Our national mental health crisis is in full display at your local Emergency Department

My wife volunteers one day a week at our local hospital’s emergency department. During the worst of the covid-19 pandemic she was told to stay home, but for the last six months or so she’s been invited back. She’s heavily gloved and double masked and of course has all her shots and boosters. She mostly cleans bays in the E.D. and tries to lower stress by offering patients snacks and drinks.

When she was allowed back there were still a lot of covid-19 cases coming in. There are procedures to isolate these patients in special rooms. My wife can’t clean these rooms. A special technician in something like a spacesuit comes in and uses a large machine to shine ultraviolet light all over the place. This kills the virus better than wiping down surfaces.

There’s still a lot of covid-19 out there, but it’s been around long enough where most cases don’t require hospitalization or a trip to the emergency room. Most days though when she is there the place is bursting to overflow. What she’s been seeing most of this year are people having mental health crises.

In better days, these people would go into a local psychiatrist ward, but there’s no beds for them; they’re all taken. So they end up in the E.D. As my wife can attest, there are a lot of mentally struggling people out there.

In a recent case she related, an adult son took his mother to the E.R. because he couldn’t deal with her craziness. He just dropped her off; his mom was their problem now. Confused and disoriented, all the bays were full so she was placed on a gurney in the E.D. hallway. She was triaged as best they could handle her, but she decided she was going home. Dressed only in a hospital gown she made a beeline for the exit to be stopped by a security guard who was hastily called in.

Most of these patients “graduate” to a hospital room. That doesn’t mean they get much in the way of treatment, at least for their medical condition, but at least they can be effectively monitored. A staff psychiatrist might come by once a day, but everyone’s waiting for some bed to open up somewhere in a facility that can treat these people. Naturally, many of these people are poor, underinsured and in some cases, even here in Massachusetts, uninsured.

Nationwide, it’s adolescents though who are disproportionately affected. Suicide is now the second cause of death among adolescents. Parents are left holding the bag trying to keep their kids functional while waiting months for a therapist, which often they cannot afford. Ending up in an E.D. is something of an act of desperation, but an E.D. visit can easily become a traumatic episode to a child who is already having problems coping with life.

It’s pretty clear that, at best, the pandemic made things worse. For many adolescents, a healthy self-image comes from relationships occurring mostly at school. That was suddenly taken away with classes held online. Making it back after months online trying to get an education didn’t help much either. It wasn’t the same. There were new protocols and masks. For many, the pandemic turned their whole lives upside down. It was a huge burden placed on all the other burdens that come with adolescence.

I might well have had a mental health crisis too when I was a teen had I gone through what teens today are going through. I suspect it would have helped that I am naturally introverted, but that doesn’t mean I don’t need some regular company other than my wife and cats. One thing I didn’t have to worry about were school shootings. Nuclear war was a theoretical but existential threat. Worrying about sudden death from some crazed gunman, largely unprotected by a society that placed the rights of gun owners over the lives of kids probably would have been enough of a trigger.

We live in a crazy, topsy turvy world now. In some ways it strikes me that it’s entirely logical that so many teenagers can’t keep it together. They face myriad stresses I never had to face. My biggest concerns were overcoming my shyness so I could get a date and pimple control.

I can keep it together today because I’m introverted and relatively isolated. I have my wife as my primary company and a supportive community of seniors nearby. I don’t have to struggle to raise a child anymore; she’s 32. I don’t have to worry about rent increases and soaring food costs. I find inflation somewhat concerning but we have the assets to see this through.

But we are the exception. Most people are struggling, anxious and nervous, and this is inculcating a general public mental health crisis. There is too much personal and global risk and it affects almost all of us. We’re becoming unmoored as a society. It seems like this mental health crisis is a harbinger.

I don’t know how my wife continues to keep volunteering at the E.D. It’s one of the last places I would volunteer. I already know that my capacity for dealing with this kind of stress is not large. She reports the staff there is stressed too and burned out. It’s been a true hell of a last few years, but emergency departments are usually challenging places to work. There’s just little to no downtime there these days.

I can already sense that regardless of how much the pandemic wanes over the next year, our local E.D. will be mostly the same a year from now, and about a third of the people in it will be trying to cope with a mental health crisis in a place not really equipped to deal with the depth and breadth of the problem.

Trump is likely to meet the 25th amendment

Like most of America, it’s hard for me to turn my eyes away from the disastrous Donald Trump presidency. On May 19 I noted that every day of his presidency was worse and more unbelievable than the day before. Here it is June 7, and it’s still if not more the case. Tomorrow the excessively sober former FBI Director James Comey gets his turn to openly add to the huge pile of evidence that Trump obstructed justice. Comey’s initial statement is already online. My wife plans to pop some popcorn and watch it live.

Trump is everywhere and most lately has been infecting my dreams. As a classic narcissist, Trump is probably happy about this. The details of the dream are a little sketchy, but somehow I’m in a room with Donald Trump. Like Trump with Angela Merkel (who in his trip the other week told Trump eleven times he can’t negotiate a trade pact with Germany, but only the European Union) I find myself keep saying the same stuff to him and it just does not register.

How does this end? On May 29, I said it wasn’t going to end well, and that’s truer now than ever. I am more convinced than ever that he won’t see out his term, but I am less convinced that he will resign hastily and testily. While that has been his pattern, Trump seems to be going into full bunker mode. Nothing is more precious than his insatiable ego and his conviction that he can never do wrong. You can see it in fine display with his weird tweet the other night where typoed a new word: covfefe. Any other human being would follow it up with a tweet that, oops, he mistyped. Trump misspells all the time, but simply can’t admit this baffling typo so he tried to make a joke out of it. He can’t admit that he has any human frailties. Darn it, he meant to use covfefe and it’s your problem if you don’t understand it.

Trump has already passed Nixon’s “smoking gun” test. This was the evidence that ended in his resignation. Trump has admitted that he fired Comey in part because of “this Russian thing”, which clearly meant Comey investigating potential links between the Russians and his campaign. By all reasonable and lawyerly standards, Trump has obstructed justice, which independent special counsel Robert Mueller will doubtless charge Trump with in time. Trump wanted Comey to drop any investigations into his short-lived National Security Advisor Michael Flynn. He pressed others in positions of power to do the same thing.

Why did he do it? Here’s the scary part. Nixon did it because he was mendacious. Nixon knew better but assumed it would remain a little Oval Office secret. But Nixon went to law school. Trump’s education consists of a bachelor’s degree from Wharton. One hopes he had a civics class or two in school, but obviously not much of it took hold. Trump asked these inappropriate and illegal questions mostly because he didn’t know he shouldn’t. Of course this is the way you do things, was probably what amounted to his rationalization. I’m the president. I am in charge. What I say goes. The idea that the president is accountable to the law and the constitution seems to never entered his brain, even though he swore to do both when he took the oath of office. He doesn’t get this. Frankly, he doesn’t understand the job he signed up for.

Trump was qualified to be president only in the sense that he was native born, age 35 or older and got a majority of votes in the Electoral College. He is clearly not mentally qualified to hold the office though because he has shown no competence in faithfully serving the office.

Which is why I now think his most likely exit will be via the 25th amendment. Republicans will find it convenient not to impeach him as long as it is in their political interest not to do so. Considering that so many of their constituents voted for him there’s plenty of incentive to overlook his dangerous eccentricities via impeachment and conviction. Republicans are tribal in nature. More than ninety percent of them will vote for any Republican on the ticket, no matter how bad or unqualified they happen to be, which proved true in the last election despite Trump’s known problems and temperament. Nixon found out that things do change very quickly. If consensus develops that Republicans in Congress realize they (and their jobs) are better off with him gone, the will should be there. My brother is betting October 15, 2017 is that date. We’ll see.

Me, I’m now betting on the 25th amendment solution. The amendment, adopted in 1967 and amended in 1992 basically says the president can be temporarily removed from office if the vice president and at least half of the cabinet agree that he is unable to discharge his duties. There is plenty of evidence to this already. For example, he’s more than four months into his administration and his government is about 5% staffed. To my way of thinking you are certainly unable to discharge the duties of the presidency if you just don’t understand what they are. If you aren’t aware that your job is to enforce the law as it exists, you cannot faithfully discharge the duties of the presidency. If you aren’t smart enough to know that you can’t ask the FBI director to compromise his required independence from Executive Branch coercion, you can’t discharge your duties. These of course are but a few examples that show that Trump is unable to discharge the powers and duties of the presidency.

It’s also the way Republicans can get rid of his toxic presidency with the least political damage. Which is why I believe that there are already all sorts of backdoor conversations going on amongst Trump’s cabinet and Vice President Mike Pence on whether, but more likely how and when to take this unprecedented step. Trump can of course declare that no inability exists. Congress gets 21 days to decide if Trump is incapable of discharging the duties of presidency adequately. A vote of at least two thirds of both the House and the Senate would remove him from office and we’d have President Pence.

Mental health experts could certainly be called to testify. It would not be hard to make a case that Trump’s excessive narcissism is a mental illness, one probably that cannot be cured, and the illness affects his ability to discharge the duties of the presidency. They could even call Trump to testify in his own defense. Just ask him a few fundamental questions about the duties of the president. There is plenty of evidence already that makes an airtight case. Republicans could use this as the cover they need because it’s irrefutable.

For the sake of the nation we can only hope this happens sooner rather than later.