Opinion: Polarized Politics Is Straining Mental Health, and Patients Increasingly Want Therapists Who Share Their Views

A psychiatrist, Elisa Brietzke, says she has never talked about politics with her patients as much as she has in the past two years. What caught her off guard was the change in the questions. Patients stopped raising politics in the abstract and began asking what she personally thought: about COVID-19 controversies, about Donald Trump's mental health, about freedom of speech, the Black Lives Matter movement and neutral pronouns.

Brietzke, writing in an opinion piece, describes a world in which politics has become hard to avoid. Twenty-four-hour news, social media hashtags and endless campaigns surround people, and many are drawn into the arguments themselves. Taking part in decisions that affect a community is healthy, she writes. But a significant number of people, in her view, let political stress get so far under their skin that it makes them ill.

She points to a 2019 study in which almost 40 per cent of Americans said politics was a source of significant anxiety, insomnia and even suicidal thoughts. The effect was strongest among people who were young, politically engaged or opposed to the government. Ongoing exposure to political stress, she notes, has been associated with a higher risk of anxiety and depression, poorer lifestyle choices and a decline in general medical health.

Part of the problem, she argues, is polarization. A relevant share of the population now sits near the extremes of the liberal-conservative spectrum, and social media algorithms seem to amplify voices from those extremes. COVID-19 arrived in a society already divided, and partisan identity shaped how people saw the pandemic and, in turn, whether they followed measures such as masks, lockdowns and vaccines. A 2020 American study found that conservatives were more likely to say the pandemic was getting too much media coverage and that people were overreacting. Liberals were more likely to say the government was not doing enough to contain the spread.

Given all that, she writes, it was only a matter of time before political stress reached the offices of psychotherapists, psychiatrists and other mental health workers. Since 2019, she says, the political climate has had an unexpected and overwhelming effect on psychotherapy patients. Politics has been at the centre of multiple sessions in a way that, for some therapists, has not been seen since 9/11.

Patients increasingly want to know where their providers stand. A recent American study of 604 Democratic and Republican patients found that two-thirds said they talked about politics with their therapists. Those who believed their therapist shared their political orientation reported a better therapeutic alliance. Another study found that 87 per cent of therapists discussed politics with patients in sessions, and 63 per cent said they disclosed their own views to some degree, more often when they saw patients as sharing those views.

Brietzke warns that the combination of a health crisis and political division affects mental health directly and can also feed extremism. She says it is not yet known whether political stress harms health the way other forms of chronic stress do, and she calls for deeper, systematic research. Mental health professionals are not immune to the animosity either, she adds, since patients whose views differ sharply from their own could make care harder.

Her conclusion is practical: clinicians need training in recognizing and managing political stress, and the field needs evidence-based strategies for dealing with it. Brietzke discloses funding from FAPESP, CAPES, CNPq and Queen's University's Faculty of Health Sciences, and honoraria from Daiichi-Sankyo and Janssen-Cilag.