Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of 

 (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on

Ronald W. Pies, MD

Welcome to America, a year and a half into the COVID-19 pandemic. Emergency departments and hospitals are swamped with COVID-19 patients. Patients with possible heart attacks and strokes are being 

 Medical staff are feeling overwhelmed and burned out in the face of patients who have 

 Tragically, nearly 9 months after the first safe and effective vaccine became available in the US, only about 54.7% of Americans are fully 

 The situation has been rightly characterized as “a pandemic of the unvaccinated.”

 columnist David Brooks wrote, “We Americans enter the July 4 weekend of 2020 humiliated as almost never before. We had one collective project this year and that was to crush COVID-19, and we failed.”

It is extraordinary—and far more humiliating—that at this advanced stage of the pandemic, we are still far from containing, much less crushing, a contagion that has now killed more Americans than 

What accounts for this massive societal failure in one of the world’s most scientifically advanced countries? What accounts for the resistance to vaccination among a substantial percentage of the US population? As psychiatrists, we are accustomed to exploring resistance on an individual level, usually in the context of psychotherapy. But societies and their subcultures may also manifest resistance to public health measures.

 In my view, answers to these questions require a deep dive into the realm of social psychiatry, which Eugenio M. Rothe, MD, has 

as follows: “Social Psychiatry is a paradigm that combines medical training with the perspectives of social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to the human condition and to mental distress and disorder.”

In this essay, I want to argue that our failure to contain the COVID-19 pandemic—and in particular, our inability to overcome public resistance to vaccination—stems from the convergence of 3 sociocultural forces: 1) systemic deficiencies in science education in the US; 2) the failure of American civics education to inculcate a sophisticated understanding of individual rights; and 3) the deterioration, over the past few decades, of community and communitarian values in American culture. The confluence of these forces has amounted to a perfect storm, in which the entire nation has become a casualty.

Worse still, these forces have been amplified and strengthened by massive amounts of misinformation regarding vaccination against COVID-19, promulgated by 

; several prominent politicians; and, alas, even by some irresponsible physicians.

I hasten to add that I am considering those forces that foster a deliberate decision to refuse vaccination, not to situations in which access to COVID vaccines is 

—a significant problem in some minority communities.

 I am also omitting discussion of individuals who have documented medical contraindications to receiving the vaccine; or those who claim—controversially—that they are opposed to vaccination for religious reasons.

Consider this plaintive question: how on earth do we educate the general public regarding m-RNA vaccines, in a country where 42% of Americans believe that ghosts really exist; 29% believe in astrology; 21% believe the government is hiding space aliens; and 14% of Americans believe in Bigfoot?

I wish I were making up these figures, but reliable surveys support those 

 I think it fair to say that suboptimal science education in the US bears at least some of the blame for these beliefs—or at least, blame attaches to our country’s failure to support optimal science education. It is telling, for example, that less than one-third of California students met or exceeded standards on a new science test developed by the California Department of Education.

American Association for the Advancement of Science (AAAS)

scientific achievements in the US are the best in the world (45%), or above average (47%), 

they are far less sanguine about science education in this country. Fully 75% of 

AAAS scientists say too little STEM (science, technology, engineering, and math) education for grades K-12 is a major factor in the public’s limited knowledge about science.

Given this backdrop, it is not hard to understand the difficulty of explaining the nuances of COVID vaccines to the general public—or reassuring individuals that approved vaccines are safe and effective, notwithstanding some rare but serious side effects.

Deficiencies in American Civics Education

If we can point wistfully to the woeful state of science education in the US, we can justify even more gloom regarding civics education in this country. 

, to be clear, refers to “the study or science of the privileges and obligations of citizens.”

 Unfortunately, there is evidence that, in the US, “…Civic[s] knowledge and public engagement is at an all-time low.”

 For example, a 2016 survey by the Annenberg Public Policy Center found that only 26% of Americans can name all 3 branches of government, which was a 

 According to the (nominally nonpartisan but left-leaning) Center for American Progress, “Most states have dedicated insufficient class time to understanding the basic functions of government at the expense of other courses.”

In my view, one consequence of inadequate civics education in the US is a widespread misconception of what constitutes an individual 

. This has played out during the COVID pandemic in ways that put the public’s health in grave jeopardy. Thus, many vaccine refusers or anti-vax activists argue that vaccine refusal is an 

But legal scholars hotly dispute this claim. For example, law professor Mark Hall, JD, director of the Health Law and Policy program at Wake Forest University, argues that, “Because one person’s choice affects the health of other people and the public at large, people do not have a fundamental right to refuse vaccination.”

This position was affirmed by the US Supreme Court in the famous 1905 case, 

 to mandate vaccinations for smallpox. That same principle was likely applied when associate justice Amy Coney Barrett, JD, left standing Indiana University’s COVID vaccine mandate.

The Deterioration of American Communitarian Values

And finally, the third force in the triadic perfect storm: the gradual erosion of community and communitarian values in the US. As philosopher Aeon Skoble, PhD, has noted, the term 

 refers broadly to the concept that: “…the community can be thought of as a bearer of rights, or at least as the holder of interests, to which an individual’s interests may have to be subordinated in some cases.”

David Brooks has fleshed out this concept, arguing that American society in recent years has lost: “…a civic consciousness, a sense that we live life embedded in community and nation, that we owe a debt to community and nation, and that the essence of the admirable life is community before self.”

Perhaps the communitarian ideal is most strikingly illustrated when we meet up with its polar opposite—what 

 as a puerile sense of personal entitlement, acted out as passive-aggressive behavior.

 In my view, this attitude was forcefully illustrated by one congressman from Ohio, who commented in May 2020, “I will not wear a mask . . . quite frankly, everyone else’s freedom ends at the tip of my nose. You’re not going to tell me what to do...”

As the writer Damon Linker, PhD, expressed the problem in this country

…individualism, cultural libertarianism, atomism, selfishness, lack of social trust, suspicion of authority…it takes a multitude of forms. But whatever we call it, it amounts to a refusal on the part of lots of Americans to think in terms of the social whole—of what’s best for the community, of the common or public good. Each of us thinks we know what’s best for ourselves. We resent being told what to do. If wearing a mask is unpleasant, we don’t want to be forced to do it. In fact, a governing authority—or really, anyone, even fellow customers at a grocery store—reprimanding us for failing to do our part for public health is enough to make us dig in our heels and stubbornly refuse to go along.

The Israeli diplomat Abba Eban (1915-2002) once quipped that, “Men and nations behave wisely when they have exhausted all other resources.”

 It is painful to contemplate how many more resources—human, material, and spiritual—some of our fellow citizens will exhaust before behaving wisely during the COVID-19 pandemic. As psychiatric physicians, we may well encounter patients who refuse to take even basic health precautions during the pandemic, including availing themselves of the approved vaccines. While we owe these individuals respectful listening and empathic understanding (a tall order, given the harm they inflict on society) we are surely under no obligation to condone their behavior.

Furthermore, as guardians of the public health, we need to adopt a social psychiatry perspective in order to understand the sociocultural forces at work in this pandemic, particularly those that have created a perfect storm of civic irresponsibility. Finally, as physicians and concerned citizens, we must work to strengthen science education; improve civics education; and mend the fraying fabric that knits us together as a human community.

is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Editor in Chief emeritus of

1. Radcliffe S. Why rising COVID-19 hospitalizations are a risk to everyone’s health. 

. August 30, 2021. Accessed September 30, 2021.

2. Facher L. ‘It’s soul-draining’: Health workers deployed to Covid hot zones are overwhelmed by deaths among the unvaccinated. 

. August 18, 2021. Accessed September 30, 2021.

3. At least 214 million people have received one or both doses of the vaccine in the U.S. 

4. Kalter L, Ellis R. CDC: COVID-19 Is a 'Pandemic of the Unvaccinated.' 

. July 16, 2021. Accessed September 30, 2021. 

5. Brooks D. The national humiliation we need. 

. July 2, 2020. Accessed September 30, 2021. 

6. Yan H. The US death toll from Covid-19 just surpassed that of the 1918 flu pandemic. CNN Health. September 20, 2021. Accessed September 30, 2021. 

8. Rothe EM. What is social psychiatry? American Association for Social Psychiatry. Accessed September 30, 2021. 

9. Jimenez D. Covid-19 vaccines: the role of social media in disinformation. 

. June 4, 2021. Accessed September 30, 2021.

10. Brumfiel G. This doctor spread false information about COVID. She still kept her medical license. 

. September 14, 2021. Accessed September 30, 2021.

11. Feldman N. Why Black and Latino people still lag on COVID vaccines — and how to fix it. 

. April 26, 2021. Accessed September 30, 2021.

12. Nearer my god to thee, but not to a Covid vaccine. 

. September 21, 2021. Accessed September 30. 

13. Mello MM, Parmet WE. Public health law after Covid-19. 

14. Van der Linden S. How come some people believe in the paranormal? 

. September 1, 2015. Accessed September 30, 2021.

15. Johnson S. Less than a third of California students met or exceeded standards on new science test. 

. February 7, 2020. Accessed September 30, 2021.

16. Pew Research Center. Public and scientists’ views on science and society. January 29, 2015. Accessed September 30, 2021. 

17. What is civics? League of Women Voters of Delaware. Accessed September 30, 2021. 

18. Shapiro S, Brown C. The State of Civics Education. February 21, 2018. Accessed September 30, 2021. 

19. Annenberg Public Policy Center. Americans’ knowledge of the branches of government is declining. September 13, 2016. Accessed September 30, 2021. 

20. Abutaleb Y, Linskey A. Republicans maneuver to block vaccine mandates, undercutting a policy widely seen as an effective tool to end pandemic. 

 September 20, 2021. Accessed September 30, 2021.

21. Todd S. Do mandatory vaccines violate human rights? 

. August 5, 2021. Accessed September 30, 2021.

22. Klasfeld A. Justice Amy Coney Barrett rejects Indiana Students’ bid to block COVID-19 vaccine mandate. Law & Crime. August 12, 2021. Accessed September 30, 2021.

23. Skoble A. Communitarian and individualist ideas in business. Do community rights override individual rights? Foundation for Economic Education. July 1, 1994. Accessed September 30, 2021. 

24. Brooks D. The strange failure of the educated elite. 

. May 28, 2018. Accessed September 30, 2021. 

25. Pies RW. Masks, machismo, and the American man-child. 

. June 29, 2020. Accessed September 30, 2021. 

26. Fieldstadt E. Ohio lawmaker refuses to wear mask because he says it dishonors God. NBC News. May 6, 2020. Accessed September 30, 2021.

27. Linker D. Coronavirus is revealing a shattered country. 

. July 1, 2020. Accessed September 30, 2021. 

28. Americans will always do the right thing — after exhausting all the alternatives. Quote Investigator. Accessed September 30, 2021.

Articles

Three forces have converged to generate the perfect storm of civic irresponsibility.

How American Culture Created the Pandemic of the Unvaccinated 

Many years ago, I read of a young woman—an institutionalized patient with schizophrenia—who approached her psychiatrist, “Dr Rosen,” and asked him a question: “Dr. Rosen, do you water the roses in your garden?” The doctor was rushing to some meeting and hardly had time to think through his answer. He assumed that the young woman’s question was merely an example of the thought process disorder that characterizes schizophrenia, whereby his name (“Rosen”) was conflated with “roses.” If memory serves me, Dr. Rosen answered rather brusquely, along the lines of “Sorry, got to run, let’s talk later.” Sometime following this interaction, the patient was seen sitting alone, weeping softly. Only later , upon reflection, was Dr. Rosen able to understand what his patient had been trying to ask him: “Will you take care of me, Dr. Rosen, just as you take care of the roses in your garden?” Although he heard her question, he had not listened attentively to what his patient had left unspoken.

This vignette brings us to the Hebrew word 

. (Not to be confused with that sweet confection made with sesame paste—that’s 

.) Hakshavah is difficult to translate into English. Although usually rendered as “attentive listening,” hakshavah is more subtle and more complicated than that. It has affinities with what psychoanalyst Theodor Reik, PhD, (1888-1969) called, “listening with the third ear.”

 It is what rabbinical scholars describe as inner listening, which requires attaining “an inner quiet and avoiding the great noise that envelops us in this world.”

 Hakshavah means not only listening empathically to what someone is saying, but also listening to what they are 

saying. This may sound like some arcane Zen paradox, but I believe that it is close to the core of our profession.

The concept is well-illustrated in a tragic event recorded by the philosopher and religious scholar, Martin Buber, PhD (1878-1965). Buber is best known for his classic work 

 (1923), in which he distinguished between 2 archetypal relationships: “I-Thou” relations, in which one individual views another as a full-fledged human being, worthy of respect, understanding, and empathy; and “I-It” relations, in which one individual treats another as a kind of useful object. Unfortunately, we often treat others as mere agents of our own needs—in effect, as walking utensils—and relate to them in an I-It fashion

Rather than truly making ourselves completely available to them, understanding them, sharing totally with them, really talking with them, we observe them or keep part of ourselves outside the moment of relationship. We do so either to protect our vulnerabilities or to get them to respond in some preconceived way, to get something from them.

Tragically, on one occasion, Buber was unable to achieve the very sort of I-Thou relationship he championed. It seems he was hard at work editing some mystical text when his doorbell rang. A very distraught young man asked Buber if he could speak with him. Impatient to return to his scholarly work and a bit annoyed by the intrusion, Buber somewhat reluctantly agreed to hear out the man. Buber answered the questions the young man asked but, as Buber later acknowledged, “I didn’t try to answer the questions he didn’t ask.” A short time later, Buber learned that, apparently, the young man had killed himself.

I am guessing that many of us who have been in the field a long time can recall a few encounters like this. Listening attentively is hard work, especially when we become distracted by our own thoughts, problems, and egocentric preoccupations. In her book 

, the French philosopher, mystic, and political activist Simone Weil (1909-1943) put it this way: “The capacity to give one’s attention to a sufferer is a very rare and difficult thing; it is almost a miracle; it is a miracle… Above all, our thought should be empty, waiting, not seeking anything, but ready to receive in its naked truth the object that is to penetrate it.”

How can we pay attention in the right way? The rabbis, writing about hakshavah, instruct us to “Listen from your heart, not from your ears.”

 They are referring to a kind of introspection that is needed when we try to listen attentively to others. Hakshavah is “not an ability of our intellect – it is rather a ‘heart’ ability. It is to listen with our heart, to listen to what’s going on inside ourselves.”

I realize that all this may sound quite esoteric and a bit new age-y. But in my view, psychiatrists can make use of these insights in very practical ways, particularly when dealing with patients who evoke strong counter-transference feelings, such as those with borderline personality disorder. In working therapeutically with these patients, listening with the third ear can be extremely difficult when we find ourselves experiencing anger, frustration, or feelings of professional inadequacy. (As one therapist put it, “The rewards with these patients often come in the next life.”)

It is even harder to listen to what severely disturbed patients are not saying but may be communicating through their nonverbal signals and body language. Attending to such nonverbal nuances is roughly what Reik meant by “listening with the third ear” to the patient’s “speech of silence.” For example, Reik asks us to pay attention to the patient’s

[D]ress and peculiarities in his gestures...an olfactory nuance; a sense of touch while shaking hands...the manner in which [the patient] glances up or looks...the minutest movements [that] accompany every process of thought; muscular twitches in face or hands and movements of the eyes speak to us as well as words.

Attending to our countertransference with challenging patients requires a certain inner quiet, as we process our emotional reactions to their non-verbal signals: a frown, a look of anger, a slight slumping in the chair. However, if we as therapists cannot “listen to what’s going on inside ourselves” in reaction to the patient’s nonverbal communications, we will not be able to achieve hakshavah. As I was taught in my residency: When working with borderline personality disordered patients, “It’s not the words, it’s the music.”

To process our patients’ subtle cues on a deep level, we need, as much as possible, to empty our thoughts of egocentric concerns. Easier said than done, of course. As Weil recognized: Such deep attentiveness “is a very rare and difficult thing.”

And yet, hakshavah is critical in our work with patients. As the rabbis put it

When you really listen to others from an inner place in yourself, you don’t just hear his words; you hear the feelings going on inside him…When you listen to others who come to you with their problems, don’t just listen to what they are saying. Listen to what’s going on in their heart. Feel their pain and their other emotions; don’t just superficially hear their words and take note of what they are saying. When you listen to them from your inner self, you feel another’s feelings as he talks to you.

Indeed, this is how we water the roses in our garden.

1. Safran JD. Theodor Reik's listening with the third ear and the role of self-analysis in contemporary psychoanalytic thinking. 

Inner Silence Series: 22 Gateways to Developing Solitude (Hisbodedus) ‘as an Ideal Path to Intimacy With God.’

 Unedited internet version V5. July 10, 2019. Accessed September 10, 2021. 

https://bilvavi.net/files/Inner.Silence.Series.pdf

3. Martin Buber (1878 – 1965). Jewish Virtual Library: A Project of AICE. Accessed September 10, 2021. https://www.jewishvirtuallibrary.org/martin-buber

4. Kidadl Team. 100 Simone Weil quotes from the French philosopher and activist. kidadl. February 18, 2021. Accessed September 10, 2021. https://kidadl.com/articles/simone-weil-quotes-from-the-french-philosopher-and-activist

Paying attention to what is not said is near the core of our profession.

Hakshavah: Listening to the Speech of Silence

by Richard M. Berlin, MD; Dos Madres Press, 2021

Poetry can be dangerous. Plato knew the potentially subversive power of poetry and banned poets from his authoritarian utopia, the 

. With the exception of poetry that extolled the state, Plato feared that it would “corrupt youth and incite the passions instead of the faculties of reason.”

 Sigmund Freud—whose theories of infantile sexuality were themselves viewed as subversive by Victorian society—appreciated the power and psychological depth of poetry, famously writing, “Everywhere I go, I find that a poet has been there before me.” Indeed, this is the epigram that begins the latest collection of poems by Richard M. Berlin, MD, aptly titled Freud on My Couch.

 readers know Berlin’s work from his monthly columns, which have been an enlivening feature of this publication since 1997. As a friend and colleague of Berlin, and as a contributor to 

 since forever, I have been privileged to witness the evolution of his poetry over nearly a quarter century. He is widely regarded as one of the foremost physician-poets today, and has been the recipient of several awards, including the 2010 John Ciardi Prize in Poetry for his collection 

. His latest collection represents a worthy addition to his body of work—and, given Berlin’s many medically-themed poems, the word body seems particularly appropriate.

Berlin’s world of medicine is no place for starry-eyed idealists or worshippers at the shrine of Doctor God. If there is one feature that runs like a dark thread through his poetry, it is his own doubts, fallibility, and perceived weaknesses. In the poem, “Confessions/Prayer,” he writes of “an altar where I worship and pray / For mercy for all my failings;” and “how I hide behind my white coat’s / illusion of purity and perfection.” He prays “to remember the healer / I yearned to become when I started / my studies.” There is, indeed, a kind of lamentation that runs through this collection of poems. To be sure, Berlin’s medical vocation gives him a sense of deep pride and personal satisfaction, but also a wistful sense of what might have been. He feels drawn to the wider life beyond medical care. In “Daydreaming,” Berlin writes, “It’s hard to listen to patients / when songbirds sing outside / my open window and laughter / drifts up from families strolling / the shop-lined street.”

And, not surprisingly, there are complaints that will strike a chord with many practicing physicians: the endless battles with “the insurance mob…demanding records of patients’ private confessions”; the insurance company reviewer “who always wins”; and the ambiguities of psychiatric diagnosis (“all the old Borderlines and angry / adolescents melted down to Bipolar/slush.”).

What becomes of old Freud in Berlin’s hands? The striking book cover shows a leather-upholstered couch floating in a swirling sea of brown-toned fabric. The dream-like image seems quite fitting for a book titled Freud on My Couch. In the 3 linked poems of the same title, Berlin takes us into the many-layered world of the father of psychoanalysis, from his “twelve years deep into coca”; to the odor of the cigars Freud ceaselessly smoked; to his hiking through the Dolomites with his young daughter Anna.

Of course, Berlin the man is more than Berlin the physician. He is also a husband, father, and sometime jokester. His poem “Sleeping Daughter” strikes the poignant chords that epitomize a father’s love for his daughter, “desperate to protect her any way I can.” I recall one of the formative poems of my own development as a poet: W.D. Snodgrass’s “

” and its epigram drawn from Irish legend: “an only daughter is the needle of the heart.”

 In “Psychiatrist Baseball Cards,” Berlin allows himself and his colleagues a bit of good-natured fun: “So take heart, dear colleague, misses / and swings are part of The Show.” Finally, Berlin provides the reader a few pages of helpful notes that explain some of the less familiar medical and biographical terms that appear in the poems.

I suspect that for his frankness, honesty, and humor, Berlin would have been among the poets banned from Plato’s Republic. Plato’s loss, our gain. I believe that 

 will ennoble the physician’s calling and deepen both the medical and nonmedical reader’s perspective on our profession—even as Berlin casts a cold eye on some of our collective shortcomings.

is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Editor in Chief emeritus of 

1. Plato. From the Republic. Poetry Foundation. Accessed June 30, 2021. 

2. Snodgrass WD. Heart’s needle. Poetry Foundation. Accessed June 30, 2021. ❒

The philosopher Plato kicked poets out of his republic because they elevated passion over reason. Do they belong in a psychiatrist's office instead? 

Art Imitating Life: A Poet’s Words

The following poem grew out of a wistful sense that the summer of 2021 has been burdened by so many sad or disturbing events in the United States and the world. The elegy is both for summer, with its wounded innocence, and for the sorry—but perhaps redeemable—state of the world. The poem was written before the tragic deaths of 13 brave US service members in Afghanistan, to whom the poem is dedicated.

brought back life to the cafes and theaters, our breath

coming easy for the first time in months. Yet a vague

of some ghost ship lost at sea, its breadth

so great we couldn’t swim free, or gauge our depth,

July brought east a bleak procession of storms.

In early August, we heard auguries and warnings,

The planet, we were told, is burning up. Fumes

from the California fires reached us each morning,

clouding the eastern sky. And the Taliban, swarming

By mid-August, the Delta strain had sliced

the neglectful or misinformed; the easily sacrificed.

to prepare for another insurrection, to secure

the Capitol from another mob. We heard obscure

A house divided against itself cannot stand,

Late August, and summer’s ebb. Haiti suffered earthquake,

then torrential rain, burying houses in rivers of mud.

Some say the world will end in fire, some say in flood.

I say, in ignorance that buries us in our own mistakes.

Kabul fell without a fight. The thousands we’ll forsake

Soon, the leaves will turn against unfaithful summer,

and vagrant geese will make their southern flight.

June will be a ghostly memory of yearning and pain.

in a world of broken vows and encroaching night,

and hope for healing summer to come around again.

The summer began with such promise. Where did it go? And what hope can we see in the future?

Elegy for a Wounded Summer

Ronald W. Pies, MD, shares how writing is far more than a hobby for him.

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Writing: the core of one doctor's identity. 

Shaping Career and Character Through Writing 

Science Over Stigma: Education and Advocacy for Mental Health

by Daniel B. Morehead, MD; American Psychiatric Association Publishing, 2021

, Stephen R. Marder, MD, describes the struggle to eliminate the stigma associated with schizophrenia. 

that “the negative attitudes and beliefs about schizophrenia have detrimental effects, including discrimination in housing, employment and social opportunities.”

 Now comes Daniel B. Morehead, MD, with a book whose title hopefully proclaims, “Science over Stigma.” This is an outcome devoutly to be wished—but can it be achieved, given so many entrenched prejudices regarding both psychiatric illness and those of us who treat it?

To his credit, Morehead believes the answer is 

. This, despite the fact that, as Morehead notes, “blame, shame, and guilt have always been the grim fellow travelers of mental illness.” Importantly, he speaks not only as a clinician and educator, but also as “…a close family member of several people with mental illness.”

Morehead’s book consists of 10 succinct chapters, covering (among many other issues) the nature of mental illness and its prevalence; the wrongheaded notion that mental illness is a myth, and the overwhelming evidence that, alas, it is all too real; the serious consequences of mental illness; the issue of who is to blame for mental illness (nobody); the many effective treatments for mental illness; and how those who suffer from mental illness can gain and convey what he calls “deep wisdom about life.”

Among the most valuable sections of Morehead’s book is chapter 5 (“Mental Illness is Real”), which provides a richly detailed review of the numerous biological abnormalities associated with psychiatric illness (a term I intend as roughly synonymous with 

). Morehead elegantly summarizes the abundance of data demonstrating that “mental illness is medical”; ie, that “mental illness is true biological dysfunction.” He presents a brief, focused review of structural and functional imaging studies, as well as of genetic and neurobiological factors in mental illness. But Morehead is circumspect in his claims. He notes that, “…we know a vast amount about the biology of mental illness, [but] we also don’t know a vast amount” about it. Furthermore, “…we do not know precisely how each mental illness works or how it can be cured.” (This is true, of course, in much of 

To be clear: Dr Morehead is far from advocating a purely biological approach to understanding psychiatric illness. Rather, he makes a strong case for a viewing mental illness as the outcome of biological, psychological, and social factors, arguing that “there is no difference between the biological and the psychological in regard to mental illness and its treatment…they do not exclude or compete with each other.” Nor does Morehead neglect the spiritual dimension of mental health and illness, understood as the belief that “…we are part of something much greater than ourselves [and] that life has purpose and meaning beyond our individual existence…” He cites data showing that, for the most part, religious and spiritual practices have a positive effect on body and brain.

Finally, the subtitle of Morehead’s book is critical to understanding his aims in writing it; i.e., his emphasis on “education and advocacy.” Morehead is, in the first place, intent on breaking down the barrier between those with mental illness and everybody else. He argues that “…people with mental illness are not ‘those people,’ they are ‘us people,’ because there is no meaningful social group that does not contain people with mental illness.” Rather, mental illness “…is part of being human, of having a body and a brain, and of getting sick.”

Furthermore, Morehead argues, psychiatrists and other mental health professionals need to be more active in defending what we do and why we do it; and yet, “…we rarely see anyone explaining the entire edifice of mental health diagnosis and treatment, much less defending it.” One tragic result of this lack of advocacy is that “…treatment of severe mental illness in this country constitutes a scandal and a human rights disaster…” such that “…individuals with severe mental illness are more likely to be jailed than treated…” as E. Fuller Torrey, MD, and others have argued for 

For Morehead, our charge, as psychiatrists, is to explain that mental illness is common, real, serious, and treatable. This means, among other things, making the scientific case for psychiatric treatment to the general public. As Morehead puts it, “…they need to see the science for themselves. They need to look at the numbers, the graphs, the [brain imaging] photos, and even some of the studies for themselves.”

Morehead’s book should serve as a wake-up call to both mental health professionals and the general public. Few readers will agree with everything in this book, but fair-minded and objective readers should come away persuaded of its principal arguments and values. I believe that for this reason alone, Morehead has performed a valuable service for both our profession and our patients.

1. Marder SR. Changing the face of schizophrenia. 

2. Pies RW. Why Thomas Szasz did not write 

. July 29, 2021. Accessed August 11, 2021. 

3. Torrey EF, Kennard AD, Eslinger D, et al. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. US Department of Justice. May 2010. Accessed August 11, 2021. 

A new book argues it’s time for psychiatrists to let the public know that mental illness is common, real, serious, and treatable. 

Science Over Stigma: Education and Advocacy for Mental Health 

The next time one of psychiatry’s detractors tells you that psychiatrists do not treat real diseases because we have not identified the precise pathophysiology of schizophrenia, bipolar disorder, or other psychiatric illnesses, try this: Ask the skeptic to explain the precise pathophysiology of migraine or cluster headaches. Follow up by asking what laboratory test or neuroimaging study neurologists use to diagnose these devastating conditions. At that point, the critic should be either blushing or blanching.

For the coup de grace, ask them why the late Thomas Szasz, MD—who insisted that real diseases always entail the identification of specific morphological or physiological abnormalities—did not write a book titled 

 as a sequel to his famous (or infamous) 1961 work 

How is “disease” defined? A popular criticism of psychiatry gets debunked. 

Ronald W. Pies, MD

Articles

How American Culture Created the Pandemic of the Unvaccinated

Hakshavah: Listening to the Speech of Silence

Art Imitating Life: A Poet’s Words

Elegy for a Wounded Summer

Shaping Career and Character Through Writing

Science Over Stigma: Education and Advocacy for Mental Health

Why Thomas Szasz Did Not Write The Myth of Migraine

Anti-Vaxxers and Water Witches: Mistrust of Science and the Limits of Reason

Against Assisted Suicide

Freud on My Couch