Luck and Psychiatry
Key Takeaways
- Luck is framed as chance-driven success or failure, contrasted with the measurable impact of personal adherence behaviors, illustrated by dietary diligence as a determinant of glycemic control.
- Placebo-like expectancy effects offer a clinically adjacent construct, where beliefs about outcomes can shape symptom trajectories and perceived efficacy without invoking parapsychological explanations.
Explore how “luck” shapes mental health, trauma recovery, and doctor-patient fit—while revealing why personal choices still drive outcomes like A1C.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
This past Tuesday was St. Patrick’s Day, which is generally associated with the “luck of the Irish.” Though to define it is somewhat elusive,1 luck can be described as:
“The success or failure brought by chance rather than through one’s own actions.”
The story goes that Saint Patrick, who lived in the fourth century of the common era, was the foremost patron saint of the Irish. The day honoring him became an official Christian feast day in the 17th century and nowadays is generally a day of revelry, wearing green, eating Irish food, good cheer, and parades.
The good luck of the Irish refers to the gold rush in California, where the Irish seemed to have relatively more success. Many had escaped the apparent bad luck of the potato famine in Ireland in the mid 1800s.
That morning, I went for my 6-month medical check-up, having felt pretty good the last 6 months, despite having many conditions requiring some medical attention. Back then, even my A1C had fallen below the diabetic range. However, after a benign live appointment, my A1C had shot back up again. Why? Was it bad luck? The luck of the Irish? Chance? Generally, I am most interested in serendipity, 2 chance events occurring rather simultaneously and suggesting a common important message.
How about my own actions, as in the definition of luck? I cannot say that I was as diligent with my diet as I should have been.
In psychiatry, I had never thought much about luck, nor read about it.2 If anything, it seemed sort of superstitious or even in the realm of parapsychology. Perhaps the closest was the concept of placebo, just believing that an action would turn out positive or negative, and that belief influencing the outcome.3 Yet I can think of so many positive lucky chance occurrences in my life that led to my becoming a psychiatrist.
For the most part, I perceived that patients and the public thought that that mental illness was either thought to be bad luck or some sort of punishment for doing the wrong things. If knowledgeable, attributing the cause to genetics might be present. Sometimes it took a lot of processing to accept that one’s own actions placed a role.
Though it may seem paradoxical, sometimes a mental disorder might turn out to be for the better over time. Often, one can conclude that it was luck, just chance, that caused the exposure to major trauma, say surviving the 9/11 destruction in New York after being in the vicinity at the time. Generally speaking, it never seems desirable to go through the degree of trauma eventuating in posttraumatic stress disorder, but there is the possibility of posttraumatic growth, strength, and resilience. Clinically, we can be part of that improvement, given the essential ingredients of processing the trauma: ventilating the experience, revising one’s view of the future in a positive way, and having enough support of loved ones and the surrounding community. Does that suggest there that there is bit of luck involved, paradoxical as that seems?
Perhaps there is sometimes luck at who the patient gets to see in terms of a good and comfortable clinical match, along with the requisite knowledge of the clinician. How the patient views luck in their lives is also important, but most importantly, what they can do for themselves by their own actions. For me and my A1C, right now it is doubling down on the relevant diet.
Dr Moffic is an award-winning psychiatrist who specializes in the social, cultural, ethical, spiritual, and religious aspects of psychiatry, and since 2012 is in retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekdays column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He has been an advocate and activist for mental health issues related to climate instability, physical burnout, and xenophobia, among other social justice causes, serving on many related local and national community and professional Boards. He serves on the Editorial Board of Psychiatric Times.
References
1. Smith M, Wiseman R, Harris P, Joiner R.
2. Pritchard D, Smith M.
3. Miwa K, Yang W, Matsubayashi S.
