Exploring the Connections Between Mental Health and Our Environment

SPECIAL REPORT: PSYCHIATRY & THE ENVIRONMENT

“True transcendence always includes the previous stages, yet somehow also reshapes and expands them.”

—Richard Rohr, Franciscan friar

Since its introduction in the early 1970s, psychiatrists have relied on Engel’s biopsychosocial model to understand the influences of nature and nurture, the biological predispositions, the psychological organization, and the relationships that have shaped whom a patient has become. Like the proverbial fish in the water, we have taken for granted the health of the medium in which they and we swim: the sun, atmosphere, air, food, water, oceans, warmth, and energetic reactions that support our thriving.

Outside psychiatry, however, the biopsychosocial perspective has been expanding since the 1960s. The ecopsychological perspective¹ has emphasized that human consciousness is in nonhierarchical, codependent continuity with the large ecological and cosmic consciousness(es) of nature. Socioecological theory² has conceptualized the individual in a series of broader sociological and ecological systems than those of immediate relationships.

Five years ago, in this journal, H. Steven Moffic, MD, called on psychiatry to expand our model—to give it a name like “bio-psycho-social-environmental” or “bio-psycho-eco-social” to acknowledge the interdependency of mental health and environmental health.³ Since then, our awareness of the direct impacts of poor environment on the brain has only grown as global warming has advanced despite literally 150 years of awareness of the impacts of carbon-based fuels on the atmosphere.

We now know that we are more violent when it is hot outside,⁴ that the gains of our suicide prevention programs will be wiped out by global warming,⁵ that our rates of dementia and autism double when we expose our brains to traffic-related air pollution,⁶ that wildfires lead to more prescriptions for psychiatric medications,⁷ that our patients die more in the heat, that the micronutrients that are increasingly less prevalent in rapidly grown foods have significant impacts on depression and psychosis,⁸ and that there are microplastic shards everywhere in our environment and our bodies.⁹

These microplastic shards are in our breast milk, protruding from atherosclerotic plaques and increasing the risk of myocardial infarctions, and, in animal models, causing Parkinson disease-like changes in the brain.^9,10

In honor of this Earth Day of April 22, 2024, the articles in this Psychiatric Times Special Report highlight the relationship of health to the environment. They encompass the impacts of climate change and food additives, and the disparities of health for global and vulnerable populations as we inflict more and more damage on the planet.

As our awareness of environmental impacts grows, our assessment model and our professional response must grow in kind. We must move toward an inclusion of the environment in every patient assessment and embrace our duty of care toward the planet in our medical ethics and personal actions as leaders and role models in our communities.

Dr Haase is physician director for Carson Tahoe Regional Medical Center and chairs the climate committee for the Group for the Advancement of Psychiatry. She is also the climate editor for Psychiatric Times.

References

1. Roszak T. The Voice of the Earth: An Exploration of Ecopsychology. Touchstone; 1993.

2. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32(7):513-531.

3. Moffic HS. Now’s the time for the bio-psycho-social environmental model. Psychiatric Times. November 2, 2017. Accessed March 15, 2024. https://www.psychiatrictimes.com/view/nows-time-bio-psycho-social-environmental-model

4. Hsiang SM, Burke M, Miguel E. Quantifying the influence of climate on human conflict. Science. 2013;341(6151):1235367.

5. Burke M, González F, Baylis P, et al. Higher temperatures increase suicide rates in the United States and Mexico. Nat Clim Chang. 2018;8(8):723-729.

6. Cacciottolo M, Wang X, Driscoll I, et al. Particulate air pollutants, APOE alleles and their contributions to cognitive impairment in older women and to amyloidogenesis in experimental models. Transl Psychiatry. 2017;7(1):e1022.

7. Wettstein ZS, Vaidyanathan A. Psychotropic medication prescriptions and large California wildfires. JAMA Network Open. 2024;7(2):e2356466.

8. Joe P, Petrilli M, Malaspina D, Weissman J. Zinc in schizophrenia: a meta-analysis. Gen Hosp Psychiatry. 2018;53:19-24.

9. Marfella R, Prattichizzo F, Sardu C, et al. Microplastics and nanoplastics in atheromas and cardiovascular events. N Engl J Med. 2024;390(10):900-910.

10. Gaspar L, Bartman S, Coppotelli G, Ross JM. Acute exposure to microplastics induced changes in behavior and inflammation in young and old mice. Int J Mol Sci. 2023;24(15):12308.