The Local: Shrinks Anticipate Expansion

One of the inadvertent beneficiaries of the Wall Street meltdown may be the city’s mental health professionals. Many of them said their practices have either grown or stayed stable over the past year, as the economy worsened and the conditions that spawned Wall Street’s meltdown coalesced.

They believe, grimly enough, their business will only boom as the bust reverberates.

"This is multi-level stress in that it is financial, political, [and] social, and rocks the foundations, or perhaps the myth, that this country rests upon," said addiction recovery specialist Bob Lynne, who managed the state of New Jersey’s therapeutic response to the September 11 attacks. "It is more like a major disaster than a plane crash. We recover from the crash, but many folks do not believe they will recover from this crisis."

Ironically, just as more New Yorkers may need therapy fewer will be able to afford it because of the very thing driving them to it-financial uncertainty.

Upper West Side psychiatrist Harold Bronheim said all his patients, from those moored directly to Wall Street’s gyrations to the ones who still have healthy bank accounts, are "cutting back on the goodies," though he has yet to see a drop at his practice.

Some patients are coping with financial anxiety by taking more pills, sleeping less, or "being avoidant of others who are doing well compared to themselves," Dr. Bronheim said, while others are just "talking about it."

"What happens is that people bundle their fears and anxieties together in bad economic times, and displace it on a person or group of people," he explained. "Sort of like in Germany after World War I, when the Nazis blamed the Jews for all the ills of Germany.

"In my practice, the backlash seems to be most actively directed at Sarah Palin," Dr. Bronheim added. "She has become a particular object of ridicule, sort of a hot button for peoples’ concerns and anxieties. The issue [is] that you can hire someone who’s unqualified for a crisis, based on gender. She represents the old system, keeping up with the same economic nonsense, no matter what the results."

If the markets keep fluctuating wildly and unemployment continues to rise, Dr. Bronheim worries that the anxiety may spark depression, especially among people predisposed to it.

"I have a patient who works for Lehman Brothers, and there is a lot of depression there," Dr. Bronheim said. "Losing a job is similar to losing a love relationship."

Men in particular often deal with emotional strain poorly, according to Robert Klitzman, an associate professor of clinical psychiatry at Columbia University Medical Center and the author of When Doctors Become Patients.

More drinking as well as prescription drug abuse are common reactions to "white-collar financial stress," he said, and can trigger a further downward spiral and more destructive behaviors personally and professionally.

Financial changes, especially of the sudden variety, only exacerbate money issues. "If there is less money in a family there are difficult choices that have to be made that impact autonomy, like let’s say I want to go on a vacation and my wife wants to buy a car," Dr. Klitzman said. "Now we can only do one."

Meanwhile, financial problems can alter the "golden rule" that Dr. Klitzman says governs most relationships: whoever has the gold rules. "If the traditional bread-winner is no longer bringing home the bread, he or she may lose power in the relationship, and the breadwinner may feel angry because he… is used to having power and having his way.

"And I say he because it is usually a he. [When] he no longer has his power and his way he could become angry; he could become verbally abusive and there is a potential for other kinds of violence.

"I’m not saying financial stress leads to affairs [or domestic violence]," Dr. Klitzman said. "but it can spiral so it’s best to catch things early."

Lynne Spevack, a licensed clinical social worker and psychotherapist with offices in the Financial District, said her practice has grown, particularly in the past few months, though she does not attribute the rise to the economy.

"Initially [after the September 11 attacks] there was not an increase in clients," she said. "Over time it brought people in sideways ways. Even today, there are clients who come in all these years later and don’t realize the concerns bringing them in are somewhat related to [9/11]."

Ms. Spevack’s current roster of clients are plagued by "anticipatory anxiety" over the economy as they wait for the other shoe to drop, and the degree of turmoil is similar to what she saw after September 11. Much of the advice she gives patients today is similar to what she told them then.

"There are some people who are going to feel inclined to drink or drug, or drink or drug more, and that is certainly going to make things worse because then you have two problems to deal with," she said. "But the inclination to escape from things so you don’t feel so bad makes sense."

Though people often feel the need to be glued to media in crisis situations, Ms. Spevack added, monitoring the amount of news consumed remains key to managing financial stress. "The idea not to worry alone but worry in pairs and groups is one of the most important things people can do," Ms. Spevack said.

But reaching out to people for help is not usually the first thing on peoples’ minds when a crisis strikes, said Linda Furst, the education director at the Mental Health Association of NYC. The organization’s suicide hotline Lifenet has yet to see a spike in calls, but they do expect an increase "at a future date," she said.

"Usually, when people are in immediate eye of the storm," Ms. Furst said, "they are marshalling all their emotional strength to get themselves through it."

The Local: Shrinks Anticipate Expansion