Psychologist: No, It's Not Post-Election Stress 'Disorder'

President Donald Trump addresses a joint session of Congress on Capitol Hill in Washington. (Jim Lo Scalzo/AP)
President Donald Trump addresses a joint session of Congress on Capitol Hill in Washington. (Jim Lo Scalzo/AP)

Here in heavily Democratic Massachusetts, you see plenty of people with blue-state blues: What began as acute personal distress about President Trump, by now, is so prolonged it must count as chronic.

Just after the election, stress expert Dr. Ellen Slawsby of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital said that she had never seen an election cause so much stress. She predicted that it would abate after a few weeks, and for most of her clients, she was right. But a few "are still struggling at a high level" of angst, she says.

(Let us stipulate here: There are also many people who are feeling no angst whatsoever, quite the opposite, even, in Massachusetts: WBUR is doing a whole series about some of them called "Red Voters In A Blue State.")

But among the politically distressed, is this anxiety -- toxic Trump-related concern concentrated among blue-voting people — enough of a thing that it needs a name? Like maybe "post-election stress disorder?"

Please, no, pleads Health News Review, a media-watchdog website, in a pointed piece headlined "Just Say No To News Stories About Post Election Stress Disorder." It's responding to a recent essay in Psychology Today and a report by Kaiser Health News on CNN about Democratic strongholds seeing  "a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.”

Health News Review deputy managing editor Joy Victory argues that calling people's struggles to adapt to political change a "stress disorder" trivializes a real disorder — PTSD — and medicalizes normal challenges.

I turned to Dr. Philip Levendusky, director of psychology of McLean Hospital, the Harvard-affiliated psychiatric hospital in Belmont, for his take. Our conversation, lightly edited, follows.

Did you see the recent Psychology Today article that was arguing for an election-related stress disorder, focusing particularly on women with a history of trauma who find Trump triggering?

Yes, I've seen reference to the Psychology Today article, and creating a diagnosis based on an opportunistic situation doesn't make sense to me. This is a kind of reaction that people have to major events. So if a hurricane is coming, the anticipation of it is going up, people are getting more agitated. And if the hurricane is like a Sandy or Katrina, it's a horrific event, and the after-effects of it are not altogether different in terms of the emotional upset from what we saw during this election.

My perspective on what is related to people feeling increasingly vulnerable is the notion of  "perceived sense of control." If you're in a circumstance, it can be a very complicated kind of circumstance, but if you feel like it's predictable, you understand what the rules are, then the situation feels like it's manageable and it doesn't trigger that kind of increase in emotional upset.

I think in the outcome of the election, the "perceived sense of control" factor was enormously high, because nobody predicted it. The candidate was somebody who ran counter to most of the people that I interact with in terms of what their values are, what their expectations are. So their sense of being in control really dropped, and got replaced with a lot of agitation, depression, upset.

I've heard people suddenly saying, "Wait, I think I need a refresher on how the whole political system works..."

Good, that's absolutely critical. My approach to this, when I'm engaged in a therapeutic process and somebody is upset about how all of this played out, I will go to that: "You know, we have a system. The system is 200 years old. It has weathered any number of different things." The catastrophic kind of outcome that someone might be fantasizing about — it kind of brings them back down to earth a bit in a positive way.

I would imagine that you've seen symptoms largely abate over the last few weeks?

Well, not to belabor the perceived sense of control comment I made earlier, but I think a lot of the grassroots activities that people are engaging in now is their expression of being back in control. They'll march, they'll protest, they'll talk about it in groups on how to deal with the next election. So, objectively, not much has changed. He is the president, he is not going away. But once people are attached to something that makes them feel like they are able to take some action and are not helpless, that goes a long way towards bringing down their anxiety. I've seen that in colleagues, I've seen that in clients of mine.

Are you still seeing clients who are experiencing really a lot of politically related distress?

The short answer is yes. They're continuing to talk about it in a way that it feels like the election just happened yesterday. The election didn't just happen yesterday, but what did just happen yesterday was yet another thing that is consistent with ''Oh my god, I knew when he got elected this was going to be a problem."

So it shouldn't be its own disorder, but maybe we should call this prolonged distress something?

Well, I think it's not unreasonable to call it a post-traumatic stress reaction. It isn't a post-traumatic stress reaction for all of humanity, it's a post-traumatic stress reaction for people whose perspective on the president is extremely negative. And if we get a thousand people somewhere else who are in the more pro-Trump camp, they'll be saying "What are you talking about? This is great."

So it's not trivializing PTSD to call it a post-traumatic stress reaction? 

It is not trivializing PTSD. There are degrees of post-traumatic stress reaction and I use the term on my own personal experience. I would never diagnose myself with PTSD, but using the term is descriptive and accurate. It's post, it's after the event. It was experienced as a trauma, so traumatic. And reaction is how you felt about it. And I'm not going to carry "disorder" after it. That's where we would be treading in the land of diagnosis.

It's sort of in-between-y.

And if you were driving into work this morning, and you're on Route 128, and you see a fatal car crash, you're going to have a post-traumatic stress reaction: It's a horrible thing. You see it. But that doesn't equal that you are then going to develop a diagnosable post-traumatic stress disorder. But on the other hand, you're going to carry it forward and it's going to be affecting you — for the day. Maybe two days. And if every fourth day you went on 128 and there was a crash, then it would continue for as long as that was happening.

So if you're having a post-traumatic stress reaction, what do you do? 

I would go back to people's need to feel like they can do something about the situation: talking to friends about it, engaging in initiatives that are designed to try to amend the problem, and keeping that confidence in our system, in our checks and balances and those kinds of things — to know that we are in an environment that ultimately is going to protect its citizens.

So, raise your level of perceived control.

That’s very important.

Anything else?

The advice for this situation is much like the advice I offer to any patients, friends and colleagues who are feeling stress and angst: Take care of yourself. Meaning, make sure you're getting plenty of exercise, you’re enjoying your time with friends, and taking time to do what is important to you. If you get into a situation where you become a worrywart about the situation and forget to take care of yourself, that just exacerbates the problem. I also stress that if your feelings of stress and anxiety begin to impede your normal activities and are affecting your behavior, you should seek professional help.

And if Trump is triggering for you, should you try to avoid him on TV, or should you maybe try to do immersion therapy on yourself, inure yourself to the effect by watching a lot?

There’s no question: If Trump serves as a trigger, you don't have to apologize for it or be defensive about it. But I do strongly recommend that you don't continually expose yourself to him. This is something you can control. Don’t go to every news station that’s having Trump interviews and instead, use your energy in a way that feels like, "OK, I’m going to make sure he doesn’t get elected the next time around."

Readers, thoughts? If you get blue-state stress reactions, what helps most? 

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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