Commentary

Climate change: A call to action for psychiatry


 

 

In a recent survey of about 90 psychiatrists attending a national general psychiatry meeting, the overwhelming majority believed that climate change is human caused and the impacts were already or would soon be harming their patients. They expressed an interest in knowing more, reporting that they sometimes had little knowledge about the issues. They also believed that psychiatrists have a role to play in making the case to be better prepared for what our communities are facing. Professional organizations were a desirable choice as a source of information and training.

Because of these responses we, the Climate Psychiatry Alliance, believe that a scientific and well thought out program addressing the mental health impacts of climate disruption with practical advice on how to help our patients and our communities in the face of climate disasters while emphasizing preparedness and prevention, is called for.

Dr. Lise Van Susteren Rob Wilson
Dr. Lise Van Susteren


As physicians, we are keenly aware of and concerned about the physical harm of extreme weather events causing acute harm, including tornadoes, fires, floods, hurricanes, and so on. We also know about the longer-term chronic conditions, including sea level rise, drought, and permanent and high temperatures.

We also know that the spread of infectious diseases, both old and some new, on us, our children, and even the unborn, is a rising challenge to our communities. The National Academy of Sciences, for example, recently linked the Zika outbreak to a rise in temperature (Proc Nat Acad Sci. 2017;114[1]:119-24). The expanding reach of malaria and the growing incidence of such illnesses as dengue, chikungunya, and Lyme also are linked to higher temperatures.

Though the physical harm from climate disruption is increasingly being discussed, more attention needs to be given to the psychological harm: When the place we call home is burned down, blown away, flooded … when we lose our possessions; maybe our pets, our livelihood; see injuries, illness, and death; the mix of fear, anger, sorrow, and trauma can bring on a full range of psychiatric disorders. Mental health professionals are already seeing posttraumatic stress disorder, depression, and anxiety disorders, as well as an increase in drug and alcohol abuse, violence against women, and child abuse (Ann Glob Health. 2014 Jul-Aug;80[4]:332-44), (Soc Sci Med. 2015;[141]:133-41), (Soc Sci Res. 2013;42[5]:1222-35), (Soc Sci Med. 2017 Jan 6;[175]:161-8).

The link between climate and aggression is clear: For each standard deviation of increased temperature and rainfall, a 4% rise in aggression between individuals and a 14% rise among groups can be expected (Science. 2013 Sep 13;34[6151]:1235367). This is true across all ethnicities and regions. General unrest around the world should come as no surprise to us – nor should its rise in the years ahead, given that temperatures will continue to rise.

The psychological needs and impacts on our communities of exploding numbers of refugees from mounting climate disruption in many areas of the world are of grave concern as the impacts of the upheaval grow ever more profound. The United Nations reports that what we are seeing now and are already unable to address, is just the tip of the iceberg.

Psychiatrists have a special role to play in all of this, because we not only are experts in physical health, we are experts on psychological harm.

We also know that any physical condition or illness carries an attendant emotional toll. Trained in science, we respect the scientific method and the peer-reviewed work that goes into validating what the scientists are telling us.

We know that harm that is entirely accidental is much easier to get over than harm experienced as avoidable. That appropriate action to protect our climate was not taken in time will become more apparent – with fear and anger among patients, families, and communities directed at policy makers and a compounding erosion of trust in our institutions. We must look at how fear, anger, and mistrust drive politics not only in our country but elsewhere since we are now a global village, interconnected.

And we must confront our values: Climate disruption is an issue of social justice, because those who will be hurt the most are from disadvantaged communities, and it is an intergenerational justice issue, because our children will inherit our mistakes. How will we answer these questions?

As experts focused on changing behaviors before it is too late, at confronting denial and resistance in ways that build people up and help influence them to change, and with the standing we have in the community, as psychiatrists we have a unique role to play. We also take seriously that our canon of ethics states our responsibility to serve our communities in ways that enhance their health.

We call upon our professional communities to help us respond to the growing public health crises. Among the many needs: education – putting together trainings for our colleagues and other thought leaders and policy makers that identify the public health burdens and drive action on them; preparedness – advising communities and individuals about how to deal with climate challenges; and prevention – advocating for solutions that reduce our vulnerability with sustainable habits and promote resilience. There is much more for us to uncover and act upon together in the months ahead.

We call upon one another for action, because only collective success will restore our health and keep us safe.

Dr. Van Susteren wrote this commentary on behalf of the Climate Psychiatry Alliance, a professional group dedicated to promoting awareness and action on climate from a mental health perspective. She is a practicing general and forensic psychiatrist in Washington. Dr. Van Susteren serves on the advisory board of the Center for Health and the Global Environment at Harvard T.H. Chan School of Public Health, Boston. She is a former member of the board of directors of the National Wildlife Federation and coauthor of group’s report, “The Psychological Effects of Global Warming on the United States – Why the U.S. Mental Health System is Not Prepared.” In 2006, Dr. Van Susteren sought the Democratic nomination for a U.S. Senate seat in Maryland. Recently, she founded Lucky Planet Foods, a company that provides plant-based, low carbon foods.

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