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Many of our patients are in distress, coping with “eco-anxiety” in ways that we have up to now not experienced.
Dr Cooper is in Private Practice and Assistant Professor, Department of Psychiatry, University of California, San Francisco.
As I contemplated cooking the big Thanksgiving meal and the arrival of family from distant places, I was compelled to pause . . . what was there to be thankful for in this season of sharing, joy, and blessings?
My northern California neighbors will not be counting their blessings. They did not bake turkeys to serve at Thanksgiving tables. They have no dining rooms left; no ovens in which to prepare the feast and for some, lost loved ones to mourn.
They will have no Christmas trees. In fact, there are no trees left in their forests. They have no living rooms where Christmas trees can be trimmed, and decorations can be hung. Santa Claus will not come down their chimneys. They have no chimneys. They will not display menorahs in windows. They have no windows. In fact, they have no homes, no community and many have lost loved ones; the final death toll is not yet counted.
They will not even have burials for many of the lost, since remains are sparse or impossible to identify, with only fragments of bones left of many who perished.
And as I write this, I sit 175 miles from the ravaging fires that continue to burn, I look out my window and wonder about a white Christmas. But, no, the white sky is not snow but air pollution; air pollution so severe that San Franciscans are wearing respirator masks, stores have run out of supplies and everyone seems an expert on the distinction between levels of respiratory protection. My hometown looks like Beijing.
Many of my patients are in distress. I am sitting with “eco-anxiety” in ways that I have up to now not experienced. My patients are scared, fearful of not being able to protect their children and confused about what to do. The “rainy day” schedule imposed by schools to keep children inside does not escape the ironic awareness that there has not been rain! The years of drought, which is due, in large part, to climate disruption, has made California the unenviable site of what are now called “megafires” with the predictions that this is the new normal. Families are making plans to leave the area for “cleaner pastures,” but really . . . where does one go if one confronts the reality that our experience is just one of many that have occurred throughout our country and the world? The specifics vary, including drought, wild fires, super storms, flooding, hurricanes-but the underlying impact of climate change cannot be escaped nor denied.
Psychiatrists are experts in helping people cope with adversity. We understand the deep, profound psychic pain of coping with loss. But we are beyond our normal element as we confront the losses of entire communities and the forced displacement this entails, losses of treasured possessions and connections, as well as threats to livelihood and employment.
Our community mental health services, which are already stretched to the limit are not prepared to respond to such overwhelming needs.
Yet, we have real skills to bring to the effort. Psychological first aid and recovery are essential. We must increase our training and availability for what will be required as we face more climate-driven crises. Triage and identification of those most vulnerable to long-term psychiatric symptoms of PTSD or depression as well as early intervention techniques must be in our toolbox. Protecting the most vulnerable, the elderly and children, and persons with preexisting mental illness must be high priority strategies.
But this is not enough. We must develop and implement public health prevention strategies. This includes helping communities, states, and nations to develop the means to mitigate, prevent, and reverse the impacts of climate change. We, as psychiatrists, have a role in helping those communities accomplish these overwhelming tasks while maintaining and improving psychological health, so that the inhabitants of those communities will remain committed for the long haul to healing their communities and the earth.
The recent Intergovernmental Panel on Climate Change report underscored the urgency of climate disruption, warning that we have less than 20 years to make dramatic changes in how we do business throughout the world. As physicians, we must heed the call. We must develop policies and practices that address the underlying causes of this massive public health threat. And, we must reduce and eliminate our reliance on fossil fuels that drive greenhouse gas emissions and climate chaos.
The American Psychiatric Association (APA) has begun some of this work by joining with other health organizations to address this through participation in the Medical Society Consortium on Climate and Health and by the recent passage at the APA Assembly Action Plan for the APA to divest from fossil fuels, which only awaits approval from the APA Board of Trustees before becoming official APA policy.
I continue to hope that psychiatrists, physicians , and citizens will join together and bring our expertise and creativity to face this enormous threat to local, regional, national, and global health. Join us in our efforts to truly bring joy to the world through the Climate Psychiatry Alliance, www.climatepsychiatry.org.
This article was originally posted on 11/16/18 and has since been updated.