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“Let me be very clear: The scenes of chaos at the Capitol do not reflect the true America. This is not who we are.” —

Psychiatrists need no lecture on the concept of “denial.” After all, it was Anna Freud who first identified and explained this well-known defense mechanism, over 70 years ago.

 In brief, as Dr Rui Miguel Costa put it in a recent paper,

“By denial, individuals cope with stressors by not acknowledging their reality and/or their consequences. This can range from common resistance to accept consequences of certain events to psychotic denial, in which even denial of physical aspects of immediate surroundings can happen. In a broader sense, denial may include negation, constructing fantasies to replace the stressor, minimizing the stressor, and maximizing what could make one dismiss the stressor . . .”

The days and weeks leading up to the egregious mob takeover of the U.S. Capitol building suggest that denial was very much in evidence, among multiple persons and agencies. In retrospect, it seems clear that authorities at several levels of government either ignored or denied the reality of the nightmare that was about to unfold. Thus, Alex Newhouse—an expert on far-right extremism—

“The attack on the U.S. Capitol building on January 6 was shocking, but no one following right-wing activity on social media should have been surprised. The attempt by President Donald Trump’s far-right supporters to violently stop Congress from certifying the Electoral College vote and formalizing Joe Biden’s election victory was consistent with their openly expressed hopes and plans . . . By surveying social media data from mid-December to Jan. 5, I discovered thousands of posts referring to the planned protests as if they were a coming revolution. In some circles, the event became synonymous with a final battle . . . when ordinary Americans would take back the government.”

In the aftermath of the Capitol riot, it was left to novelist Francine Prose to express 

“Perhaps the most powerful shocks, the most painful surprises, are the ones that we saw coming yet refused to believe would happen. Our ability to fear something and, at the same time, assume it will never occur is one aspect of human nature that seems particularly ill-suited to our continued wellbeing and survival . . .”

Denying the American Legacy of Seditious Violence

President-elect Biden’s speech to the nation on January 6 was, in my view, heartfelt and moving. I am among those who would dearly like to believe that the unspeakable actions of the Capitol building mob “. . . 

do not reflect the true America. This is not who we are.”

 And yet,with all due respect to Mr. Biden, I believe our history as a nation suggests that the violent takeover of the Capitol building does indeedreflect 

 of “who we are” as a nation. To claim otherwise, even with noble intentions, is to engage in some degree of denial.

As Professor of History Shannon M. Smith recently wrote, the violent takeover of the Capitol is part of “. . . a long history in the U.S. of local, state and national political leaders encouraging white supremacist groups to challenge or overthrow democratic governments . . . [and] today, white supremacists appear to interpret politicians’ remarks as support for their cause of a 

 to create a white-dominated government.”

To cite but 1 example of the “long history,” there was the coup and riot staged in Wilmington, NC, in 1898. As Brent Staples explains:

“The uprising was engineered by white supremacists who unseated a government that had been elected by an alliance that included black citizens and white progressives. Scores of black citizens were killed during the uprising . . . and prominent blacks and whites were banished from the city under threat of death. White supremacists eventually hijacked the state government, stripped black citizens of the right to vote and brought black political participation to a close.”

In short, scenes of men with Confederate flags parading through the defiled Capitol building last week—though unprecedented—should not be seen as merely an aberration in our history. But is this sort of event really representative of “who we are,” to use Mr. Biden’s phrase? The answer is complex. In my view, the tensions and animosities that led to the American Civil War have never been fully resolved and continue to surface to this day. Journalist Edward Ball, author of 

“We cannot come to terms with the Civil War because it presents us with an unacceptable kind of self-knowledge. We think, as Americans, that we possess a heroic past, and we like to think of our history as one of progress and the spread of freedom, even transcendence. But the Civil War tells us that we possess a tragic history instead, over which we must continually paste a mask of hope.”

Indeed, we might redefine “denial” in the terms Ball uses: the defense mechanism whereby we bury “an unacceptable kind of self-knowledge.” In this broader sense, denial grades into its kindred defense mechanism, 

And yet, “who we are”—as a country and a people—is not fixed in the stars or written in stone. If the American experience has taught us anything, it is that we can address and correct our past mistakes; otherwise, there would be no 13th Amendment or Civil Rights Act. The process of change is often slow and painful--and, as the unconscionable attack on the Capitol has demonstrated, sometimes violent. Yet in the end, I count myself a believer in Martin Luther King’s teaching: “The arc of the moral universe is long, but it bends toward justice.”

 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 

Share comments with your colleagues by emailing 

. Comments may be shared online pending review and editing for style. 

The views expressed in this article are those of the author and do not necessarily reflect the opinions of

1. WATCH: President-elect Joe Biden delivers remarks on situation in DC. WSLS 10. Accessed January 12, 2020. 

https://www.wsls.com/news/politics/2021/01/06/watch-live-president-elect-joe-biden-speaks-on-economy/

. New York: International Universities Press; 1946.

3. Costa RM. Denial (Defense Mechanism). In: Zeigler-Hill V, Shackelford T, eds. 

Encyclopedia of Personality and Individual Differences.

 Cham, Switzerland: Springer; 2017. https://doi.org/10.1007/978-3-319-28099-8_1373-1

4. Newhouse A. Far-right activists on social media telegraphed violence weeks in advance of the attack on the US Capitol. 

 January 8, 2021. Accessed January 12, 2020. 

https://theconversation.com/far-right-activists-on-social-media-telegraphed-violence-weeks-in-advance-of-the-attack-on-the-us-capitol-152861

5. Prose F. Anyone shocked by the US Capitol attack has ignored an awful lot of warning signs. 

https://www.theguardian.com/commentisfree/2021/jan/11/us-capitol-attack-warning-signs-charlottesville-michigan

6. Smith SM. US Capitol protesters, egged on by Trump, are part of a long history of white supremacists hearing politicians’ words as encouragement. 

 January 7, 2021.Accessed January 12, 2021. 

https://theconversation.com/us-capitol-protesters-egged-on-by-trump-are-part-of-a-long-history-of-white-supremacists-hearing-politicians-words-as-encouragement-152867

7. Staples B. When Democracy Died in Wilmington, NC. 

 January 8, 2006. Accessed January 12, 2021. 

https://www.nytimes.com/2006/01/08/opinion/when-democracy-died-in-wilmington-nc.html

8 Ball E. An American Tragedy. The Opinionator. 

 April 11, 2011. Accessed January 12, 2021. 

https://opinionator.blogs.nytimes.com/2011/04/11/an-american-tragedy/

9. Dr Martin Luther King Jr. “Remaining Awake Through a Great Revolution.” Speech given at the National Cathedral, March 31, 1968.

What role does denial play in the collective American psyche?

Denial, The Capitol Takeover, and a Tragic American Legacy

As psychiatrists, we are constantly challenged by complex patients with a wide variety of clinical presentations. In fact, 2 patients with the same condition are never the same. Yet for all this diversity, there may be some common features. I propose that cognition is paramount in this respect.

 is a word that we use frequently, perhaps without pondering all that it entails. It is an important human attribute that has played a crucial part in our evolution. Yet the concept is so broad as to span many fields, from philosophy to psychology and the neurosciences. At the end of the day, we can all agree that cognition is essential for human fuctioning and flourishing.

Cognition involves many processes, both conscious and 

s. Different aspects include introspection, memory, learning, reasoning, perception, attention, problem solving, and the use of language. In some ways, this sounds so abstract that it is difficult to make practical sense of it. This is why I often reflect on my interactions with patients and what they have taught me.

On any given day, I see patients who are asymptomatic for their condition, yet they are certainly not enjoying a robust quality of life. For instance, one gentleman is without a doubt brilliant. He reads constantly and voraciously, and he can engage in a detailed discussion of various topics. After deciding that he wanted to read scripture in the original language, he learned several languages.

This patient is in remission from bipolar disorder. His scores are extremely low to nonexistent on the Patient Health Questionnaire (PHQ) 9, General Anxiety Disorder (GAD) 7, and Young Mania Rating Scale. Yet, he lacks significant organizational skills and has great difficulty in prioritizing tasks. This manifests in an extremely cluttered house, which is in shambles since his last manic episode approximately 2 years prior. Furthermore, this patient is obese and has increased inflammatory markers.

Another patient, a mechanical engineer who has been through extensive schooling and is given to preciseness, was seen by a neurologist who focuses on neurodegenerative disorders. His quantitative magnetic resonance imaging (MRI) showed no degeneration in his hippocampus. In addition, 

 showed no evidence of any memory disorder. He presented complaining of “adult-onset/attention deficit disorder.” Yet, on further exam, we realized his cognitive difficulties were due to depression.

Earlier I saw a woman who was morbidly obese. She very much wanted bariatric surgery and knee surgery for the immense pain. Her other physicians were in agreement with this plan. In the processes of her workup, she saw a sheet of labels with her name—the ones that are commonly used to identify information on documents or containers with biological specimens. The patient incorrectly deduced that each sticker was meant for a different test tube of blood. She thought the staff was going to draw at least 12 tubes; she began to think that she was going to be admitted against her will. It became clear that this patient was delusional; she was drawing incorrect cognitive conclusions that were negatively affecting her progress.

In addressing cognition, it is important to remember that psychotherapy, in addition to medications, can be an effective tool. Studies have demonstrated physical changes in the brain that occur as a result of effective psychotherapy. The work of 

, for instance, elucidated the synaptic changes related to memory and learning. (This won him, along with 2 others, the Nobel Prize for medicine in 2000.)

It is hard to overstate the importance of cognition in our day-to-day lives, especially as it relates to our work as psychiatrists. It is my hope that you will enjoy this 

 on cognition and that it serves as an appetizer to awaken a deeper hunger and curiosity.

is the medical director, Division of Neuropsychiatry, at Dent Neurologic Institute, and the medical director, Addiction Services, at Brylin Hospital in Buffalo, NY. The author(s) report no conflicts of interest concerning the subject matter of this article. ❒

In psychiatry, 2 patients with the same condition are never the same.

Diverse Patients, Common Ground

This article was originally posted on December 20, 2017, and has since been updated. -Ed

A therapeutic approach to the holiday wish list.

Psychiatry Comic: Santa Therapy

“A time to tear down and a time to build up.”

Most of us entered January 2020 with the fresh hope that accompanies a new year. Little did we know that a new virus was percolating across the other side of the globe that would have a tremendous impact on so many aspects of our lives. Since those early days, attitudes have changed, with many individuals reporting that 2020 has been the worst year of their lives. Fortunately, history has taught us that bad things come and go. For instance, the Biblical wisdom from the book of Ecclesiastes teaches that off years happen. In one translation, the third chapter of Ecclesiastes begins: “Everything has its moment. There is a time for everything beneath the heavens.”

Since Ecclesiastes is in the public domain, Pete Seeger famously rearranged the words for the song he wrote in the late 1950s—“Turn! Turn! Turn! (To Everything There Is a Season).” In 1965, it was 

 and became an international hit. The only new words in Seeger’s song are the phrase “Turn! Turn! Turn!” and the closing line of “a time for peace, I swear it’s not too late.” Those additional words seemed crucial for the controversial Vietnam war and ring true again for our present contentious time.

Most views of world history consist of a linear or circular model, but it may be a spiral model, with some progression forward peppered with occasional slips backward. One example of this spiral theory is the history of violence. Although a case can be made that 

, there have been periods of intense escalation (eg, World War II and the Holocaust).

 As we review some of the major social psychiatric challenges from 2020, we may still find reasons for optimism in 2021 as we move upward again through the spiral.

So many of the events in the adverse half of Ecclesiastes’ verses seem timeless and like a perfect fit for 2020.

It was a time to die. Large numbers of loved ones died from the coronavirus.

It was a time to kill. The news and social media shed light on the unjust brutality toward Black Americans.

It was a time to avoid embracing. The contagious nature of coronavirus disease 2019 (COVID-19) necessitated social distancing.

It was a time to lose. With the pandemic-related lockdowns came the loss of jobs and livelihoods.

 has highlighted many social psychiatric problems. From the 

 these issues often intersected and caused additional problems. As this issue goes to press, we are dealing with the uncertainties of the presidential election and additional stress and anxiety. Yet, the upcoming presidential term is symbolic of a time for hope and renewed opportunities, no matter who wins. Indeed, our current social problems seem to resonate with the difficult times predicted in Ecclesiastes (

), but they also may be indicative of an expected move up the spiral.

If we look to the Chinese symbol for crisis, we see it represents both a danger and an opportunity. In that light, not everything has been completely negative from a social psychiatric perspective. For instance, quarantining gave some an opportunity for increased closeness with loved ones; yet, it also increased the risk for domestic violence and political conflict. Academic and other health care institutions used the opportunity to rise to the occasion to address the pandemic. Although this caused extra stresses, it may have also enhanced resilience. In reviewing some of the greatest psychiatric challenges from 2020, it becomes clear there is still much for which to be grateful and 

There is no doubt the pandemic was a punch to the gut, and we likely will be dealing with medical, neuropsychiatric, emotional, and financial fallout for years to come. Yet, there are at least 2 reasons to be optimistic. First, we now scientifically know that wearing masks and practicing adequate social distancing significantly reduces the infection rate. The key is to psychologically convince enough of the public to do so.

The Group for the Advancement of Psychiatry (GAP) 

 A seeming politicization of the pandemic and masks is an obstacle to adherence. There are also other issues. Individuals may need to gradually desensitize their discomfort or trauma triggers to wear masks. GAP members noted the importance of reminding individuals that social strategies help everyone, just like stoplights and street signs.

Indeed, our field is uniquely suited to help the country by addressing the psychological factors associated with mask resistance. Many lives are still at stake, as 

 As of October 2020, approximately 50% of Americans were regularly wearing masks; projections note about 300,000 lives could be saved by the spring if we increase that percentage to 95%.

The passage of time is the second thing for which there is optimism. The last major pandemic, the Spanish flu, ended after about 2 years, even without therapeutics or a vaccine. A little patience may go a long way and, by the end of 2021, the pandemic will likely be less worrisome.

Racism, as we know, got intertwined with the pandemic. As is often human nature, society looked for blame and an outlet for the fears and frustrations at the onset of the pandemic. Because the virus originated in China, Chinese and Chinese-Americans became victims of harassment. Other minorities, such as Hispanic Americans and Jewish Americans, encountered rising hatred as well.

Because of socioeconomic inequities, we also discovered minorities were at higher risk for infection and death due to preexisting illnesses and social circumstances that made them more vulnerable. Black Americans, Native Americans, and other low-income minorities paid the price with their lives.

The nightly news also served as a racism wake-up call after videos showing police brutality against Black Americans surfaced. Although a comprehensive concept of racism was presented by the Kerner Commission in 1968, the issue was largely ignored after the civil rights gains of the time. This has resulted in the continued structural/societal, institutional, and individual racism of today.

In response, the American Psychiatric Association (APA) began to implement some organizational procedures to address racism internally and externally. There are critics who think the APA has not done enough, calling for the APA to 

 for their part in racism, as other guild medical organizations have done.

It is not a surprise to climate scientists that 2020 was not a good year for the environment. In the United States alone, we experienced a near-record number of hurricanes and unprecedentedly destructive wildfires in the west. Earlier in the year, unparalleled wildfires devastated part of Australia during their scorching summer season. Calls were made for the United States and Australia to help each other, and included requests for assistance from psychiatrists.

Thankfully, on the other side of the coin, there were some promising developments in the midst of the devastation. For instance, researchers found the dialectical approach can help the psychotherapeutic process with patients who have 

 There was also a turn toward using the traditional environmental knowledge and, especially in Australia, the focus on mirroring indigenous individuals’ desire for balance and protecting their environment.

Finally, the pandemic lockdowns reduced fossil fuel use and carbon emissions—a faint but important silver lining. The question remains: can these reductions be maintained when the pandemic is over?

Burnout is a common issue for all professions, especially during the pandemic, but 

 Physicians, including psychiatrists, have experienced a rising rate of burnout, which affects both patients and physicians. The burning out process starts in medical school and continues into residency and thereafter. Depending on the specialty and the measurement tool, 40% or more clinicians experience burnout; the APA’s survey indicated that the percentage is close to 

 Although we lack data on the pandemic’s impact on burnout, there is definitely a reason for concern—not just for clinicians and employees, but parents as well. On the other hand, we have also heard rewarding stories from clinicians, who took pride in the recognition of their dedication during the pandemic.

 The gratitude and outreach may help turn the burnout tide.

As we move forward, we can work on removing the barriers to self-care and encourage businesses and communities to make positive changes. For instance, there is the promise of reducing burnout and saving money by installing a chief wellness officer. We can continue to fight stigma, especially within the medical field. Our clinician colleagues in medicine and psychiatry should feel empowered, not dissuaded, to reach out for mental health care support.

Unfortunately, while we can identify some of these “social psychopathologies” (even without a formal classification system), we do not have the tools to treat them. Our treatment armamentarium for individual patients and small groups cannot readily be transferred to social problems. And yet, during 2020, some social processes that seem therapeutic have become a potential kind of social glue, like apologizing for racism.

 It is psychologically beneficial to apologize for doing something harmful to individuals, inadvertently or not. If that leads to forgiveness, all the better.

In South Africa, formal truth and reconciliation events helped prevent violence, allowing the country to come out of apartheid with a degree of social healing. We may need to leverage those strategies in the United States to address our current divisiveness. It might also help healing from the historical injustices of Native American displacement and Black slavery.

Similarly, we can take a page from research that shows the importance of collaborative care and integrating psychiatry into the rest of clinical medicine. It would be helpful to have a psychiatric expert who partnered with the surgeon general. In essence, it could be a psychiatric assistant to the surgeon general or, better yet, a psychiatric general. At the very least, we should increase our presence and further share and promote our knowledge of human nature with regards to societal issues.

As reported in the October 2020 article on election anxiety, many varieties of undue anxiety seemed to increase over recent years, and more dramatically in 2020. The same holds true for variations of depression, especially as we grieve the lost experiences, people, and opportunities. Substance use, abuse, and dependence remain a concern. The full repercussions of this year’s traumas will take time to emerge. While these increases may not reach the level of a mental health pandemic, millions of individuals are suffering emotionally as a 

At the same time as this increased need for mental health services, there have been limited advances in therapeutics. There is some promise from the new research on psychedelics, as discussed in a report from the 

2020 Annual Psychiatric Times® World CME Conference

 Underground micro-doses of lysergic acid diethylamide (LSD) have been used for self-help, with anecdotal evidence concerning its 

 Given that LSD and other psychedelics have been touted for eliciting a sense of cosmic connections, could they be of help in reducing our divisiveness and scapegoating?

On the positive side, we saw major advances in the integration and use of telepsychiatry, which was quickly and widely used to replace in-person visits for safety reasons. Historically, this modality was used in remote areas to help underserved populations. During the pandemic, telepsychiatry 

 clinicians to see where and how patients lived, meet members of their family (and pets), and connect with their patients on new levels.

The third chapter of Ecclesiastes suggests that difficulties do not last forever. Will 2021 turn around the spiral toward healing, building up, speaking out, bringing peace, laughing, and loving? Time will tell, but given what we have learned in 2020, it would seem that those in mental health care can promote these positive goals (

). There are clear examples of how we need to fulfill our ethical imperative to improve the health of our communities. Importantly, social psychiatric goals (such as those listed here) correlate with social justice, and new research suggests that countries with greater concern for social justice initiatives have 

And so we look to 2021 with optimism, which is often described as viewing the glass half full instead of half empty. In general, optimism has its own therapeutic repercussions for health and mental health, and it is part of the driving force behind the 

 A Jungian sense of optimism can occur amidst our country’s periodic chaos and conflict; an example of such is the innovation and renewal that followed 

 Nevertheless, optimism does need to be tempered with realism, as in the 

 Otherwise, it can lead to undue risk-taking, as the country witnessed during the early days of reopening during the pandemic.

Given the limitations of prediction, and that this article was written before the election results, the prognosis must be tentative and guarded, as it is for our individual patients.

Nevertheless, I am cautiously optimistic.

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 being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in ٢٠٠٢. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Kohelet: A Modern Commentary on Ecclesiastes. 

The Better Angels of Our Nature: Why Violence Has Declined. 

3. Tirado A. Surviving coronavirus: a psychiatrist’s personal journey.

4. Moffic HS, Bailey R, Clark F, et al. Dismantle racism in psychiatry & society. 

5. Moffic HS. Presidential election anxiety and the role of psychiatry. 

6. Moffic HS. While Australia burns: what psychiatrists can learn from each other. 

7. Buckley P. Resilience and being thankful. 

8. Clegg K, Brenner G. To mask or not to mask? Why is this even a question? 

October 5, 2020. Accessed November 3, 2020. 

https://www.psychiatrictimes.com/view/to-mask-or-not-to-mask-why-is-this-even-a-question-

9. Reiner R, Barber R, Collins J, et al. IHME COVID-19 Forecasting Team. Modeling COVID-19 scenarios for the United States. 

10. Moffic HS, Bailey R. Answers to your questions on dismantling racism. Psychiatric Times. October 1, 2020. Accessed November 3, 2020. 

https://www.psychiatrictimes.com/view/answers-to-your-questions-on-dismantling-racism

11. Lewis JL, Haase E, Trope A. Climate dialectics in psychotherapy: holding open the space between abyss and advance. 

12. Summers RF, Gorrindo T, Hwang S, et al. Well-being, burnout, and depression among North American psychiatrists: the state of our profession. 

13. LoboPrabhu S, Summers R, Moffic HS, eds. 

Combating Physician Burnout: A Guide for Psychiatrists. 

American Psychiatric Association Publishing, 2020.

14. Pies R. Is the country experiencing a mental health pandemic? 

15. Kuntz L. The new frontier: psychedelics as treatment. Psychiatric Times. October 16, 2020. Accessed November 4, 2020. https://www.psychiatrictimes.com/view/the-new-frontier-psychedelics-as-treatment

16. Waldman A. A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life. Knopf; 2017.

17. Duerr HA. Making telepsychiatry work for you and your patients. 

 May 22, 2020. Accessed November 6, 2020. 

https://www.psychiatrictimes.com/view/making-telepsychiatry-work-you-
and-your-patients

18. Di Martino S, Prilleltensky I. Happiness as fairness: the relationship between national life satisfaction and social justice in EU countries. 

Learned Optimism: How to Change Your Mind and Your Life.

Cultural Complexes and the Soul of America. 

In Love and War: The Story of a Family’s Ordeal and Sacrifice During the Vietnam Years, Revised and Updated. 

The field of psychiatry is uniquely suited to address the psychological factors associated with the past year (and what lies ahead).

An Optimistic Prognosis for 2021

 interviews Omar Reda, MD, about international medical graduates (IMG) and his own personal and professional journey. In this podcast he discusses:

1. His childhood and medical training in war-torn Libya

2. The challenges facing immigrants who want to become doctors in the United States

3. How his colleagues, and the American medical establishment at large, can help IMGs realize their dreams

is a practicing psychiatrist, Providence Healthcare System, Portland, OR.

In their quest to become American doctors, international medical graduates face formidable obstacles. A psychiatrist from Libya explains how his colleagues can help them along the way. 

The Road Less Travelled: An Immigrant’s Story

 determined everyday usage of social media adversely affects a person’s well-being. Researchers examined if social media impacts 3 components of subjective well-being—positive affect, negative affect, and life satisfaction—and found how a person uses social media that impacts their overall happiness.

“Social network sites are an integral part of everyday life for many people around the world,” lead author Derrick Wirtz, PhD, an associate professor of teaching in psychology at the Irving K. Barber Faculty of Arts and Social Sciences, said to the press. “Every day, billions of people interact with social media. Yet the widespread use of social network sites stands in sharp contrast to a comparatively small body of research on how this use impacts a person’s happiness.”

The study focused on the usage of 3 popular social media sites: Facebook, Twitter, and Instagram. Participants were monitored over a 10-day period, and it was found that those who used social media everyday had an increased negative affect, and therefore lower well-being. As to why social media had such a strong negative affect, researchers suspect social comparison, where users compare themselves to other users.

While people have turned to social media during the coronavirus-19 (COVID-19) pandemic to reduce feelings of isolation, Wirtz states that social media usage increased participants’ feelings of loneliness.

“Today, the necessity of seeing and hearing friends and family only through social media due to COVID-19 might serve as a reminder of missed opportunities to spend time together,” Wirtz explained.

Offline social interaction had the opposite effect: users’ positive affect increased, and negative affect decreased. Wirtz therefore recommends phone calls or safe, face-to-face interaction over social media.

So what should you tell patients about using social media responsibly, particularly in this COVID-19 era?

Wirtz and colleagues offered the following tips to share with patients:

- Resist comparing yourself to others on your feed.

- Use the sites to directly interact with friends and family (ie, to find a time to talk in-person, obviously with proper precautions and gear).

- Reduce your day-to-day use, if possible. 

Wirtz offered this final advice: “We need to remember how we use social media has the potential to shape the effects on our day-to-day happiness.”

1. Wirtz D, Tucker A, Briggs C, Schoemann AM. How and Why Social Media Affect Subjective Well-Being: Multi-Site Use and Social Comparison as Predictors of Change Across Time. 

https://link.springer.com/article/10.1007%2Fs10902-020-00291-z

2. University of British Columbia. It’s not if, but how people use social media that impacts their well-being. News release. November 2, 2020. 

https://www.newswise.com/articles/it-s-not-if-but-how-people-use-social-media-that-impacts-their-well-being

Have you chatted recently with your patients about their social media use? This study shows how and why it is important. 

Is Social Media Making Your Patients Unhappy? 

Not only in America, but throughout the world, difficult conversations are taking place in many homes. Behind closed doors, children are exposed at early ages to discussions about heavy topics like violence, hate, and human cruelty.

I am blessed to have three daughters. I try to create a safe and sane home for them, but I have never imagined engaging them in some of these talks, especially here in the United States, and in the 21st century.

When I moved to Portland, Oregon in 2009, I thought the city’s nickname (the Rose City) was a sign that things would be much safer and more comfortable for my family. Similarly, my wife believed that moving from the southern to the northwestern part of the country would make things easier for us as 

But shortly after arriving, a young Somali boy was accused of planning a terrorist attack in one of the city’s busiest spots, the Pioneer Square. We found ourselves working with community leaders and the Muslim youth on topics like emotional safety and well-being, how to be a proud American Muslim, strengthening family ties, and improving the relationship between the community and its neighbors and law enforcement agencies.

Fast forward to 2011, a bloody civil war started in my home country Libya. I left my small immediate family behind to care for my extended family overseas, trying to heal some of the many psychosocial wounds of that protracted conflict. I lost friends and loved ones to violence and extremism. My wife and children had to live through periods of uncertainty and high anxiety every time I boarded a plane and partook in that dangerous journey.

We thought and prayed the new decade would bring a better energy, but the year 2020 has been one of the most challenging years of all. Here in Oregon we have been struggling to breathe, literally and metaphorically. It is not only the threat of the 

 (COVID-19) to our respiratory system, but also the systemic knee of injustice on the necks of our black brothers and sisters and the wave of hate facing minorities and people of color. The mask can help with the former crisis, but unmasking is what is needed for the latter.

It became the norm to talk with kids about their identity and self-worth, about micro- and macro-aggressions, about speaking up on behalf of the voiceless, but also about how they can defend themselves when someone decides to attack them verbally or physically. After the Portland max train stabbing incident and the New Zealand mosque shooting, we spent time and energy brainstorming ways on how to stay alive and feel safe at our places of social gatherings and worship. Trauma steals precious moments and impacts the potential for beauty.

I recently participated on a panel discussion about combating hate. A young black female stated that, “at least [things] are not as bad for this generation as it was for our fellow citizens in the 1950s and 60s.” That really broke my heart. Just because hate and violence are “not as bad,” does not mean things are OK. Children should not have to settle for a dysfunctional world.

“The talk” we thought we would have with our children is about how to survive the emotional turmoil of puberty. In the black community, that talk is also about how to stay alive in America. In the Latino community, it may be about the immigration system. In the Muslim community, it may be about terrorism. Hate is horrible, and it not only makes survivors doubt their own beauty, but it also makes us miss out on each other’s beauty.

We thought COVID-19 was only going to impact our ability to breathe, but then Mr Floyd’s death reminded us of the ugly pandemic of oppression. In Oregon, the smoke of the wildfires stirs different discussions about existential themes, like our relationship with God and the meaning of life.

Is it bad that our children are growing up very quickly and having these mature conversations at a young tender age, or is that the new norm? My hope is that trauma will eventually produce a more resilient generation and a more compassionate and cohesive society, I believe that many trauma survivors become better humans not despite, but because, of their trauma stories.

is a practicing psychiatrist in Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article.

This article was originally posted on September 21, 2020, and has since been updated. -Ed

With the state of the world, there are so many difficult conversations about racism, hatred, and violence that we need to have with our children. 

Behind Closed Doors 

Spooky or cute? Scary or whimsical? What do you see in this image when you think about Halloween? 

Scary or sweet? Read about the value of nonverbal communication and have some spooky fun.

Cultural Psychiatry