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Is President Trump causing toxic stress?

The central question of the third ScattergoodEthics confab-- "Is President Trump causing toxic stress?"-- prompted a wide ranging discussion about the impact of the Trump presidency on the mental health and wellness of people across the country.  The question may be dismissed as simply partisan, but that would ignore growing concerns by mental health, public health, and policy experts that actions of the Trump administration are having a negative mental health impact. Here are the perspectives of Confab attendees.

  • dr baum baicker 1

We are living in unprecedented times in America, times which stoke the flames of fear and uncertainty--core ingredients of anxiety. This is an age of anger and disinhibition: hate crimes are at an all-time high; N Korea threatens nuclear war; an epidemic of unpredictable gun violence kills numbers of unsuspecting citizens in unsuspected venues. There is a generational echo, as parents worry for their offspring about the denial of global warming, xenophobia, environmental abuses, ultra-conservative judges, and taxes that increase the deficit and continue to intensify the divide among the haves and have-nots. In the midst of all of this, Mr Trump's propaganda machine continues to play with peoples' sense of reality, as he works to turn night into day, gas-lighting Americans, attempting to dismantle their trust in a free press. The rule of law seems barely a consideration.

Mr Trump is the great inciter--flaming the fires of fury and bigotry in his base; fear, frustration, and anger in those who oppose him; and turning world leaders against us with his contempt for diplomacy. In this bifurcated America, social media has contributed to increasing the contempt each group has for the other. Lawrence Wright and James Gilligan (in J Gentile, LA Review of Books, 11/12/17) have shown that the "seeds of radicalism thrive on shame and humiliation, making fertile soil for violence." Add to this, Gary Wills' idea that "Bomb Power" is inseparable from the office of the presidency, and I'd say we're at "code orange" tinged with red.

We have a President who violates social norms, expressing unbridled narcissistic needs, externalization of blame, impulsivity, objectification of women, and acting (role-modeling) more like a schoolyard bully than a respected senior leader. Is it any wonder that many Americans are feeling overwhelmed and experiencing "toxic stress?" There is a debate among those in the psychological sciences: Is President Trump mentally ill or is he evil? When it comes to the impact of this presidency, I fear the the debate matters little. The lives of Americans are at stake: We know that when stressed, risk-taking behaviors increase, blood pressure elevates, and cortisol is released. The associated health risks include heart disease, obesity, drug/alcohol abuse, depression, anxiety, decreased immune function, cancer, and potentially death. Is Mr Trump causing toxic stress? The answer, I would submit, is self-evident.

-Cindy Baum-Baicker, PhD, Clinical Psychologist; Chair of the Board, Thomas Scattergood Foundation

  • howard

Empathy, in many ways, stood as a theme throughout the round-table. I agree that studying the role of empathy in health is of great importance. I had argued at length (eg, Oed. Paradigms in Collision, 1998/2016-reissued et al) that Empathy and its absence (the inability to see others as Subjects in Their Own Right, as we see, for instance, in DJT) are at the center of what it means to be a healthy individual or for a collective to be a healthy polity. More recently, I've been willing to push the idea that the most central questions in psychology include: "Why one person might and how one person comes to "give two hoots" or, as they say, "two shits" about anyone else. Dag Hammarskjold asked a similar question in the 1950's. I do hope some Department or Organization, someday, picks up these queries. Sounds like Scattergood may be poised to contribute meaningfully to this conversation.

Howard H. Covitz, PhD, ABPP, NCPsyA, psychoanalyst and contributor to "The Dangerous Case of Donald Trump" edited by Bandy Lee, MD.

  • Reenie King

What causes stress? Uncertainty, change, fear, vitriol, and conflict… these cause stress. And these are all words that immediately come to mind when I think of President Trump and his White House. The man seems to thrive in circumstances of anger, hatred, one-sidedness and exclusivity. He is creating the perfect environment for stress to flourish. The office of the Presidency is one historically treated with respect and great humility. President Trump does not appear to care about anybody else other than himself and winning. With him, one loses confidence in the fact that our leadership should demonstrate general goodwill for the people and a desire to nourish our country’s global relationships. Trump’s language is aggressive and antagonistic. It’s hard to think of anyone he hasn’t attacked: Muslims, minorities, LGBTQ, the impoverished, women, students, lovers of nature, scientists, journalists, not to mention those outside of our own country. All this comes from the man with the nuclear button within his reach at a moment’s notice. That is stressful.

Vulnerable people in America are more vulnerable under Trump. Our president’s incoherent, untrackable ramblings and daily bullying and provoking tweets are a clear example of the stress he is causing. His disrespect for the most important position of leadership in the world is concerningly stressful. His inability to be counseled, educated, informed or guided on any number of issues is concerningly stressful. His clear and present anger and hatred with his unprepared speeches, off the cuff, unfiltered, nonsensical tweets and overall angry body language and disposition is concerningly stressful.

As an educator of early elementary students and the mother to one, soon to be two, babies, perhaps the most stressful thing about Donald Trump and his presidency for me is his mean behavior and explaining this behavior to children. I can’t think of anything worse to call someone other than just plain old mean. And that is what he is. Mean is how he behaves. As adults - educators, parents, models for the impressionable youth within our own homes, in our schools and in our society - it is our job to model the behavior we hope our future generations will embody. How do you explain this man and his mean behavior to young, innocent, kind-hearted, empathetic and impressionable minds? Thinking about the process of using his mean behavior and bullying as a teachable moment is overwhelmingly stressful in and of itself.

Reenie O’Brien King, Mental health advocate and coordinator, ScattergoodEthics Program

  • sistid 120

The President is causing a public health crisis that will have far reaching and as-yet-unknown ramifications. He is undermining basic institutions of our democracy, failing to understand and support fundamental American values and Constitutional rights. He has an abusive personality. He actively gaslights and enjoys demeaning others publicly. His lack of competence and his disconnect with reality creates a sense of general instability. More specifically, the President is willfully injecting confusion and instability into our public health system, actively sabotaging health care and harming America's most vulnerable citizens. Health care providers, policy experts, and concerned citizens must work to ensure our democratic institutions do not buckle under the pressure of the President's ultimate goal--plutocratic and authoritarian rule. This is a disturbing possibility that has created a kind of stress I've never before encountered.

Dominic Sisti, PhD, Director, ScattergoodEthics Program

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Donald Trump’s election and presidency appears to be causing toxic stress for at least some segments of the country. One question is how such stress varies across groups such as immigrants, low-income individuals, upper-middle class liberals, and Trump supporters.

For example, recent media reports suggest that the Trump administration’s crackdown on undocumented immigrants have contributed to agricultural labor shortages. Whereas lower rates of migration into the United States partly explain this, it seems likely that the current policy climate has encouraged immigrants to leave the country out of fear, a trend that has been on the rise even before Trump’s election. Congressional attempts to alter U.S. health care can also be expected to have caused stress to large segments of the population, notably for the millions of people living on a fixed income or benefitting from the Medicaid expansion.

Beyond the consequences of the Trump administration’s policy agenda, the current political climate likely has also affected both well-off pro- and anti-Trump voters, notably by increasing the level of political polarization, even for topics that some had previously viewed as apolitical. A recent report from the APA confirms this: a majority of democrats but also republicans see the future of the nation as a significant source of concern, although the latter are less likely to attribute stress to the outcome of the election itself.

Melanie Terrasse, PhD candidate in sociology at Princeton University; Research Coordinator, ScattergoodEthics Program

  • ken

Yes. An effective president must display positive leadership. It has been said many times that Trump is a divider, not a unifier. I’d like to tackle this from a psychiatric perspective, but without making a medical diagnosis. A president is like a parent, and it is important for the public to look to the chief exec as a source of love and nurturance. Trump’s outstanding characteristic is his inconsistency and bending of the truth. This is not a way for citizens to bond to a leader. Some 20th century psychiatrists talked about the good mother or the good, bad or wrong breast. Using the breast as a stand-in for love, we see that Trump has no sense of expressing love for Americans except when he is manipulating or supporting some cause for his own purposes. The combination of insincere statements, lack of nurturance, and inconsistency makes bonding nearly impossible. Some people who voted for him continue to support him, but it is largely based on his manifest ideas of helping the ordinary citizen. These people do not see through him. For those of us who do, having to deal with his behavior every day is a form of toxic stress. For those who support him, whom I see as being in their own bubble, their time will come, and they will feel betrayed.

Kenneth J. Weiss, MD, Robert L. Sadoff Clinical Professor of Forensic Psychiatry, University of Pennsylvania.

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