LAUSR

Comprehensive Psychiatry does not print many editorials: this is the second since I became the Editor more than two years ago. It would be remiss, however, for a journal that focuses on psychopathology to ignore a national – if not global – rise in anxiety since the November U.S. election, and indeed during the preceding presidential campaign. This wave of distress has been evident in media coverage, letters to newspaper editors, on listservs, and among patients and doctors. I have seen it in the Veterans treatment clinic and other services at my hospital, and in my private practice. Clinical listservs report floods of patient intakes with Trump-related anxieties. Psychiatrists have joked with gallows humor about “Post Trumpian Stress Disorder.” Although President Trump has vitriolically attacked particular social targets, the patients reporting anxiety have not been circumscribed by ethnic, religious, or sexual background, gender, or Democratic party membership (albeit many of the New Yorkers my colleagues and I see fall into one or more of those categories). In response to new levels of overtly aired hatred and aggression, and a perception that our leaders lack responsibility and morality, most Americans, and especially the most vulnerable, our patients, report heightened anxiety, uncertainty, and instability about the future. Patients with major depression feel more hopeless; patients with obsessive compulsive disorder find life more out of control; patients with posttraumatic stress disorder feel more frightened of another disaster around the corner; patients with psychosis further distrust reality. Although a presidential election does not constitute a DSM-5 criterion A trauma for PTSD (“exposure to actual or threatened death, serious injury, or sexual violence...” [1]), it appears evidently capable of eliciting symptom exacerbation or recurrence in vulnerable individuals. A month after the election, one patient answered my opening, “How are you?” with the question: “As patient or citizen?” It was a moment to acknowledge that, as with PTSD, dreadfully upsetting, unexpected events can occur. The point was not to discuss politics but to understand how the changing social climate threatened this patient. I write not in political advocacy, nor to breach the American Psychiatric Association’s 1973 “Goldwater rule” in attempting to diagnose the new President [2]. The goal is merely to emphasize a stress-diathesis model: the 2016 election and its aftermath have greatly raised social stress. This has had a generally destabilizing effect on cultural assumptions and protections while putting some groups, such as immigrants in the United States, at particular risk. Nor does this antagonistic social upheaval appear likely to subside in the near future. Clinicians need to recognize, rather than to ignore or dismiss, the real social pressures patients face, and the symptoms these may trigger. Many clinicians may feel the strain themselves.