Climate anxiety is real. That does not make it a diagnosis

As climate change causes more harm, in more places, and with greater frequency, young people face a future of uncertainty on many levels. Increasing media attention and a growing body of research on young people’s attitudes toward climate change have led to a number of related terms – eco-anxiety, climate distress, solastalgia. When does a reasonable reaction to a threat become a clinical diagnosis? Is this even the right way to think about how climate change affects young people? Here to help is child psychiatrist and pediatrician Elizabeth Pinsky.

Ann-Christine Duhaime: How does something like “climate anxiety” or “eco-anxiety” go from an observation of something new to a term defined presumably for use by mental health professionals? And then how do you get from there to a mental health “diagnosis”?

Elizabeth Pinsky: Over the last decade, the reality of climate change has become more obvious to more people. There have been catastrophes throughout human history, but I would argue that climate change is different in terms of how universal, severe, and foreseeable it is. That last part is really unique; we know what’s coming and theoretically, anyway, we know how to stop it. Naturally, as we’ve started to think and talk about the experience of living through this moment in human history, we need a language for those conversations.

In 2005 the Australian environmental philosopher Glenn Albrecht published an essay coining the term “solastalgia,” the experience of feeling homesick when you are still at home, but home has changed around you. The landscape you grew up with in northern California is now choked with smoke every summer, or the backyard ice rinks are disappearing from your childhood neighborhood in upstate New York. Solastalgia is a good example of a term that was invented to describe something that we see phenomenologically, something that we can relate to. All these other descriptive terms – “climate anxiety” and “eco-anxiety” and “climate grief” – are similar, recent inventions.

Where does the mental health field come in?

Psychiatry has always had a tension between describing human experiences as opposed to medicalizing them in order to establish diagnoses. There are good reasons to establish diagnoses: tracking and identifying risk, guiding treatment, providing prognoses, research. Even funding. But the medical lens doesn’t exactly fit for all conditions that cause suffering. Grief is one example.

We’d all agree grieving is painful but normal and should not be medicalized. In mental health, we typically distinguish between normal human experiences and things that are disorders by whether or not they impair function or cause extreme distress. Certainly grief can be impairing. How much impairment is too much for someone who has lost a partner of 70 years? What about someone who loses a child? As a field we’ve attempted to answer these questions, but where to draw the line between normal and not-normal is ultimately arbitrary.

This is similar to the spot we’re in with climate anxiety, trying to distinguish between what’s inside the range of human experience and what is outside and constitutes pathology. But it’s a similar problem: What is the upper limit of normal for distress if you fear civilization might collapse? How many nights of disrupted sleep are appropriate if your ancestral lands are being swallowed by the seas?

Is there now a relative consensus in the U.S. or globally about how these terms are operationally defined, for instance using specific scales or scores?

I don’t think there’s any consensus. There are definitions from organizations like the APA [American Psychological Association], and very well-conceptualized and validated scales; the Climate Change Anxiety Scale by Clayton and Karazsia [2020] is probably the most commonly used and would be deployed mostly in the research setting.  Certainly “climate anxiety” is not currently a recognized diagnosis in the DSM [Diagnostic and Statistical Manual of Mental Disorders].

Are there people who are particularly prone to scoring high on these scales, demographically, age-wise, geographically?

It’s all so new and the literature is still pretty sparse. What is very clear is that young people are more worried about climate change than adults. It’s also clear that distress is higher in people who have been more heavily impacted by climate change. This is true in terms of communities in the Global South, but even here in the U.S. young people who have experienced severe weather, for example, are more likely to be distressed about climate change than those who have not. It also depends how you ask the question. If you say, “Do you have climate anxiety?” that doesn’t resonate with many people. You may get a different answer if you ask, “Are you afraid of extreme heat?” or “Do you worry that the changing weather will harm your family?”

Where do you think this topic is heading over the next decade?

Disaster psychiatry and climate psychiatry are becoming one field. The vast majority of mental health outcomes related to climate change have nothing to do with climate anxiety. The clinically relevant outcomes are things like post-traumatic stress disorder, anxiety, and depression resulting from trauma associated with climate hazards, including extreme weather and other disasters.

I think discussions about climate anxiety will become less of a clinical question and more of a behavioral question in terms of what interventions help people reach a place where they can both have anxiety and take action. Ideally, interventions that address climate distress and facilitate action will be bundled with interventions that improve general resilience in our communities and neighborhoods, bolster social cohesion, and build structures through which people can provide mutual aid. Those neighborly actions are what actually protect physical health and safety and mental well-being after disasters.

As someone who’s given a lot of thought to this issue, both as an experienced child psychiatrist and a climate advocate, how do you land on this question of climate anxiety not being a disorder? And how do you wish people talked about it or thought about it?

For me, this is another tension. As a physician, I see value in clear descriptions and ratings for climate distress, because you can’t get resources and interventions for something that is not well-defined. And like grief, whether “climate anxiety” is a disorder or not, if it’s causing distress or impairment it may benefit from treatment in the form of therapy.

It’s also essential that we understand how climate emotions impact climate action. We know they are related, but is there a right “dose” of climate anxiety? What level of distress spurs action without paralyzing people because they’re hopeless or demoralized? And is that a quantitative difference, or a qualitative difference?

On the other hand, it’s obviously problematic to characterize distress about climate change as pathology. It’s inaccurate, but that’s not the biggest problem. My real beef with so-called “climate anxiety” is by pathologizing young people’s experience, we make it about individual suffering and individual experience, as opposed to being about the systems that have created the conditions that caused the suffering. We individualize something when we diagnose it. Diagnoses are not collective. The problem is not that young people are anxious about climate change. The problem is our ongoing dependence on fossil fuels.

All perspectives expressed in the Harvard Climate Brief are those of the authors and not of Harvard University or the Salata Institute for Climate and Sustainability. Any errors are the authors’ own. The Harvard Climate Brief is edited by an interdisciplinary team of Harvard faculty.