Hanukkah Psychiatric Gifts

PSYCHIATRIC VIEWS ON THE DAILY NEWS

“Life is so complicated.

We need more psychiatrists.”

-Judy Steininger

A regular reader of my columns and occasional Psychiatric Times contributing writer, the former English professor Judy Steininger sent me that quote after reading my eulogy on a trans psychiatrist. (She gave permission to use it and her name). It felt like a gift of affirmation for psychiatry from outside our profession, though to be sure there is much psychological wisdom in literature.

Some families share gifts each night of the 8 days of Hanukkah, and this got me thinking of 8 gifts that I think psychiatry gives to the world. They are:

1. Therapeutic alliances. The therapeutic alliance between a psychiatrist and a patient is generally the most important variable for treatment success.¹ Similarly, the parent-child alliance is crucial for developmental success. Both are the essence of social psychiatry.
2. Diagnostic classification. Though often criticized for its limitations, as well as its growing numbers of diagnoses, it has provided the essence of what needs our help. I wish—and hope—that sometimes we can provide the same for what I have called the social psychopathologies. In the meanwhile, the endeavor to make DSM a living document with ongoing adjustments is gaining adherents.² Also, there is a creative endeavor to bridge the categorical-dimensional divide of the DSM with what is called the PRiSM Diagnostic Instrument.³
3. Psychopharmacology. Given our current emphasis on the biological aspect of our bio-psycho-social model, psychopharmacology is probably our most commonly used treatment. Yes, there is valuable concern over possible overuse and adverse effects, yet the benefits seem worth it, starting with the emptying of the overcrowded and desolate state psychiatric hospitals that I first visited during my college years in the mid 1960s.
4. Psychotherapy. Freud began the rapid expansion of the psychotherapies with psychoanalysis. High cost, long treatment, and variable results have led to scores of different psychotherapies and other mental health disciplines to provide them, making standardization quite a challenge.
5. Research. The brain is so well protected that research on it has had to overcome many obstacles but is gratefully making strides.
6. Ethical principles. What is appropriate or not for us to do is spelled out in the annotations geared to psychiatry of the American Medical Association’s principles of medical ethics. Surely there is continued controversy about the so-called Goldwater Rule. There is much less controversy about putting the patient’s needs first. However, after leading many ethical committees of colleagues, I often wonder if we psychiatrists should be put first as we are the vehicle of care and now are facing increasing burnout and moral injury.
7. The American Psychiatric Association. This is our membership guild, so important for such a diverse and stigmatized field. Membership is hovering around 40,000, and 75% to 80% of all American psychiatrists. With those numbers, it is not surprising that there are intense internal disagreements at times, such as if and how to respond to societal politics.
8. Subspecialties. Our diversity is responsible for special foci on different areas of expertise. There are both subspecialties that require formal certification and those that do not. Besides, there has been ongoing controversy about the basic certification process and whether it reflects actual clinical care success. My own basic subspecialties have been the connected community psychiatry and social psychiatry, for which I had leadership roles for both.

Future Gifts

The social aspects of our bio-psycho-social model seem at a crossroads. What is relevant for psychiatrists to try to address? Any of what I call the social psychopathologies like the anti-Semitism that just erupted in the mass Hanukah shootings in Australia? I would draw our field’s boundaries wide.

Like most every field, how artificial intelligence (AI) will influence psychiatry is just emerging. Some predict that it will provide gifts of new medications, diagnostic verifications, and tech-based therapy. Others think that AI will be a gift that should be returned before it replaces what living human psychiatrists can do.

New interventions are likely to emerge, especially with direct stimulation of the brain. However, a better and more equitable delivery system is needed for all interventions, especially now as already inadequate resources have been cut by our government. Many psychiatrists, including myself, have been long advocating for a single payor system as the solution.

Then there are the threats to humanity and the earth like climate change, nuclear war, environmental toxins, and authoritarian leaders that are all based on human behavior and our human nature vulnerabilities. What can we do to help prevent such a disaster?

Finally, as our reader quote began this column, we need more of us all over the world.

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.

References

1. Frank J, Frank J, Wampold B. Persuasion and Healing: A Comparative Study of Psychotherapy. John Hopkins University Press; 2025.

2. Moran M. What’s next for the DSM? Psychiatric News. 2025;60(12).

3. Pies R, Ruffalo M. Bridging the categorial-dimensional divide: exploring the PRiSM diagnostic instrument. Psychiatric Times. 2025;42(11).