For decades, experts have foreseen the encroaching threats posed by climate change and environmental degradation, but the past year may be remembered as the time when the veil was fully lifted.
Since October, three separate reports from the United Nations[1,2] and the US government have offered an alarming prediction of the world to come if greenhouse gas emissions continue at their current rate: rising sea levels inundating coast lines, the dying out of coral reefs, loss of freshwater and crops, massive famine and poverty, the imminent risk of extinction of a million species of flora and fauna, and devastating disruptions to the global economy.
These were not the plotlines of disaster films or the alarmist rantings of doomsday prophets, but the measured reporting of venerable groups assessing tens of thousands of scientific publications. Their message was clear and daunting. This is the world to come, unless we can marshal efforts to substantially reduce and then altogether phase out carbon emissions by the middle of the century.
Beyond these projections, visceral real-time evidence of climate change's devastating impact is found in the recent California wildfires, flooding in the Midwest and Southeast Asia, drought in East Africa, and heat waves in the Middle East.
As noted in the US government's National Climate Assessment, these multifaceted stresses can have considerable mental health consequences, leading to clinical disorders like anxiety, depression, and suicidality. Many people appear to be turning to mental health care professionals for guidance and relief. One such professional is Lise Van Susteren, MD, a Washington, DC-based psychiatrist who for decades has advocated for attention to the mental health risks inherent to climate change.
"These last months have been particularly terrifying for people," Van Susteren told Medscape.
She reports that her phone has been ringing constantly these days with patients and fellow practitioners seeking her guidance. Even her own long-term patients are now bringing it up to her regularly.
"Many people were able to repress some of these thoughts, often by figuring that somebody will take care of it or there will be an almost magical technological fix, but it seems all of a sudden to have burst into our consciousness."
Taking the Pulse of an Anxious Populace
The media has taken notice of rising angst, with reports of people describing their struggles with eco-anxiety (one of the many terms for the mental health fallout of climate change), questioning the morality of having children in these times, and even sales pitches from cities now advertising themselves as a climate refuge.
In March 2018, before the first of these high-profile government reports, a Yale poll found an uptick in concerns around this issue. Compared with a similar poll 4 years prior, nearly double the respondents (21%) reported being "very worried" about global warming. Climate change-related anxiety, depression, and stress may be higher in women, people younger than 35 years of age, and those with existing pro-environmental dispositions.
Beyond anticipatory anxiety, there is also evidence linking direct effects of climate change to adverse mental health. In a 2018 analysis of meteorological data coupled with information from nearly 2 million randomly sampled US residents, Obradovich and colleagues revealed that deteriorating mental health outcomes were associated with increased temperature and precipitation, as well as exposure to tropical cyclones. Heat and drought have also been linked to increased rates of suicide and psychiatric hospital visits.[10,11,12,13,14,15,16]
Elizabeth Haase, MD, a psychiatrist in Carson City, Nevada, and chair of the Group for the Advancement of Psychiatry Climate and Health Committee, said that moving this out of the realm of the anecdotal into the quantitative is difficult, because the effects are so multifaceted.
"A lot of eco-anxiety expresses itself through these other kinds of indirect feelings of distress that things are not going well," said Haase. "That's one of the things that makes it a little bit hard to nail down."
"One of our working hypotheses is that this filters through society in terms of what are considered the social determinants of health. As our resources decline, people are eating less well, have less available money, they're not exercising because it's hotter, they're sicker because the air quality is lesser. So they're spending more time inside in the summer, which cuts down on their sense of community."
Grieving for What Is Already Here and What Is Coming
Ashlee Cunsolo, PhD, director of the Labrador Institute of Memorial University in Newfoundland, Canada, has spent more than a decade in the small Inuit town of Rigolet, on the coast of Labrador, and other Northern Canadian communities, where climate change and rising ocean temperatures are rendering entire ways of life obsolete. Her research does not consist of taking samples of the permafrost or measuring the rate of vanishing ice, but instead conducting hundreds of interviews with the residents.
Cunsolo and a colleague conducting similar field research with farmers in drought-stricken rural Western Australia compared their notes and observations. What they found was that, despite the notable cultural, geographical, and climatological differences between these locations, these populations reported strikingly similar feelings. Together, they have given a name to the phenomenon they observed: "ecological grief." It stems from the loss of identity, culture, and attendant ways of life resulting from ecological loss in these communities, whether directly experienced or simply anticipated.
"One of the interesting things about this topic is that people's lived experiences with ecological grief has actually outstripped what research can really talk about in any peer-reviewed publications," Cunsolo said.
When she first started her work, Cunsolo said many of the residents would express their grief as being primarily anticipatory.
"Years ago, people would sort of say, 'I'm really worried about the changes that are going to come, and I feel a lot of grief about it, and I'm scared about the losses of animals and ecosystems,'" she said. "Now I just find that people are already feeling grief."
Although she sees herself as belonging to a long lineage of public health and conservationist researchers, she does not believe that what she's observing has much overlap with earlier global crises, such the HIV/AIDS epidemic or fears of nuclear annihilation accompanying the Cold War.
"The fear and anxiety of the possibility that something is to come, and that it's scary, dangerous, dark, and full of pain—those are similar to sentiments we've seen in other historical moments. But I think that environmental change is different, because there's this global nature to the very foundation of what supports humans."
The Gift of Grief and Anxiety
The communities of Northern Canada and rural Australia may seem like outliers, particularly vulnerable to natural disasters and ecological changes, but they could in fact be bellwethers.
What is the toll paid by a mind accepting these difficult truths? According to researchers, psychiatrists, and mental health advocates interviewed, there are two likely paths.
"There are going to be people who are frozen with panic, and I am worried because that is a very contagious feeling," said Van Susteren. "There aren't enough psychiatrists or Zoloft in the world to keep us all on point."
There is a paradox at work in looking clear-eyed at the coming world. Grief, anxiety, and despair are normal responses; their absence would be a more troubling sign. But if left unaddressed, these feelings can easily metastasize into inaction and nihilism, the very conditions under which climate change has been allowed to progress unchecked for decades.
Yet there is also great power in these feelings, according to Cunsolo.
"Grief, while something many people want to avoid, is also an opportunity to realize how much we love something or someone and how connected we were to it; that's its gift," she said. "If we start to frame it as such, grief actually has a unifying potential."
Similarly, anxiety is also embedded with potential, with evidence showing that those dealing with ecological worry are more likely to participate in constructive, beneficial environmental practices.
Turning such negative and often incapacitating emotions into productive engagement would seem to be a role tailor-made for mental health professionals. Yet many say the field has struggled to attend to these emerging health issues. As such, it has often fallen to groups outside of established mental health care to fill the void.
Seeking Communal Solace
Dick Meyer, a 69-year-old father of three adult children who operates his own landscaping company in Nebraska, had always wanted to explore the American West. When his wife's job as a nurse epidemiologist afforded them the opportunity to travel, they seized on it. There were stints in Santa Fe, Fresno, and Berkeley, among others cities.
At the same time, Meyer became very aware of how climate-related issues were facing each of the communities in which he lived. The droughts, forest fires, water shortages, and air pollution served as a "sort of real-life preview of the likely future that the science I was reading was predicting," he recalled.
Soon, he began to experience profound grief. He attended activist meetings but found them unhelpful to alleviating his emotional concerns.
While living in Salt Lake City, he heard on public radio about an organization called the Good Grief Network, which offers a chance for those struggling with feelings of ecological-related anxiety and grief to process them in a group setting.
"My immediate reaction was surprise that there was a group of people actually talking through their feelings of grief and anxiety about climate change," he said. "Without a doubt, the worst aspect of my own process had been the isolation of it."
Laura Schmidt, MS, cofounder and director of the organization, explained its purpose. "We are deeply disconnected from others, the natural world, and even from ourselves," she said. "The Good Grief Network helps participants understand the interrelatedness of our predicaments."
Good Grief's meetings take place over a 10-week session in which participants focus on individual steps, from accepting the severity of the problem to eventually reinvesting in the struggle to combat it. The program was shaped in part from interviews with prominent authors, activists, and scientists, who shared their own insights about the anxieties, frustrations, and stresses of working at the frontlines of this epochal crisis.
When Good Grief first started, Schmidt said most participants had been actively involved in climate change and environmental issues for years, and had suffered heartbreak and burnout as a result. That began to change with the October release of the UN report, which Schmidt said has brought in many who were not activists and who range in age from teenagers attending with their parents to those in their 80s.
Meyer said participating in Good Grief hasn't reshaped his relationship to the emerging concerns of climate change.
"How does one change one's emotional and mental reaction to the conclusion that human life is likely to go extinct within a century?"
But what it can do, he said, is help members live within this reality.
"From what I read, the restorative capacity of Nature is such that such a transformation is possible. What is in doubt is the capacity of the human species to evolve transformationally. I live with hope that this is possible and that I must do what I can to make that hope a reality. But I am not blind to the difficulties."
Schmidt said this is very much the intention of Good Grief.
"We are firm believers that the sweet spot is between false optimism and resignation/nihilism," Schmidt noted. Optimism begets the thinking that some technological leap just around the corner will save us, whereas if there's nothing to be done, why bother?
"Thus, those of us in the middle of the spectrum realize that if we're in it for the long haul, we have to do our work to remain resilient," she said. "Otherwise, we too will fall into hopelessness, denial, despair, and then more clinical impacts like depression, anxiety."
Working From Within
Good Grief advises that participants may need to seek the aid of certified therapists in addition to the 10-step program. But are mental health specialists adequately prepared to deal with what many predict will be an onslaught of people seeking such help?
That's the question that fuels the work of the Climate Psychiatry Alliance, which counts among its members the psychiatrists Haase and Van Susteren.
"I see psychiatry as absolutely at the epicenter of the cultural change that needs to take place," said Van Susteren.
Van Susteren would like to see the American Psychiatric Association (APA) move toward establishing a subspecialty in climate psychiatry. She envisions specialists trained in climate issues, who can provide preventive help and attend to the needs of communities beset by natural disasters, but also engage with policymakers in understanding the possible mental health ramifications.
Both would also like to see the APA develop nomenclature around a formal diagnosis for this phenomenon, and to create a registry tracking the cases of patients presenting with these symptoms so that they can more easily understand it.
Yet as Haase noted, the APA has historically lagged behind on these issues, especially compared with the American Psychological Association, which issued an in-depth report on the myriad mental health effects of climate change in 2014 and updated it again in 2017. In comparison, the APA has only issued a brief position statement in 2017 supporting "efforts to mitigate the adverse health and mental health effects of climate change."
Despite frustrations with the speed of this process, Haase is actively involved in pressing the necessary bureaucratic levers to advance the issue through the APA. She views it as a necessary battle to prepare for the problems ahead.
"It may be that we have at least double the number of people wanting to see psychiatrists because of climate change," Haase said. "They may feel suicidal because they don't see a future, or feel violent and aggressive. That could significantly change the dynamics in emergency rooms, and we are going to need to be ready for that."
Another frontline in these efforts, and the one that is likely to affect clinicians the most, is their own practice.
The recent report from the Yale Program on Climate Change Communication found that even though an increasing number of Americans are feeling anxiety over this issue, 65% say they "rarely" or "never" discuss it. This probably means that psychiatrists and therapists may not be getting to the root causes of their patients' emotional upheavals.
"The idea that people aren't being affected by this, and so we just stick to what they bring to our office and don't try to unpack what is lying deeper, is really being complicit," said Van Susteren. "You have to ask uncomfortable questions sometimes, and that's the art of being a good practitioner."
The trick for mental health practitioners will be rethinking their traditional approaches to treating anxiety, fear, and depression. For once, these are not foes to be bested with chemicals or therapy, but natural expressions of humanity's well-earned grief over the state of the world.
"In the old days, you could say to someone with anxiety that there is no alligator under the bed," Van Susteren said. "They could get up, lift the covers, and see that. Well, the fact is, when it comes to this, there is an alligator under the bed."
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Cite this: Climate Concern Fuels the Rise of 'Eco-anxiety' - Medscape - Jul 08, 2019.