Psychology must do more

“The events of 2020 illuminate and challenge the core principles of the nation’s founding—liberty, justice, equality. We have never lived up to these ideals. Psychology needs to be a leader in understanding the nature of beliefs about justice, how people become fervently attached to their beliefs, how hard it is to change them and how variations in lived experience alter what justice means. Race is at the heart of this work, and psychology, which has done much over the years, needs to do more. We need to focus a laser light on systemic racism, exposing its damaging effects on all it touches. We need more voices, more guiding questions, more intention. The transactional relationships within and across racial boundaries must be better understood, and that understanding must lead to stronger bonds and mutuality. Developing approaches to building coalitions of the willing would be a major contribution to stanching the erosion of our democracy and building a better society.”

James M. Jones, PhD, is a professor emeritus of psychological and brain sciences and director of the Center for the Study of Diversity at the University of Delaware

Equal access for all

“These events have required psychology to respond to the oppressive systems plaguing our society and undergirding and perpetuating inequality for marginalized communities. Psychological science and understanding have been used to deepen conversations about health inequity, xenophobia, racism, bias, privilege, power, violence and more, on individual, organizational, community and societal levels. We have been called to use our skills to promote behavioral, affective and cognitive shifts that are long overdue and much needed. We have brought psychology to people in ways that have forever changed the scope of our reach. We are now well positioned to move toward a psychology of liberation that recognizes and supports the need for equal access to psychological services for everyone and leans into the best of our field to guide the world to a more ethical, just and free society.”

Shavonne J. Moore-Lobban, PhD, chairs APA’s Board for the Advancement of Psychology in the Public Interest and is the campus director of training at the Washington, D.C., campus of the Chicago School of Professional Psychology.

Honor voices of color

“COVID-19 has unveiled the stark inequities that communities of color experience in health, health care and recovery. But to address health and its psychological consequences, psychology must address the historical systems and structures that limit opportunities for health and the social discourse that dehumanizes the lived experience of communities of color. We must start by examining our bias and exclusion of communities of color. For far too long, we have studied these communities or treated their symptoms using our evidence and not theirs. Psychology can level the playing field by honoring the voices of communities of color and activating their expertise. By moving toward community partnerships and changing how research, practice and education are created and disseminated, we can position our field for sustained equity promotion and innovation.”

Carmen R. Valdez, PhD, is an associate professor at the Steve Hicks School of Social Work and chief of community engagement and health equity in the department of population health at Dell Medical School at the University of Texas at Austin.

Diversify our scholarship

“2020 has highlighted serious systemic inequities in many spheres of our lives, including law enforcement, health and health care. Unfortunately, inequities also underlie the work in my area, developmental psychology. Our research still focuses disproportionately on white participants. Our research agendas need to change to include more attention to the lives of Black and Brown children so that we better understand the manifestations of discrimination and oppression. More attention is needed to identify sources of resilience and their implications for later development, especially for children growing up in marginalized communities. This research can inform efforts to make schools and communities more supportive of the needs of Black and Brown children.”

Deborah L. Vandell, PhD, is president of Div. 7 (Developmental Psychology) and a professor of education at the University of California, Irvine.

Pivoting to a new normal

“Some of our colleagues became sick and recovered, some lives were lost to COVID and some colleagues lost jobs or their finances were hit hard. Practice transitioned rapidly to telephone and telehealth platforms and included service provision to first responders, nurses and physicians. Education, training and clinical science research changed to maintain safety. Flexibility and perseverance were vital, and we are continuing to educate ourselves, encourage institutional anti-racism policies, support practice and engage in advocacy.”

Monica Kurylo, PhD, ABPP, is president of Div. 31 (State, Provincial and Territorial Psychological Association Affairs) and professor and director of neurorehabilitation psychology at the University of Kansas Medical Center & KU Health System.

New challenges

“COVID-19 had a major acute effect on psychological research by dramatically disrupting in-person data collection. This will have long-term impacts, including greater use of online behavioral assays and redesign of procedures for in-person behavioral testing. The pandemic also has dramatically disrupted undergraduate and graduate research, and adapting lab classes for online learning is a particularly great challenge. George Floyd’s murder has catalyzed a movement for racial justice in the United States and beyond, including intense attention on equity, diversity and inclusion in psychology. One important domain is how psychologists—especially BIPOC psychologists—are recruited, trained and supported in careers. Another is recognizing the limitations of relying on convenience samples such as college students who may not be diverse in race, ethnicity or class.”

Jeffrey Zacks, PhD, is the chair of APA’s Board of Scientific Affairs and a professor in the department of psychological and brain sciences at Washington University in St. Louis.

Global behavior change

“The biggest lockdown in our lifetime called for a sea change in our everyday behaviors: wearing masks, physically distancing and switching to the use of technology for teaching and learning, providing services and conducting business. Ignoring behavioral changes has cost us surges in disease incidence and death rates in some places. Compounding the COVID crisis were the police killings of George Floyd and Rayshard Brooks, causing protests worldwide calling to eradicate racism. Psychologists globally should have a clear mission to help us move to more peaceful, civilized and healthy societies by aggressively promoting research on bringing about behavioral changes at the societal level for better physical and mental health; eradicating racism, poverty and societal violence; and how best to use media and technology to disseminate authentic information globally to achieve these goals.”

V. Krishna Kumar, PhD, is president of Div. 46 (Society for Media Psychology & Technology) and a psychology professor at West Chester University.

Shared vulnerability

“Therapists have come to know a different level of mutual experience with patients. We no longer have the privilege of offices with our familiar protocols of engagement. We have all had to recognize our vulnerability and the anxiety of a public health crisis that touches every one of us. In spite of the trauma that we inhabit, we will continue to create ways of engaging one another that privilege relationships and the recognition of our radical humanity.”

Joseph Schaller, PsyD, is president-elect of Div. 39 (Society for Psychoanalysis and Psychoanalytic Psychology) and a clinical psychologist in Philadelphia.

A time of unparalleled stress

“Increases in mental health concerns are occurring, including increased stress, anxiety, depression, domestic violence and the consequences of unemployment. Although economic downturns typically predict increased stigma against devalued groups, it is possible that many elements of society will come to realize how precious life and mental health are—with consequent increases in empathy and compassion, and with increased access to evidence-based services via telehealth here to stay. Such would be truly silver-lined outcomes; major resources must be committed to ensure equitable access. And in terms of the huge rise in racism-linked consciousness, the ultimate goal—transcending expectable and justified outrage expressed throughout our nation—is for sustainable actions. We need to open all aspects of society, and our profession, to diverse individuals and to realize that we must all become aware of the institutionalized pervasiveness of racism.”

Stephen P. Hinshaw, PhD, is president of Div. 53 (Society of Clinical Child and Adolescent Psychology) and a professor of psychology at the University of California, Berkeley.

An evolving landscape

“The social strife and physical distancing of 2020 have been humbling and reminded us that we are emotional beings. While technology offers new virtual solutions in psychology, our fundamental roots for connectedness, community and public service run deep. We must be careful to not let the rapidly changing world disrupt our important ancient psychological and societal foundations. The challenge for psychologists moving forward is to foster and maintain these foundations in our evolving landscape of telehealth and virtual communication, job automation, social media and disparate access to digital information.”

Jack Tsai, PhD, is president of Div. 18 (Psychologists in Public Service) and campus dean for the University of Texas School of Public Health.

Broadening the lens

“The pandemic has seen many people without traditional diagnoses struggling with emotional and psychological concerns. This means that psychology must take seriously the use of population-level models so that our discipline can better serve communities in culturally appropriate ways, with maximum impact. Widespread attention to systemic racism underscores the need for our field to continue broadening its lens to become more centrally integrated and multicultural. This approach is needed to address other global issues, including COVID-19, violence and climate change. And as technology continues to play a huge role in communication and health care, psychology has a key role to play in developing effective and ethical human-technology interfaces and innovations.”

Sandra L. Shullman, PhD, is APA’s president and a partner in the Executive Development Group consulting firm in Greensboro, North Carolina.

A time for reason

“2020 revealed that people struggle with decisions that require assessing and balancing risks to self and to others, economic outcomes, personal freedoms and civil interaction. The science of decision-making should be taking center stage, but too often citizens and policymakers are retreating to emotion and intuition rather than reason. Once we are no longer in the middle of these crises, I hope a retrospective examination of the events of 2020 will provide an opportunity for psychology to advocate for more effective risk communication and the systematic evaluation of trade-offs.”

Michael Young, PhD, is chair of the Council of Graduate Departments of Psychology and the psychological sciences department head at Kansas State University.

Our science is critical

“The plagues of 2020 forever politicized scientific storytelling. The year began with Australia on fire, transitioned to a global pandemic and reignited flames of protest against racist state violence. The thread that unites these tragedies is that science can help avert them. Additionally, each scientific literature—from climate change to viral contagion to racial bias—is deeply politically contested. That means reporting our science clearly for a general audience is vital. It also means that, for much of our science, it is not possible to report our findings responsibly outside of the political context. Anthropologists will say that it never was. But 2020 makes that fact undeniable. My hope is that, as we move toward 2021, we embrace the necessarily political nature of studying the human mind. Politics is about power, and no scientist should pretend our field exists outside of that.”

Phillip Atiba Goff, PhD, is the co-founder and CEO of the Center for Policing Equity and a professor of African American studies and psychology at Yale University.

Never more important

“If one considers the breadth of individual and societal responses to the pandemic, from fear about infection and coping with bereavement to the disruption of children’s lives due to school closures to the impact of loneliness and economic disruption on well-being, I cannot think of any single discipline whose relevance is more urgent and pervasive than psychology. The diverse contributions of psychological science, in particular our understanding of how environments and personal skills can be modified to address the consequences of the unprecedented stressors affecting all of us, need to be acknowledged and scaled up to mitigate the adverse impacts that are already becoming visible and will only worsen in the coming months. Never has psychology been as important as now.”

Vikram Patel, PhD, is the Pershing Square Professor of Global Health in the department of global health and social medicine at Harvard Medical School.

A place at the table

“The crises of 2020 have inspired many psychologists to conduct timely research and engage in outreach. The public has realized that behavioral science is necessary to understand many of the most important issues of the day. From understanding racism to addressing political polarization to promoting effective responses to the pandemic, psychologists should be part of the discussion. For most of my life, fields like economics have driven most of the conversation. But I hope that psychology research and practice will have a seat at the table to help people separate science from science fiction. Our work is relevant to many of the most important issues facing society and should receive more robust funding.”

Jay Van Bavel, PhD, is an associate professor of psychology and neural science at New York University.

A global awakening

“The traumatic events of 2020 put psychology front and center, as the world became aware of what psychology has to offer, from the use of psychological science to understand systemic racism and people’s behavior during this most challenging time to changing behaviors and making psychological services available to others during a time of physical distancing and extreme distress. The way we practice psychology changed as we were forced to do things differently to continue to reach vulnerable populations. It was a learning experience, and the practice of psychology will be forever changed.”

Jennifer F. Kelly, PhD, ABPP, is APA’s president-elect and director of the Atlanta Center for Behavioral Medicine.

A Time to speak up

“The COVID-19 pandemic has forced psychologists to recognize that the world is faced with catastrophic conditions, such as pandemics, climate change and loss of biodiversity. It has also shown that in a world full of inequalities, solidarity plays an essential role. The pandemic has also confirmed long-standing arguments that nuclear weapons, massive armies and border walls do not make humans more secure. The killing of George Floyd has forced psychologists to reckon with racism, discrimination and police violence. Psychologists can only go forward by grasping causal links between economic development, disappearing biodiversity, climate change and pandemics. Psychologists must prioritize public health over private interests and stop the forces that cripple health services. Psychologists must choose peace over militarism: Militarism wastes funds that should go to public health and puts the world in danger. Psychologists must prioritize addressing racism and discrimination across the world and in their own work settings, organizations and structures.”

Serdar M. Değirmencioğlu, PhD, is the past president of Div. 48 (Society for the Study of Peace, Conflict, and Violence) and a professor at the University of Hagen in Germany.

Confront assumptions

“The events of 2020 have unmasked the depth of psychological dysfunction in society. Artificially constructed social hierarchies perpetuate major psychological challenges such as racism; intergenerational poverty; inequities in education, health and wealth; and global climate change. Going forward, psychologists will need to make it a priority to challenge and retire existing hierarchical assumptions that perpetuate these psychological stressors and work toward interventions to transform hierarchical social systems and behavior that interfere with psychological wellness.”

Art Blume, PhD, is president of Div. 45 (Society for the Psychological Study of Culture, Ethnicity and Race) and a professor of psychology at Washington State University in Vancouver.

Be nimble

“2020 has changed how we deliver and apply our science to address human suffering, whether that’s through telehealth for individual patients, applications of what we know about health behavior to large public health issues or advocacy for social justice. Going forward, we need to remain nimble to meet the needs of those we serve.”

Zeeshan Butt, PhD, is the past president of Div. 38 (Society for Health Psychology) and an associate professor at the Northwestern University Feinberg School of Medicine.

Improve lives everywhere

“One encouraging experience to come out of this tough time has been the bond people have for valuing human life and how psychologists have been able to help increase awareness of social justice issues, and the ability of our clinical acumen, research and innovation to be impactful during such crises. This shift speaks to the strength of psychology to be a voice and a mechanism to navigate societal issues and crises; never is this more evident than now. This is a time to speak up, advocate and share all the knowledge we have so that we help advance our human race.”

Erika Carr, PhD, is an associate professor and the director of the inpatient psychology service at Yale University School of Medicine and the chair of APA’s Committee on Early Career Psychologists.

Researchers are working around the clock to understand how COVID-19 is affecting the brain. It’s likely that there are several different disease processes at work.

Complications from intensive care

People who have been hospitalized in the ICU, for any reason, are more likely to experience long-term problems with cognition and have an increased risk of anxiety and depression. One (pre-COVID-19) study found 20%–40% of ICU patients experienced delirium, with rates climbing to 60%–80% for patients on ventilators (Pandharipande, P.P., et al., Intensive Care Medicine, Vol. 43, No. 9, 2017). Such complications are thought to be related both to severe illness and to intensive care treatment. Some portion of people seriously ill with COVID-19 will likely experience delirium and other neurological side effects simply as a result of being in the ICU, says Robert Stevens, MD, FCCM, of Johns Hopkins Medicine.

Inflammatory or immune response

In some patients, COVID-19 seems to trigger a runaway immune response that can cause problems throughout the body. In their Brain study of patients with neurological complications, Ross W. Paterson, PhD, of University College London, and colleagues described several types of encephalitis, as well as acute disseminated encephalomyelitis, or ADEM (an autoimmune disorder in which the immune system attacks the brain). Patients with encephalitis may experience mild flu-like symptoms, such as headaches, fevers and fatigue, or may experience more severe symptoms including confusion, seizures, paralysis, problems with speech or hearing, and more.

Stroke

COVID-19 has been found to cause blood clots, both large and small, that can travel to the brain and cause a stroke. Strokes have occurred in COVID-19 patients of all ages—and in fact, physicians have reported that some adults under 50 have presented to the hospital with a stroke as their first complication from COVID-19, while their respiratory symptoms were mild (Oxley, T.J., et al., The New England Journal of Medicine, Vol. 382, No. e60, 2020).

Viral infection of the brain

There have been a handful of accounts of the virus turning up in cerebrospinal fluid, raising the possibility that SARS-CoV-2, the virus that causes COVID-19, may be able to directly infect brain cells. But the evidence that the virus can make its way into brain cells is still uncertain, both Majid Fotuhi, MD, PhD, of NeuroGrow Brain Fitness Center, and Stevens agree. “Based on the literature and what we’ve seen so far, if viral infection of the brain occurs, it’s probably pretty rare,” Stevens says. “We think that immune-mediated encephalitis is probably much more common.”

A neurological framework

To integrate these concepts and form a preliminary framework for studying COVID-19 in the brain, Fotuhi and colleagues have proposed a three-stage system to classify neurological complications from the disease:

• Stage 1: Damage to the nervous system is limited to the epithelial cells in the nose and mouth. The main neurological symptoms include loss of smell and taste. These side effects seem to be quite common. One study found smell reduction in 41.7% of people with COVID-19, while 55.4% experienced taste reduction (Mercante, G., et al., JAMA Otolaryngology—Head & Neck Surgery, published online, 2020).
• Stage 2: The virus triggers an inflammatory response that leads to the formation of blood clots, which can cause strokes.
• Stage 3: A explosive inflammatory response called a cytokine storm damages the blood-brain barrier. This may allow inflammatory cells and molecules—and possibly viral particles—to enter the brain. Patients may develop seizures, confusion, coma or encephalopathy (a brain abnormality that leads to altered mental states or behaviors).