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September 13, 2020 by Rob Wipond | MadInAmerica.com

Will the Mental Health Industry Undermine the Community-Based Climate Change Revolution?

(Image: Project LM/Flickr)

As mainstream mental health ideas and approaches are increasingly incorporated by community resilience-building groups, critics warn about the dangers of pathologizing and medicalizing reactions to climate change.

Citizen-driven efforts to make communities more “resilient” or “adaptive to stress and crises” can be inspired by many challenges, from small-town sawmill shutdowns to COVID-19. However, climate change has been fueling a dramatic rise in community resilience-building. Ordinary people collaborate to both reduce energy consumption and prepare for emergencies by making their buildings, blocks, neighborhoods, or communities more socially connected and mutually supportive, economically self-reliant and equitable, and ecologically sustainable.

Part activism and part pragmatism, piloting what’s needed at larger scales to tackle climate change, projects include community gardens, reskilling, sharing of tools, space, and equipment, Transition Towns with Energy Descent Action Plans, community-supported agriculturealternative currencies, and relocalized economies. Hundreds of Transition Town groups now exist in the US alone, and proliferating community resilience organizations like the nonprofit I volunteer with garner support from charitable fundersgovernment agencies, and business associations.

But recently, another refrain has spread alongside—that climate changes, looming climate threats, and climate-related disasters cause “mental health problems” and “mental illnesses” requiring treatment. Fear, sadness, ecological grief, “eco-anxiety,” and PTSD intermingle with climate change, community resilience, and “treatment” in webinarsTED talksmajor newspapers, and magazines covering psychiatrynature, and urban life.

(Image: mesbahuk/Flickr)

Mainstream mental health services are promoted as pillars of resilient communities in climate science journals and info-hubs for resilience leaders. A growing number of community resilience groups educate the public about climate change alongside trauma therapists or the Substance Abuse and Mental Health Services Administration, and channel people in distress toward treatments.

I’ve watched this with deepening concern. Obviously, the possibility of globally apocalyptic climate change, let alone climate impacts already occurring, presents us with one of the most profound personal, social, economic, environmental, spiritual, and political challenges in modern history. But for that reason, isn’t it expected and important that many of us go through anxiety, sadness, despair, trauma, and other inner distress—feelings that, hopefully, will ultimately help transform us and bring us together to build a more environmentally sustainable society?

That is, isn’t inner distress likely a key precursor for more people to ultimately decide to take decisive actions, or become activists? Conversely, what happens if we instead label these potentially revolutionary feelings as pathologies, as brain disorders, as “mental health problems” and “mental illnesses” needing “treatment”?

Yet I’ve seen no visible debate occurring.

So I decided to investigate more and seek other perspectives, particularly from prominent critics of our mainstream mental health system, including a renowned pioneer of community engagement. Three key warnings emerged:

  • Mainstream, conventional mental health ideas and approaches pathologize and medicalize people’s negative reactions to climate change, effectively depoliticizing those feelings.
  • These approaches suppress rather than encourage emotions, ideas, and behaviors that challenge or disrupt dominant cultural beliefs and norms.
  • And they undermine the diversity, citizen empowerment, and mutual assistance essential for resilient communities.

Ultimately, mainstream mental health services move society closer not to environmental sustainability but to sedating burgeoning activists.

Community Resilience Meets Guild Public Relations

The meme interweaving climate change, community resilience, and mental health, I quickly discovered, didn’t just spontaneously spread. Health organizations have long expressed concerns about increasing disaster-caused injuries, heatstroke, vector-borne diseases, etc.

“Mental health problems” got added to the list after efforts from the professional guilds and pharmaceutical conglomerates that routinely expand markets for psychiatric and psychological treatments by pathologizing common feelings, labeling distraction as ADHD, anxiety as anxiety disorder, or slight sadness as mild depression. In 2017, the American Psychological Association teamed with resilience organization ecoAmerica to produce guidance on solving climate change impacts with community resilience and mental health services. The American Psychiatric Association (with its pharma funders) and a new Climate Psychiatry Alliance helped ensure similar messaging got included in the Pharma-backed Medical Society Consortium on Climate & Health, the international Lancet Countdown on Health and Climate Change, and the United Nations’ Sendai Framework for Disaster Risk Reduction.

It’s obvious why well-meaning mental health professionals embrace community resilience: Many people report “therapeutic” benefits from being more socially connected, contributing towards practical, positive changes, and becoming better prepared for climate crises. But conversely, how do the typical treatments provided by mainstream mental health services—psychiatric drugs and sometimes cognitive behavioral therapy—affect climate change or feelings about it?

All the papers and presentations trumpet that mental health professionals will help us survive and thrive—but none provide evidence. Typical is a report on the impacts of disasters co-produced by the Center for Public Integrity, Mother Jones, and Texas Tribune that calls for dramatic funding increases for mental health services while never asking if science supports it. A 2018 paper by public health specialist Katie Hayes and others, endorsed by the Climate Psychiatry Alliance as a “standard foundation” text, acknowledges that “there are research needs” where “the efficacy and accessibility of mental health interventions related to climate change are assessed.” Nevertheless, even this paper calls mental health services “catastrophically” underfunded for what’s coming.

The promotional rhetoric diverts attention from considering the risks of pathologizing reactions to climate change.

Pathologizing, Depoliticizing, and Disempowering

The pathologizing and medicalizing of feelings about climate change derails social activism, said David Cohen, a UCLA social-welfare professor and co-author of Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. “The use of the expression ‘mental health’ is such a game-changer,” he said. “It’s so terrible.”

Scanning excerpts I sent him from Hayes’ paper, Cohen noted that “mental health” and “mental illness” were loose categories encompassing all possible states of mind. Simultaneously, “mental health problems” became a catch-all for climate-influenced distresses—loss, anxiety, agitation from wildfire smoke, depression and PTSD after floods, domestic violence from increasing poverty, and more.

Yet, Cohen said, health and illness are medical terms that bring along conventions from our medicalized mental health system.

The terms frame negative feelings in response to climate change as, in part, pathologies or illnesses inside individual brains that require psychiatric or psychological treatments rather than social-political solutions.

This medicalization then “enfeebles” us, said Cohen, making us feel dependent on “expert” mental health professionals to help manage these feelings.

So, while there are many different intellectual, emotional, spiritual, social, political, and other ways to understand and respond to distressing feelings caused by climate change, when we apply medicalized diagnostic labels, said Cohen, “those are culturally-bound words that conquer and take away all of the natural flora and fauna, and just put a highway on there and say, that’s the way you go.”

From a different vantage point, John McKnight described how professionalized mental health services, by recasting the impacts of many social-environmental problems as personal pathologies, effectively depoliticize and disempower entire communities.

McKnight is an iconic grandfather-emeritus of community resilience, as he co-founded a widely adapted engagement method called “asset-based community development.” Popularized through the ABCD Institute and books like Building Communities from the Inside Out and The Abundant Community: Awakening the Power of Families and Neighborhoods, his approaches bring neighbors together to share “assets” such as passions, knowledge, skills, gifts, and available resources, and to collaborate on “mobilizing creative vision” to enhance their lives and neighborhoods and tackle social and environmental problems.

The Careless Society: Community and Its Counterfeits lays out McKnight’s argument that our massive social service industries sabotage this whole process.

The harm starts with these industries’ tendencies to view communities in terms of “needs,” not assets: The mental health services industry, which McKnight frequently uses as an exemplar, sees emotional distress, drug abuse, illness, homelessness, etc.

Although such problems are obviously fueled by broad societal economic inequities, social injustices, and environmental degradation, service industries don’t organize collective social change but instead seek individual “consumers.” So, they reframe social problems as rooted in pathologies or personal deficiencies—mainstream mental health professionals label individuals as mentally ill, addicts, diseased, disabled, etc. Finally, social service industries proclaim that only they can deliver the “expert services” these “deficient” people purportedly “need”—and drain resources from communities while the real societal root problems remain unaddressed.

In summary, writes McKnight, mental health services divert resources from collective, community-driven solutions to social problems, and instead foster dependency on professionals treating individuals. Influenced a half-century ago by the mental patients’ civil rights movement and critiques of the expanding roles of psychiatry and psychology in managing capitalist societies by Ivan Illich (Limits to Medicine), Thomas Szasz (The Therapeutic State), and Michel Foucault (Madness and Civilization), McKnight remains just as critical today—a fact seemingly unknown or ignored among many contemporary community resilience leaders influenced by McKnight’s other ideas.

When I described the training of community resilience workers to “spot symptoms” of climate distress, deliver preliminary counseling, and channel people toward mental health services, McKnight called it a “cultural invasion” or “colonialization” that suppresses other responses to distress.

Similarly, McKnight was already aware that many people work to make communities more “trauma-informed,” so he wasn’t surprised to hear that mental health professionals and community resilience groups are collaborating to teach people that climate change causes “treatable” trauma. “A ‘needs survey’ [of a community] was a set of things that [social service industries] would identify or measure, that allowed for an ever-growing dominance of institutional solutions,” said McKnight. “I think ‘trauma’ is the same racket. It’s a new way that’s spreading control and dominance of professionals. And it’s absolutely unbounded; it is amoeba-like.”

So, what evidence is there that the impacts Cohen and McKnight warn about are happening in contemporary community resilience discussions and initiatives?

Replacing Adaptation and Mitigation with Treatments
Common, understandable reactions to climate change are getting pathologized and medicalized. As ordinary citizens consequently feel inexpert and enfeebled, mainstream mental health approaches influence or determine community resilience agendas.

The process often begins with a muddy tendency to simultaneously view distressing reactions to climate change threats and impacts as understandable and good motivators for community resilience-building and also possible signs of serious mental health problems needing treatment. The effects of pathologizing then seep in.

For example, Hayes’ Climate Psychiatry Alliance-endorsed paper acknowledges the “risk of pathologising” and medicalizing “normal” distress in response to climate change. However, the authors suggest “underdiagnosing” is also risky, and go on to pathologize virtually every negative reaction. They list anxiety, grief, and fatigue alongside PTSD and Major Depressive Disorder as mental health problems caused by climate change, and push for citizens to learn mental health “first aid” techniques that promote medicalized labeling and triaging people towards mental health professionals. As climate change adaptation methods, they list community resilience alongside “pharmacotherapeutics”—without qualification, essentially equating political activism and taking sedatives.

In another study frequently referenced by journalists and community resilience workers, Northern Canadian Inuit people described their lives on the land as like breathing, blood, a limb, and vital energy, and loss of access due to climate changes as devastating, frustrating, and scary.

Lead author Ashlee Cunsolo then framed these findings for news media as, “The mental health impacts [of climate change] were actually what [Inuit] people were identifying as their biggest concern.”

Reframings like this undoubtedly contributed to the Canadian government, after rashes of youth suicides in northern indigenous communities, prioritizing increased funding to mental health services rather than supporting local food production, activity spaces, improved environmental practices, and other approaches commonly used to build community resilience that the youth themselves asked for.

Pathologization and deference to mental health professionals emerge in many Transition Towns. In The Transition Handbook: From Oil Dependency to Local Resilience, founder Rob Hopkins boldly outlined how ordinary citizens can lead climate-friendly innovations in transportation, energy, food, finance, governance, and more. Yet when it came to feelings, Hopkins wrote that he had “no background in psychology,” and let a professional psychologist write that chapter. Chris Johnstone diagnosed us all as oil “addicts” and prescribed self-reflection steps, methods of public engagement, and meeting procedures for activist groups based on treatment programs for substance use disorders.

“Inner Transition” subcommittees often morph into ad hoc emotional support groups, but pathologizing influences still emerge: A resource from a recent webinar circulated through Transition Network advises that mental health treatments can help distressed activists avoid getting addictively “stuck” in “flawed,” imbalanced “brain chemistry.” A shared Post Carbon Institute essay regurgitates antidepressant ad pseudoscience, contending that we struggle to build a more resilient society because we seek dopamine hits while serotonin “spreads happiness signals” and “too little leads to depression.” A workshop on managing reactions to climate change concludes with contacts for mainstream mental health services.

I presented some of these examples to Don Hall, co-director of Transition US, and he emphasized that Transition Towns are mostly independent, volunteer-driven, and engaged in practical projects. “We’re not saying we’re equipped to deal with acute mental health crises,” said Hall.

Yet, I responded, no Transition groups end talks about, say, revitalizing local economies, by advising people with “acute” money problems to consult mainstream credit providers. Why direct people to mainstream mental health services?

“That’s a great question,” said Hall, agreeing there’s a need for clearer strategies surrounding emotional distress and community resilience-building. A burgeoning Transition US “Inner Resilience Network” may grapple with some of these issues—it involves many mental health professionals, but mainly ones bringing spiritual and social-justice perspectives.

Some prominent leaders, like Bob Doppelt, told me they’re well aware there’s a paradigm battle underway. Doppelt, an urban planner, Buddhist, and psychologist, often runs workshops for mental health professionals on channeling climate distress through mindfulness, spiritual views of nature, group cooperativeness, and community resilience-building.

But most mental health professionals, Doppelt said, strongly believe in “individually focused,” pathologized, and medicalized approaches. Some members of Doppelt’s International Transformational Resilience Coalition are psychiatrists involved in the Climate Psychiatry Alliance. “I know they’re trying to move their group away from the medication model,” said Doppelt. “They’re trying to work as hard as they can but not get tossed out of the room.”

The threat posed by that dominant paradigm becomes most starkly visible when mental health professionals declare they know which reactions to climate change are the “mentally ill” ones requiring treatment—whether activists agree or not.

The American Psychological Association report, for example, states that “negative emotions” about climate change are “normal”—unless they’re “extreme” and “interfere” with thinking or acting “rationally.”

The authors don’t specify what “reacting rationally” should look like amid climate change feedback loops that might destroy civilization virtually overnight. But psychiatrist Burns Woodward pronounces in a psychiatry trade journal that people whose feelings are “distressing or disabling,” or who have “catastrophic thinking” about climate disruption have serious mental disorders. “Such patients need treatment with psychotherapy and/or medication,” he writes.

Woodward adds that climate activists are “especially vulnerable,” and therefore it may be clinically advisable to use psychiatric or psychological interventions “to curb internet searches, calls to public officials, and hounding of family members about energy usage.”

Once mental health professionals move from pathologizing distress towards curbing activism with treatments, for Bruce Levine it raises alarms.

Suppressing “Abnormality” and Diversity

“Anybody who takes seriously what a psychologist or psychiatrist declares to be ‘normal,’ ‘abnormal,’ ‘rational,’ or ‘irrational’ is just not paying serious attention to history,” said Levine, a socially-critical psychologist and author of books like Commonsense Rebellion: Taking Back Your Life from Drugs, Shrinks, Corporations, and a World Gone Crazy and Resisting Illegitimate Authority: A Thinking Person’s Guide to Being an Anti-Authoritarian—Strategies, Tools, and Models.

Levine said unscientific, politicized judgments like Woodward’s reveal a real threat: The mental health system has long helped manage society by subduing emotions or behaviors that are legal but viewed as unduly disruptive to dominant cultural norms. Levine’s writings frequently examine how this undercuts burgeoning social-change activism.

There are well-documented, ongoing histories of mainstream psychiatry and psychology pathologizing and coercively treating Black rebellion as psychosis, Native Americans’ spiritual views of nature as schizophrenia, and women’s defiance as hysterical, depressive, and borderline personality disorders. And amid rising social stresses likely to worsen alongside climate change, treatments are increasingly used to subdue disruptive activities in workplacesschoolsprisons, and nursing homes.

So, to many of the millions of Americans who’ve been subjected to forced psychiatric detentions, tranquilization, or electroshock, mental health services aren’t viewed as caring supports for the marginalized, but as threatening, often brutal guardians of dominant norms.

However, said Levine, explaining this to average liberal environmentalists, clouded with prejudices about “the mentally ill,” is like inner-city Black Americans, absent video evidence, describing police to comfortable suburban Whites. “Some will try to get it, they’ll try to understand, but they just can’t at an emotional level,” said Levine. “And in their own head, they’ve had a very different experience; maybe they know psychologists or psychiatrists and they seem like very nice people.”

Linking White privilege, environmentalism, and support for psychiatric oppression isn’t hyperbolic: Both America’s environmental movement and mental health system have historical roots in White supremacism. And environmentalists still skew predominantly White and middle-to-upper class—a demographic more likely to have experienced expensive private psychotherapy than social oppression and psychiatric detentions.

Recently, the Sierra Club, one of America’s largest environmental groups and a community resilience supporter, publicly acknowledged how its founders were eugenicists, excluded people of color, and sought “natural purity” by displacing Natives. “It wasn’t a very good beginning for the conservation movement,” commented Ayako Nagano to me. “It still has a legacy of very white-dominant power structure… The environmental movement has to speak to a wider audience. Otherwise, it will fail.”

Nagano is a Japanese-American lawyer who volunteers with Transition Berkeley, the Inner Resilience Network, the International Transformational Resilience Coalition, and the Green Leadership Trust—the latter of which focuses on expanding involvement by people of color and indigenous descent in environmental organizations.

I discussed with Nagano how eugenicists also helped forge America’s “mental hygiene” laws, and beliefs that Native, Black, and other marginalized groups were “irrational” and “savage” due to genetic brain conditions that required psychiatric intervention. Still today, people of color are more likely to be forcibly tranquilized.

“I think it’s important to acknowledge that,” said Nagano. “Open that wound, and put it in its place.” From oil pipelines cutting through indigenous lands to hurricanes that more severely affect people who are disabled, poor, or Black, Nagano said climate change requires diverse groups to understand each others’ suffering and collaborate.

“Social justice work at this juncture requires emotional intelligence,” she said. Nagano finds certain mental health ideas useful—such as psychobiological descriptions of trauma—but avoids stigmatizing labels. “There’s this need to define and categorize in the Western world that is harmful,” she said. “Diagnosing is really not necessary right now… Everybody is traumatized, everybody is triggered, everybody is feeling challenged.”

Nagano agreed that community resilience groups could benefit by hearing more from people with concerns about mental health approaches. And Levine suggested that the mental health industry’s darker role in our collectively “insane” drive toward climate change is best explained by social activists who’ve been oppressed in the name of mental health. “They’ve been radicalized by their own personal experience,” said Levine, pointing to David Oaks and MindFreedom International.

Suppressing “Extreme” Reactions
For two decades, David Oaks directed MindFreedom, a coalition of groups run by patients and ex-patients fighting for “freedom and human dignity in the face of forced psychiatry.” In the 1970s, Oaks experienced intense, unusual ideas and feelings and was detained, labeled mentally ill, and forcibly tranquilized. But Oaks told me that, for him and many others, “extreme states” can be challenging yet also bring transformative insights about oneself, society, nature, and spirituality—a perspective shared by socially-critical psychotherapists like Stanislav Grof.

So, once freed, Oaks stopped taking psychiatric drugs and recovered through, in part, channeling his feelings into human rights activism. He currently offers consulting on disabilities, community organizing, and environmental sustainability, and decries the mental health system’s role in “climate change Normalgeddon.”

“The big-picture question [about climate change] is: Why are we so numb? Why aren’t we doing the really deep changes?” said Oaks. “The mental health industry is one of the institutions in society that has really controlled our thinking and feeling to keep us so-called ‘normal.’ It’s very dangerous.”

For people struggling inwardly in relation to climate change, Oaks contrarily proposed “going into your extreme deep feelings and thoughts, extreme overwhelming feelings and differences, and translating those into action.” He pointed to Greta Thunberg. Labeled with depression, anxiety, OCD, mutism, and Asperger’s, Thunberg recently described her traits as a “superpower” for her activism, and activism as a boon to her well-being.

“Her willingness to be different is why she went to [Swedish Parliament] every Friday, and that’s become a movement led by young people all over the world,” said Oaks. “That wasn’t called normal.”

Tellingly, a high-profile Australian psychologist last year declared that Thunberg was delusionally “caught up in a doomsday scenario” and she “should be getting treatment.”

An Alternative: Embrace Diversity and Mutual Assistance

Is there a better path forward than climate change-driven community resilience-building groups collaborating with mainstream mental health agencies and organizations? Through all my conversations, one proposal kept emerging: mutual aid.

However, to fully appreciate the potential, it’s vital to understand McKnight’s observations on how professional mental health services quell diversity, creative capacity, and social disruption and change across entire communities.

An email exchange posted by McKnight is illustrative. A crisis line worker wrote that he provided emotional connection for mentally ill, socially isolated callers. Couldn’t McKnight support that? McKnight answered, “Everywhere in my neighborhood and with friends I hear ‘she needs professional help’ as the natural and necessary response to every form of deviance, pain, misbehavior. The result is that our communities are evermore homogenous and incompetent.”

I asked about it, and McKnight explained: “One of the side effects—if not direct effects—of [mental health services] is the competence of the local community to deal with deviance goes down.”

In effect, we’re all losing our capacities to truly care for others in distress and to embrace, celebrate, and incorporate into our lives unusually intense or extreme feelings or behavioral deviances in ourselves or those around us—let alone work together to channel them into constructive community change—because we constantly turn to professionals instead.

But robust, democratic revolution in response to any major challenges affecting communities, including climate change, said McKnight, requires engaged groups of diverse citizens who aren’t just deficient, dependent “consumers” of services. We must “relentlessly” understand ourselves as vital, capable “producers” of our social realities, he said, and our most different, oppressed, or marginalized must always be valued, core participants.

Impassioned, shared commitment to mutual assistance in truly diverse communities, said McKnight, drives grassroots social innovations that can ultimately coalesce into transformative political movements.

Notably, mutual assistance among neighbors remains central to today’s climate change-driven community resilience-building in everything from tool-sharing and renewable energy to neighborhood emergency preparedness—just not explicitly for “mental health.” Yet the proposal fits strikingly with the socially-informed peer support done by some MindFreedom groups and Intentional Peer Support (IPS).

As distinct from co-opted models where peers keep each other engaged with professional mental health services, in the IPS approach, people assist each other through emotional challenges without pathologizing or ceding power to professionals while becoming more engaged together in changing their social circumstances. IPS describes true peer support as “a way of thinking about and inviting transformative relationships” to generate social change and “stronger, healthier, interconnected communities.”

So, could we expand an IPS-like model to encompass buildings, blocks, neighborhoods, and communities, where we’re all peers helping each other grapple with the inner challenges of dealing with and turning back climate change?

Only our society’s cultivated dependence on professional mental health services hinders us, answered McKnight. He described a group of neighbors who surveyed everyone on their block about their skills and gifts, and who added the question, “In your life, if you had big problems, hard times that you have gotten through, would you be willing to share that information with your neighbors?”

This, said McKnight, could create an excellent launchpad for a diverse, asset-based, mutual-aid group that can grapple with both inward difficulties and transformative community resilience-building to help meet the challenges of climate change. “On your block are people whose life is a victory statement,” he said. “Why don’t you get together with them?”

 

 

 

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