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Climate Change-Driven Mental Health Inequities

  • March 01, 2023

In the inaugural episode, our expert panelists touch on the difference between resilience and resistance, learning from ancestral indigenous knowledge and observation, tolerating uncertainty and eco-anxiety as clinicians, consumerism, centering equity into the climate crisis and more. Join us as we gain important insight from Dr. Robin Cooper, Dr. Carissa Caban-Aleman, Dr. Joe Neidhardt, and Dr. Jessica Isom.


Dr. Regina James: [00:00:11] Welcome to the American Psychiatric Association podcast series Looking Beyond Unplugged. And I'm your host, Dr. Regina James. Today, we have an opportunity to hear from invited psychiatrist who will continue their discussion from the online webinar on how climate change has driven mental health inequities. Thanks to DRS Robyn Cooper, Carissa Caban, Aliman, Joe Neidhart and Jessica Isom will have an opportunity to hear them touch on the difference between resilience and resistance, learning from ancestral Indigenous knowledge and observation, tolerating uncertainty and eco anxiety as clinicians. Consumerism, centering equity into the climate crisis and so much more. I hope you enjoy our podcast.

Dr. Robin Cooper: [00:01:09] So I'm Robyn Cooper. I'm an associate clinical professor at the University of California, San Francisco Department of Psychiatry and Behavioral Sciences. But I also am one of the co founders and leaders of the Steering Committee of the Climate Psychiatry Alliance, which is the group that focuses primarily on the mental health toll of the climate crisis.

Dr. Joe Neidhardt: [00:01:30] I'm Joe Neidhart. I'm a board certified psychiatrist and have devoted most of my life to working with indigenous populations both in Canada and the US, and have been working in climate change for about eight years now and wrote a book on Indigenous knowledge and its application to climate change.

Dr. Carissa Caban Aleman: [00:01:56] Hi, I'm Carissa Caban Aleman, speaking to you from Puerto Rico from Guaynabo. I'm a board certified community psychiatrist and a clinical associate professor and community based faculty with the Department of Psychiatry of the College of Medicine at Florida International University. I work in psychiatry right now.

Dr. Jessica Isom: [00:02:16] I'm Dr. Jessica Isom, a community psychiatrist working in an RHD in the Dorchester neighborhood of Boston. I am also a clinical instructor in the Yale Department of Psychiatry and co-director of the Social Justice and Health Equity Curriculum offered as a core part of residence Education.

Dr. Robin Cooper: [00:02:33] Well, the conversation that we just had, I feel like it just scraped the surface. And there's so much that that we could delve down into. And I don't want to be the only one here leading that conversation. You all have ideas. I as I said in the webinar, I was particularly struck by that need to both embrace and honor the solutions that come from the bottom up, as well as not getting the powers that be off the hook in creating and funding and supporting what is needed for all of the communities that are so impacted. So that's one of the things I came up with. I also think we left on a really interesting topic of that tension between what is resilience and what is resistance. And I know that there's some thoughts that we can continue to talk about in that regard. But all of you, what what did you hear and see?

Dr. Joe Neidhardt: [00:03:44] As the oldest one here. I'll start by saying I've been working with Groundswell Climate Collective. It's young people in art and this is such a complex problem. None of us know what exactly to do or where it's going. But I have comfort in knowing the things that you're talking about and knowing that we can get back to knowledge that we've often ignored and rely on other people to give us guidance in that regard. So I just hope we can do it over the next 5 to 10 years because we're going to have to if we're going to make this all work.

Dr. Carissa Caban Aleman: [00:04:23] I have some thoughts that I that I wanted to expand on. I talked a little bit about how important it is to unlearn certain things that have been taught to us and learn from our indigenous ancestors and so forth. And I wanted to clarify that. Of course, I work in clinical psychiatry and I will do whatever I have to do to help my patients get better. I prescribe medications I work with more calm on or status quo therapy and treatment modalities. But I do really think that it's important for us to really reflect on the systems that we work in, that we work in, and really give more respect and importance to the knowledge of of our ancestors in terms of scientific knowledge in hundreds of years of observation and try to learn as much as possible from that knowledge and realize that a lot of a lot of the decisions that are made in modern science and medicine are for the benefit of certain health industries that want to sell certain things. And so for me, it's really important to utilize those tools that are given to us by modern medicine for the real benefit of patients and communities. But to be very careful about not crossing that line and work for corporations, hospitals or clinics that are more focused on making profits. And so that's that's the systemic underlying aspect of of of how oppression happens, oppression towards minorities that are racialized but also towards Mother Nature or other living beings and so forth. So I just think that that's important to reflect on and really trying to to contribute in any way that we can to a paradigm shift and wish. We we understand ourselves and we help others understand that we're really not becoming happier by doing a lot of stuff and having a lot of stuff, but just really getting to know who we are and just being and being alive and just experiencing and observing. And that's what I see that a lot of Indigenous communities and the agriculture movement really shows well that that we don't have to be so busy doing so many things. We can just observe, be and, and enjoy our existence instead of extracting consuming so that we can move towards a level of mentality in which we can really protect nature and respect it and and feel like we're a part of it. You know, more many indigenous populations talk about how we are sisters and brothers of trees, of plants, of cows, of frogs, you know, and I'm really trying to learn from that and really try to try to implement it. And sometime times with my clinical work, I've realized that there's a lot of young folks that are also trying to do that even in urban areas like Miami where I used to work. I've had some really nice discussion, for example, with students at FIU, where I worked in the student health clinic, some things from environmental sciences that are studying that, that are really trying to connect to that knowledge and fostering that and and really spreading that seed is is really powerful and has been very healing for me. And I see that sometimes. It's very healing for a lot of the students that I was treating and the clinic.

Dr. Jessica Isom: [00:07:50] Yeah. Carissa I want to speak to that. I'm a very early career psychiatrist. I finished training three years ago, and the tension that you're highlighting is a real tension, and it's a tension between being a part of the system as a cog in the wheel and then really opening up space to see other opportunities for intervention outside of what we've been socialized into viewing as our lane as psychiatrists. So I really appreciated your comments during the webinar around stepping outside of that clinical space at least full time and really diving in, rolling up your sleeves to be of use in other ways. It's it's a pool for me that I'm interested in and I know so many other young psychiatrists are as well. So it's really helpful to see that be real minded role models by the folks here on the panel. I'll also say for young persons, one of the things I've really enjoyed seeing in the carbon Square area, I've been much more involved in visiting the space, which is the Carbon Square Neighborhood Council, where they are actively working to address the carbon square area, which is a neighborhood a part of the Dorchester neighborhood. And one of the things that they've done with you specifically is is value them equitably, meaning their presence in the space being just as relevant and valued, if not more than those who are more senior in that space. The relevance of that is felt in that particular context, but also as a parent, as an aunt, you know, as I'm looking at my nieces and nephews and my own daughter, there's this question of what world have I brought my daughter into who is a toddler, and then what world am I leaving behind? And I and I'll just be transparent. I am still trying to figure it all out. And and again, I want to emphasize, it's really helpful to see some guiding posts about, well, what can we do? What could some pivots be that we could ultimately adopt as younger persons in the profession and also just generally in society, that role model for those that come after us, what's possible, including growing our own food, really rejecting this capitalistic focus on consumption and things of that nature. So my wheels have been turning for for the past few years, and I'm just really eager to define that more for myself and then have more transparent conversations with others.

Dr. Joe Neidhardt: [00:10:17] You know, along that same line there's a saying I like it's we are all and all in this together. And the all is that we are all part of nature. We're all related. Our genetics is very similar all the way down the chain of of organisms. And if we bring that into our consulting room, then we are connecting with our patients in a different way. We're not the expert, but we are sharing. And we have to learn from them as much as they are learning from us. And so it's a very dynamic and reciprocal relationship. And I think that's really helpful, especially in climate change, because we need to adapt that so much further. And reciprocity in mining is a huge problem. Reciprocity and CO two is a huge problem. And so finding that way of communicating with the people we're working with will also inform us and help us move along in the same way. So I think that to be able to do that, though, we have to tolerate a lot of uncertainty as clinicians and, and we also have to deal with and be with a lot of emotional content. And we're not going to have the answers and we're going to be affected just like our patients are. So finding that space where we can share our emotional lives together in a meaningful and constructive way I think will be really, really helpful in terms of how we approach dealing with eco anxiety and PTSD and all of that sort of thing.

Dr. Robin Cooper: [00:12:00] I. I really agree. I don't think there's anything like the climate crisis, maybe COVID recently that that shows us or tells us again, we are in this together and we can't protect our own emotional lives by by assuming we are protected. And this is an issue for our patients. This is something that we all share and we all have to come to grips with because we're all experiencing the degradation in our environment and the threats to that. So we are grappling with the same emotional. Issues and anxiety that our patients do. And I think that that the conversation that's being brought up here reminds us that the best part of being a psychiatrist or a clinician is that we can listen and that the relationship matters and that we both sides bring something to that. And for me, working with patients in this regard also has healing aspects for me.

Dr. Carissa Caban Aleman: [00:13:25] I have to resonate with that in terms of us thinking about us and the patients? But unfortunately, a lot of the people that are controlling the world financially do not do not see that there's in my personal opinion, this is a personal, personal opinion. There's so blinded by greed and ego that they can't really see that they're there. They're in this together. At the end of the day, they will be. And that that is really hard to accept for people that have been constantly disrespected, oppressed and affected by by their decisions and their their actions to become more, more and more and more rich, financially speaking. So so that's being with with the communities and the patients in that process of sometimes we have to work on acceptance that that's where the resistance versus resilience that we were talking about in the in the panel comes in just to sit sit there with them and listen to them and let them, you know, think things as they as they feel it is really is really the right way to go. But at the same time, in my personal experience, I've realized that if I hold on to resentment and anger and I don't practice detachment and spiritual ways to cope with this, I really was I've been through a lot of moral injury and survivor guilt, and I really needed to strengthen my ability to detach and just accept, you know, the behaviors and the actions of other people to have enough energy, self respect and capacity for long term action in whatever little way I can help. So I think that sometimes just sharing that can be really powerful for some people to, you know, get that energy and that motivation and work on their own psychological tools to really be able to continue that resistance that in Puerto Rico people prefer to talk about versus being resilient.

Dr. Joe Neidhardt: [00:15:32] You know, there's an economic model called the doughnut model. And. And she does a really good job of because we don't share the wealth very well in this world. We especially in the United States, it's, you know, ten, 10%, all 90%. And so the donut model approach is that so does the gifting model that you find in indigenous communities, especially on the West Coast, Vancouver Island, you know, they used to have ceremonies and they would give away everything and that was that's how you got status as you gave away what you had. And that model works really well in small communities. It's a little bit hard to translate it into larger ones, but there are ways of doing it. And so I think we can we can be forceful in saying, hey, we got to share the wealth better and we need a different economic model. The one we've got is not working. And if we're going to deal with climate change, we're going to have to change it from a consumer based, extraction based economy to something like the donut model. And and we can do that. Economics is manmade, so we can change it.

Dr. Carissa Caban Aleman: [00:16:43] So there's a solidarity and social economy movement that's global. And I think similar to that circular, circular economy approach where it's all about cooperating and there's a there's some there's some movements going on here about that. And people in the communities really, really know that giving is is important for them to be okay with themselves. They they know, I'm telling you that that's how resilient they are. They they don't have anything. They have so much less than we have. And they keep giving and giving and giving. There's a community leader here that she has. She's going for a major chronic medical illness. She has so much things going on. But she she gives and gives and gifts. And you see how how that eventually gets back to her. It's reciprocity. And that comes from indigenous principles.

Dr. Robin Cooper: [00:17:32] And those are directly opposed to what drives our economy more stuff. More buying. Oh, how wonderful. People are now back in the stores buying for the holidays. All that stuff that accumulates and mostly goes in the garbage can. But that kind of growth and need for more and more really requires a paradigm shift. And that the things that you've brought up about the Puerto Rican community and indigenous communities have something to to offer.

Dr. Jessica Isom: [00:18:13] Yeah, I. I mean, I have lots of thoughts. I'll just share one thought and I think just kind of makes a connection between the traditional approach to our the work that we do and how relevant anti oppressive frameworks would be to connect psychiatrists to how they might intervene in the climate crisis. Because there is what stood out to me from what you were sharing. Carissa There is this necessity to accept that there are some things that we will be powerless to change as a, as a way of allowing us to cope more successfully with that reality and then focus our efforts on the things that we can change. And also there's a recognition in this conversation of the importance of relationships as a source of resistance slash resilience in ways that are really countercultural for Western demographics, which are very individualistic focused. So there's just so much here that for me is connected to my questions around how to make use of the psychiatry profession broadly and then of course, specifically in the climate crisis conversation. So just wanted to highlight those comments.

Dr. Carissa Caban Aleman: [00:19:21] Thank you. Me too.

Dr. Robin Cooper: [00:19:23] I also wanted to go back to something that you mentioned, Carissa, about that kind of way that that anger can just burn one up or burn you up, that kind of can just kind of eat at you and destroy you. And that's an important idea. But I also think I want to say that there are a range of really broad emotional states that are under that big umbrella of eco distress or climate distress, anxiety, despair, hopelessness, panic, states and rage, anger, and all of those feelings are real and need to be acknowledged and are not and not made wrong or pathological. We are supposed to feel really bad and really upset when bad things are happening and we are faced with real threats. I think it's more how do we modulate, how do we tolerate, how do we make use of the wide range of feelings that we have that allow us to tolerate them and then use those emotions to move us in a space both of of of emotional strength, but also to move in this space of connectedness with others, to be able to contain out of control feelings and translate them in useful ways and finding solutions both at the community, individual and at the larger political space.

Dr. Carissa Caban Aleman: [00:21:14] Thank you for sharing that. That's extremely important. We can't afford conformity. Yeah. And we just have to learn coping skills, but really have to acknowledge your feelings and live and live them and and share them with other people so we can go into action. Very. Thank you.

Dr. Robin Cooper: [00:21:30] It also brings up a question that has come up that people have brought to me a number of times. Oh, isn't all of that climate anxiety the stuff of the privileged, those white people who have the space to feel anxious? And I think that that's just really saying we're asking the wrong questions. And I think we're ignoring a really deep sense of feelings in a why in all of us. This is not just about distress, that those who are privileged have the space to feel. And I would love to hear what you guys think of that.

Dr. Joe Neidhardt: [00:22:10] You know, in terms of there was a survey article by Bowden Bayard. And the bottom line is that almost all of our psychotherapeutic modalities work for people with climate change. You can do dream analysis and it helps people. You can do cognitive behavioral therapy, you can do insight oriented psychotherapy, you can do Freudian things. And they all work. And it's because we get to the core issues through these different ways. And we really can help people as psychiatrists to cope with it much more effectively and even medications. My criteria for medications is, you know, if you're impaired so much that you can't get yourself out of the situation, then you need medications. And the medications can help you get to a state where you can then start taking responsibility for yourself and you can even help other people. And then you can do relaxation training, you can do yoga, you know, you can do a wide variety of things that really do make a difference and make people's lives much more comfortable and not deny the problem. In fact, you even become better at dealing with it. So that for me, when I'm working with climate change in any way, the bottom line is you have to get to action. If you don't get to action, you haven't done your job. And so we do all of these other things, and it enables then people to take action that will make a difference because we all we need a few billion people to get on board and and do something to make this all happen. And I think we can be a big part of that as psychiatrists, both in our office and well as in the community as well as nationally. It's one of the reasons I wanted to go to COP 26 because I thought I had something to say at international level. And so I would really encourage psychiatrists to look at all of these opportunities as something that you can do effectively without knowing everything and being as confused as everybody else but making a difference as we go forward. So for me, it's really exciting the opportunities that we can do without having to solve all the problems.

Dr. Jessica Isom: [00:24:24] As a person who's newer to this particular part of the equity conversation. There is a way that whiteness collapses everything else and only represents itself. And I did a public health degree during my medical school between my third and fourth year, and I took an equity course and also a environmental course as well. And I still remember the moment that I learned that black communities specifically in North Carolina were living beside toxic waste and were actively advocating for reduce exposure to that environmental risk. Since then, I have developed or had developed this opinion that the conversation was a conversation of the white and privilege. And that's because in related to the very reason why Sheff exist as a fellowship program, the representation of who it's relevant to is is white. Those are the voices that are often elevated and presented. There is a focus on this eco anxiety concept that's very much shaped in the public as a conversation of the privileged. So I consider the Sheff Fellowship experience to be a reintroduction to the relevance of the climate crisis to all of us, and specifically to those communities that are often not put on the front and center stage of the conversation. So I do think there's some work, and I and I've been asked to do this work to show up as a visibly minoritized person to remind people of the relevance of this conversation beyond the white and privilege in other ways. But I think also in all of our efforts, making sure that we do that, whether we're writing or speaking as psychiatrists, is an important part of our contribution to the conversation as well. Centering equity, centering the racialized experience of the climate crisis. Just as much as we talk about how that experience is classed and also geographic and related to, for example, the West and its hoarding of resources versus the global South. Totally second that. Yeah.

Dr. Robin Cooper: [00:26:22] Thank you for deepening what I said, Jessica, for adding a lot of nuance there. You're very welcome. Thank you all to this is a great discussion. I wanted to go back to your saying how we psychiatrists can help. And I think one of the things is we have got to move away from a one on one treating people individually as the paradigm within which we work in this. We are just we don't have the resources. We don't have the capacity to do that. The escalating mental health toll of the climate crisis is growing, growing, growing, and we're going to have to shift to community based peer to peer using that. And that also allows people to be more interconnected and not be so isolated as they face these crises.

Dr. Joe Neidhardt: [00:27:24] You know, I don't see any conflict in that in the sense that when I was working in Shiprock, we had a school based program and we would go into the school and we would talk to the teachers and we would give talks and communicate with the students. We had the day treatment programs where we had 50 people with chronic mental illness that were coming into that. And we so we use that group model, we use the community model, and we did private individual work as well. So. I think I think we need it all and we need to look at our role like we have in most cases, most training for mental illness of any group. We go to four years of medical undergrad, four years of medical school and four years of residency training. So we've got 12 years under the belt and we need to share that and we can share it by taking on complex cases, challenging situations, and we can support other therapists and doing what they do. So we definitely have a role. I think we can can gravitate to all of this and then we can also work at the community level. We can talk about housing, I mean, education. These are all things that would would benefit from our from our input without putting ourself on a pedestal. I don't think that's helpful either. Our knowledge base is such that we can share it in a good way. And then at the international level, I think the same thing that we can be engaged and help with that.

Dr. Jessica Isom: [00:29:03] And I'll just add really briefly, I think the three things and this is from my work in organizations and trying to support them in a change process is that we as psychiatrists can know our power. So acknowledge that we, when we have power and that power can be used in a number of different ways, we can get people to do things, we can influence decision makers and things of that nature. We can leverage our networks and use that kind of network based power so we can acknowledge our power and know it. We can use it in ways that are strategic. And then also we can cede power, which means give it away. So and how I'm thinking about next steps moving forward, I'm thinking about how to acknowledge and continue acknowledging that I have access to power, make use of it in ways that are supportive and then also give it away. I definitely know as a Yale trained, board certified psychiatrist, I'm going to get invitations to spaces where I don't have the proper expertise or lived experience to offer the most useful intervention in that space. And I have to figure out what to do with that invitation and that those three things, knowing power, using it and seeding it, would be a way of me figuring out what to do with that particular attention.

Dr. Robin Cooper: [00:30:15] And I have to say, Jessica, I wish I had more power because I think if I did, the world would be a different place. I just wanted to add that we can't forget that we have to do an act, but we also we also need time to step back, pause and not consume. And because, you know, going to Egypt to just talk or just listen to people and spend all, you know, all of those emotions and all that time and effort, all of that is contributing to the problem, not really, really helping it. But I understand that we also have to engage in and have. But I think that right now I'm with Jessica. I'm thinking more about seeding and giving away power. So thank you for sharing your ideas. It's been a lovely discussion. Incredible. And I feel just really honored to be with all of you and thank the APA for allowing us to have this conversation and facilitating our being together.

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