Why Black and Latino people still lag on COVID vaccines — and how to fix it. 

. April 26, 2021. Accessed September 30, 2021.

12. Nearer my god to thee, but not to a Covid vaccine. 

. September 21, 2021. Accessed September 30. 

13. Mello MM, Parmet WE. Public health law after Covid-19. 

14. Van der Linden S. How come some people believe in the paranormal? 

. September 1, 2015. Accessed September 30, 2021.

15. Johnson S. Less than a third of California students met or exceeded standards on new science test. 

. February 7, 2020. Accessed September 30, 2021.

16. Pew Research Center. Public and scientists’ views on science and society. January 29, 2015. Accessed September 30, 2021. 

17. What is civics? League of Women Voters of Delaware. Accessed September 30, 2021. 

18. Shapiro S, Brown C. The State of Civics Education. February 21, 2018. Accessed September 30, 2021. 

19. Annenberg Public Policy Center. Americans’ knowledge of the branches of government is declining. September 13, 2016. Accessed September 30, 2021. 

20. Abutaleb Y, Linskey A. Republicans maneuver to block vaccine mandates, undercutting a policy widely seen as an effective tool to end pandemic. 

 September 20, 2021. Accessed September 30, 2021.

21. Todd S. Do mandatory vaccines violate human rights? 

. August 5, 2021. Accessed September 30, 2021.

22. Klasfeld A. Justice Amy Coney Barrett rejects Indiana Students’ bid to block COVID-19 vaccine mandate. Law & Crime. August 12, 2021. Accessed September 30, 2021.

23. Skoble A. Communitarian and individualist ideas in business. Do community rights override individual rights? Foundation for Economic Education. July 1, 1994. Accessed September 30, 2021. 

24. Brooks D. The strange failure of the educated elite. 

. May 28, 2018. Accessed September 30, 2021. 

25. Pies RW. Masks, machismo, and the American man-child. 

. June 29, 2020. Accessed September 30, 2021. 

26. Fieldstadt E. Ohio lawmaker refuses to wear mask because he says it dishonors God. NBC News. May 6, 2020. Accessed September 30, 2021.

27. Linker D. Coronavirus is revealing a shattered country. 

. July 1, 2020. Accessed September 30, 2021. 

28. Americans will always do the right thing — after exhausting all the alternatives. Quote Investigator. Accessed September 30, 2021.

Three forces have converged to generate the perfect storm of civic irresponsibility.

How American Culture Created the Pandemic of the Unvaccinated 

Health care workers are at high risk for contacting or spreading contagious diseases. Even so, only half of health care workers have traditionally been vaccinated for the common seasonal flu. The percentage of psychiatric professionals who do so is unknown, as far as I can tell.

The only approach that seems to produce near-total compliance is mandatory vaccination. The power of the government to mandate vaccination “for the public good” has long been recognized by the Supreme Court.

Ethically, the Hippocratic oath conveys the need to try to “do no harm.” COVID-19 unvaccinated health care workers inevitably will do harm to colleagues, patients, the public, and loved ones.

Psychiatrically, we can help to find the appropriate amount of fear and understanding of reality in regards to the pandemic. We know how to positively reframe inappropriate negative thinking as we do in cognitive behavioral therapy. Given our experience with establishing therapeutic alliances with reluctant patients, it very well might help to establish a federal mental health team to guide reassuring messaging.

That takes us to a week ago, when the New York State deadline for health care workers getting vaccinated expired. Enough did get vaccinated to apparently avoid staffing shortages. There have been peaceful counter protests. I do not know if they got input from us, but I do hope we in mental health care become increasingly vaccinated one way or another, and wear our masks where we scientifically should. That is the ethical way.

Getting vaccinated and wearing a mask: the ethical way. 

To Mandate or Not to Mandate Vaccination? That is a Social Psychiatric Question

We all know psychiatry, and the health care field at large, have been greatly impacted by the COVID-19 pandemic, but John J. Miller, MD, Editor in Chief of 

, shared a little bit more about how psychiatry will be impacted in a postpandemic world during his presentation at the 2021 Annual 

“This virus has impacted virtually everybody,” said Miller wistfully. “The health effects of the individual who’s infected. The effects on family and friends of the infected individual. Individuals who modify their life in many ways because of a fear of getting infected. The stress, the unknown, the guilt, the anxiety of first responders. Health care providers often with overwhelming situations and not enough staff and too many patients.”

Miller shared a range of psychiatric symptoms that can occur directly due to COVID-19, as published in the 

 in early 2021. The list includes anxiety, depression, insomnia, fear, grief, phobias, posttraumatic stress disorder, social avoidance, increased substance abuse, suicidality, psychosis, and obsessive compulsive disorder.

He also shared a list specific to children and adolescents, based on a study published in 

 Out of 29 studies and 81,000 participants, 25% had clinically elevated depression, 20% had clinically elevated anxiety, and it was estimated that the degree of depression and anxiety in older children was double that of what would be expected prepandemic.

More disturbingly, Miller shared that COVID-19 could have a more direct effect: “This is clearly in the early stages of understanding, but based on what is out there now, we do know that it appears the virus can directly attack the brain.”

The Sars-COV-2 virus can access the brain through 3 tracks: the olfactory tract, the vagus nerve, or the trigeminal nerve, Miller explained. If Sars-COV-2 traverses the olfactory mucosa, it can cause the loss of smell while gaining access to the brain.

Miller shared a number of ways the virus can damage the brain. Damage to endothelial cells that abut the brain can lead to inflammation in thrombi and thus cause direct damage to the brain. Astrocytes, the primary type of brain cell affected, play an important role in brain fog and fatigue. Also well known is the neuroinflammation caused by COVID-19, which can cause an aggressive, systemic cytokine storm in serious COVID-19 infections. This storm can damage the blood brain barrier and make it more permeable, allowing in more cells and potential active viruses. Furthermore, Miller shared, cytokines in the brain can activate microglia and enact astrocytes, which put a further stress on the brain and can result in damage.

“In an ideal situation, there would be a recovery. But sometimes there’s a partial recovery, and other times, there's no recovery, such as if there was a subsequent stroke,” Miller added.

Substance abuse is another of Miller’s concerns with COVID-19. The stress, trauma, and grief, compounded by a reduced access to substance use disorder treatments, caused a rise in drug overdose deaths with more than 92,000 deaths according to the National Center for Health Statistics.

Furthermore, the antivaccine movement poses a significant threat to the safety of the general populous, Miller fears, as compounded by the editorial written by Joseph Goldberg, MD, featured in the 

“When these mass groups with mass hysteria mistrust, or frankly develop pure paranoia and the secondary behaviors intrude into the realm of public safety, society needs to engage in a serious ethical debate as to what actions should be taken to protect the harm or risk to the many from the distortions, actions, or lack thereof, of from the few,” said Miller.

Miller called COVID a “modern medical challenge of the first order,” as described by authors in a 

 one we anticipate will continue affecting psychiatry and the health care field as a whole for many years to come.

As to recommendations, Miller suggested individuals get vaccinated, educate others compassionately and accurately, and increase the number of vaccines available to the global community—that way, everyone can be safe.

Are you interested in hearing more like this? There’s still time to 

2. Racine N, McArthur BA, Cooke JE, et al. 

Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis.

3. Rossen LM, Ahmad FB, Anderson RN, et al. 

Disparities in excess mortality associated with COVID-19 - United States, 2020.

How should psychiatry respond to COVID-19 anti-vax attitudes?

Understanding long COVID: a modern medical challenge.

Psychiatric Times' Editor in Chief shared some insights and data on the psychiatric impacts of COVID-19, and what we might expect in the future. 

Hello, From the Other Side: Psychiatric Complications in a Future Postpandemic World

“For us to say that this has been a time of change, stress, and loss is an understatement,” 

. “Because the COVID pandemic has fundamentally taken the rug from underneath our feet, change the fabric of how we live our lives, how we work, and understandably, the amount of change and stress is very palpable and the amount of loss is even more.”

Iglewicz, assistant clinical professor of psychiatry at the University of California at San Diego, shared insights on the impact of COVID-19 on health care workers, specifically looking at burnout. In addition to the regular stressors, health care professionals faced many challenges during the height of the pandemic. Work-life balance was disrupted, there were longer shifts, and fears about personal risk and risk to family members abounded, she explained. There also were increased home-life demands associated with children’s virtual school, caregiver burdens, and a general sense of lack of control.

A recent study of COVID-19 and stressors looked at close to 21,000 health care professionals between May and October 2020 and found alarming rates of burnout and stress, Iglewicz reported.

 Investigators found that 61% feared exposure transmission, 38% reported anxiety or depression, 43% reported work overload, and 49% reported burnout. Not surprisingly, there were some gender and racial differences, she said. Higher rates of burnout were found among females and those from minoritized backgrounds.

Despite the pandemic’s impact on stress, Iglewicz reminded attendees that burnout has been an issue for years, and it has even garnered media attention due to its very real consequences. In health care, burnout can impact patients, the health care system, and the induvial, she explained. In patient care, burnout leads to worse patient outcomes and increased medical errors, Iglewicz said. On systems level, there is a drop in productivity as well as a great cost in replacing clinicians. On an individual level, burnout can lead to substance use and abuse, depression and suicidal ideation, and even an increase in motor vehicle accidents, she said.

Fortunately, there was some improvement in burnout found before the pandemic, Iglewicz explained. She shared details from a study by Tait D. Shanafelt, MD, and colleagues, that looked at rates of burnout in 2011, 2014, and 2017.

 There were a lot of interventions between 2014 and 2017, she noted, and, accordingly, Shanafelt et al found a slight decrease in burnout reports in the 2017 data. Interestingly, she said psychiatrists had some of the lowest reported rates of burnout. “But it's still unacceptable,” Iglewicz added, “as about 50% of psychiatrists are experiencing burnout.”

“Maybe we have gotten some of this wrong,” Iglewicz said of the attempts to address burnout. She used the analogy of the straw that broke the camels back. “We put our focus on trying to make that camel stronger. Tell the camel to meditate, teach that camel to be more mindful, tell that camel: You better sleep more, better eat healthier. Encourage that camel to exercise, and coach that camel to be more resilient.”

“We realized that there was a flaw,” she explained, “because we were essentially blaming the victim.”

Then the shift to address burnout fell on the habitat, Iglewicz said. Things like electronic health records, excessive workloads, and clerical burdens were addressed. Although these are important aspects, it still involved finger-pointing. She suggested it would be more productive to move to an understanding and self-introspective perspective.

Since words have meaning, Iglewicz entertained the idea of changing the term 

. She suggested “loss of meaning.” Essentially, folks enter medicine with idealistic notions, and now their work no longer matches those notions and they have a loss of meaning in their work

Similarly, she suggested considering burnout as unresolved grief. In other words, she said, there is so much to mourn in terms of why people entered the medical field. With this definition, it allows you to face the limitations and begin to accept it. 

Finally, burnout in the health care field may be code for depression, she suggested. There is no stigma associated with the term 

; it is tossed around casually in conversations, the media, and the like. There is still, however, stigma associated with depression. Looking at the issues associated with both, Iglewicz said there really is a very fine line between depression and burnout.

So, what can be done to address burnout, loss of meaning, and unresolved grief? The first step, she said, is that clinicians must become reformed perfectionists. “The same traits that helped us get into medical school comes with a price,” she said. She noted perfectionism, detail-oriented focus, desire for control, empathy, and competitiveness. Whenever possible, she said try to turn down the level perfectionism, even in your personal life. Let the struggles, hurdles, and adversities refine you, not define you, she explained.

It is also important to engage in system level change, she added. And, although it should not be a singular focus, self-care is indeed important, she said.

She then shared 5 antidotes to burnout: find a health relationship with anger, pick your battles, practice ordinary kindness and compassion, support one another and seek out support when needed, and live with contradictory truths.

Iglewicz took the opportunity to conclude her talk with a contradictory truth that rings very true on the subject of burnout: “We're all stronger than we know. Simultaneously, we are all more vulnerable than we'd like to acknowledge.”

1. Prasad K, McLoughlin C, Stillman M, et al. P

revalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: a national cross-sectional survey study

2. Shanafelt TD, West CP, Sinsky C, et al. 

Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017

Health care workers have always been prone to stress and burnout, and the COVID-19 pandemic exacerbated the issue. What do we know about burnout and how can we prevent and address it? 

Finding Antidotes to Burnout Through Contradictory Truths

On the National Mall in Washington, DC, there is an artistic memorial installation titled “In America: Remember.” Over 660,000 white flags have been planted in order to honor and visualize every American who has so far died from COVID-19. This number surpasses the estimated loss of lives from the Spanish flu of over a century ago but, of course, the percentage of those who have died is much less in our time because our population is so much greater, which should remind us of the success of the vaccines and masking.

I have not seen it in person and it is only on display until October 3rd, but just looking at a photograph of them makes those numbers feel much more than just numbers. They do not seem to me to be like white flags of surrender, but of connection. It is as if the flags are waving goodbye, a necessary temporary gravesite that can remind us of the enormity of what has been lost. Like the loss of a loved one, we must adequately mourn our fellow citizens of all colors to be able to move on successfully as a society. Please take a minute to do so.

What COVID-19 memorials have you witnessed? Share your thoughts with 

The National Mall is currently filled with over 660,000 white flags memorializing those lost to COVID-19. 

COVID-19