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    Key takeaways: RFK Jr’s ‘Maha’ report on chronic disease in children

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    Donald Trump’s health secretary and long-time vaccine skeptic, Robert F Kennedy Jr, presented a highly anticipated report on children’s health this week.The “Maha commission” report, referring to the “Make America healthy again” movement, was required by a presidential executive order in February. The report focuses on chronic disease among children.The 68-page report broadly summarizes five areas affecting children’s health, with a focus on ultra-processed foods, environmental chemical exposure, lack of physical activity, “overmedicalization”, and “capture” of regulatory agencies.It notably omits some of the most common causes of chronic disease and death in children, insinuates there could be harms where there is lack of evidence, and avoids discussing how Republicans have already changed the health system in ways researchers believe are harmful.Art Caplan, a professor of bioethics at New York University’s Grossman School of Medicine, told the Guardian that the report has “interesting ideas about health and children’s health and crackpot fringe tin-hat-wearing nonsense – it’s got it all”.Here are five of the key takeaways from the report.1. The report ignores some common dangers to childrenThe most common causes of death among children are car crashes and firearm accidents. The report ignores these issues, as well as behaviors that often start in adolescence and lead to chronic disease in adulthood, such as smoking and alcohol use. It also criticizes water fluoridation, without mentioning its protective effects against cavities.Also, absent from the report is a discussion of how the administration has already changed the health department in ways that advocates argue will benefit industry and could exacerbate chronic disease.For instance, Kennedy eliminated two smoking prevention offices at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) in what one former regulator told Stat was “the greatest gift to the tobacco industry in the last half century”. He also eliminated a world-leading sexually transmitted infection laboratory.In another example, one of the nation’s leading researchers of ultra-processed foods quit his “dream job” after facing what he described as censorship from the administration (the health department reportedly asked him to return). In a similar vein, the Trump administration cut a program that delivered local whole foods to schools soon after taking office, in spite of Kennedy calling for healthier school meals.2. The report focuses on issues key to Kennedy’s view of healthThe report is roughly broken up into five sections focusing on ultra-processed foods, environmental chemical exposures, children’s mental health, “overmedicalization” and “corporate capture” of regulators by the industries they are supposed to oversee.Kennedy has harped on many of the issues listed in the report for months in public appearances and even though his defunct presidential campaign – especially including ultra-processed foods and obesity. Although some of these concerns may find bipartisan support – such as the focus on “forever chemicals” such as Pfas – it also pushes into areas where the science is unsettled.For instance, the report mentions that high levels of fluoride are potentially associated with reduced IQ, but does not mention its well-established protective effects against cavities – the most common chronic condition in children, according to the National Institute of Dental and Craniofacial Research.Similarly, the report argues that the childhood vaccine schedule is causing concern among parents for,“their possible role in the growing childhood chronic disease crisis” – without citing evidence that vaccines are linked to any specific chronic disease.3. It’s likely to face diverse pushback – and create new alliancesEven before the report was published, congressional lawmakers were being bombarded by calls from agricultural and chemical lobbyists wary of how the report would criticize their products – and indeed it did.One of the report’s sections questions whether “crop protection tools” including “pesticides, herbicides and insecticides” could harm human health. It then specifically name-drops glyphosate, the key ingredient in Roundup, and atrazine, a common herbicide. That is sure to make for strange political bedfellows and consternation within the Republican party. Similarly, the report cites synthetic dyes and ultra-processed foods are potentially harmful.Chemicals and food additives have been issues of concern for decades on the left. However, the Maha movement has also catalyzed opposition to them on the right.4. The report’s authors are not namedThe commission’s members are made up of the heads of intersecting agencies, including Kennedy at the Department of Health and Human Services, and the heads of the departments of agriculture, housing, education, veterans affairs and the Environmental Protection Agency, among others.However, the exact authors of the report are unknown. This contrasts with Kennedy’s repeated promise at his confirmation hearing that his health department would practice “radical transparency”.The work of the “Maha” commission was reportedly spearheaded by senior Kennedy adviser Calley Means, a former food lobbyist and healthcare entrepreneur who rose to prominence as a Maha truth-teller. Means co-wrote a bestselling book with his sister, current US surgeon general nominee Casey Means, which blames many of America’s ills on sedentary lifestyle and poor diet.5. Changing any of the issues identified is likely to be toughOne of the key issues the report identifies is the influence of food, pharmaceutical and chemical companies on American policy. They are monied and powerful.As a result, getting real change through Congress is certain to be tough – especially in an administration devoted to reducing regulations. More

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      Systems are crumbling – but daily life continues. The dissonance is real

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      View image in fullscreenIn January, the comedian Ashley Bez posted an Instagram video of herself, trying to describe a heavy mood in the air. “How come everything feels all …?” she says, trailing off and grimacing exaggeratedly into the camera.Digital anthropologist Rahaf Harfoush saw the video, and got it immediately.“Welcome to the hypernormalization club,” Harfoush said in a response video. “I’m so sorry that you’re here.”“Hypernormalization” is a heady, $10 word, but it captures the weird, dire atmosphere of the US in 2025.First articulated in 2005 by scholar Alexei Yurchak to describe the civilian experience in Soviet Russia, hypernormalization describes life in a society where two main things are happening.The first is people seeing that governing systems and institutions are broken. And the second is that, for reasons including a lack of effective leadership and an inability to imagine how to disrupt the status quo, people carry on with their lives as normal despite systemic dysfunction – give or take a heavy load of fear, dread, denial and dissociation.“What you are feeling is the disconnect between seeing that systems are failing, that things aren’t working … and yet the institutions and the people in power just are, like, ignoring it and pretending everything is going to go on the way that it has,” Harfoush says in her video.Within 48 hours, Harfoush’s video accrued millions of views. (It currently has slightly fewer than 9m.) It spread in “mom groups, friend chat circles, political subreddits, coupon communities, and even dog-walking groups”, Harfoush tells me, along with variations of: “Oh, so that’s what I’ve been feeling!” and “people tagging their friends with notes like: ‘We were just talking about this!’”View image in fullscreenWhy hypernormalization is relevant in the USThe increasing instability of the US’s democratic norms has prompted these references to hypernormalization.Donald Trump is dismantling government checks and balances in an apparent advance toward a “unitary executive” doctrine that would grant him near-unlimited authority, driving the US toward autocracy. Billionaire tech moguls like Elon Musk are helping the government consolidate power and aggressively reduce the federal workforce. Institutions like the National Institutes of Health, the Centers for Disease Control and Prevention and the Food and Drug Administration, which help keep Americans healthy and informed, are being haphazardly diminished.Globally, once-in-a-lifetime climate disasters, war and the lingering trauma of Covid continue to unfold, while an explosion of generative AI threatens to destabilize how people think, make a living and relate to each other.For many in the US, Trump 2.0 is having a devastating effect on daily life. For others, the routines of life continue, albeit threaded with mind-altering horrors: scrolling past an AI-generated cartoon of Ice officers arresting immigrants before dinner, or hearing about starving Palestinian families while on a school run.Hypernormalization captures this juxtaposition of the dysfunctional and mundane.It’s “the visceral sense of waking up in an alternate timeline with a deep, bodily knowing that something isn’t right – but having no clear idea how to fix it”, Harfoush tells me. “It’s reading an article about childhood hunger and genocide, only to scroll down to a carefree listicle highlighting the best-dressed celebrities or a whimsical quiz about: ‘What Pop-Tart are you?’”In his 2016 documentary HyperNormalisation, the British film-maker Adam Curtis argued that Yurchak’s critique of late-Soviet life applies neatly to the west’s decades-long slide into authoritarianism, something more Americans are now confronting head-on.“Donald Trump is not something new,” Curtis tells me, calling him “the final pantomime product” of the US government, where the powerful are abandoning any pretense of common, inclusive ideals and instead using their positions to settle scores, reward loyalty and hollow out institutions for personal or political gains.Trump’s US is “just like Yeltsin in Russia in the 1990s – promising a new kind of democracy, but in reality allowing the oligarchs to loot and distort the society”, says Curtis.Why the concept of hypernormalization is usefulWitnessing large-scale systems slowly unravel in real time can be profoundly surreal and frightening. The hypernormalization framework offers a way to understand what we’re feeling and why.Harfoush created her video “to reassure others that they’re not alone” and that “they aren’t misinterpreting the situation or imagining things”. Understanding hypernormalization “made me feel less isolated”, she says. “It’s difficult to act when you’re uncertain if you’re perceiving reality clearly, but once you know the truth, you can channel that clarity into meaningful action and, ideally, drive positive change.”Naming an experience can be a form of psychological relief. “The worst thing in the world is to feel that you’re the only one who feels this way and that you are going quietly mad and everyone else is in denial,” says Caroline Hickman, a psychotherapist and instructor at the University of Bath specializing in climate anxiety. “That terrifies people. It traumatizes people.”People who feel the “wrongness” of current conditions acutely may be experiencing some depression and anxiety, but those feelings can be quite rational – not a symptom of poor mental health, alarmism or a lack of proper perspective, Hickman says.“What we’re really scared of is that the people in power have not got our back and they don’t give a shit about whether we survive or not,” she says.View image in fullscreenMarielle Greguski, 32, a New York City-based retail worker and content creator, posted about everyday life feeling “inconsequential” in the face of political crisis. Greguski says the outcome of the 2024 election reminded her that she lives in a “bubble” of progressive values, and that “there’s the other half of people that are not feeling the same energy and frustration and fear”.To Greguski, the US’s failings are not only partisan but moral – like the racism and bigotry that Trump’s second term has brought out of the shadows and into policy.Greguski is currently planning a wedding. It’s hard to compartmentalize “constant cruelty, things that don’t make sense”, she says. “Sometimes I’ll be like: ‘I have to put aside X amount of money for the wedding next year,’ and then I’m like: ‘Will this country exist as we know it next year?’ It really is crazy.”The effects of hypernormalizationConfronting systemic collapse can be so disorienting, overwhelming and even humiliating, that many tune it out or find themselves in a state of freeze.Greguski likens this feeling to sleep paralysis: “basically a waking nightmare where you’re like: ‘I’m here, I’m aware, but I’m so scared and I can’t move.’”In his 1955 book They Thought They Were Free: The Germans, 1933–45, journalist Milton Mayer described a similar state of freeze in German citizens during the rise of the Nazi party: “You don’t want to act, or even talk, alone; you don’t want to ‘go out of your way to make trouble.’ Why not? – Well, you are not in the habit of doing it. And it is not just fear, fear of standing alone, that restrains you; it is also genuine uncertainty.”“People don’t shut down because they don’t feel anything,” says Hickman. “They shut down because they feel too much.” Understanding this overwhelm is an important first step in resisting inaction – it helps us see fear as a trap.Curtis points out that governments may intentionally keep their citizens in a vulnerable state of dread and confusion as “a brilliant way of managing a highly febrile and anxious society”, he says.When we feel powerless in the face of bigger problems, we “turn to the only thing that we do have the power over, to try and change for the better”, says Curtis – meaning, typically, ourselves. Anxiety and fear can trap us, leading us to spend more time trying to feel better in small, personal ways, like entertainment and self-care, and less time on activism and community engagement.View image in fullscreenHow to overcome hypernormalizationProgressive commentators have urgently called for moral clarity and mobilization in response to changes like the cuts to USAID funding, which has resulted in an estimated 103 deaths per hour across the globe; the dismantling of the CDC; and Robert F Kennedy’s campaign against vaccine science.“Where is the outrage?” asks the Nation’s Gregg Gonsalves. “Too many lives are at stake to rest in this bizarre moment of frozen agitation.”“I don’t know if there’s a massive shift toward racism as much as an expanded indifference toward it,” the historian Robin DG Kelley said in a February interview with New York Magazine. “People are just kind of like: ‘Well, what can we do?’”Experts say action can break the spell. “Being active politically, in whatever way, I think helps reduce apocalyptic gloom,” says Betsy Hartmann, an activist, scholar and author of The America Syndrome, which explores the importance of resisting apocalyptic thinking.Greguski and a co-worker have been helping distribute multilingual information about legal rights and helpline numbers, to be used in the event of Ice raids.“It’s easy to feel like: ‘Oh, I’m in community because I’m on TikTok,’” she says. But genuine community is about “getting outside and talking to your neighbor and knowing that there’s someone out there that can help you if something really bad goes down,” she says.“You’re actually out there talking to people, working with people and realizing there are so many good people in the world, too, and maybe feeling less isolated than before,” says Hartmann.“But I also think we need a broader vision,” Hartmann notes. She suggests looking to resistance efforts against authoritarianism in countries like Turkey, Hungary and India. “How might we be in international solidarity? What lessons can we learn in terms of rebuilding sophisticated, complex government infrastructure that’s been hacked away at by people like Elon Musk and his minions in a more socially just and sustainable way?”“We are in a period now when it’s absolutely essential to protest,” says Hartmann, citing the Harvard professor Erica Chenoweth, who argues that just 3.5% of a population engaging in peaceful protest can hold back authoritarian movements.What makes dysfunction so dangerous is that we might simply learn to live with it. But understanding hypernormalization gives us language – and permission – to recognize when systems are failing, and clarifies the risk of not taking action when we can.In 2014, Ursula Le Guin accepted the National Book Foundation’s Medal for Distinguished Contribution to American Letters, saying: “We live in capitalism. Its power seems inescapable. So did the divine right of kings. Any human power can be resisted and changed by human beings. Resistance and change often begin in art, and very often in our art, the art of words.”Harfoush reflects on this quote often. It underscores the fact that “this world we’ve created is ultimately a choice”, she says. “It doesn’t have to be like this.”We have the research, technologies and wisdom to create better, more sustainable systems.“But meaningful change requires collective awakening and decisive action,” says Harfoush. “And we need to start now.” More

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      Trump administration to cancel $1bn in Biden-era school mental health grants

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      The Trump administration is moving to cancel $1bn in school mental health grants, saying they reflect the priorities of the previous administration.Grant recipients were notified on Tuesday that the funding will not be continued after this year. A gun violence bill signed by Joe Biden in 2022 sent $1bn to the grant programs to help schools hire more psychologists, counselors and other mental health workers.A new notice said an education department review of the programs found they violated the purpose of civil rights law, conflicted with the department’s policy of prioritizing merit and fairness, and amounted to an inappropriate use of federal money.The cuts were made public in a social media post from the conservative strategist Christopher Rufo, who claimed the money was used to advance “left-wing racialism and discrimination”. He posted excerpts from several grant documents setting goals to hire certain numbers of nonwhite counselors or pursue other diversity, equity and inclusion policies.“No more slush fund for activists under the guise of mental health,” Rufo wrote.The education department confirmed the cuts. In an update to members of Congress that was obtained by the Associated Press, department officials said the Republican administration would find other ways to support mental health.“The Department plans to re-envision and re-compete its mental health program funds to more effectively support students’ behavioral health needs,” according to the notice.Donald Trump’s administration has cut billions of dollars in federal grants deemed to be related to diversity, equity and inclusion (DEI) and has threatened to cut billions more from schools and colleges over diversity practices. The administration says any policy that treats people differently because of their race amounts to discrimination, and it argues that DEI has often been used to discriminate against white and Asian American students. More

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      The United States is witnessing the return of psychiatric imprisonment | Jordyn Jensen

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      Across the country, a troubling trend is accelerating: the return of institutionalization – rebranded, repackaged and framed as “modern mental health care”. From Governor Kathy Hochul’s push to expand involuntary commitment in New York to Robert F Kennedy Jr’s proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative, policymakers are reviving the logics of confinement under the guise of care.These proposals may differ in form, but they share a common function: expanding the state’s power to surveil, detain and “treat” marginalized people deemed disruptive or deviant. Far from offering real support, they reflect a deep investment in carceral control – particularly over disabled, unhoused, racialized and LGBTQIA+ communities. Communities that have often seen how the framing of institutionalization as “treatment” obscures both its violent history and its ongoing legacy. In doing so, these policies erase community-based solutions, undermine autonomy, and reinforce the very systems of confinement they claim to move beyond.Take Hochul’s proposal, which seeks to lower the threshold for involuntary psychiatric hospitalization in New York. Under her plan, individuals could be detained not because they pose an imminent danger, but because they are deemed unable to meet their basic needs due to a perceived “mental illness”. This vague and subjective standard opens the door to sweeping state control over unhoused people, disabled peopleand others struggling to survive amid systemic neglect. Hochul also proposes expanding the authority to initiate forced treatment to a broader range of professionals – including psychiatric nurse practitioners – and would require practitioners to factor in a person’s history, in effect pathologizing prior distress as grounds for future detention.This is not a fringe proposal. It builds on a growing wave of reinstitutionalization efforts nationwide. In 2022, New York City’s mayor, Eric Adams, directed police and EMTs to forcibly hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Governor Gavin Newsom’s Care courts compel people into court-ordered “treatment”.Now, these efforts are being turbocharged at the federal level. RFK Jr’s Maha initiative proposes labor-based “wellness farms” as a response to homelessness and addiction – an idea that eerily echoes the institutional farms of the 20th century, where disabled people and people of color were confined, surveilled and exploited under the guise of rehabilitation.Just recently, the US Department of Health and Human Services (HHS) announced a sweeping restructuring that will dismantle critical agencies and consolidate power under a new “Administration for a Healthy America” (AHA). Aligned with RFK Jr’s Maha initiative and Donald Trump’s “department of government efficiency” directive, the plan merges the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and other agencies into a centralized structure ostensibly focused on combating chronic illness. But through this restructuring – and the mass firing of HHS employees – the federal government is gutting the specialized infrastructure that supports mental health, disability services and low-income communities.The restructuring is already under way: 20,000 jobs have been eliminated, regional offices slashed, and the Administration for Community Living (ACL) dissolved its vital programs for older adults and disabled people scattered across other agencies with little clarity or accountability. This is not administrative streamlining; it is a calculated dismantling of protections and supports, cloaked in the rhetoric of efficiency and reform. SAMHSA – a pillar of the country’s behavioral health system, responsible for coordinating addiction services, crisis response and community mental health care – is being gutted, threatening programs such as the 988 crisis line and opioid treatment access. These moves reflect not just austerity, but a broader governmental strategy of manufactured confusion. By dissolving the very institutions tasked with upholding the rights and needs of disabled and low-income people, the federal government is laying the groundwork for a more expansive – and less accountable – system of carceral “care”.This new era of psychiatric control is being marketed as a moral imperative. Supporters insist there is a humanitarian duty to intervene – to “help” people who are suffering. But coercion is not care. Decades of research show that involuntary (forced) psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes. Forced hospitalization has been linked to increased suicide risk and long-term disengagement from mental health care. Most critically, it diverts attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.The claim that we simply need more psychiatric beds is a distraction. What we need is a complete paradigm shift – away from coercion and toward collective care. Proven alternatives already exist: housing-first initiatives, non-police and peer-led crisis response teams, harm reduction programs, and voluntary, community-based mental health services. These models prioritize dignity, autonomy and support over surveillance, control and confinement.As Liat Ben-Moshe argues, prisons did not simply replace asylums; rather, the two systems coexist and evolve, working in tandem to surveil, contain and control marginalized populations. Today, reinstitutionalization is returning under a more therapeutic facade: “wellness farms”, court diversion programs, expanded involuntary commitment. The language has changed, but the logic remains the same.This moment demands resistance. We must reject the idea that locking people up is a form of care. These proposals must be named for what they are: state-sanctioned strategies of containment, rooted in ableism, racism and the fear of nonconformity.Real public health does not rely on force. It does not require confining people or pathologizing poverty. It means meeting people’s needs – through housing, community care, healthcare and support systems that are voluntary, accessible and liberatory.As budget negotiations in New York continue to drag on – with expansions to involuntary commitment still on the table – and as RFK Jr advances carceral care proposals at the federal level, we face a critical choice: will we continue the long history of institutional violence, or will we build something better – something rooted in justice, autonomy and collective wellbeing?The future of mental health care – and of human dignity itself – depends on our answer.

      Jordyn Jensen is the executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law More

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      Trans soldiers served their country. Now the US is rolling back their healthcare

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      When Savannah Blake joined the air force at 22 years old, she was looking for stable employment and a way out of poverty. For the last few years of her service, she worked as a cyberdefense operator in the intelligence squadron. But the work, which involved overseeing computers operating drone surveillance, eventually took a toll on her mental health.“If I had to watch any more of this, I was going to not be alive anymore,” Blake said, who says she experienced suicidal ideations. “I just felt like the bad guy. I felt evil.”View image in fullscreenAfter seven years of service, Blake, who is trans, left the air force with PTSD, generalized anxiety disorder and chronic depression. But she also left with the hope she could finally live as herself without fear of harassment from fellow service members. Last year, she began receiving estrogen through the Department of Veterans Affairs. Now she fears for the future of that care.“Every day, I wake up and I don’t know what the rules are anymore in the country I live in,” said Blake. “It’s becoming increasingly hard to see a future where we’re OK.”Blake is one of about 134,000 transgender veterans living in the US. It’s an alarming time to be someone like her. On his first day in office, Donald Trump issued an executive order recognizing only two sexes, stamping out gender identity in federal documents and public spaces. A series of other orders have attempted to restrict trans rights, including participation in sports, access to gender-affirming care for youth, educational materials in schools and military service.The crackdown has sent shock waves through the VA, which functions as one of the US’s largest healthcare providers, offering free or low-cost care to more than 9 million veterans. After Trump’s inauguration, some VA health centers began removing LGBTQ+ affiliated objects, including pride flags, rainbow magnets, stickers and posters.When Mary Brinkmeyer’s medical center ordered the removal of LGBTQ+ patient flyers and other affirming material days after Trump’s executive orders, she refused, and ultimately resigned. For nearly three years, she had worked as a psychologist and LGBTQ+ veteran care coordinator at the VA facility in Hampton, Virginia. Hospital leadership ordered her to stop LGBTQ+ outreach, advocacy and gender-affirming training to departments because it could be considered “gender ideology”.View image in fullscreen“We all have ethics codes in our professions that say that you’re supposed to do no harm, and that if you’re caught between institutional pressure and the ethics code, you’re supposed to resolve it in a way that’s consistent with the ethics code,” Brinkmeyer said.Brinkmeyer fears for the mental health of trans veterans, whom she saw experience “really intense suicidal crises” after Trump announced a ban on trans people enlisting in the military in 2017. After the election last November, some of her patients requested the removal of trans identifiers in medical records, and others withdrew from coverage over fears of being targeted and losing access to care. For many, those fears have become a reality.Rollbacks became official in March when the VA rescinded directive 1341, a policy that ensured “the respectful delivery of health care to transgender and intersex Veterans”, and announced the phasing out of gender-affirming medical care. The agency had been providing gender-affirming treatment including hormone therapy, prosthetics, hair removal, voice coaching and pre-surgical evaluation including letters of support for more than a decade. While cisgender veterans will still be able to access these treatments, veterans diagnosed with gender dysphoria are now excluded. Mental health services for trans patients and existing VA and military coverage for hormone therapy won’t be affected, according to the memo, which also formalizes banning trans patients from using facilities that align with their gender identity.View image in fullscreen“I am scared for the huge amount of people that are about to be forcibly separated, because the VA is not there to actually catch these people,” Blake said, referring to an influx of trans service members who could be forced out of the military under Trump’s transgender military ban. “I hate that the ladder was pulled up behind me.”‘A death sentence’The changes have put trans veterans seeking gender-affirming care in limbo. It has also created a climate of fear for the trans veterans already receiving hormone therapy, who worry it could be pulled at any time.View image in fullscreenThat’s the reality for Kaydi Rogers. While at the moment her hormone therapy will not be disrupted, she is terrified of losing access to estrogen if the VA continues its crackdown.Rogers spent about five decades acquiring estrogen pills through pharmacies in Mexico or friends with prescriptions.“I was desperate,” Rogers said. “I didn’t know any way of doing anything about what was going on with me. It was not a common thing back in the 70s and 80s to come out trans.”She finally switched to VA coverage because of the potential health risks of taking unregulated pills. But Rogers said if the VA ever stopped prescribing her estrogen, the desperation would return and she would again rely on self-medication for survival.Beyond her concerns about continued access to care, Rogers feels the loss of welcoming and safe spaces inside VA clinics. She says she tries to avoid drawing attention to herself during appointments, fearful of being harassed or attacked.“Before last year, every time I went to the VA, I went dressed as Kaydi and no one seemed to bother me or care,” Rogers said. “Now, not so much.”Other veterans share these safety concerns, including Lindsay Church, the executive director and co-founder of Minority Veterans of America. Church, who is non-binary and uses they/them pronouns, has experienced harassment and discrimination inside VA clinics in the past, and began carrying a printed copy of directive 1341 to prove they were entitled to treatment that respected their gender identity. With that directive rescinded and no guarantee of protection, they’ve canceled VA appointments and sought care elsewhere.View image in fullscreenThe veterans affairs secretary, Doug Collins, stated that trans veterans “will always be welcome at VA and will always receive the benefits and services they’ve earned under the law”. In response to questions about the new policy, the VA press secretary, Peter Kasperowicz, directed the Guardian to the press release from 17 March.Church said the discriminatory climate is having a chilling effect on trans veterans, regardless of whether their care plans have been discontinued under the VA’s new policy. “If I can’t use [my healthcare plan] because I’m scared of being harassed and intimidated, and experiencing physical violence in a bathroom, I can’t use the system,” they said.They called the policy reversal a “death sentence”.View image in fullscreen‘We tell them we will take care of you, and that’s a lie’Trans veterans face higher rates of homelessness, unemployment, PTSD and military sexual trauma compared with cisgender veterans. They are also twice as likely to die by suicide compared with cisgender veterans, and almost six times more likely than the general US population. Advocates and providers say these psychiatric and socioeconomic risk factors, when combined with the loss of an affirming medical environment, places an already vulnerable population even more at risk.One VA clinical social worker, who requested anonymity, said his LGBTQ+ patients don’t feel safe and are experiencing more suicidal ideations than before Trump took office.“I have seen an increase in suicide risk evaluations,” he said. “I’ve done more of those in the last two months than I’ve done the last two years.”View image in fullscreenAnother LGBTQ+ veteran care coordinator said a trans patient attempted suicide at her facility after Trump’s inauguration, and she fears there could be more people who attempt the same. She said notifying trans patients of the policy change has been heartbreaking.“I’ve worked for the past two and a half years to gain people’s trust, and now all of a sudden, I’m pulling out the rug from under them,” she said. “It feels terrible.”She had to tell one patient wanting to start hormone therapy that the VA could no longer help them, and is preparing the same message for trans patients on a months-long waitlist to begin treatment. While she has been looking for ways to provide alternatives, many of her trans patients live in rural areas where accessing gender-affirming care is difficult.Other VA employees see cutting trans healthcare as a betrayal of the benefits promised to service members when they enlist.“We’re asking these 17-year-olds to give their entire bodies to the US government,” said one VA nurse, who requested anonymity over fear of losing her job. “And they’re given one promise, which is that we will care for them. And this is part of care, whether you like it or not.”Gender-affirming medical care has been endorsed by every major medical association in the US, and medical providers say that politicians shouldn’t be allowed to decide how they care for their patients.“You’re giving so much to the military. You give your whole life, you have no say over where you live,” the nurse said. “Then we tell them we will take care of you, and that’s a lie. We’re lying to people – and not just trans veterans, all veterans.” More

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      ‘Trump derangement syndrome’ and the Goldwater rule for psychiatrists | Letter

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      A bill was recently introduced to the Minnesota legislature to categorise “Trump derangement syndrome” as a mental illness. The proposed bill defines the syndrome as characterised by “verbal expressions of intense hostility toward” Donald Trump and “overt acts of aggression and violence against anyone supporting [Trump] or anything that symbolises [Trump].”Such a bill obviously infringes on our constitutional right to freely criticise our elected leaders and can serve as a stepping stone towards labelling and punishing political opponents under the guise of utilising a variety of compulsory psychiatric interventions. However, this bill is reminiscent of anti-Trump mental health professionals who have opined that President Trump poses a great danger because of a severe personality disorder.Clearly, a psychiatric diagnosis can only be made by mental health professionals who are licensed to do so, and only after having examined a patient. It poses great danger to our society both when legislators use their political power to impose a psychiatric label on their political opponents and when mental health professionals misapply their expertise to give a psychiatric label to those whom they fear.In the 1960s, many psychiatrists opined on the mental health of the Republican presidential candidate Barry Goldwater. As a result of that controversy, in 1973 the American Psychiatric Association developed the “Goldwater rule”, which applies to public figures. It states that it is unethical for a psychiatrist to offer a proper authorisation for such a statement.This rule is still in effect, though much too often broken. Perhaps we need to develop a comparable national rule prohibiting political personnel, both elected and appointed, from creating psychiatric diagnoses as a tool against their political opponents.Leon Hoffman Psychiatrist, New York City, US More

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      View from the couch: therapists on sessions in new Trump era

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      In his conversations with trans clients, Will Williams, a therapist in Oakland, California, sees the psychic toll exacted by the fusillade of recent executive orders targeting transgender protections. Many of his patients are filled with fear – and for legitimate reasons.In the days after Donald Trump took office, the administration required passports to be marked with sex assigned at birth, banned trans people from serving in the military and cut funding for gender-affirming care. On some federal websites, the “T” was removed from “LGBT”.“There’s this literal embodied experience of ‘Oh I’m a target,’” said Williams, who is trans. “[We are] the 1% that is going to be targeted and blamed, and when it comes down from the theoretical into daily life – psychically there’s an experience of being erased.”When clients ask him “Do I even exist?”, Williams can at least offer some comfort. He asks: “How is it to be in a room with another trans person?” The question makes plain what is in front of them: yes, they both exist. “The medicine is in that,” Williams says. “Trump can say the moon doesn’t exist anymore, but the moon still shines, and it still waxes and wanes.”Williams is among the many therapists who are figuring out how to navigate a profession that has been plunged into uncharted territory during a tense second Trump term. It’s a new atmosphere, and therapists say they are “learning beside” their clients as they go.Many of those who spoke with the Guardian requested anonymity so they could speak freely about sensitive issues.Liberal therapists say they sometimes incorporate their political views into the healing process to provide support for clients distressed by Trump’s actions. “You’re taught in school that therapists aren’t supposed to be political, but it’s very political,” one liberal practitioner said. “Now, at least in my therapist friend group, we’re like, ‘Screw that, no, this is very political.’”Trump’s policies, such as deporting immigrants, go against therapists’ code of ethics that requires them to uphold client’s dignity and worth, she said. That hasn’t precluded her from working with Trump-supporting clients. Some don’t return “and that’s OK”, but she successfully works with a range of conservative patients.On the other end of the spectrum, some therapists say they are encountering liberal clients who are fearful of coming to therapy: “They want to know if their therapist voted against their human rights.” Providing assurance to anxious clients is an instance in which many are choosing to share their political views. “When appropriate, I want to let them know that it’s really safe,” one therapist said.Liberal therapists, conservative clientsThe relationship between liberal therapists and conservative clients has demanded a slight revision of therapeutic calculus. A few said they find themselves revolted by their clients’ beliefs but figure out how to work with them effectively despite the fraught dynamic.None of the therapists I interviewed said they try to change clients’ political views, but therapy is often about getting people to think about problems in their lives differently – and sometimes there’s overlap.One therapist I spoke with used the example of some of her clients’ fear and hatred of transgender people. She asks them where those fears stem from, because they are often passed on generationally.“What kind of things were you taught as a child? If you heard your parents talking about this – do all of your values align with your parents’ values? Have you ever broken from them? Will you feel rejected by your family or community if you think differently?” she asks.As therapy progresses, fears are often unlocked, and some of those questions are answered. “Even if the client isn’t focused on the political aspect, we can work on some of those themes, like fear, without getting into politics,” she said.Another liberal practitioner who took on a Trump-supporting client had doubts about their potential for growth in part because of the latter’s very religious, conservative beliefs. The client was upset with their church’s liberal positions on some issues, and that was causing a problem in their life.The therapist encouraged the client to talk with church leadership and to try to understand a different viewpoint. “I didn’t look at it as an opportunity or say, ‘Oh, I got a chance to try to win them over,’” she said. “It was, ‘Oh, you have this conflict, and maybe if you can see another perspective that would help you.’”Sometimes, the roles are reversed and fear is on the other foot. A practitioner who fears fascism and societal collapse, and has stocked up on supplies in case “the shit hits the fan”, said the money she makes taking on conservative clients is worth it.“You know, I’m billing $90 an hour, and I can listen to that bullshit for 50 minutes for $90,” she said. “I feel gross saying that because I do think my [Trump-supporting] clients are doing something awful, and are the personification of the problems I deal with.”A website, ConservativeCounselors.com, highlights the work of conservative therapists around the country. The Guardian sent emails to five of them, but only one responded in a brief email.“Conservative therapists have formed a pretty tight group, and many of us have shared that you’ve reached out for an interview,” the therapist, Maria Coppersmith, said. “The general consensus is that the Guardian is so ultra-liberal, that any conservative therapist that shares his or her viewpoint is likely to have their words twisted and will be highly misrepresented. You might get a naive newbie therapist that will agree to an interview, but I am respectfully declining.”‘Screw that, this is very political’To describe what’s occurring in the interplay between therapy and politics, Bill Doherty, co-founder of Braver Angels, a non-profit that works toward depolarization, borrowed a term from practitioners in destabilized Latin American countries: political stress. “It’s the anxiety and psychological preoccupation that stems from what’s happening in our political situation, how government officials are behaving and how we’re treating each other when we disagree,” Doherty said. “The challenge is therapists have their own viewpoints – they vote – this is not external to their lives. So the major challenge that’s now happening is therapists trying to keep their own political leanings from influencing clients.”Broadly speaking, therapists say the profound shock and sharp sense of fear that was almost universal among liberal clients after Trump’s first win has been replaced with variations of numbness, hopelessness and resignation.“After Trump won in 2016 everyone was like, ‘Oh my God what’s going to happen? What are we going to do?’ And during Covid they were like, ‘Oh my God, there are no adults in Washington! What are we going to do?’” a therapist said. Now his clients are much more despondent. “They’re like, ‘Fuck it, let it burn,’” he said.Williams said there was indeed less “fear and scrambling” in November 2024, but it has been more difficult for trans clients this time around. Many are running against the clock to make changes to identification cards, birth certificates, passports and other documents.Similarly, a therapist who works with federal employees says there is a broad sense of “whiplash”. The administration has also attacked minorities and women employed at federal agencies, claiming that they are unqualified and were only hired due to DEI initiatives. That takes a toll on some clients, who may end up questioning how people view their worth.And then there’s intra-family strife. One therapist certified to practice in Michigan and California said familial stress is greater in Michigan, a purple, more religious state. His clients feel a dissonance: “They say, ‘I love my parents, and they’re showing up for me, but then I also know that they voted for this person who’s completely appalling.’”Start honoring the numbnessEach therapist who spoke with the Guardian said anger and numbness over the second administration are initially appropriate responses. “Anger is a protective force,” Williams added.But to help his clients to settle their nervous systems, he directs them inward: “In the stillness they can access the greater wisdom – usually the message is there of what’s going to be supportive to them.” He also urges them to “go to nature and connect to systems older and larger than this moment, and put energy toward something life-affirming and creative”.Another therapist has clients accept this new reality. “Normalize that there is this threatening energy that is closing down certain civil liberties and trying to change social norms,” he said, adding that he also urges people to be curious about their numbness.This doesn’t mean embracing being inactive, however. “Find ways to start honoring the numbness, while starting to move energy, whether that’s physical movement, or getting out, seeing people and finding light in what feels like a dark time for some folks, whether that’s through art, music or nature,” he added.Doherty recommends what he calls “buffering”: limiting intake of news and conversations with friends and family about politics. That’s an especially helpful strategy for couples he counsels who have differing political viewpoints. Many still make it work, Doherty said.Most therapists tell their clients to focus on what they can control. Some suggest putting energy into mutual aid projects or partaking in local political action. One therapist is seeing her siblings more, making herself an ally to trans folks. She also likes to listen to the Moth story hour as a healthy escape from reality.However, another therapist pointed to a meme in which a person is lying in the road, about to get hit by a large truck. In the meme, a nearby therapist waves, shouting: “Just focus on the things you can control!” She finds the advice to be ludicrous. “I feel like an asshole as a therapist sometimes, so I try to not say shit like that.”Liberal therapists often face many of the same fears as their clients. Williams recounted how he worked with some of his youngest clients who were “heartbroken”, and how there was synergy in that process.“What I tried to do in those situations was reconnect them to: ‘We’re here, we’re alive, there’s a purpose,’” Williams said. “I actually left those sessions feeling more purposeful, and feeling more power from what I witnessed after reconnecting them with themselves.”Another therapist said she felt a similar energy by opening up about her political views and fears: “It feels more like we’re in this together,” she said. More

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      Medicaid recipients fear ‘buzzsaw cuts’ for Trump’s agenda: ‘We’re not going to be alive forever’

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      At the age of 62, Marya Parral knows that her, and her husband’s, years of being able to care for their two developmentally disabled sons are numbered, and so they have done everything they can to ensure their children can continue to live independently.For their oldest, Ian, that’s meant placing him in a program on an organic farm that caters to people diagnosed with autism. For Joey, their youngest, who has both autism and Down syndrome, Parral has found a caregiver who can help him deliver newspapers and run errands around their community of Ocean City, New Jersey.Parral said none of this would be affordable without help from Medicaid, the federal government’s insurance program for poor and disabled Americans. But this week, the Republican-controlled House of Representatives approved a budget framework that would make deep cuts to the program, and Parral worries her sons will lose what she has worked so hard to build.“We’re not going to be alive forever. We’re trying to set up a life for them, but that entire life that we’re working so hard to set up for them is dependent on Medicaid,” Parral said. “So it’s really devastating to think about cuts.”Producing a budget is the first step in the Republican-controlled Congress’s drive to enact legislation that will pay for Donald Trump’s priorities. House lawmakers will now spend weeks working to write and pass a bill that is expected to approve $4.5tn in extended tax cuts, as well as funding for Trump’s plan for mass deportations of undocumented immigrants.To pay for it, Republicans are considering a rollback of the federal social safety net, particularly Medicaid, which has nearly 80 million enrollees in all 50 states. The budget plan proposes an $880bn reduction in funding for the insurance over the next 10 years, an amount that experts warn would hollow out the program and have ripple effects across the entire American healthcare system.Megan Cole Brahim, a professor at Boston University School of Public Health and an expert on Medicaid, said the cut was the largest ever proposed, and if enacted would “have far-reaching impacts not just for those who rely on Medicaid, but for entire communities and economies”.“These changes mean millions of Americans – including the low-income, elderly, persons with disabilities, children – will lose health insurance coverage,” she said. “Others may see significant reductions in benefits or limited access to care. The impact on hospitals and health systems will be significant, particularly for safety-net and rural hospitals, which are already on the brink of closure. Patient revenues will fall, uncompensated care will rise. There will be staff layoffs and site closures.”John Driscoll, a healthcare executive and chair of the board of UConn Health in Connecticut, said: “The scale of the buzzsaw cuts to Medicaid would undermine every hospital’s ability to actually support its mission to care for the community, and would be a dangerous cut to the nursing-home infrastructure in the country.”Republican leaders backed the cuts to Medicaid, as well as to similar programs such as one that helps poor Americans afford food, as a way to mollify lawmakers in their party who want the US’s large budget deficit addressed. Still, not everyone is pleased. As the budget was being debated, eight Republican representatives, some of whom Democrats are keen to unseat in next year’s midterm elections, wrote to the House speaker, Mike Johnson, warning that their districts’ large Hispanic populations would be harmed.“Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open,” they said.All eight ultimately voted for the resolution, but the dissent may be a warning sign for the budget’s prospects of enactment, particularly in the House, where the GOP has a mere three-seat majority. It also remains unclear whether Republicans will try to pass all of Trump’s priorities in one bill, or split them into two.The GOP has made clear they want to fully pay for the extension of Trump’s tax cuts, and Elyssa Schmier, vice-president of government relations for advocacy group MomsRising, said Medicaid and social safety programs are the party’s prime targets for cost savings.“If you’re not going to go after, say, the Pentagon budget, if they’re only going to go to some of these big mandatory spending programs, there’s only so many places that Republicans feel that they can go,” she said.In the days since the budget’s approval, Johnson and Trump have scrambled to downplay the possibility of slashing Medicaid, insisting they intend only to root out “fraud, waste and abuse.”“The president said over and over and over: ‘We’re not going to touch social security, Medicare or Medicaid.’ We’ve made the same commitment,” Johnson told CNN in an interview.Democrats have little leverage to stop the budget, which can be passed with simple majorities in both chambers. But the Democratic senator Ruben Gallego warned that gutting the social safety net to extend tax cuts that have mostly benefited the rich will alienate voters who sided with the GOP last November.“It will be on Donald Trump and Republicans, the fact that he’s going to side with the ultra-rich versus the working poor,” said Gallego, who won election to his seat in Arizona even as Trump captured the state’s electoral votes. “Families that are barely making a living, scratching a living, they’re now going to get kicked off healthcare to give tax cuts to the mega-rich.”The proposed cut to Medicaid would remove billions of dollars in funding from congressional districts nationwide that are represented by lawmakers from both parties, according to an analysis by the liberal Center for American Progress.In California’s San Joaquin valley, the Democratic representative Jim Costa’s district would lose the third-largest amount of funding, according to the data, and Medicaid coverage would be imperiled for more than 450,000 residents.“This reckless budget prioritizes the wealthy while devastating those who need help the most,” Costa said. “I voted no because this resolution is bad for our valley and a threat to the wellbeing of the people I represent.” More

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      In this age of rage, it’s easy for Trump to keep stoking people’s anger | Henry Porter

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      Donald Trump and the Republican party may have won a decisive victory, but do not expect the anger that has blighted America since Trump announced he was running for office nine years ago to subside. Anger and grievance are the fuel rods of Maga populism, and they must be kept at dangerously high temperatures for the movement and a second Trump term to operate.Watching the last four weeks of the campaign, the uninhibited rage of Trump and his supporting acts at rallies was very striking. There was no attempt at decent norms. As the election neared, speeches became louder and more laced with vitriol, to the degree that commentators believed they had gone too far for the American public.First lesson of the Democrat defeat is that most US voters lapped it up. This is what they want. America is a very angry place, much more so that than its neighbour to the north, Canada. In the US, dissatisfaction with opportunities, the state of the country and the government have risen sharply since the Reagan era, whereas in Canada dissatisfaction has only increased over the government’s failure to protect the most vulnerable in society. That says a lot about the wildly differing tone of the two societies as well as levels of available empathy.Road rage in the US doubled between 2019 and 2022, with 44 people killed or wounded by gunfire on the roads every month, a ­figure that bucks the trends of violent crime and murder that have been generally declining in the US since 1990.There are a lot of people walking around with the bewildering, hair-trigger rage of John Goodman’s character Walter Sobchak in the Coen brothers’ 1998 film The Big Lebowski. Trump echoes the craziness, amplifies it, then uses the energy tha t it returns to him.This is a feedback loop, but the anger doesn’t just circle with the same intensity between Trump and his people; it steadily increases.At a Trump rally you became aware of the exuberant high of the outrage, that this is a fix enjoyed across America both by those who tend towards unreflective negativity, racism and misogyny and by people who have a genuine complaint about their lives. In both cases they have acquired the habit of rage, and it has become a meaningful and gratifying part of their identity.The anger is not simply going to evaporate when Trump takes over in January, not only because it’s too important to people’s sense of political self but also because the communication channel between the president and his supporters works only at this level. There is no exchange of ideas, of course, no sense that he leads with a vision other than the one that meets their anger with a promise of destruction.The early evidence of this political wrecking machine comes with the appointments of Tulsi Gabbard as director of national intelligence, Matt Gaetz as attorney general and Fox News anchor Pete Hegseth at the Pentagon, all of whom cannot fail to vandalise and degrade the institutions they take over. Indeed, that appears to be their brief.When he moves back into the White House with the Senate, Congress and supreme court in the control of the Republican party, he will be one of the most powerful presidents ever to have governed and he will be 100% responsible for the fortunes of Americans.How will his supporters, so used to reflexively blaming Washington and the government, confront his responsibility when he fails to improve their lives, as he certainly will because of a suicidal tariff regime, tax cuts to the rich and corporations that will increase national debt, cuts to Medicaid and mass deportations of undocumented immigrants that will severely damage growth as well as cause unbelievable pain to separated families across America?His failure will be a problem for his supporters, who can’t lose faith in their idol, and also for Trump, who must not let their support fall away. The solution for both parties will be to maintain the anger but divert it away from Trump.skip past newsletter promotionafter newsletter promotionAnd this is where we should fear for America. Trump has been lining up scapegoats. He has promised to persecute “the enemies within” and “radical left communists” like Adam Schiff, the new senator for California, and the former speaker Nancy Pelosi. He has made threats to Michelle Obama and Liz Cheney, who endorsed Democrat candidate Kamala Harris, and has demanded that CBS’s broadcast licence be revoked. He has suggested “one really violent day” and “one rough hour” against petty criminals.He will resort to this list whenever he needs to, but it will be America’s undocumented immigrants who will initially suffer, for next to the economy they topped the concerns of Republican voters. Trump will always be able to satisfy Maga anger by promising new and more cruel actions against immigrants, among which measures are likely to be privately run detention camps.There is no telling where this will end, no sense where national resistance will come in a society that is unused to dealing with an authoritarian who exploits dark and violent emotions as expertly as Trump does.The Democrats are plunged in a round of recriminations about the defeat, but they need to find new leadership and a strategy to deal with the anger that now threatens America and its institutions of government. When fuel rods overheat in a nuclear reactor, the result is usually meltdown. More