"If we ignore or do not successfully address these future risks, we may need more than luck to avoid these looming disasters."
We are in the midst of times that seem increasingly dangerous for the future of both humans and the planet. In this article, we will cover some very tentative predictions about the future of some social psychiatric challenges, or what I call social psychopathologies. If we ignore or do not successfully address these future risks, we may need more than luck to avoid these looming disasters.
Prediction 1: Artificial Psychiatry
Often, the best predictor of the future is what has happened in the past. However, when we turn to the future of artificial intelligence (AI) and psychiatry, we have little history to fall back on. With the advance and emergence of ChatGPT, certain intellectual capabilities are beginning to rival—if not at times exceed—that of humans. The upgrades now are coming fast and furious. What might be the role of the field of psychiatry in this process?
First is an expansion of clinical need. Some patients will be adversely affected by AI in various ways and will need help for that. We will also need to help with any of the adverse brain changes that are paradoxically caused by the technology of social media, such as the selfie effect of adverse personal self-assessment of appearance.
Second is the technology of mental self-help. There is a proliferation of online symptom checkers, which can also provide recommendations for diagnosis and treatment. In the future, I would not be surprised if ChatGPT or related technology exceeds the diagnostic ability of some psychiatrists. From the financial standpoint, AI will become cheaper for what it can do.
At its best, we can develop a partnership between AI and psychiatry. It would be wonderful if it expedited and enhanced current research projects, especially given how hard it is to research our well-protected brains. Clinically, we can also use the technology to help diagnose and choose medications. Psychotherapy is a different story, given the importance of the therapeutic alliance and human relationship.
A recent Pew Research Center survey indicated that 60% of Americans would be uncomfortable with their provider relying on AI in their own health care.1 Of course, that may decrease as we get used to AI, especially if it is successful. But can AI match or exceed our human capabilities of empathy, compassion, touch, and assessing nonverbal communication?
My own personal lesson on this came years back, preinternet, when I brought a new clinic patient, who was a middle-aged Black woman, into my office. She immediately said, “I’m so glad you’re my psychiatrist.” I thanked her and asked why. “I got here early, and you were the only psychiatrist that smiled when you saw your patient,” she said. We worked together successfully thereafter.
Where does all this leave the field of psychiatry and psychiatrists? I think it leaves us with the need for a subspecialty of artificial psychiatry. I predict AI will advance the field of psychiatry but reduce the numbers of needed psychiatrists. In other words, there will likely be more psychiatric need but less of it done by psychiatrists.
Whatever possibilities, and regardless that some patients will prefer working with a machine, goodness knows that the psychiatrists who will flourish the most will be those who are both adept enough at technology and radiate what is irreplaceable in our caring and healing humanity.
Prediction 2: Psychedelic Daily “Vitamins”
We are in what might be called the second coming of psychedelics.2 After a tumultuous period of psychological benefits and harms in the 1960s, psychedelic legal availability was curtailed until it opened up a little over the past few years. Now some careful research has emerged, along with an underground citizen experimental use of microdosing. Some of this development is fueled by investors who fund various developments, including the transformation of plant substances into standard pill dosages.
Ketamine, which seems to have some psychedelic properties, is available because it was already approved by the US Food and Drug Administration as an anesthetic, so live and online ketamine clinics have sprouted. However, as one of our editors recently reported, more than 50% of Americans who use ketamine at home misuse it.3
Effectiveness is being touted for treatment-resistant depression, posttraumatic stress disorder, and undue anxiety, especially death anxiety. In underground citizen usage, memoirs tout microdosing for everyday anxiety and mild depression, as well as enhancing creativity.4
In his recent memoir, Prince Harry, The Duke of Sussex, conveys how psychedelics helped him recover from what we now call prolonged grief disorder, stemming from his mother’s death.5 He said the use of psilocybin (commonly known as “magic mushrooms”) and ayahuasca helped him to redefine reality.
As if all these potential benefits were not enough at a time of drought in new psychiatric medications, with a supportive therapeutic setting accompanying usage, a sense of cosmic connection with others and the universe often emerges and persists to some extent. Until it was legally prohibited, 3,4-methylenedioxymethamphetamine (MDMA, or ecstasy) was used as a supplement to enhance and speed up psychotherapy in the late 1970s.
Although this second coming of psychedelics could also fail, it is not hard to predict more ongoing success this time around. In fact, given the public’s quiet psychiatric experimentation with microdosing, would it be too much of a stretch to predict that someday they could be taken just like daily vitamins or, in terms of a psychoactive substance, like the daily cups of caffeinated coffee or tea?
Someone perhaps already predicted a version of a psychedelic future. Aldous Huxley wrote the novel Brave New World, published in 1932. A psychedelic user himself, Huxley created “soma” as the tranquilizer for the masses in the book. Soma allowed an escape from reality and critical thinking, producing a strong sense of well-being and calm.
Toward the end of the book, fictional character John the Savage rebels, focusing on soma, which he sees as an oppression tool of the state that controls a rigid class system. Gradually losing control after being in a psychiatric hospital, he ends up hanging himself. Here we have government control over psychedelics, whereas our government has turned to limiting their use while the public has resumed experimenting themselves anyways.
Huxley’s dystopia is not the kind of sad new world we would hope for with our current psychedelics, is it? In our time of authoritarianism versus democracies and cultish control versus freedom of our minds, we might want psychedelics to open our minds and hearts—not close them.
What is the alternative? Probably only pediatrician and psychoanalyst Donald Winnicott’s “good enough” parenting, which teaches tolerance and not undue fear and scapegoating of the other,6 coupled with political policies that support the same, with adequate psychiatric resources available to help when necessary.
Prediction 3: A Psychiatrist US Surgeon General
The US Surgeon General is the highest governmental position for a physician. Whoever serves in the position is known as the “nation’s doctor.” Although the specialist term “surgeon” is used, the physician need not be a surgeon. Psychiatrists are physicians but have never been a US Surgeon General. That omission is despite the fact that so much of health care has a crucial psychological component.
Certainly, a nonpsychiatrist can pay attention to mental health. Our current one—Vice Admiral Vivek H. Murthy, MD, MBA—is doing just that as far as the deterioration in adolescent mental health goes. However, these questions remain: How far will his general psychiatric expertise take him, and us? Has he been consulting with psychiatrists?
The COVID-19 pandemic years have also had their own important mental health aspects: the denial and delay of responding to the crisis, the poor messaging to the public, and the rise in all kinds of undue psychological symptoms.
During President Donald Trump’s term, the question of whether a confidential mental health assessment is needed for anyone running for president, as well as yearly mental checkups of whoever is elected, received serious attention. Who better to take responsibility for that than a US Surgeon General who is a psychiatrist?
In a recent presentation I made to psychodynamic psychiatrists about our social psychiatric problems, an attendee asked: When has a psychiatrist successfully participated with politicians at the highest levels?
One obvious example is Jerrold Post, MD. Due to the nature of his work, he was an exception to the Goldwater Rule to not use psychiatric expertise to comment on public figures. Post spent many years working for our Central Intelligence Agency.7 Among many others, Post’s profile of Saddam Hussein was valuable for Hussein’s country’s defeat and his capture. If Post was still alive, wouldn’t he be consulted about Vladimir Putin?
There is so much more that needs psychiatric attention. In his column for The New York Times, “What It Means to Be Woke,” Ross Douthat pointed out our deep and little recognized psychological structures that have inscribed themselves in our country’s own psyche from the intergenerational transmission of racist, homophobic, sexist, and heteronormative power.8 That chain of trauma reinforcement needs psychological recognition and intervention—our country as a patient, if that can be imagined.
There also are psychiatrists who are dually trained in psychiatry and general medicine. Perhaps they would be the ideal options to cover both general and mental health. I would not be surprised that someday—if our social psychiatric problems continue to escalate—we could have a psychiatrist as US Surgeon General. Or if not, perhaps a new position as Assistant US Surgeon General or US Psychiatrist General. As the saying goes, there is no health without mental health.
Prediction 4: The United States Psychiatric Association
What’s in a name? A lot, as any parent or child knows well. Names evoke admiration, dislike, embarrassment, curiosity, and other reactions.
Organizations prefer to trademark their name. However, in terms of mental health, 2 organizations have similar names and exact initials: the American Psychiatric Association and the American Psychological Association—both APAs. We know the public often does not understand the differences between psychiatrists and psychologists, and having 2 APAs certainly does not help to differentiate the 2 related professions. There are also other APAs that have some connection to mental health, such as the American Philosophical Association.
This confusion is why, off and on, I have recommended that one of them change its name. But who should do it? The smaller organization? The one who got the name last?
Maybe the one who does so will consider that the American part of its name has some not-so-positive associations—maybe even an imperialistic one in this age of wokeness and political correctness. How so? There is much more to America than the United States; there is North America, Central America, and South America, all with various countries. Psychologically speaking, what gives the United States the right to claim the word, and what kind of cultural sensitivity and respect is that?
The solution I would recommend, if not predict, is for the American Psychiatric Association to change its name to the United States Psychiatric Association (USPA). Goodness knows we would be unique and have an opportunity for a public relations campaign as to our unique identity. In my mind, a much less desired alternative would be a breakaway USPA to supplement or rival the American Psychiatric Association.
Prediction 5: A Social Psychopathologies Classification
Of course, clinical psychiatry is based on seeing a patient one-on-one for mental problems that neurology and the rest of medicine did not help well enough. Like the rest of medicine, a diagnostic classification emerged and developed more than 5 reiterations. This individually based psychiatry can expand into couples, family, and small groups, which have tried at times to break down what problems are being treated.
However, there are other psychological problems that fall outside of such classifications. There are large social tendencies to scapegoat and hurt others, often from our inborn tendencies to fear the other and gain power over them.
These include the following:
Data have suggested that most of these continue to worsen. Occasionally, there is a call to include them in our DSMs. For example, some have suggested racism should be included, but it has always been turned down because of uncertainty on where to draw the line—everyone has some racial bias, it is said—and the perpetrator generally does not feel anything is wrong with them, to the contrary that they are right and even in danger.
What has not been tried is to medicalize these conditions, meaning to develop a separate classification that I would call social psychopathologies. Psychiatrists can join with other mental health disciplines and social science experts, such as sociologists and anthropologists, to put it together, hopefully to lead to more research and new, innovative interventions.
Such a classification can be a parallel to what the APA uses in its guide to DSM-5: “A mental disorder is a major disturbance in an individual’s thinking, feelings, or behavior that reflects a problem in mental functioning.” Changing just a few words for the social perspective, and we get this framework: “A social disorder is a group disturbance in societal thinking, feelings, or behavior that reflects a problem in social functioning.”
With increasing ways for mass destruction—whether nuclear, climate, poisoning, or perhaps AI—finding ways to reduce our hate and conflicts will be essential for the survival and thriving of humanity.
Prediction 6: A Comeback of Indigenous Individuals
In the United States, from the mid-17th century through the 19th century, many of the numerous Indigenous tribes were decimated or displaced from the East Coast westward. This left the Indigenous individuals in the United States with probably the highest psychiatric morbidity of any cultural group.
Much external trauma is still added to the intergenerational transmission of prior trauma. However, to date, the American Psychiatric Association’s focus on racism has not included a corresponding focus on Indigenous individuals.
Because much of the history of Indigenous individuals around the world is similar, an International Work Group for Indigenous Affairs eventually emerged and is headquartered in Copenhagen, Denmark.9 Although what defines Indigenous may be unclear, there are approximately a half billion Indigenous individuals worldwide.
In the United States, although scores of Indigenous tribes and perhaps 10 million individuals existed when the Europeans came, the population dipped to the hundreds of thousands but has increased once again into the millions, depending on whether and how those with diverse ethnic backgrounds are counted. Moreover, various strategies have emerged for their resilience and recovery.
There was a Red Power movement in the United States at the same time as Black Power. Legal gambling casinos came to be thought of as the Indigenous individuals’ financial revenge. There have been some restorative justice processes, and respect for using the prior Indigenous lands became routine, though little has been given back.
Recognition is emerging that the values and knowledge of Indigenous individuals may be a key to the future well-being of the world, so many of our social psychiatric problems lend themselves to Indigenous expertise: sustainability of the land, cooperation for collective well-being, their value of transgender identification and vision, and therapeutic use of sweat lodges and the permissible religious ceremonial use of the psychedelic peyote.
There is even an increase in Indigenous psychiatrists and those who serve in our federal government. Indigenous individuals could be thought of as the original discoverers of our world, and they can also become its saviors.
Prediction 7: More Psychiatrist Eulogies
Whether any of my previous social psychiatric predictions come to pass in any way is uncertain and even unlikely, but this is a certainty. We will continue to lose psychiatrists, including those who have specialized in the social aspects of psychiatry and, in my perspective, the social starts with relationships.
Pedro Ruiz, MD—a renowned psychiatrist, educator, and researcher—died recently. It was his collegial relationships, including with me, that set him apart as a social psychiatrist. Although it is easy to collect information on the career of Ruiz, I had the extra advantage of working fairly closely with him in the 1980s at Baylor College of Medicine in Houston, Texas. Maybe that was meant to be, in some way, because we were both inspired by reading Sigmund Freud in our teenage years.
At Baylor, he became chief of our public psychiatric hospital, whereas I was medical director of the largest community mental health center. This arrangement had its benefits and limitations. If continuity of care was important, having 2 public systems under different contractual relationships was a limitation. I could not follow my clinic’s patients in the hospital if I wanted to. However, our common home base of Baylor and our identification as social psychiatrists provided good communication and understanding.
That relationship proved dividends when we became presidents of the American Association for Social Psychiatry (AASP) around the new millennium. The AASP presidency was only 1 of many for Ruiz in the United States and globally. I ended up calling him “President Pedro,” a reflection of his being such a savvy political psychiatrist.
Our time together in Houston also illustrated what a family man he was. When we coedited the book Mental Health Care For Allied Health and Nursing Professionals, his son, Pedro P. Ruiz, who was a premed student at the time, was his coauthor for his chapter on psychiatric diagnosis.10
Moreover, like much in his purview, this book had prophetic aspects. Written for nursing and other allied professionals more than 3 decades ago, it predicted how widespread nurses, especially nurse practitioners and peer specialists, were to come in community and general psychiatry.
As the popular song by Chet Baker goes, “there will never be another you,” Ruiz. In turn, that should remind us that in the future, we should do what we can to honor those who have done so much for psychiatry in any way before they pass away.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the 1-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.
1. Tyson A, Pasquini G, Spencer A, Funk C. 60% of Americans would be uncomfortable with provider relying on AI in their own health care. Pew Research Center. February 22, 2023. Accessed March 20, 2023. https://www.pewresearch.org/science/2023/02/22/60-of-americans-would-be-uncomfortable-with-provider-relying-on-ai-in-their-own-health-care/
2. Moffic HS. The road less taken: the rise and fall and second coming of psychedelics. Capital Psychiatry. 2022;3(1):12-17.
3. Kuntz L. Report reveals more than 50% of Americans misuse at-home ketamine. Psychiatric Times. March 13, 2023. https://www.psychiatrictimes.com/view/report-reveals-more-than-50-of-americans-misuse-at-home-ketamine
4. Waldman A. A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life. Knopf; 2017.
5. Harry P. Spare. Random House; 2023.
6. Wedge M. What is a “good enough mother”? Psychology Today. May 3, 2016. Accessed March 21, 2023. https://www.psychologytoday.com/us/blog/suffer-the-children/201605/what-is-good-enough-mother
7. Moffic HS. A psychiatrist for our national security: Jerrold M. Post, MD. Psychiatric Times. December 6, 2020. Accessed March 21, 2023. https://www.psychiatrictimes.com/view/a-psychiatrist-for-our-national-security-jerrold-m-post-md
8. Douthat R. What it means to be woke. New York Times. March 18, 2023. Accessed March 23, 2023. https://www.nytimes.com/2023/03/18/opinion/woke-definition.html
9. Singh M. It’s time to rethink the idea of the “Indigenous.” New Yorker. February 20, 2023. Accessed March 28, 2023. https://www.newyorker.com/magazine/2023/02/27/its-time-to-rethink-the-idea-of-the-indigenous
10. Moffic HS, Ruiz P, Adams G, eds. Mental Health Care For Allied Health and Nursing Professionals. Warren H. Green; 1989.