A number of my friends have written to me, as a psychiatrist, to ask for four-year prescriptions for antidepressants. And, with a little less levity, several people have asked me to write from my perspective as a mental health practitioner on coping with post-election emotional difficulties. I have been reluctant to do so for several reasons. First, it has been difficult to rouse myself from my own torpor. Second, should post-election stress be treated as a mental health problem and pathologized? Certainly, somewhere around 50% of the voting public are grieving at the present moment. One of the characteristics of most psychopathology is that it is suffered in loneliness and isolation from those around you, who have a hard time understanding the distress. But once a condition crosses a certain prevalence threshold, considering something pathological yields to treating it as a feature of the population . Most of us who are in distress about the results of what many of us called the most important election struggle of our lifetimes at least have others around us who share our sentiments and support our suffering.

It is true that we often turn to mental health professionals after a traumatic event which affects an entire population; this is highlighted after plane crashes or, most recently, as psychological practitioners poured into New York City after 9-11. But I have long considered it a dubious proposition that the training and experience of psychotherapists and psychiatrists in ministering to individuals are necessarily pertinent to the demands of ministering to traumatized populations. Certainly, it is good preventive medicine that people whose degree of distress is beyond the range of ‘expectable’ reactions to a trauma be identified and followed, but not the traumatized population as a whole, even if we could. After 9-11 a closer look suggested that crisis intervention with the population based on trauma-treatment principles turns out not to have a measurable preventive effect. Not only that, it can apparently impair people’s native abilities to cope and further traumatize them.

Finally, even if we were experts on coping with mass trauma, we cannot ignore the fact that there is not just one single prescription for dealing with distress at a time like this. People’s ways of experiencing the trauma, and the coping strategies and resources they have on hand to bring to bear, vary tremendously. In what turned out to be a rather surreal experience, I listened to one of NPR’s call-in talk shows yesterday afternoon which had a psychiatrist on talking about dealing with post-election stress. Listeners would call telling him how they had been getting by, or asking whether he would recommend certain things they had thought of doing — getting more politically involved, taking a break from political involvement, getting out of the country for awhile, putting their head under the covers. His answer to each and every suggestion was little more than a variant on, “Yes, that would be a good idea. Yes, that would be a good idea too…” Yes, everything is acceptable (nothing is forbidden).

(By the way, one of the most constructive suggestions I have heard is that progressives should have much more sex, not only to lighten up and start enjoying things more but to procreate more. Liberals seem to be having fewer children than those in the religious right, the argument goes, and more and more decisively losing the demographic race for a voting edge. So if we want to take back the White House and Congress in our children’s generation, start now…)

But, more seriously, I find that most helpful framework for understanding what we are going through is what has been popularly called the “five stages of grief.” Popularized by the late psychiatrist Elizabeth Kubler-Ross in the ’60’s to help people dealing with terminal diagnoses, this paradigm had actually been a way of understanding how we cope with receiving any catastrophic news; only more recently was it hijacked as a way of understanding grief. The five stages, probably familiar to many of you, are denial(“Bush didn’t really win”), anger (“Why the f**k did this happen to me?”), bargaining (“If I’m only energetic enough as a political activist, it’ll nullify the impact of Bush’s victory, I promise”), depression (in which one is paralyzed by the outcome) and acceptance.

A couple of things to notice. First, tuning in to the progressive media like Air America in the first couple of days after the election, many of their personalities seem still to be stuck in the denial stage, with elaborate arguments on how the votes just needed to be retallied and we would find that Bush hadn’t really won. Get real; if anyone can give me a convincing reason to see this as a realistic concern and not just a stage in attempting to cope with the devastating reality, I would be impressed. (Of course, I still believe Bush never won in 2000, so in another sense this ‘reelection’ is not legitimate. But that’s water under the bridge.)

Second, while the bargaining phase in which many of us find ourselves (how many times have you heard people saying since the election that the answer to how they are feeling is to get more involved?) sounds like it promises a fresh and overwhelming influx of activists for the next time around, if it precedes a thorough-going acceptance of the proportions of the problem, it is unrealistic and will be unsustainable. Bargaining is based on deluding yourself that the uncontrollable is really controllable, promising that bad outcomes will never occur if one’s efforts are just perfect enough. It is essentially a grandiose way to try to comfort oneself. In this light, all the analyses you are hearing, or will hear, about why the Democrats’ ran an imperfect race, and we will win next time if we only clean up our act, are flawed. Organizing has to start from the realization that we are not destined, or even likely, to win any particular campaign. (That is certainly what led to an effective Republican machine, as everyone’s comparisons to the Goldwater defeat of 1964 indicate.) To be effective , the devotion of energy has to be based on disabusing ourselves of the notion that we would inevitably win if only…

So, although there is no absolute timeline for passing through the stages, I would be more impressed with someone who resolves a week or a month from now to step up their political activity, once they are past their depressive lassitude and pessimism, and past the omnipotent bargaining. Some say that “grief work’ — in which one, accepting the reality, can truly and genuinely experience the pain, adjust, and reinvest energy in productive activity — can only begin after negotiating all five stages of the grief reaction.

Curmudgeon that I am, I am tempted to suggest that one should not fully abandon phase II, the angry phase. But unconstructive anger that it happened has to be supplanted, again after acceptance, by constructive anger at the perpetrators. Although in many ways we live in a pathologically anger-averse society, it can be a tremendous source of productive energy. You know I am a great fan of rage, properly directed. Some have said that I am at my best when I am finding fault with others. Well, there is something to be said for that! There’s a bumper sticker I like that says something like, “If you’re not outraged, you’re not really paying attention.” (IMHO, it ought to say “…enraged…”.) Even classical psychoanalytic theory speaks of the reciprocal relationship of anger and depression; that the latter is the former turned inward. Certainly, militant acting up is a better solution than remaining a suffering victim self-perpetuating the violence that Bush’s reelection has done to us all by taking it out on ourselves.

It’s not the naive anger of “I’ll be damned if I am going to let myself suffer while living the next four years in Bush’s America”. Get real, Eliot, you are going to suffer. But I’ll be damned if I am going to suffer in silence, and if there isn’t going to be hell to pay for the Republican assault on our freedoms, our security, our peace of mind, our environment, and the world my children and grandchildren will inherit.