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How Psychiatry Can Help in the Present Crisis

Published in the Salt Lake Tribune, June 4, 2020
By Michael A. Kalm, M.D.
Freud, asked what the goals of psychotherapy were, replied, “Just two.  Empower the individual to love and to work.”  Just as educators have their “three R’s” – reading, ‘riting and ‘rithmetic,” we psychiatrists have our “three R’s” - for empowerment – reality testing, reframing and risking. Never have the three R’s been more important than now in the era of Covid-19, Climate Change, and persistent racial injustice.

  We challenge our patients to “risk,” to try out new behaviors, first in the safe “laboratory” of our professional offices, then later, when they feel comfortable enough, out in “the real world.”  

We invite our patients to “reframe,” to look at an old situation in a new way, one that may feel strange, but will actually serve them better.  We help a teenager see his mother’s nagging as a statement of concern and positive expectations, helping him reframe criticism into love.

The third “R,” reality testing, is the most difficult of all.  We think of faulty reality testing as a symptom of psychosis, a delusional state, i.e. reality is true, and delusions are false.  But problems with reality testing are much more pervasive than just in psychosis, because they are often grounded not in true vs. false, but in two realities that are contradictory!

This paradox was present from our country’s beginning.  The Declaration of Independence has phrases like “All men are created equal,” “with unalienable rights,” “life, liberty and the pursuit of happiness.” and the U.S. Constitution has a preamble that begins with “We the People,” “to form a more perfect Union” and “promote the general Welfare.”  Such was the reality of the American Dream, sanctified in our most hallowed documents.  But simultaneously, we had an alternate reality, slavery – a reality in which we could own other human beings as property, and use them as we willed, including rape and murder.

Lincoln saw the problem with this paradox in 1858, in his “house divided against itself cannot stand” speech.  Later, in his Gettysburg Address, he was still questioning, whether “government of the people, by the people and for the people” “can long endure.” 

And now, we have Covid-19 and Climate Change.  One reality says that people are dying by the thousands, that those deaths disproportionately affect minority populations and poor people.  That same reality says that if Climate Change is not addressed, the suffering and deaths of Covid-19 will seem like a minor blip by comparison.  Simultaneously, the President, most Republicans in Congress and Fox News declare it all a hoax, a liberal, Communist, Chinese scheme.  What are people to believe?

Reality feels so tenuous that people are giving up, disbelieving even core ideas that government represents them, or that police are there to protect them.  And so, they don’t bother to vote, feeling that they do not have a voice and it won’t make a difference anyway – the very opposite of empowerment.

In rage and frustration, they violently protest – without masks, burning things.  I have a saying that the definition of a neurotic is someone who creates what he tries to prevent.  Protests that become violent like Saturday’s are the epitome of this – people who are most vulnerable to Climate Change and Covid-19 acting to increase, rather than decrease their risk.

I urge those in the protest yesterday – continue to protest and resist, but not violently.  Protest with a loud clear voice, remembering that you really do count, and you are empowered to change the course of history.  

AND – I also urge the corporate oligarchy, the people of wealth and power who believe in a reality that they DESERVE all the good things they have and that they need have no concern for the poor and oppressed – it is time to come to a different reality.  Realize that in addition to hard work, a large share of the good life you have comes from a great deal of luck and being able to depend on the work of others.  Now it is time to make the preamble to the Constitution the genuine reality it is supposed to be.  Remember that once upon a time, there was a corporate/aristocratic group that would not listen to the reasonable demands of American colonists.  The American Revolution was the inevitable result.  Let’s not make that mistake now.  Listen, come together, share, agree on a common reality and RISK living together as real neighbors. 
Michael A. Kalm, M.D. has been in the practice of Psychiatry for over 40 years.  He still remembers as a youngster, seeing Obi-Wan Kenobi educating Luke Skywalker about paradoxes.
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