Takeaway
Political stress is affecting many patients' mental health. You can address it by asking about universal concerns—safety, family, finances, media consumption—rather than partisan beliefs.
Lifelong learning in clinical excellence | May 22, 2026 | 5 min read
By David Kopacz, MD, Clinical Tele-Psychiatry Practice
Many people are suffering—many feel angry, scared, sad, and/or afraid. There’s war in Ukraine and war in the Middle East. In the U.S., there’s fear in immigrant communities and even in colleagues in medicine and healthcare who are working on various visas. People are worried about finances and the increased cost of gas and groceries. While so many people are worried about the state of the nation and the state of the world, most of these topics are politically polarized and difficult to discuss—yet they take a toll on individual health and the health of our democracy.
Avoiding polarization
My concern is how patients are doing in their lives and not with partisan politics, so I try to ask in open-ended ways that allow patients to talk about their concerns without falling into political polarization. A question like, “How are you doing with everything happening in the world right now?” is one way to start a conversation.
Sometimes patients will ask for clarification, “What do you mean?”
I follow with another question like, “Do you have family or connections to places where there’s war right now, or do you worry about your family here or in another country?”
These are universal human fears and talking about what unites us as human beings and as citizens of a shared democracy can help to create a safe place for people to talk.
If a patient says, “I try not to talk about politics,” I’ll reframe that I’m asking about their well-being and if their consumption of media and social media is affecting their health. I’ve found that many people of all political views may share the same feelings even though they have different explanations for what the problem is and different ideas of how to address them. Many will say that they’re concerned about their safety, their family’s safety, the future of our democracy, finances, and about war. Again, these are universal concerns that transcend political opinions.
The threat of fear-based division
Educator Parker Palmer wrote in “Healing the Heart of Democracy: The Courage to Create a Politics Worthy of the Human Spirit”:
“If American democracy fails, the ultimate cause will not be a foreign invasion or the power of big money or the greed and dishonesty of some elected officials or a military coup or the internal communist/socialist/fascist takeover that keeps some Americans up at night. It will happen because we—you and I—became so fearful of each other, of our differences and of the future, that we unraveled the civic community on which democracy depends, losing our power to resist all that threatens it and calls it back to its highest form.”
Regardless of a patient’s political beliefs, highlighting shared concerns of citizens, independent of political affiliation, may help decrease polarization, even in a small way. Anything we can do to help decrease fear-based splits of us versus them can help patients feel more secure.
From enemyship to friendship
My own perspective is that democracy is based on caring for others. Jeremy David Engels wrote in “On Mindful Democracy: A Declaration of Interdependence to Mend a Fractured World” that “true democracy” is “working together to care for each other and for the life we share.” In a recent “Becoming a True Human” podcast I did with Jeremy and my co-host Chris Smith we spoke about how we can help decrease political polarization. Jeremy focuses on shifting away from a perspective of “enemyship” (us versus them) thinking and promoting its opposite of “friendship.” He also uses mindfulness for himself and in his work with students for decreasing hyperarousal and reactivity when discussing polarizing topics.
We also talked about another idea of how mindfulness can promote democracy, the idea of “inner democracy.” I think of inner democracy as the mindful cultivation of a sense of oneness and interconnectedness. In this way, democracy isn’t just something “out there,” it’s also something that’s “in here,” inside each person. As Jeremy Engels points out, mindfulness can lead to experiences of oneness and interdependence. Inner democracy can help us on the journey from Me to We. I have started to write about this topic on my Substack.
Practical approaches when caring for patients
Returning to how I talk with patients about politics while not talking about politics, I don’t have all, or even any, of the answers, I just care about the suffering of patients, of the U.S., and of our world. Talking about feelings is one way of avoiding short-circuiting into political beliefs and ideology. Talking about how these feelings are things we all share as citizens, regardless of our political explanations, is one way to turn down the heat in the country.
Without taking sides or even identifying which “side” I’m on politically, I also talk with patients about how challenging it is to hold family events when there is political polarization within the family. Political polarization is present in most extended families and even in some immediate families. Moving from Me to We, moving from enemyship to friendship, and recognizing our interconnectedness and shared humanity, are all ways that we can support the health of our patients and the health of our democracy.
Here are a few things I’ve found helpful when talking with patients about these topics:
1. Ask about how politics are affecting them without talking about politics. Ask about what they’ve been concerned about lately. Concern for our families is a shared human concern.
2. Create a safe space for patients to talk about their concerns without letting your own political beliefs intrude. Concern for our democracy is a common concern across the political spectrum.
3. Focus on emotions, which we all share, instead of political beliefs or ideology.
4. Ask about media and social media use without asking about the content or perspective of that media—encourage limiting or taking breaks from doomscrolling.
5. Encourage mindfulness and meditation as ways of modulating political hyperarousal and reactivity. There are many different apps available—at Veterans Affairs we used Mindfulness Coach and many people find the Calm app helpful. Sustainable Compassion Training and Try iRest Now are two websites that offer numerous free downloads for practicing mindfulness with a focus on building compassion and fostering states of oneness and interdependence.
6. Cultivating inner democracy through nourishing self-compassion, loving kindness, compassion for others, and inner peace can help us focus on our shared humanity.
The more we care for each other despite our differences, the healthier the individual and the healthier the democracy.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.