 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

H. Steven Moffic, MD

As I presented at a Thanksgiving presentation and discussion this past Sunday, I viewed this Thanksgiving as extra special because the lessening of the COVID pandemic allows more live get-togethers. I called it COVID Relief Thanksgiving. Yet, because of the mortality and morbidity of COVID, there will also be sadness. Although it is usually considered a happy and inclusive holiday in the media, Thanksgiving is much more complex than that.

Add 30 Exclamation Points to “Remember Transgender Individuals This Weekend”!

The Benefits and Limitations of Resilience

The gratefulness we are supposed to feel on Thanksgiving Day is often laced with anxiety over the quality of the food, the family dynamics, missing members, and political divisiveness. To address that, I devised an acronym that can also be applied to other holidays that bring family and friends together. It is called CHEERFUL, which stands for:

Many already told me they are using it, including a man who was grieving the recent death of his wife:

“Trying to be cheerful, as you suggested in your talk.”

In addition, the day after Thanksgiving, when many are also off from a formal workday, is also full of complexity and contradictions. This Friday is known as Black Friday, when people pursue sales of merchandise, a celebration of capitalism for those who have enough money and opportunity. But that Friday was federally designated as Native American Heritage Day in 2008. However, many Indigenous designate it as a National Day of Mourning because Thanksgiving has historically been associated with the decimation and displacement of Native Americans.

As I discussed on Sunday, one example goes back to 1863-1864. In October of 1863, while still in the midst of the Civil War and all the anxiety about it, President Lincoln made Thanksgiving an annual national holiday. Yet, no thanks to the Indian Removal act of 1830, the Navajo Long Walk began in early 1964, where thousands were marched over 400 miles from their homelands in desirable Arizona territory to New Mexico. Much morbidity and mortality occurred along the way.

These associations left me coming up with a different acronym for today, the other side of the Thanksgiving coin. It is TEARFUL, which stands for:

Given the continuing divisiveness and xenophobia in the United States, our challenge is to provide equity and understanding across our cultures, including the social disparities in psychiatric care. Thanking Native Americans for using their land—as is done at many events—that was taken away from them will not cut it. At most, it may be heard as value postering without real corrective action. Profits from their gambling casinos help, but only getting back some of the better lands, appreciation of their cultural values, and reduction of their higher prevalence of mental disorders, will provide a Thanksgiving of adequate thankfulness.

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

Articles

The two sides of the Thanksgiving coin… what are they and what do they mean? 

Cheerful and Tearful Over Thanksgiving Weekend

It was just about 2 years ago that we did this Thanksgiving video, which was not long after we started this weekly video series on Psychiatry & Society, and not too long after COVID-19 became a major concern. That year most extended family get togethers were by Zoom. 

This year is the first that seems more or less completely open to live interactions as COVID is much less of a major health concern, but with the added blessing of Zoom supplementation when desired. Besides COVID and Zoom, this video from 2 years ago seems important for 2 other reasons. One is that I focused on my colleague Carl Hammerschlag, not only for his work for Native Americans, for whom tragic triggers connect to Thanksgiving, but that he thought of his talks as prayers, which seemed to me the best way to think of my own. However, this year will be the first Thanksgiving time when he is no longer with us, having passed away in January of this year. May his memory continue to be a blessing to us all. Secondly, I got to directly thank all of the 

™ staff of the time for making these videos work so well. Actually, I could not imagine at the time that we would still be doing them 2 years later, but such is the continuation of our social psychiatric challenges.


What I would like to add for this year’s rerun is the acronym I have developed to approach a holiday that is often laced with gratitude and/or anxiety, which I imagine as 2 psychological strands of DNA spiraling around each other. This acronym is meant to reduce the anxiety to helpful levels and that in turn allows for more gratitude. The acronym is CHEERFUL and it stands for:


So, a toast to being CHEERFUL over this Thanksgiving holiday weekend!

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

Videos

Again Giving Thanks to Psychiatry and Society

If you are of a certain age, you will recall the saying: “Doctor knows best.” After the civil rights era and the social justice advances of various groups, including patients, the saying became more like: “Both doctors and patients know best.” Actually, it is even broader than that when you go beyond an individual private practice office to treating more complex patients with serious illnesses. Then we have something like: “The team know best.”

The Importance of Avoiding Implicit Bias in Advocating for Patients

Natasha Massoudi, MD, MPH; Agata Piotrowska, BS; Kayla Behbahani, DO

Affirming Evidence-Based Care for Young Patients Who Are Transgender or Gender Diverse

Valeria Roldán; Z Paige Lerario, MD, NYS CRPA/CPS-provisional

Following doctors’ orders in psychiatry has always been a challenge. Stigma, denial, confusion, and misinformation often contributed to the reluctance, or nonadherence, of patients. That was what led me early on in my career to try to empower patients. What follows is what a colleague remembered from sitting in on my patient interactions in the early 1980s

“Dr Moffic was a coleader with the patient in the room. He found ways to ask his patient what the patient thought about his/her treatment. This may sound like a small thing, but it was rare. . . .I had never heard another psychiatrist ask his patient what medication they thought would work best. . . .He was empowering his patients to have a voice in their treatment and medication. I believed this partnership approach also improved his patient’s [adherence] with taking their medication.”

This caseworker, Herb Bateman, started and empowered one of the earliest patient peer services.

As patients with severe mental illness are involved with their families in one way or another, families were brought in with the permission of the patient because their positive expression was therapeutic and they needed to be empowered too.

Education had similar feedback loops. Though we psychiatrists were usually the most thoroughly educated and had much to teach, we had to try to follow what other clinicians wanted to learn and also what they could teach. This feedback was especially important in recognizing and reducing structural racism in our clinics.

Back in the early 1990s, I was asked to be the medical director of a clinic specializing in working with those with gender concerns, which was, at that time, the only such clinic in the Midwest. I asked, “Why me?” I knew virtually nothing about such patients. The head of the clinic responded: “Well, you have a good reputation in helping the underserved minorities. If you come here with the same attitude, we and the patients will teach you most everything else you need to know.” And they did. And that is what Valeria Roldán and Z Paige Lerario, MD, NYS CRPA/CPS-provisional, and the other authors in this Special Report, do in their articles.

Nowadays, that is called cultural humility. Psychiatry, like the rest of medicine and other fields, is a work in progress. We are all wrong at times, have to admit that, and move on. I would call that psychiatrist humility.

The informative and empowering papers in the Special Report follow this same spirit and model. Learn from them!

Pathway to Treasure: Discovering the Hope Empowerment Can Bring Toward Recovery From a Serious Mental Illness

“Both doctors and patients know best.”

Psychiatrist Humility and Patient Empowerment

“What doesn’t kill you, makes you stronger.” - Nietzsche

After the tragic mass shooting in a LGBTQ+ club in Colorado Springs over the weekend, Nietzsche’s well-known statement takes on tragic proportions. Five were killed, and many more wounded. There will be inevitable traumatic ripples into the wider LGBTQ+ communities, and those who love them.

Remember Transgender Individuals This Weekend

The goal of trauma recovery will include resilience. Resilience is the ability to bounce back stronger after trauma with the supportive help of community and a vision for the future. That vision, which we have discussed in the last 2 columns, must include less violence and hate toward LGBTQ+ individuals.

Generally, resilience is thought to be a positive characteristic, even a panacea for getting through trauma stronger. Yet, like most good things in life, too much resilience may be problematic at times. Why? How could increased psychological strength be a problem?

Too much resilience can cause individuals to keep plowing through untenable circumstances and be unnecessarily tolerant of adversity. Goals may become unrealistic with undue conscious or unconscious denial.

Whether with LGBTQ+ individuals, burnout, climate instability, racism, or other ongoing social psychiatry problems, we need resilience to develop after trauma, but also to turn that resilience to a vision of reducing the causative factors of the trauma. The causative factors are psychological, our human nature tendency to fear and then scapegoat the other. That makes psychiatry not only important in the treatment of trauma stemming from such events as mass shootings, but in preventing it.

Let’s imagine the ripples of trauma tapering off, then reversing course to flow back to blocking the build-up of such trauma in the first place.

While resilience is beneficial to mental health, we need to reduce the reasons individuals require resilience. 

.” On Saturday night at a LGBTQ+ Club in Colorado Springs, 5 were killed and at least 25 injured in a mass shooting. Two attendees courageously tackled the shooter to end the shooting.

So far, the exact motive is unclear, and how many transgender individuals were hurt is unknown. However, it has been conveyed that the bartender was trans and amongst those killed. His partner, a drag performer, was behind the bar during the shooting and survived.

Saturday was the last day of Transgender Awareness Week. Club Q, where the shooting occurred, generally features a “Drag Diva Drag Show” on Saturdays. Drag-related events have drawn extremist political protests recently about their imagined danger to children. In a tragic example of synchronicity, the shooting took place only hours before Sunday’s International Transgender Day of Remembrance, as if to punctuate the present and past losses of life.

I had ended that column with a personal plea for help in reducing the hatred and violence toward the transgender. Let me add 30 exclamation points, 1 for each of the victims so far.

On Saturday night at a LGBTQ+ Club in Colorado Springs, 5 were killed and at least 25 injured. 

As we approach the Thanksgiving holiday, we are in the middle of the week of a mental health concern for which we should not be grateful. From November 13-19, it is Trans Awareness Week. In other words, we need to remember the psychological and societal challenges of being trans. The following day, November 20th, is the Transgender Day of Remembrance.

Psychiatrists and the 2024 Presidential Race

What do we currently need to be aware of? The Human Rights Campaign announced on Wednesday that at least 32 transgender and gender-nonbinary people have been killed in the United States so far in 2022. Over half of them were Black and about 80% of darker skin color or a trans woman.

This data is the tip of the physical and psychological violence iceberg towards trans individuals which, despite positive gains in recent years, still includes a higher rate of discrimination, hostility, and suicide than those within the gender binary. The social challenges also seem to contribute to increased rates of psychosis, such as schizophrenia spectrum disorders.

 Backlash is taking place in some locations, including the threat that Florida will legally block any transgender medical care.

Transgender Awareness Week was designed to help raise awareness and action to address these challenges. A 2021 Pew Research Center survey suggests that about 58% of Americans think that they have never met someone who is trans.

 Passing without notice may be desired at times, but knowledgeable interpersonal relationships generally seem to reduce prejudice.

Organized psychiatry has done much to try to reduce the stigma of being trans, yet has not completely eliminated it from the DSM as had been done with homosexuality.

Personally, I experienced the paradox of working part-time with trans individuals from 1992-2012, and ended up feeling that they were the most courageous patients I ever saw, but wishing they never had to use such courage to go through those difficult transitions. In our own family, we will be grateful for our own trans individuals this Thanksgiving, but will be even more grateful when the risks diminish.

My psychological and human plea: Our family would be so grateful if you helped make that happen. Thank you.

1. Schoenbaum H. Report: At least 32 transgender people killed in US in 2022. AP News. November 16, 2022. Accessed November 18, 2022. 

https://apnews.com/article/transgender-deaths-america-2022-data-76c8ba3936e9a724377d1733a4619d7c

Psychosis in transgender and gender non-conforming individuals: a review of the literature and a call for more research.

3. Minkin R, Brown A. Rising shares of U.S. adults know someone who is transgender or goes by gender-neutral pronouns. Pew Research Center. July 27, 2021. Accessed November 18, 2022. 

https://www.pewresearch.org/fact-tank/2021/07/27/rising-shares-of-u-s-adults-know-someone-who-is-transgender-or-goes-by-gender-neutral-pronouns/