H. Steven Moffic, MD

Following a financially successful weekend opening, what might the movie 

 mean for our mental health? Most important may be the movie’s statement that whoever economically controls the psychedelic “spice” controls the future world. Then we add the confluence with the resurgence of interest in psychedelics, layered upon the common desire of humankind to take various mind altering substances.

Providing Realistic Optimism for Our Future

What has led to the current second coming of psychedelics after they began to be criminalized not long after the novel 

 was published in 1965? From the psychiatric perspective, it seems to be the need to obtain more effective and safer medications after a couple of decades of stagnant psychopharmacology. This second era is illustrated by the article, “Shrooms! Shamans! Kosher LSD! Why Los Angeles Is Suddenly Tripping Out” in 

, the psychedelic “spice” enhances various mind expanding functions, but apparently not our prior counterculture search for a loving spiritual awakening. Approved updated research on current psychedelics has shown that with proper dosage, set, and setting, there is unique promise for treating various difficult mental conditions. Moreover, lower and micro dosage is found to have nonpsychedelic benefits, including calmness, creativity, and, yes, maybe even enhanced connectivity.

Ketamine, an anesthetic that was found from recent off label trials to be uniquely helpful for clinical depression, seems to be a transitional psychedelic product. Different this time, too, is investor funding for such endeavors, but perhaps as we have now seen in both medicine and the movie, this is the kind of business control over health care ethics that we may have to be wariest about.

The mental health promise is surely here, but so is the peril.

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

1. Kiefer P. Shrooms! Shamans! Kosher LSD! Why Los Angeles is suddenly tripping out. 

October 21, 2021. Accessed October 25, 2021. 

https://www.lamag.com/citythinkblog/shrooms-shamans-kosher-lsd-why-los-angeles-is-suddenly-tripping-out/

Articles

What does the movie Dune say about our society’s current relationship with psychedelics? 

Dune and the Second Coming of Psychedelics in the United States

It has taken quite a long time, but a new version of a movie based on the ongoing best-selling 1965 novel 

 by Frank Herbert is releasing this week. The novel came out right in the midst of the counterculture conflicts of the 60s.

This movie was delayed over a year because of the pandemic. Tonight is the official public opening. My wife and I saw it Thursday night on the wide screen as a preview, but I will not spoil anything. I will also self-disclose that the main character, a young man on a Campbellian heroic journey, reminds me of my 18-year-old grandson in many ways, so I have to be careful of countertransference reactions to the movie.

The Promise of MacArthur Fellows for Solving Complicated Social Problems

The novel itself had many sequels, including by Frank Herbert’s son, so in some ways the story was never finished—unless it becomes more of our story.

What gives the novel such staying interest? Perhaps it is its prophetic powers that provoke sprawling reflections on our times. Simply put for now, these social psychiatric themes include the use of psychedelics, messianic religion, colonialism and racism, climate and ecology, digging under sand dunes, political infighting, the centrality of the Oedipal conflict, and the power of women.

For better or worse, the movie only covers about half of the novel, so it is called Part 1. Unless there is other breaking social psychiatric news, I will try to cover some of these themes for the daily columns next week. As a reference, it seems to have some Star Wars connections in it, including the violence, though not so much of the tongue-in-cheek humor. Whether you have read the novel or not, consider seeing it in the meanwhile, and, as part of a collective review, let us know what you think about it.

Dune releases in theaters this week. What echoes of our current socio-cultural situation does it contain? 

Digging the Movie Dune (Part 1)

It has struck me that many of my recent weekday daily columns have focused on the best of us in terms of heroism, genius, and reaching for the stars. These include the 

As presented in the October 13th episode of CNN’s media review show “Reliable Sources,” media personality and late night television host Jon Stewart should be added to that list! In response to a question of where his current optimism came from, he emphasized a historical perspective and the repeated resilience of humans to move forward and recover from great trauma and obstacles.

Compare today to the Civil War, the great economic Depression, and World War II. We have the potential and capacity for incredible inventiveness and learning from our mistakes. Jon Stewart did not seem to be joking. Rather, it is as if he was pulling on the wisdom he has learned from life experiences as he has aged.

I believe Stewart. We do see remarkable resilience and recoveries in psychiatry. We see it in everyday life amidst the tragedies and divisiveness. We see it in the invention of a new form of vaccination for the pandemic. That and these other examples provide some realistic optimism for the future, don’t they?

In everyday life amidst the tragedies and divisiveness, we see remarkable resilience and recoveries in psychiatry.

H. Steven Moffic, MD, talks love, envy, and how long marriages last on average in the United States. 

To see the last video in this series, watch 

What Kind of Love Do We Need Over the Next Season?

To see the latest in his column series, Psychiatry Views On The Daily News, see 

The Promise of MacArthur Fellows for Solving Complicated Social Problems.

Videos

How long do marriages last? What about love? 

What About Love and Marriage?

“Love and work are the cornerstones of our humanness.”

Ezekiel Emanuel, MD, penned the controversial article “Why I Hope to Die at 75.”

 Although he was not planning to end his life at the age of 75, he noted he was stopping any efforts to prolong his life, such as taking medications and undergoing other medical interventions. Not surprisingly, he was met with quick medical criticism.

 Nevertheless, he reaffirmed his viewpoint 5 years later, in 2019.

At the time he wrote the original article he was a mere 57; he was due to turn 64 on September 6, 2021. Perhaps becoming 64 fits his thesis, especially if you recall the lyrics of The Beatles’ song “When I’m Sixty-Four”:

Will you still need me, will you still feed me
When I’m sixty-four?

What was his ethical reasoning? Basically, he felt that only a small percentage of individuals continue to be active, engaged, and creative past 75 years old. He specified that play did not qualify, as it was not meaningful work. He did not seem to address the love part of Sigmund Freud’s statement; that is, one’s value to loved ones at the age of 75 and beyond.

This issue became personal to me—I turned 75 on May 5—when someone reminded me of Emanuel’s article. That, in turn, led me to recall that many of our psychiatrists’ eulogies over the years were given for those who died after the age of 75 and had continued to contribute to work, let alone love. Moreover, our newest eulogies seem to be relevant for that age consideration.

Below is a list of those eulogies, in order of their deaths, along with more than the usual focus on age. Unless referenced, as usual, sources are public obituaries and my personal knowledge.

Akiskal died on January 20, 2021. He was 77 years old.

He was an internationally recognized expert not only on bipolar disorder but also on a new area of psychiatric attention—affective temperaments. As a by-product of his focus on 

, he noted that lithium markedly reduced suicide risk. Besides being a prolific author, writing more than 500 articles and 25 books, he was a persuasive speaker and presenter, often referring to ancient masters of the subject. He was likened to a brilliant jazz soloist who played the same piece differently each time.

It is rare to find memorial testimonies of any psychiatrist in as many psychiatric publications as Akiskal has received, including from the World Psychiatric Association; 

; and the American Psychiatric Association (APA) 

 A paper in memory of him was coauthored by 10 colleagues from 8 countries, a global village of psychiatrists.

Napoli died on April 9, 2021, just short of the age 75.

Before his terminal illness was apparent, he had become Speaker of the Assembly of the APA.

, and he received the 2003 APA Bruno Lima Award for the care and understanding of victims of disasters. He coauthored the book 

Resiliency in the Face of Disaster and Terrorism: 10 Things to Do to Survive.

Near the end of his life, when I interacted with him the most, he became an activist for addressing climate concerns. He passed information on 

 skeptics to his colleagues for as long as possible.

Riordan died on July 17, 2021, at the age of 83.

After developing maintenance treatment for opiate addiction, Riordan became a longtime faculty member at Yale School of Medicine, establishing a pioneering substance abuse remedy. He was felt to be the medical glue of the system. Riordan was a stickler for perfection, but he could also defuse tension with cherished jokes. As an offshoot of his substance abuse expertise, he consulted for 

He retired from Yale in 2007 but continued in some private practice and helped at the Connecticut Hospice. However, his major focus in his later years was as Pop to his 11 grandchildren. On family trips, he often would get up early to buy a big bag of doughnuts for his grandchildren, with the unspoken goal of spending time talking with them.

Liberman died on August 20, 2021. He was 84 years old.

In 2017, he offered to give community psychiatrists copies of his magnum opus, 

Recovery From Disability: Manual of Psychiatric Rehabilitation

. Of course, many accepted his offer. I did, too, even though I already had an autographed copy. Not much later, he announced his retirement from his full-time position at the University of California, Los Angeles (UCLA). And, as usual, he continued to offer me support and advice, as in this communication:

“When we get to the age of 78, we see the important things more clearly—including time with family and the beauty around us…Your comments on the AACP [American Association of Colleges of Pharmacy] round-robin are always ‘right on’! Keep on and on and on!!”

Liberman was one of the world’s experts on psychiatric rehabilitation. More broadly, he kept alive a decreasing therapeutic focus in psychiatry, that of behaviorally oriented treatment. In fact, that was the focus of his first book, 

A Guide to Behavioral Analysis and Therapy

, which was published in 1972. Unfortunately, he recognized—and lamented—that reimbursement never caught up to the complexity and time necessary to fulfill his expert guidelines.

Less well-known is that he was also an activist regarding the Vietnam War. And, when he deemed it appropriate, he self-disclosed about his own 

. Perhaps he was most proud of his family as well as spending time exploring other countries and cultures with them.

Collegial recognition poured in quickly after his death was made public. My favorite came from a colleague who referred to Liberman, his former boss and mentor, as “our Jewish godfather”: If not for Liberman and the center he established at UCLA, this man would not have met his wife, and his family would not exist.

Perhaps Emanuel was not too familiar with the work and lives of psychiatrists, and he does not appear to have consulted with any while writing his manifesto. Not limited by the need for physical dexterity, as long as their cognitive ability continues, psychiatrists traditionally work to late in life, often to death—at least until burnout became a more common limitation. As this group of eulogies conveys, once again, psychiatrists can work well up to age 75 and beyond. Besides that, they often have cultural and family interests that make their lives so valuable to others. Emanuel may change his mind when the reality of being 75 becomes imminent.

Regardless, let us recall and celebrate these well-lived psychiatrist lives, close to 75 and beyond.

 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. He serves on the Editorial Board of 

. October 2014. Accessed September 2, 2021. 

https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/

Bioethics and why I hope to live beyond age 75 attaining wisdom!: a rebuttal to Dr. Ezekiel Emanuel’s 75 age limit.

3. Hall SS. A doctor and medical ethicist argues life after 75 is not worth living. 

. August 21, 2019. Accessed September 2, 2021. 

https://www.technologyreview.com/2019/08/21/238642/a-doctor-and-medical-ethicist-argues-life-after-75-is-not-worth-living/

4. Karam EG, Soghoyan A, Hantouche E. In Memorium: Hagop Akisal (1944-2021). World Psychiatric Association. February 7, 2021. Accessed September 2, 2021. 

https://www.wpanet.org/post/in-memorium-hagop-akisal-1944-2021

In memoriam of Professor Hagop S. Akiskal. 

6. In Memoriam: Hagop S. Akiskal, M.D. (1944-2021). 

. March 3, 2021. Accessed September 2, 2021. 

https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2021.3.57

Reflections on Love, Work, Psychiatry, and Long Lives

After I realized that I had missed the announcement of the CNN Heroes that we covered yesterday, I also realized I missed the announcement on September 28th of another favorite award of mine. These are the annual MacArthur Fellows who receive a $625,000 no-strings-attached grant for showing exceptional creativity. Often those selected are working across multiple disciplines because social problems, such as racism and climate change, are so complicated.

Once again, I homed in on those that connect to psychiatry and found Marcella Alsan, MPH, MD, PhD in public health, medicine, and economics respectively. Combining medicine and economics training is unusual, but perhaps just what we need in focusing on racial disparities in health care. Her recent focus has been on the mistrust of medical institutions experienced by Black men in the USA and how that contributes to poorer health indicators. A research study she did in 2019 verified the benefits of having racially concordant Black physician-patient matches. She is following that up by hypothesizing that non-Black physicians who acknowledge and discuss past injustices with their Black patients can overcome the mistrust.

Although there have been questions of the choices and worth of the Fellows ensuing work, I would hope there would not be such a concern about the psychiatrist chosen in 2007, Jonathan Shay, MD. Also a classicist, he applied stories of Greek mythological warriors to veteran soldiers and came up with the concept of moral injury about the injustices they felt in their mission, which could complicate any psychological trauma. That has not only helped in adjusting their treatment, but is now applied to burnout in physicians, nurses, and others.

The MacArthur Fellows for this year have been chosen. How is their work contributing to the field of psychiatry? 