Author’s note: Throughout this commentary, I use female pronouns and terms to designate the individuals who have abortions. I am aware that there are individuals who identify as male, transgender, or nonbinary who have abortions, but most pregnancies and abortions happen to women.

The US Supreme Court defied the court’s tradition and the expressed intentions of some of its members during their confirmation hearings by overturning the 50-year-old precedent, 

, which had established abortion as a right. Immediately after the 

Dobbs v Jackson Women’s Health Organization

 decision was rendered on June 22, 2022, many states applied or enacted laws either severely limiting or banning abortion.

A week after the decision, a 10-year-old girl, pregnant by rape, was taken to Indiana, having been denied an abortion in her home state of Ohio. She was at high risk, not only for exacerbations of the trauma she had already experienced but for complications of pregnancy and childbirth, not to mention those of motherhood. It is notable, and relevant, that the first responses of Mike DeWine (Ohio’s governor), 

, and other media was to declare that the story was untrue or could not be confirmed.

 No apologies were offered when the rapist was arrested and confessed. Next, the physician who performed the abortion was accused of not recording the procedure as required by law. When the girl’s evidence was produced, there was no apology or retraction.

 This is the country in which we now practice not only obstetrics and gynecology but also psychiatry.

 This is the country where our patients live.

Across the board, pregnancy leads to more danger of morbidity and mortality than abortion. Abortion is one of the safest procedures in all of medicine. One in 4 women in the United States will have an abortion during their lifetimes. Before the 

 ruling, approximately 1 million abortions were performed in the United States each year.

 Clandestine, unsafe abortions deprive hundreds of thousands of children of the mothers who undergo those procedures. Abortion has been practiced throughout history and long before the advent of anesthesia and antibiotics.

 Perhaps the danger of abortion without those protections is the reason abortion is mentioned in the Hippocratic Oath. In any case, it means that abortions were happening in the fifth century BC.

In the United States, notably, the distribution of religious affiliations among women who have abortions is the same as that of the general population.

 Every day, women who oppose abortions have abortions—and many go on actively opposing abortions.

The terms commonly used to characterize positions for and against abortion are deeply prejudicial. In my opinion, 

 likens a decision about a pregnancy to a choice between menu options or minor purchases. A decision about a pregnancy concerns the lives of the potential mother, the potential child, and many other individuals. All the evidence indicates that women consider abortion to be a serious decision. 

 implies that individuals who have an abortion do not care about life. It is notable that the anti-abortion movement is completely divorced from any activism to support life other than that of a conceptus. It is not linked to concerns about war or the death penalty, not to mention the lives of children born into circumstances where their mothers doubt their ability to provide for and protect them (poverty, domestic violence, immaturity, the needs of other children). The terms 

 carry misleading and damaging meanings. One positive effect of the 

Commentators decrying abortion prohibitions are especially exercised about laws that do not make exceptions for rape and incest. Stop for a minute and consider the unescapable, excruciating assumptions that underlie those exceptions. Abortion opponents proclaim themselves to be protectors of the unborn. If the embryo or fetus is a human being, why should it be deprived of life because of circumstances over which it had no control? It is because the woman pregnant by rape or incest was not responsible for the sexual act that caused the pregnancy. Exceptions for rape and incest lay bare the unspoken, unacknowledged belief that women who willingly engage in sex and become pregnant should be punished by having to stay pregnant. The punishment is usually rationalized by casting it as responsibility. It is twisted logic to consider that having a baby when one is not going to be able to care for it properly is responsible. It is twisted to make what, under good circumstances, is a blessing—a baby—into a punishment.

We are still operating under the conviction that the ills of society were caused by Eve eating the forbidden fruit in the Garden of Eden and then seducing Adam. But it does not work that way. Women with untenable pregnancies are unlikely to have conceived out of carefree unbridled lust—and what if they had?

Another unspoken assumption is that women have abortions because they do not care about children. In reality, they have abortions because they want to have 

 children—children they can provide for. In the United States, where sex education—if provided at all—may be full of misinformation, individuals sometimes become pregnant because they do not know how to avoid it.

There are all sorts of reasons women become pregnant under circumstances adverse for motherhood. They cannot afford contraceptives. Contraceptives fail. Their partners refuse to use condoms. Their partners force them to have unprotected sex. There are many ways to force sex on someone without committing what is legally defined as rape. Some women are living in violent relationships. Most women who have abortions already have children.

 Especially in the United States, which offers minimal—if any—parental leave and subsidized child care, adding another child would deprive the existing children of essential care and protection. Some women have psychiatric and/or other medical disorders that may prevent them from providing good maternal care.

What about the hidden part of the iceberg? The 

 decision leaves the country in a legal and clinical quagmire. On the basis of what I consider a ragbag of dubious constitutional arguments and false statements about the psychiatric sequelae of abortion, it removes the already attenuated protections of 

, leaving abortion’s legality to be decided by each of the 50 states. Some of the results are already apparent, and many others are expected. We have some forewarning about the implications because Catholic hospitals and inhospitable parts of the country have already significantly limited care. Catholic (and evangelical) hospitals are not required to, and do not, inform patients that medical staff are not allowed to mention contraception or abortion. This prohibition also extends to psychiatrists at the hospitals.

In Catholic hospitals, women with incomplete spontaneous abortions, ectopic pregnancies, and fetuses with anomalies incompatible with extrauterine life are left to bleed, endure pain, and risk ectopic rupture rather than having their pregnancies terminated as medically indicated—as long as the clearly doomed fetus is considered to be alive.

 There are approximately as many spontaneous miscarriages each year as abortions. In many cases, it is impossible for a clinician to distinguish a miscarriage from an attempted abortion.

 Some of these laws will allow state officials to review medical records, question patients and doctors, and perhaps examine whatever tissue was removed in the hospital in an attempt to uncover an unlawful abortion.

We know that physicians in some places cannot obtain misoprostol, which has been approved for the treatment of serious medical conditions, because it is also used as an abortifacient. We know that many women have been tried in court, and some incarcerated, to punish them for behaviors that legal—not medical—practitioners have deemed deleterious to the fetus, including attempted suicide.

 In an illustrative case, a woman experienced a stillbirth at home. The authorities went through her computer and found that, at some point, she had searched for information about abortion pills. There was no evidence that she had ordered, obtained, or used them. The woman had to endure 3 years of anxiety before the case was dropped. We know that, although white women and women of color are equally likely to use street drugs while pregnant, poor, minority women are more likely to face these consequences.

. Research clearly demonstrates that although abortion is more likely in highly stressful life situations—which may include mental illness—abortion itself does not cause psychiatric illness; the most common response is relief. Publications purporting to demonstrate psychiatric harm from abortion have been thoroughly and emphatically debunked because of unacceptable, biased, methodology.

 There is no evidence that abortion leads to later regret any more than any other life decision. There is, of course, a taboo against the expression of regret that one has had a child. Often, a woman who expresses regret about a past abortion, when asked to remember the circumstances at the time, will say that the abortion was the best option under those circumstances.

Many states have laws requiring a waiting period between the time a woman presents for abortion care and when the abortion is performed. This is a major hardship for women who have to travel to reach an abortion provider and provide coverage, if possible, for the absence from work and home. No other medical procedure, no matter how serious, requires a waiting period (except when there is a wait for available care).

 There is no evidence that abortion decisions are made on impulse. Abortion is similarly unique in being the subject of state laws mandating specific language that abortion providers must use with patients. This language generally conveys misinformation, including statements that abortion causes adverse psychiatric sequelae. Some laws require that a patient seeking abortion undergo—and view— ultrasound imaging of the embryo or fetus. Anti- abortion protesters outside abortion facilities, of course, cause distress. All these restrictions and mandates add stress to having an abortion.

Many states require that the parents of an underage girl be informed about or consent to her abortion. These laws seem like common sense; youngsters need parental guidance and support. But there is no evidence that mandated parental involvement is beneficial. Abortion providers will assist those who need help approaching their parents. Some girls realistically anticipate that their parents would punish or reject them if aware of their pregnancy—and/or force them to remain pregnant. The logic of mandated parental involvement is flawed. The situation is not difficult to understand; one will have a baby or one will not. The young woman deemed too immature to make the decision to abort will otherwise, in a few months, become the mother of an infant for whom she will have legal responsibility.

There is also the idea of fetal personhood. Many existing and pending state laws explicitly state that from the moment the sperm fertilizes the egg, that fertilized egg is entitled to all the legal rights of an individual. The conceptus, the embryo, the previable fetus can only survive inside the body of a woman. Pregnant women may be made to undergo surgery or other interventions aimed at improving the well-being of the fetus. This is a unique exception to American law, under which it is illegal to forcibly invade the body of a nonconsenting adult, even to remove 1 drop of blood that will save another person’s life. Many fertilized eggs are washed out of the body with menstrual blood, are resorbed, or otherwise disappear.

 How the states propose to protect fertilized eggs is unclear; when a law protecting them was passed in Indiana, protesting women sent used tampons to the state capitol.

Giving personhood to the unborn puts every woman who could become pregnant at risk of state investigation, control, intrusion, and prosecution.

 There are laws mandating that every woman seeking abortion care be registered in a state database, inviting intrusion and harassment not only by the state, but also by anti-abortion individuals or organizations.

 A Texas law, which is also under consideration elsewhere, offers $10,000 to any individual who identifies and sues someone who helps a woman obtain an abortion.

 Pharmacists are refusing to fill pregnant women’s prescriptions for clinically indicated medications, and oncologists are refusing to provide chemotherapy for pregnant women with malignancies. All these laws destroy the confidence and privacy of the 

. Fetal personhood completely undermines the personhood of the pregnant woman.

At this moment, potential medical students and medical students planning to train as obstetrician-gynecologists have to decide whether to consider institutions in states where abortion is forbidden.

 Obstetricians are refusing care for women having spontaneous miscarriages and ectopic pregnancies for fear that they will be prosecuted for homicide.

 positions find that prospects are unwilling to consider anti-abortion states.

Millions of women stand to lose ob/gyn care. Proposed and existing anti-abortion laws are so varied and often so ambiguous that there may be decades of litigation about them. For example, some states have proposed criminalizing travel from an anti-abortion state to another state to have an abortion. Is there not a right to travel freely between states? If there is not, what apparatus will states need to enforce such a prohibition—or will states rely on friends and neighbors to spy on and report one another? Some states propose to forbid mailing abortion medications to residents of their states. Can they legally control postal services? When challenges to these laws wend their way through the judicial system, they will arrive at the same Supreme Court that has just overturned the right to abortion.

The fate of in-vitro fertilization is also in doubt. When a woman’s ovaries are hyperstimulated to produce eggs, as many eggs as possible are harvested and fertilized to maximize the possibility of a successful pregnancy. Generally, they are genetically tested and those with abnormal genes are discarded—what if they are considered individuals with legal rights? As it is, state laws vary widely about control over frozen embryos. Infertility programs in some states have begun shipping their frozen embryos to “safe” states. Some will relocate their practices, leaving states that deem every embryo they create a human being entitled to state surveillance and protection. There reportedly has been a major increase in the number of men seeking vasectomies.

A US senator who is an obstetrician recently stated at a Senate committee hearing about reproductive rights that there are 4 times as many pregnancy crisis centers in the United States as abortion clinics. A crisis pregnancy is one for which the pregnant woman is considering abortion. These centers exist to keep women from having abortions. According to a 

 story by a reporter who spent time inside a Tennessee crisis center, they offer sonograms—which are often provided by untrained, nonmedical personnel—to demonstrate the heartbeat and any human-appearing features of the embryo or fetus.

 They dismiss concerns about circumstances and extol the joys of motherhood. They inform the woman that state laws require the father of a baby to provide for it, but they do not offer information about how rarely those laws are effective in the circumstances of the women they counsel.

 They exaggerate the support the state provides for mothers and babies.

 They attempt to delay the process in hopes that the pregnancy will progress beyond the abortion limit of the state. And they have an explicit policy of offering the bare minimum of support for the baby they hope the woman will have (a few diapers or something similar)—and they do not share this policy with those who are seeking help.

 Our patients may seek help at these centers.

: provides up-to-date information about abortion laws and statistics in the United States and all over the world

: provides support and information for the public and pregnant women, whether they intend to abort or not; information about criminal cases against pregnant women; and advocacy

: a group of clinicians who use evidence, training, and organized action to champion health care rights

: provides information about legal challenges to abortion restrictions

The impending crisis of access to safe abortion care in the US

: This article includes a list of organizations that help patients find abortion care in a wide variety of ways.

So we now practice psychiatry, and teach medical students and residents, in a country with a patchwork of 

—some of which trample the cherished privacy of the doctor-patient relationship.

 Well-educated, financially able patients will continue to have access to abortions wherever they live; they can travel and are unlikely to get into trouble with the law. They will, however, continue to be at risk of dangerously delayed treatment for miscarriages and ectopic pregnancies—and of having fewer obstetricians in their states. Exceptions for the life of the mother are often interpreted to mean that, as long as the fetus is alive, despite having no chance of ultimate survival, the woman’s condition must deteriorate to the brink of death before her pregnancy is terminated.

Our most vulnerable patients in many states will lose their ob/gyn care. They will live in fear of a problem pregnancy and of government surveillance and criminal accusations. Some of our patients will be enraged and frightened by the 

 decision. We can help them strategize and to develop plans to protect themselves and those they care about. Our most vulnerable patients, if not pregnant at the moment, may be too preoccupied with the exigencies of their daily lives to focus on their loss of rights and care. Our responsibility is to know and communicate the facts and to help patients making pregnancy decisions review, consider, and act on their own values, beliefs, and circumstances.

The topic of abortion has 2 disadvantages. One is the general stigma of abortion, and the other is that individuals do not like to contemplate unpleasant, painful life possibilities. We like to believe that untenable pregnancies only happen to others. We often must help patients contemplate and plan for contingencies they would prefer to ignore, such as continuing to take medication even when they feel better. Now all our patients capable of becoming pregnant also need to be prepared to cope with a pregnancy that is untenable—for any reason. Perhaps everyone who could become pregnant should be equipped with both Plan B—the “morning-after pill”—and a home medication abortion kit. Perhaps in some cases we will need to prescribe them.

has a lifelong interest in psychosocial issues in women’s reproductive health. She is the editor or author of 

Psychiatric Aspects of Abortion and Abortion: Facts and Feelings, both published by the American Psychiatric Press. 

She has represented the American Psychiatric Association in testimony before the US Senate and Surgeon General and in several state courts about proposed and challenged laws related to abortion.

The opinions expressed are those of the author and do not necessarily reflect the opinions of 

1. Wong A, Yancey-Bragg N. ‘Set them up for failure’: sex education not required in many states where abortion is or will be banned.

https://www.usatoday.com/story/news/education/2022/07/02/roe-overturn-sex-education-states-with-abortion-ban/7748267001/?gnt-cfr=1

2. Sasani A. Suspect is arrested in Ohio after rape of 10-year-old girl. 

. July 13, 2022. Accessed July 21, 2022. 

https://www.nytimes.com/2022/07/13/us/ohio-arrest-rape-abortion.html

3. Mahdawi A. The right denied the story of a 10-year-old getting an abortion—it only gets worse. 

. July 16, 2022. Accessed July 21, 2022. 

https://www.theguardian.com/commentisfree/2022/jul/16/rightwing-rape-abortion-10-year-old-worse

Navigating loss of abortion services—a large academic medical center prepares for the overturn on

The comparative safety of legal induced abortion and childbirth in the United States

A Study of Abortion in Primitive Societies: A Typological, Distributional, and Dynamic Analysis of the Prevention of Birth in 400 Preindustrial Societies

. International Universities Press; 1976.

Contraception and Abortion From the Ancient World to the Renaissance

Reproductive rights and women’s mental health

9. Hafner K. As Catholic hospitals expand, so do limits on some procedures. 

. August 10, 2018. Accessed July 21, 2022. 

https://www.nytimes.com/2018/08/10/health/catholic-hospitals-procedures.html

Arrests of and forced interventions on pregnant women in the United States, 1973-2005: implications for women’s legal status and public health

11. Chin C. What privacy in the United States could look like without Roe v. Wade. Center for Strategic & International Studies. May 25, 2022. Accessed July 21, 2022. 

https://www.csis.org/analysis/what-privacy-united-states-could-look-without-roe-v-wade

12. Munk-Olsen T, Laursen TM, Pedersen CB, et al. 

Induced first-trimester abortion and risk of mental disorder

13. Government-mandated delays before abortion. American Civil Liberties Union. Accessed July 21, 2022. 

https://www.aclu.org/other/government-mandated-delays-abortion

Parental involvement in minors’ abortion decisions

15. Spector-Bagdady K, Mello MM. Protecting the privacy of reproductive health information after the fall of Roe v Wade. 

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794032

16. Domonoske C. Periods as protest: Indiana women call governor to talk about menstrual cycles. NPR. April 8, 2016. Accessed July 21, 2022. 

https://www.npr.org/sections/thetwo-way/2016/04/08/473518239/periods-as-protest-indiana-women-call-governor-to-talk-about-menstrual-cycles

17. Tolentino J. Another risk in overturning Roe. 

. February 28, 2022. Accessed July 9, 2022. 

https://www.newyorker.com/magazine/2022/02/28/another-risk-in-overturning-roe-v-wade-abortion

18. Piore A. Doctors: ‘chilling effect’ of abortion laws imperils women’s lives. 

. July 21, 2022. Accessed July 21, 2022. 

https://www.newsweek.com/doctors-chilling-effect-abortion-laws-imperils-womens-lives-1726503

Overturning Roe v Wade has had an immediate chilling effect on reproductive healthcare

20. Vinekar K, Karlapudi A, Turk JK, et al. Projected implications of overturning Roe v Wade on abortion training in U.S. obstetrics and gynecology residency programs. 

. April 27, 2022. Accessed July 9, 2022. 

https://journals.lww.com/greenjournal/fulltext/9900/projected_implications_of_overturning_roe_v_wade.449.aspx

21. Venkataraman M. Men rush to get vasectomies after Roe ruling. 

https://www.washingtonpost.com/health/2022/06/29/abortion-vasectomies-roe-birth-control/

22. Dias S. Baby food, bassinets and talk of salvation: inside an Evangelical pregnancy center. 

. August 23, 2019. Accessed July 21, 2022. 

https://www.nytimes.com/2019/08/23/us/abortion-evangelical-pregnancy-center.html

23. Khan N. How you can protect yourself online, post-Roe. Michigan Radio. July 8, 2022. Accessed July 9, 2022. 

https://www.michiganradio.org/health/2022-07-08/how-you-can-protect-yourself-online-post-roe

Articles

"Research clearly demonstrates that although abortion is more likely in highly stressful life situations—which may include mental illness—abortion itself does not cause psychiatric illness; the most common response is relief."

Just the Tip of the Iceberg: Psychiatric Implications of Overturning Roe v Wade

Videos

Stephen Faraone, PhD; Theresa Cerulli, MD; Craig Chepke, MD, FAPA; and Andrew J. Cutler, MD, discuss efficacy and safety of treatment options in adults with ADHD.

Efficacy and Safety of Treatment Options Utilized in Adult ADHD

: Let's move on, Doctor Chepke, what are current unmet needs in adults with ADHD?

 There's quite a few of them, the first one that I would mention would be the under diagnosis or misdiagnosis of ADHD, but we've covered that very well already, so far here. But then, even once the ADHD is diagnosed in adults, then having it under treatment of it what I think is a significant problem, I mean, I practice in the southern part of the United States and sometimes I say that ADHD around here isn't treated with stimulants, it's treated with a hickory switch. And that tends to persist until adulthood too, that there's this stigma, is the biggest unmet need is combatting the stigma, because there's the belief that the person is just lazy, that they just need to work harder, they just need to pick themselves up by their bootstraps and do it, similar to what we hear in many different diagnosis in psychiatry, and having the acceptance of this diagnosis and the treatments for it is a significant unmet need. But then also, just the treatments that we have themselves. Although we have dozens, literally, of stimulants, and we have some non-stimulants as well, we still don't have enough treatment. One aspect is the small range of molecules that we have, we only have a few molecules despite the dozens of stimulants, and then of the non-stimulants as well, and each one of those has certain pharmacokinetic limitations, and we could get, we could have a very long discussion about that but, really, when it comes to the stimulants, you have to match the pharmacokinetics to the person, and I find that I need all the dozens of stimulants for each individual person, because everyone's day is a little bit different, and they have different needs.

 Yes, I would add, one of the unmet needs is, more effective non-stimulants, we only have 2, as of now, that are FDA approved, non-stimulants, that is, and there's a lot of adults that I'm concerned about abuse or diversion, or I don't want to use a stimulant because, as we talked about earlier, maybe they have hypertension or cardiovascular issues, and medications that help us address the comorbidities, because those comorbidities are so common, depression, anxiety, substance abuse, as we talked about, bipolar disorder as well.

Craig Chepke, MD, FAPA, and Andrew J. Cutler, MD, discuss unmet needs in adults with ADHD.

Unmet Needs in the Treatment of Adult ADHD

Although virtually all physicians have experienced a sense of exhaustion in the context of unceasing demands from work, burnout is often ignored by health care leaders. Even if its presence is acknowledged, burnout tends to be misunderstood. Prior to the pandemic, lack of understanding on the part of health care organizations exacerbated the problem, as this left physicians and other health care workers feeling resentful and, in some cases, even betrayed. The onset of the pandemic amplified the problem, as the moral authority and guiding purposes of physicians were relentlessly attacked by “anti-vaxxers” and other propagandists who were intent on spreading misinformation and disinformation.

At least that is what we suspected. In order to determine whether or not this was the case, we conducted a literature review and harvested some of the more exasperated voices in social media.

 We found that there was a significant rise in burnout across health care providers. There were differences around gender, age, race, and other factors including specialty, which is known. Therefore, a need already exists to engage leaders in this challenge.

Unfortunately, there are common inadequate responses to burnout data and engagement studies by leaders that are making it worse.

“Not one more mandatory lecture on mindfulness!”

“We do not need more pizzas sent to the lounge!”


Does it matter that burnout exists? Yes. Its consequences are broad and deep. These include medical errors and premature departure from the profession. Interpersonally, burnout manifests as irritability and lack of full personal engagement at work, which harms teams and affects work quality. And, has COVID-19 had an impact? Also, an emphatic 

 Many worry about erosion in the quality of care because of the disengagement from the work (divided attention, fatigue from poor sleep, etc) and fears of harm both to the patients and to the profession itself, given the loss of so many skilled and experienced practitioners.

For those who have influence over physicians and within health care systems, we offer 3 recommendations:

1) It is important to recognize that the governance of organizations is on the threshold of significant change. The general theme relates to “sustainability”—ie, changing our way of working so that it aligns with values beyond profit such as diversity, equity, and inclusion (DEI) and preservation of the biosphere—humanity’s life-support system. Our future survival demands that we pay attention to things beyond “the bottom line,” and leaders in the world of accounting are taking notice.

 We need to attend not only to the biosphere that physically sustains us but to fairness and functionality. These problems relate directly to burnout because physicians and other health care workers need to feel that their work and work organizations contribute to the creation of a kind of world in which they would like to live

2) The investment dollars and momentum for environmental, social, and governance (ESG) frameworks and sustainability are impressive. But that is not the whole story. We must pay attention to things that are both financially and 

material. Physicians and other health care workers should be encouraged to advocate for changes—and leaders should listen to them when they do so.

3) The third challenge entails recalling that the need to derive meaning is at the core of human psychology. Each situation is different, and each situation has its own meaning. As psychiatrist Viktor Frankl, MD, PhD, observed, “Between stimulus and response, there is a space. In that space is the power to choose our response. In our response lies our growth and our freedom.”

 Working toward a goal that has a value outside of oneself is psychologically material and alleviates the individual’s sense of insignificance. This challenge is particularly salient in light of the increasingly fractious and normless culture within which we find ourselves.

is a clinical assistant professor of psychiatry at Rosalind Franklin University’s Chicago School of Medicine, and past president of the Academy of Organizational and Occupational Psychiatry. He is also a member of the Group for the Advancement of Psychiatry (GAP) Committee on Work & Organizations; the Institute for Fraud Prevention (IFP); and the Tomkins Institute of Applied Studies of Motivation, Emotion, and Cognition. He is a co-author of

 A.B.C.’s of Behavioral Forensics and Psychiatry of Workplace Dysfunction

 and a regular contributor to the B4G™ blog,

is a department psychiatrist at the Boston Police Department and immediate past president of the Academy of Organizational & Occupational Psychiatry. He is a co-author of

Getting serious about people over profit: addressing burnout by establishing meaning and connection

2. Galanis P, Vraka I, Fragkou D, et al. 

Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis

3. Preber B. ESG investing needs standards to prevent fraud and greenwashing. 

. November 22, 2021. Accessed September 1, 2022. 

https://fortune.com/2021/11/22/esg-investing-needs-standards-to-prevent-fraud-and-greenwashing/

4. Brown AO. What makes work feel meaningful? 

. May 21, 2022. Accessed September 1, 2022. 

https://workosophy.org/2022/05/21/what-makes-work-feel-meaningful/

The Will to Meaning: Foundations and Applications of Logotherapy

Leaders of health care institutions may want to pay closer attention to burnout, as more environmental, social, and governance frameworks take shape.

Can Sustainability as a Source of Meaning Help Leaders Unlock Employee Burnout?

Richard Berlin, MD, shares major American poet Donald Hall's poem, "

has been writing a poem about his experience of being a doctor every month for the past 24 years in

the “Poetry of the Times” column. He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. His latest book is Freud on My Couch. 

"We ate, and talked, and went to bed, And slept. It was a miracle."


Summer Kitchen

 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

“The day will come when people like you will curse duh day you evah laid eyes on people like us. And we gone be all duh better for it.” - from the Steppenwolf play, “The Most Spectacularly Lamentable Trial of Miz Martha Washington”

Most every eulogy I have heard—or done—for an individual who has recently died has been positive, almost exclusively so. But that perspective leaves behind and unsaid other aspects of the person. More than once, it almost seemed that a patient left the eulogy in dismay and came right to a session because of the one-sided eulogy.

What King Charles III Said About Religion That Resonates with Psychiatry

In a parallel process, it seems that something similar can occur for countries that are involved in national mourning. Most recently, it seems like almost any discussions about the adverse colonial actions during the Queen’s long reign, or discussions of 9/11/01, have been “whitewashed.”

Such a preponderance of positivity makes some psychological sense by not tarnishing an important loss. Yet, at its best, reviewing the life of a person or the history of a country also offers an opportunity to redress prior wrongs.

In the current cases, that redress may come funneling down to the intergenerational and current transmission of traumas to the indigenous. England and its settlers in their American colony seem responsible for the displacement and deaths of countless Native Americans. Just take what is sometimes called the “Trail of Tears,” with the forced removal of tens of thousands of the “Five Civilized Tribes” from the Southeast between 1830-1850. Both countries are also responsible for the institution of the slave trade of the indigenous from parts of Africa.

There are many other countries around the world that have traumatized and decimated the indigenous in the quest for control, power, and economic riches, even under the possibly guilt-reducing guise of civilizing “the other.” Now, in an ironic turn, some of the indigenous can be resources on sustainability to offset the over-reliance on fossil fuels by their conquerors.

The reckoning by reparations, whether psychiatric or monetary, is still relevant.

 In the United States, their legal gambling places are sometimes called “the Indian’s revenge.”

Psychiatry, locally and internationally, can convey the psychiatric damage done to the descendants of colonized and slave-trading countries, remnants of which are embedded in modern institutions.

In clinical care, part of any evaluation of any patients may be whether they have traumatized trails of ancestors. This may be called an ancestral history. Ignoring, forgetting, or denying the traumatic history of individuals or countries is not mentally healthy in the long run for anyone involved.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

1. Moffic HS, Bailey R, McLean A, Okamoto T; The PRO Group (Psychiatric Reparations Opportunities). 

Ignoring, forgetting, or denying the traumatic history of individuals or countries is not mentally healthy.

Taking the Trails of Traumatic Tears: The Indigenous in the National Mourning of the United Kingdom and the United States

is the president and founder of Physician Tax Solutions.

Taxes are inevitable, but proper planning can protect against an outsized portion of your income going to taxes. Recent changes to the tax code have made some past strategies outdated and new possibilities available. With inflation at the highest it has been in four decades, the need for physicians to utilize these strategies has gained outsized importance.

The first part of developing an effective tax strategy is determining which tax bracket you fall into and how much more you can earn before you move up to the next bracket. Based on experience, most doctors will find themselves paying around 35% and possibly up to 37%. If you have a C-corporation, the tax is a flat 21%, whereas self-employed physicians have a 12.4% and employed physicians have a 6.2% Social Security tax. Physicians should also factor in their capital gains taxes, as well as state income and corporate tax liability.

President Joe Biden has proposed increasing taxes, but legislators are running out of time to make the changes into law before the end of this year. Auer does not believe taxes on the highest earners will rise to the historical high of 94%. Depending on what state you live in and what other taxes you might be subject to, (your tax rate) could very well be into the 60% to 70% range, and that becomes very important when it comes to tax planning.

Doctors should maximize their retirement plan contributions, which lowers their taxable income and moves them to a lower tax bracket. Also consider a Roth conversion, which involves rolling over transferring funds from a traditional IRA or plan funds to a Roth IRA. This maneuver can be done by individuals who own a traditional IRA, a SEP IRA or those who have had a SIMPLE IRA for at least 2 years. It is also available to those with a 401(k), 403(b), or a government 457(b) plan eligible for distribution.

Roth IRA funds can be withdrawn tax-free so long as the funds have been held for at least 5 years and the holder is at least 59.5 years. There is also no lifetime required minimum distributions for Roth IRA owners.

Also considering funding a “back door” Roth IRA and a Mega Roth 401(k) to further lower taxable income. If properly utilized, these can enable physicians to put away an additional $66,000 and lower their taxable income.

When it comes to investments, harvesting capital losses is a good plan, as it can offset current and future capital, plus an addition $3000 a year. However, beware of the capital wash rules that say you cannot buy the same assets, which leads to the initial loss for 30 days.

Physicians should also consider converting W-2 income to 1099 income either in part or entirety. This is helpful, especially if the physician has locum tenens income in addition to their regular job. This also adds the ability to claim business expenses as deductibles.

For those physicians who already have Schedule C/1099 income, consider converting that income to an S-Corporation LLC. This will lower self-employment taxes and reduce the risk of an audit. Based on the most recent published statistics the IRS has provided, generally speaking, if you have a Schedule C income of over $250,000, you currently have about a 2.5% chance of an IRS audit. If you have that same income going through an S-Corporation, statistically, that drops your audit risk down to 0.7%—a fairly significant drop in the risk of an audit, everything else being the same”

With an S-Corporation in place, consider employing family members by putting them on the payroll and assigning responsibilities. This shifts income from being subject to your tax bracket to being subject to their tax bracket.

A physician can also maximize their home office and automobile deductions. There are acceptable ways to do this; physicians should work with a tax planner to ensure they are getting the most out of the vehicle and workspace. Physicians should also consider the per diem allowances for lodging and meals as opposed to the actual expenses.

Finally, physicians should consider making a pass-through entity (PTE), such as an S-Corporation or partnership, to pay individual state income taxes at the PTE level, which enables the clinician to deduct the cost of that tax dollar for dollar. This is available in 40 states.

Planning for Your 2022 Taxes

September always feels like back-to-school season, even though many districts across the country start earlier. The smell of fall is in the air as the kids gather their books and march back to school, some with more enthusiasm than others. Little do they realize the importance of ongoing education and the likely role learning will continue to play in their lives.

As professionals in a dynamic medical field, psychiatrists and psychiatric clinicians recognize this need to continue learn and grow, especially as science progresses. Perhaps that is why the serotonin debate that hit the popular press struck such a chord with readers and contributors alike. In this issue, you will read insights from a former editor in chief and the current one. They discuss the facts and the myths and provide balanced commentaries to keep you up-to-date and confident in your prescribing practices.

No doubt, the onslaught of criticisms against psychiatry can take its toll. This month’s Special Report continues the exploration of physician wellness and burnout prevention. Sometimes the hardest lesson is learning to take care of oneself, especially for those in caring professions. However, the friendly skies provide the cues you should follow: It is important to put the oxygen mask on yourself before assisting others.

School continues to be in session as, from cover to cover,

™ provides you with clinical pearls, data, and practical support aids so you can successfully take care of yourself and your patients.

September always feels like back-to-school season...