To avoid potential controversy, I’m going to preface this post with this: get vaccinated. Vaccines save lives. That statement should seem obvious, and yet the past years have seen the rise of the antivaxx movement. Why? Part of the answer is a conspiracy mentality: believing in a sinister, clandestine elite that tricks the masses with elaborate hoaxes in order to further their own agendas is a shockingly good predictor of antivaxx beliefs, data shows. Trump was one of these people, and he was not quiet about it. As a result, vaccines have been inextricably tied with politics, a very dangerous situation indeed. Personal beliefs should have no bearing on matters of public safety. In terms of partisan correlations, there is no simple explanation. Antivaxx beliefs are not limited to the far right or the far left and are more united by conspiracist mindsets. Peoples’ beliefs are a product of their own personalities, cultural and social identities, and ideologies. I think the diagram provided in this article sums up this idea succinctly:
However, people have a right to believe what they want. After all, it is not like antivaxxers came out of their mothers’ womb believing that vaccines would give them autism. What is problematic is how information is spread to people, a topic I discussed in my previous post. Certain people are more susceptible to misinformation, either because of a lack of contrasting evidence or the environment in which they live. If we’re not careful, misinformation can spread as easily as COVID did pre-vaccine. This post is not partisan or even trying to convince people to vaccinate. It is a cautionary tale of the repercussions of ignoring how the human mind processes information when developing policy.
War is bad. There are obvious physical repercussions for civilians caught in the crossfire, as is documented in the daily news coverage in Ukraine – the endless bombings, brutality, and deaths are a tragic reality for Ukrainians. However, there are also substantial risks to the mental health of civilians, especially for children, who are most vulnerable to the drastic changes in routine and protracted trauma of war. In past wars, children who lived through conflict were likelier to develop anxiety and depression, and though not all will become traumatized, most react to trauma. For example, some will become more agitated and restless, while others withdraw and internalize, which is mistakenly interpreted as a “good” reaction to trauma. The mental health of adults is no less important. The care and support that parents provide to their children play a significant role in how children are affected by war, and if those parents are despondent or traumatized themselves, they cannot provide that support. Babies, while they may not understand the full scope of the situation, are also susceptible to the negative impacts of impaired parental interaction. Experts recommend providing some sort of structure to children – such as school or time to spend with families or play. Ukrainians certainly have it the worst, but ordinary people around the globe are also mentally affected by the war. Anyone who has felt depressed or anxious after watching the news knows what I mean. In addition, unfiltered footage of disturbing scenes of death, destruction, and tragedy are disseminated directly to the populace through social media platforms such as the immensely popular TikTok or Instagram. It is not that the interconnectedness and information accessibility of social media is a bad thing – social media can be used to foster positive awareness and solidarity. However, the flip side is true: depending on how it is used, it can have repercussions on mental health. Studies have indicated links between watching too much news coverage of 9/11 and the Boston Marathon bombing with greater acute stress, and even symptoms of PTSD. Social media is also a breeding ground for fake news and misinformation, a digital pandemic that has infected the world far longer than COVID has. Lack of certainty about whether a source can be trusted can blur the line between reality and fiction and cause psychological distress. The rampant social media coverage of the war is a continuation of a pattern that has existed as long as social media, but which escalated around the 2016 presidential elections. The same urge that causes you to waste an hour watching cat videos also encourages you to feverishly scroll through psychologically damaging images and videos. That is not to say, however, that one should ignore the war. It is important to be informed and aware, but how you do it is up to you, and depending on the choice you make, your mental health could suffer.
As always, this particular issue speaks to a larger defect of the system – the usage of social media. This isn’t my first post about social media. TikTok is a multiple offender, back when kids were mistakenly self-diagnosing with mental illnesses. The technologies of the age are becoming more and more metaphysical (think Metaverse and NFTs) and information-based. In my opinion, the world is experiencing a paradigm shift towards a more introspective, independent, and psychological mindset. So far (so far!), the primary human function that machinery has not replaced is the brain, and the job market is increasingly becoming reliant on expertise (shoutout to all the minimum-wage immigrant manual laborers). Indeed, the “information age” is aptly named. The human psyche now finds itself at the center of civilization, putting it under great pressure. However, the system has not adapted to this shift, and as a result lacks support for mental health. Think about it this way – if we gave coal energy to humans without climate controls, they would pollute the atmosphere with greenhouse gases (wait, where have we heard this before?). Policy has historically been rather slow, but that by no means excuses its failure to address the evolving needs of humanity. Technological progress is accelerating, and at some time in the future, we will reach a tipping point. On the other hand, by focusing on the mental health of non-combatants, I don’t mean to belittle the struggles of Ukrainians, which have the most priority and significance. But as for the war, I have little to say. Why is there even war in this day and age? War is unacceptable in more ways than one and is a disease many times more ancient than COVID and social media misuse. We should have found a vaccine for war a long time ago, but I suppose there will always be anti-vaxxers (*cough cough* Putin). Anti-vaxxers? That’s a great idea. Maybe I’ll make it my next blog post.
It’s obvious just how much the pandemic is affecting our mental health – but it is not the only thing. A recent United Nations climate report puts mental health at the forefront of the many climate-related issues our world is facing. Not only are younger populations indirectly affected by climate anxiety, but those who live through hurricanes and floods are also susceptible to mental disorders – in fact, 20-30% of them develop PTSD or depression. Wildfires induce anxiety, substance abuse, and sleeping issues. Interestingly, hotter weather by itself causes mental health problems, demonstrated by a study of almost two million Americans. Displacement, unemployment, and food insecurity brought on by climate change are also behind many of the stresses people around the globe face. Walking through wildfire smoke and city smog all day isn’t exactly enjoyable, either. It is even possible for people to experience psychological distress from seeing the destruction of landscapes which are important to them. Especially negatively impacted are first responders, youth, women, indigenous peoples, and outdoor workers. For example, the Inuit, who live in the Arctic and who must hunt and fish for sustenance, are facing increasingly dangerous and unpredictable environments. However, part of the problem is how we think about climate change: most of the time, climate change conversation is centered on pessimistic fatalism, and we often ignore the fact that taking steps to counteract climate change, such as using cars less and walking instead, can have positive effects on our mental health.
In my opinion, this climate change report is not a game-changer: it is simply one more reason to prioritize climate change, if there weren’t enough reasons already. It is also yet another indication of the nation’s nonexistent mental health support system. Of course, that is not to say we should just ignore the problem. In my opinion, the value of this report is not in its actual content, but rather what it shows us about how to think about mental health. The more the professional lens is focused on mental health, the more it becomes just how important it is to look the world in that way. Starting with the pandemic, studies have been finding previously overlooked yet critical ways that our society interacts with mental health. It turns out that politics and TikTok can take a toll on mental health, for example. Moreover, we must ask ourselves how people of different ages, socioeconomic statuses, ethnicities, occupations, and genders are affected differently. How can we outfit the response to mental health crises in a way that befits the specific situation? If I were any more pretentious, I would call this my model for mental health policy. Climate change is just one example of where this could and should be applied. What about the war in Ukraine? That’s a great idea. Maybe I’ll make it my next blog post.
*Note: since this entry is so long, I have split it up into multiple paragraphs. Only the last one is my opinion on the matter.
While pointless war and unspeakable violence rage in Ukraine, we are waging our own war at home, argues a recent Slate article. Like soldiers on the front line, healthcare workers must battle a crafty, intricate, dangerous foe, and experience suffering and stress in the process. This enemy is COVID-19, and though we may now think of the pandemic as the status quo, our nation’s soldiers are bearing the brunt of the attack. In recent years, there has been an exodus of health care workers, with almost 1 in 5 quitting their job. The commonly offered explanation is burnout: before the pandemic, burnout rates were as high as 54%, and COVID-19 exacerbated the situation. However, the authors of the article seek to highlight other, subtler stress mechanisms at work behind the scenes, by comparing the battle against COVID-19 to actual war. For example, the decreased individual attention that patients receive due to limited availability of resources and personnel can cause health care workers to experience moral injury, or the feeling that one has failed due to the disparity between their idealized and actual jobs. In addition, the inconsistency of care standards and conditions across hospitals can make workers feel insecure, and the constant transitioning between the front lines of the pandemic and the home environment is disorienting and can cause people to cope by fixating on only one reality. Finally, health workers have had to fill the role of providing mental health care as well, adding even more emotional stress.
These stressors combine to produce a form of trauma. The type of disorder that is often associated with trauma is Post-Traumatic Stress Disorder (PTSD), in which a single extremely traumatizing event produces psychological aftereffects, but the trauma experienced by health care workers is closer to complex trauma, a type of trauma characterized by chronic exposure to stressful, unpredictable environments. The latter type has a PTSD equivalent, or c(complex)-PTSD, whose symptoms include dissociation, relationship issues, destructive behaviors, emotional dysregulation, and feelings of shame and guilt. No doubt health care workers are experiencing these symptoms as they struggle through the stressful environments of the front line. Granted, due to the lack of research on the mental struggles of health care workers during the pandemic, the exact nature of this trauma is unknown. However, understanding these challenges as trauma is important, and using this framework, we can copy the way the military deals with trauma. As a result of World War II, the military evolved to integrate mental health care into the fabric of its system. Ironically, though, the health care system stigmatizes mental health, as professionals are expected to stoically endure hardships. What’s worse, the stressors that health care workers experience during the pandemic are subtle and harder to notice than sudden traumas, such as the death of a patient.
To address these needs, the authors suggest a government-run professional mental health taskforce, carefully and equitably coordinated, with “a trauma-informed approach; an emphasis on interpersonal, family-based care; standardized criteria for recognizing those at risk; and more universal mental health screening.” In addition, the authors encourage continued research into the nature of health care-related trauma, not just in the pandemic environment, but in general as well.
Health care workers are hailed as heroes, yet they do not receive the support that heroes generally receive. To me, the system has failed to recognize the universality and intersectionality of mental health. Veterans suffering from PTSD (or “Shell Shock,” as they called it then) after World War I were very visibly afflicted, leading to the incorporation of mental health services into the military after the next World War. Apparently though, society has not deemed the daily grind as warranting sufficient attention. The ghastly statistic of 54% burnout even before the pandemic demonstrates just how little attention mental health had been receiving. Just as the world is experiencing the physical conflict between Ukraine and Russia and the subtler battle waged against COVID-19, so too in the United States are our health care workers and general populace fighting against the physical symptoms of the virus and the mental symptoms of the pandemic. The pandemic has stripped bare our country’s mental health care system and exposed the pitiful paucity of support. In my opinion, sending in health care workers without mental support is tantamount to sending soldiers to the front lines as suicide bombers. Of course, the pandemic front lines are not as dramatic as military front lines, but the essence is the same – sacrificing valuable workers by failing to invest in their long-term usefulness (i.e., providing mental support so that workers don’t quit). Health care workers care for us, but who cares for them? The answer is “nobody,” and that needs to change.
The former director of the National Institute of Mental Health (NIMH), Thomas Insel, writes in his book, “Healing,” that although during his directorship countless medical breakthroughs led to reductions in death rates from heart problems and infections, the nation’s mental health crisis ballooned out of control. Today, suicide kills three times as many people as homicide, and this figure is only growing. The reason for this, Insel asserts, is that there is a “gap between what we know and what we do.” Specifically, the healthcare system is designed to help people only when they get sick; it does not prevent them from getting sick in the first place. In other words, the system ought to provide social services, rehabilitation, and job opportunities, and treat patients holistically: that is, treating them socially as well as biologically. In the current system, patients spend their time in one of three places – the homeless shelter, the emergency room, or prison. The first results in tragedies such as the death of Michelle Go, the second drains our resources, and the third perpetuates negative stereotypes and causes unnecessary and unjust suffering. Insel estimates that the current system costs us $1 Trillion a year (a lot!). Mental healthcare that does exist is often expensive or of low quality.
There is only one word to describe how the system is now: lazy. That’s one drawback of the rapid advancement of modern technologies and science – people often don’t understand how limited it really is, and assume that medicine can fix all our problems. I, myself, am guilty of this fallacy. It’s the same with climate change: it seems so far away until it happens right in front of you. While it’s true that neuroscience is a rapidly developing field, it is important to understand that the brain is an immensely complex and enigmatic organism, such that we’re probably not even close to understanding a tiny fraction of its inner workings. But we do, more or less, know how to help people with mental illnesses, and at that task we are failing horrendously. In Insel’s words, “We know what works, we’re just not doing it.” Well, it’s time for policymakers to start doing it.
In the largest study of COVID-19 and mental health to date, researchers from the Veterans Administration and Washington University in St. Louis found that COVID-19 survivors had a 35% higher risk of developing anxiety, 39% for depression, 41% for sleep disorders, and 80% for neurocognitive decline, or “brain fog,” in layman’s terms. Antidepressant use increased proportionally, as well as the likelihood of opioid usage (a 76% increase in risk!) and thus substance abuse. Even when compared to the typical negative mental effects of ordinary sickness or hospitalization, COVID-19 had a significantly greater impact, suggesting that the study’s results were unique to COVID. This side effect of the virus is hypothesized to be a direct result of the virus’s influence on the brain. The study examined 153,848 COVID-19 patients from March 1, 2020, to January 15, 2021, and compared the data with more than 5.6 million COVID-free people. The sample size was relatively diverse, containing a sizable number of women, African Americans, and people of different ages. Granted, this study was conducted before the large-scale introduction of the vaccine and the Delta and Omicron waves.
Even so, this study demonstrates, with little room for doubt, just how dire this country’s situation is. The previous posts have mainly focused on the stress caused by the effects of the pandemic, but the virus itself has an incredible impact on mental health, and this discovery was made only very recently. Obviously, one way to circumvent this issue is to help prevent infections – by wearing masks and getting vaccinated. Of course, these measures cannot possibly prevent all infections, even if everyone follows them, so we must be prepared to deal with the inevitable mental health fallout from COVID-19 cases. As I have said time and time again, the mental health pandemic is possibly one of the greatest threats this country has faced, and yet it continues to worsen and languish in relative obscurity. The day that this issue is brought into the limelight will hopefully be the day that we start to fight back against the enemy right under our noses.