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One psychiatrist’s take on election anxiety


I have to start this column with a disclaimer: I live in Maryland, and like most Marylanders, I am a Democrat. We’re one of the bluest states – today, you’re welcome to give that statement two meanings – and as such, I live in what today has been somewhat pejoratively called the educated, liberal, elitist, East Coast, “Hillary bubble,” where I can be one of the first to admit that I’m not in touch with the country as a whole. I’ll add one more disclaimer: I married a man I fell in love with during my freshman year of college.

As a teenager, I didn’t care much about politics, but my then-boyfriend was a political science major who was a Republican and spent a summer on Capitol Hill. So my blue world is just a bit influenced by decades of living, quite happily, in a bipartisan household. The adult children seem to have settled in as Democrats; the dogs have split parties.

Dr. Dinah Miller

My election anxiety started in late winter. I was watching the news, and there were reports of polls putting Donald Trump in first place among the 17 Republican candidates. I called my husband at work.

“I thought Donald Trump was a joke, a reality TV thing.”

I hadn’t been paying much attention, and my husband, who remains calm and wise, reassured me that it was months until the primaries, and that Trump would not be the Republican nominee.

Time went on, and my anxiety grew. I found myself caught up in Facebook posts, and I mostly read like-minded rhetoric. In March, I was on vacation and found myself terribly distraught about a colleague’s post. He talked about his anxiety about the election, likened Trump to Hitler or Stalin, and asked what people would do if they found out their friends supported Trump. Should one end their friendship? I have strong viewpoints, and if I limited my friends only to those who agree with me on controversial issues, I would be rather lonely. I started to argue with my colleague’s friends – they likened voting for Trump to being anti-Semitic, and many felt one should end friendships with people who supported him. I decided I didn’t want to be Facebook friends with people who made their friendships contingent on how I vote. This was different, I was told, because of Trump’s xenophobia, and I ended up “unfriending” my colleague (only on Facebook), and turning off all my social media for a while.

When Trump won the Republican nomination, my husband told me I should be happy: This ensured that Hillary Clinton would win the election. He would not vote for Trump; our Republican governor, Larry Hogan, was not supporting Trump; it seemed that neither the Republicans nor the Democrats were enthusiastic about his nomination, and my anxiety waned.

A colleague noted he was having trouble listening to Trump supporters in therapy sessions. In my entire practice, only one patient mentioned being a Trump supporter, a transplant from a Southern state. It was not a major focus of therapy, except that he used it as an example of how he felt out of place in Maryland, and I had sympathy for his sense of isolation here.

My anxiety waned in the weeks before the election, though my patients talked more and more about it. I posted a countdown on Facebook – this nightmare of an election has divided our country, and given a voice to vulgarity and hate speech. While I still would not end a good friendship over a vote, I see Trump as unkind and undignified. He invests energy in being purposely cruel. And since I apparently don’t understand the “non-elitist” voter, it doesn’t make sense to me that disenfranchised blue collar workers hope a privileged billionaire with a history of deceit and mistreating others will be anyone’s savior. At one point, The New York Times’ The Upshot gave Trump a 9% chance of winning. If you are a Trump supporter, please don’t feel insulted, and I would be happy to try to understand your enthusiasm for his presidency.

On Tuesday night, my husband had to be out of town. My friend, psychiatrist Anne Hanson, came to “babysit” me as I didn’t want to be alone as the returns came in – perhaps I had some sense that Clinton could possibly lose. We ordered Indian food, and together, we sat in front of the television, completely dumbfounded.

The morning after came, and Maryland psychiatrists started posting about their despair on our listserv. Others offered support; one suggested that Trump might be just what our country needs; and numerous psychiatrists have said this a call to action, a time to get more involved. On Thursday morning, one psychiatrist noted: “Seeing my patients the day after the election this week felt very much like seeing patients the day after 9/11. What was different though was that on 9/11, we were all in high distress, sadness, and fear. However, unlike 9/11, this time I have the uncanny experience of a few patients that were rejoicing or simply glad that Trump had won.”

My social media sites looked the same – disbelief, distress, obscenities, words of comfort, calls to action. Journalist Andrew Solomon posted on Twitter this morning: “It’s begun. A friend was walking in NYC and someone driving a U-Haul yelled, ‘Hey, homo. So what do you think of President Donald Trump?’” Meanwhile, Trump supporters were reportedly attacked with punches, eggs, and bottles at a protest rally in California. The country remains divided: President Obama and Hillary Clinton remind us that we should give Mr. Trump a chance and support his efforts as we are all one country, while thousands protest his victory in cities across the country.

What will President Trump’s election mean for psychiatry? The American Psychiatric Association gave money to support both candidates, and in the spirit of working together, President Maria A. Oquendo has sent him a letter of congratulations. There is nothing to be gained by having an antagonistic relationship with our country’s leader.

Trump has promised to repeal the Affordable Care Act on his first day in office. What will that mean? Will those covered by ACA policies suddenly lose their coverage? I can’t imagine that would be the case, or at least I hope not. And what about all the time, money, and effort that have been invested in Meaningful Use and the planned transition to MACRA to collect data? Do those systems vanish? I have a son who is about to turn 26 and works as a freelance writer for a fantasy sports website. Will he be able to get health insurance?

And Mr. Trump is a bit unpredictable. He has changed his political party affiliation seven times over the last 2 decades, and until 3 years ago, he was a registered Democrat. Perhaps he won’t repeal the ACA on day 1. Or day 2. We’ll have to wait and see, but in the long run, I think we all have to worry that there might be people with health insurance now who won’t have it in the future.

The mystery of Trump is that he ran a campaign without exposing any strategies. His health care plan boiled down to, We’ll get rid of the lines around the states; there will be open competition with health insurers; and it will be a beautiful thing. (My quote may be inexact, but I took careful note of it during one of the debates.)

Finally, we can ask what will happen with the Mental Health Reform Act of 2016, originally known as the Murphy bill or The Helping Families in Mental Health Crisis Act. The bill, calling for major mental health reforms, passed in the House by a vote of 422-2, and awaits a vote in the Senate during the lame duck session. While the APA supports passage of the bill, there is a great deal of controversy surrounding it, and in a Politico article, former congressman and current mental advocate Patrick Kennedy is quoted as saying that in its current form, the bill should not be passed. The latest version is “‘watered down’ and does nothing more than ‘reallocate money around block grants’ when it should instead ‘try for higher reimbursement rates’ for behavioral health providers. ‘Passing that bill will take the wind out of the sails for real reform,’” he added. “‘Kick it to the next Congress and the new administration to do this the right way.’” How the new administration will react to mental health reform is anyone’s guess.

Anne and I were scheduled to be on NPR’s Diane Rehm radio show this morning to talk about our new book; the unexpected election results led to a postponement while coverage of the election continues. My countdown until the end of this nightmare election reached 0, and I had planned to extend a Facebook re-friend request to my colleague and see if he’d have me back, but election coverage and speculation continue. It may be time for me to take another social media break.

The sun is shining in Baltimore today, and we certainly live in interesting times.

Dr. Miller is coauthor of “Committed: The Battle Over Involuntary Psychiatric Care,” which was released Nov. 1 by Johns Hopkins University Press.

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