What can be done to mitigate these effects? What should governments do?
What lessons can be drawn from the Great Depression, the 2008 Great Recession, and the 1918 Spanish Flu pandemic?
And why do people in lower socioeconomic strata appear to be disproportionately affected by COVID 19?
In this episode, we sit down with Dr. Roger McIntyre, a Professor of Psychiatry and Pharmacology at the University of Toronto who heads the Mood Disorders Psychopharmacology Unit in Toronto’s University Health Network. He’s also the CEO of AltMed and President of the Canadian Rapid Treatment Center of Excellence.
This is American Thought Leaders 🇺🇸, and I’m Jan Jekielek.
Jan Jekielek: Dr. McIntyre, so great to have you on American Thought Leaders.
Roger McIntyre: Thanks for having me, what a pleasure.
Mr. Jekielek: Recently you wrote a paper that is about to be published, which speaks to something that’s really been on my mind and on the minds of a lot of our viewers. Your paper is titled “Projected Increases in Suicide as a Consequence of COVID-19”. We have essentially shut down the economies of most free countries at the moment to deal with COVID-19, or CCP virus, as we call it, and a lot of people are wondering, is the cure worse than the disease? For example, we have the highest unemployment numbers in memory in the US, and there are a lot of consequences of that. Your paper caught my eye. Tell me what you are thinking.
Dr. McIntyre: … For several decades, I have been reflecting on the relationship between economics and brain health, specifically suicide. I’ll really narrow it down a little bit. We know, from many lines of research conducted for decades, that there is a mixed relationship between social determinants, which includes aspects of macroeconomics and general well being, such as medical illness and mental illness. I can say this as a representation of the world of academia. People in academics like to carve their little nation and talk to certain issues and relationships. In summary, what we can say is that the relationship between economics, more specifically changes in the economy like recessions or depressions, and physical health, like heart disease, diabetes, and respiratory diseases, is a bit of a mixed relationship. This is a long conversation that is wonderful for a tutorial class at a university for a three hour in-depth discussion.
But what is unequivocal is the relationship between economic hardship and suicide. Suicide is not a mental disorder; it is an act that is horrific for the families and people around these people. It is an act that serves as a proxy of mental distress. In other words, more than 85 percent of people who commit suicide have a diagnosable mental disorder.
The COVID-19 reaction has called for global social isolation or physical distancing. No matter what we call it, social isolation, quarantine (which is a different concept than social isolation), and the orders to stay at home and don’t go to work is, in my view, the biggest assault on mental health ever recorded.
I say that for a couple of reasons. We have many factors here that form a horrifying combustible myth. We are seeing the unemployment numbers change on a weekly basis. Starting March and early April, now up to 16 million people have applied for unemployment. We have heard from the labor bureau that there is a contraction of the labor market already. This alone is disquieting. Along with that, there is economic insecurity. There is job security and economic insecurity, which are overlapping but different. All the while, we’re asking people to stay at home to be quarantined.
Now, if we take history as a lesson and look at the Great Recession 10 to 12 years ago, the Asian financial crisis in ’97 and ’98, and the Great Depression back in the late 1920s, there is a lot that we can learn. Firstly, we see that unemployment as a macroeconomic indicator, is powerfully associated with suicide. This has been described by epidemiologists, sociologists, and psychiatrists. It is a well accepted and well established relationship.
Let’s bring it closer to today. Between the years 2007 and 2009, the Great Recession in the United States saw an increase of roughly four percentage points in the overall unemployment rate. What was observed during that time was a proportional increase in suicide. A 1 percent increase in unemployment, was associated with a 1 percent increase in suicide.
Looking across to Europe, there were many different economies in Europe that were affected by the great recession, which makes it an interesting laboratory. Because of political regimes in place, some governments had different types of approaches to the recession. Some were very neoliberal; others were more conservative. There were different approaches. And it provided us an opportunity to look at various relationships. The key with this theme of unemployment and suicide, is that they also observed it in Europe across many countries. In Europe, an increase of about 1 percent in the unemployment correlates with an increase of 1 percent in suicide. So we have European and North American data because Canada was also included.
So I woke up, as we all did a few weeks ago, to this pandemic and saw that everything was happening very quickly. We have a projection rate. Janet Yellen recently said she thinks it is going to be about 13 percent. Miguel Castro from the Federal Reserve Bank of St. Louis last week reported up to as high as 35 percent unemployment. We don’t know what the percentage will be exactly, but it is going to be very significant. This is from a starting point of just less than 4 percent, so taken together, we can expect a significant increase in suicide.
As I have watched the government’s approach to this, I think there have been areas of strength with how they have handled this. In terms of communication, we can discuss to what degree the communication has been clear, but there has been communication. There has also been an effort to provide services at the point of care, etc. That is of course warranted.
What I am concerned about is what economists call externalities and the negative externality. This isn’t just a biomedical threat, this is an economic threat and a mental health threat.
We have just completed the article that you made reference to which is now in press. We went with different assumptions in our analysis. Unfortunately, in the United States, the increase in suicide that really accelerated during the recession, did not slow down and kept going up and up. We have seen an increase in suicide by 30 percent in the last 15-20 years in the US. So we took data from the Department of Labor and suicide statistics from the Center for Disease Control, and we built a model with certain assumptions about trends and so on. We went with two different models. What would be the increase in suicide if the unemployment rate is 5 to 10 percent, versus for example, 15-20 percent? What we found was very concerning and in keeping with the model. With a 1 percent increase in unemployment there is a 1 percent increase in suicide for the first five to seven percentage points. After that, it gradually levels of, so point 1 percent corresponds to .9 percent, and then, point .8 percent corresponds to .7 percent.
This translates into up to as high as 8,000-10,000 excess deaths due to suicide. For me, I’ve been very concerned about the unintended consequences of that, because that is the economic and mental health part, which has not been part of the conversation. At least not for most people, but some of the politicians and some of the officials are speaking to it, which is what provided the impetus for us to do this analysis.
Mr. Jekielek: That is extremely fascinating. It immediately begets the question of mitigation, and how to deal with this right? Is there a way to deal with this? This prediction will probably be true to some extent at least, whether or not the projections are exactly right. Is there anything that can be done while people are still isolated?
Dr. McIntyre: The isolation piece is a key part. At the end of the day, we will need an exit strategy; people will need to return back to their lives. Quarantine is a hazard to brain function in and of itself. Let me give you an example of that. In Toronto, outside of Asia, we were the city most affected by the SARS epidemic back in 2003. We had 44 people in Toronto who lost their lives because of SARS. One thing we learned from the SARS experience was that this was a direct stress, especially for frontline workers as we are seeing today, but quarantine in and of itself is a stressor, too.
Quarantine in and of itself predicted whether people went on to have problems like depression or post-traumatic stress or started to abuse alcohol. So the quarantine part is something we are going to have to deal with very thoughtfully. The notion of just staying at home and then getting back later does not resonate well with brain function. The literature in animal science and in human science shows that if we have a chronic stressor, then that is bad for our mental and physical health. If we have a chronic stressor that is unpredictable, then that is even worse. So we need to have a clear exit strategy for mental health.
Let’s go back to the Great Depression. In the 1930s, [President Rosevelt’s] New Deal spending increased. Some very careful analysis that was done revealed that the cities that spent the most in the 1930s on welfare programs such as wage subsidy, unemployment, and health care, were the cities that had the lowest suicide rates. In Japan, during the Great Recession, for every 1 percent increase in GDP spending on health care and social services, there was a commensurate decrease in suicide of about 0.2 percent. This was also seen in Europe. It has been replicated.
Spending money is not the solution. Spending money thoughtfully on wage subsidy, helping people in terms of tax obligations, forbearance, obligations, forgiving and so on [will help], but also, in this situation, which was also seen during the Great Recession, we are going to need money invested towards work retraining, because many of these jobs, especially the face-to-face economy, are not coming back after this situation is finished.
Your question is critical. How do we handle this while we are quarantined? Well, part of this relates to security. What we have learned about the relationship between economics, employment, and suicide, is that there is a intermediary, which is the person. There is a difference between losing your job or losing your source of income versus not knowing if you’ll get a job again and not knowing when the next dollar is going to come. In the last two weeks, the University of Michigan published data on consumer sentiment, showing that confidence is going down. No surprise. I think it is important to have regular communication by public officials. Federal, state, and municipal officials should speak frequently to the public about strategies – of course presented in speech that we can all understand – that will provide income, money to pay the bills, and income security. This is a critical thing that will be helpful for us as we are sitting at home.
I call all those strategies social resiliency enhancement. There are things that we can do for our general well-being, such as sleeping well, getting exercise, dieting better, and drinking alcohol in moderation. That is important for general well-being and security. That all matters. But I do think that at this stage, societal input is going to be really important as well. I think it is also important to state that like many things in life, there is intention, and then there are unintended consequences.
There was a wonderful analysis published recently from MIT in the Federal Reserve, looking back at the pandemic of 1918, which really was longer than 1918 and went through 1920. During the so-called Spanish flu or the influenza pandemic that took place in America, it was estimated that between 500,000 and 750,000 people lost their lives during that time. This wonderful analysis that came out of MIT and the Federal Reserve, recently showed that those cities in the United States during that pandemic that had the earliest and most aggressive social distancing/isolation and stay at home orders not only had the lowest mortality, but also had the fastest and most robust economic rebound. Quarantine has a positive intention. It spares us from exposure to the virus, and it could have implications for getting the economy back faster, but there are unintended consequences. The longer this goes on for, the greater economic and job insecurity there will be. That is what leads to suicide in our analysis. That is exactly what we have done.
Mr. Jekielek: Aside from being a professor of psychiatry, you are also a professor of pharmacology. I have been advising people against drinking, but there have been instances where people are saying that drinking heavily will help you not get COVID-19. As I understand it, drinking actually impairs the immune system. Can you comment on that briefly?
Dr. McIntyre: That is correct. It has been very difficult for states and other jurisdictions to manage what is considered an essential service. Is alcohol an essential product? This is a discussion that is probably going to be reflected on much more deeply after this crisis is done. Alcohol is an immunosuppressive, and it is bad for the immune system. Moreover, people who drink alcohol often engage in other behaviors that further adversely affect your immune system, for example, smoking cigarettes and so on.
You probably know that in the US and UK, there has been by some reports a 50 percent to 75 percent increase in the last four weeks of alcohol purchasing at the retail level. It is very concerning that we are seeing that. When you go back to history’s lessons from previous economic recessions, you do see an increase in alcohol, especially impulsive, binge drinking. That is associated with suicide. I think it’s important that people drink in moderation.
It is interesting because many public officials have been asked recently, “What’s the rationale for allowing people to buy alcohol?” Some states have had mixed messages on this, but some people have said, “The reason is that we have people in our population who abuse alcohol, and if it is not available to them, that would precipitate a withdrawal, and then require emergency room visits which would take up beds that we need for COVID-19.” That is a fairly linear way of connecting dots.
Certainly, I appreciate that there is a delicate managing act politically when it comes to this issue, but certainly nowhere in my medical training did I learn that for people who have a serious alcohol problem, the provision of whiskey is the ideal treatment. I did not learn that in my training. I think we need to be a little bit facetious on one level, but also very careful. I think that we need a bit of frankness on the topic. If the government is indeed wishing to facilitate the access not to precipitate withdrawal, but utilize hospital services, it would seem to me that we should at the same time be providing support services for people who abuse alcohol. That makes sense to me. So the short answer to your question is that alcohol is an immunosuppressant.
Mr. Jekielek: I want to jump back to the need for communication that you talked about earlier as one of the mitigation strategies. The President of the United States is doing briefings pretty much every evening these days. What would mitigation look like? How could people feel more secure in spite of these issues?
Dr. McIntyre: The daily reports from the White House Coronavirus Task Force are touching on key aspects that address some of the areas of concern. I am hearing comments around the provision of immediate funding not just for the people but also for small businesses. People say that small businesses are the engine of the economy. That is true. It is also a vaccine against mental illness. Going to work is not just a paycheck, it is often your only support network, your identity, and your structure. I think hearing [about immediate funding] almost every single day is great. I am also hearing about how the funding is being made available vis-a-vis employment and unemployment, as well funding being made available for larger corporations. What I’m hearing is really important.
I have also been really pleased to hear that during these White House Coronavirus Task Force press conferences, they are speaking about suicide and depression. I am actually genuinely perplexed as to why we don’t hear this more. I’m so pleased that this issue is being spoken about, because people sitting at home are distressed and insecure, and it’s going to help them if they hear their leaders say that they are going to have money available, saying things like “Give us your bank account. We are going to try and get it to you tomorrow. We’re going to try and speak to your employer, your local sandwich shop, your local grocery store.” They are also recognizing that suicidality, depression, and alcohol are serious issues. We want to end this as soon as possible. I think that is all the checkmarks, and I have been very pleased to hear that.
I am especially pleased to hear that there is an exit strategy. For reasons I’m not clear about, I don’t hear as many public officials in other countries, including Canada, talking about the exit strategy. It is a false choice choosing between isolation and getting the economy back. As you said, we don’t want the cure to be worse than the disease.
What is especially concerning and something that dovetails into what I started off with is the economics and how long this is going to go on for. If we had 10 economists on the show today, we would probably get 20 opinions as to what is going to happen with the economy in the next two or three years. The point is that we don’t have an agreement. Last time I checked, no one can predict the future. What we are seeing is a consensus that the notion that our immediate rebound will be a victory does not seem likely. It’s going to take a little while to come back. Who knows, but the gist of this is that it is going to take a while.
Academics are very good at getting lost in all the theory, but sometimes you just have to be concrete. How confident will you be going to the movies two months from now or sitting in economy class, flying with all your pals squeezed in there? I think common sense has to prevail. People are not going to be confident doing that. I think it is reasonable that the consumer sentiment is going to be adversely affected for a while.
Another thing that makes this an interesting assault on the economy is that this assaulted the supply side immediately. Businesses shut down, and that is going to eventually affect the demand side. That is quite opposite to what happened during the Great Recession, where the demand side was immediately effective. My point is that the demand side of the economy is going to be slower to warm up here. That comes back to the individual. They are thinking, “I’ve lost my job, or I might lose my job, and how am I going to pay my bills? I’ve just signed up for a mortgage, how am I going to do this?” My point is that this is going to go on for a while.
I’m pleased to hear that the White House Task Force is speaking to the key social interventions that were shown through the Great Recession and the Great Depression to be effective. As well, they are speaking to the distress that people are experiencing, and they’re also speaking about an exit strategy. I know that the political officials are being hammered on whether or not it is safe to be talking about an exit strategy. That question is missing the point. We need an exit strategy, because the brain does not react well to uncertainty. So whether the exit strategy is April 10th, 20th, 30th, or May 15th, we need an exit strategy. For some reason, discussion of the exit strategy seems to have become taboo. I’m not even sure why that is. It is so critical for mental health, suicide, and distress related to this event.
Mr. Jekielek: That’s incredibly fascinating. I’ve never heard this perspective before, but it is incredibly valuable, and I suppose, helps inform a little bit of the strategy behind what’s going on in the administration.
Dr. McIntyre: I know there’s a lot of different polls and so on that the White House is trying to do. I don’t think the President’s job is one that anyone would ever envy, but I think as a leader, you need to provide hope. As a leader, you need to surround yourself with people who have expertise in the decisions, and I’m seeing that.
As a leader, you need to speak to the person’s experience. Not people who work on Wall Street, not people who’ve got the jobs at the higher end of the socioeconomic scale; they’re just fine. They’re at home right now playing games with the kids, and life is fine. Their bills are paid. It’s the face-to-face economy, people in the lower end of the socioeconomic strata that don’t have the privilege of staying at home. They are distressed, and many of them have lost their jobs. The leader should speak to that experience, and I think that is what we are seeing from this taskforce. I’ve been very pleased by it.
I know that people are debating some of the details and so on, but that’s not the point. The human experience needs structure. It needs certainty and it needs safety, safety from infection and immediate harm and also financial safety, employment safety, and we need safety for the future. I’ve been hearing at least the effort to speak to that from this taskforce.
Mr. Jekielek: Dr. McIntyre, this is incredibly interesting. Certainly offering a different perspective than I’ve been considering. One thing I’m wondering if you could clarify is the supply and demand side of the economy.
Dr. McIntyre: We all know capitalism rests on the seesaw of supply and demand, and we know that there needs to be a balance of the two for the economy to thrive and do well. In simple language, because of COVID-19, companies and various agencies were told to shut down by government law. Manufacturing and retail had to shut down, so the supply of goods immediately stopped. That’s called the supply assault.
In the short term, people still have savings from the last paycheck, which unfortunately is not a lot. They are hearing from the government, “We’re going to take care of you,” but of course that can go on forever. People have enough to make the bills over the next couple of weeks or so. Let’s say the government gives the green light for all the companies to open next week. What will happen is people will go out and they will demand goods, which are often essential goods, but because many of them lost their jobs, they are now going to be in a position where they are not going to demand the goods as much. Because many of these jobs have been lost and are not coming back, the time to recover the demand side is going to take quite a bit of time.
Again, I don’t know how this is going to be, but I find it hard to believe that there’ll be a sudden return in the economy. I think it’s going to be a longer time for the consumer to come back, and this is different than the Great Recession. In the Great Recession, because of the mortgage situation that took place, and the loss of personal wealth because the value of their home being lost, etc. the end result was people lost a lot of money. There was the demand aspect that was the first part to it at that time. Here in this situation, we have this supply side that was immediately assaulted, and then we have the demand side, which is going to be assaulted over the next little while as people get back.
Now, there is one point of reassurance. We have been hearing this over and over again from economists and some of the business experts: there’s a lot of liquidity out there. Said differently, there is a lot of cash. This was not a structural problem that led to this collapse of the economy. This was a government shutdown of everything because of the virus. Companies are still sitting on a lot of liquidity, and there is a lot of liquidity available. So many experts in the area believe that companies will get up and going right away since there is liquidity to help them.
That does not, however, speak to the demand side. Most of the economy is consumer driven. It is a demand economy. If people don’t feel good about it, or literally don’t have any money, then the economy can’t keep going. That will spread the recession longer and continue to hazardously effect well-being, notably suicide statistics, depression, alcohol, and trauma-related disorder.
Mr. Jekielek: You talked with me when we were speaking offline about some of the successful mitigation strategies of some European countries following the Great Recession in 2008 and 2009. Some of them were better off, some of them were less well off. Can you speak to that a little bit?
Dr. McIntyre: Europe is a great laboratory to look, because the economies of Europe are desperate, not just with respect to the size of the economy, but the political structures. Some of these countries are older, and some of them are not as old.
We can look at Europe, maybe in two different ways. You can look at those countries in Europe that are known for the percentage of the GDP that goes to social programs. So they are more liberal type governments. People think of Scandinavian countries: Finland, Norway, Sweden, and others. But those are the ones we always think about as the exemplars. And then other countries went with more of an austerity approach post-Great Recession. We think about countries like Greece and Italy. There is this sort of unaffectionate acronym, PIGS: Portugal, Italy, Greece and Spain.
The data is pretty clear on this, looking at the trajectory. Some economies in Europe post-Great Recession in 2009 – 2012 spent more as a percentage of their GDP on programs like work retraining in the labor market (which is getting people to be retrained for other jobs), providing health services, expanding mental health service opportunities, instead of a six month extended to one year employment insurance eligibility, providing bridge-funding for small businesses to keep going. Those types of revisions were associated with a decrease in suicide.
What is interesting about this, and what I think is so compelling, is that mitigation of suicide did not always go hand-in-hand with the decrease of unemployment. We talked about the 1 percent rule, which is that a 1 percent increase in unemployment in the US, Canada, and Europe, was met with a 1 percent increase proportionately in suicide. The countries in Europe that spent more money on these social programs were able to some degree, reduce unemployment. But the decrease in suicide far exceeded what would have been expected by the reduction in unemployment.
Other countries, for example, the unaffectionate acronym that I mentioned Portugal, Italy, Greece and Spain, continue until now to have staggering unemployment rates and very high suicide rates. These rates continue to be very high in many of these countries. I think that is empirical evidence. Again, this extends into Japan around the Great Recession. It has also been seen that as the Shinzo Abe government post Great Recession increased the spending on some of these programs that I mentioned, there was a commensurate decrease in suicide in Japan. We can conclude that it does work. In other words, we can conclude that if the spending is thoughtful, and targeting mental health resiliency and climate finances, that translates into a decrease in suicide. I think those lessons can be brought here.
Some people have asked me how that explains the USA, because during the Great Recession, America saw this massive increase in unemployment of about 4 percent, we call that massive, in fact that seems puny now. We saw 3 percent to 4 percent increase in suicide in some states more than others, but what happened in the United States is the economy got better and unemployment went down, but the suicide rate kept going up.
That probably speaks to other aspects that confound the model. For one, the opioid epidemic, which has ravaged America the last decade. That’s a big issue. Wealth inequality is probably speaking to some of this as well. Then, thirdly, what’s different about America versus other countries, is that 50 percent of all suicides in the US are committed with a gun. So perhaps we didn’t have in the US, sufficient policies and procedures in place for protections around guns. In other words, people can still have guns, but measures should be in place to reduce the risk with guns in their possessions.
Mr. Jekielek: You mentioned that the people in the lower socioeconomic spheres are disproportionately affected by the stopping of the economies, so to speak. There is also a lot of literature now suggesting that similarly, they are also more affected by getting COVID-19. I’m wondering if you could speak to that as I’m sure you have seen some of this.
Dr. McIntyre: History has shown over and over again that whenever there’s an economic crisis and whenever there are pandemics, some groups are affected more than others. These are not mutually exclusive, and they can overlap, but consistently, what we see is that the people most affected are people who are of lower socioeconomic advantage, people who have mental illness, as well as people who are either immigrant and or certain racial groups. We are hearing, for example, in the state of Louisiana, that the mortality rate due to COVID-19 is significantly higher than many other states were being told. The observation that African American individuals are more susceptible to mortality from COVID-19 is perhaps in part due to the fact that [the African American] population is also more likely to have overweight obesity, diabetes type 2, cardiovascular disease, or smoke cigarettes. All of this can be contributing because the inability to breathe is a major risk factor for mortality and complications from COVID-19.
Everything that I just mentioned, that is some of these non-communicable diseases, heart disease, obesity, diabetes, as well as the behavior of smoking is also the case for people with chronic mental illness. So approximately 40 percent of all cigarettes smoked in the United States, are smoked by someone who has a mental illness. When we think about the mentally ill, they are more likely to have conditions that put them at risk of a COVID-19 complication. They also are more likely to be economically impoverished, have housing insecurity, and they are less likely to have sufficient interpersonal supports in place to help them. Again, this would extend into our immigrant population.
There is no question that these factors are being observed. No surprise. This is always observed where the lower socioeconomic, mentally ill, and immigrants, which are different populations but have some degree of overlap in that Venn diagram, are folks that are often affected.
That segues into something that I think we need to be very cautious about. When you look at the Gini index, which is a measure of income inequality, a score of zero on the Gini index means that there’s no inequality. Everyone is even when it comes to the wealth distribution. A score of one means that one person or one group has all the money, and everyone else has nothing. When you look across the 36 wealthy nations of the OECD, most of these countries come in somewhere between 0.2 and 0.6. The country that probably has the highest reported Gini index is often South Africa with 0.7, meaning extreme wealth inequality.
The point I want to get at is that if we think about wealth distribution in America, and in other OECD nations globally, we have empirical evidence to show that it is not proportionate. And whenever you have a crisis of this magnitude, often many governments become very much bigger. Bigger government is one consequence of these types of situations. There is one other consequence of something like this that we need to be cautious about. This doesn’t amplify the gap between the haves and have nots. People who are in the brain capital economy like finance, science, technology, and math, folks who have those types of positions, are not as nearly as affected as people who are in the face-to-face economy, including retail, and manufacturing. That could potentially amplify. We have examples of further wealth inequality. That not only has implications for the well-being of our citizens, but also has implications for democracy, because the literature is clear that the greater the wealth inequality, the more it undermines democracy.
Mr. Jekielek: Are you suggesting that there should be some kind of stimulus? I hate to use this word because stimulus usually means throwing a trillion dollars at something right? How about stimulating manufacturing and these core industries or the face to face economy somehow that are disproportionately affected?
Dr. McIntyre: I do [think we should take action], and you are right, words matter. The word stimulus has a valence to it that gives people indigestion. This is my view, and I know that many share this view: if there has been malfeasance or been inappropriate behavior that a company has done, and now they are in financial distress, I don’t believe in the privatization of the profit with the socialization of all their problems. I don’t think that’s a fair deal. I think corporations should enjoy the profits they deserve, but should not be actually asking the taxpayer to pay for their nonsense.
This is not what happened here. In fact, the economy was doing very well on the statistics that we define it on. We know that there are some groups that were clearly not doing as well, but on the macro numbers, the economy was doing very well. The government by law shut them down. Yes, the corporations are making a profit, but they’re also putting money into the 401K’s for people and giving people jobs, which is good for their mental health.
I don’t like the word stimulus. I’m not sure I have the right vocabulary to replace that very radioactive word with something more perhaps neutral, but I think some type of bridge to get the doors back open again makes good sense. I don’t think that’s socialism. I don’t think that is against the guiding principles of capitalism. I think that this is really warranted given what has happened.
Mr. Jekielek: Let’s talk a little bit about what you can do at home. In a sense, I’m lucky because I’m in an essential industry, and you are too, so I’m working. In fact, I have had more work recently, because there is so much that needs to be reported on at this time. A ton of us are not in this situation, as I have just described. What should we be doing at home? I was just talking with a good friend of mine who put her whole heart into suddenly discovering the concept of homeschooling. Basically she’s very busy now as are many parents, but again, that is not everyone’s situation. What is it that you recommend for people?
Dr. McIntyre: First of all we are talking about the difference between how these types of stressors affect different parts of our society. There is a part of our society that will take a disproportionate weight. That is not to imply that people who have high paying jobs are not also under stress. These are people, and they have their lives to live. I think the first job of the day is to take care of your own health and take care of your family’s health. That is essential. Many people are so darn successful, because they work all the time, and this is also very difficult for them. This is a significant adjustment, and they’ll need to adapt, because if you don’t adapt, you’re going to maladapt.
It’s an interesting time because people are discovering for the very first time that they had neighbors. They are discovering for the first time there is a house next door to their house. If you have a major bankruptcy, major loss of consumer confidence, major loss of consumer sentiment as a consequence of something like this, everybody loses. Everyone loses not just from an economic perspective, but capitalism also takes a hit, and obviously, society takes a hit. So I’ve been really inspired by what I’m seeing.
I’m seeing a lot of private public partnerships that have unfolded, which takes leadership in the corporate sector with different organizations, not just providing N95 masks and NPP and things like that. That’s wonderful when we need that, but also being very thoughtful around taking care of people with prospective laws of social distancing, and the extent to which people can involve themselves in a broader social mission [is essential].
Jack Welch died recently, and he certainly was well known for his emphasis on profit, but also the emphasis on purpose. I think those are not mutually exclusive, and I think this is a wonderful time to be thinking about broader purpose and to take care and get involved with people. I have been seeing and hearing all kinds of stories that people are doing just that, and I think that it is a win for all of us. I’ve been quite impressed at how much I’ve been seeing this, for example, corporations are working together and also working with the public sector. For the most part, partisanship has been put aside, and we are all working together.
In the world that I work in psychiatry, there have been many great emissaries who have talked about fulfillment in life, and the generativity and the sense of accomplishment you have when you fulfill. Materialistic acquisition and conspicuous consumption are certainly very validating but don’t often lead to fulfillment. Sometimes it does, but it often doesn’t, and these [community] contributions can for many people add to the sense of fulfillment, along with other pursuits in their life.
Mr. Jekielek: Dr. McIntyre, you mentioned that you’re seeing a bit of reduction of partisanship or polarization. I have to say, where I stand in the media, looking at the Beltway, DC, and New York, looking at my Twitter feed daily, I’m not really seeing that.
Dr. McIntyre: When I say production and partisanship, I’m referring to the stimulus agreement that took place, and there was wide agreement on that. I’m also a pharmacologist, and we talk about half-lives. The half-life may be very long, in terms of the goodwill, but we are probably going to see a resurgence of the partisanship. I think it’s still there. I don’t think it’s completely abrogated at all.
We are going to see it, and that is unfortunate, because frankly I think that some of that partisanship is getting in the way of some of the public policy. What I mean by that is, we have been talking about how important it is to quarantine for a finite period of time with an exit strategy. It’s also important to emphasize exit strategy and getting people back to work.
In passing, I mentioned that work is a vaccine. Work builds resilience against mental illness. Literature is clear on that concept. For reasons unclear to me, but my working hypothesis is that it is because of partisanship, [the coexistence of work and health] is not coming into the conversation. It is somehow this false choice: either you have to either believe in the health of Americans or believe in the economy. That makes no sense to me. Those clearly have to go together.
I think this rhetoric reflects the partisanship. I do think the partisanship is still there. We saw a little reprieve for a while with that passive stimulus, but I do think it’s still there, and I think it’s affecting this discourse. It has adversely affected the discourse. I would like to see the exit strategy, and specifics for how this economy is going to be protected, and I want to see specifics on how mental health will be protected. That conversation seems to be either not taking place or strangulated with accusations that you don’t care about people. Well, again, that is a false conversation. So I think partisanship is still there, but I would hope that some goodwill would continue. Unfortunately, I am not so confident that it will.
Mr. Jekielek: Should I be studying my Twitter as much as I do? I’m asking this because of some of the literature you and I talked about earlier. Tell me what you think about that.
Dr. McIntyre: … During a time of quarantine and social distancing, you want to connect. It’s called being a human being. And you want to have information. We learned from the SARS epidemic that accurate information reduces anxiety, but like most things in life, you have to have moderation to this.
We found in research that we did in China in the last month, that the more time you spend on social media, the more likely you’re going to be reporting yourself as depressed, anxious, stressed out, and having a very negative quality of life. This is not just some outlier study; this is a highly replicated finding before COVID-19. The more time you spend on social media, the more likely you’re going to report all of the things I just mentioned, all these negative outcomes, as well as more likely to report yourself as lonely.
We have had a loneliness epidemic going on for a long time in Europe and North America and as well as in Asia. People often say to me “Wouldn’t it be the other way around? Isn’t it that people who are more anxious, stressed, and lonely go on social media more?” Well, there are ways that we can look at that, and I won’t get into all the details, but the direction seems to be that a moderate exposure to most things in life is probably what’s best, including social media. People at the extreme spending three, four or five hours a day on social media definitely begin to report a downturn in their well-being, a downturn in their overall positive outlook of life, and absolutely become more likely to report negative expectations of their life and their future.
Mr. Jekielek: I hope everyone that’s watching makes a point of listening to this, because I imagine that most of us are spending more time than normal on social media, so this is such valuable information. We are actually going to finish up in a moment. Any final words before we do?
Dr. McIntyre: We have been hearing a lot about flattening the curves, and we need to flatten curves as soon as possible. We also need to prevent curves. What I mean by preventing curves is not only the return of the virus, but also the emergence of suicide, and the emergence of conditions that are highly associated with suicide, like depression and alcohol related problems.
Secondly, we have had experience in recent years where we’ve been able to learn that direct funding to building social resilience, like you and I talked about, really benefits our citizens and reduces some of these complications that I’ve talked about. Where we go from here is as follows: we not only need a biomedical approach to this virus, we need to have an economic strategy, work strategy, and a mental health strategy. That all goes together. We’re seeing hints of it, but if we can instantiate it, I think we can mitigate some of these awful projections of suicide that my study is suggesting is going to come out of this COVID- situation.
Mr. Jekielek: Right. Have all these strategies and also communicate them effectively. That’s what I’m hearing. Such a pleasure to speak with you today, Dr. McIntyre.
Dr. McIntyre: Thank you for having me.