Whither Psychiatry?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

On last Sunday night, “60 Minutes” ended their interview of George Clooney with a quote from the upcoming Broadway show “Good Night and Good Luck,” which is about the newscaster and journalist Edward R. Murrow. It focuses on the McCarthy era of the 1950s, when media were under political pressure, somewhat like now.

The “60 Minutes” interview concludes with Clooney, playing Murrow, stating: “The question is a very simple one. Not what power unchecked will do. We’ve seen that before. The question is: What are you prepared to do?”

The “you” in this column are first me, my psychiatrist colleagues, other mental health professionals, the public, our psychiatric media, and politicians on all sides.

It seems common now to hear from the various media and on the street that America is in a crisis. Is our democracy in danger? Is science in jeopardy? Are cuts causing our already inadequate resourced mental health care system to deteriorate? As one of society’s safety systems for our well-being, is psychiatry up to the following challenges?

Alternatives to Psychiatry

Psychiatry itself seems under some duress. At the same time as our political turmoil, a representative book of criticism and alternative care was published.¹ When I was asked to write blogs for the start of Mad In America many years back, the first psychiatrist to do so, I quit after a few months when there were increasing calls to “throw psychiatrists under the bus,” and the author of the book was becoming a prominent critic. By now, she has set up a business to help individuals smoothly get off their psychiatric medication and find other ways to cope. She is not the only one. Robert F. Kennedy, as Secretary of Health & Human Services, joins her in criticizing and reviewing some psychiatric medications. As one response and justification, our Editor in Chief, John Miller, MD, has recently explained our psychiatric perspective on medications in a video for Psychiatric Times.

Another alternative is psychedelics. Still awaiting any US Food and Drug Administration approval, psychedelics are becoming more and more popular in the underground of public use, especially in micro dosing. Legal consequences for their possession and usage seems minimal right now as compared with the 1960s and 70s. In this second coming of psychedelics, we have another consumer led intervention, for better or worse.

As regards our other traditional set of treatments, talk-based therapies, we now have competition in coaches, though some psychiatrists do both psychiatry and coaching. Coaching has less (if any) educational requirements, but seems attractive to individuals for more superficial advice-giving. There are also many other kinds of psychotherapists, with varying standards for licensing in different states. For-profit managed care has already set us up for not providing much psychotherapy by financially guiding us toward psychopharmacology.²

The Neglect of Social Determinants

Yes, psychiatry has paid more attention to social determinants of mental health in recent years, but the current political upheaval indicates how inadequate that has been. Attention to diversity, equity, and inclusion (DEI) has been dissipating under new governmental orders and politics. Yes, DEI consultations and programs have had their troubles, but their desired elimination leaves what I have come to call and write about in these columns, the social psychopathologies, without as much continuing concern and education. No wonder that anti-Semitism, Islamophobia, sexism, burnout, loneliness, cultish and divisive thinking and the like seems to be rising. All have negative repercussions on mental health.

Off and on when I have written about racism and other social psychopathologies, I have suggested an alternative metaphor to America being a “melting pot.” I suggested a potluck meal, but recently heard of a better one in the obituary written by written by H. Richardson on Sunday, March 23, 2025, in the Deseret News of former Utah congresswoman Mia Love³:

“I actually love the idea that America really shouldn’t be a melting pot but instead should be a salad bowl. I do love a good salad! The salad bowl is really quite instructive because the ingredients, while coming together, never lose their identities or stories. The tomato remains a tomato, the crispness of the cucumber continues, the flavor of the onions does not disappear, and the color of carrots stays bright. The lettuce doesn’t need to hide itself, and the spinach doesn’t need to transform into a blueberry. Each of the ingredients do not try to become something else. We need more of that in America.”

Sitting on the Sidelines

As protest demonstrations and critical Town Hall meetings are emerging from the public resistance, organized psychiatry, so reliant on federal funding, so far has focused publicly on occasional press releases of concern. However, as good as the content of those may be, one must wonder about the effectiveness of such traditional responses in this time of an avalanche of changes.

I have not seen psychiatrists speaking or protesting like, say, Robert Jay Lifton did in Vietnam wartime,⁴ getting thrown in jail in the process, or a concerned group of psychiatrists successfully did about the abuse of psychiatry by the Soviet Union and our own inappropriate classification of homosexuality as a mental disorder in the 1970s. Speaking of the Soviet Union, Russia’s invasion of Ukraine continues without the concern from many psychiatrists that the war in the Mideast has evoked. Both wars, though, are bound to tax their national mental health care systems with rising rates of posttraumatic stress disorder (PTSD) and prolonged grief.

Unhappiness

A more general gauge of collective mental health resides in the annual 2025 World Happiness Report.⁵ Again, Finland comes out on top, seemingly from high social trust, safety nets, and a strong sense of community. Our social welfare services in America instead are being dismantled. No wonder that we in the United States went even lower, down to 25th place. In 2012, we were 11th. Israel, not only in political turmoil, but also in war, still comes out 8th. Costa Rica, without an army but with the collectively embraced saying of “pura vita,” rose to 6th. Our downward trend in life satisfaction is particularly steep among those under 30 and in women.

In recent times, there has been attention to “deaths of despair,” those preventable deaths from substance abuse and suicide. Only 2 countries, the United States and South Korea, had a rapid rise in such deaths.

Climate Instability

Record high temperatures keep being broken in various places around the world. This spring in the United States has been filled with more intense and common tornadoes, let alone raging wildfires, some in unanticipated locations. There is increasing disconnect between the nations most responsible for carbon contamination and those most likely to suffer climate catastrophe. Climate disasters are always associated with an increase in PTSD and anxiety for the future. Psychiatry and climate activism has had some success with incorporating climate concerns into treatment,⁶ but less so in prevention.

Technology and Psychiatry

As AI invades most every field, with promises and potential of both health and harm, so is the case in psychiatry. However, the paradox of aiding psychiatry, say, in diagnosis, treatment options, and outcome measurement is that it could reduce the numbers of necessary psychiatrists.

A recent Wall Street Journal Tech News Briefing on March 20 presented research that sometimes computer chatbots are better at expressing empathy than humans are, though humans generally prefer other humans as the known source of empathy.⁷ Our human limitation compared with computers is our tendency to make the mistake of turning the conversation to ourselves by quickly provided advice or personal examples.

All kinds of apps to monitor, access, and address mental health are also emerging. Virtual reality exposure therapy is promising for helping PTSD, anxiety, or attention-deficit/hyperactivity disorder.⁸

Our Own Mental Health

Given our overriding ethical concern for our patients, it may be no surprise that we have been neglecting our own well-being. We have been in an era of physician burnout for about 20 years now.⁹ Though there has been successful emphasis on personal wellness endeavors, the main causation of oppressive and overly controlling systems remains resistant to change. The success of Chief Wellness Officers is unclear. Patient outcomes do suffer when their physicians are burned out. Losing mental health services through governmental funding cuts is bound to even increase the epidemic rate.

A Wish for America

Yesterday, I wrote 2 eulogies for my column. One of them was not a psychiatrist, Kitty Dukakis. There might have been another had I known about her death on Sunday. Mia Love, mentioned earlier in this article, had served Utah in Congress and later worked as a media commentator and educator. Her parents had come from Haiti before she was born.

In 2022, she became ill with a brain tumor, the same kind of tumor that had killed Ted Kennedy, John McCain, and Joe Biden’s son. On March 11, 2025, as she was dying, she wrote for the Deseret News a moving and loving article. It closed with something akin to George Clooney’s speech, and can be a rallying call for an updated psychiatry, for a psychiatry devoted to freedom of the mind and the ensuing personal liberty¹⁰:

“My living wish and fervent prayer for you and for this nation is that the America I have known, is the America you fight to preserve and that each citizen, and every leader, will do their part to ensure that the America we know will be the America our grandchildren and great grandchildren will inherit… that you will hear my words in the whisper of the wind of freedom and feel my presence in the flame of the enduring principles of liberty.”

Whither psychiatry? Perhaps back to helping to fulfill our Declaration of Independence: “Life, Liberty, and the Pursuit of Happiness,” and thereby reducing deaths of despair, cultish thinking, unhappiness, and related mental challenges. Maybe, like America’s forefathers, we will have to fight in some way once again for these principles. Are we ready to do so?

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Delano L. Unshrunk: A Story of Psychiatric Treatment Resistance. Viking; 2025.

2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

3. Richardson H. Former Utah congresswoman Mia Love has died at age 49. Deseret News. March 23, 2025. Accessed March 25, 2025. https://www.deseret.com/politics/2025/03/23/mia-love-obituary/

4. Lifton RJ. Witness to an Extreme Century: A Memoir. Free Press; 2014.

5. World Happiness Report 2025. World Happiness Report. Accessed March 25, 2025. https://worldhappiness.report/ed/2025/ 

6. Kaplan Y, Levounis P, eds. Nature Therapy. American Psychiatric Publishing; 2024.

7. What AI chatbots can teach us about empathy. Wall Street Journal Tech News Briefing. March 20, 2025. Accessed March 25, 2025. https://www.wsj.com/podcasts/tech-news-briefing/what-ai-chatbots-can-teach-us-about-empathy/467baa4b-0e33-4cab-a557-b18c9ec5cba4

8. Mihajlovic A; Committee on Technology and Psychiatry at the Group for the Advancement of Psychiatry. Could virtual reality be a game changer for mental health? Psychology Today. March 12, 2025. Accessed March 25, 2025. https://www.psychologytoday.com/us/blog/psychiatrys-think-tank/202503/could-virtual-reality-be-a-game-changer-for-mental-health

9. LoboPrabhu S, Summers R, Moffic HS. Combating Physician Burnout: A Guide for Psychiatrists. American Psychiatric Publishing; 2019.

10. Love M. Mia Love: My living wish for the America I know. Deseret News. March 11, 2025. Accessed March 25, 2025. https://www.deseret.com/opinion/2025/03/11/mia-love-my-living-wish-for-the-america-i-know/