James L. Knoll IV, MD

Psychiatry and politics do not have a history of mixing well. In 1972, democratic presidential nominee George McGovern briefly considered US Senator Thomas Eagleton as his vice-presidential nominee. Despite Eagleton’s impressive record of being the youngest Missouri attorney general in the state’s history at age 31, McGovern requested that Eagleton withdraw as his nominee. Why? For the simple reason that Eagleton was known to have voluntarily sought effective treatment for depression. Yet the damage was done, as McGovern’s opponents used the opportunity to question the soundness of his judgment in selecting Eagleton. One wonders how such a scenario might play out today. Would society be more enlightened or would we repeat this pattern of weaponizing mental health?

The Goldwater Rule Is Fine, if Refined. Here’s How to Do it.

Alan D. Blotcky, PhD, Ronald W. Pies, MD, H. Steven Moffic, MD

My esteemed colleagues assert that the Goldwater Rule (GWR) is “fine,” but in need of refinement.

 I will be mercifully brief—particularly because I would like to introduce a new set of unofficial “rules” that I hope will bring clarity to a debate that has been ongoing for some 50 years. My colleagues do well in quoting a favorite Bob Dylan song about the changing times. Yet the weight of change is often counterbalanced with the time-worn aphorism 

plus ça change, plus c’est la même chose

. Even in this era of social media and information overload, human nature remains the same. Students of human nature will recognize how little has changed since American Psychiatric Association President Daniel Blain, MD, denounced such “professional opinions” many years ago, calling them a “low blow to all who would work to advance the treatment and care of the mentally ill of America.”

Since the inception of the GWR, the pushback and boundary-blurring around it has neither resulted in any appreciable “helpful knowledge” nor served to “improve the community and better the public health.” By now, it is painfully apparent that most advocates of liberalizing or abolishing the GWR are motivated by political partisanship. The temptation is evidently too great for us to avoid using the mantle of our profession to stigmatize a political figure with pejorative labels.

The examples given by my colleagues seem generally unrealistic insofar as easily observable symptoms are very likely to be attended to by those who will see them long before the public would. Any “refinements” notwithstanding, it still seems implausible that a psychiatrist who 1) has not examined a sitting US president and 2) has no access to that president’s private health care information is in a position to make psychiatric diagnoses or conduct risk assessments on that president.

At the end of the day, we are left with mere speculation based on symptoms observed in a nonclinical, time-limited setting. The speculation typically amounts to a tallying of perceived character flaws—not public education about serious mental illness. My psychodynamic training, now quite out of fashion, compels me to dwell a moment on my colleagues’ repeated use of negatives (eg, “I do not want to speculate…”). I commend them for acknowledging this, as some may be so bold as to claim they are not speculating at all. They have “seen the movie,” so to speak—they have confirmed their findings via multiple news media clips and have been able to amass a checklist of findings to prove their point. However, enumerating symptoms and criteria of a particular diagnosis, without explicitly stating that diagnosis, seems questionable. It allows one to speculate right up to the line and point to the diagnosis from inches away without touching it or speaking its name.


All this begs the question: Why do psychiatrists continue to wrestle with the GWR as though it is either obsolete or in need of change? Is it because our brave new world demands a retrofitting of a longstanding APA ethics rule? Has ubiquitous video monitoring abrogated the need for a personal exam and record review? Or perhaps, having vanquished all mental suffering, we have become restless and wish to set our sights higher. A noble goal indeed. Yet in practice, it seems GWR violators are primarily focused on spotting character flaws they believe voters are too unenlightened to perceive.

Having said my piece about the GWR, for what I hope is the last time, I am now prepared to roll out what I should like to call the 

1. GWR violations damage the credibility of psychiatry.

 Psychiatry is not in need of further credibility damage.

2. GWR violations have not appreciably improved public trust of psychiatry (see rule 1).

3. When psychiatric terms, diagnoses, or medical authority are used to express opinions in public media about political figures without examining them, look for a political agenda.

4. Psychiatrists are poorly able to depoliticize their opinions in public media about political figures. This rule is immutable regardless of how the GWR might be revised.

5. GWR violations involving a US president have resulted in neither a cornucopia of public health benefits nor increased public appreciation of the importance of mental health. Other approaches to achieving these goals are highly recommended.

6. Duty-to-protect and Tarasoff-type laws apply to patients being treated by psychiatrists—

 to US presidents with whom one has no doctor-patient relationship. Should a US president require civil commitment, an appropriate state hospital psychiatrist will surely be provided.

7. Accomplished individuals have been known to have character flaws. This applies to both US presidents and psychiatrists.

8. The GWR does not prevent psychiatrists from engaging in political activism—

In sum, it seems to me that the GWR is fine. Period. No refinements needed. Passionate advocacy may be best redirected to improving mental health care in the United States. As excellent as one’s diagnostic skills from afar may be, one might remember the 25th Amendment and take some comfort in the fact that the president’s cabinet, the vice president, congress, the chief White House physician, and the entire White House medical unit are likely to be in a slightly better position to observe concerning signs and, if necessary, recommend an emergent course of cognitive therapy and mindfulness training.

is a professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor in Chief of 

 and president-elect of the American Academy of Psychiatry and the Law (2022-2023).

1. Blotcky AD, Pies RW, Moffic HS. The Goldwater Rule is fine, if refined: here’s how to do it. 

. January 6, 2022. Accessed January 10, 2022. 

https://www.psychiatrictimes.com/view/the-goldwater-rule-is-fine-if-refined-here-s-how-to-do-it-

2. Knoll JL IV, Pies RW. Psychiatry, “dangerousness,” and the president. 

. February 16, 2018. Accessed January 10, 2022. 

https://www.psychiatrictimes.com/view/psychiatry-dangerousness-president

3. Levin A. Goldwater Rule’s origins based on long-ago controversy. 

. August 25, 2016. Accessed January 10, 2022. 

https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.9a19

Role of physicians and mental health professionals in discussions of public figures.

Articles

Psychiatry and politics do not have a history of mixing well. Is this why we need the Goldwater Rule? 

Gilding the Goldwater Lily

interview with James L. Knoll IV, MD. In the first half of the conversation, Knoll discussed the challenges of treating patients with traits like psychopathy or 

Forensic psychiatrists have emotionally taxing jobs: They spend countless hours studying acts of violence and the individuals who commit them. How could anyone endure this job for more than a few years?

James L. Knoll IV, MD, has survived decades in the field. In this edition of 

, Knoll talks about how he maintains his mental well-being. He also reveals the childhood obsession that set him on his career path, reflects on how forensic psychiatry has changed over time, and looks forward to how it might change for the better in the future.

His childhood fascination with the Jonestown murder-suicide.

How he got interested in forensic psychiatry.

The risk of burnout in forensic psychiatry (or any other psychiatric specialty).

How the arts and other creative endeavors can help psychiatrists stay mentally and physically well.

The tension at the heart of the forensic psychiatrist’s identity: are they primarily treaters of mental illnesses, or expert witnesses?

The new importance of social media for forensic investigations.

Why it’s important not to judge patients—no matter how difficult they may be.

is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the 

 and President-elect of the American Academy of Psychiatry and the Law (2022-23).

Podcasts

Forensic psychiatry is not for everyone, but looking back on his life and illustrious career, James L. Knoll IV, MD, realizes that he was destined to study crime. 

A Forensic Psychiatrist Takes the Stand

Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed 

How prisons’ strict social hierarchies can contribute to psychiatric illnesses.

The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes.

The different challenges of treating patients in prisons vs jails.

Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses.

The role of mental health courts in improving psychiatric care in the correctional system.

The challenges of treating patients who are high in psychopathy or have anti-social personality disorders.

, in which Knoll talks about how he first became interested in forensic psychiatry (at age 10). 

James L. Knoll IV, MD, shares insights from his decades in forensic psychiatry, where he has treated some of the criminal justice system’s most difficult and dangerous patients. 

Treating ‘Morally Objectionable’ Patients

, I find my thoughts returning to the topics of death, terror, and the absurd.

 Now this anniversary must be considered alongside the pandemic. As the pandemic began to unfold, I became curious about 

, particularly as viewed through the lens of Terror Management Theory (TMT).

 Briefly, TMT posits that our awareness of death’s inevitability creates an existential crisis and desperate need for self-preservation. TMT has shown that affirming one’s worldview, self-esteem, and close relationships may help maintain psychological well-being by buffering death-related thoughts and providing outlets for symbolic immortality.

One of the most unsettling aspects of the pandemic has been the amount of uncertainty surrounding it. The pandemic has surprised and confused us because we are watching it all unfold in real time: Variants arise, and medical decision-making requires continuous flexibility and updating.

It seems intuitive that the COVID-19 pandemic would significantly affect global mental health.

 However, since all this is developing contemporaneously, it is difficult to be certain. We are left to infer that children and adolescents are probably more likely to be vulnerable to depression and anxiety during and after isolation ends.

 Yet a recent review and meta-analysis found that the“psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous.”

 How can this be? Any amount of time spent watching news media assures us that social unrest, ideological division, and urban violence have been escalating. Frequency and magnitude aside, there can be no denying such remarkable events as the 

, economic damages, and multiple protests across the country. We have witnessed a cooccurrence of pandemic and social upheaval that has produced a continuous outpouring of terrifying messages. If TMT has informed us of anything, it is that when death terror increases, society reaches out for the familiar, the safe, and the protective.

A reasonable estimation at the current time is that there are “widely varying ways in which people have responded to the COVID-19 pandemic.”

 But it is the general commonalities of response I would like to address, and for which TMT has relevant explanations. For 35 years, TMT research has suggested that individuals employ both 

defenses in response to death terror. Proximal defenses are used for death thoughts that are the conscious subject of current attention. Such defenses include suppression, denial, and behaviors designed to reduce vulnerability. Current-day examples might include trivializing the impact of the virus, or even denying its existence. Proximal behaviors of greater utility might include employing social distancing, hand-washing, and mask-wearing. In contrast, the distal defenses are unconscious and/or on the periphery of consciousness. Distal defenses are focused on maintaining faith in one’s worldview, enhancing self-esteem, and finding outlets for symbolic immortality. A present-day example might include adopting a strikingly polarized, ideological narrative about the virus—as can be currently seen in the absurd, almost comical, political polarization of the pandemic.

A common challenge in the face of tragedy and death terror is the tension between these proximal and distal defenses. Post 9/11, the tension was between securing air travel and national security (proximal defenses) and our ability to freely travel and visit loved ones (distal defense interruption). During COVID-19, the 

tension has been between masking and vaccination

 (proximal defenses) and social distancing (distal defense interruption). Thus, the tension between fears of a deadly virus and the desire to reopen the economy and have a normal life produces a situation in which “[p]roximally, we want to forestall death and feel safe from it in the short term… [and] distally, we want to maintain the view that life is meaningful and that we are valuable contributors to that meaningful life.”

 In the case of strong and persisting death terror, efforts to keep safe in the moment may interfere with efforts to find meaning and significance in the future.

This death terror tension places us in a precarious situation. Consider the aftermath of the 9/11 response: For the first time in history, all nonemergency airflight in the United States was immediately grounded, leaving virtually all citizens without freedom of travel to see family. Further, the 9/11 attacks precipitated the invasion of Afghanistan, which in turn became the United States’ longest and most expensive war. To say that 9/11 and its aftermath impacted civil liberties, privacy, and freedom would be an understatement. A similar death terror tension can be seen during the COVID-19 pandemic, where large social gatherings (concerts, protests, political rallies, etc) have directly put large numbers of individuals in danger of disease. In such situations, the need for meaningful social interaction and/or symbolic immortality has the paradoxical effect of increasing risk of death. When faced with a conflict of extremes, finding a middle path or compromise is often a reasonable option.

Whenever tragedy strikes and produces a no-win situation, as it often does, I am always reminded of the masterpiece play written by Nobel laureate Samuel Beckett titled 

. It is an existentialist-absurdist play about the will to survive in the face of deep despair and meaninglessness. The play, which premiered in 1957 at London’s Royal Court Theatre, “portrays a universe which is nearing its end but which could continue repeating itself; the end which all seem to be moving toward is both certain and elusive.”

 The setting is suggestive of a post- apocalyptic scenario in which the characters “pass the time mortifying each other and toying with fears and illusions of a possible change, all along sensing the inevitability of their end.”8 The entire play takes place in a partially underground room for the 4 characters: Hamm (the master), Clov (the servant), and Nagg and Nell (Hamm’s father and mother). Hamm is in a wheelchair and orders Clov around the room and to look out the window for signs of life. But outside, there appears to be no such signs—nothing, in fact, but gray skies.

 and both 9/11 and recent circumstances. To start, the characters stay in a single, bleak room and are left to face “isolation, claustrophobia, loss, nostalgia, and an extremely tight and structured repetitive form.”

 Much of Beckett’s work contains similar themes (eg, 

). This was because Beckett, who was deeply affected by WWII, developed the belief that “life itself is absurd, and this incurs reactions of both black mirth and profound despair.”

, the character Hamm states, “You’re on Earth, there’s no cure for that!” Beckett does not attempt to deny or soften his message that “human existence is characterized by suffering, decay, and isolation as we crawl towards death.”

 Yet despite the pain, monotony, and absurdity, it can be argued that Endgame’s overarching message is positive. The play’s existential slow burn ultimately leaves us with compassion for the human condition. Despite the characters’ awareness of the absurdity and meaninglessness of human life, they persevere with attempts to construct meaning through language and imagination. One interpretation of Beckett’s message is: 

In the midst of negation, I revolt – and I do this by creating meaning. I laugh when I can, accept what I must, and persevere to the best of my ability.

 This is the same sentiment Camus demonstrates when he wrote the 

 and imagined him happy: “The struggle itself… is enough to fill a man’s heart.”

In a sense, death-denying cognitions are a form of a wish. Held up to the light of day, this wish is for nothing other than a compensatory sense of triumph over reality. But of course, reality cannot be overcome, and to maintain such a stance toward life is to increase one’s suffering. The fact that we spend so much energy denying this truth must ultimately lead us down the road of compassion. It is perhaps one of our biggest challenges as a species and has been so for most of recorded history. The ancient Japanese described the challenge wisely and poetically: “There is a saying of the elders that goes, ‘Step from under the eaves and you’re a dead man. Leave the gate and the enemy is waiting.’ This is not a matter of being careful. It is to consider oneself as dead beforehand.”

 In other words, the end was built in as soon as we entered consciousness. Surrendering to and accepting the 

 means freedom, and a corresponding diminution of excessive ego. In contrast, too strong a denial of death results in a pervasive unawareness, particularly with one’s connectedness with others and the whole of life.

What lessons might incomprehensible tragedies like 9/11 or pandemics have for us when our death-denying maneuvers have exhausted themselves and our defenses have been rendered ineffective? The lessons of psychology, philosophy and human nature suggest we might consider these 3 antidotes: compassion, compromise, and creativity.

Compassion is not weakness, nor is it passive. Rather, it is emotionally challenging, daring, and life-altering. Certainly, when we practice compassion, we can expect to experience fear and pain. Our conscious existence is a series of plays put on by characters and voices in our heads, and this is the same for everyone until the end. This alone is cause for compassion. Compassion for the human condition teaches us to relax and move gently toward our fears. The benefits accrue when we slowly relinquish our hardened aversion to mortality and allow our fear to increase our flexibility.

Compromise should be familiar to psychiatrists and psychoanalysts. Life requires continuous compromise, as the pandemic has taught us. The compromises may be practical and concrete, such as using telemedicine or wearing masks in public. Or the compromises may be less discernable—such as intrapsychic or existential compromises. For example, we may know that we have only so many years left (if lucky) to spend time with elderly relatives. Not wanting to risk harm to them and/or others, we compromise by seeing them virtually and feeling more gratitude for the fewer in-person visits we might have left with them. Regardless, note that to achieve successful compromise, it is critical that we do not ask more of the world than it can possibly deliver. Since the pandemic is still unfolding and narratives remain unfinished, there will be plenty of opportunity for compromise.

As writer Melissa Fay Greene noted in a 2021 article in 

, “Sometimes you just have to come to terms with the world as it is, and to human beings as they are, rather than how we wish the world and people were.”

 Greene observes that the pandemic has given rise to a theme: “…[I]n the worst of times, even as many people surprised us with their indifference,” some have “managed to cross barriers and offer us kindness, compassion, alliance, and strength.”

This finally brings us to creativity, which requires imagination and leads to innovation. Analysts who understood drive theory might relate creativity to libido or life force. Creativity is freeing and motivating. When a society has become paralyzed with fear, it is at risk of losing touch with its creativity, resulting in less freedom, diminished perspectives, and stagnated innovation. Even when afraid, we should cultivate human creativity because it is among our greatest and most reliable strengths. Our capacity for creativity gives birth to meaning and, thus, direction and purpose.

 that leads to successful compromise is no simple feat. To even move in the direction of compassion and compromise, 2 mental processes must first take place: 1) disengage from current mental drama, and 2) let go of all mental chatter to become more present in the moment. Meditation is helpful to practice these skills, but they can be learned in whatever way best suits the individual. For example, one can simply notice throughout the day when compassion comes more easily, or just as importantly, when it is difficult. Take note of when it is resisted and become curious as to why. If having self-compassion is a problem, attend to this early in order to generate compassion for others. Another helpful practice is to consider the common humanity and efforts required for routine things we take for granted (eg, numerous people contributed to any simple meal you eat, from the farmers to the local grocery store staff). Explore and consider whether this is more mentally helpful than watching the evening news and becoming perturbed by one’s own inner monologue.

The Buddhist tradition teaches that sitting meditation is a practice to carry into one’s daily life. When the current of the mind whisks us away, we notice this, and then return to the present. This pattern is an eternal recurrence throughout our lives. Repeatedly, we are hit by both small waves and devastating tsunamis. The practice of bringing ourselves back to reality trains the mind to return to a state of equanimity. We are reborn into the present—over and over. By being continually reborn, we may yet transcend the uncertainty, absurdity, and fear that limit us.

is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the 

 and President-elect of the American Academy of Psychiatry and the Law (2022-23).

Acknowledgments: The author would like to acknowledge the help and insights of Ron Pies, MD, and the inspiration of David Keith, MD.

1. Knoll JL IV. 9/11 10th Anniversary: a mortality salience reminder. 

 September 9, 2011. Accessed August 9, 2021. 

https://www.psychiatrictimes.com/view/911-10th-anniversary-mortality-salience-reminder

2. Knoll JL IV. Panic and pandemics: the return of the absurd. 

 March 30, 2020. Accessed August 9, 2021. 

https://www.psychiatrictimes.com/coronavirus/panic-and-pandemics-return-absurd

3. Pyszczynski T, Lockett M, Greenberg J, Solomon, S. 

Terror management theory and the COVID-19 pandemic.

4. Alzueta E, Perrin P, Baker FC, et al. 

How the COVID‐19 pandemic has changed our lives: a study of psychological correlates across 59 countries.

5. Loades ME, Chatburn E, Higson-Sweeney N, et al. 

Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19.

The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments.

http://fajardo-acosta.com/worldlit/beckett/endgame.htm

8. An analysis of Beckett’s Endgame—the human condition. 

https://www.sciencesnail.com/philosophy/an-analysis-of-becketts-endgame-the-human-condition

9. Wenaus A. “Zero, zero, and zero”: Beckett’s 

 2017;4:74-103. Accessed August 9, 2021. 

https://westernchiasma.files.wordpress.com/2017/08/chiasma-4-materialism_wenaus.pdf

12. Greene MF. You won’t remember the pandemic the way you think you will. 

. Published online April 6, 2021. Accessed August 9, 2021. 

https://www.theatlantic.com/magazine/archive/2021/05/how-will-we-remember-covid-19-pandemic/618397/

How has human behavior been affected by the tragedy of 9/11 and the recent trauma of the COVID-19 pandemic? 

9/11 20th Anniversary: COVID-19 Endgame

FORENSIC PSYCHIATRY SPECIAL REPORT: PART I

We are pleased to offer a broad sampling of fascinating subjects by experts in forensic psychiatry. This 2-part Special Report focuses on pyromania, court testimony, avoiding malpractice, and psychopathy. Psychopathy is a particularly interesting subject in that it has been heavily researched, yet it remains something of a puzzle, and most certainly a huge burden on society.

 In forensic psychiatry, psychopathy is generally thought of as a more aggressive, narcissistic, predatory form of antisocial personality. French physician Philippe Pinel introduced the concept of the psychopathic personality at the turn of the 19th century.

 He described characteristics such as impulsive violence in the absence of appreciable deficits in intellect or cognition. In 1941, the classic text by Hervey Cleckley, MD, T

y, provided more detailed clinical descriptions. Building upon the work of Cleckley, Robert D. Hare, PhD, has approached the clinical construct by developing a research tool—the Psychopathy Checklist (PCL-R).

Nevertheless, there remain multiple conceptualizations of psychopathy, as well as problems with reliability.

 While a large body of research has been generated on the subject, the heterogeneous nature of psychopathy renders many conclusions speculative.

 In fact, the epidemiology of what I would like to call “antisocial spectrum” disorders is complicated by their heterogeneity. While it appears that antisocial behavior is heritable, its expression varies by age, definition, and adverse life circumstances—among other factors.

 Psychopathy research, conducted primarily on caught or “unsuccessful” psychopaths, continues to seek clarity via grouping characteristics into various facets or models.

For example, the triarchic model of psychopathy is a more recently developed model identifying 3 primary domains: they include boldness, meanness, and disinhibition (

 relates to fearlessness, toleration of danger, and high self-confidence. 

 encompasses lack of empathy, disregard for close attachments, and exploitative tendencies. 

 refers to poor impulse control, inability to delay gratification, and possibly frontal executive dysfunction.

Throughout the centuries, we have continued to puzzle over our capacity for antisocial behavior. All the while, it may be helpful to keep in mind the aphorism, “Bad men do what good men dream.”

 Or as the great psychoanalyst, Mick Jagger, aptly noted, “Just as every cop is a criminal, and all the sinners saints . . .”

is director of forensic psychiatry and professor of psychiatry at SUNY Upstate Medical University in Syracuse, NY. He is editor in chief emeritus of Psychiatric Times® (2010 to 2014).

1. DeLisi M, Reidy DE, Heirigs MH, et al. Psychopathic costs: a monetization study of the fiscal toll of psychopathy features among institutionalized delinquents. 

Traite, Medico – Philosophique Sur L’Alienation Mental.

3. Hare R. Psychopathy: A clinical and forensic overview. 

4. DeMatteo D, Hart SD, Heilbrun K, et al. Statement of concerned experts on the use of the Hare Psychopathy Checklist—Revised in capital sentencing to assess risk for institutional violence. 

5. Woody RH. Incidence of Psychopathy. In: 

Risks of Harm from Psychopathic Individuals.

 Cham, Switzerland: Springer; 2019: 29-31.

6. Goldstein RB, Chou SP, Saha TD, et al. The Epidemiology of Antisocial Behavioral Syndromes in Adulthood: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III. 

7. Gard A, et al. Genetic influences on antisocial behavior: Recent advances and future directions. 

8. Hyatt CS, Crowe ML, Lynam DR, Miller JD. Components of the Triarchic Model of Psychopathy and the Five-Factor Model domains share largely overlapping nomological networks. 

9. Skeem JL, Polaschek DL, Patrick CJ, Lilienfeld SO. Psychopathic personality: Bridging the gap between scientific evidence and public policy. 

Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior.

 Arlington, VA: American Psychiatric Publishing; 2009.

Throughout the centuries, we have continued to puzzle over our capacity for antisocial behavior

Bad Men Do What Good Men Dream

In late March 2020, the United States was in full panic mode. What I observed compelled me to write about 

, the absurd, and whether there were any reasons for optimism or perhaps some positive growth opportunities.

 It was my hope that we might tap into our creativity to manage the overwhelming death fears, regression, and unhelpful acting out. I wished for our “better angels” to shine forth, leading us away from despair and irrationality and toward hope and gratitude.

Sometimes, life’s lessons appear unexpectedly. Several weeks ago, a forensic psychiatry fellow who graduated from my program—now a friend and colleague—called to tell me that he had almost died from COVID-19. He explained that he now had a completely altered view of life. Of course, I was awestruck and grateful that he reached out to share his story with me. I suggested that 

® readers might find his story inspirational and asked if he would feel comfortable sharing it. Consistent with his reenergized sense of humanity and gratitude, he agreed and penned the essay here: what I found to be a beautiful, moving, and inspirational story. Thank you, Dr Tirado: This is medicine we all desperately need at this point in time.

Surviving Coronavirus: A Psychiatrist’s Personal Journey

is director of forensic psychiatry and professor of psychiatry at SUNY Upstate Medical University in Syracuse, NY. He is editor in chief emeritus of 

1. Knoll JL IV. Panic and pandemics: the return of the absurd. Psychiatric Times®. March 30, 2020. Accessed July 30, 2020. 

Sometimes, life’s lessons appear unexpectedly. 