H. Steven Moffic, MD

H. Steven Moffic, MD, discusses the APA's apology for internal and external racism. 

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

Apologies are a psychological process. H. Steven Moffic, MD, talks about an important apology this week. 

Let the Sunshine in: APA's Racism Apology

H. Steven Moffic, MD, discusses the events of last week's attack on the Capitol, both in terms of potential causation and what can be done moving forward.

"The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people..."

Lord of the Flies and Society's Regression

LEADERS WHO LUST: Power, Money, Sex, Success, Legitimacy, Legacy

by Barbara Kellerman and Todd L. Pittinsky; Cambridge University Press, 2020

As I was writing this review on Wednesday, January 6th, our Capitol was stormed by protestors as Congress debated the certification of the presidential election. Was this a tragic serendipitous example of how lust can exist between a leader and the supporters who are eager to follow?

The evolution of this book review and its parameters are unusual and relevant for the reader. Back in October, I received an e-mail from the senior media associate of Cambridge University Press; the associate had read some of my pieces in 

 and thought I might be interested in the book and the topic. Included in the offer was the possibility to talk with the authors, the first such offer I ever received for a book review. Not only that, but I was given permission to quote their feedback to any of my queries or concerns. Read on for some of what I learned from communicating with the lead author, especially about the Goldwater Rule.

Not sure if my own leadership lust or something else drew me to the offer, it did not take long for me to agree. Reading the book, however, would have to wait until I finished the combined memoir reviews for 

Disclosing Ourselves: A Review of 4 Psychiatrist Memoirs

. At the very least, I thought I would learn something new about leadership and my own mixed leadership outcomes. In addition, I learned there apparently is a new or expanded use of the word and concept of “lust,” which is typically just applied to sex.

The authors are not psychiatrists. In fact, at this time it would be surprising for a psychiatrist to write such a book given the Goldwater Rule, which bars us from professionally commenting on public figures. This standard was tightened soon after President Trump took office. Since the rule only formally applies to members of the American Psychiatric Association, a nonmember could write something like this without any direct repercussions, but it might still appear to be unethical because of this professional standard.

Fortunately, there are scholars from other fields that are not bound by this controversial provision. Both of the authors of this book, 

, are leadership experts who have individually written many books on the subject. In this book, their combined writing was done well, which made for a quick read.

Six types of leadership lust are discussed, with 2 example leaders for each category. Analyzing these leaders, both alive and not, would violate the Goldwater Rule for members of the American Psychiatric Association, but Kellerman and Pittinsky offer us an excellent look. They included:

: Bill and Melinda Gates and George Soros

Among the scores of leadership books, what makes this one unique is its unusual use of the word 

 and the diversity of lustful types of leadership that are posited. The authors wrote (p2):

We define lust as a psychological drive that produces intense wanting, even desperately needing to obtain an object, or secure a circumstance. When the object has been obtained, or the circumstance secured, there is a relief, but only briefly, temporarily.

Mental health professionals will note a connection of this characteristic to compulsivity and obsessiveness, although the stories of those featured do not exhibit other features of a full-blown obsessive-compulsive disorder. These lustful leaders are typical in their desire to lead, but also desperately want something else in addition. At the highest intensity and success, such lustful leaders can have major impact on the world. As Billie Jean King once said (and is quoted in the book): “No one changes the world who isn’t obsessed” (p204).

Although a psychiatrist was not among the lustful leaders in the book, I believe the concept could apply to us, too. While I am not sure what type of lustful leader might fit best, I once knew a psychiatrist who wanted to lead every major psychiatric organization—and did. I also knew of other psychiatrists who would run for leadership positions until they either got it or were prohibited from doing so.

Although it appears that none of the leaders in this book were interviewed, their lives were well-researched but not to the extent that a psychiatrist might like. For instance, for the gay activist Larry Kramer, the discussion of “Context” begins with his influential relationship with his father. Apparently, his father was both disappointed and disgusted by his stereotypically unmanly behavior. Kramer felt that he “could never do anything right.” For years, he also felt rejected by society, triggering anger and the need to fight back, which originated the traumatic relationship with his father. A loving older brother provided some corrective emotional experience, although he, too, had to brace himself and not leave when Kramer’s anger erupted. What is missing from this history that most psychiatrists would notice? The mother.

In the epilogue, there is a call for both leaders and followers to learn more about the lustful aspects of leadership. Of course, lustful leaders might also learn from seeing a psychotherapist. However, unless there is enough pain in failure, it seems doubtful that they would pursue such a path. None of the examples are said to have seen a therapist, but that may be unknown to the authors.

With regards to followers, the recent example of rioters storming the Capitol just confirms the importance of understanding leadership lust, since followers often have strong emotional ties with the leader. What we know about narcissism conveys how the idealization of leaders can lead to cultish behavior. Although there is not much discussion about the current role of social media in this relationship, it seems that the echo effects amplify the ties between followers and leaders.

The authors’ choice of leaders to examine is interesting, as there are many other leaders from whom we could learn a lot. In particular, such destructive lustful leaders like Hitler are not included. Nor, to my initial surprise, is President Trump, who is briefly mentioned now and then.

I asked the authors why the president was not included in the book. I thought perhaps it might be fear of retribution, but the answer from Barbara Kellerman was that they did not “want to embroil our discussion, or to drown our primary point, in theater politics of the day.” Kellerman adds that she has written about him in other contexts.

Certainly, this sort of book makes it clear that others will fill the void left as a result of the Goldwater Rule. That is not to say that we could do it better than the authors, but we could add something with our unique expertise. Although psychiatry can be used by political leaders, as has happened in the hospitalization of dissidents in other countries, the Goldwater Rule seems to produce an ethical problem of omission, rather than commission. As a critic, hopefully constructive critic, of the Goldwater Rule, I was curious about the authors’ views on it. Kellerman replied:

In my view it should be abandoned . . . Even the Goldwater Rule is not religiously adhered to, though psychiatrists are more inhibited than other medical professionals . . . for example, when Trump got COVID-19, doctors with various specialties could be found among the pundits, venturing their views on his condition, without having seen the patient, or having his consent, or having full information. The fact that psychiatrists have been far more constrained or inhibited from venturing their views on Trump’s mental health is testimony to, among other things, the fact that mental health remains so far behind physical health in the public’s perception of what is scientific. It is, however, not in the public interest that professionals so highly educated and trained as psychiatrists are discouraged if not prohibited from providing their expert opinion . . .

That we may appear less scientific to the public by not participating is an important new perspective for me and our profession.

In the meanwhile, I am grateful for this carefully researched and unique perspective on leadership. Indeed, the well-being of the world may depend on understanding the risks and benefits of lustful leadership. To me, it can be used for benefit or harm, like atomic energy. I would not mind having a prominent leader, for instance, that was so devoted to addressing climate change. So much good and so much bad, depending on the context and values, can be done by leaders who lust, that we all should know as much as possible about this topic.

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 

Articles

What drives leaders, and how does that help us better understand them?

Leaders Who Lust

H. Steven Moffic discusses how experiencing grief and loss is an important part of healing.

2020 was a difficult year, and to move forward, mourning losses is necessary. 

A Resolution To Mourn our 2020 Losses

H. Steven Moffic, MD, talks a little about what happiness and hope might look like on New Year's Eve around the globe. 

Happiness comes in all shapes and sizes, but what does it look like around the world? 

Happy New Year: What Makes Us Happy, Worldwide

H. Steven Moffic, MD, discusses the man, the myth, the legend... Santa Claus. Based off of St. Nicholas, Santa has typically been portrayed as white. But more and more as of late, black Santa holiday decorations can be found. 

Santa is typically portrayed as a white man, but why? Dr Moffic discusses black Santas and racism this holiday season. 

Santa in Black and White and Other Colors

December 14th was a memorable day. H. Steven Moffic, MD, discusses some of the big events and explains how psychiatry can help. 

December 14th may go down as a day in history that reveals the best and worst of human nature.

Psychiatry as Human Nurturers

Self-disclosure has a strange place in the history of professional psychiatry. Freud revealed so much about himself in his landmark book, The Interpretation of Dreams, that is, through the analysis of his own dreams. But as psychoanalytic therapy developed, a very different ideal emerged: the psychiatrist as a blank screen.

As an outcome of this seeming reversal, psychiatrists and other physicians have been reluctant to disclose too much about themselves, and they run risks if they do. Despite our professed goal of reducing the stigma surrounding mental illness, we have had limited success in reducing it in ourselves.

Finally, this reluctance to publicly self-disclose seems to be dismantling. When 

 sent out a call for self-portraits in 2019, we were overwhelmed with more than 50 high quality and moving submissions.

These 4 memoirs of psychiatrists expand those kinds of brief self-portraits into book-length revelations. The specific workplace emphasis of each varies: the psychiatrist in private practice who specializes in treating other doctors; the pioneering community psychiatrist; the group therapist facing death; and the Orthodox Jewish psychiatrist considering a move to Israel. In fact, all of these memoirists are Jewish (Dr Myers by conversion). Complementing this trend, 

 recently posted a review of a memoir by Lloyd Sederer, MD, 

, reviewed by Steven S. Sharfstein, MD. Both of them are also Jewish.

In the spirit of self-disclosure, as we go along I will mention how I know these authors, as that not only influences objectivity but also adds relevance. I am Jewish, too. In addition, I have done a workplace multimedia memoir at my wife’s suggestion, but it was designed only for family and friends. It takes courage and self-confidence to put forth a memoir, even more so a memoir for a public audience. The following are brief reviews of these 4, in order of my reception of them during 2020.

by Michael F Myers, MD; Michael F. Myers/Amazon Publishing, 2020

This was the first memoir I received. Immediately, the title and author called to mind to a submission by Myers for our 2019 self-portraits. The title was similar, “Becoming a Doctors’ Doctor,” and it was posted on 

 Since I was excited to see this book-length expansion of the earlier article, I offered to review it for 

I have long admired Myer’s work and knowledge. We have shared several panels and presentations at American Psychiatric Association (APA) meetings on burnout, mental illness, and suicides by psychiatrists and others mental health caregivers. Moreover, I resonate with some details in the book. I, too, have worked with stress-laden, married medical students, although with the addition of my wife as co-leader. We had some lived experience with that, being married before my second year in medical school.

Although Myers’ book is called a memoir, it contains much more than his own experiences. Not only is it a memoir of Myers, a psychiatrist who treats other doctors, but it also seems to be a collective memoir of many doctors, doctors who needed (and were fortunate enough to receive) psychiatric help from Myers. There are aspects that reminded me of a detective story, as he deftly pieces together information from his personal and professional life. One example of this is LGBTQ challenges, that is, the combination of concern about self-disclosure about sexual and gender preferences, along with other personal mental health challenges. Without giving too much away, let us just say that Myers makes personal revelations throughout the book.

In essence, Dr Myers developed and established the field of mental health care for physicians, starting with the tragedy of his roommate’s suicide during the first year of medical school. As any reader who has treated colleagues knows, the pressure and stress is enormous, whether that is a medical student or other physicians. Such patients are VIPs of sorts, and we have an ethical responsibility for the well-being of our colleagues. The unique responsibility of treating colleagues made it hard for Myers to balance the needs of his patients and his own personal life. Take for example the time he lost his bid to become president of the Canadian Psychiatric Association. One of his patients reacted by saying: “Thank God.” She knew that the demands of leadership could take Myers away more. However, he did win the second time he ran.

Even though Myers has had numerous successful outcomes, perhaps the emotional centerpiece of the memoir is the disguised Dr Z. Dr Z’s suicide reminded me of the need to be cautious whenever a depressed, suicidal patient seems to look and feel better for no sound psychological reason. Myers’ ’humanity is on display as he struggles when asked to speak at the funeral. Dr Z’s last request is that Myers help his (Dr Z’s) mother, and Myers does so successfully.

Once upon a time, network therapy was popular, and that seems particularly relevant for physicians, as Myers comes to view the physician patient as part of a connected network that often needs to be part of the evaluation and treatment.

Myers also grapples with his own failed first marriage, despite working successfully with so many medical couples. Like another author in this review, Herzl Spiro, MD, PhD, the second marriage is reported as going quite well, in part because he belatedly understands his own “otherness.”

If he ends his memoir with optimism for the future, he has played a major role in making a better future possible. He applauds the emotional openness of physicians and other health care workers on the frontlines of COVID-19 care. He should know.

I wrote this review on December 1st, World AIDS Day. Myers played a major role in helping victims, including physicians, of that viral infection when it was devastating communities everywhere. I cannot hope but that he is right to be hopeful, as there is only so much that someone like Myers can do in a lifetime, and now we have the added psychological epidemic of physician burnout.

by Herzl R. Spiro, MD, PhD; Balboa Press, A Division of Hay House, 2020.

Continuing in the spirit of my own self-disclosure, I should say that Spiro has been a relatively close colleague of mine in Milwaukee since my arrival in 1989. Moreover, I am mentioned on page 61 when he writes:

“I had tried unsuccessfully to recruit Dr Moffic, former chair of the International Association for Social Psychiatry, when I was chair.”

Spiro was referring to the time when he was chair of the department of psychiatry at the Medical College of Wisconsin (MCW) in the late 1970s and early 1980s. After the necessary and belated transformation of antiquated warehousing of public patients in Milwaukee with mental illness, President Ronald Reagan halted the necessary federal funding to community mental health centers like this one in Milwaukee. Years later, I became responsible for some of the remaining public community systems at MCW. Once I retired in 2012, they were eliminated. One unfortunate lesson learned is that it is so much easier to destroy than build such quality services.

In his community psychiatry leadership, Spiro interacted with many other leaders of society concerned with the care of poor minorities. The star who integrated baseball, Jackie Robinson, apparently helped Spiro establish the first legal methadone clinic in 1969 to reduce heroin addiction; Spiro helped out Martin Luther King, Jr. by serving on the stand-by medical team in case of illness or physical harm from violence for the March on Washington; Rosalynn Carter, the wife of President Carter, was the keynote speaker at the opening of those new community mental health buildings in Milwaukee. 

Spiro’s clinical skills are displayed particularly well in an example from the years 1956 to 1959, before and after the availability of chlorpromazine. In 1956, when he worked at Vermont State Hospital, a catatonic patient was always lying in the doorway, and Spiro carefully stepped over him. Three years later when Spiro came back for a visit, the patient lauded chlorpromazine and Spiro, saying: “You were always kind. You were careful not to kick me.”

Another clinical highlight was treating scores of Holocaust survivors for free in Baltimore early in his career. Spiro came from a long line of rabbis, including his father.

The second half of the memoir focuses on his more than 20 years of work in Israel. By then, he had met and married his second wife, the artist Barbara; this turned out to be a successful partnership that has continued to date. In Israel, he helped apply the principles of community mental health to that newly developing country, but specifically helped to absorb thousands of Black Ethiopian Jews, with relative success in avoiding the racism he encountered earlier in Baltimore.

Contrary to his dismay over the “failed community mental health revolution,” it continues to this day in new, influential, and creative ways, including his own recent clinical work in a federally funded outreach community health center. Perhaps we can hope for a courageous and competent president like John F. Kennedy in this regard, someone who will put together another system, perhaps one that would be part of a single-payer system.

In our “Ethics” chapter for the 2012 

 Herb Bateman and I wrote that hope for realistic recovery was among of our ethical essentials.

It is fitting that Spiro’s memoir is titled 

. It starts with a quote from the great Holocaust survivor and teacher, Elie Wiesel: “Despair is the question. Hope is the answer.”

It closes with his own quote: “That is my story of hope.”

Becoming Myself: A Psychiatrist’s Memoir

Yalom’s memoir, although published earlier than the prior books, came to me recently in another serendipitous way. I was co-teaching a class on the biblical Book of Ecclesiastes with my son, a rabbi, Evan Moffic and that book clearly connected with what is sometimes called existential psychiatry, the branch of psychiatry having to do with the struggle to find meaning in one’s life. It was first popularized by the psychiatrist Victor Frankl, MD, in his perennial best-seller, 

 when he discovered how to find meaning in love and work even in a Holocaust concentration camp. Yalom reached out to (and connected with) Frankl, and then turned to the psychologist Rollo May, PhD, who had taken up the mantle of existential psychology. Yalom then focused existential psychology on death and dying, summarized in his book 

 So, in this roundabout but connected way, the Book of Ecclesiastic led to Yalom’s psychiatrist memoir right when I was putting together this review.

However, existential psychiatry is not Yalom’s only claim to fame. He, in essence, popularized group psychotherapy. I recall reading his then-recently released text 

The Theory and Practice of Group Psychotherapy

 when I first was learning how to do that back in 1973. Yalom had realized that many psychological problems came from inauthentic relationships and that groups could be training grounds for relating to others.

Besides these 2 major psychiatric breakthroughs, his memoir conveys so much more, including material about his immigrant parents who never talked about the old country of Russia, and how he decided he wanted to be a doctor.

He gives many examples of always trying to learn and improve himself. For instance, after reading about the rise of empathy in Steven Pinker’s book 

 he was awakened by a recurrent nightmare since he was 12. Riding his bike, he saw a girl on her porch, who was attractive even though her face had red spots. He called out “Hello, Measles!” Suddenly, her father rushed out and confronted him about how he likely made this girl, Alice, feel. He was too fearful to answer any query. After the father finished, Alice asks Irvin if he wants to play. He declined, feeling so ashamed.

This time he finally consciously remembered that he once called out to a girl in real daylight as he rode past on his bicycle, “Hey, Measles!” He realizes that he still feels guilty about taunting her, and he ends the vignette by saying, “Forgive me, Alice.”

Although elder psychiatrists routinely sought personal psychotherapy during residency, Yalom went well beyond that. He underwent psychoanalysis, which was helpful, but he later realized that he never talked about his own death and dying. That he did more with Rollo May, PhD, seeing him in therapy twice as well as socially.

In his personal life, he has had a long marriage to Marilyn Yalom, and together they have 4 children. She is also a writer, including the books 

 (She died on November 77, 2019, not long after his memoir was published.) At the time of finishing his memoir, Yalom was 85 and still seeing patients.

He writes that the basic lesson he learned is that life is lived meaningfully and happily through a creative pursuit of learning in order to end up with a regret-free life. When that happens, we truly can become ourselves.

by Yaakov Freedman, MD; Brooklyn, New York: Menucha Publishers, 2020

I met Freedman online on the recommendation of our emeritus editor-in-chief, Ronald W. Pies, MD. I was seeking an Israeli psychiatrist to provide a perspective from Israel on Anti-Semitism for a book that I was editing, 

Anti-Semitism and Psychiatry: Recognition, Prevention, and Interventions

 It actually took me a while to realize how Orthodox he was Jewishly.

Not long after that book was published, he published his own, based on his experiences as a young psychiatrist working in Israel with the Orthodox Jewish community. One of his goals was to bridge gaps between spirituality and medicine, a goal that makes his journey of interest to any mental health caregiver who appreciates the need to address spirituality and religion in their work, and especially the challenge of helping the orthodox of any religion who are dubious about psychiatry.

The first part of the book is more like a memoir, qualifying it to be included in this article. He tells the autobiographical story of going to Israel from Boston, not long after he was an award-winning chief resident at Harvard University.

He recalls being a difficult child, with detentions and suspensions being handed out to him “like chocolate” at school. He thanks his father, principals, and deans for not throwing him out. (It sounded familiar to me from my growing up.) Coming from an Orthodox Jewish background, he was also encouraged to be “a doctor of the souls,” combining medicine and the Torah.

As his professional story starts, he was asked by Rabbi Naftoly Bier: “What can you do to help the Jewish people to the best of your ability with the skills that Hashem has given you?”

Despite his work and family being “everything I could have dreamed up and more, I was missing something. . . My life was perfect, and yet I was missing something.”

He was further troubled by weekly anti-Semitism when a new patient would call him a “dirty Jew” and even spit in his face. No wonder he was interested in contributing to Anti-Semitism and Psychiatry.

At a conference in Jerusalem, he was challenged to come to Israel by an Israeli psychiatrist who just happened to be sitting next to him. To be sure that he was not getting the so-called Jerusalem Syndrome, a kind of temporary insanity caused by exposure to the spiritual power there, he sought out his wife right away. She was a social worker and psychotherapist, and she led the way to leaving.

A great test in his life came when his wife had a precipitous drop in blood pressure from hemorrhaging while delivering their baby. When he heard that the chance of the baby living was 0%, he rejoiced, feeling that it was now in Hashem’s hands. That baby survived and thrived. I was in tears reading this story, both for the outcome and my own sense of receiving daily divine serendipities this past year.

The rest of the book covers stories of his daily work, complemented by religious study. Given that he is still in his early career years, perhaps we can look forward to a full memoir later in his life, Hashem willing as is said.

For years now, I have been writing periodic eulogies for 

 of psychiatrists who have passed away. The goal was not only to honor their lives, but also to leave us with lessons learned from their careers.

Memoirs provide a way of honoring and learning from others while they are still alive, without the accompanying sadness over their passing. It takes self-disclose to a different and higher level. Anyone familiar with the heroic journeys described by Joseph Campbell will see these as heroic journeys, too, full of obstacles.

The reader probably readily notices that all of these memoirs were by men, and that includes the memoir reviewed by Sharfstein separately. What does that mean? Perhaps it is indicating a change in the guard for psychiatry. During the earlier stages of the development of psychiatry male Jewish psychiatrists were over-represented. That is no longer the case. More psychiatrists are coming from different backgrounds, bringing hope for further advances in cultural psychiatry.

All these landmark memoirs are worthwhile reading for anybody in our field, their loved ones, and members of the public who would like to demystify psychiatrists. We sort of read minds, but not in the way the public thinks. I am sure others will also see connections to their lives, as I did.

Self-disclosure is often therapeutic, so was reading the self-disclosures in these memoirs. May they be the harbinger of more to come.

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 

. 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

. November 11, 2020. Accessed December 10, 2020. 

https://www.psychiatrictimes.com/view/stains-of-ink

2. Myers M. Becoming a doctor’s doctor. 

. March 19, 2019. Accessed December 11, 2020. 

https://www.psychiatrictimes.com/view/becoming-doctors-doctor

3. Bateman H, Moffic HS. Ethics for community psychiatry: evidence-based policies and procedures. McQuistion HL, Sowers WE, Ranz JM, Feldman JM, eds. 

https://www.penguinrandomhouse.com/books/206272/mans-search-for-meaning-by-viktor-e-frankl/

Staring at the Sun: Overcoming the Terror of Death

https://www.amazon.com/Staring-Sun-Overcoming-Terror-Death/dp/0470401818

https://psycnet.apa.org/record/2006-01425-000

The Better Angeles of Our Nature: Why Violence Has Declined

https://www.penguinrandomhouse.com/books/302858/the-better-angels-of-our-nature-by-steven-pinker/

 Ballantine Books; 1998. https://www.amazon.com/History-Breast-Marilyn-Yalom/dp/0345388941

https://www.amazon.com/History-Wife-Marilyn-Yalom/dp/0060931566

10. Moffic H, Peteet J, Hankir A, Seeman M, eds. 

. Springer; 2020. https://www.springer.com/gp/book/9783030377441

Psychiatrists often disclose as little about themselves as possible. But these memoirists break the mold.

Gender dysphoria is still listed in the psychiatric nomenclature as a disorder; Dr Moffic argues why that should be removed, and why the trangender patients he helped in his career are some of the bravest. 

H. Steven Moffic talks transgender patients and Elliot Page's recent announcement. 

The Most Courageous Patients I Ever Saw

“A time to tear down and a time to build up.”

Most of us entered January 2020 with the fresh hope that accompanies a new year. Little did we know that a new virus was percolating across the other side of the globe that would have a tremendous impact on so many aspects of our lives. Since those early days, attitudes have changed, with many individuals reporting that 2020 has been the worst year of their lives. Fortunately, history has taught us that bad things come and go. For instance, the Biblical wisdom from the book of Ecclesiastes teaches that off years happen. In one translation, the third chapter of Ecclesiastes begins: “Everything has its moment. There is a time for everything beneath the heavens.”

Since Ecclesiastes is in the public domain, Pete Seeger famously rearranged the words for the song he wrote in the late 1950s—“Turn! Turn! Turn! (To Everything There Is a Season).” In 1965, it was 

 and became an international hit. The only new words in Seeger’s song are the phrase “Turn! Turn! Turn!” and the closing line of “a time for peace, I swear it’s not too late.” Those additional words seemed crucial for the controversial Vietnam war and ring true again for our present contentious time.

Most views of world history consist of a linear or circular model, but it may be a spiral model, with some progression forward peppered with occasional slips backward. One example of this spiral theory is the history of violence. Although a case can be made that 

, there have been periods of intense escalation (eg, World War II and the Holocaust).

 As we review some of the major social psychiatric challenges from 2020, we may still find reasons for optimism in 2021 as we move upward again through the spiral.

So many of the events in the adverse half of Ecclesiastes’ verses seem timeless and like a perfect fit for 2020.

It was a time to die. Large numbers of loved ones died from the coronavirus.

It was a time to kill. The news and social media shed light on the unjust brutality toward Black Americans.

It was a time to avoid embracing. The contagious nature of coronavirus disease 2019 (COVID-19) necessitated social distancing.

It was a time to lose. With the pandemic-related lockdowns came the loss of jobs and livelihoods.

 has highlighted many social psychiatric problems. From the 

 these issues often intersected and caused additional problems. As this issue goes to press, we are dealing with the uncertainties of the presidential election and additional stress and anxiety. Yet, the upcoming presidential term is symbolic of a time for hope and renewed opportunities, no matter who wins. Indeed, our current social problems seem to resonate with the difficult times predicted in Ecclesiastes (

), but they also may be indicative of an expected move up the spiral.

If we look to the Chinese symbol for crisis, we see it represents both a danger and an opportunity. In that light, not everything has been completely negative from a social psychiatric perspective. For instance, quarantining gave some an opportunity for increased closeness with loved ones; yet, it also increased the risk for domestic violence and political conflict. Academic and other health care institutions used the opportunity to rise to the occasion to address the pandemic. Although this caused extra stresses, it may have also enhanced resilience. In reviewing some of the greatest psychiatric challenges from 2020, it becomes clear there is still much for which to be grateful and 

There is no doubt the pandemic was a punch to the gut, and we likely will be dealing with medical, neuropsychiatric, emotional, and financial fallout for years to come. Yet, there are at least 2 reasons to be optimistic. First, we now scientifically know that wearing masks and practicing adequate social distancing significantly reduces the infection rate. The key is to psychologically convince enough of the public to do so.

The Group for the Advancement of Psychiatry (GAP) 

 A seeming politicization of the pandemic and masks is an obstacle to adherence. There are also other issues. Individuals may need to gradually desensitize their discomfort or trauma triggers to wear masks. GAP members noted the importance of reminding individuals that social strategies help everyone, just like stoplights and street signs.

Indeed, our field is uniquely suited to help the country by addressing the psychological factors associated with mask resistance. Many lives are still at stake, as 

 As of October 2020, approximately 50% of Americans were regularly wearing masks; projections note about 300,000 lives could be saved by the spring if we increase that percentage to 95%.

The passage of time is the second thing for which there is optimism. The last major pandemic, the Spanish flu, ended after about 2 years, even without therapeutics or a vaccine. A little patience may go a long way and, by the end of 2021, the pandemic will likely be less worrisome.

Racism, as we know, got intertwined with the pandemic. As is often human nature, society looked for blame and an outlet for the fears and frustrations at the onset of the pandemic. Because the virus originated in China, Chinese and Chinese-Americans became victims of harassment. Other minorities, such as Hispanic Americans and Jewish Americans, encountered rising hatred as well.

Because of socioeconomic inequities, we also discovered minorities were at higher risk for infection and death due to preexisting illnesses and social circumstances that made them more vulnerable. Black Americans, Native Americans, and other low-income minorities paid the price with their lives.

The nightly news also served as a racism wake-up call after videos showing police brutality against Black Americans surfaced. Although a comprehensive concept of racism was presented by the Kerner Commission in 1968, the issue was largely ignored after the civil rights gains of the time. This has resulted in the continued structural/societal, institutional, and individual racism of today.

In response, the American Psychiatric Association (APA) began to implement some organizational procedures to address racism internally and externally. There are critics who think the APA has not done enough, calling for the APA to 

 for their part in racism, as other guild medical organizations have done.

It is not a surprise to climate scientists that 2020 was not a good year for the environment. In the United States alone, we experienced a near-record number of hurricanes and unprecedentedly destructive wildfires in the west. Earlier in the year, unparalleled wildfires devastated part of Australia during their scorching summer season. Calls were made for the United States and Australia to help each other, and included requests for assistance from psychiatrists.

Thankfully, on the other side of the coin, there were some promising developments in the midst of the devastation. For instance, researchers found the dialectical approach can help the psychotherapeutic process with patients who have 

 There was also a turn toward using the traditional environmental knowledge and, especially in Australia, the focus on mirroring indigenous individuals’ desire for balance and protecting their environment.

Finally, the pandemic lockdowns reduced fossil fuel use and carbon emissions—a faint but important silver lining. The question remains: can these reductions be maintained when the pandemic is over?

Burnout is a common issue for all professions, especially during the pandemic, but 

 Physicians, including psychiatrists, have experienced a rising rate of burnout, which affects both patients and physicians. The burning out process starts in medical school and continues into residency and thereafter. Depending on the specialty and the measurement tool, 40% or more clinicians experience burnout; the APA’s survey indicated that the percentage is close to 

 Although we lack data on the pandemic’s impact on burnout, there is definitely a reason for concern—not just for clinicians and employees, but parents as well. On the other hand, we have also heard rewarding stories from clinicians, who took pride in the recognition of their dedication during the pandemic.

 The gratitude and outreach may help turn the burnout tide.

As we move forward, we can work on removing the barriers to self-care and encourage businesses and communities to make positive changes. For instance, there is the promise of reducing burnout and saving money by installing a chief wellness officer. We can continue to fight stigma, especially within the medical field. Our clinician colleagues in medicine and psychiatry should feel empowered, not dissuaded, to reach out for mental health care support.

Unfortunately, while we can identify some of these “social psychopathologies” (even without a formal classification system), we do not have the tools to treat them. Our treatment armamentarium for individual patients and small groups cannot readily be transferred to social problems. And yet, during 2020, some social processes that seem therapeutic have become a potential kind of social glue, like apologizing for racism.

 It is psychologically beneficial to apologize for doing something harmful to individuals, inadvertently or not. If that leads to forgiveness, all the better.

In South Africa, formal truth and reconciliation events helped prevent violence, allowing the country to come out of apartheid with a degree of social healing. We may need to leverage those strategies in the United States to address our current divisiveness. It might also help healing from the historical injustices of Native American displacement and Black slavery.

Similarly, we can take a page from research that shows the importance of collaborative care and integrating psychiatry into the rest of clinical medicine. It would be helpful to have a psychiatric expert who partnered with the surgeon general. In essence, it could be a psychiatric assistant to the surgeon general or, better yet, a psychiatric general. At the very least, we should increase our presence and further share and promote our knowledge of human nature with regards to societal issues.

As reported in the October 2020 article on election anxiety, many varieties of undue anxiety seemed to increase over recent years, and more dramatically in 2020. The same holds true for variations of depression, especially as we grieve the lost experiences, people, and opportunities. Substance use, abuse, and dependence remain a concern. The full repercussions of this year’s traumas will take time to emerge. While these increases may not reach the level of a mental health pandemic, millions of individuals are suffering emotionally as a 

At the same time as this increased need for mental health services, there have been limited advances in therapeutics. There is some promise from the new research on psychedelics, as discussed in a report from the 

2020 Annual Psychiatric Times® World CME Conference

 Underground micro-doses of lysergic acid diethylamide (LSD) have been used for self-help, with anecdotal evidence concerning its 

 Given that LSD and other psychedelics have been touted for eliciting a sense of cosmic connections, could they be of help in reducing our divisiveness and scapegoating?

On the positive side, we saw major advances in the integration and use of telepsychiatry, which was quickly and widely used to replace in-person visits for safety reasons. Historically, this modality was used in remote areas to help underserved populations. During the pandemic, telepsychiatry 

 clinicians to see where and how patients lived, meet members of their family (and pets), and connect with their patients on new levels.

The third chapter of Ecclesiastes suggests that difficulties do not last forever. Will 2021 turn around the spiral toward healing, building up, speaking out, bringing peace, laughing, and loving? Time will tell, but given what we have learned in 2020, it would seem that those in mental health care can promote these positive goals (

). There are clear examples of how we need to fulfill our ethical imperative to improve the health of our communities. Importantly, social psychiatric goals (such as those listed here) correlate with social justice, and new research suggests that countries with greater concern for social justice initiatives have 

And so we look to 2021 with optimism, which is often described as viewing the glass half full instead of half empty. In general, optimism has its own therapeutic repercussions for health and mental health, and it is part of the driving force behind the 

 A Jungian sense of optimism can occur amidst our country’s periodic chaos and conflict; an example of such is the innovation and renewal that followed 

 Nevertheless, optimism does need to be tempered with realism, as in the 

 Otherwise, it can lead to undue risk-taking, as the country witnessed during the early days of reopening during the pandemic.

Given the limitations of prediction, and that this article was written before the election results, the prognosis must be tentative and guarded, as it is for our individual patients.

Nevertheless, I am cautiously optimistic.

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 ٢٠٠٢. 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

Kohelet: A Modern Commentary on Ecclesiastes. 

The Better Angels of Our Nature: Why Violence Has Declined. 

3. Tirado A. Surviving coronavirus: a psychiatrist’s personal journey.

4. Moffic HS, Bailey R, Clark F, et al. Dismantle racism in psychiatry & society. 

The field of psychiatry is uniquely suited to address the psychological factors associated with the past year (and what lies ahead).