Well, good afternoon everyone, and thank you for joining today's webinar, which we hope will be a lively review of the current status of our climate crisis, as well as a frank discussion of those aspects of our cultural paradigm that has gotten us to where we are. And then after that, we will delve into what we see as the responsibilities and options for us as psychiatrists to shift that paradigm in the direction needed for realistic and long-term change. I've added a few of my own photos here to brighten the talk a little and to remind us all of what our end goal is. Next slide. The hard truths about our climate disaster is how we like to think of the reality of our current situation, and can psychiatry help to shift the cultural paradigm? Both Dr. Thompson and I are members of the APA Committee on Climate Change and Mental Health, and neither of us has any financial disclosures to report. Next slide. We are hoping to cover the following objectives in today's discussion. Essentially, my role will be to review the current state of the crisis and discuss the factors of how we got here, essentially what I would call a review of some of the hard truths. And then Dr. Thompson will shift and offer us some reflective thinking and hopefully hope and options for change. Next slide. I've chosen to start the discussion by whipping a few headlines for our review because it's interesting how timely so much of the multimedia headlines currently addressing the crisis for us. This first one here, it's not that long ago, it came out of New York Times. The Congo is planning on auctioning land to oil companies, and their response to criticism is that our priority is not to save the planet. In the article, it goes on to say that the peat lands and rainforests in the Congo basin protect the planet by storing carbon, and now, in a giant leap backward for the climate, they're being auctioned off for drilling. Well, it's interesting that this particular action is raising complaints around the world. And Africa's response to that was that this auction highlights a double standard that many political leaders across the African continent have called out. How can Western countries, which built their prosperity on fossil fuels that emit poisonous planet-warming fumes, demand that Africa forego the reserves of coal, oil, and gas in order to protect everyone else? This concern and this response is not unique just to Africa. Much of the global South feels the same way. The next headline is from an op-ed in Time magazine, which came in August this year. What comes after the coming climate anarchy? Comments in this article, I quote, today it's fashionable to speak of a civilizational collapse. The UN Food and Agricultural Organization states that just a one and a half degree Celsius rise will prove devastating to the world's food systems by 2025. We're getting close. However, even if the Paris Agreement goals are implemented, basically 2.4 degrees Celsius rise is all but inevitable. The article goes on then to raise the point that no matter what, however, no matter how many people perish, and we currently have about 8 billion on the planet, around 6 billion will survive. And that will raise the question, where will these people seek to live in 2050? Humankind is on the hunt for locations blessed with sufficient water, food, and energy resources. Canada and the Great Lakes region, Central and Northern Europe, Southern Russia, and other regions are becoming more livable, despite some volatility in their temperatures. And in the decades ahead, these are becoming much more open to development. And then finally, we have to, as NASA recently reported in their climate report, that the effects of human-caused global warming are happening now. They're irreversible on the timescale of people alive today, and they will worsen in the decades to come. Next slide, please. More current, Hurricane Ian, our most recent disaster. These are interesting headlines. This was an editorial in Rolling Stone, which appeared just after Hurricane Ian. I think the headline speaks for itself. But as he reports here, Hurricane Ian was a hugely damaging and deadly storm. Most recent reports at that time had 102 people dead and over 40 billion in damages. He reported it as the most deadly hurricane to hit Florida since 1935. However, it wasn't the deadliest. Let me take a moment to tell you about other hurricanes. The records show that the deadliest hurricane to hit the US and Florida behind Galveston in 1900 was the 1928 hurricane that hit the Lake Okeechobee region of Florida. More than 1,803,000 people died in that hurricane. More than 75% of them were African-American migrants, and most of their bodies were never recovered. Why then do the stats for the 1935 Labor Day hurricane overshadow those of the 1928 hurricane? It's for the same reasons, as we will continue to discuss, that our cultural paradigm ignores those populations that have suffered the greatest as a result of both deadly disasters and climate change. I continue this article just to comment on the fact that Al Gore had told the author that there is a moment in our climate crisis, which he called, I quote, an oh, shit moment, when the scale and the immensity of what we face in this climate crisis becomes obvious. And it should, I say, prompt you to take action. Hurricane Ian should have been Florida's moment. And then we go to the following headline, which was, again, at the same time after Ian NPR reported that shutting an agency managing sprawl might have put more people in Hurricane Ian's way. And what were they referring to? Well, it seems that back in 1985, Florida created a Department of Community Affairs. This agency was established to manage risky development due to increasing threats from overdevelopment and potential climate change. However, in 2011, it was abolished by the Republican-controlled state legislature, despite the increasing evidence that development without restraint was going to result in just such a disaster as Ian. This agency was to address and control the retirement communities and the sprawling gulf developments paving over wetlands and floodplains. The laws for this agency gave the state power to provide checks and balances that governmental regulations failed to accomplish. But developers disliked the checks and balances. And they especially bristled over the requirement that developers pay for schools, police, roads, and other services that the new housing would require. And hence, the law was abolished in 2011. And along came Ian, and hence continues our cultural paradigm that we live in. Next slide, please. Next slide. I think we skipped a slide. I'm sorry. Can we go back one? There we go. Oh, nope. There. Okay. And to be sure, there's the rest of the story that we're seeking to tell here today. The story that continues to fight to be heard. These are two different headlines from two different sources. The first in September, the public media, Black public media, started a storytelling campaign with regards to climate justice. Headlines that it shared include the following. That racism is magnifying the deadly impact of rising heat. That came out of Nature magazine. Poor neighborhoods bear the brunt of extreme heat. That came out of the LA Times. And Black Americans are drowning because of climate change. That was the Black Wall Street Times. African American, Indigenous, and other disadvantaged communities have historically been victimized by the ravages of environmental racism. And now, these are being compounded by the climate crisis. From Green American magazine, a recent issue focusing on climate justice for all, following comments that people of color are on the front lines of the climate crisis. Dr. Beverly Wright, who is CEO of the Deep South Center for Environmental Justice, writes that communities of color are in double jeopardy from the climate crisis. From the climate crisis, I'm sorry. First, if you're a person of color, particularly Black or Latino, you're more likely to live near toxic facilities. And then, our communities are on the front line of impacts from climate change. Living in places where there could be more floods and a higher incidence of different climate-related diseases. Next slide, please. And then, I think the identified voice of the next generation, Greta Thunberg, says it quite poignantly in this editorial from The Guardian. Again, all of these generated right around Hurricane Ian. As she said, we've been greenwashed out of our senses and it's time to stand our ground. The point she makes here, and I underscore it, the fact that three billion people on this planet use less energy on an annual per capita basis than a standard American refrigerator gives you an idea of how far away from global equity and climate justice we currently are. I'm sure you've all seen those yellow signs on our appliances, how much energy is used by that particular device in the course of a year. Three billion people use less of that. Saving the world is voluntary. There are no laws or restrictions in place that will force anyone to take the necessary steps towards safeguarding our future living conditions. The world is run by politicians, corporations, and financial interests, mainly represented by white, privileged, middle-aged, straight, cis men, this is her quote, whose purpose is not to save the world, it is to make a profit. It will take many things for us to start facing this emergency, but above all, it will take honesty, integrity, and courage. Because according to climate mental health just recently, climate change has created a global mental health crisis. To heal the planet, we have to collectively heal ourselves. Just a reminder, on one of my vacations, next slide, please. Next slide, please. This illustration comes from a carbon brief several years ago. I imagine the slope has increased even in the past five years. But essentially, it's why scientists know, now know, that 100% of global warming is due to humans. As you can see, the red line represents the human factors contributing to the rise in the Earth's temperature. In the past 50 years, the growth has been the greatest since 1850. And these factors include the burning of fossil fuels for transportation, industry, electricity, as well as altering natural landscapes for agriculture, flora, and human enjoyment, our lawns, our golf courses. And according to the IPCC, or the Intergovernmental Panel on Climate Change, since systematic scientific assessments began in the 1970s, the influence of human activity on planet warming has evolved from theory to established fact. This, I imagine, was created in order to counter the deniers that it's not happening. The facts remain. All right, next slide, please. So now let's look at how did we get here, laying the groundwork. We've had some interesting events over the last 100 years, of which I bring up a couple here, talking about government policies and how they have contributed to the problem. I saw an interesting program not too long ago, American Experience, on the Dust Bowl. The Dust Bowl of the 1930s lasted 10 years, 10 years in which the soil and the ground in the heartland of this country was not usable. And that was due to over-planting, causing soil depletion. And it took 10 years to turn that around to whereby the wheat fields began to grow again. I only say this because it was interesting at the end of that particular documentary, two gentlemen were sitting there discussing, well, what did we learn from this? And as one of them said, probably nothing. Flint, Michigan paid a heavy price for government policy when its lead-based water supply was discovered. And while this was not directly a climate-related event, it does underscore the policies of neglect and systemic racism that continue to compound the vulnerabilities of our communities. And least we forget the BP oil spill. That seemed like ancient history, doesn't it? But that the cleanup of that and the debris was dumped in landfills in African-American communities in Louisiana, Alabama, and Florida. We just got finished discussing how the loosening or the abandonment of restrictions on development in vulnerable areas, such as Florida's 1985 laws, were overturned and the disasters that resulted from that. Systemic racism and pervasive and persistent policies, creating and maintaining vulnerable communities without power or influence to mitigate against recurring disasters. You know, Mother Nature may not discriminate, but those with power influence, they often do. And there's certainly the impact of private corporations and individuals themselves. The abuse, the misuse, the overuse of resources, destroying the balance of nature with deforestation, indiscriminate use of water supplies, development in ecologically fragile and vulnerable waters, indiscriminate consumption and non-biodegradable waste. The deniers, the misinformation, the sabotage of legitimate sources of fact. These got us to where we are. Profit over protection. Did everyone know that those wildfires in California caused by the power grids, which had not been upgraded in over 100 years? And the build back better, with limited to no regulation on development in vulnerable areas. These are the policies. These are the profits, and this is the greed that has driven our cultural paradigm to the point where we cannot continue. Next slide, please. So I created this little diagram of interplay, and it is continuous. At any point, we can break this cycle. But we have continuing segregation. We have continued inequity in education, health, finance, and housing. These in and of themselves contribute to the climate crisis, the environmental racism, as well as natural and man-made disasters that feed upon themselves. And vulnerable communities do not have the resources to rebuild, which then will repeat their re-victimization and create the unequal protection in the failing planet for which these policies and politics and communities have established. Next slide, please. I just simply continue to underscore that these communities arose from direct neglect and discrimination by government through their policies based on race and a legacy of unequal protection in housing, employment, schools, and health care. That social, environmental, health, and political policies are race-based. And as a result, the inequities of climate change have fallen first and hardest on African-American, Indigenous, and other people of color, Indigenous and other people of colors left behind in this cultural paradigm of ours. And disasters compound vulnerability, and vulnerable groups find it hardest to reconstruct their lives following a disaster. Communities of color are now experiencing the most severe outcome of environmental racism with enhanced vulnerability to disasters, which in turn are compounded by the impact of climate change. Climate change brings further problems associated with air pollution, extreme heat, droughts, water shortage, rationing. And remember, these are conditions which arose much earlier from the discriminatory policies of our paradigm of systemic racism. You know, I'm reminded of our first Earth Day, and the founder of that, Arturo Sandoval, the Chicano activist, who stated at one time that after Earth Day, which was April 22nd, 1970, after Earth Day, there was the succession of a lot of national federal regulation and legislation enacted specifically to protect the environment. However, that success was primarily, sometimes exclusively felt by more affluent and white communities. This outcome, Sandoval argues, led the largely white middle and upper class environmental groups to believe such success was enough and there was no need to reach out to marginalized groups. In fact, some of the legislation following Earth Day directly diverted toxic waste into black, brown and low-income communities. This is what happens when you don't have intersectional advocacy explained. It diverts the problem to other people where it becomes out of sight, out of mind for those more privileged. This is our cultural paradigm. Next slide, please. So finally, we look to climate justice, which we hope can provide this broad paradigm shift. It's a justice that addresses a just division, fair sharing and equitable distribution of the benefits and burdens of climate change and the responsibilities to deal with it is for all of us. Currently, there are demographic, geographic, technological shifts that are evidence that we are already doing things differently. We're not waiting on the inevitable. Humanity will come together. Question is, will it fall apart first? And I leave you with this comment, which goes back to the initial headline that we saw here. When asked what oil company in an era where consumer awareness is higher than ever would consider drilling in a protected gorilla habitat, which is the Virunga National Park in the Congo where drilling is being proposed, Mr. Mpanu, who is Congo's climate issues advisor did not hesitate to answer the question. As he said, it is what it is. We just have to see how much people value that resource. And on that note, I'd like to turn it over to my colleague to continue the discussion. Thank you. Thanks, Sondra. I'm going to put up my slides here in just a second. Let me play them here. There it is, play. All right, hopefully everybody can see that and that you all can hear me. I'm very pleased to be here. I'm especially pleased to be following Sondra's discussion. And I hope to add a little bit to the information that she's already masterfully conveyed to all of you. I am now, just going to let me see if I can figure out how to, hang on one second, I need to get rid of something that's blocking my view of my own screen. Okay, there we go. So climate change, social change, collective emotions and psychiatry. And the question I want to ask, are we ready for what's coming to us? And I want to start with just saying I have no disclaimers as Dr. Robinson mentioned before. And I want to start with just giving you an idea of what the agenda of what I want to address following on her remarks. I want to consider climate change as a product of the Anthropocene and in particular to talk about it as a new species of trouble, a term that was coined by Kai Erikson, who I'll talk about in a minute. I then want to talk a little bit about the phases of disaster in the context of climate change and introduce the concepts of aftermath and an idea that admittedly is probably a torturing of words but the concept of pre-math as we are facing that today. And then I would like to discuss psychiatry's role in addressing collective emotions and sufferings and the social climate going beyond our immediate work that's always obvious to us to take care of people who are individually suffering as casualties of various kinds of events or disasters or psychiatric challenges. So to start, let's talk about a new species of trouble. I'm going to speak here as a person who lives in Pittsburgh, Pennsylvania. Pittsburgh, Pennsylvania is actually not very far away from where the first commercially successful oil drill was dug by a guy named, I think it was Edward Drake in 1859, a momentous year in the United States history in terms of the civil war coming, but also apparently what it portended for us as a nation in terms of our energy economy. So Pittsburgh and the region around it and now again has been a place of significant extraction of fossil fuels beginning with coal and now including oil and now recently the whole fracking boom. So we are a place that has been built on the economy of extracting fossil fuels and then burning them. We used to, and some of you may have a notion of Pittsburgh as being a dark and dirty smoke-filled place that was where there was a haze at noon and everywhere else be bright sun, but in Pittsburgh, no sun because of the burning of coal with the steel mills. That has long passed because our steel mills have long gone away. And I want to talk about that a little bit in the context of the kind of changes that we are looking at. The change when Pittsburgh essentially decarbonized, the amount of carbon that we burn in Pittsburgh now is significantly less than it was during the times of the steel mills. However, we did that not because of climate change. We didn't do that because we were threatening or even destroying our own environment, which we were. We did it because people started making coal steel elsewhere and they became much more efficient at it so they didn't need as many workers. So the challenge of steel collapse, of the collapse of steel is not one of responding to the environment despite the fact that the environmental movement really started in the area of Pittsburgh with Rachel Carson's work on Silent Spring. We knew and know that we can absolutely destroy our environment. We can, to take the words that were used in that Rolling Stone, this being an oh shit moment, well, we're very capable of shitting up our own backyard. And we've done that in places and we continue to see the price of that. When steel collapsed, we had a collapse of the entire economy and really, really very difficult times in Pittsburgh for a long time. And that kind of change has been influenced, has impacted on much of the Midwest and other parts of the Northeast in the collapse of industry and de-industrialization. So we've seen some glimmer of what happens when you have a change that is not really well thought out and where people are just put on the line at the cost of other people's profits. And we know that it is very possible for our society to absolutely neglect people as Sandra has said, in the process of change. So I raise all this because I want to introduce this idea of a new species of trouble. We are in fact, in the Anthropocene. We are in time when the history of the earth as an entity is being influenced by man's presence, by human's presence. And it is in this context that Kai Erickson who is the son of Eric Erickson, the psychiatrist, that Kai Erickson, a sociologist at Yale began to study disasters. He's famous for a book called Everything in Its Path, a story about the Buffalo Creek Dam that broke in the 1970s in West Virginia and the struggles that happened after that disaster. He wrote a book a number of years later on a new species of trouble, which is the concept of human-made disasters. And I think what you heard from Sandra is the description of the climate change as being a series of disasters, of challenges that disrupt and destroy the earth's ecology as we live in it at this moment in such a way that we disrupt the lives and potentially end the lives of many, many people as the earth heats up. That new species of trouble is caused by our human actions. And a key element that I wanna sort of emphasize here is that, and where Sandra was talking about in terms of the cultural paradigm, is that one of the things that we have thought about is that when we have a disaster that we are going to recover from it by doing what we know how to do to recover from disasters. For the most part, what we have done to recover from disasters is more of the same. We just build back and we build back even more fiercely, maybe with a few more protections in it, but we don't decrease the amount of carbon that we use when we build back after a disaster. We actually anticipate building back to exactly the same kind of community and the same kind of use of energy that we had before. So the challenge right now is that the solutions to the disasters that we have are not gonna be able to be met by just doing what we've done in the past to recover from disasters. We cannot continue the economic paradigm of fossil fuel extraction and the use of petroleum as a way to power our society. And we do not yet have all the resources yet to make the transition to renewables and other forms of energy that will not contaminate the planet or destroy the capacity for the atmosphere to dissipate heat. So we are in really a catastrophic new species of trouble. The way we have lived is producing the challenge that we have. And if we want to recover from it, we cannot continue to live the way that we are. Now, I wanna talk a little bit about that in the context of what's known as the phases of disaster. And this is looking at an individual disaster. There's been a long history of trying to describe the temporal phases that occur as people confront a disaster, deal with its immediate effects and then figure out how the heck they're going to recover, rebuild, reconstitute themselves. So this phase of this work has referred to the pre-disaster, the heroic phase, what happens when people come together to deal with the immediate effect that the disaster has caused after the impact. There's the honeymoon in which people are usually have a great deal of morale and feel like there's real opportunity in a future. And then there is inevitable fall into disillusionment when it becomes clear that the possibilities of recovering are going to be much more difficult, much more scaled back and much more challenging than people initially anticipate. And they run into what's called the disaster after the disaster. This is a period of disillusionment, working through grief and then dealing with the ongoing triggering events and anniversary reactions as things go forward. And then somehow a movement into reconstruction, a beginning of a new hope as people kind of manage to deal with the challenges that the recovery presents. So that's a way of thinking about how we deal with challenges that come to us collectively. Again, I want to emphasize that right now what we're talking about is that process of reconstruction is not gonna be reconstruction. It cannot continue to be reconstruction in the same way that we've been doing it. So we can't rely on this as a method for ourselves to get out of all the disasters. On top of that, as Sandra indicated, these disasters are coming more often. So you're not even past the phase of the honeymoon potentially before the next disaster has occurred, or you're still in the depths of disillusionment when the next disaster occurs. Certainly in the vulnerable parts, the low lying areas, the places subject to fire, et cetera. These are places where we know that the disasters are layering on top of each other. So the process of recovering from disasters is in fact becoming harder and our inability to use the same methods that we've used in the past to recover is going to start to impede our capacity to reconstruct our society as disasters occur. There is a concept now, as I just was mentioning of chronic cyclical disasters and a notion that maybe we should revamp the way we understand the phases. There's anticipation, impact, adaptation and growth and recovery. I wanna suggest to all of us that this is in fact, this is a somewhat emotionally empty description of the phases of a disaster. And in some ways I prefer the older version because it actually talks about the collective affect that people are going to experience. So we know that in fact, these disasters create just tremendous amounts of distress, disillusionment, not only because of the impact of the disaster. And that's not only the fact that your house is destroyed in the hurricane or that friends of yours are actually killed in a fire. It's not just that, it's that when you try to reconstitute yourself, when you try to find a way to go forward, the avenues are blocked. There's no possibility to move forward. There are no resources, there is no way, there is actually no destination that we can aim to to build back in the floodplain, to build back in the fire zone, to build a house that's fire retardant. This is not gonna be sufficient to protect us from the fires that are coming and the floods that will happen. And it's not gonna protect us from the changes that climate disaster is gonna bring. So I wanna hold there and say, so that's a very bad future, right? Of disaster after disaster, trying to figure out how to manage it, where are we gonna go? One option obviously is to start to pay attention to this and to actually do the things we need to do to decrease the likelihood that we continue to heat the planet up. Here, I wanna add another element of challenge that I want psychiatrists to keep in mind. Doing those changes is not going to be easy. One of the things we've learned from the COVID pandemic is that human beings have an extraordinarily difficult time listening to and deciding to act together to mitigate damages done to others. Imagine what it's going to be like if we have to start putting restrictions on the use of gasoline. If we start saying to people, you actually can't drive that car anymore. You have to buy a new car that's electric, or even this. Actually, using cars as a way to distribute, to travel around the country is a very, very costly and energy inefficient way. We need to move to mass transit. You need to give up your car altogether. You need to think about living in an entirely different kind of environment where many of the things that you use, plastics, for example, are no longer available to you because we cannot use petroleum and fossil fuels to fire the plants that make these things or to give the, or contribute the material to make them. We are looking at very significant changes in our lifestyle and how we live and what we do with our lives that is going to come because we cannot continue to use the energy that we've been using and the energy that we need to continue to live in a renewable fashion and a sustainable fashion is not yet online. So we are looking at very significant challenges likely to emerge even in the next number of years. Saundra talked a little bit about migration. We could be seeing large numbers of people having to migrate out of areas that are no longer arable, that are no longer places where they can make a living, farming, or even be able to do just any kind of work because the heat is just so high outside during most of the year, or there's no water available, et cetera, et cetera. So we are looking at massive changes that are gonna occur even if we don't have an increase in the heat of the planet in order to keep the planet from heating up any further. We are facing very significant hard times no matter what path we go forward. We can continue to heat the world up and have disasters and have similar challenges. Maybe we drive our cars as fast as we want to for as long as we want to, but we're gonna crash and burn with those. And if we decide that we can't use the car anymore and that we need to change how we live our lives, organize our lives, we're gonna have to deal with that disaster. So we are facing challenges no matter what path we go forward and psychiatry, I think, needs to start to begin to understand that and how it might participate in addressing those challenges. In that context, what I wanna talk about is this notion of collective trauma, collective emotions, and the idea of public morale. We're, I think, getting a little bit more comfortable with the idea that trauma can be collective and that when something happens to a whole community, all of the people in that community can be and are traumatized, that they experience the emotional impact of the event in whatever individual way, but in some collective sense, they understand it. I wanna argue from that point that there is a clear capacity for people to share and transmit emotions and that psychiatry has long focused on individuals and the emotions that we each individually have, but we have not paid much attention to the ground in which those emotions are created in our interactions and our interrelations. And in particular, I think one of the areas where we need to be thinking about this in particular is what we do to maintain and help public morale in the face of the very challenges I've just been identifying and talking about. That aspect of how human beings are resilient, how they work together and share and manage their collective concerns and their collective emotions, I think is something that we could begin to think a lot more deeply about. In that context, I wanna talk about aftermath. There's a sense, and oftentimes in disaster psychiatry, we tend to focus on the moment of impact and the immediate response. It turns out that when you talk about disasters and collective trauma and the collective emotions that are generated as that initial graph I showed you or path I showed you of a disaster response, it turns out that actually the major role for psychiatry isn't in the beginning, it's in the aftermath. It's in the process after the disillusionment or in the process of the disillusionment and the process of recovery of people trying to figure out how they mourn, how they go past where they were, how they begin to conceptualize a new future, how they begin to feel it and live in that possibility, how they generate hope. So the process of aftermath, I think, is a really critical element that we need to pay more attention to. It can go on for many years. In individual disasters, I'll give an example that I was involved with, which is the Oklahoma City bombing. We created essentially a crisis response center for folks who were impacted by the Oklahoma bombing. The last person who walked into that project for the first time, so a person who is presenting with a challenge that occurred because of the bombing, the last person to walk in for the first time walked in five years after the event. It took five years for that impact to resonate and go through his life. And then the whole process of his return to dealing with his own emotions took him five years before he got to a point to ask for help. That's not unusual. It is very clear that we have long, long trails to what's happening. We're seeing that now, I think, with COVID. So the aftermath is really important and we need to begin thinking about that when we think about disasters. But in this particular circumstance, I wanna suggest and introduce the idea of the pre-math. We have some idea, and I've just been talking about the idea that, in fact, any change that's gonna come is gonna create extreme disruption. Even in the best of worlds, if we figure out how to move to a zero-carbon world, we are going to see very significant changes in how people live and how they spend their time, where they can go, how they get there, what they do. It's going to be, in many ways, I think, really quite dramatic over the next 15 to 20 years as we go forward. If that is true and we can anticipate that, then we can also anticipate the fact that people are going to have an extremely difficult time giving up and mourning some of the things that we are used to and concerned about and depend on in our lives right now. So one of the aspects, I think, that we need to begin to do in psychiatry is to start living in this moment, in the pre-math, to begin to think about what that aftermath is going to be and start to address it before we get there. Start to anticipate it, start to anticipate how we work with communities and people to address that over time. So what further role can psychiatrists and psychiatry play as society prepares for difficult, challenging times? And I'm just going to give a couple of examples from a concept that I've been pushing forward called public health psychiatry. You know, beyond the clinical model, and I've been engaged in this particular work, I've started to do work with larger groups of people trying to develop a capacity in communities to build support and emotional solidarity and emotional literacy, so that as we move into this arena of more and more challenging circumstances, people have other people to connect with and to rely on and to begin to maintain human relations that don't become increasingly instrumental and negative. So that, this, I've been working particularly on a model that developed, interestingly enough, in a favela in Brazil called integrative community therapy. If you Google visible hands collaborative, you can learn more about it. Interestingly, in this particular regard, the favela that this was developed in was created by migrants from the Amazon basin where the forest had been cut down and the area with the death of the forest had become a desert. So having no place to live or work, they migrated to the favela of Fortaleza, Brazil, which is a city on the Northeast coast of Brazil. It is a model that in fact is generated by what we anticipate seeing with the impact of climate change. Other things that are being developed, and I encourage people to take a look at, there's legislation that's been introduced into Congress, the Community Wellness and Resilience Act that I encourage people to take a look at. It calls for the construction of essentially resilience centers and recovery centers in communities across the United States to help build emotional resiliency and the capacity for human beings in those communities to relate and connect with each other in positive supportive ways. So this is legislation that's there. It can actually, you can encourage your congressperson to vote for it and your senator to vote for it. It is a method that actually starts to anticipate that I would call a pre-math approach. In public policy, one of the things that we need to think really hard about is how we move to a just transition. Just transition like climate justice is a concept that I think is important for us to bear in mind as we look to what happens as we go into the future. The victims of climate change are not just going to be the victims caused by the change in the change in climate, although that is clearly a primary victim. Another group of victims are the people who've been working in the extraction zones, the coal miners, the folks who work in heavy industry that burns coal or uses oil, or the folks who are in the oil industries. All these folks who have significant power, have significant cultural power, we're gonna have to figure out how we don't just imagine that they're bad people and we need to take away their petroleum. Because if we do that, we're gonna get, and in fact, I would already argue we have gotten, the political reaction that's driven much of the challenge that we face in the current political environment. So a just transition calls for the attention to be paid to the extraction zones so that when we move from oil to renewables and other sources of energy, that we don't just abandon people and the communities that have been engaged in the extraction zone industries. They have clearly not done this to pollute us, not the workers haven't anyhow, the corporate managers, that's another story, but the workers themselves do not need to be abandoned and I think will cause greater trouble for all of us if we do just leave them hanging. So a just transition is really important. And then lastly, I think we really need to start thinking about what the stories that we tell are. How are we going to help support public morale to get through these challenges? What are the stories? What's the history that we need to pull on to help folks find ways that allow them to pull their emotional capacities and their capacities to work together together? What are the things that, and I think Sandra sort of alluded to this was thinking about some of the ways that folks of color and communities of color in the United States have managed to survive very, very difficult times. What can we learn from those communities? What can we learn from the Dust Bowl? What can we learn about how we can, when we pull together, when we work together, we actually are able to make a new future no matter how hard the path to that new future is. So I'm going to stop there. There's an email for me, just in case anybody has some thoughts or wants to challenge anything that I've said, which I'd be keen to hear. And we'll stop with that and we can go to questions, I think. And I'll stop to share. Okay. Come back and join, join you Ken and let's see how we, we have, how we want to handle the Q and A. I hope we haven't deprived everybody of any hope. The goal here is actually to find some way that psychiatry is a participant in the creation of hope and ways of moving forward as we challenge, as we have to face the challenges ahead of us that Sandra, you laid out. And I think all of us are beginning to get our heads around. Is that a question or a comment? It looks like we have some questions in the Q and A tab. Q and A, okay. Got it. How about Sandra, if I read them off and you tell me if you want to answer it and if you don't, I'll try to do what I can. How's that sound to you? Well, you jump in and I'll jump in. Go ahead, get started. Yeah, since you just finished there. So, first question is, is working from home via computer a realistic alternative to using cars and fossil fuels to drive to work? Sandra, what's your thoughts on that? Well, you know, I think anything, you know, we have to keep in mind that the, it's an all-encompassing scenario that we have to see what works and fits for each of us. And just like there's no one answer regarding what's gonna fix it, I think there's a place, and it's surprising, one of the positives that came out of the pandemic, there's certainly a place for the remote learning that has led to significant change in both our work as well as our home environment. And I remember with such fond feelings, the pictures that were shown, I think it was the first, during the first month of the pandemic, there are satellite photos showing the earth without the pollution that it was used to because everybody was home and not in cars. So we recognize that's going to, that should be, in fact, an option. It's one of the options. And I think, as you pointed out, can the issue with regards to cars and fossil fuels, the future there is not what the past has been. And exactly all that it encompasses will be parts, bits and pieces of a larger picture. Working from home is one of them, electric cars is another, and public transportation. So it's a real amalgam of changing how we live and work. Yep, I agree with that. And I have spent the last two and a half years now in my house, migrating from my kitchen to my dining room, depending on the family functions, and not using my car. I used to drive quite a bit, and I've probably maybe put 5,000 miles on my car in the last three years. It's been really quite a dramatic change. The next question is, can you please repeat and describe the legislation available? And I am putting that into the chat. You will see the proper title is the Community Mental Wellness and Resilience Act. And it's in the House of Representatives, H.R. 9201. And the full text there is linked there. It's a really important piece of legislation. And I think a significant contribution to rethinking how the mental health world is involved in the promotion of the development of the capacity for adaptability among all of us in our communities. I think that that's really something I wanna highlight. We have seen that it is very possible for people to become extremely rigid and emotionally charged about being asked to change in any way at all. I think we see this right now. I don't know how many of you, I just said I don't do much driving, but when I do do driving, I'm on the highway, no matter how expensive gasoline is, and no matter how much people are complaining about the cost of gas, I see nobody driving smaller cars. And I see very few people driving at anything but above the speed limit. So it's not like we actually are seeing people slow down, try to buy less. I mean, obviously some folks are able to buy electric vehicles, but for the most part, that is not what's happening out there. Most folks are still buying gas and they're driving as fast as they can, and then they complain about the cost. So the change that's required and our capacity to complain about it and to potentially, I hate to say it, become even violent about it is something that's, I think, something we always have to keep in mind. We are looking at potentially very revolutionary changes in the way people live. How do we get involved to do this? Well, there's a lot of different ways. Sandra, do you want to throw away and I'll come on after you? I just wanted to say on the heels of what you were just describing, the changes are going to be multifactorial. There'll be those that immediately, we find ourselves getting involved in everything from being, I'll just say this, I'm an active member of the Sierra Club, getting involved in all those activities that both local as well as national groups provide for us, those opportunities. Those are things that we can do individually, but the changes like you're talking about, that government policy resources, just the inevitability of some things are going to change the way in which people do things. So there are people right now on the coast of Florida who are not driving the cars that they were driving two months ago because they were destroyed in the hurricane. Is that going to cause them to perhaps find some other way of living? I don't know, but I think it's in those incremental and sometimes rather in-your-face experiences that will bring about major changes. The incremental daily changes are things that I think we as psychiatrists in particular, and there was something that you said a few minutes ago, Ken, I didn't write it down, but I think we can be actively engaged in encouraging people to make the kinds of changes, to become, I wish I remember what you said specifically, the phrases, but we have to, our whole paradigm in psychiatry has to shift to creating that awareness and helping people to engage comfortably in that change so that it doesn't come just on the heels of a disaster or legislation or the loss of a job that people can begin to adapt. Yeah, and I think to become involved, I'm putting in a link to the Climate Psychiatry Alliance there is the Climate Change Caucus within the APA, and then we have a APA Committee on Climate Change and Mental Health, which Sandra and I are both participants in. All these things are ways that we're trying to help psychiatry begin to approach these challenges and certainly communicating with those of us on the committee, engaging with the caucus and engaging with the alliance are all actions that people can take. I think beyond that, it's also really important for people to start to, within their own localities, begin to imagine how this is going to play out in their localities. Are you likely to be the places where you're gonna be having climate disasters? Are you likely to be places where the real challenge of flooding or fires are going to increase and then begin to engage in actions to mediate or mitigate those and help people begin to imagine what they're going to do in the face of those. Likewise, in Pittsburgh, one of the things I'm really working on is trying to figure out how to make sure that these folks who are in the extraction industries and the communities that are involved in the extraction communities feel like there's a path out because if they think that the only way that they're gonna continue to exist is to continue to extract petroleum and fossil fuels out of the ground, they are going to do that and they are going to do everything they politically can to continue to do that. And we are gonna continue to reap the problems that that brings. So we need to figure out how to get the Joe Mansons of the world to begin to change because of the fact that people in those neighborhoods and those communities begin to see a different future than the one that is currently being held out to them. So that's an answer to getting involved. And then there may be some more here. We've got a bunch. A quick comment. There's a question here addressing social isolation that has resulted from working from home, school, et cetera. We need, I encourage developing an awareness of kind of the rest of the world. I think we tend to be somewhat myopic and looking at this, our cultural here within the United States which is fairly isolated by nature. Our communities, well, I can speak from Atlanta. We're connected by cars and we're not integrated walking communities that serve to limit that isolation. Whereas a lot of European and other worldly communities, there's much more of a sense of coming together and being together that minimizes the isolation that I think we as a society have created just based upon especially our mobility. So looking for answers to that factor that has arisen from the pandemic. And like you say, the isolation of working from home, how do we now collectively gather as a community to get beyond and to help to ameliorate the isolation that comes from the communities that we've already created. And there are a lot of mixed use communities and other developments that are taking place seeking to both more localized and limit our mobility but also open us up to more community and less isolation. So I think we've got to look, we really got to be much more aware of what's happening out there in the world to address these societal issues. And I would call attention to, I'm posting right now in the chat information about integrative community therapy which is this large group dialogic process that is specifically focused on decreasing isolation and increasing connection. The Brazilians who invented it call it solidarity care and it's focused on developing emotional connections and solidarity between peoples so that isolation is not something that is always gonna be present. And interestingly, it can be done online and there's information about getting an example of participating in a sample or a demonstration of ICT in the, at the website on Visible Hands Collaborative. So, and we're looking for other ways, other ways to begin to think about how to approach building the social infrastructure in a world in which the fossil fuels no longer are present. And we have to think about what it means to us to do that. And in a world in which pandemics and other kinds of challenges occur that increase loneliness. There's a bunch of other questions here that I want to make sure that we talk about. Let me just see. Jacqueline, you asked about recommendations and our examples do you have for supporting public morale. I guess it's a thing that I really find missing in the United States right now. And I don't want to call this propaganda although there's an element which this is a sort of form of propaganda. But I would really like to see some examples from our history where Americans actually pulled together and accomplished something really extraordinary in the face of very difficult times. I think we need a lot more examples of that kind of action where people of all kinds really pulled together because if they didn't they were all gonna be in deep trouble. Unfortunately, our history has been riven by not doing that often, but there's got to be some examples, maybe the dust bowl, maybe some other things that we've experienced, other disasters we've responded to. But we've got to capture a history that we can help people use as a guidepost for what it takes for people to manage really difficult circumstances. And not essentially fraction themselves off and in doing so actually make our challenges even greater. So I don't know if that's a good answer but I think if you Google public morale, I can't find any, there's nobody writing about it, nobody's talking about it. So I think it's a very fertile area to sort of investigate and think about particularly as a collective emotion. Then another question here is what is the role of psychiatrists and climate refugees helping and educating our legislators especially? Saundra, do you want to respond to that in any way? Let me see that question again, I just wanted to be sure. Right, it's from Karam Durrani. Yeah, well, I think, you know, we as psychiatrists add the buck always stops with us. And I think those psychiatrists who represent or both represent the populations that you're referring to as well as are invested in those populations, we need to appreciate, well, the word is not appreciate but to engage them in the same processes of both integration and education and survival that we're talking with for the general population. I think, you know, we, many of us may soon be a part of that population. And I think we're thinking of it as often them versus us but we are all on some level climate refugees and recognizing what that means. We're not all gonna move to Montana, I'm sure but we're aware of the fact that the climates that we're living in are affecting us. How is it affecting us? And what are we individually as well as collectively looking to survive it, to thrive in it? So I think it's a concept that is not, it's much broader applied than specific groups. We've got an entire world that is, whose populations are moving as a result of climate. And while I don't like the word refugee just simply because it suggests, you know, kind of having left everything behind, it does mean a complete change in one's environment to survive. Right, and I, you know, we can see the, in terms of the social political aspects of this, countries hardening their borders, for example, becoming more and more distressed about folks who are in their country, who represent an unwanted population who've gotten in, in their minds. And that's a recipe for a great deal of social pain and social distress and of clearly psychiatric concerns. So how we are gonna help mitigate the need for people to have to move really and fully in the way that climate may drive is gonna be a real challenge for us into the future. I think we have to figure out how we're gonna engage in politics. Maybe another way to answer your question. There's another question here. How will our collective mental health, especially in light of COVID and the negative consequences that have ensued impact climate change? Do you think we are more capable or less capable of change? My wife just gave me a card that says everybody's entitled to my opinion. So I recognize that this is just my opinion. And in some ways, much of what I've said is sort of an opinion. But I have to say, I think we're gonna get some clue to it next week with the election. I really am worried that we clearly could go firmly in the direction of just continuing to do what we've been doing and act as though there's nothing really happening or we can begin to think about how we more aggressively react to what is happening. And there was an earlier question, maybe it's a little bit later. What do we do about the fact that there's a large number of people who are denying climate change? And I think that this is a conversation that many of us ought to have in terms of how we begin to help do the sort of motivational interviewing at the both individual and social level to help folks move beyond places where they are really protecting their psyches and identities by actively pretending that something that's going on is not actually happening. That's something, engaging people with the reality principle, I think is gonna be something that we need to figure out how to be helpful in doing. So- Yeah. I think our training and our expertise as psychiatrists is we clearly understand that denial is a very convenient and prevalent and pervasive coping mechanism. And especially in many cases when the problem is too big and you don't know how to solve it and you can't imagine what needs to be done, you deny that it exists. And I think the extent to which this country is so divided over so many issues, I think is further manifestation of the fears associated with the change that is going to happen with or without us. And the magnitude of that, what it's gonna require on individuals, the way we used to live our lives, it's over. And that's just not a comfortable place for a lot of people to be. So they will fight it and there will be hard times before some people are drag kicking and screaming. But I think we're recognizing as we do how strong to the point of delusions, denial can be. It's something we're gonna have to face. I think we've got to keep in mind some way to... One of the things that Sandra and I talked about in doing this presentation was, what is the key ingredient for moving into the future? And we didn't wanna just come and lay this heavy tract on you guys about the world is going to hell, literally. Or I think about the Twilight Zone episode where the world is burning up. We don't wanna leave with that. We wanna actually leave with some sense of hope. And I think that maybe the way to say this is that while we know that denial is a very strong coping mechanism and is in use, it is not always the only position that people end up taking. And it is possible for people to be in denial and to then move out of that. And it's in the construction of the hope for something different and better that we're advancing this conversation with all of you. That there have to be ways for us to convene and converse, not only with the individual patients that we see, but with the larger communities and leadership that is shaping our evolution as a society, that these things are things we need to figure out how to participate in. Which leads me to another thing that I didn't mention, but I think is really important. We do really need to figure out how to cultivate relationship with the media of all sorts. Social media, the print and visual media, any media that we can that gets messages out to folks and helps people begin to think through and develop the capacities to manage the challenges emotionally that they're facing. This is critical information for us to do. If we could figure out how to get the right kind of concepts and ideas around managing and dealing with fear, anxiety, and the development of hope into some of the comic book movies, let's do it. We have to figure out what we're gonna do at these large scales to get to people to begin to think differently. And I would just say that back to the very premise for our discussion here is that we as psychiatry, we have tremendous ability to influence, to comfort and in fact, to provide and help to create options within individuals who fear not having them. And I think more than anything, I really do feel we have a responsibility to think in terms of those options and then to promulgate them however we can. That's kind of what we're trained to do, to help people figure their way out of what appear to be hopeless situations. And this is not hopeless. The world is not going to disappear. A lot of people on it may in the process, but the earth is going to continue, which is the good news. We'd like it to continue in the best way possible. And I wanna be a part of that. I want us to be a part of that and to encourage others in the same way. And I think we can, I know we can do that. That's the hopefulness of it. And there are many, many, many people out there who feel the way we do. It's a lot of hopefulness out there. And we've got to get in touch with it. There's a question here from Lee, the basis of disaster mental health is psychological first aid. That works based on establishing an area of safety with access to food and shelter. If those become no longer available to large portions of the population, how do you help those who seek your existence? Exactly. I mean, that's kind of the paradigm that we're talking about no longer working. We are not going to have all of these resources that we've had in the past available to us in the way that we've used them for the ongoing disasters that we continue to have. And using the resources that we have used in the past to rebuild areas is going to be incredibly much more difficult, especially in the years until we figure out how to really have adequate source of renewable energies and sustainable resources. We have at least a number of years of a gap between the capacity for oil to deliver so much energy to us and other options for our survival. I'm reminded, we don't talk about this very much, but there was a period of time, maybe 30 years ago, which is sort of a weird time to think about when there was the concept of peak oil and the idea that oil was actually going to run out and that we would no longer be able to extract petrochemicals. This is right before the whole notion of climate change really started to take off. But there was a series of things written at that point about what a world would be like where we did not have the energy that we needed to move our society, to power our society. That is a gap that we have to face. Without oil, until we have sustainable and renewable sources we are gonna have an energy gap that is going to be very problematic. You're gonna, we're gonna see it, examples of it with what happens with Russia and Europe this winter in terms of the gas supplies. That's obviously a new species of trouble, a person made, Putin made disaster, but we're gonna see what happens when people are under extreme duress and they don't have access to the energy that they need. It's going to be very, very challenging, I think. And then we, in our last couple of minutes, Karen asks, how can we best highlight the way that smaller communities come together to take care of their own in the wake of disasters and amplify that to get that to catch on in the larger communities? I think the response is out there. It's just not widely systematic or systemic. I think, well, what do you think, Sandra? It seems like that's a really good question. Yeah, and this was kind of what I was referring to before when I was saying that there are models for which, you know, they exist. And I think that's back with the same question. How do you spread the word, so to speak? And I think that, you know, Ken, as part of what we were talking about in terms of shifting the whole psychiatry paradigm away from the individual, the focus on the individual in so many ways and really get into what the community is about and how the community in itself is the safety for individuals to identify with and to engage with rather than the individual. I mean, that's a long history of our profession. But if we're going to look to anywhere that we can make some difference, I think that's the shift. And several of the resources that you listed in there, in the chat, I think are critical for people to kind of embrace and spread the word. Yeah, so I think that, you know, wherever we can find hope, we need to kindle it, and we need to find the examples of where people connect and work together. Maybe that's a way to sum up what we've been talking about. Climate change and what it will take to mitigate it or to deal with it is a collective action. This is not something we can do individually. And the costs of it are going to be borne collectively with each of us individually having some form of suffering in that process. We have to figure out, I think, for psychiatry, how we address this scale of problem, how we begin to think about this level of challenge in the communities and the places that we work. And it's a re-change. It's not just the paradigm of society that has to change. It's psychiatry's paradigm has to change a little bit. That's not to say that we don't need to still take care of people who've got very significant psychiatric challenges on the individual, you know, personal level. I think we really have to figure out how to do that, but we've got to get really efficient at doing that, as well as figuring out how we can mitigate the number of people who are likely to enter into the stream of casualties of trauma and other kinds of psychiatric sequelae that come from communities being completely disrupted, people being driven off their land or no longer being able to make a living. Those are challenges that we want to make sure we're helping to address before we get there in the pre-math. So that's kind of the takeaway, that the climate change is a collective challenge, and it's going to take a collective response. Did we miss anybody in terms of the questions? Is there a burning question out there? Anybody's got, there's some, thank you, Anthony. We need all the insight we can get, and anybody who's got it, please share. There's one last one down here, I don't know if we, oh yeah, there it is, Gary's got one, just. Yeah. Oh no, don't bring doomsday up. Let me read this. Okay, let's take this a few steps more, doomsday. So Dwayne Elgin, a PhD from Stanford, has been studying this topic since the seventies, when the government asked him to come in and study overpopulation. They did not want to hear how huge of a problem he said it was going to be. In his book, Choosing Earth, he talks about a great burning and a great dying, where he predicts 100 million people are going to die in this great transition we face. Can the fear of death, perhaps the greatest fear of all, be a motivation to break the denial? Looking squarely into the face of how many could go, could this help? Then in the area of the carrying capacity of the earth is 100 million even enough? All right, so that's pretty doomsday, Gary. But I don't know that fear is always the best thing that drives people to change. I wish maybe it would be, but there's some combination of fear and some sense of a way to escape that we need to also figure out how to provide, which is why we try to emphasize the hope aspect, that there's things that we can do as a human race to change our circumstances and to adapt to the situation we'll find ourselves in. I think too, keep in mind when you're really digging deeper into our cultural paradigm, what is it that this country in particular believes of itself that is able to skirt this very question? And that is the American psyche, the rise of the individual, the role of, I mean, the narcissism inherent in the belief that, yeah, that's true for everybody else, but we'll survive. 100 million may die, but it won't be me. That's this whole cultural overuse paradigm that the way we see ourselves in such an isolation rather than it's part of a global community and not being a part of that community, we still find ourselves scrambling to keep what we want, what we hold dear to hold onto that at the expense of others. So that's, I don't think it's fear, it's arrogance that keeps us from really being able to open up to other possibilities and embrace the need to care for our fellow man. And it's certainly, the good news is it ain't all of us, but it's a lot. And as a result, that makes us push this boulder. I'm always thinking of Indiana Jones pushing this boulder back up the hill, more difficult because some folks are pushing it back down on us, but we have to move from the individual and move to the collective. I just don't see how else. I think that is a great summary, Sondra, thank you. And I don't know if Violet's around, but we're at four, I guess five o'clock. That's what we said we would do and don't wanna take you guys any further than into this. And God knows what more doomsday effect would come up. We probably ought to stop now and hope that something better. Thanks and thanks everybody for joining us today. Appreciate that. Thanks Sondra, that was wonderful. Love it. Thanks Violet for all the help. All righty, bye-bye.

climate crisis

psychiatrists

cultural paradigm

double standards

marginalized communities

global mental health crisis

recovery and reconstruction

lifestyle changes

energy use reduction

collective trauma

public morale

emotional support