Preventive Interventions in Politics and in Psychiatry
Key Takeaways
- Preventive frameworks in psychiatry distinguish spurious acute-risk cues from actionable early intervention, emphasizing primary and secondary prevention over “watchful waiting” for progressive syndromes.
- Clinical trajectories in PTSD, emerging bipolar disorder, and schizophrenia commonly deteriorate without timely treatment, increasing complexity and morbidity.
How preventive psychiatry reframes war debates, weighing acute risk, nuclear escalation, and why "watch and wait" can worsen global outcomes.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Some political comments have recently arisen from those high up in our government administration and then taken up by political pundits. It is in regard to the question of acute risks in the attack and ensuing war on Iran. More specifically, one of them has been consideration about whether Israel was ready to invade Iran alone and, if so, then that Iran would turn to punishing America and our Mideast allies. Continuing are the questions from politicians, mainly Democrats, about what was the imminent danger for the United States to attack with Israel. There may be other motivations for what was said that have not gone public.
If we look at medicine and psychiatry, acute risk can be an isolated and spurious concern. Whenever we have an opportunity to prevent a likely mental disorder in the first place or before it develops further, that is a clear call for intervention. That is primary prevention and secondary prevention, respectively. Watching and waiting in regard to some symptoms have their places at times, but in general for most disorders, wait and the symptoms will often worsen and treatment may become more difficult. That would be a common course in posttraumatic stress disorders, early bipolar disorders, and schizophrenia, for instance. It also can occur in evaluative and care situations for patients experiencing suicidal or homicidal ideation. Some psychiatrists have tried to apply that principal to greater society, that what politicians decide to do or not do in regard to national and international conflict can have immense mental and physical health risks.1
Whatever the real reason for attacking Iran was, if we apply preventive medical and psychiatric information to politics and world affairs, the worse acute outcomes for international conflict would be the use of nuclear weapons against an opponent. That has not been done since World War II—thankfully. But now the available nuclear weapons are much more destructive. When an opponent keeps saying “death to America” is that just inflammatory rhetoric for followers and threatening messages to opponents, or an actual goal that just needs the right tools to put into practice?
We always should go for safety in medicine when the information is not yet clear enough for routine treatment. That is one of the goals of the Hippocratic oath. Ultimately, the more we can closely anticipate in life, the better we can plan for the better.
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.
Reference
1. Lee B. The Much More Dangerous Case of Donald Trump. World Mental Health Coalition, Inc; 2025.
