Trepidation, Fears, Unrest, and Hope Sprinkled in as the Global Community Attempts to Move Forward
As society begins to cautiously re-emerge, we must take heed to ensure that we are minding our very fragile mental temperature. The extreme disruption in daily routines, social connections, finances, and places of employment has lead to increased anxiety, rising mental health problems, and an accelerated rate of suicides. (source, source, source)
Health day reported on additional dire results from another timely screening, authored by Mental Health America, of over 21,000 Americans. The statistics are enormously humbling:
- At least 88,405 more cases of depression and anxiety than expected.
- More than 54,000 moderate-to-severe cases of depression and more than 34,300 moderate-to-severe cases of anxiety between February through May.
- The per-day number of depression screenings was 394% higher and the per-day number of anxiety screenings was 370% higher in May than in January.
- There’s a huge toll on young people (younger than 25). Roughly 9 in 10 screened had moderate-to-severe depression and 8 in 10 had that level of anxiety.
- There are strong feelings of loneliness and isolation. The two factors accounted for 73% cases of moderate-to-severe depression and 62% of anxiety.
- More than 21,000 people considered killing themselves or harming themselves on at least 16 days during May. Nearly 12,000 had these thoughts almost daily.
- LGBTQ individuals, caregivers, students, veterans and active duty military personnel, as well as those with chronic health conditions are especially hard-hit.
- The pandemic is also contributing to other mental health conditions, like psychosis.
Adding to the worldwide unrest, violent protests have emerged, with apparent racial overtones. This has created further confusion, divisions, and helplessness. Experts worry that these recent events could lead to a “breaking point” for some individuals. (source, source, source, source, source, source, source)
There is some good news.
Since the crisis, a current survey indicates that 64% of Americans are becoming more aware of their mental health and many are taking self-care more seriously. Furthermore, the eye-opening revelation that prejudice is still rampant has caused many to “wake up” to the disparities in our world. (source)
Across the world, Blackout Day got more attention and many physicians, previously not in the know, started to reclaim the white coat for black lives. (source) In my area, police knelt down to show their support to their protestors, uniting the two for a common cause.
With the current events and crisis, it seems beyond insensitive to throw out a recommendation for eating organic, adding in kale to our diet, using an essential oil, or a mindfulness practice. Not while there is a raging inflammatory fire of stigma, bias, rising income inequality, racism, and disparities that are influencing health outcomes way more than any other lifestyle factor. Although these can help, we need to start where we are.
This is why I have been advocating for how healthcare not only has to pay more attention to mental health, but also the socioeconomic disparities that are one of the most powerful influencers of overall health, beyond any physical metric.
In this post, I will explore why medicine needs to be more aware and how we may be more accepting and more inclusive in our approach to serving others.
(Note: I also just released an article on dealing with uncertainty as society re-emerges. Click here to bookmark it for later.)
Compassion for Others and Self- Are They Related?
The data is all over the place on how self-compassion impacts compassion for others. Some studies report that there is an association, others show none. This may be due to the fact that the measurement and definition may vary. (source, source, source, source, source, source, source) Interestingly, though, in one experiment, it was found that certain characteristics are associated with more compassion. By a mail-in survey, the authors measured various aspects in 328 individuals and reported the links as follows:
Low-educated individuals reported higher compassion for others compared to their counterparts. Similarly, previous research found that lower-class individuals reported greater compassion for others during laboratory inductions and real social interactions, compared to upper-class individuals (Stellar et al. 2012). The association between social class and compassion for others was mediated by the perception of distress in others, supporting the idea that lower-class individuals, who often live in more threatening environments, initiate cooperative relationships as a strategy to deal with external threats (i.e., tend-and-befriend response strategy). Self-compassion was found to be lower in lower-educated individuals. It is possible that lower-educated individuals have difficulty in understanding the scale items, and in turn, this affects their scores. Considering that the SCS was pilot tested and validated with university samples (Neff 2003a), some of its items can indeed be complex. More research is needed in order to clarify whether and how education influences self-compassion.
I find this very intriguing.
Basically, the “easier we have it,” the less likely we are to tolerate or relate to others who may not “measure up” to our standards.
It is easy to judge others and brush aside trying to understand why someone may have acted out when one feels superior and has all resources available to them within arm’s length.
However, not everyone has a Vitamix to blend their nootropics (“smart drugs/supplements”), access to gyms to boost BDNF (brain-derived neurotrophic factor), or have the luxury of being raised in a financially and emotionally stable environment.
Physicians Heal Thyself… and Look into Your Own Biases
I worry that integrative medicine can sometimes be quite presumptuous. This was and still is true for me at times. I get excited about the power of food as medicine or another lifestyle intervention and sometimes forget that this will do no good without access to it.
Is it not a form of medical prejudice to assume that people are lazy, un-educated, or some other derogatory term because they aren’t eating healthily or exercising?
For example, many use associative studies as “proof” of causation for those who have large body sizes. For this reason, many assume that body size is associated with diet and exercise and that weight loss is the sole answer.
Just because ice cream consumption increases when deaths from shark attacks peak, doesn’t mean that eating ice cream will cause a shark to sneak up your toilet, slither to your living room, and decapitate you. (Excuse the visual, but this very irritating to me. It has been since the “obesity paradox.”) (If you want the science on this, I go through it here.)
Still, I read blogs that say, for example, going organic and gluten-free can be the sole answer to solve someone’s chronic cardiovascular systems problems. Maybe it will help their lab markers and make them feel better temporarily, but if their marriage and social connections are disintegrating, they are doomed! News flash: Isolation and toxic relationships will make your heart give out quicker than those French fries and bread crumbs. (source)
As physicians and health care practitioners, we need to know and do better. Medscape reports:
Although we are not policymakers, these events are a reminder that we must be educated about injustice and inequities so that we may better serve those in our care.
Some statistics are reported as follows:
- The current crisis disproportionately affects people of color; whereas Black people are 2.6 times more likely than their white counterparts to die
- In North Carolina, Black people make up 35% of laboratory-confirmed cases and 34% of deaths , but are only 22% of the population.
- In New York City, Black people are 22% of the population but 28% of deaths. Similar trends can be seen among Hispanic and Latino populations at national and state levels.
When students learn about antihypertensive medications in medical school pharmacology, they should learn about racial bias that spawned misperceptions that are still widely accepted. When students learn about the nephron and acute versus chronic kidney disease, they should learn about racist distortions that led to an estimated glomerular filtration rate that is different for Black people than for other racial groups. When students learn that being Black is a risk factor for sexually transmitted infections, they should have a discussion about the ways in which structural racism limits sexual and reproductive health.
Dr. Peter Attia, along with his daughter, had an interesting podcast on a zero tolerance in medicine for normative errors. It’s worth a listen.
Finding Compassion for Everyone
Racism, cruelty, hate should not be tolerated, that is evident. Of course, society should have laws that protect people from hurting each other.
Justice is needed.
Most certainly, those who are meant to serve the public and protect them should not be harming them!
When people act out in violence, our rules dictate to defend the victim, seek justice, and examine our own prejudices and biases in order to not contribute to the acceptance of it
It’s the other silent pandemic, the pandemic of fear and judgement.
Every time one doesn’t speak up when a sexist, racist, or “fat” joke is issued, or when we turn a blind eye to someone treated unfairly, are we not silently affirming that it’s okay?
We have to start with us because the problem is global, beyond politics, beyond the justice system, beyond a group.
Then we have to make a personal commitment to break the cycle.
Do we perpetuate the cycle of “us” vs. “them” by hating and shaming?
Rather than the silos we have created for ourselves by weeding out any viewpoints that make us uncomfortable with an “unfriend” or “unsubscribe,” I would love to see a world where we are safe and determined to listen to all viewpoints to breed more understanding and broader, more impactful solutions.
I would love the young children to be taught the importance of minding mental health, how to stay healthy without fear, and have exposure to intelligent dialogue with people from all different perspectives and ethnicities.
Most importantly, I would love to live in a world where we honor and teach compassion, trolling is not tolerated, and sharing of resources is a given.
I’m hesitant to write all this, as we need to definitely not let what happened be swept under the rug. However, we need to do more than protest.
Every day, we thought beyond our comfort zone?
We knelt besides the “other” and opened our ears, shut our mouths, and listened to someone else’s experiences at the grocery store, on the phone with loved ones, or when watching the news?
What if we took their viewpoint?
We looked at someone who did something so violently, seemingly unforgiveable, and tried to understand why? This is not to condone the behavior, but to prevent it from EVER happening again.
We asked ourselves what made us not learn from our history and keep things so broken that someone would feel that it’s okay that they could harm someone based on the color of their skin, their political affiliation, who they love, their gender or their career?
There can no longer be ANY “us” or “them.”
In medicine, only our patient’s best interest, all our patients.
I’ve leave you with this.
My aunt, an avid and devote human and civil rights activist, gave me a bumper sticker last year.
It says, “Our lives begin to end the day we become silent about things that matter.”- MLK
It’s on my car bumper.
I’ll keep it there, indefinitely, and move it to the next car.
I, personally, don’t want to forget.
This material is for information purposes only and is not intended to diagnose, treat, or prescribe for any illness. You should check with your doctor regarding implementing any new strategies into your wellness regime. These statements have not been evaluated by the FDA. (Affiliation link.)
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