My Decade of Psychiatric Times-and Yours

February 18, 2020
H. Steven Moffic, MD

Volume 37, Issue 2

We are privileged to hear and are trusted with our patients' darkest secrets. Our availability for whatever is needed that is not addressed in the rest of medicine makes us invaluable to society, and this will undoubtedly be the case in the 2020s.

PSYCHIATRY 20/20

I started writing regular blogs for Psychiatric Times about a decade ago. Blogs, by their very nature, seem to focus on a current event, although I also tried to make them more timeless and personal. In fact, this was my internal guideline: try to make them timely, timeless, of interest to clinicians, and personal. Not personal in a narcissistic sense, hopefully, but in the assumption that what was of personal interest to me had to be of interest to at least some colleagues.

Well, blogs on this website are no longer a regular entity. And, for now, the comment section is also gone. Yet, I recall some pretty contentious discussions. Whatever these articles are now called, more than 170 of them have been published over the decade.

A 20/20 look at the 2010s

As we were approaching the 2020s, with a given catchy association to 20/20 vision, I started to wonder what themes and memes were of particular interest to me, and how they evolved over the decade. I was not surprised when I saw that other publications were doing something similar. For example, on November 24, 2019, the New York Times posted “33 Ways to Remember the 2010s: A look back at what we watched, heard, read, liked, and shared.”1

Several had psychiatric implications and connections

• “Reality TV moved into the White House” (#2), evoked our poll on the last presidential race (and, President Trump was not even close to being ahead), as well as our poll on the Goldwater rule.

• “Me, Myself, and I” (#3), brought to mind some of the blogs that focused on insights I had about myself, such as my birth being connected to the Holocaust.

• “So many murders” (#26), which connected to guy culture in the perverse sense that most mass murderers are male, addressed somewhat on blogs on these tragedies.

• “#Me-Too changed everything” (#29), which reminded of our coverage on women’s issues.

• “Guy culture took center stage” (#32), which reminded me of a blog on fathers, sons, and the presidential election, as well as the psychological roles of fathers in general.

• “Spandex ruled everything around us” (#33), which brought to my mind a blog I once did on sex and climate change.

Although I tried to cover various social psychiatric topics, in a 20/20 review I am not at all sure that our field made much progress.

Looking to the 2020s

Such lack of progress leads me to declare: We need a decade of the social in the 2020s!

Why is that even more critical now? We have a rise in Islamophobia, Anti-Semitism, and Xenophobia in general. We continue to have mass murders and no progress in gun control. We have escalating burnout in America, with the highest rates in physicians, both those treating humans and animals. We have the end of the decade societal decisions to increasingly legalize recreational marijuana, even without adequate research about biological and psychological effects. Given the so-called Goldwater rule, we have the challenge and conundrum of how psychiatrists can participate in the debate about the mental status of elected officials and their policies. And we now have the President’s impeachment. Has there been a psychiatrist who has not been asked: What do you think of President Trump?

Some psychiatrists feel we should stick to individual patient care and that our knowledge and skills do not generalize to society. On the other hand, and a stance that I would personally support, perhaps we need to consider a classification of social psychopathology in addition to that of DSM on individual psychopathology. There were other prominent themes and subjects of my coverage over the decade. One of them was annual eulogies of psychiatrists, with special exceptions such as the actor Robin Williams and the neurologist Oliver Sacks. There were so many to honor, both the unknown and the well-known.

One escalating subject of attention has been climate change, although I have reframed that as the more psychologically meaningful term of climate instability. The social importance of climate instability for the next decade and beyond is reflected in Time magazine’s choice of 16-year-old Greta Thunberg for Person of the Year. Connecting the climate with the environment falls under the rubric of ecology. Given that, perhaps our bio- psycho-social model not only needs to emphasize the social more but add a fourth component to become a bio- psycho-social-eco model.

These blogs and articles reflect my own interests, though I try not to duplicate the focus of other Psychiatric Times writers. This includes articles on the arts and humanities, that for some reason have received decreasing attention over the decade.

Moreover, I have paid less attention to everyday clinical challenges. Perhaps that is a reflection of my retirement. When I retired from clinical work in 2012, I wrote several articles about retirement, partially because it turned out that I suffered from psychiatrist burnout without knowing it. Although I was quickly cured, it is crucial that the 2020s provide other ways to reduce and prevent burnout for all mental health care clinicians.

Gratitude and love

As I began this reflection right after the Thanksgiving holidays, I was re- minded how thankful I was-and am-to many others for what turned out to be good as far as these writings go. There is Ron Pies, MD, an editor- in-chief emeritus of Psychiatric Times as well as all the editors-in-chief who followed and did not kick me out. The Psychiatric Times staff editors, who improve everything I write and even conducted some podcasts with me.

Of course, thanks goes to you, our readers, even if I do not know who most of you are. Extra gratitude goes to those of you who have made your- selves known, whether you agree or disagree with what I write.

As a member of the Editorial Board, we have taken on some very controversial topics not covered else- where, including the landmark series Portrait of a Psychiatrist. This series should help reduce the stigma associated not only with psychiatric patients but ourselves as well.

One of my blogs was, “You Are What You Love.” I love psychiatry and Psychiatric Times. I am clearly still a psychiatrist despite retiring from clinical and administrative work; sometimes I work harder than I did when I was not retired. I hope you feel that love, too. As I noted in another blog titled, “Once a Psychiatrist, Always a Psychiatrist,” we are privileged to have insights about human nature that can potentially deepen all of our experiences in life.

Conclusion

A recent article in the New England Journal of Medicine, “Medicine and the Mind: The Consequences of Psychiatry’s Identity Crisis,” caused some controversy.2 Personally, I do not think we have an identity crisis. To paraphrase the poet Walt Whitman, we are composed of multitudes. We have the broadest mental health training of any professional discipline. We are trained to be leaders. We are privileged to hear and are trusted with the darkest secrets of patients. Our availability for whatever is needed that is not addressed in the rest of medicine makes us invaluable to society, and I have no doubt will be even more so for the 2020s.

References:

1. The New York Times. 33 Ways to Remember the 2010s. November 24, 2019.

2. Gardner C, Kleinman A. Medicine and the Mind: The Consequences of Psychiatry’s Identity Crisis. New Eng J Med. 2019;381:1697-1699.

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