H. Steven Moffic, MD

H. Steven Moffic, MD, talks about the current trends of sexism.

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 being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Videos

Female leadership can—and will—make a difference in the future. 

Not Everything Goes With the Bonobos

H. Steven Moffic, MD, discusses how religion fits into the current scene. 

How has religion helped you as a physician? Share your thoughts and comments by emailing 

Religion doesn't seem to be part of the conversation on these difficult times. How and why can it help? 

This Holy Week of Passover, Easter, and Holi

In mid-March, as we reached the 1-year anniversary of COVID-19’s designation as a world pandemic, there were scores of media articles about what that year meant to our country and world, unsurprising given how unprecedented the year has been in our lifetimes. I meant to do one from the psychiatric perspective, but wanted to obtain the perspectives of both colleagues and the public.

I also thought these perspectives should be brief, given the potential numbers of them, and how that would dovetail with their popularity on social media. Therefore, in a mid-March video, I asked viewers for their preferred word or 2 to describe the year, or more if necessary, and repeated my request to those who I know follow my videos and articles.

Psychologically speaking, we know that when we name something, that in itself provides some comfort in knowing what we are dealing with. Some of that reaction depends on our personal history of responding to stress and trauma, and some to our current circumstances. Therefore, we each differ, and each of us can differ within ourselves over time.

, posted on St. Patrick’s Day, I provided my 2 single words and why I came up with them. First was BEWARE, which came to mind because March 15th is the Ides of March, the day when Julius Caesar ignored the warning of a seer, culminating in his assassination. Second came EGAD, because of its Oxford dictionary definition that combines anger, affirmation, and surprise, a mix-up of what I had seen over the year.

To both my surprise and not surprise, from adolescents to the elderly, I received many words, well over 50. One-word responses dominated, and they are reflected in Word Cloud #1. They seemed to break down into the following categories.

 One of the traditional activities in psychiatry is INTROSPECTION, both for the clinician and patients. That was mentioned 5 times. One goal is ENLIGHTENMENT, and that was mentioned 3 times.

 Many words conveyed positive psychology: COMPASSION, HOPEFUL, RESILIENCE, OPPORTUNITY, KINDNESS, and GRATEFUL twice.

 Though not necessarily a reflection of clinical concern, certain words we often encounter in psychiatry were chosen: LOSS or ALONENESS 5 times, along with SADNESS and DEPRESSION. Other negative words were: FATIGUE, STRUGGLING, DISCOURAGED, and UNAPPRECIATED.

 For me, hearing 2 clergy use x-rated words was a surprise, even if they seemed to be conveyed with a bit of tongue-in-cheek. The word SURREAL was unexpected, and I had to look up what INTERREGNUM meant.

 Perhaps reflective of mixed feelings were pairs of words that were opposites: YIN and YANG; FRIGHTENING and ENLIGHTENING; PARALYZING and CATALYZING; FEAR and NO FEAR: LOSS and GAIN; and CERTAINLY UNCERTAIN.

After reviewing that list, I thought of several words that I anticipated being there, but were not. ZOOM was one, given how common it is now. Perhaps it escaped mention precisely because it has become so routine. LOVE is another. Certainly, passionate love is more of a 4-letter word in psychiatry, given the ethical principle against that between a clinician and patient. But what about the increase of being home more with loved ones? Then there is the love of care and compassion, the kind of love I recommended for administrators when I received the Administrative Psychiatrist Award from the American Psychiatric Association in 2016. HELP was yet another, perhaps because it is not clear when and what kind of help is needed for normal reactions to an abnormal situation.

Given the promise of the vaccines, someone like myself might assume that more individuals would be optimistic about year 2 of COVID-19. Yet, the first week indicated how unrealistic that may be. Our country was hit with at least 4 major crises. One is the horror on our border with Mexico, the children who are alone with an uncertain future. The second one was predicted by many, but allowed to occur anyways, which was the spring break crowds in Florida, with some added mayhem. Then, after the COVID-19 year of markedly reduced mass murders, we had 2 in a single week: one near Atlanta where 8 were killed, 6 of them being Asian women; the other in Boulder, where 10, including a police officer racing to the scene to help, were killed in a grocery store where our basic need for food is fulfilled.

These traumas and tragedies necessitated adding them to the 

 I did on March 24th, when I was planning to discuss the responses of our audiences. On that same day, I contacted the same audiences to see what their words were a week later, as displayed in Word Cloud #2. Some kept the same words. Many went to more negative words. Introspection was no longer submitted.

I picked WHIPLASH this time around, feeling once again, despite my prophetic aspirations, that my mind was shocked by yet more unexpected tragedies. A new 4-letter word that I was expecting that was not submitted was GUNS. There were 2 new submissions of non-English words: the Hebrew one of MITRAYIM, related to the upcoming Passover holiday and the need to emerge from narrow and constricting physical and psychological spaces; and the Hindu one of SRISHTI-STHITI-PRALAYA, which refers to the ongoing cycles of Creation-Maintenance-Destruction, of which we might be in the destruction phase now. If anything, the words for a week later seemed to refer to our grey state of uncertainty about where we are headed, for better or for worse.

For both time periods, 2 or more words were submitted, but they are not shown on our Word Clouds. They include: GO WITHIN; A REMARKABLE PASSAGING HOPEFULLY; ANNO COVIDI; BIOPSYCHOSOCIALCULTURAL GROUNDING; DEEPENING SOCIAL SENSITIVITY; SAD AND LONELY; SAD AMERICAN or SAD TO BE AN AMERICAN!; SHOULDN’T HAVE HAPPENED; AN ANXIOUS EXISTENCE; OY VEH; HUMBLING AND HORRIFYING; PRESENT MOMENT; and UNLEASHING OF WRATH ON HUMAN SURVIVAL.

Both times, some contributors added explanations for their choices, all of which provided extra value. In fact, VALUE was one of them. Here are some of them in their anonymous authors’ own words.

 “The first word that came to mind was value—in all its iterations. I think this extended moment in time/history has demanded that we rethink what we value, how we measure value, what we consider valuable, how we manifest value(s). . . And, of course, it’s a derivative or sibling to valor—that of heroes.”

 “Maintaining many jobs: psychiatrist, improvised special education teacher, speech, occupational and physical therapists, and solo crisis team, and extremely sleep deprived!”

 “Without sounding like a conspiracy theorist, I have deep suspicions about China’s role in it, above and beyond what ‘accidentally’ happened in their lab.”

 “As I’ve been calling it in my writings, has been something akin to a repeated stress test—increase the speed, the inclination and let’s see what your heart can take and what you’re made of.”

 “I lost my mother and gained a daughter-in-law. What a crazy dichotomy.”

 “Coping with change and loss, getting under control, then it all falls apart and you have to do it and get on top of it all over again. But you are resilient, so you do it and move on. And there were some good things which happened during this year from hell. Being grateful, more exercise, closer to nature, connecting with folks, etc.”

 “Or, rediscovering that we need family almost more than anything else.”

 “Unbelievable that it was such a disaster and unbelievable for the ability for people helping people.”

 “Regarding those who ignore the need to consider their fellow citizens, by ignoring science and reality.”

 “It was the longest hurricane that I didn’t have to sit through with my elderly grandparents. This year was like a 90s mash up of twister, Dante’s peak, and brave new world with modern English singing ‘I’ll melt with you’ on half speed in repeat in the background with Jim Carrey dancing across my lawn in a tutu leading a parade of small children dressed as the Arctic creatures our lack of climate policy is slaughtering.”

 “Once a community has a massacre, there is life before and after that event. Same for the pandemic except that one horror is acute and the other is chronic. Either way, there is surely some degree of PTSD to set in. The King Soopers on Table Mesa is the hub of our South Boulder community, and now it is a crime scene and will forever be a reminder of the darkest shadows of our American reality.”

 “The world has endured stormy waters. No matter how far we are submerged, humanity always resurfaces. The pandemic has pushed us in very deep, but this just means we will re-emerge more rapidly, according to Archimedes’ principle!”

These words, phrases, and explanations of our readers have both personal and general implications. It seems all of us started with some degree of built-in evolutionary reaction to perceived danger, “fight or flight,” when COVID-19 was deemed a pandemic over a year ago. It was a unique danger for our time—not only was it invisible, but it posed a danger of dying. Flight can not only fit the social distance recommendations, but internal flight to deny the risk. Fight can include all those on the health and essential frontline services. Then, we add on our individual variations that can complement any general review of our COVID-19 year. Although the surveys were on both mental health professionals and the public, there didn’t seem to be major differences in the responses of the 2 populations.

However unexpectedly, the first week afterwards added some concerns.

. Over the year and continuing in this week, scapegoating has gone from Asians to Black Americans to Jews to Navajo Native Americans to Hispanics to sexism, and most recently likely to Islamophobia given the Muslim identity of one perpetrator. All scapegoated groups may need to try to support each other to avoid being divided and conquered by those in power.

. Though mass killings by guns were down in the COVID-19 year, mass shootings were not. Why, though, did we have 2 mass killings in this first week after the COVID-19 year? Was this a form of societal regression? A backlash to the new government, similar to Lincoln’s assassination and the dismantling of Reconstruction after the Civil War?

. Given the amount of prolonged grief and the typical delay of PTSD symptoms, we are bound to see more as time goes on. Usually, we cannot see all of the effects of crises until they are over. In particular, frontline health workers are at high risk, which may require ongoing outreach with screening and services.

The best projection, perhaps, is that even with the invisibility of the virus and its ability to mutate, individuals have the potential to do what is necessary to come out of this portal with gains of gratitude and global cooperation. Will we?

喜 is to love, 怒 is anger, 哀 is sorrow and pain, and 乐 is happiness. All together it means that we feel all the emotions all at once.

Articles

What meanings and values can be found from the past year, and what words will be found going forward? 

The Pandemic Project: Our Readers Describe the Year of COVID-19 

H. Steven Moffic, MD, shares words inspired by the last year of COVID-19 and the seeming societal regression over the past week with shootings, trouble at the border, and spring break mayhem. 

What words do you associate with the past year? Share your thoughts and comments by emailing 

What words do people associate with the past year? 

Our Readers' Words Provide Insight Into COVID Time

Just about a year ago, on March 27, 2020, I wrote an article for “Coronavirus Chronicles,” the series I curated for 

,” as I tried to coin a term for the developing fear of Asians due to the COVID-19 pandemic, which seemed to start in China.

There was disagreement in one of the professional listservs about how important scapegoating was in view of the life-and-death impact of the virus. Yet, we know from what happened in Nazi Germany and Rwanda that when scapegoating is politicized, the danger to those scapegoated escalates. Although then-President Donald Trump called it the “Chinese Virus,” he countered that by saying that, “It is very important that we totally protect our Asian-American community in the United States, and all over the world.”

 However, that protection was not adequate, and the harassment and harm to Asian Americans continued over this past year, including a recent escalation in the San Francisco area, and a killing of an Asian American man who was walking in his neighborhood.

Nevertheless, I knew of no concerted effort by my professional associations, by neither the American Psychiatric Association (APA) or the American Association for Community Psychiatry (AACP), to prevent this escalation of scapegoating. How could we, then, be surprised by the killings of the Asian women outside of Atlanta?

Today, on March 18, 2020, the APA released an alert titled “APA Condemns Violence Against Asian Americans in Georgia.”

 It confirms that “there has been a well-documented uptick in hate crimes against Asian-Americans and Pacific Islander Communities since the start of the COVID-19 pandemic,” although that seems like an underestimate of these incidents. (To make matters worse, Asian Americans have long been underserved in psychiatry.) Yet, the only suggested action is “condemnation.” From my 50-year history of treating the underserved and developing the first model curricula on cultural psychiatry, I know that condemnation does very little to change anything, although it might make us feel like we are doing something. Sometimes, due to confirmation bias, it actually backfires, as the hate of the haters even escalates. Community vigils after the tragedy, which are common nowadays, helps the grieving process, but nothing more.

Seems to me that what is needed is a much more focused, concerted, and ongoing effort, either in the form of a Think Tank or Task Force composed of a variety of cultural psychiatry experts to address this challenge internally, just as the field has been doing with Black American racism. More than that even, a broad overall focus on addressing all kinds of scapegoating and discrimination in America and psychiatry is necessary for issues like sexism, ageism, Islamophobia, anti-Semitism, transphobia, and more. Since we have a built-in tendency to fear the “other,” a countering effort has to include childrearing and school education for the public, and intensive continuing education for psychiatrists.

To supplement that, psychiatry needs a representative at the highest level of our country’s government to be included on President Joe Biden’s health care and COVID-19 teams. This psychiatrist, or psychiatrists, needs to have cultural psychiatry expertise as one of the qualifications in order to produce effective messaging and strategies for the public.

1. Reuters staff. Trump: Asian-Americans not responsible for virus, need protection. 

. March 23, 2020. Accessed March 18, 2021. 

https://www.reuters.com/article/us-health-coronavirus-trump-asians/trump-asian-americans-not-responsible-for-virus-need-protection-idUSKBN21A3V6

2. APA Statement on the Shootings in Georgia. American Psychiatric Association. March 17, 2021. Accessed March 18, 2021. 

https://www.psychiatry.org/newsroom/news-releases/apa-statement-on-the-shootings-in-georgia

The wave of anti-Asian violence needs a better response than mere words. 

The Need for an Ongoing Effort: Reacting to Anti-Asian Violence

H. Steven Moffic, MD, talks about the learning experience of COVID-19, St. Patrick's Day, and (hopefully) a bit of luck for the next year. 

Everything we thought we knew was wrong...

The Year in a Word or Two

H. Steven Moffic, MD, shares some of his thoughts on Oprah's masterful interview and shows how this TV interview can be translated into real, psychiatric practice. 

How can Oprah's interview with Meghan Markle and Prince Harry inform the psychiatric interview? 

Oprah Can Teach Us a Thing or Two About Interviewing


H. Steven Moffic, MD, discusses burning out and burning up, plus more on the controversial birthday of one famous children's book author.

1 fish, 2 fish, burning up, burning out...

Burning Up With Dr Seuss

H. Steven Moffic, MD, talks about climate instability, surpassing the 500,000 death count for COVID-19, and an old British proverb.

After a long, dark week comes the refreshing sunshine. 

Here Comes the Sun After a Harsh Week

Virtually all of the eulogies that we have published over the years have been about psychiatrists. The only exception I recall has been the neurologist Oliver Sacks, MD. We now add another, a 22-year-old black male who was planning to be a psychiatrist. Purcell Pearson was shot and killed in broad daylight on Saturday February 6th, in Milwaukee.

Milwaukee is where I have lived for over 30 years now. When I first came to town, I was asked by the media if there was rampant psychosis in the black community. I answered that it was more likely posttraumatic stress disorders (PTSD) from all the trauma encountered by those living in our very segregated inner city. That was verified 20 years later when I worked part-time in our medium security prison, where young black males were overrepresented and were almost inevitably diagnosed with sociopathy, whereas my reassessment often came up with PTSD.

Over those 30 years, the number of black psychiatrists was minuscule. Research continues to indicate that black psychiatrists are significantly underrepresented among psychiatrists nationally, yet black patients trust them more and tend to have better outcomes, all other variables being more or less equal. In 2020, the overt resurgence of racism, which seems to me to be a psychosocial pathology, calls for more black psychiatrists.

We had Mr Pearson in that pipeline in Milwaukee. A 

 reported that he wanted to be a psychiatrist to help people of color and to address the stereotypes that negatively influence how black males view themselves.

 posted by his college, the University of Wisconsin-Whitewater, Pearson is quoted as saying:

“If you start to break down some of the stereotypes and break down some of the challenges and barriers to African-American males being successful in society, you might start to create different outcomes for these males.”

A psychology department chair and mentor also noted Pearson’s interest in how buildings influenced people psychologically. Also stressed was his curiosity about individuals and the world.

Of course, we have black male psychiatrists who are doing just what Mr Pearson called for, including the editor of this series, Frank Clark, MD, and my coauthor, Rahn Bailey, MD, among so many others. But what a tragedy that we will not have another in Purcell Pearson, who already showed signs of being a charismatic leader. We can honor his legacy and life by continuing to address racism, not only with an increase in black psychiatrists, but by reducing gun violence, among other antiracist actions.

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 being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of 

1. Shastri D. ‘He held us all together’: UW-Whitewater grad and young entrepreneur Purcell Pearson remembered as a leader. 

https://www.jsonline.com/story/news/obituaries/2021/02/11/purcell-pearson-uw-whitewater-grad-killed-milwaukee-leader/4440656001/

2. Pohorski J. Warhawk Purcell Pearson wins 2020 WiSys Quick Pitch state final. 

https://www.uww.edu/news/archive/2020-06-purcell-pearson

A potential young psychiatrist lost too soon. 