Witness to Witness Update | July 2025
All views are my own and do not necessarily represent the views or opinions of organizations with which I am associated.
Note: Welcome to my monthly Update, newly hosted on Substack! Thank you for your ongoing support. The Update is a space where I select articles that are at the intersection of healthcare, mental health, and immigration. Sometimes other kinds of articles slip in. My hope is that I am curating articles that readers may not have found themselves but are glad that I did.
It’s hard to remember a bill as bad for the majority of Americans as H.R.1—known as the One Big Beautiful Bill Act. Many organizations, from the AMA, the ANA, and the Children’s Defense Fund immediately posted press releases explaining what the cuts will mean. Most of the cuts won’t go into effect until after the elections in 2026 so many people won’t know what hit them when they do. Also, in many states, Medicaid is not the name of the insurance plan. In California its MediCal. In Maine, it’s MaineCare. Sadly, 20% of Americans rely on a Medicaid program and will find services they need no longer available to them.
Jeremy Faust, on whose column Inside Medicine I depend, composed this meme using ChatGPT. The photograph is real.
As Jeremy Faust points out, given passage of this horrendous bill, it’s unlikely that Congress will fight RFK Jr. when the HHS appropriations vote takes place. I am also doubtful that members of Congress will have been persuaded by the Bethesda Declaration if they even read it. In my now shortened, one-page handout on reasonable hope, I write: “Look for courage. Reasonable hope depends on people taking chances, on having the courage to take risks. Doing hope together means we can notice, reach out and support the whistle blowers, the risk takers, the brave so that they do not stay out on a limb, but instead are joined there, like birds on a telephone pole.” These are times we need to flock and there are many ways to do so. In June, over 300 scientists at the NIH signed the Bethesda Declaration, formally to protest: “We are compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.” A video of Dr. Jenna Norton bravely speaking out about the declaration has gone viral on Instagram, as she risks her job so that she can “be brave for my kids.”
One of the consistent approaches taken by this administration is to twist logic and use Orwellian rationales in service of burying and obscuring what it is actually doing. On July 17, the Trevor Program, that has been overseeing the section of the 988-suicide prevention hotline that specifically responds to LGBTQI+ callers, will have to stop doing so. SAMHSA, which oversees the funding allocation, said the decision was based on their desire to serve “all help seekers (italics in the original.)”. This is nonsense, especially since in SAMHSA’s statement they use “L.G.B.+ youth services,” leaving out the T consistent with the administration’s erasure of transgender persons.
Along those same lines, the VA hospital system has now stopped all services related to transgender persons. In addition, according to an article in The Guardian, “Doctors and other medical staff can also be barred from working at VA hospitals based on their marital status, political party affiliation or union activity, documents reviewed by the Guardian show. The changes also affect chiropractors, certified nurse practitioners, optometrists, podiatrists, licensed clinical social workers and speech therapists.” VA officials cite the president’s January 30 EO titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”, which is a perfect example of inverting reality. According to Dr. Kenneth Kizer, The VA’s top healthcare official during the Clinton Administration as quoted in the Guardian article, “he said the changes open up the possibility that doctors could refuse to treat veterans based on their ‘reason for seeking care – including allegations of rape and sexual assault – current or past political party affiliation or political activity, and personal behavior such as alcohol or marijuana use.’”
The next two articles refer to issues that impact children directly, which means the impact is felt by everyone – family, school and community members. One might conclude from these two articles that as a nation, we do not prioritize the health and safety of our children. This is always deeply troubling, but the levels of irony are particularly intense as the current administration is promoting pronatalist policies to confront the declining birthrate. Protecting children might be a far better solution.
In a landmark study of pediatric deaths from firearms – the leading cause of death in children in the US – researchers were able to answer the question as to whether or not in states with permissive firearm laws there was higher pediatric firearm mortality. They found statistically significant rates of excess death for children ages 0 to 17 in those states with permissive laws and a decrease in pediatric firearm mortality in the four states with stricter laws. Under a different administration, one can imagine legislation being introduced to enact stricter firearm regulation but that is unlikely to happen now. Jeremy Faust, as mentioned above, was the lead author of this study.
There is a moving article in the LA Times about what ICE raids look like in neighborhoods that are familiar to the author. He writes: “The locations are recognizable, even comforting, yet the vibes are anything but. A row of camouflage Humvees on the 105 Freeway. Abandoned work sites, food trucks, fruit vending carts, and even lawn mowers left running after the gardeners were arrested.” In online videos he can see community members screaming at masked, unmarked people whom they presume are immigration enforcers: ““What’s wrong with you?!” a woman screams while filming the ICE arrest of a street vendor selling tacos in Ladera Heights.”
But what is the aftermath? In this powerful op-ed in the LATimes, Marsha Griffin, a pediatrician, and her two colleagues who were members of the humanitarian teams that monitored detention facilities from 2015-2019, can attest to the dangerous conditions facing people who are detained in these prison-like conditions. They write: “As pediatricians, we are watching in horror as immigration raids in Los Angeles and across the country are tearing families apart. The current administration’s deportation policy arrests people regardless of immigration status or criminal record and places them in detention. Make no mistake, this is family separation 2.0.
“We are also seeing entire families, parents with their children, apprehended in our communities and being sent to newly reopened family detention centers.
“These immigration policies are placing the health and well-being of children at risk….
“As the authors of the American Academy of Pediatrics’ policy on the detention of immigrant children, we insist that our federal government stop these dangerous practices. Our policy emphasizes that detention is not in the best interest of the child and that family separation should never occur unless the child’s well-being is at risk. Disturbingly, this administration’s policies are resulting in both.”
At this point, it seems like only intensive community action against these policies will make a difference. One group, Freedom Trainers, has very interesting materials that feature noncooperation as a tool to resist authoritarianism.
This blog post is about moral injury. Witnessing events in LA, witnessing the flooding in Texas, is placing us all in a psychologically dangerous position. Like many people, I am hearing the phrase moral injury more than I ever have before. When people in positions of trust behave in ways that violate our understanding of right and wrong, of moral and immoral, when lies and deception are used to justify actions that are intended to create new norms, witnesses near and far can feel betrayed and offended to their moral core. The concept is appearing in many arenas since January where its use may not be precise, but it captures an experience people are having at work and in the public sphere. This blog speaks about this experience at length.
I also want to provide some specific clinical articles. A one-of-a-kind long-term study of PTSD followed first responders from the World Trade Center disaster for over twenty years, analyzing 81,298 observations from 12,822 WTC responders. They found that about 10% of participants still met criteria for PTSD two decades later and for most, symptoms took as long as 8-10 years to resolve. “Our findings highlight the enduring impact of PTSD among World Trade Center responders, with substantial variability in individual trajectories. Despite overall modest declines, a subset remained highly symptomatic, underscoring the need for continued treatment. These results emphasize the importance of long-term monitoring and highlight the need for tailored treatment strategies for trauma-exposed populations.”
July is BIPOC Mental Health Month and there are a number of excellent resources available. Migrant Clinicians Network is showcasing resources on its social media feed (Facebook, LinkedIn). Once again, Mental Health America has an excellent set of resources available. These resources are particularly urgently needed now when mental health and addiction resources have been so dramatically cut.
Finally, the health and mental health impact of current policies is being written about in a wide variety of places. I have not read a better analysis of health impacts than this article by Adam Gaffney, David U. Himmelstein, and Steffie Woolhandler, the last paragraph of which summarizes their main points: “We find ourselves living under a federal government unconcerned with the well-being of its people. The administration’s assault on health—coupled with Republicans’ planned surge in spending for the military and deportations—indicates that it cares far less about preserving the lives of Americans than about controlling, surveilling, and policing them. All of us ought to fight to minimize harm from these depredations. In the process, we should channel the dismay they inspire not just into restoring the nation’s health institutions as they were, but into reimagining them so that, at last, they truly serve the public good.”
The New Yorker, a mainstream magazine, recently published an article about how clinicians are changing some of their practices from insight-oriented approaches to approaches that offer practical tools needed in this realistically scary moment. It’s not that the article itself was particularly insightful but the fact that it appeared at all in that magazine is remarkable.
In this article, the author’s opening paragraphs do not bury the lede!
There’s a myth still floating around in therapy rooms: that we, as clinicians, should remain politically neutral. That talking about politics is ‘biased,’ ‘inappropriate,’ or ‘outside the scope of practice.’
That myth is not only outdated — it’s dangerous.
Because in 2025, politics is personal. It’s in the couple fighting over whether their kid deserves access to gender-affirming care. It’s in the immigrant family wondering if it’s safe to drive to work. It’s in the exhausted single mother who lost her Medicaid, who now chooses between medication and groceries. And it’s in every client who walks into therapy wondering if their grief, anxiety, or rage is “too much,” when in fact it’s a rational response to being gaslit by a society that treats their pain as an inconvenience.
The article discusses many aspects of how politics impacts the people we serve and us. Her main point is that ignoring politics in the service of so-called neutrality is actually unethical. It perpetuates the very systemic oppressions from which we all suffer, albeit highly differentially. Therapy should never have been spaces only for individual coping and now more than ever the inadequacy of that approach is excruciatingly salient.
In her conclusion, Silvi Saxena writes, “We don’t need neutrality. We need courage. We need therapists willing to take the risk of being misunderstood in order to be truly present. We need clinicians who understand that the real risk isn’t speaking up — it’s staying silent while injustice becomes normalized.
“So here’s my plea to my fellow therapists: stop playing neutral. Stop using ‘scope of practice’ to avoid hard conversations. Stop minimizing systemic trauma to keep your comfort intact. Clients don’t need you to save them. But they do need you to stand with them — to see them, believe them, and name the truth with them.
“Because in times like these, silence isn’t therapeutic.
“It’s betrayal.”
And with that, we come full circle to the moral injury blog above.