Dr Robert London

Economic Turmoil and Mental Health

Clinical Psychiatry News - Volume 36, Issue 11, Page 15 (November 2008)

Over the last few months, at least a dozen people have sought my advice about their finances amid the current housing and financial meltdown. It's been a startling experience. With their personal finances tumbling and despair setting in, these folks have been desperate for solutions.

The problem is I don't know any more than they do about the complexities of the current crisis. I'm a psychiatrist, not a financial adviser.

But I do have a sense of why many are turning to us in search of answers: This economic turmoil is causing overwhelming stress and anxiety. Although folks are framing their questions in terms of finances, I believe they are searching for answers about their stress and anxiety. Some people are battling serious depression, which can be life threatening. Others suffer with insomnia, the beginnings of posttraumatic stress disorder, and subthreshold variations of PTSD, which are now being better recognized. Still others are experiencing problems of identity and decreased self-esteem and are blaming themselves for circumstances outside their control.

I'm afraid that some people are not eating properly, which can lead to multiple physical problems. Now factor in those millions of people with some underlying mental disorders who had been doing relatively well before the current slowdown, and we get a sense of the magnitude of this problem from a psychological perspective. People are hurting. The emotional turmoil caused by economic pressures is bound to have a cultural and societal effect for decades to come. And these problems have broad implications for our field and our patients.

We know that the generation that lived through the Great Depression tended to be frugal, fearful, and overly cautious about saving, spending, and investing. The depression generation also instilled in its offspring a tendency toward excessive worry.

So, just as therapists began to hear a few years ago about anxiety and worry from patients with Great Depression-era parents, the current crisis is creating a generation of adults with fears and anxieties. The manifestation of this turmoil will hinge on underlying family dynamics. Some people will figure it out on their own; others will seek psychotherapeutic help. I hope that this help focuses on cognitive-behavioral processes, including my own learning, philosophising, and action (LPA) technique.

For those seriously disturbed and unable to function—whether from this current financial crisis or from an underlying mental illnesses—there is no substitute for psychiatric care. However, for many others, stress-reduction techniques can be used. One possible strategy is yoga, as I mentioned last year in a column on alternative and complementary medicine (“Yoga: A Beneficial Integrative Therapy,” December 2007, p. 20). In that column, I quoted Astrud Castillo, a yoga instructor who teaches in California and New York, as saying that yoga helps to “quiet the mind.” That is just what I refer to when discussing strategies of relaxation. I want patients to quiet the mind so that clearer thinking can emerge in dealing with stress and anxiety. Another strategy that can help patients so inclined is to participate in athletics. As I've written before, participating in athletics can reduce stress (“Treating Situational Anxiety,” August 2008, p. 27).

Besides yoga and athletics, many other complementary and alternative medicine (CAM) therapies can prove to be great stress reducers. For example, relaxation and self-hypnosis can help people shift gears and enter different mental states.

During this long election season that we just endured, calls for town meetings focusing on politics were many. In the current environment of economic uncertainty, I propose a series of town meetings of a different sort: I'd like to see mental health professionals hosting meetings in community centers, libraries, and other public spaces in which we would teach people about stress-reduction techniques. Here's a listing of techniques I've found useful in treating and educating people:

? Get the patient to do deep breathing exercises to achieve a calming effect. Have the person sit down comfortably, take five to eight deep breaths, and drift into a relaxed state. After remaining in this state for 1 or 2 minutes, most people will feel relaxed and better able to think clearly.

? Try using reciprocal inhibition techniques. Teach the patient to sit comfortably in a chair and imagine that favorite movie screen that I like so much. Encourage the person imagining the screen to project himself into pleasant, relaxing scenes. As he visualizes these scenes, anxiety disappears. This technique allows the person to clear anxiety from his mind, offering a path to clearer thinking.

? Encourage the patient to split the screen and use one side for projecting anxieties and the other side of the screen to add a pleasant set of experiences. Linking the unpleasant with the pleasant would be an example of the systematic desensitization process.

? Challenge absolutes such as “things will never get better” and change them to “there is a very good probability that things will get better,” especially as the nation galvanizes its strategy for turning this crisis around.

The idea is to help people learn think about options. Some people are dealing with this economic downturn by taking charge of their work lives.

There are many ways to develop home businesses, especially with the Internet. These businesses can offer a measure of autonomy that many 9-to-5 working people dream of having. A niece of mine, Rachel Clemow, is an example of someone who took the initiative to change her work life long before the economic crisis. Rachel, who is trained as a fitness and nutrition expert, became frustrated with working harder and achieving and less financial security. So she started a business that focuses on health and nutrition as part of a network marketing company. Today, Rachel has clients on three continents, and her home business is thriving—despite the global economic crisis.

Such options can be offered as educational tools that can help people cope with their fears and anxieties.

We need programs aimed at helping people decompress. When I read about ongoing heart disease and cancer prevention efforts, I wonder: Why aren't stress and anxiety prevention programs in place?

As psychiatrists and other mental health professionals, we have much to offer. Let me know your thoughts about helping people with stress and anxiety related to this financial crisis, and I will try to pass these along to my readers.

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