VIPs in Psychiatry and Society


What should be done with billionaires?

billionaire, money



I finally was able to catch up on and read the New York Times Magazine issue titled “How Many Billionaires Are There, Anyway?”1 and find the issue with billionaires is their undue and unaccountable influence on our society. There has been a dramatic increase in them since Reagan became President, from about 70 to 700, spurred on in part by a dramatic reduction in taxation. The Reagan era was also the time that the federal Community Mental Health Center program was dismantled, leaving us with fragmented and poorly funded public mental health care services. The current estimate is that San Francisco now has over 80 billionaires, while at the same time the downtown is overflowing with the homeless. Elsewhere, I have called this capitalism run amok.

What billionaires do with their money can help or hinger the rest of society. Yesterday on CBS Sunday Morning, there was a feature story about how a billionaire has helped the arts, always poorly funded by the government in America. Alice Walton of the Walmart family, now the second richest woman in the world, decided to build a museum in Bentonville, Arkansas, the home turf of Walmart. Her goal for the striking Crystal Bridges Museum of American Art was to tell the American story in art and make that freely available to people who usually do not come to such museums. Now about a decade old, it has worked.

Money, though, cannot necessarily buy health and mental health, or even wisdom. Moreover, if VIPs (Very Important People) of great wealth become mentally ill, there is certainly no evidence that they will receive better treatment. To the contrary.

There is a long history of concern and research that VIPs, of which billionaires are some, receive as compromised care as the poor.2 They can use their status and money to demand unhelpful services. Transference may produce a demeaning attitude to the clinician. Countertransference in the clinician is common, especially fear of negative outcomes and a desire to be valued. Privacy is paramount, sometimes including cash on the table with the demand for no record-keeping.

The most effective adjustment to help VIPs in psychiatry is to utilize a team that has experience with such patients. They will be more prepared to act promptly, firmly, and unanimously in devising and carrying out an appropriate treatment plan. Is there a way to apply this methodology to billionaires in our wider society, both for their own good as well as our own? Is there some billionaire(s) that will be the Alice Waltons of mental health care?

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 one-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 relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.


1. Staley W. How many billionaires are there, anyway? The New York Times Magazine. April 7, 2022. Accessed April 25, 2022.

2. Silverman BC, Asby A, Brendel DH, et al. Psychiatric treatment of the VIP: some paradoxical risks. J Nerv Meant Dis. 2012;200(6): 545-548.

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