Conclusion
When the U.S. presidency, a position that already occupies the focus of global attention, is held by an extreme individual such as Donald Trump, his dramatic and inconsistent behavior captures all media attention. This constant coverage becomes a compulsive fixation for us all. For those of us who have been previously subjugated, this kind of exposure is particularly overstimulating and blocks us from recruiting the tools so necessary for healing from trauma. We are prevented from taking time to use language to validate truths and create meaning through narratives of those experiences. Without adequate time to process what shocks or destabilizes us, we cannot make sense of what happened; nor can we communicate our horrors to others. This robs all of the opportunity to humanize the subjugating effects of terror, abuse, and attack or to lift the isolation and shame that accompany them.
Moreover, the unfortunate symbiosis of our president’s narcissistic, attention-hungry outrageousness with our Internet era’s insatiable appetite for spectacle has resulted in a flood of incendiary news and information that none of us, whether previously traumatized or not, has the time or mental space to process. Yet, we gorge ourselves on such toxic infotainment with a niggling sense of impending doom. As New Yorker editor in chief David Remnick said of White House press secretary Sean Spicer’s unusually high ratings for press briefings: “Undoubtedly, some people watch Spicer to be entertained. But there’s another reason his ratings are high: we watch because we’re worried” (Remnick 2017).
Indeed, we are worried. Due to Trump and his administration’s constant and volatile shifts in mood, communication, and representations of basic truths, far more Americans now possess narrower “windows of tolerance” in managing stress. As president, Trump has created an epidemic of heightened anxiety. By denying us access to time and calling our perceptions of truth into question, he shuts down our ability to reflect, causes us to doubt reality, and thus encourages reactivity and stress, keeping us in a difficult-to-sustain state of crisis.
It is hard to predict how tenable this is for us, as individuals or as a society. Uncertain times call for collective strength and stability, and such disempowerment is detrimental to our individual and national mental health. We can, however, use this deeper understanding of trauma, and of its elements of time and truth, to promote measured thought instead of reactive freezing, panic, or avoidance. We can be aware of the propensity for new media outlets to privilege emotionally stimulating falsehoods over measured and nuanced facts. We can unplug ourselves and take time simply to enjoy the act of thinking freely. It is a privilege we still enjoy in the United States, and it will be the skill we need to prevent us from careening toward crisis, as it seems Donald Trump would have us do.
Betty P. Teng, M.F.A., L.M.S.W., is a trauma therapist in the Office of Victims Services of a major hospital in Lower Manhattan. A graduate of Yale College; UCLA’s School of Theater, Film, and Television; and NYU’s Silver School of Social Work, Ms. Teng is in psychoanalytic training and practices at the Institute for Contemporary Psychotherapy. She is also an award-winning screenwriter and editor whose credits include films by Ang Lee, Robert Altman, and Mike Nichols.
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Davis, Jade E. 2014. “The Catholic Schoolgirl and the Wet Nurse: On the Ecology of Oppression, Trauma and Crisis.” Decolonization: Indigeneity, Education, and Society 3 (1): 143–58.
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Persily, Nathaniel. 2017. “Can Democracy Survive the Internet?” Journal of Democracy 28 (2): 63–76.
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Remnick, David. 2017. “The Presidency and the Press.” The New Yorker weekly e-mail newsletter, May 14.
Stosny, Steven. 2017. “He Once Called It ‘Election Stress Disorder.’ Now the Therapist Says We’re Suffering from This.” Washington Post, February 6. www.washingtonpost.com/news/inspired-life/wp/2017/02/06/suffering-from-headline-stress-disorder-since-trumps-win-youre-definitely-not-alone/.
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TRUMP ANXIETY DISORDER
The Trump Effect on the Mental Health of Half the Nation and Special Populations
JENNIFER CONTARINO PANNING, PSY.D.
Two thousand sixteen marked a period of intense uncertainty and upheaval leading up to the contentious American presidential election on November 8, 2016, between Donald J. Trump and Hillary R. Clinton. Despite the vast majority of polls (Silver 2016) indicating that Hillary Clinton’s odds of winning the election were 70–95 percent, and many individuals believing that Trump’s candidacy was a farce, Trump won the presidency (although he lost the popular vote by more than 3 million votes).
This stunning result led to an unprecedented level of post-election shock, grief, and anxiety in about half the American population, many being progressive by political persuasion, but not always (American Psychological Association 2017).
This chapter will detail the pre- and post-election anxiety (dubbed “Trump anxiety disorder”) widespread in the general public. However, unlike generalized anxiety symptoms, these symptoms were specific to the election of Trump and the resultant unpredictable sociopolitical climate. The role of the media, with a focus on biased and fake news reporting, is another factor in the development of these symptoms. This chapter will conclude with the author illustrating examples of this disorder from her clinical work with psychotherapy clients—most of whom are from an upper-middle-class background, intelligent, and educated.
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Many of Trump’s bombastic, grandiose attitudes and campaign untruths created an environment of uncertainty, with Americans feeling threatened in their personal safety; these ideologies created the perfect environmental factors for Trump’s nonsupporters’ anxieties to develop (Sheehy 2016). According to the “Stress in America” report, half of Americans (49 percent) endorsed that the 2016 election had been a significant stressor in their lives (American Psychological Association 2017). Many therapists were faced with the task of helping their clients manage this stress as well as the frustration of trying to “normalize” behavior that they did not feel was normal for an American president (Sheehy 2016).
It is important to differentiate generalized anxiety disorder and Trump anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (commonly referred to as DSM-V), is widely used among mental health professionals (American Psychiatric Association 2013). It describes generalized anxiety disorder (GAD) as characterized by excessive, uncontrollable, and often irrational worry—that is, apprehensive expectation about events or activities. This excessive worry often interferes with daily functioning, as individuals with GAD typically anticipate disaster and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, excessive stomach acid buildup, stomach pain, vomiting, diarrhea, bouts of breathing difficulty, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes, and an inability to fu
lly control the anxiety. These symptoms must be consistent and ongoing, persisting at least six months, for a formal diagnosis of GAD (American Psychiatric Association 2013). Generalized anxiety disorder is one of the more prevalent mood disorders in Americans; according to the National Institute of Mental Health, 3.1 percent of American adults struggle with GAD within a year, or over 7 million.
Symptoms associated with Trump anxiety disorder include: feeling a loss of control; helplessness; ruminations/worries, especially about the uncertain sociopolitical climate while Trump is in office; and a tendency toward excessive social media consumption. In fact, the polarization that this has created has caused a deep divide between families and friends of differing political beliefs. Trump’s specific personality characteristics, and his use of psychological manipulation tools such as gaslighting, lying, and blaming, are described as contributing factors to Trump anxiety disorder.
Trump anxiety disorder, albeit not a formal diagnosis, differs from GAD in regard to several measures. One difference is in the duration of time for the symptoms to develop. The volatile events leading up to the 2016 election (i.e., false news reports, Comey’s report questioning Clinton’s ethics) were challenging in themselves, but many Americans were reassured by multiple polls (e.g., Silver 2016) predicting that Hillary Clinton would win the election in a landslide. This led to a sense of shock and disbelief after Trump was announced as president of the United States.
An additional symptom of Trump anxiety disorder is that symptoms are directly related to the uncertain sociopolitical climate. An elevated stress level when reading articles about numerous topics—the Muslim ban, the threat/promise of disbanding the Affordable Care Act, tensions between the United States and North Korea, the possibility of Russia’s having interfered in the 2016 election and Russia’s financial connection to Trump, the U.S./Mexican wall, immigration issues, the defunding of environmental groups such as the National Park Service and the Environmental Protection Agency, and the defunding of medical research—is strong. An individual impacted by Trump anxiety disorder may be directly impacted by one of these singular issues, have multiple concerns, or worry about the future democratic state in America given these issues. Therefore, the ruminative worry associated with an anxiety disorder is specific to these events (Clarridge 2017).
Social media have changed the way Americans are exposed to news. Internet news sites (CNN, Huffington Post, etc.) and social media such as Facebook and Twitter provide immediate access to news as well as to comments from other readers with differing viewpoints. Many Americans impacted by Trump anxiety disorder have admitted to an unhealthy obsession with checking news websites much more often than they previously did, and the amount of news involving Trump and his new administration has been constant, chaotic, confusing, and often overwhelming. When struggling with anxiety, many individuals, in an attempt to maintain control, will falsely assume that the more they know, the more they can be prepared. However, this tends to give them a false sense of control and, paradoxically, may increase anxiety symptoms once they realize their grip on control is not solid.
Other symptoms endorsed by many Americans post-election have included: feelings of helplessness and paralysis, an inability to focus on work or family obligations, and difficulty sleeping. Maladaptive coping strategies have included stress eating, drinking, smoking, and other ways to avoid feeling anxious.
Gaslighting, a term popularized in psychological literature over the past ten to fifteen years, describes unhealthy dynamics in a power relationship (Stern 2007). A gaslighter is “someone who desperately needs to be right in order to bolster his own sense of self and hold onto his own sense of power” (Stern 2007). Our gaslighter in chief has created anxiety for many Americans. During Trump’s campaign, there were many examples of his lies, untruths, and other information that served to create doubt and to manipulate. However, gaslighting also serves to deceive someone into doubting her own perception of reality (Gibson 2017).
A February 2017 survey by the American Psychological Association (2017), “Stress in America: Coping with Change,” indicated that two-thirds of Americans say they are stressed about the future of our nation. Although 76 percent of Democrats have reported stress about the future of our nation, 59 percent of Republicans have also endorsed the same stress level.
This also related to the therapists themselves. While mental health professionals were helping their clients deal with the stress of the post-election period, they were also struggling to handle and process their own feelings, which often were very similar to those of their clients.
One Psychologist’s Work with Clients with Trump Anxiety Disorder
I am a licensed clinical psychologist and owner of a small group practice in Evanston, Illinois, a suburban, liberal, higher-socioeconomic-status, and educated suburb just north of the Chicago city limits. Evanston is a college town, home to Northwestern University, with much of its sixty-five thousand residents comprising professionals who work at Northwestern or at other white-collar, professional jobs. The majority of my clients are Northwestern University undergraduate and graduate students diagnosed with disorders as straightforward as adjusting to college life and struggling with identity development as well as more serious diagnoses such as major depressive disorder, bipolar disorder, eating disorders, stress, and other mood disorders (primarily anxiety-related). I should note that given the very progressive area in which I practice, I had zero Trump supporters among my caseload of clients during this time.
After the 2016 election, and most especially the week after it, the vast majority of my clients discussed and processed their feelings about the election. In fact, it was unusual when a client did not mention the election during this period. Most clients struggled with similar feelings of shock, sadness, worry, panic, uncertainty for the future, and anger. Some were still in shock, and many endorsed feeling as if the election results were a nightmare that they hadn’t yet woken up from.
Most notably, the clients who came in the day after the election were still in disbelief. As their therapist, I concentrated on validating, normalizing, and maintaining a safe place for them to discuss their troubled feelings. We also discussed basic self-care, such as getting enough sleep, eating healthy meals, connecting with friends and family, and limiting consumption of election news stories. Certain clients were satisfied with discussing this for a short period of time and then resuming discussing their personal issues, while others struggled with daily functioning during the days and weeks after the election.
I (along with many other mental health professionals) have struggled to help clients while struggling myself with similar feelings of shock, anger, disbelief, frustration, and fear. The majority of mental health professionals tend to be liberal in their leanings (Norton 2016), which is unsurprising, given our profession’s focus on social justice, health care rights, and other progressive causes. Therefore, many therapists were saddled with both helping their clients deal with their anxieties while also struggling with their own symptoms. Some of this work was comforting. Being able to help clients gave us welcome relief from the constant barrage of news stories. It also helped me not feel as helpless; being “in the trenches” with clients was a way to feel productive.
I found that clients with a loved one (usually a parent or a partner) with a personality disorder (most notably narcissistic personality disorder) were more impacted than others. Much of the work done with these individuals helps them to acknowledge the gaslighting involved in their relationship with their loved one; to identify that they are not crazy and do have sound and intact judgment regarding their impaired loved one; to acknowledge the limitations of their loved one; and to develop healthy coping strategies to cope with their loved one’s erratic mood changes, blaming, and lying.
One woman, “Claire” (all names in clinical situations have been changed and placed in quotation marks where they first appear), a mother of a young child with special needs and a husband with narcissistic traits,
had been referred to me by her husband because he felt that she was “going crazy” and needed professional help. Part of our work together was to help her understand the legitimacy of her husband’s assessment; continue to work on her anxiety, which had been triggered by this dynamic; and to set healthier boundaries with her husband. Claire was very educated, politically liberal, and struggled with the impact of Trump’s being elected. Her anxiety symptoms were exacerbated during the post-election and post-inauguration period. Her treatment focused on normalizing her feelings and encouraging her to establish control by making a difference in the ways she could. For her, this entailed volunteering, expressing appreciation to her child’s teachers and other related professionals, and by calling her local congressional representatives.
Another woman, “Ida,” was in her early twenties and an undergraduate student in her junior year. Ida was gifted and also extremely sensitive and inquisitive. She had struggled in therapy to make sense of her relationship with her father, who had narcissistic traits. I remember her stating after the election, “I feel like we are all in an emotionally abusive relationship with our president.” She struggled with increased anxiety as well, and our work was to help ground her in what she could and could not control. She participated in several protest marches, which helped her feel less helpless. However, she struggled with minimizing her social media consumption and would often come into sessions feeling overwhelmed by the latest news.
Working in a very progressive area without one Trump supporter as a client enabled me to be honest with my clients that I was experiencing similar feelings, and that many of these feelings were universal to progressives post-election. I like to think that my clients appreciated my honesty and my ability to see a very human side to their therapist. However, many times the role of the therapist involves helping clients feel more hopeful and confident in their lives. This task proved to be quite difficult, as we therapists were left with similar feelings of helplessness and, perhaps due to our professional training, more concern given the characterological issues we saw in Trump’s behavior and personality.
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