Mental(izing) Health: What Will the Election Mean for Mental Health Professionals
Newsletter, #59
A few weeks ago, I made the tentative decision not to write about the election; wasn’t sure I was up for it; nor did I imagine that I had anything especially insightful to say. As Samuel Beckett might have put it: less is more—more or less, and more is less—even more so. True, but after an internal debate, I realized that I not able to refrain—there’s just too much at stake. I will do my best, though, not simply to reiterate the post-mortem assessments that have been circulating and to focus my attention on what we as mental health professionals can expect from the incoming administration.
Where shall we start? It’s hard to know because Trump is mercurial and might not follow through with his announced intentions. His biggest, but quite implausible proposal is to reestablish large-scale psychiatric institutions. The notion of isolating people who struggle with mental disorders by sending them out of sight, no doubt, is appealing to Trump. He conjures people with mental disorders as a unified group, making no attempt at differentiation or to acknowledge that not everyone requires institution. In one sense, I imagine that Trump believes he is resurrecting something from a past era that he regards as sufficiently tough-minded. In another sense, it is not evident that he understands that this would constitute a whole new ballgame, given that large scale mental institutions were run by the states and never previously by the federal government (https://www.npr.org/2024/11/12/nx-s1-5184507/trumps-plan-for-people-struggling-with-mental-illness-addiction-and-homelessness).
Let us cede, though, that our current system is failing on numerous levels and in need of a major transformation. Unless there is an enormous commitment for an influx of funding, which Trump has not promised, how can we not be skeptical about what he has in mind?
Trump’s pronouncements about mental health in this campaign tended to occur around his barrage of insulting generalizations and attacks on migrants. It’s all about the anecdotes, which reinforce the priority of orchestrating people’s fear and threat.
In contemplating Trump’s views about mental health, we should never forget his infamous, mocking of a New York Times reporter who happened to be disabled in 2015. Less well-remembered, perhaps, Trump also suggested in 2016 that people serving in the military who developed mental health problems were not strong and couldn’t handle their experiences (https://www.washingtonpost.com/news/post-politics/wp/2016/10/03/trump-suggests-military-members-with-mental-health-issues-arent-strong-and-cant-handle-it/).
The most significant glimpse into Trump’s thinking about mental health this time around was revealed in his declaration about depression, which occurred just prior to the election, but somehow failed to get the coverage that it deserved: “you know the best way to stop depression? Work your ass off. You don’t have time. You want to work so hard you don’t have time for depression” Listen for yourself:
How is it possible that this was barely covered by the mainstream press?
The context is worth heeding closely, as Trump was encouraging his listeners at the rally to vote for him, warning that otherwise they risked becoming depressed. What transpired, though, was that Trump conflated the notion that electing Harris would create an economic depression, which he had been stressing in the campaign (https://nypost.com/2024/11/02/us-news/trump-warns-of-depression-in-kamala-harris-wins/) with an unplanned drift to weigh in on depression as a psychiatric disorder.
It is impossible to reflect on Trump’s take on depression without wondering about Trump’s own mental health. Suspicions of cognitive decline were raised over the course of the campaign, as his bizarre, incoherent rambling on the stump over time seemed to escalate (https://www.pbs.org/newshour/show/trumps-rambling-speeches-raise-questions-about-mental-decline). He had to cancel several events around this time.
The long-standing concerns raised about Trump having a personality disorder and thus being ill-suited to be president are hard to deny or exclude from reasonable consideration. Indeed, I hope that there will still be opportunities to use his example to improve the public’s understanding of narcissistic personality disorder. There might be more of a reception for this, once more people become disappointed, given that this has frequently happened over the course of this career.
Two other considerations are worth noting. First, in the background is the saga of Trump’s older brother whose life was compromised by alcohol. This made Trump refrain from alcohol consumption, but he has come to acknowledge some vulnerability and guilt from his role in pushing his brother to join the family business (https://www.washingtonpost.com/politics/trump-pressured-his-alcoholic-brother-about-his-career-now-he-has-regrets-/2019/08/07/58ec2d70-b216-11e9-8f6c-7828e68cb15f_story.html0. Second, I wonder how the assassination attempt has affected Trump’s psyche. Coming so close to being killed must have left its mark, however much he has tried to deny that and adopt a hero’s persona. In venturing the claim about treating depression with work, we might suspect that Trump is revealing something about his own state of mind, recognized by him or not.
I do not want to get sidetracked with speculations about Trump, so let’s return to his assessment of depression. No one would dispute that encouraging activity and feeling productive can contribute to overcoming depression. However, no mental health professional that I am aware of would countenance this simplified solution of pulling yourself up by the bootstraps. As a message, it shows a lack of empathy toward people who are suffering with depression, and it is likely to have the effect of discouraging people from seeking help, which is unfortunate and disturbing. In addition, it demonstrates a profound disrespect for mental health professionals whose understanding of depression is based upon research and experience with treatment. As several professionals interviewed in a Newsweek article testify, Trump’s statement ignores that while depressed, work can become more stressful and counterproductive (https://www.newsweek.com/donald-trump-cure-depression-hard-work-1980296).
If this is what we are in for, it’s going to be a rocky road. We must be willing to face Trump’s utter failure to value our labor, even if we cannot exactly predict the consequences. It remains uncertain, for example, whether Trump has an intention to renew his attempt to roll back Obamacare. If he does, this could mean that parity between mental and physical disorders will be rejected. We don’t know how Draconian things might become, but the line-up of cabinet nominations does not harken much hope and raises the specter of idiosyncratic, and dangerous policies and practices that are dismissive toward science.
It is heartening to know that people in our field are stepping up in various ways to protect our rights and freedom. There have been calls on various list-servs for volunteering to assist with asylum cases. This is admirable; however, I just heard a concerning anecdote from a graduate student whose classmate has a current placement at an externship site that does asylum hearing. Apparently, since the election, they have no patients—people are simply too afraid even to venture to seek help. An upsetting harbinger of the future?
In the realm of self-serving activities, Kris Yi and I are both board members and serving as co-chairs of the program committee of PsiAn (https://www.psian.org/) and are planning a conference in New York next September, where we will address our unfolding plight, along with pressing concerns like Social Justice, AI/Technology, Research, Integration of Different Treatment Approaches (stay tuned for details).
Let us hope that activism thrives. Let us also not underestimate what it means to show up for our patients these days. This can be challenging, especially when we are all affected, and anxious about our own future. There might not be much recognition for our work in the coming period, but we must continue to affirm the value of epistemic courage, that is, courage in the realm of facing yourself.
I will conclude this newsletter by leaving you with some hope. I have been reading Rebecca Solnit’s book, A Paradise Built in Hell: The Extraordinary Communities That Arise in Disaster (2010), a series of stories about catastrophic events—fires, earthquakes, explosions, terrorist attacks— and the aftermath.[i] The theme running through the book is that under threatening conditions humans behave surprisingly altruistically as well as joyfully, and that if anything, bad behavior comes from top down (elected officials, administrators and politicians). What is especially fascinating is that research, which supports what Solnit finds in her case examples, is typically ignored—we fear that the worst will occur under difficult circumstances, although the reality is often the opposite and even gratifying emotionally.
It would be hyperbolic, of course, to claim that the election of Trump constitutes being a disaster at this exact moment, even if the plan for government reform seems to feature retribution as much as it does efficiency. The world in 2024 is in a much more delicate place, compared to the time of Trump’s first election in 2016. Is it possible to lead the country wisely without knowledge or interest in history, as we respond to the various flashpoints around the world? Does it make sense to prepare for disaster? Not only war, but environmental disasters.
Mental health professionals need to unite behind their share commitments—treatment for mental disorders, the importance of ongoing research, their experience in dealing with the range of human emotions as well as human suffering. We need to be leaders in defending and reformulating the just causes of diversity, equity and inclusion. We need to keep asking ourselves at what point does civil disobedience become necessary.
Might it be possible that preparing for disaster could stimulate the kind of altruism that Solnit describes? Here’s hoping so, as the light fades, and the darkness encroaches.
[i] R. Solnit (2010). A Paradise Built in Hell: The Extraordinary Communities that Arise in Disasters. Penguin.