Processing Post-election Reactions: Our Patients, Ourselves

COMMENTARY

B Rice/Adobestock

“Nightmare begins responsibility.” –Michael S. Harper, MA, MFA (1938-2016)

And so, the long, exhausting slog to the presidential election is finally over. It may sound cliched, but the people have indeed spoken. And yet, as a nation, we find ourselves deeply divided—politically, culturally, and interpersonally.¹ Anger and resentment abound and, as the Rev Amy Greene put it recently, “Underneath…so much of the rage and angst and animosity, I believe, is unprocessed grief.” Rev Greene wisely observed that anger is easier to live with than grief because anger “makes you feel powerful even if you are not.”²

It seems to me very likely that psychiatrists will be seeing patients who experience the outcome of the 2024 presidential election as a painful and traumatic loss. After Hillary Clinton’s defeat in the presidential election of 2016, her supporters described their feelings using “a number of violent and traumatic metaphors to make sense of Clinton's loss: betrayal, living in an alternate reality, large-scale disasters, wrecks, and crime.”³ Because many voters had hoped that the 2024 election would result in the first woman elected president, I suspect that the defeat of Vice President Kamala Harris will resonate with particular poignancy among many of her female supporters. Mary Elizabeth Williams wrote, “For women, watching Harris lose the election is like reliving all the disappointments and heartaches of your life.” Indeed, it may be felt as “a wounding disappointment.”⁴ Yes, some—perhaps many—of our patients may greet the outcome of the election with joy, but I suspect they will be in the minority.

The flip side of the coin is our own reactions to the election—as psychiatrists, as American citizens, and as emotionally complex human beings. Sorting out our own feelings about the election may prove challenging, particularly if we are treating patients whose political views do not align with our own. The potential for unrecognized countertransference reactions should not be minimized.⁵ Psychiatrists, like other physicians, are not politically homogeneous, or uniformly liberal or conservative. However, there is good evidence that most psychiatrists lean to the left on the political spectrum.⁶ Given all these roiling personal, psychological, and political currents, how should psychiatrists deal with our patients’ emotional reactions to the presidential election?

It hardly needs saying that we must avoid imposing our own political views on our patients. As the American Psychiatric Association’s Commentary on Ethics in Practice admonishes:⁷

While psychiatrists are expected to participate in activities contributing to the improvement of the community and public health, care should be exercised when the psychiatrist enters political discussions with the patient. In that context, there is potential for invading and exploiting the treatment relationship, especially when patients are asked to support political causes. Psychiatrists should refrain from attempting to influence the patient’s political views, although they may promote the patient’s civic engagement.

Well, yes…but these admonitions do not quite capture the therapeutic complexities. As my colleague, Mark L. Ruffalo, MSW, DPsa, wrote to me in an email (personal communication, November 6, 2024):

My view is that the therapist must walk a tightrope in this situation, skillfully avoiding imparting his personal views [to] the patient while simultaneously listening empathically to the way the patient sees things. In some corners of psychotherapy today, this is a very controversial position. My view is that the therapist must avoid any situation in which he uses the patient for his own narcissistic gratification, which could include commiserating with the patient about their shared political disappointment.

Grief and Responsibility: Personal and Professional

For patients experiencing grief reactions in the wake of the election, I think our main goal is to help them process and work through the grief; and in some cases, to connect their emotional response to earlier disappointments and heartaches. But I think we have a deeper responsibility, as well. The epigraph that begins this essay is taken from the poem, “Nightmare Begins Responsibility.” The poem recounts the grief for the death of an infant son in an intensive care unit—and was almost certainly inspired by the death of 2 of Harper’s 5 children.⁸ Now, to be clear: I am not in any way comparing the unfathomable grief of losing a child to the grief over losing an election. But I am struck by the last 2 lines of the poem: even in the face of “panebreaking heartmadness,” the poet’s nightmare confers new responsibility. As I read Harper, he is saying that the nightmare of losing a child is not the end but the beginning of a personal journey. Each of us has a responsibility to bear our grief and to find meaning and purpose in it. I believe that as therapists, we have a responsibility to help our patients find meaning and purpose in their losses, whatever their nature and origin. In this sense, we act as midwives, helping the patient give birth to new possibilities.⁹

Finally, in the wake of this presidential election, we can only guess at what the next 4 years will bring in the realm of health care—but some early signals are troubling.¹⁰ Beyond our individual work with patients, physicians have a collective responsibility to foster and safeguard the public health and to protect the physical and emotional wellbeing of the community. Therapeutic neutrality in the office setting does not mean that we must remain neutral regarding injurious health care policies. Indeed, for us as health care professionals, the next 4 years impose the responsibility of enlightened political advocacy.

Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.

References

1. Fried C. A new way to classify individuals delivers insights on social divisions and the culture war. UCLA Anderson Review. September 20, 2023. Accessed November 6, 2024. https://anderson-review.ucla.edu/cultural-polarization-isnt-new-but-its-alignment-with-political-divisions-is/

2. Knoll C, Dias E, Mayorquin O, Goldstein D. Behind the anger may be something else: lingering Covid grief. New York Times. November 6, 2024.

3. Carmack HJ, DeGroot J M. Trauma Metaphor Use After Hillary Clinton’s Loss in the 2016 Presidential Election. Journal of Loss and Trauma. 2018; 23(6): 468-483.

4. Williams ME. "A wounding disappointment": Why Kamala Harris' defeat cuts so deep for women. Salon. November 6, 2024. Accessed November 6, 2024. https://www.salon.com/2024/11/06/women-react-to-kamala-harris-loss

5. Pies RW. Culture Wars, COVID-19, and Countertransference: What America’s Cultural Rifts Might Mean for Psychiatry. Psychiatric Times. June 17, 2020. Accessed November 6, 2024. https://www.psychiatrictimes.com/view/culture-wars-covid19-countertransference-what-americas-cultural-rifts-might-mean

6. Sanger-Katz M. Your surgeon is probably a Republican, your psychiatrist probably a Democrat. New York Times. October 6, 2016. Accessed November 6, 2024. www.nytimes.com/2016/10/07/upshot/your-surgeon-is-probably-a-republican-your-psychiatrist-probably-a-democrat.html.

7. APA Commentary on Ethics in Practice. American Psychiatric Association, December 2015. Accessed November 6, 2024. https://www.psychiatry.org/file%20library/psychiatrists/practice/ethics/apa-commentary-on-ethics-in-practice.pdf

8. Shafer A. Nightmare begins responsibility. Literature arts medicine database. Accessed November 6, 2024. https://medhum.med.nyu.edu/view/833

9. Pies RW. Psychiatry and the dark night of the soul. Psychiatric Times. December 14, 2020. Accessed November 6, 2024. https://www.psychiatrictimes.com/view/psychiatry-dark-night-soul

10. Lawrence L. What letting RFK Jr. ‘go wild’ might mean for Trump’s FDA. STAT. November 6, 2024. Accessed November 6, 2024. https://www.statnews.com/2024/11/06/trump-victory-upend-fda-rfk-jr-influence-vaccines prescriptions/