Psychiatry’s Wrong Bet

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Introduction by H. Steven Moffic, MD

As is now becoming apparent, we are in an age of overlapping polycrises, including wars, climate change, burnout, and authoritarian leadership. One recent deadly offshoot in the US is the shooting of 2 Israeli Embassy staff attending an event for peace in Washington DC last night. One necessary way to combat the ensuing adverse mental health ramifications of the polycrises is for concerned organizations to cooperate in opposition. The author of our guest column, Gary Belkin, MD, PhD, MPH, is one psychiatrist who recognizes and acts to put such coalitions together to overcome the stagnation and fears of recalcitrant and passive psychiatric organizations. I am betting on Gary!

Prosociliaty, or behaving in ways that promote cooperation and mutual well-being, has well-studied building blocks—psychological flexibility, perspective taking, empathy, mindfulness, reciprocity.^1,2 These are valued across religions and other wisdom traditions, and animate sociological and psychological sciences. Sustained over the long run, these are very good to us, reliably predicting things like long-term health, life satisfaction, sustained employment, nonviolence, social trust and inclusion, and hope and agency for individuals and whole societies.³

They are also the oxygen of democracy. Which is why the consistent thread of the dismantling of government by our government over the last months is an emotional coup; a self-inflicted version of sociocide, a term usually applied to military action aimed at destroying social bonds and infrastructure.⁴

A partial list of that breadth includes proposals to remove funding for: child protection, HeadStart, violence prevention, Medicaid expansion, core areas of National Institutes of Health funding, critical Centers for Disease Control and Prevention operations, workplace health protection, peacekeeping, most civil and human rights functions, capacity to measure and promote population mental health and address its social determinants(especially for children and youth), almost half the world’s humanitarian aid, and key anchors of mental health treatment-access—collaborative care, acceptance and commitment therapy, and certified community behavioral health centers. Altogether these derail prosocial instincts through purging the breadth of government’s commitments and capabilities to care for other people’s well-being.

Safeguarding prosocial connections and possibilities at a societal level is not “soft” or naïve or “woke.” It is what keeps societies peaceful, resilient, and vibrant. Without them, suspect, vigilant instincts that work better in the short run in face of threats, can instead become toxic, numbing, self-destructive… and divide to help a few people concentrate power and conquer.⁵ And that is why the government’s prosocial arsenal is under attack.

As mental health professional associations compose letters to government officials hoping to save cuts to mental health care, they miss this larger purpose. The very premise that government should care about care, that society is a project of nurture, is what is up for grabs. Those premises are what need explicit defending. The deep cynicism and experienced failure of those aims are what made it so easy for them to be thrown away. Growing school based mental health care and prevention capabilities get portrayed as brain-washing,⁶ or addressing maternal attachment or social determinants of mental health are considered suspect social engineering, instead of effective and life-saving; they reflect that cynicism.

While taken political advantage of, erosion of societal commitment and trust in government as a prosocial anchor is at the root of the new politics and the ongoing culture wars around it. So, repair of that erosion must be a central task to repairing politics. Psychiatric professionals and organizations need to be part of that repair and loud voices in those culture conflicts. New habits—doubling down on rather than sidelining both its social science roots and the social roots of mental health—will be needed.

But a mental health professional renaissance is possible, one that rediscovers those roots, puts them to work, and better amplifies and addresses the grievances that cripple and fuel cynicism of prosocial instincts. One also betting on generating new collaborations with grassroots and civic organizing as partners. One that is open to very new models of care, such as task-sharing⁷ and community-led problem solving.⁸ One that plays an active role in rejuvenating mental health as part of rejuvenating the public’s prosocial health.

Dr Belkin is director of the Billion Minds Institute, and an assistant professor at Columbia University. He is the former executive deputy commissioner in the New York City Department of Health and Mental Hygiene, where he led the Division of Mental Hygiene and its development and implementation of the innovative NYC-wide public mental health initiative, ThriveNYC. As founding director of the NYU Program in Global Mental Health, Dr Belkin partnered with other groups globally to test and scale community-led models of mental health promotion and access in less resourced countries that are now widely used.

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. Atkins PWB, Wilson DS, Hayes SC. Prosocial: Using Evolutionary Science to Build Productive, Equitable, and Collaborative Groups. Context Press; 2019.

2. Biglan A. The Nurture Effect: How the Science of Human Behavior Can Improve Our Lives and Our World. New Harbinger Publications; 2015.

3. Kubzansky LD, Epel ES, Davidson RJ. Prosociality should be a public health priority. Nat Hum Behav. 2023;7(12):2051-2053.

4. Doubt K. Sociocide: Reflections on Today’s Wars. Lexington Books; 2020.

5. Forgas JP, Crano WD, Fiedler K, eds. The Psychology of Populism: The Tribal Challenge to Liberal Democracy. Routledge; 2021.

6. Mathes N. Right-wing parent groups are organizing against school mental health programs on Facebook, claiming they are a “Trojan horse” for “critical race theory.” Media Matters. June 10, 2022. Accessed May 22, 2025. https://www.mediamatters.org/facebook/right-wing-parent-groups-are-organizing-against-school-mental-health-programs-facebook

7. Singla DR. Scaling up psychological treatments: lessons learned from global mental health. Am Psychol. 2021;76(9):1457-1467.

8. Barreto ADP, Camarotti H. Integrative community therapy. In: Okpaku SO, ed. Innovations in Global Mental Health. Springer; 2021.