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Taking the temperature on global warming.

Even though summer in my neck of the woods can get fairly hot and humid, not too many people are thinking about global warming right now. We are just grateful to be far away from winter. In fact, this past winter was so long and cold that I was thinking of global "cooling" back then. I was, that is, until my epiphany--on Earth Day, April 22, 2007.

While my newborn granddaughter, the child of two rabbis, was visiting, I went to the grocery store. As usual, the young clerk asked: Paper or plastic? I was ready to choose plastic, which is easier to carry, until I felt a surprising wave of guilt sweep over me. Would not paper be better for the future of my granddaughter?

That question naturally led to others. Is there any Jewish perspective on global warming? Has my profession of psychiatry been involved in any way in environmental issues? As it turned out, the practical question of paper or plastic was the easiest one to answer.

A little later, I discovered a possible ancestral connection. As family legend goes, the 15th-century Jewish philosopher Don Isaac Abravanel--a possible namesake--advocated for sustaining the Earth's resources.

All my musing brought me back to the possible involvement of my profession in environmental issues. But here I met with some disappointment. Searching and asking wherever possible, I could hardly find any commentary, interpretation, reframing, or advocacy by psychiatrists or organized psychiatry, despite all the increasing media attention on global warming.

Not even the psychiatric group devoted to social issues, the American Association for Social Psychiatry, had addressed the problem. Unfortunately, I have only myself to blame for the oversight. I was the group's president from 1998 to 2000.

But even since then there has been no response from our profession. Why, I wondered? Could it really be that we have nothing to contribute? Are we overwhelmed with the numerous immediate problems of our profession? Do we think the science is still inconclusive? Or is my concern symbolic of an "Impossible Dream" of windmills?

The Ethical Challenge

Despite some remaining dissent, there is greater scientific certainty that global warming is a real threat, especially as the years go on. Moreover, the February 2007 report of the UN. Intergovernmental Panel on Climate Change indicated with 90% confidence that wasteful lifestyles and other human behaviors are the culprits. Well, if human behavior was--and is--responsible, the responsibility of psychiatrists and other mental health professionals seems clear.

That responsibility is an ethical one. It meets the American Medical Association's principles of medical ethics in Section VII: "A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health."

Although Hippocrates associated mortality and climate, there have only been pockets of medical interest since. Recently, Dr. George Lundberg, editor in chief of Medscape General Medicine, decried the lack of general physician involvement in a solution to global warming. Dr. Lundberg warned that future public health threats, such as heatstroke, famine, new diseases, and competition for survival in less habitable lands could be worse than the threat from nuclear war (Medscape General Medicine 2006;8:71). Although there might conceivably be tiny areas of the world where global warming may be helpful, the projections for most of the world are dire.

More than likely, the poorer--locally and globally--will suffer the most, as well as the elderly and very young. Inadequate health care systems will become even more so. We may already be seeing an initial wave of the effects of global warming in Bangladesh, where "climate refugees" are a consequence of land giving way to rising seas. Some analysts even speculate that the roots of the conflicts in Darfur and Rwanda may have less to do with ethnic tensions than with ecological change.

These wars and migrations may be examples of what earlier studies predicted: that small elevations in average temperature will increase aggressive and violent behavior. Some of these studies have been examined by Craig Anderson, Ph.D., and Brad Bushman, Ph.D. (American Psychological Association Monitor Online 1998;29:2). So if public health risks are likely, what can psychiatry do to help the community, in the context of our ethical responsibility? Perhaps quite a lot.

The Hug or Shrug Response

Freud showed that, although our psychological defense mechanisms can often be adaptive and healthy, they become pathological when used unnecessarily and/or to support maladaptive behavior that eventually threatens the physical or psychological health of the individual. With global warming, the defense mechanism of denial may be used in a maladaptive way. It may be much more psychologically comforting to deny the consequences of our current lifestyles.

Denial dovetails nicely with the brain's natural evolutionary fight-or-flight response to immediate danger, such as that presented by the terrorist attacks on Sept. 11, 2001--but not to future risks. Ignoring future risk is what I would call a hug or shrug response. A hug response indicates that everything will be all right; a shrug suggests that this isn't such a big deal right now. In addition, our natural narcissism makes us more concerned about threats that will affect our lives--not those of future generations. Defense mechanisms are well illustrated by the legendary boiling frog story. If you drop a frog into boiling water, it will immediately jump out. However, if you put the same frog into lukewarm water and gradually heat the water up, the frog will become comfortable, then sleepy, and get cooked alive, recognizing too late that it is in grave danger. Global warming can mimic this experiment on a human scale.

Polls on global warming give us perspective on the extent of concern that exists. For instance, a recent National Journal poll of U.S. senators found that only 13% of Republicans believe that "it's been proved beyond a reasonable doubt that the Earth is warming because of man-made problems." Compare that with 23% of Republican senators who believed the statement a year earlier.

Despite this denial on the part of some adults, some children do get it. There seems to be no poll of U.S. children, but a recent YouGov survey found that British children between the ages of 11 and 14 worried more about climate change than about their homework!

Psychiatrists can help combat maladaptive denial. At the very least, we can enter the national debate and do our best to affirm the potential risk. Knowing the brain's tendency not to respond to distant risk, we can help find ways to increase current anxiety, shame, or guilt in the unconcerned. One way we can increase concern is by using imaging techniques--via Power Point projection to a live audience, on the Internet, or even through personal imaging. You can conjure the scenes right now. For instance, when I have the opportunity to lecture groups on global warming, I might try to find the skeptics, then go through a series of projected images--one more upsetting than the next. I would tell those who are feeling distressed to stop imagining the damages and to think of what they can do to help. This strategy makes use of positive and negative reinforcement. Rewards and incentives will help; taking away what someone values will not. The rewards need to be valued by the individual or culture involved.

This imaging strategy is like Al Gore's in "An Inconvenient Truth." Despite the film's enormous success, it has been criticized for presenting so many worse-case scenarios. Such one-sided emphasis can have the effect of actually increasing denial among audience members

What's in a Name?

Using the word "global" certainly seems appropriate in describing a worldwide problem that calls for worldwide solutions. However, the use of "warming" to describe a threat to the future of humanity seems like psychological milquetoast. For people living in colder climates, that terminology can paradoxically sound psychologically more promising than worrisome.

So what may be more psychologically appropriate? Using the frog experiment as symbolic of slow but sure danger might work, but calling this phenomenon global boiling might be better.

Motivating Others

We all know how hard it is to sustain the motivation to change. Significant numbers of people continue to smoke, overeat, abuse substances, or fail to comply with treatment. For some, this is attributable to psychological ambivalence about changing (Scientific American Mind 2007;18:82-3). Motivational therapy techniques aimed at helping people want to change may be necessary.

When it comes to naysayers, such as conservative Republicans, it's best not to rely on confrontation to convince them of the importance of reversing climate change. Rather, respect their viewpoint, and understand that they might harbor some ambivalence. Search for whatever aspects of that ambivalence might respond to an appeal to address global warming. Although some individuals may resist the appeal for political and business reasons, you might be able to develop their support by talking about families and the future of their grandchildren.

Save the Children

The future is especially important for the young, which means that involving medical students, psychiatric residents, and early career psychiatrists in environmental issues is crucial. Given the results of the YouGov survey of British children, child psychiatrists can help us pay more attention to what our children feel about global warming. Find out what children are worried about and reassure them realistically. Convey the kinds of things they can do to help, however small.

For the whole family, reading the Dr. Seuss book "The Lorax" might be inspiring. Written in 1971, this visionary tale depicts, with disarming humor, the risks of industrialization and the importance of trees for the environment.

On a more personal note, other than hug or shrug, or awaiting some technological breakthrough, I ask myself what can I do to model behavior for my grandchildren that indicates my concern for the environment? My wife can hardly believe that I've asked for the fluorescent lights I've always hated. But there are new, improved ones, I protest. She laughs, and knowing how wasteful I've always been, also points out my use of a long sheet of paper to leave her a short note. Well, the next time I did put a very small note on a very small piece of paper--but she missed seeing it for quite a while. Maybe more moderate change is better.

On the issue of that earlier "paper-or-plastic" question, I think I'll start using that tote bag from the last APA meeting, the one with the pharmaceutical logo on it. Uh-oh, wouldn't that inappropriately advertise the company and bring up another ethical dilemma?

This is not going to be easy.

DR. MOFFIC is a professor of psychiatry and behavioral medicine, as well as family and community medicine, at the Medical College of Wisconsin, Milwaukee. He can be reached at

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Title Annotation:THE ETHICAL WAY
Author:Moffic, H. Steven
Publication:Clinical Psychiatry News
Article Type:Viewpoint essay
Geographic Code:1USA
Date:Aug 1, 2007
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