Cullud Wattah and the Psychiatric Toll of the Ecological Flint Water Poisoning

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“Lead in the Water

Lead in the water

Lead in the water, children

God said he’s gonna trouble the water . . .”

- revised spiritual “Wade in the Water,” adapted for “Cullud Wattah”

Three thousand two hundred twenty. That is the number of days for the Flint water crisis flashed at the end of a play my wife and I just saw at Stages Theatre in Houston.

It is Black History Month, but the history of the Flint, Michigan water crisis is still playing out almost a decade later, and the victims have mainly been Black Americans. All this became clearer to me when we saw the play “Cullud Wattah”—colored water in “proper” English—in Houston.

It is a play by a Black writer and Black actors, and movingly presents the complexity of the daily catch-22 moral choices of a 3 generation poor Black family of all women in Flint as the lead water crisis emerges after mysterious illnesses in children following a change in water source to save money. (Does this sound at all like the change to managed care for mental health to save money?) What was so surprising to me was that the crisis is still in process.

By 2016, the lead levels were going down to safer levels, but Michigan’s State Environmental Agency has noted that the lead level has been once again increasing over the last 2 years. The last time the lead levels were this high was 2016. Remember that among other harms to health, there are neuropsychiatric ones, including an increased vulnerability to violence from higher lead levels. Moreover, the basic point is: there is no safe level of lead in drinking water. Other cities, including Houston and Honolulu, have lead water problems, and other cities, like my hometown of Milwaukee, still have lead paint concerns.

In an update on September 20, 2022, CNN Health reported on the long-term consequences for mental health as conveyed in the JAMA Network Open: “Prevalence of depression and posttraumatic stress disorder in Flint, Michigan, 5 years after the onset of the water crisis.”¹ Even before the pandemic, Flint residents reported extremely high levels of posttraumatic stress disorder and depression, higher even than that in postdeployment military in the Middle East. Half of the positive responders were Black. These higher rates also correlated with less trust of authority, including medical. Some citizens say they will never drink Flint water again. How much psychiatric treatment has been provided is unclear.

Similar mental health repercussions seem to be emerging in the year and a half of the Jackson, Mississippi water crisis. Now, the toxic railway crash problem in Ohio is eliciting less public trust.

Although such environmental crises receive acute media—and sometimes psychiatric—attention, interest wanes over time, especially when poorer communities are involved. That fits our human nature tendency to be hard-wired to respond to acute perceived risk, but not so much to ongoing and slowly developing risk, as well as to blame the less powerful “other.”

Certainly, these ecological risks need to be assessed in clinical care, especially in children. We also have a social ethical responsibility to help address community mental health needs. That community can be local, national, or international. Connecting such environmental concerns to those of climate change is another justification for adding eco to our bio-psycho-social model.

Dr Moffic 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 related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

Reference

1. Reuben A, Moreland A, Abdalla SM, et al. Prevalence of depression and posttraumatic stress disorder in Flint, Michigan, 5 years after the onset of the water crisis. JAMA Netw Open. 2022;5(9):e2232556.