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The living, breathing source of the data and images we juggle, meanwhile, is in the bed and left wondering: Where is everyone? What are they doing? Hello! It’s my body, you know

Our $3.4 trillion health care system is responsible for more than a quarter of a million deaths per year because of medical error, the rough equivalent of, say, a jumbo jet’s crashing every day.

I can get cash and account details all over America and beyond. Yet I can’t reliably get a patient record from across town, let alone from a hospital in the same state, even if both places use the same brand of E.H.R

the leading E.H.R.s were never built with any understanding of the rituals of care or the user experience of physicians or nurses. A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift

In the process, our daily progress notes have become bloated cut-and-paste monsters that are inaccurate and hard to wade through. A half-page, handwritten progress note of the paper era might in a few lines tell you what a physician really thought

so much of the E.H.R., but particularly the physical exam it encodes, is a marvel of fiction, because we humans don’t want to leave a check box empty or leave gaps in a template.

For a study, my colleagues and I at Stanford solicited anecdotes from physicians nationwide about patients for whom an oversight in the exam (a “miss”) had resulted in real consequences, like diagnostic delay, radiation exposure, therapeutic or surgical misadventure, even death. They were the sorts of things that would leave no trace in the E.H.R. because the recorded exam always seems complete — and yet the omission would be glaring and memorable to other physicians involved in the subsequent care. We got more than 200 such anecdotes.

The reason for these errors? Most of them resulted from exams that simply weren’t done as claimed. “Food poisoning” was diagnosed because the strangulated hernia in the groin was overlooked, or patients were sent to the catheterization lab for chest pain because no one saw the shingles rash on the left chest.

I worry that such mistakes come because we’ve gotten trapped in the bunker of machine medicine. It is a preventable kind of failure

How we salivated at the idea of searchable records, of being able to graph fever trends, or white blood counts, or share records at a keystroke with another institution — “interoperability”

The seriously ill patient has entered another kingdom, an alternate universe, a place and a process that is frightening, infantilizing; that patient’s greatest need is both scientific state-of-the-art knowledge and genuine caring from another human being. Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam — reading the body — in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.

What if the computer gave the nurse the big picture of who he was both medically and as a person?

a professor at M.I.T. whose current interest in biomedical engineering is “bedside informatics,” marvels at the fact that in an I.C.U., a blizzard of monitors from disparate manufacturers display EKG, heart rate, respiratory rate, oxygen saturation, blood pressure, temperature and more, and yet none of this is pulled together, summarized and synthesized anywhere for the clinical staff to use

What these monitors do exceedingly well is sound alarms, an average of one alarm every eight minutes, or more than 180 per patient per day. What is our most common response to an alarm? We look for the button to silence the nuisance because, unlike those in a Boeing cockpit, say, our alarms are rarely diagnosing genuine danger.

By some estimates, more than 50 percent of physicians in the United States have at least one symptom of burnout, defined as a syndrome of emotional exhaustion, cynicism and decreased efficacy at work

It is on the increase, up by 9 percent from 2011 to 2014 in one national study. This is clearly not an individual problem but a systemic one, a 4,000-key-clicks-a-day problem.

The E.H.R. is only part of the issue: Other factors include rapid patient turnover, decreased autonomy, merging hospital systems, an aging population, the increasing medical complexity of patients. Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnou

burnout is one of the largest predictors of physician attrition from the work force. The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties.

I hold out hope that artificial intelligence and machine-learning algorithms will transform our experience, particularly if natural-language processing and video technology allow us to capture what is actually said and done in the exam room.

as with any lab test, what A.I. will provide is at best a recommendation that a physician using clinical judgment must decide how to apply.

True clinical judgment is more than addressing the avalanche of blood work, imaging and lab tests; it is about using human skills to understand where the patient is in the trajectory of a life and the disease, what the nature of the patient’s family and social circumstances is and how much they want done.

Much of that is a result of poorly coordinated care, poor communication, patients falling through the cracks, knowledge not being transferred and so on, but some part of it is surely from failing to listen to the story and diminishing skill in reading the body as a text.

As he was nearing death, Avedis Donabedian, a guru of health care metrics, was asked by an interviewer about the commercialization of health care. “The secret of quality,” he replied, “is love.”/•/

Just like midlife, quarterlife can bring its own crisis — trying to separate from your parents or caregivers and forge a sense of self is a struggle. But the generation entering adulthood now faces novel, sometimes debilitating, challenges.

Many find themselves so mired in day-to-day monetary concerns, from the relentless crush of student debt to the swelling costs of everything, that they feel unable to consider what they want for themselves long term

“We’ve been constrained by this myth that you graduate from college and you start your life,” she said. Without the social script previous generations followed — graduate college, marry, raise a family — Ms. Byock said her young clients often flailed around in a state of extended adolescence.

nearly one-third of Gen Z adults are living with their parents or other relatives and plan to stay there.

Many young people today struggle to afford college or decide not to attend, and the “existential crisis” that used to hit after graduation descends earlier and earlier

Ms. Byock said to pay attention to what you’re naturally curious about, and not to dismiss your interests as stupid or futile.

Experts said those entering adulthood need clear guidance for how to make it out of the muddle. Here are their top pieces of advice on how to navigate a quarterlife crisis today.

She recommends scheduling reminders to check in with yourself, roughly every three months, to examine where you are in your life and whether you feel stuck or dissatisfied

From there, she said, you can start to identify aspects of your life that you want to change.

“Start to give your own inner life the respect that it’s due,”

But quarterlife is about becoming a whole person, Ms. Byock said, and both groups need to absorb each other’s characteristics to balance themselves out

However, there is a difference between self-interest and self-indulgence, Ms. Byock said. Investigating and interrogating who you are takes work. “It’s not just about choosing your labels and being done,” she said.

Be patient.

Quarterlifers may feel pressure to race through each step of their lives, Ms. Byock said, craving the sense of achievement that comes with completing a task.

But learning to listen to oneself is a lifelong process.

Instead of searching for quick fixes, she said, young adults should think about longer-term goals: starting therapy that stretches beyond a handful of sessions, building healthy nutrition and exercise habits, working toward self-reliance.

“I know that seems sort of absurdly large and huge in scope,” she said. “But it’s allowing ourselves to meander and move through life, versus just ‘Check the boxes and get it right.’”

take stock of your day-to-day life and notice where things are missing. She groups quarterlifers into two categories: “stability types” and “meaning types.”

“Stability types” are seen by others as solid and stable. They prioritize a sense of security, succeed in their careers and may pursue building a family.

“But there’s a sense of emptiness and a sense of faking it,” she said. “They think this couldn’t possibly be all that life is about.”

On the other end of the spectrum, there are “meaning types” who are typically artists; they have intense creative passions but have a hard time dealing with day-to-day tasks

“These are folks for whom doing what society expects of you is so overwhelming and so discordant with their own sense of self that they seem to constantly be floundering,” she said. “They can’t quite figure it out.”

That paralysis is often exacerbated by mounting climate anxiety and the slog of a multiyear pandemic that has left many young people mourning family and friends, or smaller losses like a conventional college experience or the traditions of starting a first job.

Stability types need to think about how to give their lives a sense of passion and purpose. And meaning types need to find security, perhaps by starting with a consistent routine that can both anchor and unlock creativity.

perhaps the prototypical inspiration for staying calm in chaos: Yoda. The Jedi master is “one of the few images we have of what feeling quiet amid extreme pain and apocalypse can look like,

Even when there seems to be little stability externally, she said, quarterlifers can try to create their own steadiness.

establishing habits that help you ground yourself as a young adult is critical because transitional periods make us more susceptible to burnout

He suggests building a practical tool kit of self-care practices, like regularly taking stock of what you’re grateful for, taking controlled breaths and maintaining healthy nutrition and exercise routines. “These are techniques that can help you find clarity,”

Don’t be afraid to make a big change.

It’s important to identify what aspects of your life you have the power to alter, Dr. Brown said. “You can’t change an annoying boss,” he said, “but you might be able to plan a career change.”

That’s easier said than done, he acknowledged, and young adults should weigh the risks of continuing to live in their status quo — staying in their hometown, or lingering in a career that doesn’t excite them — with the potential benefits of trying something new.

quarterlife is typically “the freest stage of the whole life span,

Young adults may have an easier time moving to a new city or starting a new job than their older counterparts would.

Know when to call your parents — and when to call on yourself.

Quarterlife is about the journey from dependence to independence, Ms. Byock said — learning to rely on ourselves, after, for some, growing up in a culture of helicopter parenting and hands-on family dynamics.

there are ways your relationship with your parents can evolve, helping you carve out more independence

That can involve talking about family history and past memories or asking questions about your parents’ upbringing

“You’re transitioning the relationship from one of hierarchy to one of friendship,” she said. “It isn’t just about moving away or getting physical distance.”

Every quarterlifer typically has a moment when they know they need to step away from their parents and to face obstacles on their own

That doesn’t mean you can’t, or shouldn’t, still depend on your parents in moments of crisis, she said. “I don’t think it’s just about never needing one’s parents again,” she said. “But it’s about doing the subtle work within oneself to know: This is a time I need to stand on my own.”

ground troops, unfortunately, had more pressing concerns than existential responsibility. They did not have leisure, unlike their commanders, who also often had the philosophical training to think through the complexities of their jobs.

This training was not simply a degree requirement at Officer Candidate School or one of the United States military academies, but a sustained, ongoing, and rigorous engagement with a philosophical tradition. Alexander lived with Aristotle.

, Jeff McMahan argued that traditional “just war theory” should be reworked in several important ways. He suggested that the tenets of a revised theory apply not only to governments, traditionally represented by commanders and heads of state, but also to individual soldiers. This is a significant revision since it broadens the scope of responsibility for warfare

McMahan believes that individuals are to bear at least some responsibility in upholding “just cause” requirements. McMahan expects more of soldiers and, in this age of drones and leisure, he is right to do so.

while drones are to be applauded for keeping these soldiers out of harm’s way physically, we would do well to remember that they do not keep them out of harm’s way morally or psychologically. The high rates of “burnout” should drive this home. Supporting our troops requires ensuring that they are provided not just with training and physical armor, but with the intellectual tools to navigate these new difficulties.

Just as was the case in the invasion of Iraq 10 years ago, the most important questions we should be asking should not be directed to armchair soldiers but to those of us in armchairs at home: What wars are being fought in our name? On what grounds are they being fought?

Her husband, Brad Buchanan, was late for family dinner. She found him in the bathroom, coughing up blood — a lot of it.

Doctors found that a tumor had ruptured in one of his lungs and he urgently needed chemo. As her husband became critically ill, Ms. Washington, a freelance writer, was thrust into the role of nurse.

“My hands were shaking,” she said as she remembered apprehensively pushing in the drugs for the first time and feeling the weight of keeping her husband alive.

Mr. Buchanan had a stem cell transplant that left him with graft-versus-host disease

Depending on the analysis, between 61 and 75 percent of caregivers are women

When she explained that she had two children who also had needs, he said, “Well, usually family steps in, and it works out fine.”

Ms. Washington felt the burden of responsibility, but also the sting

The U.S. health care system relies on and takes for granted the “invisible army” of people — mostly women — who keep the system functioning by performing home care for the many people who are “too well for the hospital” but “too sick for home,” as well as for those on end-of-life care.

In 2017, AARP found that about 41 million family caregivers in America perform roughly $470 billion worth of unpaid labor a year.

they tend to do more personal care tasks like helping patients bathe and use the toilet than their male counterparts, who are more likely to oversee finances and arrangement of care.

The historical roots are complex, but as Evelyn Glenn puts it in “Forced to Care,”

emale caregivers put in more hours — 22 to men’s 17

they are also more likely to stand by their partner through a serious illness

Many people who take on caregiving roles experience negative health impacts, but women are especially at risk of the fallout from caregiver stress.

Female caregivers are also 2.5 times more likely to live in poverty as non-caregiver

A 2011 study found that women who left their jobs to care for a parent lost an average of $324,000 in wages and benefits over their lifetimes.

Ms. Washington was able to dip into savings and a recent inheritance to help pay for supplemental in-home care, but it was still a struggle, causing stress, resentment and lost income.

It was hard to have my life put on hold. Everything kind of slipped away.

I lost a sense of who I was. I was going to pick up a prescription for myself, the only prescription I had when my husband was sick, and the pharmacist asked for my date of birth, and I gave his date of birth

People talk about how it’s the most important job in the world, taking care of our children or taking care of our vulnerable elders, and yet those are some of the worst paid jobs.

How much is a quarterback paid versus someone who is doing care for a vulnerable elderly person?

How did care work become so undervalued?

A doctor told Ms. Washington that her husband would need 24-hour care and “could not be left alone for even a moment.”

Western culture has long framed care work done by women as a moral duty or obligation, rather than an economic activity.

If your earnings are lower than they would normally be because you’re busy caring for a family member, and you can’t save and pay into social security, it can lock whole families into a cycle of lower wealth and economic instability.

And what should someone not do

Don’t tell someone to stay positive. For me, there was no staying about it, because I didn’t feel positive to start with. It brought up this feeling

My time isn’t my own, but surely my emotions can be

Screens, small and large, became crucial links to the rest of the world.

In doing so, they rediscovered each other, and experienced the joys of bonding and the suffocation of constant proximity.

In some instances, these revelations were not happy ones: lawyers and mediators saw a spike in clients looking to divorce as soon as courts reopened.

Engagements and pregnancy announcements seemed to pop up constantly on social media. And there were plenty of weddings.

Couples in quarantine learned a lot about their significant others.

Inside nursing homes, Covid-19 outbreaks became all too regular, with more than 163,000 residents and workers dying of the virus.

In one study, almost one-third of the teens interviewed said they had felt unhappy or depressed.

Parents, especially mothers, left the work force quickly and in large numbers in the spring.

Those who continued working had to balance the demands of their jobs with domestic chores, child care and online schooling, putting strain on their mental health.

Retirees put off plans that had been years in the making, like travel and volunteer work.

Young people around the world, cut off from their usual social lives, faced a “mental health pandemic.”

Delivery drivers dealt with health risks, theft and assault.

Airline workers who weren’t furloughed had to confront passengers who refused to wear masks.

hospital staff around the country dealt with the gut-wrenching horrors of a steep surge in cases.

Doctors and nurses agonized over putting their families at risk, and dealt with intense burnout and pay cuts.

Some said that being characterized as heroes by the public left them little room to express vulnerability.

a toll higher than in any other country.

The world’s struggle to contain the coronavirus was often compared to a war

in this case, the enemy claimed more Americans than World War I, World War II and the Vietnam War combined

Grief and loss defined the last year

Funerals and final goodbyes took place over video calls, if at all.

a sign that people will soon be finding their way back to each other.

If you’re wondering what comes after, we are, too.Are you anxious that things will never be the same? Or are you fearful that we’ll return to “the same” much too quickly? Or maybe there is something seemingly small that you will cherish being able to do?

The day-to-day work of a pilot is unstable, and often unpredictable. They’re away from home, and from their families, for long stretches of time. The job isn’t a typical 9-to-5— instead, pilots fly overnight from timezone to timezone, at strange hours.

To reduce fatigue, which is linked to stress, rules and regulations from the Federal Aviation Administration (FAA) limit the number of hours a pilot can fly and how much rest they need. During a 24-hour period, a pilot flying alone can’t log more than eight hours, for example, and they have a ten-hour minimum rest period before taking off.

But if stress creeps past that midpoint, performance starts to drop off. Too-high levels of stress mean exhaustion, panic, and blunted brain power. That’s when mistakes happen.

CRM training is designed to help pilots and crew members develop efficiency communication and decision-making skills. “It was also saying, this is what fatigue looks like, and this is how to recognize it in your co-pilot,” Bowen says. From that point on, she says, the airlines worked to develop a culture where pilots would hold other pilots accountable when they weren’t fit to fly. “It was about not protecting their buddy, but protecting overall safety,” Bowen says.

Pilot mental health is another big issue to tackle, says Quay Snyder, a former Air Force flight surgeon and a member of the Aerospace Medical Association Working Group on Pilot Mental Health. Pilots are often reluctant to acknowledge the effect that emotional stressors might have on their ability to fly, he says.

“They’re slow to recognize mental health issues,” he says, “and they might think there’s a stigma against asking for help.”

“Pilots trust pilots,” he says. “Hearing from a peer could help a pilot recognize that they may not be fit to fly. Hearing it from a physician doesn’t carry much weight, but hearing it from a peer does.”

"People who are more socially connected to family, to friends, to community, are happier, they're physically healthier, and they live longer than people who are less well connected," said Harvard psychiatrist Robert Waldinger in his popular TEDx talk. "And the experience of loneliness turns out to be toxic."

The lessons aren't about wealth or fame or working harder and harder," Waldinger said. "The clearest message that we get from this 75-year study is this: Good relationships keep us happier and healthier. Period."

"In fact, the more positive the person, the greater the protection from heart attacks, stroke and any cause of death," said Mt. Sinai's Rozanski, who was the lead author on the study.

A sense of purpose and meaning in your life is a big part of living a longer, happier life, according to psychology professor Lyle Ungar, who has developed what he calls the Well-Being Map. It rates every US county on such psychological factors as openness, trust, agreeableness and neuroticism.

"If your sole duty is to achieve the best for yourself, life becomes just too stressful, too lonely -- you are set up to fail. Instead, you need to feel you exist for something larger, and that very thought takes off some of the pressure."

SpiritualityStudies by the Pew Research Center show that actively religious people are more likely than less- or non-religious people to describe themselves as "very happy." They also share some traits that could improve their chance at a longer, happy life: They are less likely to smoke and drink, and more likely to join clubs and volunteer at charities.

"I'm surprised how good religion is for people," Ungar said. "Religious people are more agreeable, they're happier, they live longer."It doesn't have to be a traditional religion. Layard points out that spiritual practices ranging from meditation to positive psychology to cognitive therapy can also feed an inner life.

I knew that my audience wanted to feel authenticity from me. To give that to them, I revealed pieces of myself that I might have been wiser to keep private.

when metrics substitute for self-worth, it’s easy to fall into the trap of giving precious pieces of yourself away to feed an audience that’s always hungry for more and more.

In 2018, I impulsively released a video about my struggle with burnout, which featured intimate footage of my emotional breakdowns. Those breakdowns were, in part, a product of severe anxiety and depression brought about by chasing the exact success for which many other teenagers yearn.

I was entering adulthood and trying to live my childhood dream, but now, to be “authentic,” I had to be the product I had long been posting online, as opposed to the person I was growing up to be.

Online culture encourages young people to turn themselves into a product at an age when they’re only starting to discover who they are. When an audience becomes emotionally invested in a version of you that you outgrow, keeping the product you’ve made aligned with yourself becomes an impossible dilemma.

Sometimes, I barely recognize the person I used to be. Although a part of me resents that I’ll never be able to forget her, I’m also grateful to her. My YouTube channel, for all the trouble it brought me, connected me to the people who wanted to hear my stories and prepared me for a real shot at a directing career. In the last year, I’ve directed a short film and am writing a feature, which showed me new ways of creating that aren’t at the expense of my privacy.

starting in the mid-2010s, those beloved blue skies began to disappear. First, the smoke came in occasional bursts, from wildfires in Canada or California or Siberia, and blew away when the wind changed direction. Within a few summers, though, it was coming in thicker, from more directions at once, and lasting longer.

Sometimes there were weeks when you were advised not to open your windows or exercise outside. Sometimes there were long stretches where you weren’t supposed to breathe the outside air at all.

Now lots of Bryant’s clients wanted to talk about climate change. They wanted to talk about how strange and disorienting and scary this new reality felt, about what the future might be like and how they might face it, about how to deal with all the strong feelings — helplessness, rage, depression, guilt — being stirred up inside them.

As a therapist, Bryant found himself unsure how to respond

while his clinical education offered lots of training in, say, substance abuse or family therapy, there was nothing about environmental crisis, or how to treat patients whose mental health was affected by it

Bryant immersed himself in the subject, joining and founding associations of climate-concerned therapists

could now turn to resources like the list maintained by the Climate Psychology Alliance North America, which contains more than 100 psychotherapists around the country who are what the organization calls “climate aware.”

Over and over, he read the same story, of potential patients who’d gone looking for someone to talk to about climate change and other environmental crises, only to be told that they were overreacting — that their concern, and not the climate, was what was out of whack and in need of treatment.

“You come in and talk about how anxious you are that fossil-fuel companies continue to pump CO2 into the air, and your therapist says, ‘So, tell me about your mother.’”

In many of the messages, people asked Bryant for referrals to climate-focused therapists in Houston or Canada or Taiwan, wherever it was the writer lived.

his practice had shifted to reflect a new reality of climate psychology. His clients didn’t just bring up the changing climate incidentally, or during disconcerting local reminders; rather, many were activists or scientists or people who specifically sought out Bryant because of their concerns about the climate crisis.

Climate change, in other words, surrounds us with constant reminders of “ethical dilemmas and deep social criticism of modern society. In its essence, climate crisis questions the relationship of humans with nature and the meaning of being human in the Anthropocene.”

It had been a challenging few years, Bryant told me when I first called to talk about his work. There were some ways in which climate fears were a natural fit in the therapy room, and he believed the field had coalesced around some answers that felt clear and useful

But treating those fears also stirred up lots of complicated questions that no one was quite sure how to answer. The traditional focus of his field, Bryant said, could be oversimplified as “fixing the individual”: treating patients as separate entities working on their personal growth

Climate change, by contrast, was a species-wide problem, a profound and constant reminder of how deeply intertwined we all are in complex systems — atmospheric, biospheric, economic — that are much bigger than us. It sometimes felt like a direct challenge to old therapeutic paradigms — and perhaps a chance to replace them with something better.

In one of climate psychology’s founding papers, published in 2011, Susan Clayton and Thomas J. Doherty posited that climate change would have “significant negative effects on mental health and well-being.” They described three broad types of possible impacts: the acute trauma of living through climate disasters; the corroding fear of a collapsing future; and the psychosocial decay that could damage the fabric of communities dealing with disruptive changes

All of these, they wrote, would make the climate crisis “as much a psychological and social phenomenon as a matter of biodiversity and geophysics.”

Many of these predictions have since been borne out

Studies have found rates of PTSD spiking in the wake of disasters, and in 2017 the American Psychological Association defined “ecoanxiety” as “a chronic fear of environmental doom.”

Climate-driven migration is on the rise, and so are stories of xenophobia and community mistrust.

eventually started a website, Climate & Mind, to serve as a sort of clearing house for other therapists searching for resources. Instead, the site became an unexpected window into the experience of would-be patients: Bryant found himself receiving messages from people around the world who stumbled across it while looking for help.

Many say it has led to symptoms of depression or anxiety; more than a quarter make an active effort not to think about it.

A poll by the American Psychiatric Association in the same year found that nearly half of Americans think climate change is already harming the nation’s mental health.

In June, the Yale Journal of Biology and Medicine published a paper cautioning that the world at large was facing “a psychological condition of ‘systemic uncertainty,’” in which “difficult emotions arise not only from experiencing the ecological loss itself,” but also from the fact that our lives are inescapably embedded in systems that keep on making those losses worse.

According to a 2022 survey by Yale and George Mason University, a majority of Americans report that they spend time worrying about climate change.

This is not an easy way to live.

Living within a context that is obviously unhealthful, he wrote, is painful: “a dimly intuited ‘fall’ from which we spend our lives trying to recover, a guilt we can never quite grasp or expiate” — a feeling of loss or dislocation whose true origins we look for, but often fail to see. This confusion leaves us feeling even worse.

When Barbara Easterlin first started studying environmental psychology 30 years ago, she told me, the focus of study was on ways in which cultivating a relationship with nature can be good for mental health

There was little or no attention to the fact that living through, or helping to cause, a collapse of nature can also be mentally harmful.

the field is still so new that it does not yet have evidence-tested treatments or standards of practice. Therapists sometimes feel as if they are finding the path as they go.

Rebecca Weston, a licensed clinical social worker practicing in New York and a co-president of the CPA-NA, told me that when she treats anxiety disorders, her goal is often to help the patient understand how much of their fear is internally produced — out of proportion to the reality they’re facing

climate anxiety is a different challenge, because people worried about climate change and environmental breakdown are often having the opposite experience: Their worries are rational and evidence-based, but they feel isolated and frustrated because they’re living in a society that tends to dismiss them.

One of the emerging tenets of climate psychology is that counselors should validate their clients’ climate-related emotions as reasonable, not pathological

it does mean validating that feelings like grief and fear and shame aren’t a form of sickness, but, as Weston put it, “are actually rational responses to a world that’s very scary and very uncertain and very dangerous for people

In the words of a handbook on climate psychology, “Paying heed to what is happening in our communities and across the globe is a healthier response than turning away in denial or disavowal.”

But this, too, raises difficult questions. “How much do we normalize people to the system we’re in?” Weston asked. “And is that the definition of health?

Or is the definition of health resisting the things that are making us so unhappy? That’s the profound tension within our field.”

“It seems to shift all the time, the sort of content and material that people are bringing in,” Alexandra Woollacott, a psychotherapist in Seattle, told the group. Sometimes it was a pervasive anxiety about the future, or trauma responses to fires or smoke or heat; other times, clients, especially young ones, wanted to vent their “sort of righteous anger and sense of betrayal” at the various powers that had built and maintained a society that was so destructive.

“I’m so glad that we have each other to process this,” she said, “because we’re humans living through this, too. I have my own trauma responses to it, I have my own grief process around it, I have my own fury at government and oil companies, and I think I don’t want to burden my clients with my own emotional response to it.”

In a field that has long emphasized boundaries, discouraging therapists from bringing their own issues or experiences into the therapy room, climate therapy offers a particular challenge: Separation can be harder when the problems at hand affect therapist and client alike

Some therapists I spoke to were worried about navigating the breakdown of barriers, while others had embraced it. “There is no place on the planet that won’t eventually be impacted, where client and therapist won’t be in it together,” a family therapist wrote in a CPA-NA newsletter. “Most therapists I know have become more vulnerable and self-disclosing in their practice.”

“If you look at or consider typical theoretical framings of something like post-traumatic growth, which is the understanding of this idea that people can sort of grow and become stronger and better after a traumatic event,” she said, then the climate crisis poses a dilemma because “there is no afterwards, right? There is no resolution anytime in our lifetimes to this crisis that we nonetheless have to build the capacities to face and to endure and to hopefully engage.”

“How,” she asked, “do you think about resilience apart from resolution?”

many of her patients are also disconnected from the natural world, which means that they struggle to process or even recognize the grief and alienation that comes from living in a society that treats nature as other, a resource to be used and discarded.

“I’m so excited by what you’re bringing in,” Woollacott replied. “I’m doing psychoanalytic training at the moment, and we study attachment theory” — how the stability of early emotional bonds affects future relationships and feelings of well-being. “But nowhere in the literature does it talk about our attachment to the land.”

Torres said that she sometimes takes her therapy sessions outside or asks patients to remember their earliest and deepest connections with animals or plants or places. She believes it will help if they learn to think of themselves “as rooted beings that aren’t just simply living in the human overlay on the environment.” It was valuable to recognize, she said, that “we are part of the land” and suffer when it suffers.

Torres described introducing her clients to methods — mindfulness, distress tolerance, emotion regulation — to help them manage acute feelings of stress or panic and to avoid the brittleness of burnout.

She also encourages them to narrativize the problem, including themselves as agents of change inside stories about how they came to be in this situation, and how they might make it different.

then she encourages them to find a community of other people who care about the same problems, with whom they could connect outside the therapy room. As Woollacott said earlier: “People who share your values. People who are committed to not looking away.”

Dwyer told the group that she had been thinking more about psychological adaptation as a form of climate mitigation

Therapy, she said, could be a way to steward human energy and creative capacities at a time when they’re most needed.

It was hard, Bryant told me when we first spoke, to do this sort of work without finding yourself asking bigger questions — namely, what was therapy actually about?

Many of the therapists I talked to spoke of their role not as “fixing” a patient’s problem or responding to a pathology, but simply giving their patients the tools to name and explore their most difficult emotions, to sit with painful feelings without instantly running away from them

many of the methods in their traditional tool kits continue to be useful in climate psychology. Anxiety and hopelessness and anger are all familiar territory, after all, with long histories of well-studied treatments.

They focused on trying to help patients develop coping skills and find meaning amid destabilization, to still see themselves as having agency and choice.

Weston, the therapist in New York, has had patients who struggle to be in a world that surrounds them with waste and trash, who experience panic because they can never find a place free of reminders of their society’s destruction

eston said, that she has trouble with the repeated refrain that therapist and patient experiencing the same losses and dreads at the same time constituted a major departure from traditional therapeutic practice

she believed this framing reflected and reinforced a bias inherent in a field that has long been most accessible to, and practiced by, the privileged. It was hardly new in the world, after all, to face the collapse of your entire way of life and still find ways to keep going.

Lately, Bryant told me, he’s been most excited about the work that happens outside the therapy room: places where groups of people gather to talk about their feelings and the future they’re facing

It was at such a meeting — a community event where people were brainstorming ways to adapt to climate chaos — that Weston, realizing she had concrete skills to offer, was inspired to rework her practice to focus on the challenge. She remembers finding the gathering empowering and energizing in a way she hadn’t experienced before. In such settings, it was automatic that people would feel embraced instead of isolated, natural that the conversation would start moving away from the individual and toward collective experiences and ideas.

There was no fully separate space, to be mended on its own. There was only a shared and broken world, and a community united in loving it.