How To Think About the Future: It Is Called Futures Thinking, Part 2

Futures thinking refers to a large multidisciplinary field premised on the understanding that we are in dynamic relationship, right now, with multiple potential futures we can actively shape. See part 1 of this series for a concise summary of futures thinking.

In this article, we describe the modes of futures thinking and how they lend robust support for agency and possibility within psychiatry, using the example of climate change impacts on mental health, as it is our field of expertise. Such timely support can combat disillusionment and burnout for both patient and clinician, in response to societal crises.

Modes of Futures Thinking

We discuss here 5 modes of futures thinking based upon a particularly extensive review by Muiderman et al, further developed by Mangnus et al, and elaborated on through our addition of a mode we name as containment.^1,2 As depicted in the table, each mode of futures thinking activity has its functions and its pitfalls, requiring the additional use of the other modes.

Futures Thinking Mode 1: Map It

Quantitative probability models:

Quantitative probability models, based on known science and historical data, forecast particular futures unfolding under various circumstances. Service needs can be calculated in this mode, supporting climate adaptation. Work in this arena is represented by a study from Monsour et al, which calculated the increased risks of anxiety, major depression and posttraumatic stress disorder in south Florida from hurricanes under various climate futures scenarios.³

Quantitative modeling applied to climate mitigation activities within psychiatry is exemplified in a study by Wortzel et al, which calculated the carbon footprint of a single American Psychiatric Association annual meeting.⁴ The meeting produced carbon emissions equivalent to 22 million pounds of coal, owing largely to the air travel of attendees. Projections based on future meeting locations were used to indicate optimal locations for reducing this footprint.

Quantitative modeling within climate mental health could be extended to analyzing other adaptation strategies. For instance, with sufficient data, the effects of large-scale resilience trainings in reducing various mental health consequences under varying climate conditions could be determined.

These forecasts provide valuable information, assisting professionals and the public in overcoming denial. However, stark confrontation with predicted futures can be experienced as toxic knowledge (as Wallace-Wells said), engendering forms of distress that require ongoing psychological containment for both researchers and the public.^5-7

Map It Backwards

Backcasting:

Forecasts on their own lack creativity and agency. Backcastingcan provide some remedy employing many similar methods, but in an inverse fashion, beginning from a desired future and working backward to determine necessary intermediate conditions and how to get there.

For patients distressed by forecasts, backcasting can be explained, applying patients’ particular interests and skills within a backcasting process. For example, a patient may recognize that a necessary intermediate step to a desired future is a more prosocial society and may apply their talents to that end. Being agentically engaged is containing, though other ongoing sources of containment will also be required as obstacles and failures emerge.

Futures Thinking Mode 2: Try It On

Practicing with futures:

Practicing with futures takes information from various quantitative projections and fleshes out particular plausible futures pathways. Participatory scenario development is often employed, where a group together, using imagination and rationality, envisions various future circumstances and formulates preparations. Work with futuristic fiction may assist in relating to the range of possible futures.⁸

Anticipated futures that include increased disasters, uneven breakdowns of infrastructure, and civic stresses such as large migrations, social disruptions, and political instability, along with their resultant levels of trauma are examples of futures that can be anticipated, envisioned, and planned for.

Models relevant to mental health that arise from such practicing with futures include:

• Model for Adaptive Response to Complex Cyclical Disasters offers educated speculation about the needs of survivors, responders, and leaders within scenarios of repeated disasters, divided by disaster phases.
• The Transformational Resilience Model which anticipates high levels of toxic stress and psychological regressions by individuals and groups with the advancement of climate change and lays out a plan for large-scale resilience training to support community-wide adaptation.
• The Deep Adaptation Model which practices possible responses to societal collapse.⁹ This futures thinking movement, though criticized as eschewing uncertainty and hope, contains a useful framework of Socratic questions and tasks for responding to social collapse called the 4 Rs: resilience, relinquishment, restoration, and reconciliation. Practicing with these 4 Rs involves active imagining of possible futures.

In practicing with futures, as with quantitative modelling, emotional work is involved in tolerating the gap between potential future circumstances and what is known of current capacities. Abilities to tolerate and productively engage in situations of shared uncertainty are required, with trust in the positive generative collective process of a shared “as if” world.

Futures Thinking Mode 3: Innovate It

Experiential and experimental interventions of cocreation:

The experiential and experimental mode of futures thinking generates shared social experiences intended to have a mobilizing power, using the evolutionary power of the present.²This third mode of futures thinking can be seen as accessing “the adjacent possible” a concept coined by evolutionary biologist Stuart Kauffman.¹⁰ Experimentation is necessary because “not only do we not know what will happen, we do not even know what can happen.” The maintenance and sharing of Indigenous and Shamanistic practices have valuably widened the field of these adjacent possibilities. Eco-villages or other communities seeking to live with minimal impact on the environment are such social experiments.

We may at first blush consider experimentation unlikely to be accommodated in our conventional mental health spaces. In this mode of futures thinking, however, we would be designing new mental health paradigms and techniques, as Sigmund Freud and Aaron Beck did, based on our models of the observed present and anticipated futures’ needs. Climate change processing groups for and led by mental health professionals have already organically formed. Experimentally, they could more systematically interface with and influence clinical, administrative, advocacy, research, and educational work as changes in these systems are needed. Lay therapies have similarly arisen with climate change in mind. These can be seen as collective experimentation towards new ways of living—many are grounded in accepted psychological practices, eg, mindfulness work incorporated in The Work that Reconnects.

Experimental cocreation brings to bear our imaginal, communal, and agentic capacities. Its challenges involve the discomfort of radical personal change, working with others in novel circumstances, and tolerating a poignant gap—the current gap between evolved experimental gains and the structures needed to further develop and disseminate them across society.

Futures Thinking Mode 4: Revamp It

Critical deconstruction:

The critical deconstruction mode of futures thinking ferrets out biases and blind spots that maintain structural inequalities or are otherwise detrimental, to eliminate their influence on future scenarios. Climate justice critiques of imagined futures would be one example. Climate change is known to be a threat multiplier, requiring increased attention to disadvantaged populations.

Critical deconstruction plays a crucial role in discussing psychiatry's futures. We are easily biased towards maintaining current models and paradigms within our clinical work, research, and education, as we have invested years or decades of our professional lives in them; though often they may not entirely align with our values, or current and future needs. Allowing ourselves to more fully accept and act on this awareness necessarily entails some moral injury as we reinterpret our historical behaviors in light of desired futures. An unconscious refusal to do so impairs the elimination of biases, constricting potential futures.

Emphasis on individual care deserves critique. With expected increasing trauma, a greater proportion of our attention and resources are clearly needed at the community and population level. Necessary foci of attention include needs of vulnerable populations, interventions promoting community cohesion and resilience, and anticipating the needs of clinicians working under increasingly stressed and rapidly changing conditions that they and their patients will share, while advocating for the structures and resources required in these activities.^11,12 Active examining of assumptions will be required by those in all facets of care delivery and advocacy.Deferring this reflection to those in leadership may no longer be appropriate, due to the complexity of the circumstances and the natural entrenchments of social and professional institutions.

In its healthful function, critical deconstruction aids in dislodging from cultural patterns and aligning visions with values. A pitfall, however, is in its serving defensive purposes such as intellectualization and avoidance of the existential issues of choice and agency, deconstruction without the messy business of collective construction.

Futures Thinking Mode 5: Strengthen the Futurizing Mental Processes

Psychological containment:

Containment is the relational process that makes the unbearable bearable in a way that is foundational to the abilities to think, to innovate, and to apprehend internal and external reality. Psychological containment within early child-caregiver relationships, originally described by Bion, is thought to be the psychological birthplace of all abilities for rational and imaginative thought, particularly in response to distress, and it remains critical in adulthood.¹³ Crucially, containment prevents emotional overwhelm during the challenging emotional work of all forms of futures thinking. In infancy, containment occurs as the child's emotional overwhelm is taken in by the caregiver, who metabolizes it and then willingly gives new bearable things back that are taken in by the child. In this way, containment is the mechanism by which new thoughts are made, producing potential future and the abilities to think about it.

More generally, containment refers to important relationships and social structures; cognitive models; spirituality and other sources of meaning, narratives, images, relationship with nature; and our own agentic involvement in activities—anything that in our interaction with it makes the unbearable bearable in ways that are functional and not dissociative.

Within mental health we have 3 main responsibilities with regards to deploying containment to support possible futures work:

1) Given the increasing state of polycrisis due to diminishing planetary resources, globalization, and forms of social regression, one task is to scale up and promote all psychologically adaptive forms of emotional containment. Ojala’s studies on meaning focused coping for example, demonstrate use of cognitive reframing, spirituality, and pro-environmental activity as particularly promising.¹⁴ Many popular lay therapy programs (Climate Cafes, The Work that Reconnects, the Good Grief Network), also employ relational, narrative, and ritual means of containment.

2) Our second task is to more explicitly help patients and the public understand that means of containment are not only for coping with adversity; they are also part of engagement with potential futures—a natural part of the demand of life. Taking a patient through the process of backcasting for example, while also helping the patient find means of containing the feelings arising is important psychoeducation. Patients can be helped to understand that regardless of what one chooses to work on, repeated containment will be required, as goals and pathways to goals meet heartbreak, obstacles, and failures, necessitating flexible adjustment.

Concluding Thoughts

Futures thinking is a model of cognitive and emotional functioning that should be disseminated and further integrated into the thinking and work of mental health professionals. Futures thinking’s modes provide a therapeutic framework to firmly pull oneself out of the current sociocognitive-emotional mud of complexity and threat. As a containing meta-model, futures thinking supports needed agency in each foundational approach to future while making clear the interrelated functioning of all the modes. The forecasts are stark, and the systems involved are exceedingly complex. Through human consciousness, more futures are possible, and through continual application of futures thinking, they can be positively influenced.

Drs Haase and Lewis are steering committee members for the Climate Psychiatry Alliance and co-chairs of the climate committee of the Group for the Advancement of Psychiatry.

References

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2. Mangnus AC, Oomen J, Vervoort JM, et al. Futures literacy and the diversity of the future. Futures. 2021;132:102793.

3. Monsour M, Clarke-Rubright E, Lieberman-Cribbin W, et al. The impact of climate change on the prevalence of mental illness symptoms. J Affect Disord. 2022;300:430-440.

4. Wortzel JR, Stashevsky A, Wortzel JD, et al. Estimation of the carbon footprint associated with attendees of the American Psychiatric Association Annual Meeting. JAMA Netw Open. 2021;4(1):e2035641-e2035641.

5. Wallace-Wells D. The uninhabitable earth. In The Best American Magazine Writing 2018. Columbia University Press; 2018

6. Hoggett P, Randall R. Engaging with climate change: comparing the cultures of science and activism. Env Values. 2018;27(3):223-243.

7. Koder J, Dunk J, Rhodes P. Climate distress: a review of current psychological research and practice. Sustainability. 2023;15(10):8115.b

8. Horst R, Gladwin D. Multiple futures literacies: an interdisciplinary review.J Curr Pedagogy. 2024;21(1):42-64.

9. Bendell J. Deep Adaptation: A Map for Navigating Climate Tragedy. University of Cumbria; 2018.

10. Björneborn L. Adjacent possible. In The Palgrave Encyclopedia of the Possible. Springer International Publishing; 2023.

11. Doppelt B. Transformational Resilience: How Building Human Resilience to Climate Disruption Can Safeguard Society and Increase Wellbeing. Routledge; 2017.

12. Doppelt B. Preventing And Healing Climate Traumas: A Guide to Building Resilience and Hope in Communities. Routledge; 2023.

13. Bion WR. Learning From Experience. Heinemann; 1962.

14. Ojala M. Hope and climate-change engagement from a psychological perspective. Curr Op Psychiatry. 2023;49:101514b