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“Talents for low intrigue, and the little arts of popularity,” might suffice for someone to be elected to the governorship of a state, but not the presidency. Election would “require other talents, and a different kind of merit,” to gain “the esteem and confidence of the whole Union,” or enough of it to win the presidency. As a result, there would be “a constant probability of seeing the station filled by characters pre-eminent for ability and virtue.” This was the Framers’ goal in designing the system that would make “the choice of the person to whom so important a trust was to be confided.”

In a nutshell, while carrying out his official duties, a president has to put the country, not himself, first; he must faithfully follow and enforce the law; and he must act with the utmost care in doing all that.

can Trump do all that? Does his personality allow him to? Answering those questions doesn’t require mental-health expertise, nor does it really require a diagnosis. You can make the argument for Trump’s unfitness without assessing his mental health: Like James Fallows, for example, you could just ask whether Trump would have been allowed to retain any other job in light of his bizarre conduct

More than a diagnosis, what truly matters, as Lincoln’s case shows, is the president’s behavioral characteristics and personality traits. And understanding how people behave and think is not the sole province of professionals; we all do it every day, with family members, co-workers, and others.

its criteria for personality disorders—they don’t require a person to lie on a couch and confess his or her innermost thoughts. They turn on how a person behaves in the wild, so to speak.

Donald Trump, as president of the United States, is probably the most observable and observed person in the world. I’ve personally met and spoken with him only a few times, but anyone who knows him will tell you that Trump, in a way, has no facade: What you see of him publicly is what you get all the time, although you may get more of it in private

accounts of a person’s behavior from laypeople who observe him might be more accurate than information from a clinical interview, and that this is especially true when considering two personality disorders in particular—what the DSM calls narcissistic personality disorder and antisocial personality disorde

These two disorders just happen to be the ones that have most commonly been ascribed to Trump by mental-health professionals over the past four years. Of these two disorders, the more commonly discussed when it comes to Trump is narcissistic personality disorder, or NPD—pathological narcissism

it touches directly upon whether Trump has the capacity to put anyone’s interests—including the country’s and the Constitution’s—above his own.

A certain amount of narcissism is healthy, and helpful—it brings with it confidence, optimism, and boldness. Someone with more than an average amount of narcissism may be called a narcissist. Many politicians, and many celebrities, could be considered narcissists

“Pathological narcissism begins when people become so addicted to feeling special that, just like with any drug, they’ll do anything to get their ‘high,’ including lie, steal, cheat, betray, and even hurt those closest to them,”

The “fundamental life goal” of an extreme narcissist “is to promote the greatness of the self, for all to see,

To many mental-health professionals, Donald Trump provides a perfect example of such extreme, pathological narcissism: One clinical psychologist told Vanity Fair that he considers Trump such a “classic” pathological narcissist that he is actually “archiving video clips of him to use in workshops because there’s no better example”

The goal of a diagnosis is to help a clinician guide treatment. The question facing the public is very different: Does the president of the United States exhibit a consistent pattern of behavior that suggests he is incapable of properly discharging the duties of his office?

Even Trump’s own allies recognize the degree of his narcissism. When he launched racist attacks on four congresswomen of color, Senator Lindsey Graham explained, “That’s just the way he is. It’s more narcissism than anything else.” So, too, do skeptics of assigning a clinical diagnosis. “No one is denying,” Frances told Rolling Stone, “that he is as narcissistic an individual as one is ever likely to encounter.” The president’s exceptional narcissism is his defining characteristic—and understanding that is crucial to evaluating his fitness for office

The DSM-5 describes its conception of pathological narcissism this way: “The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.”

The diagnostic criteria offer a useful framework for understanding the most remarkable features of Donald Trump’s personality, and of his presidency. (1) Exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements?

(2) Preoccupied with fantasies of unlimited success, power, brilliance

(3) Believes that he or she is “special” and unique and should only associate with other special or high-status people?

Trump claims to be an expert—the world’s greatest—in anything and everything. As one video mash-up shows, Trump has at various times claimed—in all seriousness—that no one knows more than he does about: taxes, income, construction, campaign finance, drones, technology, infrastructure, work visas, the Islamic State, “things” generally, environmental-impact statements, Facebook, renewable energy, polls, courts, steelworkers, golf, banks, trade, nuclear weapons, tax law, lawsuits, currency devaluation, money, “the system,” debt, and politicians.

(4) Requires excessive admiration? Last Thanksgiving, Trump was asked what he was most thankful for. His answer: himself, of course. A number of years ago, he made a video for Forbes in which he interviewed two of his children. The interview topic: how great they thought Donald Trump wa

(5) A sense of entitlement? (9) Arrogant, haughty behaviors? Trump is the man who, on the infamous Access Hollywood tape, said, “When you’re a star, they let you do it. You can do anything you want”—including grabbing women by their genitals. He’s the man who also once said, “I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.”

(8) Envious of others? Here’s a man so unable to stand the praise received by a respected war hero and statesman, Senator John McCain, that he has continued to attack McCain months after McCain’s death;

(6) Interpersonally exploitative? Just watch the Access Hollywood tape, or ask any of the hundreds of contractors and employees Trump the businessman allegedly stiffed, or speak with any of the two dozen women who have accused Trump of sexual misconduct, sexual assault, or rape.

Finally, (7) Lacks empathy: is unwilling to recognize or identify with the feelings or needs of others? One of the most striking aspects of Trump’s personality is his utter and complete lack of empathy

The notorious lawyer and fixer Roy Cohn, who once counseled Trump, said that “Donald pisses ice water,” and indeed, examples of Trump’s utter lack of normal human empathy abound.

“It made no sense, Priebus realized, unless you understood … ‘The president has zero psychological ability to recognize empathy or pity in any way.’

What kind of human being, let alone politician, would engage in such unempathetic, self-centered behavior while memorializing such horrible tragedies? Only the most narcissistic person imaginable—or a person whose narcissism would be difficult to imagine if we hadn’t seen it ourselves. The evidence of Trump’s narcissism is overwhelming—indeed, it would be a gargantuan task to try to marshal all of it, especially as it mounts each and every day.

A second disorder also frequently ascribed to Trump by professionals is sociopathy—what the DSM-5 calls antisocial personality disorder

Central to sociopathy is a complete lack of empathy—along with “an absence of guilt.” Sociopaths engage in “intentional manipulation, and controlling or even sadistically harming others for personal power or gratification. People with sociopathic traits have a flaw in the basic nature of human beings … They are lacking an essential part of being human.” For its part, the DSM-5 states that the “essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”

Trump’s sociopathic characteristics sufficiently intertwine with his narcissistic ones that they deserve mention here. These include, to quote the DSM-5, “deceitfulness, as indicated by repeated lying, use of aliases, or conning others.” Trump’s deceitfulness—his lying—has become the stuff of legend; journalists track his “false and misleading claims” as president by the thousands upon thousands.

Other criteria for antisocial personality disorder include “failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest”; “impulsivity or failure to plan ahead”; and “lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

As for impulsivity, that essentially describes what gets him into trouble most: It was his “impulsiveness—actually, total recklessness”—that came close to destroying him in the 1980s

And lack of remorse? That’s a hallmark of sociopathy, and goes hand in hand with a lack of human conscience. In a narcissistic sociopath, it’s intertwined with a lack of empathy. Trump hardly ever shows remorse, or apologizes, for anything. The one exception: With his presidential candidacy on the line in early October

In a way, Trump’s sociopathic tendencies are simply an extension of his extreme narcissism

articular, “They change reality to suit themselves in their own mind.” Although Trump “lies because of his sociopathic tendencies,” telling falsehoods to fool others, Dodes argues, he also lies to himself, to protect himself from narcissistic injury. And so Donald Trump has lied about his net worth, the size of the crowd at his inauguration, and supposed voter fraud in the 2016 election.

The latter kind of lying, Dodes says, “is in a way more serious,” because it can indicate “a loose grip on reality”—and it may well tell us where Trump is headed in the face of impeachment hearings. Lying to prevent narcissistic injury can metastasize to a more significant loss of touch with reality

Experts haven’t suggested that Trump is psychotic, but many have contended that his narcissism and sociopathy are so inordinate that he fits the bill for “malignant narcissism.” Malignant narcissism isn’t recognized as an official diagnosis; it’s a descriptive term coined by the psychoanalyst Erich Fromm, and expanded upon by another psychoanalyst, Otto Kernberg, to refer to an extreme mix of narcissism and sociopathy, with a degree of paranoia and sadism mixed in

In the view of some in the mental-health community, such as John Gartner, Trump “exhibits all four” components of malignant narcissism: “narcissism, paranoia, antisocial personality and sadism.”

Mental-health professionals have raised a variety of other concerns about Trump’s mental state; the last worth specifically mentioning here is the possibility that, apart from any personality disorder, he may be suffering cognitive decline.

His “mental state,” according to Justin A. Frank, a former clinical professor of psychiatry and physician who wrote a book about Trump’s psychology, “include[s] so many psychic afflictions” that a “working knowledge of psychiatric disorders is essential to understanding Trump.” Indeed, as Gartner puts it: “There are a lot of things wrong with him—and, together, they are a scary witch’s brew.”

when you line up what the Framers expected of a president with all that we know about Donald Trump, his unfitness becomes obvious. The question is whether he can possibly act as a public fiduciary for the nation’s highest public trust. To borrow from the Harvard Law Review article, can he follow the “proscriptions against profit, bad faith, and self-dealing,” manifest “a strong concern about avoiding ultra vires action” (that is, action exceeding the president’s legal authority), and maintain “a duty of diligence and carefulness”? Given that Trump displays the extreme behavioral characteristics of a pathological narcissist, a sociopath, or a malignant narcissist—take your pick—it’s clear that he can’t.

To act as a fiduciary requires you to put someone else’s interests above your own, and Trump’s personality makes it impossible for him to do that. No president before him, at least in recent memory, has ever displayed such obsessive self-regard

Indeed, Trump’s view of his presidential powers can only be described as profoundly narcissistic, and his narcissism has compelled him to disregard the Framers’ vision of his constitutional duties in every respect

Trump’s incapacity affects all manner of subjects addressed by the presidency, but can be seen most acutely in foreign affairs and national security.

All in all, Trump sought to impede and end a significant counterintelligence and criminal investigation—one of crucial importance to the nation—and did so for his own personal reasons. He did precisely the opposite of what his duties require. Indeed, he has shown utter contempt for his duties to the nation

hat constitutional mechanisms exist for dealing with a president who cannot or does not comply with his duties, and how should they take the president’s mental and behavioral characteristics into account?

it turns out that impeachment is a more practical mechanism

In short, now that the House of Representatives has embarked on an impeachment inquiry, one of the most important judgments it must make is whether any identified breaches of duty are likely to be repeated. And if a Senate trial comes to pass, that issue would become central as well to the decision to remove the president from office. That’s when Trump’s behavioral and psychological characteristics should—must—come into pla

One of the most compelling arguments about the meaning of those words is that the Framers, in Article II’s command that a president faithfully execute his office, imposed upon him fiduciary obligations. As the constitutional historian Robert Natelson explained in the Federalist Society Review, the “founding generation [understood] ‘high … Misdemeanors’ to mean ‘breach of fiduciary duty.’

Eighteenth-century lawyers instead used terms such as breach of trust—which describes the same thing. “Parliamentary articles of impeachment explicitly and repetitively described the accused conduct as a breach of trust,” Natelson argues, and 18th-century British legal commentators explained how impeachment for “high Crimes and Misdemeanors” was warranted for all sorts of noncriminal violations that were, in essence, fiduciary breaches.

why the discussion of Morris’s suggestion was so brief—the drafters knew what the words historically meant, because, as a House Judiciary Committee report noted in 1974, “at the time of the Constitutional Convention the phrase ‘high Crimes and Misdemeanors’ had been in use for over 400 years in impeachment proceedings in Parliament

Certainly Alexander Hamilton knew by the time he penned “Federalist No. 65,” in which he explained that impeachment was for “those offenses which proceed from the misconduct of public men, or, in other words, from the abuse or violation of some public trust.

What constitutes such an abuse or violation of trust is up to Congress to decide: First the House decides to bring impeachment charges, and then the Senate decides whether to convict on those charges. The process of impeachment by the House and removal by trial in the Senate is thus, in some ways, akin to indictment by a grand jury and trial by a petit jury

As Laurence Tribe and Joshua Matz explain in their recent book on impeachment, “the Constitution explicitly states that Congress may not end a presidency unless the president has committed an impeachable offense. But nowhere does the Constitution state or otherwise imply that Congress must remove a president whenever that standard is met … In other words, it allows Congress to exercise judgment.”

As Tribe and Matz argue, that judgment presents a “heavy burden,” and demands that Congress be “context-sensitive,” and achieve “an understanding of all relevant facts.” A president might breach his trust to the nation once in some small, inconsequential way and never repeat the misbehavior, and Congress could reasonably decide that the game is not worth the candle.

It’s also an appropriate mechanism, because the constitutional magic words (other than Treason and Bribery) that form the basis of an impeachment charge—high Crimes and Misdemeanors, found in Article II, Section 4 of the Constitution—mean something other than, and more than, offenses in the criminal-statute books. High Crimes and Misdemeanors is a legal term of art, one that historically referred to breaches of duties—fiduciary duties—by public officeholders. In other words, the question of what constitutes an impeachable offense for a president coincides precisely with whether the president can execute his office in the faithful manner that the Constitution requires.

there’s another reason as well. The people have a right to know, and a need to see. Many people have watched all of Trump’s behavior, and they’ve drawn the obvious conclusion. They know something’s wrong, just as football fans knew that the downed quarterback had shattered his leg. Others have changed the channel, or looked away, or chosen to deny what they’ve seen. But if Congress does its job and presents the evidence, those who are in denial won’t be able to ignore the problem any longer.

more significant, we are not very good at predicting who is likely to be dangerous in the future.

“Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

“Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the s

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group

But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Our journalism relies on our readers’ generosity – your financial support has meant we can keep investigating, disentangling and interrogating. It has protected our independence, which has never been so critical. We are so grateful.

2) He will say whatever feels most comfortable or good to him at any given time. He will lie a lot, and say totally different things to different people. Stop being surprised by this. While it’s important to pretend “good faith” and remind him of promises, as Bernie Sanders and others are doing, that’s for his supporters, so *they* can see the inconsistency as it comes. He won’t care. So if you’re trying to reconcile or analyze his words, don’t. It’s 100% not worth your time. Only pay attention to and address his actions.

He will have no qualms *at all* about stealing everything he can from the country, and he’ll be happy to help others do so, if they make him feel good. He won’t view it as stealing but rather as something he’s entitled to do. This is likely the only thing he will intentionally accomplish.

4) Entitlement is a key aspect of the disorder. As we are already seeing, he will likely not observe traditional boundaries of the office. He has already stated that rules don’t apply to him. This particular attribute has huge implications for the presidency and it will be important for everyone who can to hold him to the same standards as previous presidents.

5) We should expect that he only cares about himself and those he views as extensions of himself, like his children. (People with NPD often can’t understand others as fully human or distinct.) He desires accumulation of wealth and power because it fills a hole.

3) You can influence him by making him feel good. There are already people like Bannon who appear ready to use him for their own ends. The GOP is excited to try. Watch them, not him.

6) It’s very, very confusing for non-disordered people to experience a disordered person with NPD. While often intelligent, charismatic and charming, they do not reliably observe social conventions or demonstrate basic human empathy. It’s very common for non-disordered people to lower their own expectations and try to normalize the behavior. DO NOT DO THIS

7) People with NPD often recruit helpers, referred to in the literature as “enablers” when they allow or cover for bad behavior and “flying monkeys” when they perpetrate bad behavior

8) People with NPD often foster competition for sport in people they control. Expect lots of chaos, firings and recriminations. He will probably behave worst toward those closest to him, but that doesn’t mean (obviously) that his actions won’t have consequences for the rest of us. He will punish enemies.

9) Gaslighting — where someone tries to convince you that the reality you’ve experienced isn’t true — is real and torturous. He will gaslight, his followers will gaslight.

Learn the signs and find ways to stay focused on what you know to be true. Note: it is typically not helpful to argue with people who are attempting to gaslight. You will only confuse yourself. Just walk away.

10) Whenever possible, do not focus on the narcissist or give him attention. Unfortunately we can’t and shouldn’t ignore the president, but don’t circulate his tweets or laugh at him — you are enabling him and getting his word out.

“It’s throughout all the private schools here,” said DeAnsin Parker, a New York psychologist who treats many adolescents from affluent neighborhoods like the Upper East Side. “It’s not as if there is one school where this is the culture. This is the culture.”

The D.E.A. lists prescription stimulants like Adderall and Vyvanse (amphetamines) and Ritalin and Focalin (methylphenidates) as Class 2 controlled substances — the same as cocaine and morphine — because they rank among the most addictive substances that have a medical use.

merely giving a friend an Adderall or Vyvanse pill is the same as selling it and can be prosecuted as a felony.

While these medicines tend to calm people with A.D.H.D., those without the disorder find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward. “It’s like it does your work for you,”

But abuse of prescription stimulants can lead to depression and mood swings (from sleep deprivation), heart irregularities and acute exhaustion or psychosis during withdrawal, doctors say. Little is known about the long-term effects of abuse of stimulants among the young

the pills eventually become an entry to the abuse of painkillers and sleep aids.

“Once you break the seal on using pills, or any of that stuff, it’s not scary anymore — especially when you’re getting A’s,” said the boy who snorted Adderall in the parking lot. He spoke from the couch of his drug counselor, detailing how he later became addicted to the painkiller Percocet and eventually heroin.

“Children have prefrontal cortexes that are not fully developed, and we’re changing the chemistry of the brain. That’s what these drugs do

The number of prescriptions for A.D.H.D. medications dispensed for young people ages 10 to 19 has risen 26 percent since 2007, to almost 21 million yearly, according to IMS Health, a health care information company — a number that experts estimate corresponds to more than two million individuals.

Doctors and teenagers from more than 15 schools across the nation with high academic standards estimated that the portion of students who do so ranges from 15 percent to 40 percent.

“They’re the A students, sometimes the B students, who are trying to get good grades,”

“They’re the quote-unquote good kids, basically.”

After 30 minutes, the buzz began, she said: laser focus, instant recall and the fortitude to crush any test in her path.

“It wasn’t that hard of a decision. Do I want only four hours of sleep and be a mess, and then underperform on the test and then in field hockey? Or make the teachers happy and the coach happy and get good grades, get into a good college and make my parents happy?”

Madeleine estimated that one-third of her classmates at her small school, most of whom she knew well, used stimulants without a prescription to boost their scholastic performance. Many students across the United States made similar estimates for their schools, all of them emphasizing that the drugs were used not to get high, but mostly by conscientious students to work harder and meet ever-rising academic expectations.

Every school identified in this article was contacted regarding statements by its students and stimulant abuse in general. Those that responded generally said that they were concerned about some teenagers turning to these drugs, but that their numbers were far smaller than the students said.

This is one of the more vexing problems with stimulants in high schools, experts said — the drugs enter the schools via students who get them legally, if not legitimately.

Newer long-lasting versions like Adderall XR and Vyvanse allow parents to give children a single dose in the morning, often unaware that the pills can go down a pants pocket as easily as the throat. Some students said they took their pills only during the week and gave their weekend pills to friends.

She said many parents could push as hard for prescriptions as their children did, telling her: “My child is not doing well in school. I understand there are meds he can take to make him smarter.”

“These are academic steroids. But usually, parents don’t get the steroids for you.”

Asked if the improper use of stimulants was cheating, students were split. Some considered that the extra studying hours and the heightened focus during exams amounted to an unfair advantage. Many countered that the drugs “don’t give you the answers” and defended their use as a personal choice for test preparation, akin to tutoring.

One consensus was clear: users were becoming more common, they said, and some students who would rather not take the drugs would be compelled to join them because of the competition over class rank and colleges’ interest.

“Junior and senior year is a whole new ballgame,” the boy said. “I promised myself I wouldn’t take it, but that can easily, easily change. I can be convinced.”

It might also take some of the edge off the hatred many people feel for Trump. Seeing him for what he is—a terribly damaged soul, a broken man, a person with a disordered mind—should not lessen our revulsion at how Trump mistreats others, at his cruelty and dehumanizing actions.

Even now, almost a thousand days into his presidency, the latest Trump outrage elicits shock and disbelief in people. The reaction is, “Can you believe he said that and did this?”To which my response is, “Why are you surprised?” It’s a shock only if the assumption is that we’re dealing with a psychologically normal human being. We’re not. Trump is profoundly compromised, acting just as you would imagine a person with a disordered personality would. Many Americans haven’t yet come to terms with the fact that we elected as president a man who is deeply damaged, an emotional misfit

n analogy may be helpful here. If smoke is coming out from under the hood of your car, if you notice puddles of oil under it, if the engine is overheating and you smell burning oil, you don’t have to be a car mechanic to know that something is wrong with your car.

above all, accepting the truth about Trump’s mental state will cause us to take more seriously than we have our democratic duty, which is to prevent a psychologically and morally unfit person from becoming president.

Phomma is accused of deploying bear spray at police — the same kind of act alleged in some high-profile cases stemming from the Capitol riot, including charges unveiled Monday against suspects accused of assaulting a Capitol Police officer who later died, Brian Sicknick.

Defense attorneys, led by the federal public defenders’ office in Portland, have noted that the 1968 civil disorder law was dubbed the “Civil Obedience Act” by its main proponent, avowed segregationist Sen. Russell Long of Louisiana. The title appears to have been a deliberate swipe at civil rights leaders urging civil disobedience, such as Rev. Martin Luther King, Jr.

“Because Senator Long believed that criticism of white supremacy and demands for racial justice were bound to cause riots, he proposed the Civil Obedience Act as a tool to suppress such expression,” defense motions filed in several cases earlier this year argued.

It’s unclear whether Friday’s filing, submitted by lawyers from the office of the acting U.S. Attorney in Portland, Scott Asphaug, received such approval. Justice Department spokespeople did not respond to several requests Monday for comments on the brief.

About 40 of those defendants face, or faced, charges under the disputed statute.

Earlier this month, prosecutors dropped their case against Jesse Bates, a Seattle man accused of shooting firefighters with a ball-bearing wrist slingshot during a protest in Portland last July that occurred as a building burned nearby. The case against Bates was the first one where defense lawyers filed their motion challenging the civil disorder law.

Another civil disorder case in Portland was dropped last November, days after the presidential election. Prosecutors said a local court was addressing the matter.

That’s because the Capitol cases rely on language in the statute aimed at preventing interference with “any federally protected function,” but the cases from last year’s unrest establish federal jurisdiction by claiming the crimes took place during protests that interfered with interstate commerce.

While defense lawyers argue that Congress could only regulate activities that have a “substantial” impact on interstate commerce, prosecutors say a minimal impact on commerce from the civil unrest is sufficient to employ the law and the individual defendant’s actions don’t have to have had any direct impact on commerce.

One of the first of last year’s wave of civil disorder cases to reach sentencing was that of Abdimanan Habib, a Fargo, N.D., resident who admitted to throwing rocks at police and attempting to ignite an alcohol-filled bottle during unrest that followed racial justice protests in that city last May.

missing just one night of sleep impairs memory.

an impaired mind focuses “on negative information when making decisions.”

losing out on as little as 16 minutes a night could have serious negative impacts on job performance.

When we delay or speed up our internal body clock, it can have the same consequences as not getting enough sleep, a phenomenon known as advanced sleep-wake phase disorder.

“The reason is that our circadian rhythm tells our brain when to produce melatonin, our sleep hormone, so if you try to wake while your brain is still producing melatonin, you could feel excessive daytime sleepiness, low energy, decline in mood and cognitive impact,”

“There are a handful of people who can function adequately on a shorter sleep duration than the average person, but it’s very, very rare,

Missing even two hours here, an hour there, then having a wildly different sleep pattern over the weekend, is the gateway drug to chronic sleep deprivation.

you may be able to adjust your schedule

If you get less than seven hours a night, you can put on weight, since sleep loss can adversely impact energy intake and expenditure. That’s because, in part, the chemical that makes you feel full, leptin, is reduced, while ghrelin, the hunger hormone, increases

chronic sleep loss can increase the amount of free fatty acids in the blood.

People with sleep issues may also be at higher risk for depression and anxiety, while those disorders can also interfere with sleep.

The National Sleep Foundation recommends sticking to a sleep schedule. It won’t happen right away, and you’ll have to build and buy back your debt

Set a goal and regular bedtime, and turn your bedroom into a comfortable, dark, sleep-friendly area. That could mean blackout curtains, maybe a sleeping mask or earplugs.

et your body wake you up, a key to regaining natural circadian rhythm

Reading before bed, something Bill Gates and Arianna Huffington swear by, relaxes the mind

Forty-five percent claimed they were so worried that they struggled to function on a daily basis, the definition of an anxiety disorder.

“climate change might not necessarily increase mental health issues because people might adapt over time, meaning that higher temperatures could become normal and not be experienced as anomalous or extreme.”

yes. Before the media began reporting on putative temperature records—the scientific evidence for which is also weak—heat waves were treated as a normal part of summer. Uncomfortable, but figuratively nothing to sweat about.

according to a World Health Organization report last year, the very “awareness of climate change and extreme weather events and their impacts” may lead to a host of ills, including strained social relationships, anxiety, depression, intimate-partner violence, helplessness, suicidal behavior and alcohol and substance abuse.

A study in 2021 of 16- to 25-year-olds in 10 countries including the U.S. reported that 59% were very or extremely worried about climate change, and 84% were at least moderately worried

The Bloomberg article cites a July meta-analysis in the medical journal Lancet, which found a tenuous link between higher temperatures and suicides and mental illness. But the study deems the collective evidence of “low certainty” owing to inconsistent study findings, methodologies, measured variables and definitions.

Displacement is a maladaptive mechanism by which people redirect negative emotions from one thing to another

These anxieties are no more rational than the threats from climate change are existential.

A more apt term for such fear is climate hypochondria.

The New Yorker magazine earlier this month published a 4,400-word piece titled “What to Do With Climate Emotions” by Jia Tolentino, a woman in the throes of such neurosis

Ms. Tolentino goes on to describe how climate therapists can help patients cope. “The goal is not to resolve the intrusive feeling and put it away” but, as one therapist advises her, “to aim for a middle ground of sustainable distress.” Even the climate left’s despair must be “sustainable.”

there’s nothing normal about climate anxiety, despite the left’s claims to the contrary.

Progressives may even use climate change to displace their other anxieties—for instance, about having children

“First and foremost, it is imperative that adults understand that youth climate anxiety (also referred to as eco-anxiety, solastalgia, eco-guilt or ecological grief) is an emotionally and cognitively functional response to real existential threats,” a May 10 editorial in the journal Nature explained. “Although feelings of powerlessness, grief and fear can be profoundly disruptive—particularly for young people unaccustomed to the depth and complexity of such feelings—it is important to acknowledge that this response is a rational one.”

Climate hypochondriacs deserve to be treated with compassion, much like anyone who suffers from mental illness. They shouldn’t, however, expect everyone else to enable their neuroses.

Second, the legislature apparently decided that voter concerns about crime and disorder were nothing to worry about. After three decades of falling crime, Democrats had gotten complacent and disconnected, and failed to recognize that the bail reforms they passed in 2019, eliminating cash bail for most misdemeanors and nonviolent felonies, were deeply unpopular.

Fair or not, the Republican message was quite simple: Bail reform passed by Democrats in Albany had created a wave of crime and disorder.

Instead, in the face of crime rates rising some 30 percent in New York City, Democrats mostly denied that there was a crime problem on the scale that Republicans portrayed in frequent campaign ads. To the extent that Democrats acknowledged the growing disorder at all, they argued that there was no data showing that bail reforms affected crime — a claim at odds with the desire of many voters for stronger public safety, including locking up potentially dangerous people and giving judges the ability to consider dangerousness in making bail decisions.

Sadly there is little evidence that Democratic leaders in Albany heard the alarm bells ringing on Long Island or saw the Adams victory in the city as a path forward.

the changes were too little and too late, and voters were unconvinced. New York remains the only state in the nation where in setting bail, judges cannot take into account whether a person arrested for a crime is a danger to the community

Remaining insulated from swing voters is a luxury that most members of the legislature enjoy because so many of them represent overwhelmingly Democratic districts in which elections are decided in low-turnout primaries.

Unfortunately for Democratic planning, in 2014 voters had passed an amendment to the state’s Constitution that was designed to prevent just this kind of extreme gerrymandering.

It set about drawing a congressional map that so blatantly overreached that a court struck it down, threw it out and turned the process over to a special master instead who drew a map that gave Republicans every opportunity to exploit Democratic failures around crime and disorder.

As a result, Democrats lost six congressional districts won by Joe Biden in 2020 — more than in any other state in the nation.

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone. 

Soon after my arrival at the Transgender Center, I was struck by the lack of formal protocols for treatment. The center’s physician co-directors were essentially the sole authority.

At first, the patient population was tipped toward what used to be the “traditional” instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl. 

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

Drunkorexia addresses the need to be the life of the party while staying extremely thin, pointing to a flawed mind-set about body image and alcoholism among college students, mostly women.

why would a promising college freshman choose this unhealthy pattern? It’s probably not a choice, but mental health and addiction issues mixed together. Studies show that having a preexisting eating disorder or alcoholism are predictors of drunkorexia

surveys from colleges range widely: One report concluded that 34 percent of all students surveyed had engaged in this behavior; another said 81 percent of students who drink heavily had

Others suggest that Trump shows indications of sociopathy, including lack of empathy, absence of guilt and intentional ma­nipu­la­tion. Put it all together and you have “malignant narcissism,” which includes antisocial behavior, paranoid traits, even sadism.

“Mr. Trump’s sociopathic characteristics are undeniable,” retired Harvard psychiatry professor Lance Dodes concludes. “They create a profound danger for America’s democracy and safety. Over time these characteristics will only become worse, either because Mr. Trump will succeed in gaining more power and more grandiosity with less grasp on reality, or because he will engender more criticism producing more paranoia, more lies, and more enraged destruction.” And when the president stands before the U.N. General Assembly and threatens to “totally destroy” an enemy country of 25 million people, enraged destruction seems on point.

Allen Frances wrote the criteria for narcissistic personality disorder used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and he doesn’t think Trump qualifies.

In “Twilight of American Sanity,” Frances says the diagnosis requires the patient to experience significant distress because of his condition. But throughout his life, Trump “has been generously rewarded for his Trumpism, not impaired by it,” Frances writes. “Trump is a threat to the United States, and to the world, not because he is clinically mad, but because he is very bad.”

Frances’s judgment proves even more damning. He trashes Trump as a “secular antichrist,” a “two-bit, would-be Mussolini,” even an instrument of divine vengeance. “If you were assigned the task of punishing humanity for its original sins,” he thunders, “you could do no better than invent a Donald Trump and give him extraordinary power.”

Kurt Andersen is here to tell us that America has featured magical thinking and nutty impulses for centuries. Thanks to our mix of religiosity and Enlightenment values — plus the do-your-own-thing vibe of the 1960s and the super-powered distribution channel known as the Internet — Americans have developed a “promiscuous devotion to the untrue,”

On Thursday, the agency said that it considered the vaccine safe, although it would continue to watch for any connections to blood disorders.

“Right now we are examining whether this is the exact same disease picture with multiple blood clots, a low count of platelets and hemorrhages,” Tanja Erichsen, a director at the Danish Medicines Agency

This is the second death in Denmark after a person was given the AstraZeneca vaccine. Norway is examining the deaths of two people who received the vaccine.

Some of the continuing caution has been driven by preliminary findings from medical experts in Norway and Germany that suggested a possible link between the vaccine and the extremely rare blood disorders.

Dr. James Bussel, an expert on platelet disorders and a professor emeritus at Weill Cornell Medicine, said the occurrence of abnormal clotting and low platelets in people under 50 is uncommon.

Researchers in both Germany and Norway will continue investigating and in Germany, where the vaccine is again being administered, doctors are now warning anyone receiving an AstraZeneca shot to see a doctor immediately if they have headaches, dizziness or blurred vision more than three days afterward.

"The medical evidence is clear: access to medication-assisted treatment, including buprenorphine that can be prescribed in office-based settings, is the gold standard for treating individuals suffering from opioid use disorder,"

The administration's move comes at a time when the U.S. is again facing record levels of drug overdose deaths, according to the Centers for Disease Control and Prevention.

More than 83,000 people died of drug overdoses in the U.S. in the 12 months ending in June 2020, the CDC said.

"As emergency physicians, we see every day the devastating effects that the opioid crisis has had on the communities we serve—a crisis that has unfortunately only worsened during the COVID-19 pandemic,"

The American Medical Association also praised the move, saying it will allow earlier intervention by doctors treating patients suffering addiction.

"With this change, office-based physicians and physician-led teams working with patients to manage their other medical conditions can also treat them for their opioid use disorder,"

Harris also said allowing doctors to treat opioid addiction as they treat other medical conditions, without additional regulatory hurdles, will reduce the stigma that has often shaped the healthcare response to substance use disorders.

doctors who possess a Drug Enforcement Administration registration will still be limited to treating no more than 30 in-state patients with buprenorphine for addiction treatment at any one time.

The guidelines are not considered a new law or federal regulation, making it very easy for the President-elect Joe Biden administration to walk back this policy if so desired. Giroir told Stat News that he thinks that scenario is unlikely, saying, "I doubt it seriously."

Autor, Kearney and others whose work I will go on to discuss offer analyses and explanations of contemporary social dislocation that serve to reveal the oversimplification and the striking omissions in the work of social conservatives, who often fail, to give one crucial example, to account for the impact of mass incarceration.

Many factors have contributed to the income stagnation in the bottom tiers and the overall increasing inequality in the United States. Paramount among these are changes in the economy that have placed a greater premium on college-educated workers, advances in technology and the offshoring of manufacturing jobs to lower-wage countries. One can hardly understand the impact of these dynamic contributing structural factors to our rising inequality by focusing almost exclusively on so-called changes in the values of the American population

We need to address the underlying premise that there is a rise in social disorder. That claim does not hold up to scrutiny, in both the long and short term. In the United States and many other parts of the world, the last two decades have seen a remarkable decline in many of the most visible signs of social disorder.

You can see that many of these improvements in the quality of life have coincided with the creation of the modern liberal welfare state and many of place that enjoy the least social disorder are, in fact, places with leftist political systems that provide for social welfare.

Uniquely among major socioeconomic groups, the white working class decreased in absolute numbers and population share in recent decades. At the same time, the five measures of well-being we tracked all deteriorated for the white working class relative to the overall population. The shares of all income earned and wealth owned by the white working class fell even faster than their population share.

the white working class — the segment of the population with the weakest ties to, if not outright animosity toward, liberalism, feminism and other liberation movements — has, in recent years, experienced the strongest trends toward social decay.

While five decades ago, many on the left denounced the 1965 Moynihan Report, “The Negro Family: The Case For National Action” for “blaming the victim” because of its description of rising numbers of nonmarital births in the black community, there has been a striking reversal in favor of the report in the academic and liberal policymaking community.

“The broad-based decline that is unique to the white working class may be due in part to the group’s loss over time of advantages it once enjoyed relative to those of nonwhite working classes,”

These included more years of education and plentiful high-paying jobs available in white working class communities. And, as the explicit discrimination minorities faced in the workplace has diminished, so has the advantage that it had given the white working class.

. In an email, she wrote:My read of the evidence is that the declining economic position of less educated men (both in a relative and absolute sense) has probably been a key driver of the breakdown of the two-parent family among less educated populations for many decades.

The most telling critique of the claims of social conservatives is that their single-minded focus on the destructive forces of liberalism offers a facile (and erroneous) answer to developments that do not fit simple categories of good and evil

Some people believe that humans are born good and are only later corrupted by society. They emphasize the importance of a society that collectively helps each individual achieve their inherent potential. Others believe that individuals are inherently flawed, often ill-disciplined, weak-willed, and capable of evil as well as good. They emphasize the importance of social structures that help people, in the words of Edmund Burke, “to put chains upon their appetites.”

Under current conditions of stark political polarization, these two sides are at loggerheads. Sawhill argues that:What a functioning and tolerant politics would permit is a negotiated settlement of this dispute. We would devise institutions and norms but also laws and practices that bring out, in Lincoln’s famous words, the “better angels of our nature.”

the willingness to accommodate the opposition — an essential step toward compromise and reconciliation — appears modestly stronger on the left than the right.

While in absolute terms the white working class — those without college degrees, in pollster shorthand — have higher levels of marriage and cohabitation, homeownership and self-reported health ratings than members of the black working class, the trends are downward for whites and upward for African-Americans.

Similarly, “The Moynihan Report Revisited: Lessons and Reflections after Four Decades,” edited by two liberal scholars, Douglas S. Massey and Robert J. Sampson, sociologists at Princeton and Harvard, found that the trends toward family breakdown documented in the report “have only grown worse, not only for blacks, but for whites and Hispanics as well.” The authors were sharply critical of the attacks on Moynihan from the left that had appeared when the report was first published.

Patrick Deneen, whose book received near unanimous praise from conservative critics, defines the “culture war” that has characterized recent decades, and which seems to grow more virulent daily, in implacable terms: “Democracy, in fact, cannot ultimately function in a liberal regime.”

Barr, in turn, argues thatin the Framers’ view, free government was only suitable and sustainable for a religious people — a people who recognized that there was a transcendent moral order antecedent to both the state and man-made law and who had the discipline to control themselves according to those enduring principles.

The reality is that Barr is not only selling traditional values to conservative voters, some of whom are genuinely starved for them, he is also marketing apocalyptic hogwash because, for his boss to get re-elected, Trump’s supporters must continue to believe that liberals and the Democratic Party are the embodiment of evil, determined to destroy the American way of life.

The secular left, in Barr’s view, is at war with what he views as a decent America:This is not decay; it is organized destruction. Secularists, and their allies among the “progressives,” have marshaled all the force of mass communications, popular culture, the entertainment industry, and academia in an unremitting assault on religion and traditional values.

“Democracy, in fact, cannot ultimately function in a liberal regime.”

Nearly three quarters of the child and adolescent population in Pakistan experienced learning difficulties after widespread floods devastated the country in 2010.

For many young people, worry over threats of future climate change results in panic attacks, insomnia, obsessive thinking, and other symptoms

And those feelings are often amplified by a pervasive sense that older people aren’t doing enough to fix the climate problem. “There’s a feeling of intergenerational injustice,” says Lise Van Susteren, a general and forensic psychiatrist based in Washington, DC, who specializes in the mental health effects of climate change. “Many young people feel invalidated, betrayed, and abandoned.”

Research on effective interventions is virtually nonexistent, and parents and other people who want to help have little to go on. Professional organizations are only now beginning to provide needed resources.

News reports and researchers often refer to these feelings collectively as climate anxiety, or eco-anxiety, but Pinsky admits to having misgivings about the terms.

“Many people interpret anxiety as a pathological response that needs to be treated and solved,” she says. “But it’s also a constructive emotion that gives us time to react in the face of danger. And anxiety in the face of climate change is a healthy response to a real threat.”

others become progressively hyperaroused and panicky, Pinsky says, or else fall into a sort of emotional paralysis

Some people manage their climate-triggered emotions without spiraling into distress

These reactions can be especially debilitating for people who already struggle with underlying mental health disorders.

anxieties over climate change can interlace with broader feelings of instability over the pace of technological and cultural change,

“Technology is accelerating faster than culture can keep up, and humans in general are unmoored and struggling to adapt,” she says. “For some people, climate change is psychologically the last straw. You realize you can no longer count on the stability of your planet, your atmosphere — your very world.”

Van Susteren describes that anxiety as a type of pre-traumatic stress disorder, with few existing precedents in the United States apart from fears of nuclear annihilation and the decades-ago experience of living through classroom drills on how to survive an atom bomb attack.

Talk therapy for anxiety typically aims to help people identify and replace irrational thoughts, called cognitive distortions, with alternative thinking that isn’t so stressful. But since climate anxiety is based on rational fears, this particular approach risks alienating anyone who might feel their worries are being dismissed.

Younger people were increasingly arriving at Bryant’s office frightened, depressed, and confused about how to manage climate-triggered emotions. Some were even wondering if they should bring children into such a world.

“We’re not saying that anxiety is good or bad,” he says. “We just want to bring those feelings out into the open. It’s more about validating that climate concerns are reasonable given what we’re reading in the news every day.” Ann-Christine Duhaime

Emerging evidence suggests that young people do best by cultivating a sense of agency and hope despite their climate concerns.

getting to that point involves talking through feelings like despair, grief, or rage first. Without doing that, he says, many people get stuck in maladaptive coping strategies that can lead to burnout, frustration, or hopelessness. Bryant describes jumping into an urgent, problem-focused coping strategy as “going into action mode so you don’t have to feel any grief.”

Problem-focused coping has a societal benefit in that it leads to “pro-environmental behavior,” meaning that young people who engage in it typically spend a lot of time learning about climate change and focusing on what they can do personally to help solve the problem

But climate change is far beyond any one person’s control, and problem-focused coping can leave people frustrated by the limits of their own capacity and make them unable to rid themselves of resulting worry and negative emotions

she and her colleagues describe emotion-focused coping, whereby young people ignore or deny climate change as a means of avoiding feeling anxious about it. In an email, Ojala notes that people who gravitate toward emotional distancing typically come from families that communicate about social problems in “pessimistic doom-and-gloom ways.”

Ojala

Ojala and other experts favor a third coping strategy that balances negative feelings about climate change with faith in the power of social forces working to overcome it. Called meaning-focused coping, this approach takes strength from individual actions and climate beliefs, while “trusting th

her societal actors are also doing their part,”

since meaning-focused coping allows negative and positive climate emotions to coexist, young people who adopt it have an easier time maintaining hope for the future.

The overall goal, she says, is for young people to achieve more resilience in the face of climate change, so they can function in spite of their environmental concerns

When people find meaning in what they do, she says, they have a greater sense of their own agency and self-efficacy. “You’re more empowered to take action, and that can be a powerful way to deal with strong negative emotions,”

Duhaime cautions that anyone taking action against climate change should know they shouldn’t expect a quick payback

The brain’s reward system, which forms a core of human decision-making, evolved over eons of history to strengthen neural associations between actions and outcomes that promote short-term survival. And that system, she says, responds to the immediate consequences of what we do. One problem with climate change, Duhaime says, is that because it’s so vast and complex, people can’t assume that any single act will lead to a discernible effect on its trajectory

young people may benefit from seeking the rewards that come from being part of a group or a movement working to advance an agenda that furthers actions that protect the planet’s climate. “Social rewards are really powerful in the climate change battle, especially for young people,

Recognizing the mismatch between how the brain processes reward and the novel challenges of the climate crisis may help people persist when it feels frustrating and ineffective compared to causes with more immediately visible effects. Even if you don’t see climate improvements or policy changes right away, she says, “that won’t diminish the importance of engaging in these efforts.”

Malits adds that she wasn’t overly burdened by her emotions. “I’m an optimist by nature and feel that society does have the capacity to make needed changes,” she says. “And what also helps me avoid climate anxiety on a daily basis is the community that I’ve been lucky enough to connect with here at Harvard. It helps to surround yourself with people who are similarly worried about these issues and are also engaging with you on solutions, in whatever capacity is meaningful to you.”

“Climate anxiety is an important catalyst for the work I do,” Malits says. “I think you need avenues to channel it and talk about it with loved ones and peers, and have communities through which you can process those feelings and come up with remedies.” Collaborative activism dampens the anxiety, Malits says, and gives young people a sense of renewed hope for the future. “That’s why it’s important to roll up your sleeves and think about how you’d like to tackle the problem,”

Malits says she worries most about how climate change is affecting marginalized communities, singling out those who live in urban heat islands, where inadequate green space intensifies extreme heat.

nearly 30 percent of Honduras’s population works for the agricultural sector, where rising temperatures and drought are contributing to a mass exodus, as documented that year by PBS NewsHour.

Researchers are finding that young people with the most extreme fears over climate change live predominantly in the developing world. The Philippines and India, for instance, are near the top of a list of recently surveyed countries where young people report climate-driven feelings that “humanity is doomed” and “the future is frightening.”

Nearly a year after Hurricane Andrew struck South Florida in 1992, 18 percent of children living in the area were still struggling with PTSD-like symptoms, and nearly 30 percent of those who lived through Hurricane Katrina in 2005 wound up with complicated grief, in which strong feelings of loss linger for a long time.

Even when people are not uprooted by disaster, a variety of climate-related mechanisms can affect their mental health or the safety of their mental health treatment. High heat and humidity worsen irritability and cognition, he points out, and they can also exacerbate side effects from some common psychiatric medications

Levels of lithium — a mood stabilizer used for treating bipolar disorder and major depression — can rise to potentially toxic concentrations in a person who is perspiring heavily; they can become dehydrated and  may develop impaired kidney funtion, potentially causing tremor, slurred speech, confusion and other dangerous effects

“I believe the fundamental and best treatment for youth climate distress is a rapid and just transition from fossil fuels,” Pinsky says. “I genuinely consider all that work to be in the area of mitigating climate anxiety.”    

The systems and social media making teenagers sad, angry and afraid today were shaped in part by adults who grew up sad, angry and afraid themselves.

Nearly 1 in 3 high school girls reported in 2021 that they had seriously considered suicide

Teen girls reported the highest ever levels of sexual violence, sadness and hopelessnes

Rates of bullying were increasing in the state even in 2018, and researchers at Drake University found some forms of it significantly correlated with feeling sad or hopeless and attempting suicide.

One in 5 — nearly 53 million people — had a mental illness in 2020, ranging from anxiety to depression to bipolar disorder.

Yes, social media delivers concentrated, addictive stress to developing minds that were held captive by the pandemic. No, logging off TikTok and returning to school will not fix the problem — because each teen’s life ricochets off family, friends and neighbors with struggles of their own in a polity with troubles of its own.

“Increasing the sense among all students that they are cared for, supported, and belong at school” is one, as is growing access to mental health and substance use prevention services for kids and their families and health education classes to teach teens to manage their boundaries and emotions and to ask for help. These positive practices build resilience.

can we acknowledge the weight this puts on underpaid teachers and part-time counselors and nurses? People who, if they haven’t already burned out, are practicing active-shooter drills, catching students up on 18 months of lost learning and ensuring kids have enough food to concentrate in class.

A school’s four walls cannot hold back the trauma of society as well as, perhaps, the personal nightmare waiting for kids at home.

Which brings us to the adults

Solutions start with compassionate, radical honesty: American kids are unwell because American society is unwell.

Nearly 28 million adults had an alcohol use disorder.

As many as 3 in 100 people will have a psychotic episode in their lives

we, too, need a sense that we are cared for, supported and belong.

As kids, 61 percent of adults in the United States experienced abuse or neglect, grew up with poverty, hunger, violence or substance abuse, experienced gender-based discrimination and racism or lost a parent to divorce or death.

If not you, then someone you know is doing their best to stitch up those invisible wounds.

Here’s more hope: Brains wired by toxic stress, such as the sexual violence that 1 in 10 teen girls are facing today, have the ability to essentially heal when exposed to positive experiences.

Good nutrition, adequate sleep, mindfulness practices all help. Adults as well as children have neuroplasticity, and family resilience and connection are positive influences.

In some precincts, Mr. Esposito noted, most enforcement activity, like ticket writing, occurred when officers were paid time-and-a-half overtime, instead of during their regular workweek. “It’s a question as to why they can see activity when they are being paid overtime as opposed to not being able to see activity when they are on straight time,” Mr. Esposito testified.

A 2010 state law forbids the department from retaliating against officers for not making a certain minimum number of street stops. But Mr. Beirne testified that performance goals did not violate that law. “My feeling was that the supervisors or the department could set performance goals for employees,” Mr. Beirne said. “Whether they be numerical or not was not an issue.”

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So long as your polity offers mechanisms for eventually changing unjust laws, it’s better to accept the system’s basic legitimacy and work within it for change than to take steps, violent or otherwise, that risk blowing the entire apparatus up.

A vote for Trump is not a vote for insurrection or terrorism or secession. But it is a vote for a man who stands well outside the norms of American presidential politics, who has displayed a naked contempt for republican institutions and constitutional constraints, who deliberately injects noxious conspiracy theories into political conversation, who has tiptoed closer to the incitement of political violence than any major politician in my lifetime, whose admiration for authoritarian rulers is longstanding, who has endorsed war crimes and indulged racists and so on

It is a vote, in other words, for a far more chaotic and unstable form of political leadership (on the global stage as well as on the domestic) than we have heretofore experienced

what is striking is how many conservatives seem to have internalized that reality and justified their support for Trump anyway, on grounds that are similar to ones that the mainstream pro-life movement has rejected for four decades: Namely, that Hillary Clinton would usher in some particular evil so severe and irreversible that it’s better to risk burning things down, crashing the plane of state,

It is constitutional conservatives arguing that permitting another progressive president would make the Constitution completely irrecoverable, so better to roll the dice with a Peronist like Trump.

It is immigration restrictionists arguing that Clinton’s favored amnesty for illegal immigrants would complete America’s transformation into Venezuela, so better to roll the dice with a right-wing Chávez.

It is a long list of conservatives treating an inevitable feature of democratic politics — the election of a politician of the other party to the presidency — as an evil so grave that it’s worth risking all the disorders that Trump obviously promises.

the Trump alternative is like a feckless war of choice in the service of some just-seeming end, with a commanding general who likes war crimes. It’s a ticket on a widening gyre, promising political catastrophe and moral corruption both, no matter what ideals seem to justify it.

today’s conservatism has far more to gain from the defeat of Donald Trump, and the chance to oppose Clintonian progressivism unencumbered by his authoritarianism, bigotry, misogyny and incompetence, than it does from answering the progressive drift toward Caesarism with a populist Elagabalus.

the deepest conservative insight is that justice depends on order as much as order depends on justice

when Loki or the Joker or some still-darker Person promises the righting of some grave wrong, the defeat of your hated enemies, if you will only take a chance on chaos and misrule, the wise and courageous response is to tell them to go to hell.