Recent election and mental health crisis

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the5thelement

the5thelement

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I have started to see more and more patients complaining of anxiety and hopelessness re: recent election . This is despite them being on high dose of antidepressants . Is there anything I can do as a psychiatrist to help alleviate this wide spread suffering and help heal these patients?
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the5thelement said:
I have started to see more and more patients complaining of anxiety and hopelessness re: recent election . This is despite them being on high dose of antidepressants . Is there anything I can do as a psychiatrist to help alleviate this wide spread suffering and help heal these patients?
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This is why psychotherapy skills are so important. We can’t change meds every time there’s an acute crisis of 1 week or less since we would be minimizing benefit while maximizing side effects. CBT, DBT, empathy and validation etc etc all work in addition to increasing frequency of follow up
 
If only it wasn't. Thankfully I moved away from a deep blue area to middle of nowhere red, so it will be less of an issue in my office.

1) Generic supportive statements, that don't reveal your political beliefs [whether they are in agreement or disagreement of the patient].
2) Discourage meds, as won't be treating the primary symptom which isn't responsive to meds; discuss bluntly
3) Attempt CBT at your own peril - these are entrenched political beliefs - and they won't change. Nor should we be wading into politics. Although Trump Derangement Syndrome (TDS) is real, it's not recognized by the DSM so we have no business wading into it. Repeat step one.
 
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Sushirolls said:
@Nontrad_FL_LGBT you thumbs downed my post and that by @calvnandhobbs68 do you have anything more to add that might help us understand why these were worthy of a down thumb?
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Because you're calling your patients who may have real and valid concerns whiny losers and medicalizing their fears.
 
Nontrad_FL_LGBT said:
Because you're calling your patients who may have real and valid concerns whiny losers and medicalizing their fears.
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I suppose I'll clarify because this actually seems like a troll topic from my standpoint....like just deliberately trying to stoke some kind of political discussion.

Is a practicing psychiatrist really asking how to deal with patients reaction to an acute psychosocial stressor? With such a broad question as "Is there anything I can do as a psychiatrist to help alleviate this wide spread suffering and help heal these patients?" without any formulation of what they believe their role is in this situation? With such an interesting statement as "This is despite them being on high dose of antidepressants".... OP what exactly do you conceptualize as the role of medication in dealing with acute stressors?

I mean the reason other people are responding with stuff like "CBT" is because this is actually a fairly basic skill/situation that it's a surprising question from someone who should be trained in that skill.

If your question was "I've been working with this patient I've conceptualized as having X core difficulties using X specific psychotherapy approach for X amount of time around this stressor and are still encountering X problems with progress, are there different approaches or conceptualizations you might have of this?", that would be a completely different and more understandable question from a practicing psychiatrist.
 
As always with any social, economic, political, or pandemic swings... I do suspect there will be an uptick in cannabis use, and maybe alcohol. I'm curious if cannabis dispensaries in the legal states would show a sales increase or not.
 
Sushirolls said:
Attempt CBT at your own peril - these are entrenched political beliefs - and they won't change.
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Well, the B of CBT can be focused on healthy behaviors to decrease anxiety, which is possible without challenging people politically.
 
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I've had many therapy sessions with patients this week after the election on Tuesday.

Here are my steps:
1. Assess for major depressive episode criteria and other relevant psychiatric disorders. This can be precipitated by recent events such as the election or not. If they meet criteria for those disorders, then treat accordingly.
2. If they don't meet criteria, and they do for an adjustment disorder or just subthreshold depression/anxiety (which does not necessarily meet adjustment disorder criteria, a pet peeve of mine), then proceed to psychotherapy.
3. Validate their experience, empathize with their suffering, identify specific ways in which they are suffering since I often get vague responses of "this is going to be bad" without having a concrete idea about exactly what would be bad, explore ideas on how to utilize coping strategies to manage their emotions, explore what this means to them in terms of their viewpoint of themselves and the world, help them accept the future uncertainty, if they want to prepare ways to deal with specific things that may come up then you can help them discuss this as well, all of this can be done without self-disclosure or influence of political bias. My style of therapy tends to lean non-directive and more insight-oriented as I want the patient to grow their capacity for self-improvement.
4. Offer them a closer follow-up, more frequent sessions, or longer sessions if they would like. Follow-up with the concerns that were brought up previously and how they've evolved.

Politically speaking, incumbents have been defeated all around the world (Australia, Portugal, New Zealand, UK, France, Japan, etc.) and I don't think this is an American phenomenon. My impression is that it is a secondary pandemic effect, one of decreased supply and then a snapback of heavy demand resulting in many macroecnomic trends that translate down into microecnomic grievances. The Financial Times calls it the graveyard of incumbents.
 
clozareal said:
I've had many therapy sessions with patients this week after the election on Tuesday.

Here are my steps:
1. Assess for major depressive episode criteria and other relevant psychiatric disorders.
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They literally cannot meet MDD criteria. or GAD criteria. or panic disorder. or almost anything else. It's been 3 days.

This is what I'm talking about with medicalization of psychosocial stressors....in almost all cases if thinking about any kind of medication changes answer should be some flavor of "lets keep following up on this". I think your number 4 is completely correct but I'm not sure how relevant number 1 is.
 
calvnandhobbs68 said:
They literally cannot meet MDD criteria. or GAD criteria. or panic disorder. or almost anything else. It's been 3 days.
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Right. Precipitating was the wrong word I used. I'm talking about if they had symptoms prior that got worse because of the election, particularly if they've been on high doses of antidepressants already as OP mentioned.

Also, just because it's been 3 days doesn't mean the symptoms can't be intense though, such as the election results precipitating suicidality.
 
Nontrad_FL_LGBT said:
Because you're calling your patients who may have real and valid concerns whiny losers and medicalizing their fears.
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Pretty sure Sushi said the opposite of the bolded, seems like everyone here agrees that medicalizing these types of psychological responses in this situation is not the correct approach.
 
clozareal said:
Right. Precipitating was the wrong word I used. I'm talking about if they had symptoms prior that got worse because of the election, particularly if they've been on high doses of antidepressants already as OP mentioned.

Also, just because it's been 3 days doesn't mean the symptoms can't be intense though, such as the election results precipitating suicidality.
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I do appreciate a bit what you're saying but this also comes up all the time for patients who do already have a psychiatric disorder who are responding to an acute stressor. It's why I don't increase a teenagers prozac every time their boyfriend/girlfriend breaks up with them or they didn't make the baseball team.

For the last sentence, sure, but suicidality doesn't necessarily have anything to do with an identifiable or modifiable psychiatric condition.
 
And here we have a Yale Chief Resident, Amanda Calhoun, MD, giving poor advice on national news.

Advising patients to tell family or friends, that because they voted for XYZ, 'therefore I'm not going to be around you' is garbage advice and not at all in line with professionalism or psychiatry. This type of thing is something the PD at this program should be formally reprimanding this resident on - and at minimum stripping them of the chief title. This doesn't facilitate resiliency. This encourages victim identity.
 
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Sushirolls said:
And here we have a Yale Chief Resident, Amanda Calhoun, MD, giving poor advice on national news.

Advising patients to tell family or friends, that because they voted for XYZ, 'therefore I'm not going to be around you' is garbage advice and not at all in line with professionalism or psychiatry. This type of thing is something the PD at this program should be formally reprimanding this resident on - and at minimum stripping them of the chief title. This doesn't facilitate resiliency. This encourages victim identity.
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I mean, they aren't wrong. If someone is feeling overwhelmed by a situation, it's okay to ask for space. Most of the people who are anti-Trump had their entire worldview turned upside down and their very understanding of good vs evil challenged. Of course they need space, lol. That's a pretty scary thing that many people likely need time to come to terms with which is also likely hard when they have people celebrating that around them.

I would think most therapists could understand that? Furthermore, in line with therapy, encouraging patients to develop the skills to share their feelings is certainly not a negative thing.

That said, I am surprised they had a chief resident on the news to speak on politics in this way. Probably not a great idea. Usually there is a media representative who can speak on things like this unless she's doing a fellowship of some sort.
 
Exposure... line your office with MAGA posters.

Really, there are always neurotic people every election cycle. They like to come in and talk about their anxiety du jour, and it just happens the candidate they voted for didn't win. The flip side is patients' whose candidate won also like to come in and talk about their excitement du jour. Neither are experiencing actual psychiatric issues, and don't need any professional help from me for their anxiety/excitement.
 
To the extent there could be something pathological, there does seem to be varying degrees of certainty of negative outcomes among people.

There are evangelicals who are comfortable making other people uncomfortable in their evangelism because they have a certainty of the possibility of hell and of their ability to convey a message that would avert it. It's internally very logical to make someone momentarily uncomfortable to spare them an eternity of suffering.

I see the same thing in Greta Thunberg. She heard the same messages that everyone else did about global warming. I don't think I'm alone in my own feelings about global warming being that 1) It's real and 2) It's not a good thing but 3) The outcomes are kind of murky.

She on the other hand diverged with me on point 3 (and, if I am like most of the population, with them as well) and very literally has believed the messages about the certainty of global warming being an existential threat. Again her response is internally logical, given that she sees the imminent end to a habitable planet.

And that leads to the messages about Donald Trump being an existential threat. Maybe I'm blase, but I have a sort "I wonder where this is going" feeling. Whereas other people have been told very dire things and believe them with a great deal of certainty.

Is there some spectrum where people take others more earnestly when they deliver bad news? Or maybe my own ambiguity regarding bad news reflects a corruption of social trust. Maybe the "healthy" ones are the ones who still take people at their word. I've heard it in Catholicism referred to as simple faith, not derogatorily.

These threats (hell, global warming, Trump) are all non-tangible, but quite real to some and quite ambiguous to others.

If we were under under The Blitz, I'm sure it would be easier to respond to your patients with more consistent intersubjectivity.

Do you think the ones that you find are in need of CBT etc just have too much trust and certainty in reception of bad news? Who knows, they could end up being prophetic. And it's been said by some that the people who have "I wonder where this is going" feeling I do are the ones who enable historically cataclysmic events through accepting the "banality of evil." It's still my human nature, but obviously others have a different nature.

Addendum:

In the context of discussing medicating crises, I couldn't help but remember right after I posted Wyeth's contribution to allaying the anxiety surrounding the Cold War in 1987, "In a world where certainties are few no wonder Ativan is prescribed by so many caring physicians."

ativan.jpg

(I made it small so it wouldn't consume the thread, but the rest of the ad copy is in the bottom right of the image.)
 
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Sushirolls said:
And here we have a Yale Chief Resident, Amanda Calhoun, MD, giving poor advice on national news.

Advising patients to tell family or friends, that because they voted for XYZ, 'therefore I'm not going to be around you' is garbage advice and not at all in line with professionalism or psychiatry. This type of thing is something the PD at this program should be formally reprimanding this resident on - and at minimum stripping them of the chief title. This doesn't facilitate resiliency. This encourages victim identity.
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It must be something in the water at these places. Wonder if the department over there is proud of these comments, or embarrassed. A chief resident no less.
 
The repeat nature, I suspect it is a culture of acceptance to these things that stray from standard of care and professionalism.

But perhaps I'm wrong, are there any modalities in Marital / Family Therapy that actually encourage ending relationships outside of physical domestic violence scenarios, where professionally we should tell people, end it, cut these people out?
 
Sushirolls said:
The repeat nature, I suspect it is a culture of acceptance to these things that stray from standard of care and professionalism.

But perhaps I'm wrong, are there any modalities in Marital / Family Therapy that actually encourage ending relationships outside of physical domestic violence scenarios, where professionally we should tell people, end it, cut these people out?
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It's a pretty mixed area. In recent times there was an expert panel where people discussed how to approach politics in the holidays. One expert said to cut off family. The other said to connect with others and avoid topics like politics where we tend to split people up.

Intriguing
 
HaileyMed said:
I mean, they aren't wrong. If someone is feeling overwhelmed by a situation, it's okay to ask for space. Most of the people who are anti-Trump had their entire worldview turned upside down and their very understanding of good vs evil challenged. Of course they need space, lol. That's a pretty scary thing that many people likely need time to come to terms with which is also likely hard when they have people celebrating that around them.

I would think most therapists could understand that? Furthermore, in line with therapy, encouraging patients to develop the skills to share their feelings is certainly not a negative thing.

That said, I am surprised they had a chief resident on the news to speak on politics in this way. Probably not a great idea. Usually there is a media representative who can speak on things like this unless she's doing a fellowship of some sort.
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There is a difference between asking for space/understanding and isolation and completely cutting ties. She may be more suggesting the former as a short term solution, but the patients we see often apply it as the latter. Her not addressing the need to come back to the table (maybe she did after the clip cut off) is problematic. Doing so in the few days after an election or event is one thing, needing space for months afterward during the holidays is a sign of something more pathologic. Avoidance is not a means of growth or therapeutic outside of brief removal from very acute and high-acuity stressors.

There is also a difference between someone literally attacking your morals/mocking during interactions and making an assumption that because someone voted a certain way it is a direct attack on you and your morals. Most people who voted for Trump aren't evil and without talking to them anti-Trumpers aren't going to have any understanding of why those people voted that way.

To the bolded, I'm not surprised at all. It's Yale. It's been discussed in numerous other threads on this forum, but that program has a lot of media presence even with residents as well as a knack creating social s*** storms. Honestly, I'm most surprised that her message was as mild as it was, so good for her from that perspective.
 
With familial/interpersonal interactions, it is also important to address/consider displacement: people have a lot of strong feelings (fear, anger, etc.) that they can't express/act on to the true source of those feelings (now the entirety of the US federal government), but they can to someone else (e.g. relative who voted for the incoming government).
 
I honestly think that this is one of the biggest issues with our system of media/government/political parties where there's this inherent tribalism and 'your world is over if you lose' mentality. I actually think that things like ranked choice voting is part of the answer because it will force the 2 parties to action, but i digress. There are certain groups that are, imho, rightly worried about how there may be long term changes that affect their life, thinking here about some of the fears of my trans patients...

But really, I think a lot of this is the feeling of powerlessness. If these patients are over 18 and they're upset about the political process then they should do something and mobilize/organize at a level they feel comfortable. This exact same thing happened 4 years ago except there it was more limited to the online sphere and seemingly fueled by anger and conspiracy theories.

So I guess you might want to make the disclaimer to folks that they shouldn't storm the capitol...
 
I like that idea that people who are feeling powerless should work on finding their power. I'm not entirely sure encouraging mobilization or organization is exactly the right tact. Personally, I think more people should actually run for office at a local level. That can have a lot more of an effect on people's lives than protests. And if you can't run for office, at least get into some sort of corporate management so you have a locus of control somewhere and can improve somebody's life.
 
comp1 said:
I like that idea that people who are feeling powerless should work on finding their power. I'm not entirely sure encouraging mobilization or organization is exactly the right tact. Personally, I think more people should actually run for office at a local level. That can have a lot more of an effect on people's lives than protests. And if you can't run for office, at least get into some sort of corporate management so you have a locus of control somewhere and can improve somebody's life.
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When I said mobilize/organize, I meant local issues/politics. Would also help the social isolation thats so frequent in some of these patients regardless of what side of the fence they're on. I think a fair question to ask when someone is upset about something (thats actionable) is what they've done about it and ask them if they've considered doing things locally while also asking about other activities/interests they're involved with that they could engage/reengage with.

aim-agm said:
With familial/interpersonal interactions, it is also important to address/consider displacement: people have a lot of strong feelings (fear, anger, etc.) that they can't express/act on to the true source of those feelings (now the entirety of the US federal government), but they can to someone else (e.g. relative who voted for the incoming government).
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Something I hadn't thought about before was whether or not there was a strong source of feelings towards certain family members because of other history. It's one thing to not want to see the polarizing family member you only see once a year or two, but something totally different to not want to see the aunt/uncle/cousin you used to spend a lot of time with over the summer.

I wonder if it's displacement for other feelings as well. I guess some folks really do buy into the narrative of 'they hate us because they voted this way'.
 
interestingly enough my patients have been pretty quiet on their political views post election, even my more outspoken ones..Which was very surprising. I thought the opposite would happen. But i also live in a state with a huge percentage of retired geri caucasian males. Most probably were pretty happy and just kept it to themselves.

im very blunt/objective with my patients. I try to help them understand that if their happiness is dependent on other people then they will forever be disappointed. The best way to see change is to make it yourself. People feel helpless and dependent on xyz being president, but we have limited control over that. I try to reinforce to my patients that some variables we have control over, others we do not. Anxiety is a desire for control over things we have no control over. I shift focus to controlling things patients do have control over. They can engage in healthy habits, self care, furthering their own goals, etc. Ultimately people may give me **** for this statement, but in most cases i see in clinic, CBT is probably more effective than medication because most of the time their depression comes from a sense of helplessness/hopelessness, negative self perception, etc. Of course i still utilize antidepressants, but i think in the vast majority of cases the outcomes are so much better when combined with CBT, aside from maybe the high functioning people who have very mild symptoms, which i dont get too many of those patients.
 
annoyedpsychiatrist said:
interestingly enough my patients have been pretty quiet on their political views post election, even my more outspoken ones..Which was very surprising. I thought the opposite would happen. But i also live in a state with a huge percentage of retired geri caucasian males. Most probably were pretty happy and just kept it to themselves.

im very blunt/objective with my patients. I try to help them understand that if their happiness is dependent on other people then they will forever be disappointed. The best way to see change is to make it yourself. People feel helpless and dependent on xyz being president, but we have limited control over that. I try to reinforce to my patients that some variables we have control over, others we do not. Anxiety is a desire for control over things we have no control over. I shift focus to controlling things patients do have control over. They can engage in healthy habits, self care, furthering their own goals, etc. Ultimately people may give me **** for this statement, but in most cases i see in clinic, CBT is probably more effective than medication because most of the time their depression comes from a sense of helplessness/hopelessness, negative self perception, etc. Of course i still utilize antidepressants, but i think in the vast majority of cases the outcomes are so much better when combined with CBT, aside from maybe the high functioning people who have very mild symptoms, which i dont get too many of those patients.
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I find that while people understand behavioral activation is great for depression, it is less well understood that action is a huge part of the treatment of anxiety as well. Exposure is understood, but movement, volunteering, work, doing things with others, time outside, active mindfulness work etc. are all integral to the treatment of anxiety disorders.
 
Merovinge said:
I find that while people understand behavioral activation is great for depression, it is less well understood that action is a huge part of the treatment of anxiety as well. Exposure is understood, but movement, volunteering, work, doing things with others, time outside, active mindfulness work etc. are all integral to the treatment of anxiety disorders.
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The child example for this is school avoidance... the treatment for school avoidance is shockingly... going to school.
 
ridethecliche said:
The child example for this is school avoidance... the treatment for school avoidance is shockingly... going to school.
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No, I'm pretty sure it's withdrawing the child from school and doing online learning. I've had a number of parents tell me much better their child's social anxiety is when they don't leave the house!
 
Merovinge said:
No, I'm pretty sure it's withdrawing the child from school and doing online learning. I've had a number of parents tell me much better their child's social anxiety is when they don't leave the house!
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Shoot, I've been doing this wrong all along.

Goodness, I guess you can do college all virtual and then work all virtual and never leave the house forever!
 
Merovinge said:
No, I'm pretty sure it's withdrawing the child from school and doing online learning. I've had a number of parents tell me much better their child's social anxiety is when they don't leave the house!
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Can we just ban cyber school for all kids who are physically capable of attending school without undue hardship? I have yet to see a case of a kid being pulled for online school that was not a complete disaster, just different magnitudes of disaster.
 
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