Almost 20 Years Ago, a Mid-Career Psychiatrist Started Thinking About Climate Anxiety and Mental Health

In the early years, Dr. Lise van Susteren, a psychiatrist, struggled to find anyone in the therapy community receptive to exploring the ways in which climate change was affecting mental health in America.

With that in mind, she and Kevin Coyle, vice president for education at the National Wildlife Federation, organized the first meetings on climate and mental health back in 2009 that brought together representatives of the Centers for Disease Control, the Department of Defense, the National Institutes of Health and the American Psychological Association, among others. Notably absent was the American Psychiatric Association, which declined an invitation to the inaugural event.

Van Susteren, now 73, had met Coyle three years prior when he made a presentation at the first Climate Reality Project training. She was among the first 50 people trained at Al Gore’s climate crash course for the nation’s thought leaders, where she realized that though extensive research was underway on the ecological effects of climate change, no one was studying what it was doing to human mental health. 

She had spent a good part of her career by then deeply immersed in the study of anxiety, depression, neuroses and psychosis, but most people still perceived climate change at the time as more of a looming threat, and van Susteren was only beginning to delve into how people would process that. 

“On a good day, I’m angry,” says van Susteren. “Being angry is actually one of the healthiest emotions that you can have. On a bad day, I’m depressed and cynical. In between, I’m anxious, and I don’t mind the anxiety, because I usually find something productive to do with it.”

Productive, indeed. She went on to help found the nation’s two large professional associations for climate-conscious therapists, the Climate Psychiatry Alliance and the Climate Psychology Alliance-North America, and a directory of practitioners from both groups. She’s served as an expert witness in three high-profile Our Children’s Trust cases, co-authored a global youth climate distress survey based on data from 10,000 kids in 10 countries and is now raising money for a free public repository of information on climate and mental health modeled after Wikipedia called Ecopsychepedia. 

“On a good day, I’m angry. Being angry is actually one of the healthiest emotions that you can have.”

Nathan Bellinger has been at Our Children’s Trust for almost as long as van Susteren. He has watched as she absorbed the testimony of countless children and helped them find words for the injustices they faced. She even coined the phrase “institutional betrayal” to help codify the emotional response when a trusted organization, like a school, church or government, which is designed to protect you, knowingly takes harmful action. “Lise is able to come in and listen to their testimony and really validate their injuries and harms and tie them into the scientific literature, just like we do with other types of injuries for plaintiffs,” Bellinger said.

Fascinated by Scars

Van Susteren’s journey to the climate movement began after her work as a professor of psychiatry at Georgetown University and as a consultant profiling world leaders for the Central Intelligence Agency, a period in which she came to know something about delusional thinking. 

The sister of cable television personality Greta van Susteren, she watched in the early 2000s as the Bush administration confidently banned federal funding for stem cell research without any scientific knowledge to back up their decisions. 

When she realized, during the second Iraq war, that troubled psychology, conspiracy thinking and a herd mentality were getting in the way of rational decision making with hundreds of thousands of lives at stake, she entered the Democratic Senate primary in her home state of Maryland.

Though she lost to Ben Cardin, during a campaign brunch she met William McDonough, author of Cradle to Cradle: Remaking the Way We Make Things. His message of a circular economy and sustainability resonated with van Susteren. 

Andrea Ronhovde, a former colleague of van Susteren, had been central to her campaign and seen how profoundly Cradle to Cradle affected van Susteren. When Ronhovde heard Al Gore on NPR announcing his Climate Reality Project, she immediately called van Susteren. “She said, ‘Lise, you have to apply for this!’ And I had this epiphany, like I think this is going to change the course of the rest of my life,” said van Susteren. 

Thanks in part to her political savvy and media acumen, she was selected for the first cohort. She then met Coyle of the National Wildlife Federation at the former vice president’s farm in Tennessee, where the Project training was hosted. Van Susteren soon joined Coyle on the federation’s board.

As she began her climate immersion, she initially focused on the overall effects of a warming planet on human health. But her focus pivoted to mental health when Coyle, who later became the NWF’s CEO, suggested, “‘Why don’t you focus on the mental health aspects?’” she recalled. “Kevin said, ‘There’s a certain alchemy that takes place when you get bright and enterprising people together in a room.’”

Van Susteren had always been fascinated by scars. She began college at the University of Wisconsin, but fell in love with France while traveling and decided to finish out her education in Paris. As a young surgical resident in Paris, van Susteren’s mentor, plastic surgeon Raul Tubiana, specialized in reconstruction after burns. She too thought she would make her home in the operating room, but it has been decades since she held a scalpel. 

She sees her work in psychiatry as a natural transition from there, “the scars a plastic surgeon leaves are visible, the ones the psychiatrist leaves are not.” One thing that has stuck with van Susteren throughout her career is the idea that to begin repairs, you must first understand the damage. 

With that in mind, she and Coyle organized the inaugural Washington meeting on climate and mental health. It brought together members of the Centers for Disease Control and Prevention, Department of Defense, National Institutes of Health and American Psychological Association, among others. As a psychiatrist, she was disappointed, but not surprised, that the American Psychiatric Association chose not to participate.

Van Susterren had long felt that most psychiatrists and to a lesser extent psychologists at the time engaged in “an ivory tower intellectualization” of their professions. She attributed it to a “misguided” belief that involvement in social issues contaminated their professional impartiality. 

 “And of course, nothing could be further from the truth,” she said. 

Somehow, she thought, they were conflating social involvement with politics. “But climate is science. Climate is not political,” she said. “And so the idea that they should wash their hands of this or have this sort of curious sense of faint detachment from the dirty business of trying to protect the planet is something that has been a battle for a long time now.”

Making a Name for Herself as a Climate Activist

Van Susteren readily admits to being something of an iconoclast within her field, and has often shied away from working with large groups. But she has never hesitated to stir up a fuss. In 2012, she and Coyle published a 60-page report, The Psychological Effects of Global Warming on the United States: And Why the U.S. Mental Health Care System Is Not Adequately Prepared, based on discussions started at the 2009 conference. 

Though it got minimal attention from the mental health care community, it did catch the attention of leaders on climate change and climate minded organizations. Van Susteren was already making a name for herself as a climate activist, joining James Hansen, the legendary NASA climate scientist, for the 6th annual Chesapeake Climate Action Network Polar Bear Plunge on a incredibly cold day in January 2011 when highs were in the teens.  

In the following years, van Susteren found herself invited to speak about the mental health effects of climate change everywhere from Antarctica to the doomsday seed vault in Svalbard, Norway. Now the vault has intense state-of-the-art security, but things were much more relaxed back when van Susteren visited. She even climbed up onto the roof to have a look around.

As van Susteren became more involved in the climate movement, she gradually shifted her psychiatry practice to part time, freeing up more hours to work with groups like Interfaith Moral Action on Climate, which she co-founded. Interfaith Moral Action helped organize events like the 2015 rally for climate action on the National Mall, which coincided with the Pope’s visit. Van Susteren also spent Thanksgiving of 2016 serving up dinner to protesters at Standing Rock alongside Jane Fonda.

Still, no matter how active van Susteren became in climate organizations, she struggled to find a community of mental health providers focused on the climate crisis.

Then, in 2016, van Susteren heard about a U.K.-based organization called the Climate Psychology Alliance. She was already planning a family vacation with her children to the U.K. for that summer, so she decided to get in touch with the founders. 

They put van Susteren in touch with a few other American mental health providers who had contacted them about forming a North American chapter of the Climate Psychology Alliance. The group consisted of a handful of social workers and psychologists, with van Susteren standing out as the lone psychiatrist. 

But as Elizabeth Allured, one of the co-founders of the Climate Psychology Alliance—North America, was quick to point out, “Lise was always very respectful of everyone else’s perspective, she wanted to be very inclusive and welcoming. And she didn’t see the fact that she was a psychiatrist, and none of the rest of us were psychiatrists, as being at all problematic.”

The idea for creating a directory of climate therapists came from those early brainstorming sessions. It had been several years since van Susteren cut back her practice hours to free up more time for climate work, but as climate change intensified, she found herself being approached by growing numbers of people seeking help for climate distress. Though none of her close colleagues had bandwidth to take on new patients at the time, Allured said something incredibly valuable came from van Susteren’s efforts to find providers in those early Climate Psychology Alliance—North America meetings. 

Essentially, all of the therapists listed in what became the Climate Aware Therapists Directory understood that people experienced upsetting and even function-impairing symptoms in response to the climate crisis. The listed therapists, Allured said, knew not to “pathologize the feelings related to climate distress. These are reality based feelings, and as Lise would say at times, ‘well, anyone who’s not feeling climate distress, we have to wonder, how grounded in reality are they?’”

The Climate Psychiatry Alliance was co-founded by van Susteren and a group of similarly inclined psychiatrists, including current president, Robin Cooper, around the same time. The founders felt it was important to have a voice in climate and mental health, but wanted to work within their own disciplines. As time went on, collaborative projects have proliferated and the two organizations have become more closely aligned. Van Susteren’s favorite of these collaborations was the Outreach and Advocacy Group, an offshoot organization designed to reach out directly to policy makers and push for action.

Importantly for members, said van Susteren, “the Climate Psychiatry Alliance gives us legitimacy when we go out to talk to people. Otherwise, as far as they’re concerned, we could just be some cranks.” 

An Expert Witness

Around the same time that these organizations were taking off, van Susteren’s work with Our Children’s Trust began to really take off. Van Susteren first began working with the Trust helping organize youth plantiffs to sue the government over climate change in 2011. 

Since 2015, van Susteren has worked on three high profile cases with Our Children’s Trust. She has profiled the plantiffs and authored the expert report on the effects of climate change on youth mental health in Juliana v. The United States, Held v. Montana and Navahine v. Hawaiʻi Department of Transportation. As both a general and forensic psychiatrist, she made for an authoritative expert witness. “In contrast to perhaps other mental health professionals,” she said, “I feel comfortable in a courtroom. I understand much of the process, and I don’t mind being in the public eye, and I’m confident about my findings.” 

She comes by comfort with court proceedings and media circuses naturally, as her father, Urban van Susteren, was an elected judge in Appleton, Wisconsin, throughout her childhood, and both her siblings, Dirk and Greta, have had successful journalism careers. 

Van Susteren’s confidence is backed by statistics. She was a co-author on Caroline Hickman’s global youth climate distress survey, which was published in The Lancet in 2021. It used data from 10,000 kids in 10 different countries to assess the toll of climate change on youth mental health. 

Van Susteren knows studies like this are the gold standard for health policy. She is a co-author on a follow up study, due out in September, looking at the mental health effects of climate this time on a survey of 16,000 children in the U.S. “When the kids testify, you can hear a pin drop,” she said. “Everyone listens. And when you use the gold standard of healthcare policy, people have a difficult time questioning the validity of the findings or the expressed emotional toll.”

Van Sustern shows no signs of slowing down in her early 70s. In the last decade she has only gotten busier working with clients troubled by the climate. She’s so busy that she barely has time to play her beloved piano, but that, she feels, is probably a good thing. “Mother nature has really enhanced our membership,” joked van Susteren, pointing out that as the climate crisis has intensified and the toll of natural disasters has mushroomed, more mental health providers have taken interest in the burgeoning field of climate psychology. 

“[Lise] is the mother of the whole field,” said Anya Kamenetz, an education reporter turned climate organizer, when van Susteren’s name came up while discussing the development of climate cafés. As more people are seeking resources to deal with the emotional impact, both in person and online group therapy sessions have become central to meeting climate mental health needs. 

That was the idea behind van Susteren’s latest collaborative projects, Climate and Your Mind and the Ecopsychepedia. “Lise was really pushing this idea because she didn’t like the fact that for many climate psychology resources, you had to go through a paywall,” explained Allured. “She wanted there to be something similar to Wikipedia, that was free to anyone, any mother, any school child, any university student who wanted to learn about this.” 

“[Lise] is the mother of the whole field.”

Cooper, the Climate Psychiatry Alliance’s president, is currently working with van Susteren to secure grant funding for the Ecopsychepedia. “If we get the grant funding, we are planning to try to develop partnerships so that we can disseminate this to wider audiences,” she said. 

It is, therefore, only natural that people look to van Susteren for guidance when trying to predict human behavior in this crisis. But she refuses to offer empty words of comfort. She has documented the rise of “pre-traumatic stress” in the young people she has worked with. Some were consumed by anxiety over the future and a fear of natural disasters, while others wore apathy and nihilism like armor.

Van Susteren is in turns hopeful and terrified for the future. Just as there are climate tipping points, she sees social tipping points, too. “The mental health toll is surging, but so is the awareness that our choices are contributing to it. So we’re talking about climate Victory Gardens, we’re talking about policies like the Inflation Reduction Act,” said van Susteren. “We now have financial incentives for people to restore and sustain the environment, and we have policymakers who are running on this platform, and we’re particularly seeing that young people who are more deeply aware [of this] increasingly being the voting public.”

As the climate crisis has intensified, van Susteren found the human component most concerning. Van Susteren refused to speculate on the environmental consequences of the climate crisis, saying only, “I’m not going to tell you where we’re going. You know goddamn well where we’re going. You’ve been outside. It’s 100 … degrees.”

But she was concerned enough by the growing cynicism children have about the willingness of society to take action that she was willing to talk about the potential consequences. The essence of the social contract, said van Susteren, is “I will play well with you if you play well with me.”

But if that’s not happening, then the belief in our institutions begins to erode, and once you have that erosion of trust, society begins to fray. “People are not as interested in voting or in supporting institutions and movements that are meant to protect them, because they don’t believe it will,” she said. “And that’s where you get the bullies and autocrats of the world who are seizing an opportunity to take power and begin to take over. And that’s what scares me the most.”