Personal Accounts: Trying to Go Green!
Like most quests, mine began with something personal. Being so personal, I wasn’t sure how much it would be of interest to other people and my colleagues. What could connect community mental health care with the climate? That question emerged five years ago with an epiphany, but its answer has been emerging only recently, and my patients have taught me much more than I realized, even sustaining me in my quest to go green.
The initial inspiration
My third grandchild was born in March 2008. Soon after, she and her family visited our home. I was asked to go to the convenience store for some items. Checking out, I was asked the usual question: “Paper or plastic?” But this time, I momentarily froze, as I suddenly wondered, What is best for this granddaughter?
I’m still not quite sure, even with psychiatric introspection, why this instance seemed so different from my experiences when my first two grandchildren were born. Perhaps it’s because her parents are both rabbis, so that this simple choice became imbued with spiritual and religious meaning. After all, I had long advocated not only for a biopsychosocial model for psychiatry, but more than that, a biopsychosocial spiritual model. Did the answer to the question for myself have something to do with my people’s traditional imperative, tikkun olam, to heal the world?
I hesitated, at first feeling that I was doing enough as a community psychiatrist to heal the world. Besides, I was quite comfortable being the messy and wasteful person that I had always been.
But my superego must have kept intruding. I sort of knew that using throwaway bags, whether paper or plastic, would contribute to what has been termed “global warming” and climate change. Therefore, choosing neither, or at least the least destructive, would be an act toward a better future for this granddaughter. My rallying cry to myself became: “Go Green!” And going green meant trying to be environmentally sensitive in my own behavior and finding what my own profession could contribute to the cause.
The response of psychiatry
Most scientists, including a friend who is an academic geologist, had concluded that global warming is real and that its major influence is human behavior. Using a professional metaphor, let’s say that the “side effects” of carbon emissions are slowly causing an undesired rise in average temperatures.
If behavior is so involved in this problem, then surely psychiatrists must be involved in the treatment, right? Harmful behavior is in our realm of expertise and concern, even if it is not direct patient care, isn’t it? One of our ethical principles is the imperative to address psychological issues harmful to society. This is one, my thinking went.
I assumed I had just ignored what our field must have addressed in some way. But no. Almost unbelievably to me, no. Searching high and low, in print and on the Internet, I couldn’t find anything written by psychiatrists about this challenge—no presentations at the national meetings I had attended, no ad hoc task force set up by the American Psychiatric Association (APA).
Another possibility was that the psychiatric aspects weren’t as relevant as I thought they might be. The feedback of an expert outside of my field, such as the award-winning environmental journalist and editor of the long-running Dot Earth blog, Andrew Revkin, would seem to avoid some conflicts of interest. His simple e-mail response to me on December 2, 2008, was, “The psychology of this issue is clearly the hardest part.” Despite or because of that, he encouraged me to persist. That was all that I needed to hear, especially because I had long ago been fondly deemed a “gadfly” in psychiatry—time to buzz around the deniers or avoiders!
Looking into this challenge in more depth seemed to reveal more about the paradox of why psychiatry was important in this issue but also why it was uninvolved. Psychiatry surely understands the power of our evolutionary, hard-wired fight-or-flight reaction to immediate danger. We also know that there is nothing built into our brains like that mechanism to deal with future dangers. That would take our higher cortical thinking processes and just the right amount of anxiety. The legendary frog experiment illustrates this trick: Throw a frog into boiling water and it will jump right out. But throw a frog into lukewarm water that is gradually heated until boiling, and the frog will stay put and die.
We psychiatrists know that the Freudian defense mechanisms of conscious and unconscious denial could latch right onto these evolutionary processes and prompt us to prioritize the problems we are most comfortable addressing. In psychiatry, we face the major everyday problems of doing more in less time, learning to use electronic medical records, and getting ready for affordable care organizations. Now, we can add new billing requirements and new diagnostic requirements.
We psychiatrists know about all the psychological impediments to keeping ourselves as healthy as we should. Being also physicians, we know that behavior accounts for so much of such chronic health problems as overeating, eating the wrong foods, not exercising, and abusing substances.
We psychiatrists know quite a lot about posttraumatic stress disorder, having long ago made it an official diagnosis, so we should be familiar with the traumatic repercussions of disasters, and indeed we are for most disasters. However, now there are also “climate refugees,” who have already had to relocate to another country. Yet, even the disaster committee of my APA has not been interested in this new kind of disaster.
We psychiatrists, given our recent intense processing of the relationship of grief to depression, should understand the grief of “solastalgia,” a term coined in Australia to describe the despair of having one’s homestead slowly deteriorate because of climate change.
We psychiatrists should even appreciate the psychology of names, given the importance that pharmaceutical companies assign to naming psychotropic medications. (Prozac and Viagra vaguely imply what they’re supposed to do, don’t they, just in their names.) Global warming, as a term, does not evoke much fear, though, does it? In colder climates, it may even be welcome. The “change” of climate change can imply for the better or the worse. As I pondered this, it seemed like “global boiling,” akin to that frog experiment, and “climate instability,” akin to mental instability, would be psychologically more convincing.
In today’s politically charged climate, strength in numbers is important, so I tried repeatedly to get my APA interested in the issue. But the response repeatedly was disinterest; there were just too many everyday problems that were of more pressing concern to the members.
Sources of support
I have long focused my career on ethical challenges in psychiatry, ranging from serving the underserved to caring in a managed care era. Well, if not psychiatry to address this issue, then how about the rest of medicine, which laid the foundation for psychiatry’s ethical principles? And, lo and behold, I did find more interest among other physicians, most notably the Physicians for Social Responsibility (PSR). The PSR had won a Nobel Peace Prize in 1985 for addressing nuclear dangers and has since concluded that climate change is as big a risk to the future of humanity and the Earth. I was appointed to their national Health and Environmental Committee in 2010.
My wife was supportive of my quest for change. Of course, she might support anything that would make me less messy at home. We ended up doing multimedia presentations titled “Going Green Is Good for Your Mental Health” to any group that would have us. That ranged from pharmacists to synagogues. I dressed up as the Jolly Green Giant of Psychiatry and talked about the value of going green; she sang adaptations of such songs as “This Land Is Your Land.”
However, as the years went by, nothing much changed in my profession. Sometimes, the passivity of my colleagues even took a hostile turn, as in, “The day somebody comes up with a wag-the-dog agenda like global warming is the day I call it quits.” Now, I thought this was a good psychiatrist, and I didn’t want him to quit. Alternatively, I can be buoyed by occasionally hearing from the silent: “Steve, thank you for bringing up the issue of future disasters, re: our candidates for leadership. We live in an era when one of our most important challenges is preparing for the future in a climate of denial. You are speaking for many of us who share this concern.”
It has left me feeling sort of like Don Quixote tilting at windmills, but—goodness knows—we need more windmills to offset fossil fuels. As sung in the novel’s musical version, Man of La Mancha, perhaps this is just “An Impossible Dream”—or a nightmare that won’t go away. Was Don Quixote a “madman” or a metaphor for the noble struggle of Jews and Muslims against the Spanish Inquisition?
I had almost concluded that it might take an environmental catastrophe to bring more attention to the future risk, both in society and psychiatry. In fact, right before our last Presidential election came a storm so severe and unusual that it was dubbed “superstorm” Sandy. However, even after this superstorm, politics trumped people at times, most notably when emergency relief funds were delayed by a conflicted Congress.
Courage of patients
In some ways, the courage of my patients with chronic and severe mental illness has kept me working on climate change. When one has spent a clinical career working with such people, one has to have hope that recovery can occur, even with setback after setback and many years of struggle. So it may be with addressing climate change. I keep reminding myself of patients who have recovered, even without medication, after so many years of treatment. We all have to keep trying. As one patient after another would say, “Let’s keep trying, Doc.” Let’s.
