H. Steven Moffic, MD

For the past several years, I have written a brief column for our congregation’s monthly newsletter in January in honor of the Rev. Martin Luther King, Jr and his relationship to the Jewish people. For this year’s day, January 17, there is a rare confluence with another anniversary, one of the Jewish people. It is Tu Bishvat, which for centuries has celebrated trees and the sacred obligation to care for our environment.

The Psychological Worth of Our New Quarter

Ethical and Moral Rationing Decisions in Medicine, Psychiatry, and the Pandemic

Since the Jewish calendar is Lunar-based, it is generally celebrated on different days in January. However, for 2022, this combination could not be more timely. Not only has climate instability and environmental degradation become a global crisis, but the adverse changes generally hurt poor minorities the most in terms of such problems including asphalt overheating, lead and other toxins, and a death of trees, all of which contribute to increased violence, among other adverse psychological repercussions.

Though less well-known for this issue, before he was assassinated, King was starting to address ecological justice globally. As he once said:

“It is very nice to drink milk at an unsegregated lunch counter—but not when there’s Strontium 90 in it.”

Not only do these 2 days follow closely on the heels of the Texas Jewish congregation tragedy, but in Illinois, January 17th is also the inaugural birthday day honoring Muhammed Ali, the famous boxer and peace activist. Furthermore, January 17th had a full moon, often thought to cause mental disturbance, though there is no conclusive research evidence for that. We also are not too far past the first anniversary of the January 6th storming of our Capitol, and close to the upcoming anniversary of the assassination of Gandhi by a fellow Hindu fundamentalist.

Personally, as my sister JoJo reminded me, this year, January 17th, coincides with the Yahrzeit of my mother Misha, which is the beginning of the annual time of Jewish remembrance of loved ones. She was—and is—our family’s Tree of Life.

Perhaps the best way for psychiatry to honor all these interconnected special occurrences is to use our expertise to participate in how society can reduce the scapegoating that hurts those at highest risk of harm, and enhance cooperation for the well-being of all living things.

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 relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Articles

January 17th, 2022: A Day of Great Social Psychiatric Implications

“It makes me nauseous going home at night because it makes me feel like I’m deciding, with this limited resource, who should get it.” - Christian Ramers, infections disease specialist

Having devoted my 50-year career in psychiatry to public community mental health for the poor, rationing care was part and parcel of my clinics’ policies, procedures, and individual patient care decisions. We never had anywhere near the financial resources to provide the ideal and best care we could, and certainly had less funding than available for the more well-to-do.

My Word of the Year for 2021 is Instability. What’s Yours?

I also experienced that challenge in a different way in running a captivated not-for-profit academic managed care system. In my book 

The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare

 I presented the ethical challenges of using the funds as fairly as possible.

The rationing challenge has come to public attention during our pandemic, whether with the variable availability of vaccines, therapeutic drugs, testing, staff, or the most effective masks, at least for those who want them. These decisions often have life and death implications.

Most recently, a very promising new medication for COVID-19 known as Paxlovid has become available, but for now at very limited supply. Some recommend prioritizing those with weakened immunity, the elderly in nursing homes, or minority groups due to increased vulnerability. Of course, those who decide not to vaccinate or wear a mask have increased vulnerability, but also endanger others. States are using different priorities for distributing what they have to pharmacies.

In my professional administrative and clinical work with limited resources, I tried to at least fulfill the American Medical Association ethical principle of competent, basic care to all. However, if a loved one of mine was involved, my personal decision would be to do everything possible to obtain the best. That process tends to leave me with some moral conflict that I partially solved with this principle:

I will do the best I can under the given circumstances.

1. Robbins R. Lifesaving Covid treatments face rationing as virus surges again. 

. January 6, 2022. Accessed January 14, 2022. 

https://www.nytimes.com/2022/01/06/business/covid-paxlovid-antibodies-omicron.html

The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. 

Rationing of crucial materials during the pandemic, like masks and vaccines, has become a matter of life and death. 

“Be certain that you do not die without having done something wonderful for humanity.”

The next time you use actual hard copy coins for the exchange of money, take a look at them. Just in time for Martin Luther King, Jr Day and Black History Month, maybe you will see the ones being shipped out by the United States Mint honoring Maya Angelou. It is the first in a series of circulating coins dedicated to American women and their roles in American history.

Should Medical Doctors Ever Go on Strike in the United States?

The design on one side of the quarter has an image of Angelou with her arms outstretched in front of a bird, which is in turn in front of what seems to me to be a radiant sun. As usual, there is the inscribed phrase of “E Pluribus Unum.” On the other side is a likeness of President George Washington, which was designed by the female sculpture Laura Gardin Fraser.

If you do not know who Maya Angelou was, she was many things, any one of which reflected doing “something wonderful for humanity.” She was a Broadway actress, dancer, cable car conductor, professor, author, civil rights activist, and the poet laureate who was the first Black poet to read a poem at a presidential inauguration, that of President Bill Clinton in 1993.

My wife and I saw her speak many times. With her resonant voice and dramatic skills, we could not come away without being inspired. See her on YouTube is you have not had that pleasure. She died in 2014.

In terms of psychiatry, she qualifies for being a model of resilience and recovery from posttraumatic stress disorder. As first described in her best-selling autobiography, 

, she wrote about her horrendous experiences of traumatic sexual abuse and racism in her childhood. Perhaps the “bird” in the metaphor of the book’s title was part of the inspiration for the quarter’s image.

Historically, having Maya Angelou and George Washington on 2 sides of the same coin may be connecting what was separate in our nation’s history. Black individuals were slaves during Washington’s time and women could not vote for almost 150 years. At a time of so much divisiveness in the US, we can only take flight once again if there is “E Pluribus Unum,” or, as our motto means:

Maya Angelou and George Washington: now on two sides of the same coin. 

H. Steven Moffic, MD, discusses his concept of radical hope in the context of dying, and doing so gracefully.

Eulogies for Psychiatrists Who Practiced with the Courage of Their Convictions

To see the article about medical aid in dying in Colombia, read 

First Colombian With Nonterminal Illness Legally Dies via Euthanasia

To see the discussion about ethics and medical aid in dying, read 

Physician-Assisted Suicide: An Egregious Boundary Violation

Videos

Radical hope: knowing the seeming impossibility of the task and still having hope anyways. 

Radical Hope for Death and Dying

This is the time of year, after changeover, when there is often a quest to find the best word to describe the prior or upcoming year. 

 is doing so in regards to 2022, as announced in the January 6, 2022 article, “What’s Your Word of the Year?”

 The results are scheduled to be revealed sometime later this week.

How the 1/6 Anniversary Reminded Me of Clinical Psychiatry

, we did something like this from the psychiatric perspective back in March 28, 2021, as presented in my posting “

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

 This word quest was to cover the first year of COVID-19. Personally, I chose BEWARE because it related to March 15th, the Ides of March, a day when Julius Caesar is reported to have ignored the warning of a seer, with disastrous results. Could that have been true of our President’s administration?

Among our readers, the most popular word was INTROSPECTION, both from clinicians and patients. What word could be more appropriate for our profession than that in a time uncertainly and extreme risk?

Moving further along, what is my word for the calendar year of 2021? It is INSTABILITY. There were so many unstable areas, such as:

-An unprecedented invasion of our Capitol on June 6th;

-A disputed transition to a new President;

-A surprise cold climate instability disaster in Texas in February;

-A chaotic withdrawal from Afghanistan and our War on Terrorism in August;

-The new worrisome and different COVID variants, Delta and now Omicron;

-Health care workers praised as heroes, and then villains; and

-Personally finding out that I had an asymptomatic arrhythmia putting me at risk for sudden death, leading to a pacemaker on December 23rd.

What I would hope for, even radically hope for in 2022, is a transition to the opposite: STABILITY. Come to think about it, isn’t the transition from instability to stability often a desired outcome of our clinical care?

In the spirit of the word search, what 1 word would you pick for 2021 in regards to yourself, your profession, or society? Let us know.

1. Parker-Pope T. What’s your word of the year? 

. January 6, 2022. Accessed January 11, 2022. 

https://www.nytimes.com/2022/01/06/well/mind/word-of-year-2022.html

2. Moffic HS. The pandemic project: our readers describe the year of COVID-19. 

. March 29, 2021. Accessed January 11, 2022. 

https://www.psychiatrictimes.com/view/the-pandemic-project-our-readers-describe-the-year-of-covid-19

On December 28th, 2021, there was an article in 

 on “A lengthy doctors’ strike over understaffing sparks chaos at New Delhi Hospitals.”

 At the same time, the Omicron COVID-19 variant was overwhelming understaffed medical facilities there, junior doctors were going on strike, joined by medical students across India. The protests were apparently triggered by delays in placing medical school graduates in positions at government health facilities. Thousands of doctors on strike were detained by the police.

Soul Searching on the Anniversary of our Capitol Conflict

By last week, the strikes were over after promises from the government. As 1 of my prominent psychiatrist colleagues in India, who supported the strikes, communicated to me:

“In India, too, strikes by doctors are generally held illegal. It is a last resort . . . You win, if you have strength and are able to show it.”

Here in the United States, health care facilities are also becoming overwhelmed by COVID-19, with epidemic levels of burnout and compassion fatigue increasing even more. Control is not by the government so much here, but by for-profit businesses. Instead of being hailed as heroes, as they were in 2020, physicians are sometimes assaulted by families wanting some unproven treatment. Even with adequate protective equipment, they are also getting infected.

And yet, I have heard no calls for striking here. Yes, it is illegal under our seemingly obsolete antitrust laws. Should they be challenged?

Certainly, we have a terribly paradoxical situation as rising health care needs meet inadequate resources and overstressed physicians. On the surface, any sort of strike would worsen the health care problems, at least in the short run. But, in the long run, would it help? If not, what will?

1. Yasir S. A lengthy doctors’ strike over understaffing sparks chaos at New Delhi hospitals. 

 December 28, 2021. Accessed January 10, 2022. 

https://www.nytimes.com/2021/12/28/world/new-delhi-doctor-strike.html

As rising health care needs meet inadequate resources and overstressed physicians, is a strike necessary? 