22 April 2021 Oxford

Royal College of Psychiatrists Medical Psychotherapy Section annual conference. Keynote speaker.

It is a privilege to talk to you today. Thank you for inviting me. I will begin with Monica. Monica, a young woman, seeks therapy to help her with this dilemma: she wants a baby, but she feels to have a baby is irresponsible, given the climate emergency. She stipulates her therapist must be ‘climate aware’.

Royal College of Psychiatrists: Faculty of Medical Psychotherapy Annual Conference
Survival and Development; Exploring our Internal and External Landscapes
21st-23rd April 2021 (online)
On becoming climate aware as a psychotherapist

Sally Weintrobe


It is a privilege to talk to you today. Thank you for inviting me.


I will begin with Monica. Monica, a young woman, seeks therapy to help her with this dilemma: she wants a baby, but she feels to have a baby is irresponsible, given the climate emergency. She stipulates her therapist must be ‘climate aware’.

Monica’s dilemma involves a baby, a mother and a climate emergency. She wants help from someone who appreciates that the climate emergency is real. Considered dynamically, what might this emergency be? Does it concern the state of the physical climate, the state of Monica’s human climate, or perhaps both? And, who is it who is not aware of the emergency: Monica’s potential therapist, Monica herself, her archaic objects, culture at large? Potential clarification of questions like these could only hopefully emerge with therapeutic work, through time. Our experience as therapists would lead us to expect to find objects in external and internal reality psychically interwoven with each other in the clinical material, particularly if the underlying terrain is trauma. We know that external trauma likely reignites personal trauma and personal trauma will colour how we experience external trauma. We know that trying to disentangle these interwoven strands will involve working with the patient within an analytic setting best designed to illuminate the field of transference, countertransference and resistance. Our hope is to be able to help the patient better understand what belongs to external and internal reality, and to her past and the present.

A psychoanalytic attitude is the disciplined stance needed to help find our way with difficulties like these. It includes tolerating not knowing and not foreclosing on what the material might signify. It includes a kind of reflection that proceeds with: on the one hand, on the other hand. It includes constantly refocusing the mental microscope from experiencing being in the relationship to looking on at the relationship one is part of. This triangulation, a constant refocusing, helps us better understand enactments and collusions. For example, we may collude with Monica that her real emergency concerns the physical external climate. Or Monica may collude with us when we treat her genuine alarm about the state of the planet as mere metaphor, as not the real issue. She may be colluding for the sake of a quieter life with the therapist, or because she feels disempowered, but she will notice, at least unconsciously, if her distress about the physical climate is not being heard. We see this kind of collusion in accounts of therapies with white therapists and black patients where race just never comes up, or if it does, it is redefined as standing for something else. We see it with female patients with male therapists do not understand the pain of gender discrimination. Remember the film Sex Lies and Videotape? In the film the patient says she is concerned about where all the rubbish is going. Mounds of rubbish are piling up. The therapist says what she is really talking about is the state of her marriage. She may well be, but to me the therapist in the film came across as not empathically engaged with trying to understand the world as his patient saw it.

I believe that to be in a position to help Monica untangle different strands in her presenting problem we need to be climate aware, by which I mean aware there is a planetary climate emergency. My main point will be that, for the analyst, becoming climate aware entails very difficult psychic work. We are used to difficult psychic work, but attaining climate awareness creates added difficulty. To be in a position to help Monica is to place ourselves in a position likely to tax us conceptually and it may well break our hearts. It will require us to understand that we have been living in a bubble. By we, I mean all of us, more or less.

Now you may object, surely if we stick with helping Monica recognise what belongs to her, personally, then she will better be able to disentangle her personal angst from her climate angst? That, let us say for example, if she comes to understand through analytic work that she experiences the internal object – therapist, mother, herself – as narcissistic and cruelly indifferent to a baby, then she will be better able to tease out this construction from a view she also holds of her government as pumped up with Exceptionalism and cruelly indifferent to the fact that its policies are leading to climate catastrophe. This position says, analyse the psyche and leave politics, culture and ecology outside the door. They are not part of our domain.

I will argue that as therapists we are embedded within and unavoidably affected by politics, culture and ecology. All shape how we see the world. It takes a certain humility to recognise this – it is far easier to think it is only other people who are influenced by culture and political framing. To hope to be in a position to understand the patient with sufficient empathy, we need to be alert to real social political and ecological forces as they are likely to affect our thinking and fashion our blind spots. Moreover, the eco-psycho-social, while part of external reality, is an indelible part of our psychic representational world. We apprehend external reality only through representing it psychically. Bleger, who wrote so beautifully and extensively on the psychoanalytic setting understood this clearly. There is nothing external when it comes to the setting, he wrote. The external and internal worlds that inform the setting and the frame exist in the mind of the analyst. If we think the external world is not part of psychic life, we have created a negative hallucination, a blind spot that refuses to see a part of the world as being represented in the mind. Creating a negative hallucination that apparently ablates part of external reality is achieved through disavowal. It casts external reality as something that can be chopped off like a limb, to be cast aside and left unexplored. I will say something now about disavowal, keeping my focus on the climate crisis.


Most of us are, more or less, in extensive disavowal about the true state the physical climate is in. Moreover, this disavowal is fostered and maintained predominantly through the current dominant culture. I call it the culture of uncare. It including advertising, mass media, political framing and group pressure. It is designed by those currently in power to promote disassociation from the part of us that cares and feels responsible when we mistreat others and the earth. I have come to think that it operates by encouraging people to stay blocked in the mourning process at the stage of denial and recriminative blaming. That stops people feeling grief and mobilizing their care and their love on seeing realities that would ordinarily shock them. I have argued that keeping people stuck in denial and recriminative blaming suits the current economic base. That would need elaborating, but here I do not have space.
Perhaps just one example of how culture influences attitudes will indicate what I have in mind. During covid, TV network media coverage on the climate crisis dropped — from 0.7% of network airtime in 2019 to 0.4% in 2020.This despite the growth of climate change-related disasters in the U.S. — devastating fires in the West, a massive cold wave in the South. The Covid-19 pandemic, reported on daily, is thought to be related to the planetary emergency. The destruction of natural habitats has brought us in closer contact with animals carrying diseases we are ill-equipped to fight. We do not hear that from major broadcasters.
The culture of uncare promotes a climate bubble, a collective psychic retreat from climate reality. One way it operates is by promoting disavowal, a psychic defence which, as we know, acts to minimise certain felt impacts of reality. It lessens consciously felt anxiety, dulls felt moral conflict and it normalises the horror of violence by, for instance hiding it, ignoring it, bleaching out its impact, or sensationalising it creating a spurious excitement. Minimizing inner felt disturbance is disavowal’s job.

A point often not taken seriously enough is that disavowal is disavowal. It is the real thing. Try talking to an individual, a group – or even oneself – in disavowal, and one can expect to encounter the blind eye and the cloth ear. Rosenfeld referred to the action of organised narcissistic disavowal as stone walling. With stone walling, there may be arrow shafts of light where insight can get in, but these are likely to be highly defended against.

As psychoanalytic psychotherapists, we are well placed to understand the legion of wily ways disavowal defends against feelings that may be unbearable or nigh unbearable. I will give just one example. I remember a fellow health professional asking me at a social gathering (this was before covid), “now that the climate scientists know for sure climate change is real, are they feeling sad about it?” I replied, “climate scientists have known about climate change for decades. Most of them are full of, indeed overwhelmed by, grief about it and the lack of action to address it. Many are tearing their hair out.” My answer, while true, felt inadequate to me and thinking it over later, I wondered if I should have said, “I am feeling sad – are you feeling sad too?” However, this was a party and I had not raised this topic. My sense at the time, rightly or wrongly, was that the questioner was strongly deflecting the issue of climate at the same time as raising it with me. I wondered, had I become an object for projection? Was I being placed somewhere I am familiar with, which is as a ‘Mrs Climate Change’ figure, a designated someone who thinks about climate change? This man knew that I work on climate. Was I perhaps being positioned to carry the sadness, along with all the climate scientists? Was this disavowal in action? I, when a group’s ‘Mrs Climate Change’, am rendered someone to be kept at a distance by a group inside a collective bubble of disavowal of uncomfortable truths about the climate. One’s position is to do the work of explaining, the emotional heavy loading and not to be heard. For example, was the man at the party himself troubled by his question to me? Was he left worrying as I was about how best I could have related to him? Or was all this now to be left as my problem?

As psychotherapists we regularly work with the paradox of knowing that disavowal is deaf, blind and dumb, yet we still try to be heard. We are unsurprised when disavowers stonewall, yet we search for where shafts of light may get in, guided by a sense of trust in an underlying therapeutic alliance with the patient, and hopefully sensitive to problems and any potential backlash our interpretation may bring. I think I likely did not appreciate at the time that there may have been a potential appeal for help, for sharing, in that question to me at the party. And, was his question after all really so very different to a question that patients ask, again usually implicitly, without conscious awareness and often non verbally, of their analysts. The question is this: “are you able to bear the thing that I am finding unbearable? Is anyone out there able to bear it? Can we humans bear the unbearable?” Very often it is the exploration of this question that will take centre stage in an analysis, especially when the patient is struggling with areas of trauma and failures of representation.

I will return to the unbearable but here my point is I do not think it is possible or fruitful to try to understand an exchange like the one I have just recounted as only concerning two individuals. This conversation happened in the context of the climate bubble that affects the group.

The climate bubble

To understand the climate bubble, we need to appreciate that disavowal is not ignorance. There is always awareness of the real picture. The disavowal defends against the awareness of climate reality gaining the upper hand. Climate disavowal is a defence organised at the level of the group. It blocks awareness that the planet’s climate system is in crisis. Now, crisis is a word too often bandied about in our world of excitable speech, but let us consider what crisis actually means. I will focus on its medical meaning. A crisis in medicine is a tipping point. It is the tipping point in a disease process that determines whether the patient will live or is in terminal decline. Climate science tells us that planet earth is at crisis stage.

In my new book on climate, I contrast in broad sweep two different psychic positions. One is living on Planet Earth and the other is living on Plant La la. Of course, individuals and groups can and do move between the two positions.

Planet Earth: Here is what the world looks like when living on Planet Earth. We have less than ten years to drastically reduce emissions. By drastic reduction I mean by 90% in the global north. This is the optimistic picture, with an increasing number of scientists now fearing that because of the chronic lack of government intervention to address climate the world has already tipped into an unstoppable trajectory heading towards ecocide. Government, driven by an ideology infused with Exceptionalism, has insisted on imposing an impossibility: endless growth on a finite planet. Not surprisingly, we are hitting the buffers. The latest information from the arctic is that the permafrost is melting much faster than predicted releasing methane, a highly dangerous greenhouse gas with a warming effect far greater than Co2. The problem is not only global warming. By now most of the planetary life support systems are in overshoot and in trouble. Climate refugees are already with us. It is well documented that the war in Syria was sparked by climate induced drought. Refugees now making their way to the United States include many fleeing climate devastations of their habitats. Climate aware mental health experts are increasingly concerned that sane thinking may be swamped; that the climate crisis inevitably entails a mental health crisis as reality becomes progressively harder to bear.

People in the global south are already suffering hugely and are dying and they are brown poorer people, not the polluter elite overwhelmingly responsible for the climate crisis. The degree of climate injustice is staggering and it cannot be separated from racial injustice. Humanity is facing mounting crises that are not separate crises but all symptoms of a way of relating to the earth and to each other. This way of relating is rooted in Exceptionalism, the sense of narcissistic entitlement to privilege, to feeling superior, to having the lion’s share and to using omnipotent thinking to make that position appear fair and right. The root cause of the climate crisis is rising Exceptionalism during the neoliberal era. Neoliberalism, a highly deregulated form of capitalism, has gained unfettered power on the world stage over the past forty years, the period the vast majority of human caused warming has occurred.

Human caused global warming is the toxic legacy of the current economic model, one based on rapid deregulation of the rules that hold greed in check. Our economic model leaves nothing over for the next generation. I will say that again. Our current economic model leaves nothing over for future generations. They are awarded no entitlement. Knowing this with feeling is likely to be unbearable. And, importantly, that knowledge will feel different to a young person directly affected.

At this point I will say something about the unbearable.

The unbearable

I have come to think that in today’s world it is possible, very broadly speaking, to distinguish between two sorts of anxiety that can feel unbearable. The first kind we as therapists are more familiar with in our work. It is anxiety that comes from feeling and being unheld, unattached and unbearably alone, exploding into bits, falling endlessly into space. This anxiety, felt more by some than others, is part of human fragility. It is unavoidable and part of being alive. We can and we do use illusion to create a psychic bridge to step over this kind of anxiety as Freud showed with the Fort Da game of Little Hans reeling a cotton reel out and back in. The child omnipotently creates a false world to help him manage the loss of his mother. He falsely imagines he is in control of her comings and goings.

However, in our modern world today we face a different sort of anxiety about the security of our planet, our very home, and about its viability to sustain us and life itself. This anxiety is realistic, and the reason for it is that the current political system is steadily tipping our environment out of balance. The climate crisis is driving a mental health crisis as we struggle, often unsuccessfully, to contain this new level of existential threat.

We are fragile in the face of both these sorts of anxiety and can easily feel overwhelmed in relation to each. The two might be put as we fear our own individual death and we also fear the death of everything. We can see the complexity in understanding clinical material that this can produce when we revisit Hanna Segal’s point about the nuclear issue. She said for the first time ever in history we can make our most destructive phantasies come true in reality. This is a very serious psychic breach indeed.

That destructiveness and damage is now so visible in the external world is likely to be profoundly alarming and unbearable for us all. And, in the therapy setting it does not do simply to pretend the world is safe or to invite the patient into a bubble that disavows that the danger and the violence is real.

Seeing climate reality I believe taxes us emotionally in ways that are not adequately expressed by referring to a depressive position. Perhaps we need to introduce a new position, the tragic position. It deals with the unbearable and the irreparable, involving areas of trauma, of damage that cannot be repaired, and intergenerational conversations that if honestly faced would expose that the young are still awarded no entitlement to a safe trustable world. And, to my mind, the real tragedy is it does not have to be like this. We do not need to be ruled by a political system so fixated on short term profit that it leaves us unable to breathe in so many senses. My point is not party political here. It concerns a psychological attitude based on Exceptionalism that infects politics and is spread by a culture of uncare. Being a psychological attitude, it is very definitely part of our field of study.

Having outlined life on Planet Earth – a tough place to wake up to – I now turn to Planet La LA. The reality is that many people are living a bubble-like existence on Planet La La. It is a world of fake reality that pretends to be the real world but this is a world with all the anxiety and guilt airbrushed out or pushed down into the unconscious where it can only bring future trouble. Thinking in the bubble on Planet La La may look something like this.

Yes, there is a serious climate crisis but it won’t affect my children and grandchildren. I don’t think further ahead than that. (Fact check: it will affect them. Either it is already or it will soon unless action is taken right now). We may have to spend more on food and may even have to relocate where we live. We might have to instal air conditioning if temperatures rise. (Fact check: this might work in the short term for some of those with money). Thank goodness we have enough money to do this. We are dimly aware others do not have the money, and we are sorry about this, but we try not to think about them too much. Life is unfair. It has always been like that. You know, climate change is a gradual problem that largely began with industrialization fuelled by coal and oil. (Fact check: untrue. Carbon emissions have largely risen during the last forty years, in the era of neoliberal capitalism). It will be a serious problem, but for the future, probably the end of this century. (Fact check: untrue. It is a serious problem for many now). The problem is we face a number of separate crises right now: covid, the economic crisis, the racial crisis, the gender crisis, the crisis with democracy. These are the crises claiming our immediate attention. We are ringing our hands. We know we must get round to climate but that must wait. The other crises are more urgent. (Fact check: untrue. This false belief is maintained through the psychological defence of isolationism, meaning seeing related problems as separate, isolated, unconnected, problems. That stops us from joining the dots and understanding the underlying structural nature of the problem, which is an uncaring extractive way of treating the earth and others). As mental health professionals, we are not equipped to say anything about the economy, or the environment. These topics may seem to us too political, too far outside what we see as our theoretical field (This belief prevents us from appreciating that many people are now bringing anxiety deriving from social causes to their sessions). The future does looks dangerous and unsettling. We can see that with global warming there will in the future be climate refugees. (Fact check: climate refugees are here now). Thank goodness governments are now finally waking up to climate and setting targets to reduce emissions. (Fact check: these have all too often been empty targets, not met, and even Biden’s latest extraction of promises so far are not enough to address the crisis).

To live on Planet La La is to live in a climate bubble based on fraudulent accounting. All fraud bubbles eventually burst. They must, as they involve omnipotent ways of override reality constraints. The climate bubble is now bursting, and as it does, we face not just one, but a series of shocks. As therapists we understand that emerging from a psychic retreat from reality can feel very shocking.

A series of shocks

I believe we first need to appreciate we face not one, or a few, but a whole series of shocks, the first being that climate news is itself shocking. As I said, global warming has largely happened during the last forty years. It is neoliberalism’s legacy. That is shocking, but more shocking is that very recently warming has started to speed up. The problem with climate reality is we tend to feel either too much or too little about it, veering between shock (too much) and disavowal (too little). Neither state helps us to think rationally, by which I mean thinking that includes our feelings and bodily reactions.
In addition to shock at the news itself, people are likely to feel assaulted by feelings that being in the bubble protected them from. Important to note is that it can feel particularly shocking to emerge from a group still in a bubble. Shame, once unconsciously shared out amongst members of the group, may suddenly be particularly acute. When I heard about the vast number of animals who died in the Australian bush fires, I felt ashamed to be a member of my own species. Some feelings released will be melancholic and potentially paralysing. Others, while very painful, are lively and part of grieving.
A further shock is realising more clearly that most leaders currently in power are continuing with policies leading to ecocide. This means that in effect they do not care if people live or die. Surely, our leaders cannot be that collectively crazy? Knowing they are is very hard to bear. Then, when no longer in the climate bubble, we have radically to re-evaluate our sense of ourselves. We see we are vulnerable and unprotected when we thought we were invincible. Death suddenly feels closer and more real. We see how easily seducible we are and how prey to colluding with corrupting political propaganda designed to supporting continuing with business as usual. We may feel shocked that we allowed ourselves be duped.
It is also deeply replenishing to emerge from a bubble, which is in effect a collective retreat from reality, to see the real picture more clearly. Stepping out of the bubble enables us better to face as a moral issue respecting or ignoring limits and whether we treat others fairly in the way we live our lives.
Some likely feelings as we emerge from the climate bubble
With this background, my question is how do we work through the environmental tragedy unfolding and stay sane? Many people are reporting eco-anxiety’ which, unless crippling, is on the side of life; it is care’s alarm call to face reality and to act .
We may feel traumatized by climate news. PTSD is the trauma of realising that our world is not safe. Moral injury, another form of trauma, is the trauma of realising that our world is not moral. Trauma can overwhelm the capacity to think clearly . It can leave people struggling with feeling over and underwhelmed by the traumatising events. Traumatised people can find it harder to judge whom is to blame with any sense of proportion, and they are prone to disassociate from the traumatising event.

I believe breaking with the current culture of uncare requires a collective effort of working through grief, remorse and a re-shouldering of collective responsibility. It matters greatly that this is undertaken in a spirit of forgiveness of self and other.
The real tragedy with the climate bubble is that it allowed so much damage to accrue that facing climate reality now can feel unbearable. What I do know from my own experience is that trying to bear it and allowing myself to feel at times overwhelmed helps me better contain my distress and soften my rage. I find I am more reflective and sadder, knowing I too profited from ignoring nature’s limits and colluded with the culture that worked to uncare me and us. We need to find ways collectively to work these sorts of feelings through together.
I have outlined some of the difficulties we face if we step out of the climate bubble and face climate reality. If covid has shown us anything it is that we all live in the same world. Becoming climate aware is as hard for us as therapists as it is for anyone else. We may be equipped with psychological understanding but this will not reduce our shock or heart ache at reaching climate awareness.

I will end with the problem Monica raised: she wants a baby but feels that is irresponsible given the climate emergency. If we want to help her work this through, we will need to pay far more than lip service to her concern about the physical climate. By lip service I mean making the sort of interpretation that may acknowledge the climate issue the patient has raised, but without the empathy that comes from having taken the issue on board oneself. Lastly, I believe to remain sensitive to people, especially the young who will bear the brunt of the climate crisis, we must remain vigilant in assessing whether our clinical setting has become a psychic retreat from climate reality. We cannot spare our patients the pain of facing the climate emergency. But we might be able to help them better if we understand the felt impacts of that emergency. We can only do that through undertaking the difficult work of becoming climate aware ourselves.

Climate awareness is not intellectual awareness alone, or a fleeting or sudden awareness, but a sustained effort to struggle to keep the issue in mind and to work through emotionally what that may bring up.