Open letter to the unvaccinated from the AMA Section of General Psychiatry

September 29, 2021

The following is an open letter to unvaccinated Albertans from the Section of General Psychiatry

Fellow Albertans,

Can We Talk? About this “Pandemic of the Unvaccinated”?

I am very familiar with being dismissed. Let’s start the conversation there. I’m the youngest of five kids. I did an Arts degree at University – worse yet, it was in Philosophy. I’m ok with having a conversation where you’re 90% sure that at the end, you’re going to dismiss me. Let’s start there, unvaccinated person, but just know that I am not here to dismiss you. I know what that’s like.

There are reasons you haven’t been vaccinated. Maybe you are thinking, “just not vaccinated yet”. Or maybe you are thinking, “I’m not doing that to myself”. Your life is a journey, and experiences along the way help explain exactly where you’re at and what you’re thinking, unvaccinated or partially vaccinated. If you are thinking “not yet”, perhaps some logistical problem is yet to be resolved. Or perhaps you are hearing an inner voice saying, “Don’t risk that...don’t do that to yourself…if you get sick because of it, you’ll never forgive yourself.” Whatever you’re thinking, you are not alone. Other people are thinking the same thing.

I wish we were talking “live” and that you could tell me your story, your reasons and why this makes sense, looking at the world through your eyes. I know there would be valid concerns and considerations to explore. But instead, I am only able to ask you to listen to yourself and choose to involve other people in that conversation if you’re willing. Here are some questions you might consider asking…see what you think:

When I think about getting vaccinated, what are the PROs and CONs I’m weighing? This might be best done as a written list, with a PRO vaccination column and a CON vaccination column. Human beings have a universal characteristic where when our emotions reach a certain threshold, the logical part of our brain (our frontal lobe) literally switches off. There is no solving a Rubix cube when your frontal lobe has switched off. And believe me, this on/off frontal lobe thing can be as quick as a flickering light. So that PRO/CON list is a way of being able to take a look at the full list as a whole. It makes it easier for your brain to take a look at the big picture, from your perspective. It helps our logical brain sift through the variables and pull out of the emotional tunnel vision of our old “habitual” decision making processes. It can also help us pull away from the one or two PROs or CONs that we usually fixate on - that tunnel vision state where our emotions are fired up making other things seem superficially irrelevant. Emotional tunnel vision can be recognized in a few ways, but it includes things like your mind racing, heart beating faster, and physical tension, or conversely, feeling numb. Decision making in that state doesn’t allow you to access everything you know, or all your wisdom.

In this exercise, as I understand it, you aren’t done with just one PRO/CON list. Now it’s time to make another list, this time the PROs and CONs of NOT getting vaccinated. In fact, if you’re unvaccinated, it might make sense to start with this list first. Write down the good reasons you have for not getting vaccinated. If you can’t think of any, then something is blocking you from being honest with yourself. If you’re unvaccinated, there are reasons. Name and acknowledge those reasons. It’s best if you name everything, even the things you don’t like to acknowledge, as this will result in a much more useful list. But here is a helpful tip: if a thought or emotion is on your list of PROs/CONs, call them precisely what they are, just-the-facts. For instance, in the CONs to vaccination column, a person might list increased frequency of the thought ‘You are a sucker’, associated with increased self-directed anger, and in the PROs to remaining unvaccinated, a person may note an increased frequency of the thought ‘I’m not a sheep’ and maybe a sense of increased pride. You’re going down the tunnel, not doing it the “mountain view” way, if you simply list “Getting vaccinated makes me a sucker” or “Not getting vaccinated means I’m not a sheep”.

Here is another tip: if ANY box in the two PRO/CON lists is empty, tunnel vision is in effect. Even if your gut doesn’t agree with it, it’s important to list things that your mind acknowledges but your emotions are focused elsewhere. This is a system that has helped many people, including people with severe eating disorders. Their mind might 80% believe their doctor’s warning that they need to get above a certain weight or risk dying of a heart rhythm problem, but yet when they look in the mirror, they still 100% believe that they are fat and panic at the thought of eating more. Their emotions tell them they are fat, at the same time that their mind accepts that they are at higher risk of death at their current weight. So they can put on their PRO/CON list ”My doctor says I could die if I don’t increase my weight”, while also listing that anxiety increases when they eat more. PRO/CON lists can help people sift through competing impulses and make tough decisions.

At the end of the day, you are the person who needs to hear yourself. Each day that you continue the choice of not being vaccinated, there are reasons motivating that. Heck, maybe that should be on the list –the thought “Once I’m vaccinated, I don’t have the choice anymore”, such that you expect increased feelings of helplessness if you do get vaccinated. And right now, in the pandemic, who wants to feel more helpless?

Maybe you are weighing the risk of an adverse outcome of vaccination very heavily, and I know what that is like, too. As a fifth child, I watched my oldest sister die from a rare complication of pregnancy. You know, that natural phenomena that many women find so safe they prefer to give birth at home? So, when I had my two children, the fear that I might die from pregnancy or childbirth was very real to me and my close family, even though it was statistically unlikely. We all know that personal experience puts a very different spin on statistics, and how much our emotions actually believe them. I had to pull in my frontal lobe - a lot - to have kids.

If you’ve made the lists, it is now time to check in with your “mountain view”. Many Albertans know what a mountain view is like. It’s one where you can see a storm cloud raining down, and then just beside it you can see the sun shining its bright light onto a field. That is the mental state where you can look at everything, acknowledge everything, and no emotion is so fired off that other parts of the landscape seem irrelevant/non-existent. Mountain view decisions don’t ignore things or treat them as irrelevant/not-there. Mountain view decisions see everything, see the connections between everything, recognize what fires up intense emotion, and see beyond that. We are aiming for the clear day mountain view state, the one where emotions are an important part of the landscape, but they don’t create a blinding fog.

My motivation for writing to you is caring. My motivation is that my frontal lobe is concerned for your safety, your loved ones’ safety and the safety of other people in the community. If Alberta doesn’t shift course, more people will suffer and die. That’s true no matter how many ICU and other hospital beds Alberta Health Services manages to cobble together. I am concerned for the tragedy of the people currently lying in Alberta’s hospitals and morgues who never thought they would catch COVID, never thought it would be severe if they did and thought that a miracle cure would save them if they needed it.

Most of all, I know that to understand you means understanding your CONS to vaccination and PROS to being unvaccinated and encouraging you to take a mountain view perspective on those. Because I don’t believe that all unvaccinated people would speed through playground zones just to get somewhere faster, especially if they recognized children they might hit who are running after balls in the street…I don’t believe that you would deliberately cause your own or another human’s suffering and death. There are reasons behind being unvaccinated. They matter, and you matter. I really hope that you will give the PRO/CON lists approach a whirl – they are all about checking in with yourself and moving forward with more confidence in your decisions. Whatever that decision is. Even if you think you’ve got it all sorted in your head, the power of writing it all down can be huge.

Here is how one such list might look, expanding from some of the examples I mention above (NB: your list will look different!):

PRO – getting COVID vaccination

CON – getting COVID vaccination

  • Official health experts in every country recommend COVID vaccination to reduce the risk of spreading the virus or having serious disease and even death.
  • Increases frequency of the thought ‘You‘re a sucker’
  • Increased self-directed anger
  • Goes against the reassurance I’m getting from the usual people I trust
  • Decreased feelings of self-empowerment and righteousness

PRO – NOT vaccinated

CON – NOT vaccinated

  • ‘I’m not a sheep’
  • Increased pride
  • I still have the power to choose whether to vaccinate, if the situation changes.
  • If I focus on the doctors and nurses who are arguing against the severity of the pandemic or against getting the COVID vaccine, then I feel safer from COVID and justified in avoiding the risks of vaccination.
  • If I take seriously the health expert panels who recommend vaccination, then I have increased feelings of fear and helplessness.

Just so you know, I went on from my Philosophy degree to another degree that got a few more people willing to listen to me (MD), only to choose a specialty that led to more being dismissed (Psychiatry). But I know what I know, just like you know what you know. I know what value I can bring, and you know what reasons are shaping your choices.

At the end of the day, I hope you feel respected, and if you think of judgements when you’re making your PRO/CON lists, I hope you beat them down into non-judgmental descriptions. There’s a whole art to thinking non-judgementally, but let me assure you, the more you avoid labels and judgments, the more you will keep your full brain online. This full brain online state is another way to describe the mountain view, and it can help all of us more reliably solve a Rubix cube, taking into account … everything.

Wishing you all the best,

Dr. Kathy Fitch
Concerned Albertan
Youngest of 5
AMA Section of General Psychiatry President

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.