Tuesday, 8 October 2019

Exclusive: Understanding the Impact of Climate Change on Mental Health - ICD10monitor



Exclusive: Understanding the Impact of Climate Change on Mental Health

A double whammy: the coronavirus adds to our climate-based morose health concerns.
EDITOR’S NOTE: This is the final installment in an exclusive series of articles on the impact of climate change on healthcare, written by nationally renowned psychiatrist and author H. Steve Moffic, MD. Dr. Moffic is a popular panelist on the long-running Talk Ten Tuesdays live Internet broadcast, where he has carried the title of resident psychiatrist. His latest book is titled, “Combatting Physician Burnout: A Guide for Psychiatrists.” Dr. Moffic was a tenured Professor at the Medical College of Wisconsin. 
Who would have foreseen that an organization devoted to healthcare coding would have the foresight and prescience back in December 2019 to set up an exclusive series devoted to climate-related psychiatric conditions?
I mean, there really wasn’t anything about that reflected in our ICD-10 or DSM-5 diagnostic classifications. Well, Chuck Buck, Talk Ten Tuesdays, and ICD10monitor had that foresight, because such climate-related conditions were causing mental health suffering, even if that couldn’t yet be clearly defined diagnostically. And ultimately, isn’t that what anything connected to mental healthcare should be concerned about, even more than reimbursement – that is, human suffering?

Enter the coronavirus. 
But if that wasn’t enough of a challenge, it turned out not to be all – really, not even close to being all – we needed to consider. As we entered the 2020s, with unprecedented Australian wildfires, swarming locusts in Africa, record high temperatures in many countries, and now a historic flood in Michigan, another disaster was looming.

On New Year’s Eve, Dec. 31, reports of pneumonia of unknown cause came out of China. Who knows, by then maybe some had even already made a New Year’s resolution to help address climate instability!
We now know what the cause was: the coronavirus. Who among us had the 20/20 vision to predict how the 2020s would start with not one, but two global ecological disasters? A case can even be made that they are connected in causation, in that fossil-fuel environmental change has driven would-be wild animals and their viruses into closer contact with humans.
Moreover, when the coronavirus pandemic became known globally by February 2020, few recognized the relationship and inter-sectionality of that pandemic to the climate – at least in the sense that it, too, was causing some similar psychological distress. When you think about it, that makes sense. One, the coronavirus pandemic, was more of an acute disaster, while the other, climate change, is more chronic – but both are disasters. By now, some say that the pandemic is a test run for the longer and worse climate changes that are coming – unless we do something now to slow or stop it.


No wonder this concluding sixth piece in our climate series requires a much longer-than-usual concluding discussion.

Diagnostic Considerations
Writing regularly for two other national and international psychiatric publications, Behavioral Healthcare Executive and Psychiatric Times, I knew of no other journalism source that recognized the connections as early as we did here, back in early February. And so, for the Solastalgia, dysphoria, grief, the anxieties, burnout, excessive guilt, and suicide related to climate change that we covered monthly from February through May, we found many similarities with the coronavirus pandemic, including in regards to the new condition, Solastalgia. The homesickness while home with Solastalgia is just for different reasons. 

There are some differences, though. One is that the pandemic has elicited much more fear, including undue fear, than the climate. The climate actually needs more, not less, public fear. Of course, there is good reason to have the right amount of fear, due to the risk and reality of disease and dying, a risk that is higher in many minority groups for both the coronavirus and climate instability. Our own frontline mental health caregivers in the present crisis of the pandemic are still at high risk. For understanding the behavioral and cognitive aspects of climate change and the associated denial, we need psychiatrists and other mental health professionals.
Another difference is that the pandemic stay-at-home guidelines have resulted in an increase in domestic violence, sometimes coupled with increased substance abuse and job loss. With children also at home, how have they fared? There are reports of more child abuse, an increase in other adverse childhood experiences (ACEs), and even neglect. Then there is a summer of cancelled overnight summer camps coming. Thankfully, adequate buffering caregiving can mitigate the problematic harm responses, as long as it occurs.
There are also emerging reports on how coronavirus infection may directly affect the brain, among them detailing some reportedly psychotic symptoms like auditory and visual hallucinations. The closest we get to that with climate change is the delirium that can occur with developing a heat stroke.
Due to their severity, somewhere between so-called normality and disease, as well as their societal impacts, many of these mental conditions are more akin to the pathological social pathologies of xenophobia and burnout. By all polling, we have a dramatic escalation of painful anxiety in citizens in the U.S. and around the world, as well as a smaller increase in such full-blown diagnosable disorders as anxiety and depression, with an expectation of an emerging spike in unresolved wretchedness and PTSD.
Then add on those already suffering from a mental disorder and how these disasters are affecting them, good or bad. We really don’t know how the hovering of death, seemingly simultaneously everywhere and nowhere, alters the thinking of already distressed people. Simultaneously, morose healthcare organizations are closing monthly due to inadequate finances. It wouldn’t be hyperbole to carry out that we also have a mental pandemic, besides a coronavirus one.

Interventions
While this combination is diagnostically distressing, it also points to overlapping ways to intervene. Indeed, for the climate, there has already been a positive side effect of the stay-at-home reduction of climate emissions, so that we have sure and bright skies, more pristine waterways, and thriving wildlife. Though we humans couldn’t be there in person and had to watch it on a cover, did you ever before see penguins waddling through a downtown? We first of all need to flatten the curves of both the coronavirus pandemic and the climate crisis.

Although treatment for COVID-19 conditions have been readily connected into new ICD diagnosable conditions, at least those outside of psychiatry, nothing of the sort has occurred with climate-related conditions – but it needs to, from more specific Z coding to the rarer full-blown psychiatric disorders.
The coronavirus has probably received much more attention because the dangers are acute and lives are at immediate risk, which stimulates our inborn emotional fight-or-flight fear response. When that risk is more or less constant, other societal problems can fade into the background. Psychologists have a notion called the “finite pot of worry,” in which major wretchedness about one issue causes wretchedness about others to fall. Climate instability is slower and sporadic, needing the ongoing assessment of our frontal cortex thinking. In boxing terminology, they are a damaging one-two punch that can knock one out.
In terms of the climate crisis, the future challenge is how to mainstream some or most of that carbon emission reduction as the pandemic remits. The key may just well be what else both disasters have in common, and that is contagion. In the pandemic, we have the viral contagion by which it spreads. Hence, the main early intervention has been physical distancing. Although citizens didn’t have to comply as well as they did at first, they did so voluntarily well enough due to social contagion, believing that if those people they valued and admired did it, and recommended it, so would they. That may be starting to erode, however, and it could be a harbinger also for a return to more carbon emissions. At a deeper level besides the political one, those protesting the guidelines may be denying our collective wretchedness for our societal losses. Our society may need a big figurative or literal cry to move ahead healthier.
Social contagion is crucial for addressing climate change, too. That is one way to get around any political gridlock. When more and more citizens buy solar panels, eat less meat, and drive fewer polluting cars, more will follow. That includes us in healthcare. If we role-model climate concern, both professionally and personally, that can be influential and ethical. Societal political leaders and thought leaders can influence many, one way or another.
In the spiritual realm, from May 16-24, the Catholic Church recently celebrated the five-year anniversary of Pope Francis’s landmark encyclical, Laudato Si’, on the environment and human ecology. Prayer has skyrocketed to over half of Americans praying to end the coronavirus. Moreover, there is data that at least the praying, as well as the related spiritual meditation, reduces undue anxiety and stress, especially if the prayer includes a partnership with a divine force.
Then there is therapeutic art, which can be visual, literary, and/or musical. All have their formal therapeutic disciplines: art therapy, bibliotherapy, and musical therapy. Have you noticed how many positive and innovative artistic presentations, especially musical, are being made online? If anything, there are too many to determine from. Music videos of classical music, especially opera, are skyrocketing in number. Research, using MRIs of the brain, demonstrates that music activates multiple areas of higher-level cognition. 
We must indulge in the availability of online communication; just imagine what it must have been like over a hundred years ago, during the “Spanish” flu pandemic. Nevertheless, the current ban on large live musical gatherings mutes the healing power of music. We should never think that being online would adequately replace live human interaction whenever that is practically possible, as well as being psychologically and physically safe and comfortable enough.
What may help psychiatrically, when something deeper is indicated, are the kinds of existential psychotherapies created by the Holocaust survivor and psychiatrist, Viktor Frankl, author of the perennial best-seller, Man’s Search for Meaning. His own is called logotherapy. When necessary, medication can help reduce some symptoms, and I wouldn’t be surprised to learn that some of the pubic are taking underground microdoses of LSD to help find more cosmic meaning.

The Series Finale
Now it is June 2020. We are about six months from when we started this series. Maybe what has happened over this time in the world sounds more like fiction, but it is fact. It certainly wasn’t what we expected when we started, but in many ways, our consideration of how the climate was influencing mental health also connected to the coronavirus emergence.

Now there are two overlapping major global disasters occurring at the same time. Does that not suggest that humanity may have been going on the wrong path to the future? That even ignores, for the time being, the prior, but ongoing, nuclear risk. Maybe, like the substandard Robert Frost poem, we need to start trying to take the road not previously taken. May we resolve to help lead the way.
Thank you, Chuck, and all who have been supportive of this unprecedented series with unexpected complications. Although we cannot see our adversaries, experts can see that there is a collection of interventions in a bio-psycho-social-eco model of scientific psychiatry that can help address this complex challenge for now. With enough resources and realism, there are opportunities to come out of this stronger and more resilient.
At the end of The Ring, Wagner’s marathon opera, there is a “Transformations” motif that recurs as the physical environment is crumbling, signaling the beginning of a new and better world. Let that be our mental healthcare call around the world for follow-up action.
Programming Note: Listen to Dr. Moffic report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.
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SRC: https://www.icd10monitor.com/exclusive-understanding-the-impact-of-climate-change-on-mental-health-202006081747

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