Good Grief!

Guest post by Robert A. Gorkin, PhD, MD, JD

As far back as 2017, leaders of the American Psychiatric Association (APA) decided it was imperative that the profession should take a stand on climate change. The APA then formally issued a position statement entitled “Mental Health and Climate Change” which endorsed the reality of catastrophic anthropogenic global warming and committed the organization to “support and collaborate with patients, communities, and other health care organizations engaged in efforts to mitigate the adverse health and mental health effects of climate change.” (Claire Zilber, M.D., Psychiatrists’ Role in Addressing Ecological Grief, Psychiatric News, Vol. 54, No. 24, Dec. 20, 2019, (7,15 at 7.)) https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2019.12b20

The APA also maintains a “Climate Change and Mental Health Connections” feature on its website with such topics as the “effect of climate disasters on mental health, promotion of resilience in the face of climate-related disasters,” as well the assertion that climate disasters will lead to “increased social instability and reduced community cohesion, which in turn may lead to more aggression and crime.” (Id.)

In November 2019, an “action-packed” APA Assembly meeting in Washington, D.C., “approved an action paper asking the APA to sign the ‘U.S. Call to Action on Climate, Health, and Equity [: A Policy Action Agenda].’” (Mark Moran, Assembly Seeks APA Sign-On To Climate Statement, Takes Other Actions, Psychiatric News, supra at 16). https://doi.org/10.1176/appi.pn.2019.12b17

The “Call to Action” is a document drafted in part–and promoted by—“Physicians For Social Responsibility,” an organization that describes itself as the “U.S. Affiliate Of International Physicians For The Prevention Of Nuclear War”; which has now expanded its original focus of concern to include warnings of global catastrophic climate change. (https://www.psr.org)

The “Call to Action” begins with the statement that, “Climate change is one of the greatest threats to health America has ever faced—it is a true public health emergency.” (https://www.psr.org/blog/resource/u-s-call-to-action-on-climate-health-and-equity-a-policy-action-agenda/) (emphasis in the original). It goes on to state, “[t] he health, safety and wellbeing of millions of people in the U.S. have already been harmed by human-caused climate change, and health risks in the future are dire without urgent action to fight climate change.” (Id.)

Furthermore:

“Climate change is the ‘greatest public health challenge of the 21st century.’ Extreme heat, powerful storms and floods, year-round wildfires, droughts, and other climate-related events have already caused thousands of deaths and displaced tens of thousands of people in the U.S. from their homes, with significant personal loss and mental health impacts especially for first responders and children. Air pollution, whose primary driver—fossil fuel combustion—is also the primary driver of climate change, causes hundreds of thousands of deaths in the U.S. annually. Mosquito and tick-borne diseases are spreading to new communities. The agricultural, food, and water systems we depend on for our survival are under threat. Without an urgent and effective response, these harms will greatly increase.” (Id.) (emphasis in the original.)

At the November meeting, the members of the APA Assembly felt that this issue was of “‘sufficient urgency’ that it [should] be referred directly to the Board of Trustees for approval and enactment.” (Moran, supra.)

James Fleming, M.D., one of the sponsors of the Action Paper, supported the proposal by arguing (ad verecundiam) that the, “American College of Emergency Physicians has also signed the document. ‘I think it’s safe to say the emergency physicians wouldn’t sign onto something like this if they didn’t think it was a true emergency’” (Id.)

The Psychiatric News did not report whether there was any debate in the Assembly as to the actual merits of these claims, nor was there any mention of a discussion of as to what extent members of the American College of Emergency Physicians—let alone the APA Assembly attendees, themselves—have the requisite competence, education, and have spent the effort to judiciously study both sides of the issue to render truly informed judgment.

In the same edition of Psychiatric News, Claire Zilber, M.D.—who writes the “Ethics Corner” feature—starts her column by stating:

“Sometimes a matter of personal ethics is so strong that it must find its way into professional ethics as well. This is the case with climate change and the threat it poses to humanity and biodiversity. Both the institutions of our profession and individual psychiatrists must play a vital role in the response to global climate change.” (Zilber, supra at 7.)

And, even though the “APA has taken a clear position . . . institutional policy is not enough.” (Id.) So what does the good doctor recommend?

Among other things, psychiatrists need to “recognize ecological grief when it arises in the treatment setting.” (Id.) (emphasis added.) Zilber goes on to preemptively agonize about an imagined future:

“Watching depictions of the melting of polar ice or the desertification of vast swaths of once-fertile land may generate a sense of despair or helplessness. Closer to home we may be sad when we miss butterflies and bees that used to visit the garden, suffer loss because our favorite hiking spot has succumbed to wildfire, or feel anxious that our local beach will be eroded by the next superstorm.” (Id.)

Furthermore, although all humanity is vulnerable to a “personal sense of loss,” economic inequities adversely impact the “elderly, poor, and homeless [who are] at greatest risk of heat-related deaths.” (Id.) Zilber fails to discuss the data showing that cold-related deaths far exceed those attributed to heat. (See,e.g., https://wattsupwiththat.com/2014/06/02/which-is-responsible-for-more-u-s-deaths-excessive-heat-or-excessive-cold/)

She goes on to argue oddly that “trailer homes are most at risk in tornadoes,” and trailer homes are “found in parts of the country with the highest incidence of tornadoes.” (Id.) The suppressed logic here is apparently that the demographics of those people “condemned” to trailer home ownership provide even more evidence for climate disaster economic inequity. Not to be left out are the citizens of the “Bahamas, the Philippines, and Haiti [who] suffer the most after hurricanes because their structures and infrastructure are more vulnerable [than those] of wealthier countries.” (Id.)

And what argument would be complete without the obligatory, self-flagellatory mea culpa of “environmental racism” as witnessed by oil pipelines being “routed through Native lands,” and “Black, Latino, and Native communities bearing a disproportionate burden of exposure to toxic waste sites, poorly managed sewage treatment plants, and water containing lead and arsenic.” (Id.) Zilber is still not finished with her indictment of our collective guilt for environmental racism. She concludes by elaborating ex nihilo, and de novo creates a new, even more malignant, and inheritable species of eco-racist generated psychopathology: “Indeed, Native populations may have inherited ecological grief, because they have been experiencing the loss of home and habitat for many generations.” (Id.)

Not to worry, our good psychiatrist has an answer:

“If a patient expresses something that sounds like ecological grief, it may be helpful to use that term. Having names for feelings increases empathy and adaptation. Supporting patients as they articulate the further injustices experienced by their particular communities may help them feel heard and respected. There is likely an epidemic of ecological grief in the world right now, yet without the language to discuss and study it we are less able to intervene in a helpful way.

Psychiatrists know that talking about a loss helps a person to process and overcome it, to move from despair to self-efficacy. We are in a unique position to help our patients and the public name the pain that comes up so frequently these days in response to manifestations of climate change and environmental degradation.” (Id. at 15.)

It is a shame when a professional organization gets hijacked (by presumably well-meaning individuals) to take extraordinary positions on subjects that are manifestly well outside of its arena of competence. I have seen no evidence in these reports or on the APA website of any (let alone substantive) debate. Not only as to the validity of the underlying science, the inherent problems with climate models, natural variability, etc.; but even more fundamentally, there is no acknowledgement of the concept of weather as distinct from climate. Nor is there any consideration of the potential benefits of more temperate conditions on health, nature, biodiversity, agriculture, and economics, not to mention the potential and well-documented adverse environmental and economic consequences of the solutions proposed by CAGW activists.

Most unfortunately for Dr. Zilber and her like-minded comrades, her emotional endorsement of ecological guilt and other climate-related pathologies only serves to create, validate, and legitimize new mental disorders that have no basis in reality–this in a profession that has a sorry record of past iatrogenic abuses.

Dr. Zilber appeals to Section 7 of the Principles of Medical Ethics, which states, “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and betterment of public health.” (Id. at 7.)

I would suggest Primum non nocere (first do no harm) is the far better ethical guide.

As for the APA and its leadership, it is all well and good to advocate for taking care of the psychological sequelae of disasters—including the meteorological. But going beyond this by adding the imprimatur of the profession—no matter how well-intentioned—by taking one side of an issue that is demonstrably well beyond the sphere of the usual education, licensed arena of occupational competence, and scope of practice for psychiatry, significantly diminishes the integrity of the profession.

The solution; a modest proposal:

I suggest, rather than engaging in a self-imposed lobotomy, the APA should have a real debate. Rather than potentially following in the footsteps of Trofim Lysenko, the APA should welcome a Devil’s advocate. Perhaps suspending premature judgment but “Be Prepared” is, in fact, the best of all possible worlds.

Finally, it would be hard to find a better precept to guide the APA in its deliberations than Immanuel Kant’s descriptive credo for the Age of Enlightment: Sapere Aude! (dare to know, or more loosely, dare to think for yourself!).

Supporting materials.