Climate Change, Emotional Inflammation, and Physician Leaders

Climate change is most often thought of in terms of unpleasant weather events.  We occasionally think about specific animal species being impacted by climate change.  Less focused upon are the mental health consequences experienced from an unpredictable environment.

Lise Van Susteren, MD, is a general and forensic psychiatrist in Washington, DC, and an expert on the physical and psychological impacts of climate change. In 2011 she co-authored The Psychological Effects of Global Warming on the United States: And Why the U.S. Mental Health System Is Not Adequately Prepared. Van Susteren is also clinical associate professor of psychiatry and behavioral sciences at George Washington University and has been a consultant to the executive branch of the U.S. government profiling world leaders. 

She joins host Mike Sacopulos to discuss her work.  Meteorologists and politicians can debate the causes of climate change, but physicians and other healthcare professionals are left to care for the people impacted. 

This transcript has been edited for clarity and length.

Mike Sacopulos: Climate change is most often thought of in terms of unpleasant weather events. Fires, floods, droughts, and rising sea levels are called to mind. We occasionally think of specific animal species impacted by climate change. We've all seen the images of polar bears struggling with decreasing sea ice. Less focused upon are the mental health consequences experienced from an increasingly unpredictable environment. Meteorologists and politicians can debate the causes of climate change. Physicians are left to care for people impacted. We will speak with one of the foremost physicians studying climate change's impact upon health. Next on SoundPractice.

Lise Van Susteren is a general and forensic psychiatrist. Dr. Van Susteren is a clinical professor at George Washington University. She is the author of Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times. Dr. Van Susteren, welcome to SoundPractice.

Dr. Van Susteren, you've spent time studying how climate change impacts the mental health of individuals. Can you give me some examples to help me get into this topic?

Dr. Lise Van Susteren: Yes. I've been focused on this issue for about two decades, and the impacts on people are much deeper than we realize, and they're much broader than we realize. One of the things that I often say to people is, as bad as the storms are outside, which is where we tend to focus our attention, the storms inside are even worse. And the impacts range, depending upon your exposure to the extreme weather event or your consciousness of future disasters. It ranges from major depressive disorders, generalized anxiety, post-traumatic stress disorder. We're seeing domestic violence with child abuse and certainly abuse of alcohol and drugs.

And then there's something, I thought I coined the term, but it turns out I just popularized it. It's a post-traumatic stress condition that shows our awareness of what we anticipate in the future. So that is a sampling of what we're seeing. And if you want to hear about personal experiences, I can talk from my own perspective or talk to you about other people, but those are anecdotal.

Sacopulos: Your answer somewhat leads me to my next question, that climate change is typically thought of in terms of epic critical weather events, hurricanes, floods, droughts, fires out in the west, right? But it seems to me we can witness it on a less dramatic constant basis, with invasive species or fewer birds about. Do the impacts of climate change vary based upon the nature of the change?

Van Susteren: To clarify, the impacts of climate change, of course, are going to vary according to the geography, and of course to the topography. Meaning not only where you are, but in terms of your placement on the planet, but what the conditions are around. Are you in the mountains, are you at sea level, et cetera. So yes, in some areas we see terrible drought and we see mostly food shortages when there is drought. And then the Horn of Africa comes to mind, although we have a problem here in the United States as well with people going to bed hungry, it's not just places far away.

But drought in some places can cause wildfires. We've certainly seen all along the West Coast of America and in Greece very recently and other places, Portugal comes to mind, dreadful fires, incinerating everything in its path, including people and animals and of course vegetation. So yes, where you are can color what kind of event you are exposed to. And I'm going to add, we're not just potted plants sitting here. Even if we haven't experienced ourselves a particular extreme weather event, seeing other people suffer, die, lose everything. There's vicarious trauma there.

Sacopulos: I think sadly, you are correct. Have you seen this in coastal areas where the fear of long-term elevation of water levels impacts people?

Van Susteren: I sure have. And it seems like the more economically higher up you are on the totem pole, the less likely you are to consider or be affected by sea level rise and storm surges and the general intrusion of salt water in the areas around coastal areas. Because if you're poor and your whole livelihood depends on your catch, it's going to affect you differently from somebody who's building a 20 million dollar or 10 million dollar mansion back on a floodplain in Florida, that if you're a billionaire, and we've got more than I think a hundred in this area, then it's not going to affect you the same way because you have more latitude to rebuild or to move to higher ground and to leave things behind. But if your life depends on a certain pattern of weather conditions that you've been accustomed to and your life is fundamentally based on that, it's not just a second home, you're in trouble.

Sacopulos: As you know, this is the podcast of the American Association for Physician Leadership. And I'm interested to know if climate change has any specialized or peculiar impacts upon the medical community.

Van Susteren: Oh gosh, yes. Let me just tell a little anecdote. Last week during Thanksgiving, I was down in Southwest Florida, and as many know in late September, Hurricane Ian struck Southwest Florida and just ripped up Fort Meyers area, Naples, et cetera. And I was down in Southwest Florida, trying to see if I could provide some psychological first aid to the victims. And I really actually thought, Mike, that I'd just be seeing patients and talking to them about their trauma. Well, I was really doing a lot of work with medical personnel who had been trying to help people who had lost everything.

Boy, are they burned out, boy, are they angry for the inaction. They've lost so much themselves. And they feel that and recognize it's more than just feel that political leaders are not taking this seriously enough and that they are at the tip of the spear trying to hold the hands of people who have lost so much. In one instance, the clinic, which was serving underinsured or uninsured people, had been completely flooded out and they were given a new place. But in the transition phase, they met people on the lawn in front of their new place and put out a sign that anybody who needed medical help could come. And they were just filled to the brim with people standing in line. And the vulnerability that they feel personally and that they share with their patients is something that is extraordinarily contagious and devastating.

Sacopulos: I'd like to swing the focus to your book that you published in 2020 that addresses emotional inflammation, and it certainly seems that we do not lack these days for emotional inflammation. What are some of the long-term consequences of emotional inflammation on an individual level?

Van Susteren: Thank you for asking that question. I must say that though the issues I addressed in the book were very upsetting generally. And we talked about human rights violations and gun violence, in addition to what my target issue was, which is climate disruption. So, writing the book was just such a joyful affair, I got to say, because it's really all about solutions, remedies. But one of the key issues in the book is describing what happens to us when we are under stress. Medical professionals know that stress can be something which if it's short-lived is how we outrun a boa constrictor or we avoid some other sort of danger. We were evolved to have our amygdala respond to danger and for it to hit the driver's seat, shut down that prefrontal cortex. We do not want fancy thinking right now. We want action, get up that tree and figure out later that it's just the wind blowing the grasses, it's not an approaching lion.

So that's adaptive. But what isn't adaptive is what we're forced to face today, which is constant stress. So that catecholamine release that is triggered by our amygdala’s firing, and we've got big aggressions and small aggressions to deal with. Microaggressions and race is one that we think of commonly. But what was fun about this book was learning that human-made sounds, for example, are also stressors for us, seeing things that are not natural, lots of cement and the absence of trees and things like that. So, what happens is that our stress gets raised and we try to cope in various ways. Some are more adaptive than others, and I won't go through all of the different types of coping styles in favor of simply saying that chronic stress shuts down our prefrontal cortex, where we do our most sophisticated thinking, our seat of good judgment, where we weigh pros and cons, where we seek out our moral fiber, in favor of the activation of our survival mechanisms, which means the dumbing down of our thinking.

And in making this a back-brain activity, what we have is a reduction in our cognitive abilities, our ability to remember our sophisticated thinking, all of the things that are the hallmark of a prefrontal cortex. We know that stress disrupts sleep, it interferes with our digestion, and has cardiovascular effects which are far-reaching. And so, reducing our stress by restoring our relationship with nature is certainly at the top of the heap of our to-do list.

Sacopulos: Well said. In an earlier answer, when you were talking about some of the providers in South Florida that you met with, you mentioned that politics was maybe a trigger. And I'm interested if politics is a strategic trigger for emotional inflammation, and if so, what implications does that have for leadership, specifically physician leadership? Because I could see arguments on both sides of physician leaders feeling as though they need to provide political commentary and others saying that that's inappropriate for them to do so. Can you give me your thoughts?

Van Susteren: Yeah, I got a lot of thoughts. There's a lot embedded in your very sophisticated questions. So, I will try to start at the top, which is that physicians have a unique voice in advocating for a healthy planet. And you can't have healthy people on an unhealthy planet. So it isn't that we are arguing politics, we're arguing health, we're arguing common sense, and if you put people in unhealthy conditions, they're not going to be healthy. So, we are arguing values, which is protecting or restoring the health of the communities. And physicians are respected, perhaps not as much as nurses. We know nurses rate the highest, but we don't have to embed ourselves in political factions. And we don't have to key into particular phrases that might trigger people's political responses, because we can talk about stewardship, we can talk about restoring nature, we can talk about what nature does for us.

And indeed, there's a European center, I can't think of the name at the moment, but they have over 200 papers that they have culled information from. And if somebody wants to know, get back to me. But we have seen what nature does for us, just short trips into nature restores us in so many ways. It improves our immune system, it raises our feelings of generosity. It improves our memories, it reduces our self-reports of stress. And these can be very enduring impacts on us. And so, our values really in understanding the world in which we live. There's another fascinating thing that it improves our gut microbiome, about which a lot of people have been talking and hearing, because we evolved our gut microbiome in tandem with the microorganisms that we find on Earth. Our exposure to them improves all of the things that our microbiome is responsible for. And somebody else can have a podcast with you on that because it's so extensive. What fun in restoring the health of the planet, it doesn't have to be political.

Sacopulos: Medicine's been described as both an art and a science. And it occurs to me that medicine today is far more science than art. Do you agree with that? And if so, tell me about the implications of what that means to provider and patient.

Van Susteren: I am so thrilled to hear that question, because we're not just a series of mechanical functions. We do have feelings. And if it were only science, and I'm not downplaying science, let's take it out of the climate realm, then artificial intelligence could fix everything. And yes, artificial intelligence does have a role in being able to simplify answers more quickly, pick up on some things more efficiently, et cetera. But we are not just a series of mechanical reactions. Our feelings are, in fact, some people say 80% of what we do is really unconscious, and that's the realm of feelings. We're not so good always at understanding either our feelings or those of others or understanding what's in a context. And it is really the art of medicine that engages the patient. So yeah, we can slip a piece of paper about why a person should do something, but it's the art of our persuasive abilities that turns a patient into a collaborator with us.

And that's what we're looking for. We're looking for connection. Humans are looking above all for good connection. That's what's restorative. That's what influences us. And over and over again, the masters of messaging will tell us that it is our relationship, our credibility with the person who hears us, the feeling of reciprocity in the relationship, the likability. All of these things are what make a message effective. Otherwise, you could just send people an email and be done with it.

And then in the realm of climate issues, it is especially important that we connect with people. It is clear that just handing people the data, which if it was enough simply to hand people the data, we would already have made the changes that are necessary. But we got a lot more stuff going on. And one thing that we are as humans and we don't realize, we have a self-destructive streak, and Freud talked about that. So, it's really the art of the physician to heal people and redirect us from the tendency towards self-destructive choices, especially if you're a psychiatrist, towards those choices which affirm our connection and restore our health.

Sacopulos: I'm interested in this self-destructive tendency. It sounds kind of like the fatal flaw in a Greek tragedy. Maybe you can talk a little bit more about that, because I'm not sure that that always gets addressed when patients are seeking medical attention.

Van Susteren: Once again, it's really fun to talk with you. Freud, as you probably know, was a great fan of the ancient Greek philosophers. And he spoke of the drive for life, Eros, he named it. And we recognize that. But we also, let's face it, recognize that there are self-destructive decisions that we make, and namely we're soiling the nest, which is our only home even as we speak. And that is a very self-destructive aspect, which when shared seems less problematic. And I could talk about that at length too, but in social psychology, one factor is the tragedy of the commons, where we destroy essentially our setting because it's a shared common resource that when we think of it as belonging to us individually, we ruin it for everybody. But getting back to Freud, he did not name this, but subsequent thinkers did, that that drive, that self-destructive drive, It was named Thanatos after the Greek God of Darkness and Death.

And so we do have these twin forces in us, and they do need to be addressed both individually and through social psychology. And this is the art, and why, I have to admit I had not heard of Physician Leadership, your group, before, but boy, am I going to be hot on your trail now, because physicians do have such a unique opportunity and responsibility to affect change within our communities and in our patients, which when we do that, the collective impact of changing our patients like votes on election day are counted together.

Sacopulos: And is your practice of medicine strictly on an individualistic basis, or do you think that there are things that can be done on a more societal basis?

Van Susteren: Well, a couple things. One is that the Climate Psychiatry Alliance, a group I co-founded, the Climate Psychology Alliance North America, another group I co-founded have a joint project, which is called the Outreach and Advocacy Group. And we are engaged specifically in community activism. Right now, we have bills that are likely to drop. We haven't provided the bill themselves. What we have provided is the education to the legislators. So, we're a 501c3, and we very much respected that we are there to educate, but there are legislators that are dropping bills reflecting our education efforts in Massachusetts, soon perhaps in Maryland, we hope soon in Maine. And if all goes well, we're going to tackle Florida. And the action is to identify extreme weather events to which a state is vulnerable, and then to do an inventory of the mental health services, or perhaps other medical services that are now available to address those extreme weather events and what we will need down the road as extreme weather events increase and become more intense.

We also have a paper that will be addressed, encouragement on the part of the new governor of Maryland, Wes Moore, to call for a cabinet-level climate solutions office so that the state can look at what messaging works across different agencies and coordinate messaging and make sure that we are engaging in the preparatory and other actions that are necessary to make the residents of a state safer and healthier.

And then we have a third activity, which I'm very excited about. We are working with 211, which is the national disaster hotline. And that hotline we found out does not include climate disasters. So, we are working with them to include climate disasters, which will enable us to address the emotional toll that people are experiencing. It's not treatment, it's just a connection. And if they choose, we will put them in touch with groups locally that can help them engage in the collective action that is the magic sauce for people suffering with grief, with their anger and with their fears.

Sacopulos: My next question gets to the idea or your opinion on the value of hope. It seems to me that just attempting to fix a situation, climate change, or you name it, that the medical community faces, has value, whether it succeeds or not. Would you agree with that?

Van Susteren: There's a lot to say about hope, and one issue to address, because I want to talk about hope. And the reason that I want to talk about hope is we got to make sure that it isn't just empty optimism, where you pound the table about looking at the good side. It's called, my friend George Marshall refers to it as the bright-sidedness, as opposed to being realistic. We are in trouble. And it infantilizes people to suggest otherwise. We would no sooner tell a person who has cancer that it's going to be all right when we know it's not. And certainly not if they don't get treatment. The same goes for climate. We have to tell people the truth, and then we segue immediately to, here's what we can do about it. And whether or not a particular action succeeds can certainly give us feedback about whether or not we should change either our goals or our tactics. But it should never be predicated simply as an outcome.

Not everything that counts can be counted. Being together in a group fighting for something that we know will restore our planet to safety and will bring health to the people that we care about is in and of itself a magic healing sauce for us. And if there's one thing I've learned as an activist, it's that perseverance is what works. You don't get it the first time around, or you rarely do. Get used to reverses, remobilize, build a bigger coalition, and you'll get across that finish line, or perhaps some other day when you're not there, somebody else will. But it's all based on the foundation that you create.

Sacopulos: So very well said.

Van Susteren: So let me say one other thing, and that is that the issue of the science rather than the art; the number of dumb choices that we make to honor the science rather than the art is pretty staggering. One of my friends who's an expert on coral reefs, talks about the relentless focus on research within, I would say the mental health community. Now, granted, the mental health community, more people are getting involved every day. They realize the emotional toll. And they recognize the two-way street that any physical impact on us carries with it an emotional toll. So any loss or physical injury is going to drive up the emotional toll. And the emotional toll drives our physical health. But the key issue is this, and that is that the emphasis on research as opposed to an emphasis on action, is what is a now huge vulnerability in our efforts.

Because what we need to do now is take everything that we know and turn that into action. A friend of mine who's an expert on coral reefs, who complains that people will release a research paper showing it's not 37.2%, but it's now 41.5%, and they got a grant to show this. Well, of course, that's to appease universities that require people to publish or perish. But the reality is that as he says, it's like rearranging the deck chairs on the Titanic to get a better view. So, the issue now is to turn what we know into what we do, and to recognize, sometimes people will say, "Oh, well, what one person does doesn't matter." Yes, it does. The people around us, our friends, our family, our neighbors, our coworkers, they all see what we're doing.

Not everything that counts can be counted. And when we put together all of our individual actions, that's what calls an election, that's what drives markets, that's what changes a culture. And let us not forget, there's a fabulous economist, and I'm going to borrow Al Gore's statement on this. He borrowed it from this economist. And that is that things take longer to change than we ever thought they would. And then they change faster than we could have imagined. So all of us, and especially the collective action of the unique population of health professionals have an opportunity now, and I would even say a duty to do everything that we can to turn what we know into what we do.

Sacopulos: Very well said. Our time is just about up, but I'm so interested in what you're working on in going forward. Can you tell me a little bit about what we should expect from you in the future?

Van Susteren: I'm so excited to report that there will be a book out soon on climate and mental health. And it has both the problem elucidated with some personal history so that people feel, because we also know that if you want to drive change, you've got to get people to feel something. And that's why when you mentioned earlier about science and art, I should have added that the art is also getting people to feel, because that's where you cultivate the soil into which you put your persuasive techniques.

But back to the book, the book has the problem, and it also has a huge section on solutions. All of the things that excite us, that make us feel the grand sense of possibility. And it's an ebook. It is a digital book, which means that it's not behind a paywall. Well, I guess it doesn't necessarily mean, but the book will not be behind a paywall. And it is written by professionals from all over the world, mental health professionals and others, some very famous writers. And we will be updating it because what I learned about climate is that things change. The numbers change, we have before us changes, so it's going to be updateable. So, stay tuned for a climate and mental health ebook coming out soon.

Sacopulos: Excellent. My guest, who's been Dr. Lise Van Susteren. Doctor, thank you so much for your time and being on SoundPractice.

Van Susteren: Well, thank you for all you do. I am so excited to learn more about your group and maybe start thinking of ways that we can collaborate.

https://www.lisevansusteren.com/

https://www.amazon.com/Emotional-Inflammation-Discover-Triggers-Equilibrium-ebook/dp/B07SH4425B

Listen to this episode of SoundPractice.