Should we medicalize social psychopathologies?
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Of course, clinical psychiatry is based on seeing a patient one on one for mental problems that neurology and the rest of medicine did not help well enough. Like the rest of medicine, a diagnostic classification emerged and developed over 5 reiterations. This individually based psychiatry can expand into couples, family, and small groups, which have tried at times to break down what problems are being treated.
However, there are other psychological problems that fall outside of such classifications. There are large social tendencies to scapegoat and hurt others, often from our inborn tendencies to fear the other and gain power over them. They are many, including:
-The Antisocials, as in criminals
-The Isms, as in racism, sexism, and ageism
-The Phobias, as in xenophobia, Islamophobia, and homophobia
-The Antis, as in anti-Semitism
-The Brainwashed, as in cults
-The System Disorders, as in burnout
Data has suggested that most of these continue to worsen. Homophobia in the United States is a recent exception, perhaps due to activism, cognitive reframing, and relationships with heterosexual individuals. In general, interventions have been mainly educational and political, but for the most part, insufficient.
Occasionally, there is a call to include on in our DSMs. That has happened with racism, even to carve out racism to the extent of delusional, but it has always been turned down for where to draw the line—everyone has some racial bias, it is said—and the perpetrator generally does not feel anything is wrong with them, to the contrary that they are right and even in danger.
What has not been tried is to medicalize these conditions. That means developing a separate classification that I would call Social Psychopathologies. Psychiatrists can join with other mental health disciplines and social science experts like sociologists and anthropologists to put it together, hopefully to lead to more research and new, innovative interventions.
Such a classification can be a parallel to what the APA uses in its guide to DSM-5:
“A mental disorder is a major disturbance in an individual’s thinking, feelings, or behavior that reflects a problem in mental functioning.”
Changing just a few words for the social perspective and we get this framework:
“A social disorder is a group disturbance in societal thinking, feelings, or behavior that reflects a problem in social functioning.”
Goodness knows, with increasing ways for mass destruction, whether nuclear, climate, poisoning, or perhaps AI, finding ways to reduce our hate and conflicts will be essential for the survival and thriving of humanity.
Dr Moffic 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 for a better world. He serves on the Editorial Board of Psychiatric Times™.