Lise van Susteren on Pre-Traumatic Stress Disorder and the imagination

A while ago I was reading a report about the psychological impacts of climate change, and came across the term ‘pre-traumatic stress disorder’.  It fascinated me. The author of the piece that discussed the idea was Lise van Susteren.  Lise is a General and Forensic Psychiatrist in Washington D.C , and has been involved in climate change issues for the last 12 years or so.  In 2005 she sought political office, seeking the Democratic nomination to the US Senate in Maryland.

She describes ‘Pre-Traumatic Stress Disorder’ as “a before-the-fact version of classic PTSD”.  I was intrigued as to what impact living in a state of ‘Pre-Traumatic Stress Disorder’ might have on the human imagination, on its ability to flourish, and to imagine the future in positive ways.  Are we all, to one degree or another, living in a state of ‘Pre-Traumatic Stress Disorder’? When we spoke, I started by asking Lise what the term means to her?

“You know, here’s the thing.  I called it Pre-Traumatic Stress Disorder because it is the off-spring of Post-Traumatic Stress Disorder, but in fact when I look at it now, and the terminology that I used, ‘disorder’, gosh, I’m here thinking to myself, “It’s not Pre-Traumatic Stress Disorder.  It’s a Pre-Traumatic Stress condition that I wonder why everybody else doesn’t have?”

Maybe the disorder is not having a Pre-Traumatic Stress condition.  Given everything the scientists are telling us, given how late the hour is, and how grave the consequences, the abnormality now is not having a Pre-Traumatic Stress condition.

But the original question is how that came about.  Well, frankly, it’s because I’m familiar with Post-Traumatic Stress Disorder as a treating psychiatrist, especially a forensic psychiatrist.  I’ve been exposed to many patients over the years, or worked with lawyers who have clients who have Post-Traumatic Stress Disorder, and I was recognising that I had some of those same symptoms in anticipation of, or envisioning, what I had been hearing awaits us on climate.  It was really a diagnosis I was making of myself.

How do you think that Pre-Traumatic Stress condition manifests itself in the world around us in 2018?  How do we see it playing out?

Again, I’m thinking of it as a condition.  That is, if you think to yourself – if you saw a family having a picnic on railroad tracks.  The red and white tablecloth spread out over a makeshift table, and you had a train coming out of the tunnel, if you were pre-occupied with getting them off the tracks, it wouldn’t be very surprising.  And if you couldn’t think of anything but that, that wouldn’t be very surprising.  And if all of your effort went into doing this to the exclusion of everything else, and you were worried about their future, and whether or not they were going to be out in time, that would all make sense.

Then if you put it in a larger picture, this is what we are hearing about civilisation and climate change.  We are on the tracks, the train is coming.  We can hear it, we can see it, and we’re wondering if we’re going to do what’s necessary to save ourselves in time.

Do you think that some of the climate scepticism, the climate denial that we see, is also a manifestation of this?

Well, no.  That would be a separate sort of entity.  Denial and resistance.  First of all, I got to tell you that at this point, there isn’t the slightest shred of a doubt in my mind that everyone on some level now realises that climate change is upon us, and is hurting us.  And that’s whether people admit it or, accept it or not, like it or not.

I’ve been in the business long enough to understand that people can know things consciously, they can know things unconsciously.  When I was speaking to someone about this the other day, he was disputing this saying that, “Well, if you listen to Scott Pruitt and Trump and all the rest…” I pointed out that people are no longer saying it’s a hoax.  They’re not saying climate change is a hoax.  Not in this government.  The last person that did it was a Senator Inhofe on the Senate floor with the snowball a few years ago.  What people are saying now is they’re dancing around it.

They’re saying, “Well, regulations are bad for business, and for jobs, and the US isn’t get a good deal on the Paris Climate Accords.”  They’re dancing around the issue.  These people know full well what’s going on, and for those who have chosen to bury the reality, I always find the same set of reasons, or among them.

It’s because they want to have power, preserve their power.  That’s of course in the case of politicians who are speaking to their base and recognise that if they don’t have a certain standing on immigration, guns and climate, that they’re not going to get re-elected, so they’re essentially putting political office ahead of public health.

Then there are people who make money by suggesting that climate is not a problem, or is not as big a problem.  “We can afford to wait”.  Or there are people – I’ve found this is a real interest, because it says something about some of the men whom I have encountered, either directly or from afar, who are loath to acknowledge that climate change is a problem – and it’s often an issue of feeling emasculated.  I have to say that these are typically men who might, deep down inside when you flip that hood up, have some uncertainties about their masculinity.

I’m just going to come right out and say this, and the idea that Mother Nature – “Some damn woman is going to push me around…” or that, “I’m some kind of a girly man with fears about the weather”, it’s just not going to happen.  These are typically people who, again, might have some uncertainty about what masculinity really is, and what it entails.  So I’ll put that there.

Then there are other reasons.  Sometimes people are just so depressed about other things, they just can’t take it, so they put it out of their minds.  Then there are deeper reasons, and these are very sobering reasons.  They may be dependency issues.  “I don’t want to deal with this, let somebody else deal with it.  Not my problem, etcetera.”  Therefore, reasons that show that they aren’t willing to recognise their contribution, and their potential action that can be collective, they simply shrug it off.

Then there are the sort of existential issues which are the Pandora’s box.  Climate change is kind of a metaphor for ageing and death.  And in our society, our culture, there’s not much room to talk about this, and when you bring up climate at a dinner party, or climate change, or what’s going to happen, it lands with a thud.  I can shut a dinner party down in seconds, or empty a room.

Really for many people it’s like they wouldn’t bring up how they think they’re going to die, or what their funeral should be like.  So they unwittingly push it aside and think of it as being adaptive, that this is going to keep them in a good mood.  In the short term it might help them, but of course the long-term…

And this is my last point, and that is the unconscious aggression, that is directed at future generations.  Whether again, conscious or unconscious, passive, active, all those qualifiers, it’s still the same.  It is leaving for our children a future that is uncertain at best, and unless we take action now, or I should say, yesterday, some of the consequences are not consistent with stable society, with security, and certainly not consistent with the natural world as we know it, and maybe even life.

When we spoke before you drew a link between climate change and the gun control issue at the moment and described both of them I think as being a sort of cross-generational form of child abuse?

The gun issue, inaction on guns, inaction on climate, the question that people – the adults in the room need to ask themselves, “Why the target on these kids’ back?”  Because both guns and climate are issues that are unnerving them to their very core.  We saw the March for Life here after the recent shooting in Florida and we know that the kids are much less likely to deny the reality of climate, and indeed, they’re suffering greatly.

What I’m hearing that is just so profoundly disturbing, so unnatural, is that many of them don’t want to have children, because they’re thinking that their contribution to society or to future security, health of the planet, is to not add another human being to add to our existing carbon footprint.  Sure, you can say there are many reasons not to want or to have children, but these are people who at the same time, have said that they get excited – women especially – if they think action is forthcoming.  This is the Paris Climate Accords.  Then they think, “Yes, I can have babies.”  And then that mood drops again.

There’s a group, ‘Conceivable Future’, here in the US that is discussing climate change as a reproductive issue as well.  And some kids are talking about how they are hoping – and this just makes me shake my head, and put my hands over my eyes – for a pandemic because they believe that a pandemic will wipe out, or at least reduce, the numbers in the offending species, i.e. humans.  And so nature may have a chance.  So these are two issues.

There is a third one that has come up.  When I was talking with someone in the course of a presentation who remarked about a friend who has a group – this is a Post-doctoral fellow, and I’m not going to give any more information except to say he is at a very fancy university – and they are talking about – and again, here’s another issue where it’s very, very complex – but about rational suicide.  So you see, these are issues that are very deeply now impregnated in the psyche of young people.  And the older ones are just not hearing this.  They need to.

How do you think the awareness that comes with this Pre-Traumatic Stress condition affects our imagination, and in particular our ability to imagine the future as something possible, positive, something that we could actually create something good in the future?  What does living in that state do to our ability to be positively imaginative about the future?

Well it’s a real obstacle.  The question is that we can’t know whether or not it’s realistic to think that we will have action in time.  We’ll have action alright.  The question is will it come in time?  So here’s the way to look at it:  if it’s an obstacle just to optimism and to being in a good mood, well, maybe that’s some of the price we have to pay.  We certainly don’t want it to keep us from doing what must be done.

But everybody’s a little bit different.  We all have to have some hope.  Without judging the merits of having a condition like this or not, because frankly it’s not something that you can so much vow to have or not have, what we’re interested in doing – and especially as a treating physician over the years – is taking the energy of our fears, of our anger, of sometimes the despair, and turning all that energy into action.  Because if we tell ourselves that… And this comes up a lot – people don’t want to talk about individual action.  It’s a mistake.

All change begins at home, and yes, it does not substitute for national actions, the global actions.  But really it’s our individual action taken collectively that makes the difference.  That’s why we vote.  In a democracy, in November, we show up, because it’s our duty as citizens who believe in democracy.  So that individual action is what we do for each other, and it is the collective involvement of all of us that makes the difference.  The question is: will we get there in time?

So the antidote to this condition is doing something?

Yes, it is.  It’s empowering action.  Experts on persuasion, and one of my favourites and certainly one of the most celebrated, who is also a good friend, is Robert Cialdini.  He has written books on influence and persuasion, has a new book, Pre-Suasion, and he talks about how we get people to be mobilised.  People need to hear different messages depending upon their backgrounds, the demographic, their age, their jobs, etcetera.

But one of the things that is a general rule is that in trying to persuade people to take an action, even if it’s just taking action on their health, it’s a two-step process.  The first step is, “Here’s the problem.”  Don’t sugar coat it.  Tell them so that they can see the urgency and the need to take action.  If you don’t tell them that it’s a problem…

I get into arguments with people sometimes, they want me to just talk about clean water and air and the image of something positive.  But where’s the urgency if we don’t have a problem?  So number one, state it with all the urgency that the situation demands.  Then secondly, right away segue, “Here’s what we can do about it.”  And there’s a lot we can do about it, individually, personally, and of course our collective action.  The efforts of grassroots, as we call them, really drive markets and they persuade politicians to write policies.

If we turn out when it’s time to support the political process, running for office, supporting people who make climate a priority, there a number of places where we can be effective.  And where we can take the energy of these dark emotions and turn them to action.

For people who aren’t able for one reason or another to take that step across, how do you think living with that affects their ability to…

But they are.  We can transition to a plant based diet – not eating meat, which isn’t really good for our health and is not great for animals either.  Transitioning to a plant based diet, which as I say is healthier, and cheaper.  And some people don’t have this opportunity, but most people have a little square, a little patch of land where they live, where there are community gardens, or you can start one.

Just planting vegetables in a community garden or getting a city to turn over part of a park for a community vegetable garden, or instead of a lawn.  We don’t really need lawns, which just ask for pesticides and herbicides and all the rest that rinse into our waterways.  We can do many things.  Then there are the smaller things than that.  In our homes, watching how we use energy.  A big one is making sure that we use renewable energy.  That’s solar, and wind.  Most of us can ask our energy provider to transition to renewable energy or we can buy credits so other people can if ours cannot.  There are multiple ways.

If you’ve got a car, make sure that it’s a hybrid, and hybrids have come down in price.  We can buy used hybrids.  We can take public… There are lots of ways, including talking to other people all the time, until we’re ushered out…  But talking to our friends, our neighbours, our relatives, making sure that the message that we make through the establishment of social norms… What we do is sometimes the most profoundly effective means to change behaviour.

Did you once run for the Senate or for Congress?

I ran for the US Senate in Maryland.  To quote Dick Tuck, who was a good friend of Bobby Kennedy, after he lost an election, he said, “The people have spoken, the bastards” – can I say bastards here?  Just teasing.  But it really opened my eyes to the issues and it initially was prompted by… I used to do psychological profiles for the executive branch of the Government, and I could see the groupthink in our own Senate, and House, that led us to go into Iraq, and it was so painful for me to see.

I began questioning myself: if I thought I knew so much, how can I help if I just sit in a room and don’t say anything?  I was beginning to nip at my heels.  And then stem cell research, it was blocked by the George Bush administration, and as a doctor knowing how many people would be hurt by this, it was the last straw.  So I got into it.  Then Al Gore invited me to join his first training on climate, and then it became a mission.

I’ve asked this question of everybody that I’ve interviewed, and you are actually probably the closest to this possibly ever having been a reality.  So the question is, if you had been elected November before last to the highest office in the United States, rather than the present incumbent, and you had run on a platform of ‘Make America Imaginative Again’ – so you had felt that there was an overwhelming need to bring imagination back into education, to really give it a focus through university, in public life, in political life, and you ran on a platform of ‘Make America Imaginative Again’ – what might you do in your first 100 days in office?

Well obviously it’s a very interesting question.  It harkens back to what I realised and was talking about, social norms.  And that is we lead best by example.  I am concerned about democracy all across the planet.  I’m sure a lot of other people are as well.

One of the things that we realise is that people look to government to inspire them and they will look to a government to protect them, and there are various ways that we are protected.  The way that I see our democracy being the beacon of hope is the first order of business in being persuasive, and that is the issue of reciprocity.

First thing that I would do, is every bit of information that I had about how to transition to renewable energy – all of the innovations, all the science we know, everything that we know about drawing down existing carbon dioxide with agricultural techniques, how we could find seeds that are resistant to drought, other kinds of ways, there are multiple ways in which transportation and agriculture and industry can either lower carbon emissions or draw down current emissions – I would make that a priority to share with everybody.

It would have the dual effect of making the world safer, and realising that with the issues of leading by example, and this profound influence of reciprocity.  In other words, if you take the first step to share something, others will return the feeling in which you shared something by working with you.  And now more than ever, we need a world that collaborates.

Frankly, I think now the model that we have is not consistent with a stable society.  Where economics is way ahead of public health.  We need a profound realignment, consistent with nature, with how we have evolved, and with public health.  The economic model which is increasing the gap between the haves and the have nots, it’s frankly in many places polluting the environment, and it is stirring up a certain amount of apathy in people when it comes to vote.

Our twin problems of campaign finance, buying votes, and gerrymandering – which essentially is candidates choose their district, their districts don’t choose their candidate, is really the foundation for the danger to democracy that one of my favourite political scientist sociologists has written about.  That’s Stein Ringen, who was the Professor Emeritus at Oxford.

He pointed out that when these conditions – and he pointed out the UK shared some of them – the gap between the haves and have nots, the feeling of corruption, which in our country from money and everything else, and the apathy of voters, which we have as a result of the first two…  He said when Athens went down, it was 2,000 years again before we saw democracy, a republic.  So I hear what he was saying and it is deeply unnerving to me.  It tells me that we need to move quickly, and we need to move intelligently.

Just do you have any last thoughts around the subject of imagination that I haven’t asked you the right question for?  Any last thoughts on that general subject?

One thing I will say is that activists– and you’ll find activists on both ends of the spectrum, some of them are desperate and sound angry where they’re very fearful, and then you have others who might show different emotions – but every activist is at heart an optimist.  And though we’re foretelling doom, the reason that we are foretelling doom is in an effort to get people awakened so that we are safe.

There’s a fundamental optimism at the heart of every activist.  It may not always be clear, but that’s why we’re out there at the barricade, or interrupting meetings, or putting up solar panels, or planning a vegetable garden.  This is all about optimism.  I think it was Schopenhauer, but I can’t remember which German philosopher, who said, “As the twig is bent, so the tree is inclined”.

We have gotten to be an increasingly technologic society.  I am greatly fearful in this kind of setting where we are disconnected from each other, and where body language and other cues that are subliminal, but that activate the unconscious – that tell us that we are human rather than a robot, and indeed are responsible for empathy and emotional intelligence – are needed less in a highly technologic society, especially one where technology is so deeply revered.

It gives us the impression that we’re masters of the universe.  We can sit at a little computer, how many inches by how many inches, and we can cruise the entire planet.  This is a message that tells us that we are I think more awesome than we actually are.  The place to feel awe is in music, in nature, in seeing how we can fit in to an altruistic collective action, so that what makes us uniquely human – which is empathy and emotions – is something that continues to be awakened.

I fear, in this technologic society that tells us that if we can master technology we’re masters of the universe, that we get further and further away from this.  And then the sense of imagination, which obviously is a uniquely human characteristic, does begin to — as you have said, I fear – split off and become less important.  And, after all, what do we have if we don’t have empathy and emotional intelligence?