Trending topic in therapy sessions: Trump anxiety

Donald Trump, in Aston, Delaware County, Sept. 13, 2016. Therapists throughout the Philadelphia region confirmed that, for the first time in their careers, clients are so upset about politics that they're willing to pay to talk about it.

Nancy Kirsh started seeing a therapist a few months before her husband died of cancer in September.  There was already plenty to process, but, lately, she's wanted to talk about something else: President Trump.

She feels the country's core values  are under attack as she watches the new president in action.  "Everyone I know is really rocked to their core," said Kirsh, a retired health-care executive in Rydal. Her sense of disbelief reminds her of how she felt about her husband's leukemia.

"Having been so close to someone whose life was winding down and who was just declining before my eyes, wasting away, is very hard," said Kirsh, 66.  "That process is similar to what I see happening to our country."

Her therapist, she said, told her she's not alone.  Therapists throughout the region confirmed that, for the first time in their careers, clients are so upset about politics that they're willing to pay to talk about it.  Patients are not coming in specifically because of the election, but are talking about it as an added source of distress. Some physicians also report that patients are having physical symptoms of anxiety such as chest tightness and gastrointestinal distress.   

Some disconsolate voters have insomnia and a dark, permeating sense of fear and powerlessness.   They're reading obsessively about what the new administration has been up to, and they foresee worse to come, especially regarding the rights of minorities and immigrants.   Mostly, this is coming from disappointed Democrats, who are, after all, more common in this blue region. Triumphant Trump supporters have largely been quiet, therapists said.  But people on both sides of the political chasm have expressed concern about family dissension.  Depending on the dominant views in a family, anyone can feel drowned out and disrespected.

"No matter what I'm working on with a client, this comes up," said George James, a licensed marriage and family therapist at Council for Relationships.

"I have been through many election cycles over the course of my career and there has never been political conversation," said Tamar Chansky, a psychologist in Philadelphia and Plymouth Meeting who specializes in anxiety.  "Prior to this, I would not have known their political affiliation."

Dan Hartman, a psychiatrist who is vice president and medical director for outpatient behavioral health services for Holy Redeemer Health System,  said anxiety has been "notably more present" since the election. He's recently adjusted some medication doses upward.

"I had more people crying in my office the day after the election than honestly I've had since the day after 9/11," he said.  People calmed down some after that, but the new administration's frenzy of activity has renewed the "anger, fear, and sadness."

David Becker, a cardiologist in Flourtown, has seen two patients with chest tightness that was not heart-related.  "I've been feeling this since the election," one patient told him.  Others have come in with higher blood pressure, which can be triggered by stress.  Some patients talk about anxiety and insomnia, he said. In 27 years of practice, Becker has not seen this kind of reaction to an election.  He's seeing more upset women than men.  "People from Mount Airy seem to be much more upset than people from Roxborough," he said.

 Unfortunately, Becker said, there's no easy way to tell the difference between Trump anxiety and a heart attack.  If you're experiencing chest tightness, have a doctor check it out.

He added that not everyone is nervous. "I've seen other people that are just giddy with happiness," he said.  "They're sleeping just fine."

Seth Kaufer, a Philadelphia gastroenterologist, said some of his patients are worried that they'll lose their health insurance. "When people are stressed, they get a lot more gastrointestinal symptoms, especially with irritable bowel," he said. People also were stressed about losing doctors under Obamacare, he added.

Kaufer himself is optimistic and excited.  He is a Republican ward leader and Trump supporter.   His views have cost him some Facebook friends.  He wishes people were more willing to give Trump a chance.  "I know there's a lot of silent people that support us.  It takes a lot of courage ... to go out there and be a Trump supporter," he said.

"Almost in a way, coming out as a Trump supporter is like coming out as a gay man."  Kaufer has done both.

Char Kurland, a longtime liberal, is used to being that happy-go-lucky person who smiles all the time. She is a semiretired clown —  stage name Chaku the Children Chuckler.    Now, she's waking in the middle of the night and feeling tense all day, under a "constant cloud" that is new to her. It doesn't help that she is Jewish and married to a woman, which became possible only three years ago after a relationship that has spanned more  than two decades.  Even when she disagreed with past leaders, she felt they were intelligent. They read and talked to experts before they made decisions. She questions that now.

"This is like a pitchfork in everybody's heart," said Kurland, 72, of Dresher. "I'm having terrible anxiety.  ...  I'm having trouble believing there's a future.  That's horrible to think, but I'm really scared."

Kyle Holsinger, clinical director and co-owner of Delaware County Professional Services, said reactions to the political situation give therapists a chance to talk about communication skills, empathy, and handling conflict. Vince Bellwoar, CEO of  Springfield Psychological, which has about 105 clinicians,  said his therapists told him some patients are feeling retraumatized or reminded of family abusers by the new president's tone.  Again, it can lead to a better discussion.

Psychologists said the topic of how to approach clients with opposing political views is coming up on professional message boards.  Therapists need to "stay as objective as possible whether someone wants to gloat or cry," said Holsinger, whose practice employs 60 therapists.

As for what will help all these newly or more anxious people, therapists recommended taking care of yourself. Eat and sleep well.  Exercise. Chansky is a fan of practicing gratitude.

The trend toward activism  is likely good for most people, they said.   It counteracts that feeling of powerlessness.  Volunteering to help refugees or in another cause you care about might also help.  All suggested talking about feelings with someone who understands.

You may need a therapist, Holsinger said,  if the anxiety starts interfering with your life.  Ask yourself  if these statements are true:  "Family members are starting to tell me something's the matter.  People at work are asking me if I'm OK."

Many recommend limiting exposure to disturbing information, especially before bed.  Bellwoar  said one of his therapists tells clients to turn off devices 90 minutes before bedtime. 

Rick Conforto, clinical director of Springfield Psychological, promotes mindfulness meditation. He also asks patients, "The more you worry about all this, does it fix the problem?"

Keith Anderson, a pastor at Upper Dublin Lutheran Church, thinks it could ease pain on both sides if people worked on finding common, middle ground.  He arranged for an expert on facilitating difficult conversations to come to the church's monthly "God on tap" meeting at an Ambler brew pub last week.  She taught the diverse crowd about reflective listening, Anderson said,  and urged them not to jump to the question "Why?"  That puts some people on the defensive.  "What" and "how" questions can be less threatening.

"It really did help us to have a more open conversation about it," Anderson said.