How a Biden Green New Deal Will Affect Our Patients and What We Can Do to Help

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COMMENTARY

Denial, politics, and delusions have played a role in our lives this year, from the pandemic to climate change. For instance, on November 16, 2020, the Washington Post reported, “Jodi Doering, an emergency room nurse in South Dakota, was overwhelmed Saturday night. Her patients were dying of COVID-19, yet were still in denial about the pandemic’s existence. Their last dying words are, ‘This can’t be happening. It’s not real.’”

We have a paradox. As knowledge, data, and treatment methods of coronavirus disease 2019 (COVID-19) expand and as potent effective vaccines are now available, acceptance should increase, and fear should be reduced. Instead, denial, fed by fear, is increasing in some quarters.¹

As effective vaccines achieve US Food and Drug Administration (FDA) emergency use authorization and become widely available, we will need as many people as possible to receive them to build herd immunity and save lives. Yet we know there is an ever-growing, conspiracy-based, antivaccine, anti-science movement in this country that will sabotage our best efforts if unchecked.² What is true for COVID-19 is even more true for climate change.

When President Biden was sworn in on January 20, 2021, he announced one of the most ambitious programs for his first 100 days in history. This included rolling out this country’s most comprehensive plan to build a clean energy revolution: a modern, sustainable infrastructure with environmental justice, sometimes referred to (even in the title of this piece) as a “Green New Deal.” Using many proven concepts from great scientific thinkers, like Saul Griffith (https://www.rewiringamerica.org), the Biden plan (https://joebiden.com/climate-plan/#) incorporates how to fully decarbonize America. The plan will create 25 million new well-paying jobs that will be local and cannot be outsourced, cut our energy costs in half, repair our infrastructure, make our electrical grid more reliable, clean our air and water, and rally the other nations of the world to our global effort. The plan is detailed, thoughtful, and well laid out.

There is a catch, however. For this plan to work, it will require America mobilizing to a war footing, similar to World War II.³ It will also require a high adoption rate. While logically we should expect excitement and optimism readily fueling this, just as with COVID-19 and vaccines, we are unlikely to get it. In fact, we can expect quite the opposite response from a significant portion of the country.

Why is this? This paradox, this phenomenon of fear increasing when it should decrease, has been copiously studied. It has also been studied by political scientists and information scientists where it is variously known as “the Backfire Effect,” or the “Continued Influence effect,” and the “Illusory Truth effect.” The existence of the Backfire Effect is controversial in the information and political science world, in that despite hundreds of studies, replication of the effect is not reliably demonstrated—it happens sometimes and not others, with the possible implication that it may not have to happen when important information is handled well.⁴ 

However, when it exists, the Backfire Effect is attributed to 3 sources, known as familiarity, overkill, and worldview.⁵ It has also been tied into fear of loss of self-identity,⁶ as well as terror management theory, ie attempts to suppress the fear of dying from terrorist attacks or other terrifying events.⁷ Swire-Thompson, et al⁸ discuss “motivated reasoning,” or using emotionally-biased logic to find arguments in favor of conclusions we want to believe to be stronger than arguments for conclusions we do not want to believe, regardless of what actual evidence shows. Motivated reasoning is similar to confirmation bias, which stands in contrast to critical thinking.

All of these studies and theories have merit, but why then are the studies so inconsistent in replicating the Backfire Effect? One possible explanation put forth is the wording of the experimental design (the participants are given manufactured news items to read). Another is difference in the study populations. For example, the original Nyhan and Reifler study from 2006⁷ used only college students as participants. College students tend to respond differently to factual material that is offered as a correction to misperceptions. Additionally, none of the studies that I examined were able to control for when facts are dismissed in favor of counter-factual conspiracy theories from motivated and emotionally manipulative sources.

A huge issue is fear, which climate change provokes. President Biden has called climate change “an existential threat,” and this is not hyperbole. Species are going extinct. Habitats are being destroyed. The human race itself is threatened and there will be millions of deaths. People are already dying from climate change-influenced hurricanes, forest fires, droughts, and floods. Where I live in Utah, research was just published showing that “air pollution causes between 2,500 and 8,000 premature deaths each year in Utah, decreasing the median life expectancy by 1.1 to 3.6 years.”⁹

How do people respond to fear? In the best-case scenario, they respond with courage and determination. That is why President Franklin Roosevelt said in 1933 during the heart of the Depression, at America’s darkest hour, ‘The only thing we have to fear is fear itself!’”

Unfortunately, the best case is not the common case. Many times, people respond with denial, saying things like: “Climate change is not real. It is only a normal weather cycle.” People also respond with anger, toward doctors who come with bad news or inadequate treatments, or scientists who talk about climate change and what is necessary to correct it. They accuse those scientists of trying to steal the way of life they feel both accustomed and entitled to.

They also respond with depression and feelings of hopelessness: “We are going to die anyway. Let us just die in peace.” They respond with identification with the aggressor, a defense of the ego, in which the person aligns themselves with some powerful figure, often authoritarian, who promises salvation. With conspiracy theories, we see the rise of identification with an aggressor who fails to protect, like in the example of the patient in South Dakota, who staunchly proclaimed that COVID-19 did not exist even as she was dying from it. However, because of a quirk in psychiatric nomenclature, we do not call this kind of thought delusional.

Delusions are false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary; these beliefs are not ordinarily accepted by other members of the person's culture or subculture. Delusions can be classified as either “bizarre” or “nonbizarre.” Bizarre delusions are clearly implausible, for example, belief that one’s thoughts have been removed by an outside force, that alien thoughts have been put into one’s mind. A nonbizarre delusion is one that could actually occur in real life and may be difficult to distinguish from an overvalued idea. Although a bizarre delusion is considered more serious and may require antipsychotic medication, a nonbizarre delusion is referred to as a thinking error and may be amenable to correction, although the corrective effort tends to be very difficult to accomplish. This will be important as we discuss solutions to all of these problems later in this piece.

We do have another psychological factor that can work for us and that is acceptance. In this case, not acceptance of inevitable doom, but acceptance of our fears, along with acceptance of our courage to face our fears and find the will to solve our existential problems.

For Biden’s Energy Plan, we are already seeing fear, denial, and anger in statements like the following: “It’s a Socialist conspiracy! It’s too expensive! It won’t work! What about my job? What does it matter what we do without China, India and Africa?”

What can we psychiatrists do to overcome such reactions? A lot. We are uniquely trained and positioned to recognize and address all the psychological phenomena that are and will continue to occur in reaction to climate change, Biden’s plan, and conspiracy theories. We can recognize and respond to these thinking errors that will be running rampant through our communities.

As psychiatrists, our duties to our patients involve something of a paradox. On one hand, we are required to accept them as they are. On the other hand, it is our duty to challenge their thinking errors, and invite them to challenge their fears. We must do that politely, but unambiguously. We start by listening to them calmly and carefully, and then asking questions like: How do you know that to be true? How did you decide that some sources were all in error and others are correct? What is the risk for you in challenging your beliefs? In not challenging them? There is a whole host of therapeutic questions that may be asked. If one is convinced, as a psychiatrist, that adoption of a large-scale climate action plan is absolutely essential for our patients’ health, I believe we should encourage pro-climate actions from our patients’ minds and behaviors.

Also, as psychiatrists, our duties to our communities involve consulting with our leaders, our public health officials, our journalists, and our community organizations to acquaint and educate them regarding the fears and other symptoms we are likely to see among our citizens. We psychiatrists must not pretend that we or our patients live in a bubble that is somehow separate from the rest of the world. Political issues, especially in the area of climate change, directly affect our patients. They cannot be ignored.¹⁰

On to the practical suggestions. Twenty-two researchers pulled all their findings and knowledge together to create the Debunking Handbook⁵ at the George Mason University Center for Climate Change Communication. This is a handbook that provides a guide to correcting misinformation, disinformation, fake news, and both the “Continued Influence” and “Illusory Truth” effects. The whole handbook is well worth reading but there are certain key pointers that we would do well to keep in mind as we speak to our patients and communities about climate change.¹¹ The suggestions in the Debunking Handbook are geared toward helping people change from misinformation and disinformation to truth. In that way, while their suggestions are appropriate for people in general, they are also appropriate for our patients in particular.

By helping our patients to think critically, we will empower our patients to feel less alone, more connected to their communities, better able to discern truth from fiction, more confident in their ability to act, and better able to take part in building a healthier world.

The opinions expressed in this article are those of the author and do not necessarily reflect the opinions of Psychiatric Times^TM.

Dr Kalm is a past-president of the Utah Psychiatric Association and clinical assistant professor of Psychiatry at the University of Utah.

References

1. Hotez PJ. Combating antiscience: Are we preparing for the 2020s? PLoS Biol. 2020;18(3):e3000683.

2. Otto SL. America's science problem. Sci Am. 2012;307(5):62-71.

3. Maizland L. Global climate agreements: successes and failures. Council on Foreign Relations. Updated January 25, 2021. https://www.cfr.org/backgrounder/paris-global-climate-change-agreements

4. Haglin K. The limitations of the backfire effect. Research & Politics. 2017;4(3).

5. Lewandowsky S, Cook J, Ecker U, et al. The Debunking Handbook 2020. George Mason University Center for Climate Change Communication; 2020.

6. Trevors GJ, Muis KR, Pekrun R, et al. Identity and epistemic emotions during knowledge revision: A potential account for the backfire effect. Discourse Processes. 2016;53(5-6):339-370.

7. Nyhan B, Reifler J. When corrections fail: The persistence of political misperceptions. Political Behavior. October 27, 2007. https://www.dartmouth.edu/~nyhan/nyhan-reifler.pdf 

8. Swire-Thompson B, DeGutis J, Lazer D. Searching for the Backfire Effect: measurement and design considerations. J Appl Res Mem Cogn. 2020;9(3):286-299.

9. Errigo IM, Abbott BW, Mendoza DL, et al. Human health and economic costs of air pollution in Utah: an expert assessment. Atmosphere. 2020;11(11):1238. https://www.mdpi.com/893402

10. Schott B. Utah’s attorney general joins multistate effort to sue President Joe Biden over climate change order. The Salt Lake Tribune. March 9, 2021. https://www.sltrib.com/news/politics/2021/03/09/utahs-attorney-general/

11. George Mason University. Debunking handbook 2020. Center for Climate Change Communication. Accessed March 9, 2021. https://www.climatechangecommunication.org/debunking-handbook-2020/