Meet the Psychiatrist Telling Trump That Lockdowns Are Deadly
Elinore McCance-Katz is of two minds but singular purpose. An epidemiologist and a board-certified psychiatrist, she says her training is why she thinks “a little differently about things than other people.” She also talks a little differently.
Her bedside manner was abrupt and to the point -- and not a little foreboding -- at a recent White House Cabinet meeting. The Health and Human Services assistant secretary for mental health and substance use, the first person to hold that new post, delivered a warning. McCance-Katz told the president and his assembled secretaries that “the cure” for the COVID-19 pandemic has unintended but potentially grave consequences. She explained that self-isolation, while necessary to prevent spread of the virus, would exacerbate preexisting mental conditions and predicted that so-called deaths of despair would rise as lockdowns continued.
“A life lost to suicide is just as important as a life lost to coronavirus,” McCance-Katz insisted.
Citing the nation’s “already overburdened mental health care system,” she added, “I’m saddened but certain that the next major public health crisis of our time will be that of mental and substance use disorders. It is not far behind.”
The nation has been on lockdown, in one way or the other, for the better part of three months, with Trump arguing all the while that such measures cannot become permanent.
“WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” he tweeted with all-caps emphasis soon after restrictions were put in place. “AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!”
That was March 22, and the pandemic lockdowns that many state and local governments have been lifting of late are now giving way to curfew orders following social unrest triggered by the death of George Floyd at the hands of a Minnesota police officer. In the meantime, unemployment numbers are rocketing upward and the despair-related toll from booze, pills and bullets is rising too. So argues the doctor in an interview with RealClearPolitics.
McCance-Katz does not disagree that the initial lockdown was necessary to slow the coronavirus’ spread, thus buying time for the medical community to handle the patient load and for researchers to learn how to defeat the pathogen. But she now warns of dangers ignored by the political-medical community. Mental illness continues in isolation and, in some instances, accelerates. This worries the doctor.
The UConn MD and Yale University PhD insists that “it is time to move on” from the restrictions because, just as too much medicine can be detrimental, even deadly, “when you only focus on one thing, you're leaving out the entire spectrum of other illnesses that affect people.”
Data for coronavirus deaths is easily accessible. According to the Centers for Disease Control, more than 100,000 Americans have succumbed to the illness. Data for suicide and overdose deaths is forthcoming, but there are troubling signs already. Calls to the Disaster Distress Helpline, the federal service that offers free counseling, have increased 1,000% during the pandemic. Each of the 50 U.S. governors, meanwhile, have applied to secure the resources of the Crisis Counseling and Assistance Training Program for their states. And datapoints such as one coming out of Knoxville, Tenn., are heartbreaking: nine suicides in one 48-hour period.
“That number is completely shocking and makes me wonder if what we are doing now is really the best approach,” Knox County Mayor Glenn Jacobs told local press. “We have to determine how we can respond to COVID-19 in a way that keeps our economy intact, keeps people employed and empowers them with a feeling of hope and optimism – not desperation and despair.”
This is what animates McCance-Katz. At a moment when visits to emergency rooms across the country are down overall, those for suicide attempts are up. “And what that tells us,” she said, “is that, because we know that people are trying to avoid emergency departments because they're afraid of the virus, if you're being seen for a suicide attempt, it was probably a very lethal attempt.”
Will suicide deaths and those from substance abuse eclipse the coronavirus toll? McCance-Katz doesn’t know but she suspects the worst. A study by two doctors at the American Academy of Family Physicians predicted that the number of people who kill themselves by their own hands or through excessive alcohol or drug consumption could range -- depending on nine different economic recovery scenarios -- between approximately 27,000 and 154,000.
It doesn’t matter how Americans die though, and that’s the point the HHS official is making. “All lives and all deaths are incredibly important,” she said. “We must not count a life lost to coronavirus as more important than a life lost to suicide. For no other medical condition do we ever suggest that the level of death due to one condition means that we ignore the casualties caused by another.”
This makes the doctor a powerful advocate for Americans suffering from mental illness, and for a president who desperately wants the economy to reopen. McCance-Katz has briefed Trump and Vice President Mike Pence numerous times while urging all of the nation’s governors over conference calls not to forget about the less visible suffering of their constituents.
From the beginning, Trump has been receptive. He wants businesses reopened and worries publicly about how a pandemic might make addiction even worse. It may be personal. His own brother struggled with alcoholism and died young.
Asked in March about his message to those Americans who were already alienated and suffering in silence before the pandemic, Trump told RCP that his message was simple: “We love them, we're with them, and we will not let them down.” It has become a common refrain.
"You're going to lose more people by putting a country into a massive recession or depression," Trump said during a Fox News town hall in March. "You're going to lose people. You're going to have suicides by the thousands."
Fact checks disputing this followed, but McCance-Katz says the president wasn’t far off. She cites breadwinners who don’t have a vocation accessible by home computer, and for whom a missed car or mortgage payment can lead to a destructive downward spiral when one is isolated from normal societal interactions.
“It is unfortunate that the situation is such that the people who make these decisions are not people who have to really live with the decisions,” McCance-Katz said. “The people who say, ‘All businesses should close and people should still stay at home’ are the people who are collecting a paycheck every two weeks and who think that giving other people some sort of subsistence living is what Americans want.”
She would like to remind those living in Washington, D.C., brownstones and New York high-rises that “big lockdowns are not benign.” She tries to tell them that, for millions struggling with the bottle or an abusive spouse, “home is not a safe space.”
Slowing the spread of what Trump calls “the invisible enemy” remains an important task, she adds. But the epidemiologist/psychiatrist warns that more negative social side effects from battling COVID-19 are on the horizon for Americans stuck in lockdown: “We are in uncharted territory.”