Applying General Medical and Psychiatric Principles to the Mideast War

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

I had the follow ups to my preview column on past lives, death, dying, and the afterlife about ready to go, but now they have been delayed and interrupted by the hot-off-the press international event of the United States bombing 3 nuclear sites in Iran and its developing conflictual aftermaths as Iran vows revenge against Israel and the United States.

Various interfaith, multicultural, and personal heated discussions among psychiatrists seem to be emerging once again. Regardless of personal preferences and identifications, there seem to be several shared medical, as well as specifically psychiatric, principles and characteristics involved that we should keep in mind. Moreover, once we get back to the death-related considerations, we will see the opportunities to improve ourselves whether it is in one lifetime or many.

Rule-Out the Worst Disease and Outcome

In the back of most physicians’ minds, and even required in some electronic medical charting systems, is to be as sure as possible that something potentially dangerous is not missed. I used to rail against the need to document suicidality in any patient with routine attention-deficit disorder (ADD) yet came to conclude that suicide could also happen for reasons unrelated to the ADD. Such checking is one reason for what seems at times to be unnecessary medical testing. In psychiatry, we must be as sure as practically possible that a brain tumor or some other medical illness is not the explanation for the symptoms or lack of improvement.

In the conflict between Israel and Iran, the worst risk to Israel seems to be that a ballistic missile gets through, as many have, but some time with a nuclear warhead that will devastate Israel. Iran must have their own safety concerns to insist on their own nuclear policies and secrets.

Humiliation and Revenge

We know that feelings of public humiliation, especially for those with high narcissistic sensitivity, often elect desire for some kind of revenge sooner or later. That can be overcome by time, as well as by careful and comprehensive cognitive introspective of other alternatives. It seems like Israel may have been humiliated by the “surprise” invasion of Hamas on October 7, 2023, and Iran is humiliated now by the successes of the strikes by Israel and the United States. Can we in psychiatry provide some useful information and education about these tendencies?

Safety and Security

The base of Maslow’s well-known pyramid of psychological needs is safety and security that will provide for our continued existence. Israel and the Jewish people, of relatively very small global numbers, have multiple historical examples, including the stated genocide of the Nazis, to be concerned about another stated genocidal goal of Iran. Moreover, intergeneration transmission of trauma is likely to increase sensitivity to it occurring once again. Iran seems to be somewhat of an outsider in the Middle East, with a major change in government and fundamentalist religious leadership over the last generation. Even with a common belief in Islam, there are also internal Sunni and Shi’ite differences and longstanding conflicts.

Fear and Misinterpretation of the Other

Behind so many conflicts is our human nature tendency to have undue fear and then scapegoat the other, with the desire to then obtain power over them. How well does Israel and the United States understand the embrace of martyrdom and afterlife beliefs in Iran? Is cultural knowledge, sensitivity, and humility being applied, just like we need to so in cross-cultural clinical care? In turn, how well does Iran understand the Jewish emphasis on the here and now? Is the fundamentalism in each country too rigid?

The Dark and Light Triad

There is a well-known dark triad of personality traits in human beings: Machiavellianism, narcissism, and sociopathy. Newer research has focused on a positive light triad of kindness, altruism, and compassion.¹ Recommendations for actions reinforcing the light triad include: small acts of kindness, showing compassion, highlighting positivity, focused listening, and being part of like-minded communities. All of these are part and parcel of who we are as physicians. They are part of our knowledge base as psychiatrists. Modeling that at work and home spreads it socially.

There are probably other medical and psychiatric applications that will come to mind. Freud’s the narcissism of small differences may be historically relevant. Way back in history, Jews and Arabs came from the same land and probably most of the same stock of people in the Mideast of the time. The same probably holds true in part for Ukraine and Russia. Positive reinforcement of the light triad and negative reinforcement of the dark triad may all be helpful in addressing the current and future dangerous social psychiatric situations. The stakes are so high now, in both individual interactions and international conflicts. We play an important role and modeling opportunity for peace and mental health.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

Reference

1. Kaufman S, Yaden D, Hyde E, Tsukayama E. The light vs. dark triad of personality: contrasting two very different profiles of human nature. Front Psychol. 2019;10.