“When political leaders set a negative example, professional commitments to just practice become more important. It is hard to subvert a rule-of-law state without lawyers, or to hold show trials without judges. Authoritarians need obedient civil servants, and concentration camp directors seek businessmen interested in cheap labor.”
Our Duty as Mental Health Therapists in a Constitutional Crisis
Therapy is about holding space for the complexities of the human experience—both the joy and the heartbreak. As a therapist for nearly eighteen years, I’ve had the privilege of accompanying individuals through life’s most profound challenges. Our training teaches us some basic guiding principles about the boundaries of our work, particularly the importance of not imposing our own beliefs, values, or judgments on clients. This makes sense regarding personal decisions, such as whether a client should stay in a relationship or how they should navigate grief. The role of a therapist is to support, not direct. But can we still hold fast to these principles when the political climate directly impacts our client’s lives? When the world outside the therapy room demands that we, as therapists, advocate?
In times of political upheaval, mental health professionals find ourselves in a position that requires not only clinical care but also moral clarity. We cannot ignore the collective trauma, fear, and psychological wounds that rip through the fabric of our communities, particularly when those wounds are caused by systemic injustice, social upheaval, or governmental overreach.
The moments in history when societies are shaken to their core—wars, social movements, economic depressions, pandemics, and political upheaval—often have profound psychological consequences. These events disrupt people’s sense of safety and security and can have long-lasting effects. After World War II, many societies experienced collective trauma, marked by grief, loss, and disillusionment in the aftermath of a global catastrophe. The resulting psychological impact of the war, and in particular, the Holocaust, rippled across generations, with heightened anxiety, PTSD, and a pervasive sense of vulnerability lingering in the collective psyche.
In the United States today, we are again witnessing elevated levels of unrest, fear, and division. The stress of living through such moments of instability and terror is not only psychological but also physiological. Research into epigenetics—how environmental factors influence the expression of genes—reveals how chronic stress, particularly chronic stress from racism and discrimination, can have devastating health consequences. For example, Black women in the U.S. experience heightened levels of maternal mortality, which are tied to the stress of living under the weight of systemic racism and interacting with racist healthcare systems. This trauma, passed down through generations, affects their bodies on a genetic level, leading to increased risks during pregnancy and perpetuating cycles of health disparities. These are not just political issues—they are deeply personal and have tangible consequences.
When societies experience terror, injustice, or moral collapse, individuals often suffer from what is known as moral injury. This is the psychological trauma that occurs when people witness or participate in events that violate their core values. In times of political instability, when democracy is threatened or when human rights are stripped away, individuals experience deep emotional conflict, guilt, and a pervasive sense of shame. This leads to depression, anger, addiction, and distrust of societal systems.
A cogent example occurred in the Summer of 2020. As a therapist in the Twin Cities, I was experiencing the uprisings that emerged following the murder of George Floyd alongside my clients. In those moments, it would have been unethical for me to avoid confronting the realities of racism, white supremacy, and anti-Black violence. As a white therapist working primarily with white clients, to not address these issues head-on would have been to prioritize the racial status quo and ignore the psychological impacts of a community at a turning point. My clients wanted to talk about what was happening as they tried to make meaning about their own roles in racial injustice. Just as during the Covid-19 pandemic, therapy must confront the societal forces that shape our lives, our minds, and our bodies.
We cannot pretend that the current rise of white supremacy, attacks on LGBTQ+ rights, or the erosion of voting rights are abstract political issues. The decision to remain neutral is not ethically possible; neutrality is complicity. As therapists, we are duty-bound to hold space for what directly affects our clients’ well-being, especially when it manifests in our therapy rooms. We must be able to name these realities and acknowledge how they shape the psychological health of our clients. To remain silent and ignore these issues is to deny reality and our clients’ need to make sense of their lived experiences.
We have been told to avoid politics in treatment, but we cannot separate these discussions from the psychological health of our clients. The conversations we avoid in the therapy room are the very conversations that influence our client’s safety and dignity. We must help them process their lived realities with clarity, offer them the tools to resist psychological manipulation, and support them as they navigate a rapidly changing world.
In times of crisis, Timothy Snyder’s directive from On Tyranny—“Remember Professional Ethics”—is a vital reminder for mental health professionals. We are tasked with preserving the integrity of our practice, even when the societal systems around us are in freefall. History has shown us that professionals can be co-opted by oppressive regimes—whether through justifying torture, pathologizing dissent, or imposing silence. Now is the time to stand firm in our commitment to justice, to truth, and to the integrity of our profession. So how might we do that? It is easy amidst the political chaos to feel isolated, alone, and ineffectual. Fortunately, we have a rich history of people joining together to fight for a common cause. The greatest defense against authoritarianism is everyday resistance by everyday people. Resistance movements are built from small acts, repeated, until those small acts become a movement. We can create an alliance that includes mental health workers from all areas of the field: large clinics, small private practices, independent contractors, non-profits, wellness centers, treatment centers, outreach workers, school staff, and hospital staff. Together, we can offer accountability meetings; support groups, process spaces, information and resource-sharing, building funds for clients without insurance, planning for the possibility of losing Medicaid and Medicare, and more.
A constitutional crisis is not just a political event—it is a psychological reckoning. If we fail to uphold our professional ethics, we risk becoming enablers of repression. This is a call to action for my fellow mental health professionals and practitioners: let’s build a coalition committed to collective resistance and model what “Integrity” in our code of ethics truly means.
