Q&A: Psychiatry may play key role in mitigating ongoing political polarization, unrest
Results of surveys conducted by Pew Research and similar research organizations emphasize the magnitude and intensity of political division in the United States over the past few years.
Psychiatrists, as well as the overall mental health field, may play an important role in mitigating the effects of the trend toward increasing polarization, according to Steven Berkowitz, MD, professor in the department of psychiatry and pediatrics at the University of Colorado Anschutz Medical Campus, as well as director of the Stress, Trauma, Adversity Research and Treatment Center.
Berkowitz spoke with Healio Psychiatry about the link between mental health and political unrest, how psychiatrists can approach treatment in an age of heightened division and whether psychiatrists can address radicalization at the ends of the political spectrum.
Question: What role does mental health play in our current environment of political division and unrest?
A: We know that loss of status, whether it's social, financial or both, is really one of the most pathogenic experiences that people can have, and it's linked to high rates of depression and suicidality. There is plenty of literature that shows this link. Even among low socioeconomic status groups, loss of status has profound effects. When we think about loss as a term or if we consider the whole grievance mentality, grief is the response to loss and an attempt to deal with what you used to have that you no longer do. Besides the lack of social and governmental programs to address this issue, which is crucially important, we haven't really done anything as a field to help people deal more effectively with the inevitable ebbs and flows that many people experience. But when we're talking about white nationalism or any of the extreme approaches, people, by and large, are responding to that sense of loss, that they or their families are not what they used to be, or they're not as happy as they used to be. With a certain form of punditry, this feeling can be turned into an aggressive, extremist movement. We have to really help people manage those feelings, and I don't think we've done a very good job of that. If you look at rural America, we're not there. We need to help people effectively mourn what they once had so they can move on.
Q: Do you have any tips on how psychiatrists can reach some of these individuals who may be feeling this sense of loss and are expressing it on the political level?
A: We've now learned that we can effectively offer interventions via telehealth. We also need to integrate more effectively into other systems, whether it's primary care, schools, social welfare or any of the various systems through which we can actually reach people more effectively. People aren't going to reach out to psychiatrists or whomever and say, "I'm feeling this sense of shame and loss." They really need to be exposed and led to that through various areas and systems.
Q: Do psychiatrists play a role in de-radicalizing patients who might be venturing into the fringe politically? Are there any red flags for which to look out?
A: There are correlations that I think are important. We know that people with histories of child maltreatment are more likely, for instance, to be violent or have substance use issues. Are we identifying them? Are we intervening for those people who are struggling and adopting extremist perspectives? Following the Capitol riot on Jan. 6, reports emerged regarding spouses of individuals involved having ended up filing for divorce or initiating separation because of domestic violence or overly controlling behaviors. Too often, I think issues like these are ignored. There is a role for psychiatry when people start demonstrating abhorrent behavior, and I think the courts and family courts need to up their game in that regard.
Q: Can psychiatrists approach conversations with patients in a politically neutral way?
A: If the patient brings it up, yes. I don't think it's a good idea for psychiatrists to bring it up on their own. The approach can really be a cognitive behavioral therapy-like approach, where the psychiatrist can explore the evidence with the patient. The psychiatrist may ask, "Where's your evidence? Is there another way to think about this?” This approach can be implemented when the patient's process of thinking may be fantastical.
Q: Is the mental health of elected officials relevant to the mental health of voters in any way? Does the Goldwater rule play a role?
A: The Goldwater rule is interesting. I think it's a good guideline, but there are times, particularly in the last four years, where the presentation allowed one to make a diagnosis. Certainly, when you have somebody who is a classic sort of leader/sociopath, that has huge ramifications on the population. We know that many CEOs in the country have sociopathic tendencies. Leaders influence people's thinking and approaches, and that really needs to be addressed.
Q: Might our current political environment and unrest be linked to trauma among Americans?
A: It's a hypothesis. I don't think it's been studied, as far as I know. We certainly know childhood trauma or maltreatment is a pathway to violent, antisocial behavior. It seems to me that at least a percentage of these individuals, and possibly more than the national average, will have had instances of maltreatment. But I think that's unknown at this point, for sure.