A Warning for Mental Health Professionals in a Time of Crisis
Australia, like my beloved California this fall, is burning. Unprecedented bushfires have erupted around the country following a drought, kindled by high summer temperatures and winds. These fires have led to the evacuation of more than 100,000 people. In the city of Mallacoota, residents literally were driven into the ocean and evacuated by the Australian navy to escape the flames. Australia’s famed wildlife has been decimated by the burning of habitat, with nearly half a billion animals anticipated to have been harmed or killed by the flames.
Climate scientists attribute the conditions that led to the scale of these fires to climate change caused by increases in greenhouse gases, leading to what some have called the Pyrocene. Similar events have occurred here in California. When I walked the John Muir Trail in 2018, I witnessed some of the mass tree death that has occurred in the Sierra Nevada mountains as a result of climate change. It is only a matter of time before those burn, too.
In any calamity, there is often one image that that captures the profundity and the sorrow of the catastrophe. When President John F. Kennedy was assassinated, the image of his 3-year-old son, John Jr., saluting his father’s casket captured the grief of a nation. When the Twin Towers were attacked, it was an image of an anonymous man falling to the ground, forced to choose a fate of fire or jumping, that encapsulated the bewildering sense of helplessness we all shared in that moment.
When reading about the Australian fires, a video of a magpie who had learned to mimic the sound of fire trucks unexpectedly brought me to tears. Magpies, along with fellow corvids ravens and crows, are among the most intelligent birds. They are social, can communicate as they cooperate towards a mutual goal, and are extremely proficient problem solvers. What was this bird communicating by mimicking the siren? At the risk of anthropomorphizing, I imagine him saying, “I’m terrified. I don’t know what’s happening, but I sure hope you can figure it out.”
As mental health professionals, we are asked to assist when the world no longer makes sense, when our patients have left the realm of the normal and usual. But how do we respond when the affliction no longer seems personal as much as it feels collective? Is it even possible to feel healthy when the world writ large is suffering, be it from climate change or the political threats of war?
An appropriate human response to a world in which entire continents burn and animals go extinct en masse is grief. My teacher, Francis Weller, MFT, has written extensively about how we experience grief in response to the sorrows of the world. He wrote in The Sun on how the anima mundi, the soul of the world, is inextricably tied with our individual inner worlds and when the world cries out, we feel it too.
“The— the soul of the world — is trying to speak. It’s telling us that its capacity to mend itself is at risk. And we are a part of the , intimately tangled in this net of events. We think we’re somehow separate from nature because we live in cities, drive cars, and look at computer screens all day, but we’re still entangled in the earth. Michael Sendivogius, a fifteenth-century alchemist, said, ‘The greater part of the soul lies outside the body.’ My soul is entwined with those Douglas firs and the redwoods and the sorrel and the raccoon and the fox.”
Warshan Shire in her poem “What They Did Yesterday Afternoon” closes with these resonant lines that speak to this collective sorrow:
“…later that night
i held an atlas in my lap
ran my fingers across the whole world
where does it hurt?
In order for clinicians to sit with the grief of others, it is incumbent upon us to have explored and continue to address our own grief, for the container we can create is only as spacious as the work we have done on ourselves.
When we sit with the pain of our patients, it’s important to remember that our psyches do not end at the edges of our skin, and that which is going on in the larger world impacts our inner worlds. There is no pharmacological answer to an ecological quandary. We can acknowledge that collective and systemic injustices are felt not only by the whole, but also deeply impact the individual. The philosopher Jiddu Krishnamurti once remarked “It is no measure of health to be well adjusted to a profoundly sick society.” It is a grace to remind our patients that sorrow is an appropriate response to loss and we, as clinicians, are there to witness.
To do the work of witnessing is challenging even on a good day, and made even more so during a time of deep uncertainty. It is incumbent upon us as providers to take the best care of ourselves. It is de rigueur to encourage exercise, meditation, and eating well at this juncture in the essay, but I suspect this will not be enough. Radical self-care and trauma stewardship may require us to set limits on how much we can hold.
It also means that we cannot do the work of grief alone. Grief has never been a solitary exercise. Weller writes about how the work of grief is meant to take place in community, yet so many of us do our clinical work in isolation. If we are going to continue to be able to show up for our patients, we must first show up for each other.
I challenge my readers to find an opportunity this month to reach out to a colleague and to really ask about how it is for them to help carry the weight of the world. We can start this collective here. If you have an experience in doing this and wish to share, I welcome you to do so in the comments below.
Andrew Penn, RN, MS, NP, CNS, APRN-BC was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic Assisted Psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality in The Casebook of Positive Psychiatry, published by American Psychiatric Association Press. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing, where he teaches psychopharmacology, and is an Attending Nurse Practitioner at the San Francisco Veterans Administration. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.