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As we help people cope with chaos and uncertainty, therapists are struggling too

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Americans are facing uncertainty, and it's starting to seem as if uncertainty is the norm. Over the past eight months we have battled the never ending war with COVID, started, stopped and restarted virtual school, and witnessed the reanimation of a civil rights movement. We've watched daily as news outlets recount death tolls and survival numbers for the pandemic, all while trying to give our family a semblance of normalcy, but nothing about this is normal and the helpers we are used to turning to are burning the wicks at both ends.

In today's climate, therapists are battling the same battles as our patients. Once upon a time before COVID, our stressors would occasionally overlap, but in recent months the stressors are exactly the same as the majority of our clients. Therapists are encouraging our clients to do the very basics to keep from spiraling into a depression, all while we struggle to change out of our pajama bottoms for virtual sessions. At times it's difficult to put aside your own personal struggles to focus on the needs of our clients, but we still show up.

We keep showing up ready to hold space even though our own cups are empty, but the fear of the election outcome is a different level of connectedness that we as therapists were not prepared for. The fear around elections is not new, of course; we navigated this in 2016. But with the very palpable division in our country, our clients are scared. They're scared of either outcome, and so are we.

Communities of color are turning to therapists to help them not only navigate the continued shootings of unarmed Black and brown men by police, but to also have a safe place to express their fears and anxieties around the election. The state of the country is shaky, to put it mildly, for our minority communities. This includes increased depression and anxiety rates in LGBTQ+ communities as well. It seems as if therapists have noticed a collective holding of breath, and yet we also sit not breathing, waiting for the shoe to drop.

Therapists are not immune from current events. In fact, it's in many of our codes of ethics to be updated and actively advocating for things that are or will negatively affect our clients. Our clients are seeing news reports of the lines wrapped around sporting goods stores to purchase ammo and calls for a civil war should the election swing the pendulum toward the other direction. We sit in uncomfortable fear while our clients pour their hearts out, expecting us to have the answer. But we weren't trained for pandemic counseling in a tumultuous election year while the country is literally on fire. There was not a class for that.

We are sitting across from clients via screen or in person empathizing with their fear while experiencing the same gut-punching terror. We are getting hung up on what coping skills to suggest because we've tried them and they're not working for us, so we hesitate to suggest them to you. Of course, a brave face is put on display and we walk through mindfulness exercises to help ground you to the present moment, but in reality, the present moment is filled with uncertainty and doubt. When the only way out is through, we have to give our clients the tools to push through.

Therapy still works, even if at times your therapist may look haggard. We want you in our office, physical or virtually. This state that we're in is hard for everyone. It's important to know you're not alone and to develop the tools you need to push through to the other side of this election and beyond.

It's natural to have fear when nothing seems certain. We've been living in a heightened sense of survival for an extended period of time, and our brains are just not equipped to thrive in fight or flight for that long. So rest, talk to someone, and give yourself permission to feel whatever you're feeling. Even your therapist needs to do that right now.

From Your Site Articles

A mental health professional makes a strong argument against diagnosing Trump.

'Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely.'

Donald Trump is a narcissist and everybody knows it — at least in the colloquial sense of the term.

The 45th president of the United States built his brand on being self-absorbed, self-obsessed. He's the type of man who's spent the better part of the past several decades living in a gold tower with his name emblazoned on the outside. He's put his name on everything from steaks to board games to vodka. He's a real-life Narcissus, gazing into his own reflection. He is pride, he is arrogance, he is vanity.

To untrained observers, he's the embodiment of narcissistic personality disorder. And yet, at least one man thinks that we're not giving Trump enough credit — and he's perhaps one of the most qualified people to make that assessment.

Photo by Win McNamee/Getty Images.

In a letter to The New York Times, Professor Allen Frances — who literally wrote the book the subject — offered a defense of Trump against claims that the president has narcissistic personality disorder.

The letter, titled "An Eminent Psychiatrist Demurs on Trump's Mental State," came in response to a letter the previous day signed by 33 mental health professionals who called for a lift on the American Psychiatric Association's 1973 Goldwater Rule against evaluating public figures. That letter argued that Trump suffers from a "personal myth of greatness" and "grave emotional instability" that makes him mentally unfit to serve as president.

In his letter in response, Frances explains that he personally wrote the criteria that defines narcissistic personality disorder as part of the team that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and that Trump simply does not meet that criteria.

"He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder," wrote Frances.

Allen Frances. Photo by Angelika Warmuth/picture-alliance/dpa/AP Images.

Frances cautions that by diagnosing Trump with NPD, or any other form of mental illness, from afar, we risk further stigmatizing people who live with mental illness.

"Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither)," wrote Frances.

"Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely."

"Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers."

Psychoanalyzing Trump won't do anything to put a stop to what Frances calls "a dystopic Trumpean dark age." The solution, he argues, "is political, not psychological."

Donald Trump greets supporters after a rally in Mobile, Alabama, in 2015. Photo by Mark Wallheiser/Getty Images.

Stigma remains a big issue in the mental health and disability communities. Even if Trump does have a mental illness, it's probably not a worthwhile argument against his leadership.

David Perry, a journalist focused on disability rights, says he doesn't see any political benefit to trying to discredit Trump on the basis of perceived mental illness. To start, Perry explains, one has to work under the presumption that there are voters who are OK with someone who demonstrates questionable behavior — like lying, bragging about sexual assault, and being prone to outbursts, and all the other criticisms people have about Trump — but who would be be dissuaded from supporting that person only on the basis of mental illness.

"Does that voter exist?" Perry asks. "If so, isn't that a perfect example of using stigma — against 'crazy' people — to gain political advantage? It's possible that voter does exist, since such stigma is pretty pervasive, but I'm skeptical that Trump supporters are capable of being persuaded by anyone's internet diagnosis anyway."

Photo by Isaac Brekken/Getty Images.

Mental illness affects people all around us. That doesn't make them, as Trump might call them, "bad hombres."

"So I get it. ... We're going to speculate," says Perry. "But every person I know who has a mental disability finds that speculation painful, because it suggests that you might expect them to behave like Trump due to their diagnosis. So that matters to me."

Mental illness is nothing to be ashamed of. According to the National Alliance on Mental Illness, roughly 1 in 5 U.S. adults experience mental illness in any given year. That's more than 43 million people. The problem, though, when it comes to mental illness, is that shame and stigma prevent many people from seeking care in a timely fashion. The truth is that when treated — whether that's with talk therapy, medication, exercise, diet, or something else — most forms of mental illness are pretty manageable.

Stigma makes seeking help a scarier process than it needs to be, so can we all agree not to add to it by trying to diagnose Trump from afar?

Photo by Chip Somodevilla/Getty Images.

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Family

This country has only 10 psychiatrists. That's where 'professional grandmothers' come in.

Getting mental health care in America can be difficult. In Zimbabwe, it's near impossible.

The country is home to 15 million people and only about 10 psychiatrists. For comparison, the United States has at least 24,000 psychiatrists. But depression and anxiety are not just a first world problem.

"Common mental disorders impose a huge burden on all countries of sub-Saharan Africa," said health researcher Dr. Dixon Chibanda in a press release.

Zimbabwe has a secret weapon though: the Friendship Bench.

Image from The Friendship Bench Project, used with permission.

Developed from over 20 years of community research, The Friendship Bench Project is a different and smart way to tackle mental health care.

You can find one of the inviting benches outside some of Zimbabwe's many health clinics. Sitting down, you might get a visit from an older woman. These women are known as golden ladies or grandmothers. You can talk to them. They listen. Then, they might help you identify problems in your life or give you advice to help you feel positive and in control.

Its might seem simple, but these grandmothers are health workers — and very effective.

Photo from Grand Challenges Canada/Flickr, used with permission.

They're not just dispensing random advice. The grandmothers are health care workers who've have been trained in what's called problem-solving therapy. And it turns out it could be a pretty effective strategy.

A recent study published in the Journal of the American Medical Association compared the grandmothers against the usual care options, including a nurse assessment or optional medications. The study found that after six visits to the Friendship Bench, visitors were three times less likely to have the symptoms of depression six months later (50% versus 14%). The results were even more striking for anxiety or suicidal thoughts.

There were, of course, a few limitations to the study. Not a lot of men signed up, for example. And there's some more nuance, like exactly how the comparison was done. If you're interested, the full text is here. But the bottom line is that it seems to have worked.

Better mental health care is important for everyone, but low- and middle-income countries may need it especially badly.

"In many parts of Africa, if you are poor and mentally ill, your chances of getting adequate treatment are close to zero," said Karlee Silver in a press release about the Friendship Bench Project. Worse still, in many places in Africa, there's still a stigma — sometimes very serious stigma — around mental disorders and mental health care.

And all this adds up. In addition to adding to human suffering, the cost of treating mental health problems and lost productivity are estimated to cost low- and middle-income countries $870 billion a year. The number may grow to more than $2 trillion by 2030.

That's why it's so heartening to see clever programs like The Friendship Bench Project at work.

Photo from Grand Challenges Canada / ZAPP.

So far, over 27,500 people have used The Friendship Bench Project.

The program's been working with a number of other organizations too, such as the Zimbabwe Ministry and Health and Grand Challenges Canada. They are currently located in a few of Zimbabwe's cities, including Harare, the capital, but are planning to expand to even more clinics.

They also plan to reach out to more vulnerable populations, such as youth or refugees, in the future.