What Can Psychiatry Learn From the Semiquincentennial of the Constitution?

Steven Moffic, MD, offered a historical reflection on the parallel evolution of American psychiatry and the United States as a nation, framed around the country's 250th anniversary of the Declaration of Independence, with emphasis on both the field's landmark advances and its most ethically significant failures.

Moffic began by drawing attention to the intertwined origins of American psychiatry and the founding of the republic, centering on Benjamin Rush, MD—a signatory of the Declaration of Independence and widely regarded as the father of American psychiatry—who published the first American psychiatric textbook, Medical Inquiries and Observations upon the Diseases of the Mind, in 1812.¹ Moffic acknowledged that Rush's treatments, including bloodletting and the tranquilizing chair, were later discredited, illustrating how clinical practice must be understood in its historical context and remains subject to ongoing revision.

Moffic then turned to a troubling historical chapter in the field: the 1851 publication by physician Samuel Cartwright of the fabricated diagnosis of drapetomania—defined as a purported mental illness causing enslaved Black people to flee captivity—as a case study in how psychiatric nosology can be weaponized to serve political and racial ideologies rather than clinical truth. He drew a direct parallel to the inclusion of homosexuality as a diagnosable mental disorder in early editions of the DSM, a classification that was not removed until 1973 following scientific and activist pressure, and noted that the field is now navigating analogous debates regarding gender identity.²

Moffic traced the field's subsequent advances: the formation of organized psychiatry in the mid-19th century, the transformative introduction of chlorpromazine in the 1950s, the progressive development of antipsychotics and antidepressants with improving tolerability profiles, and the emergence of cognitive-behavioral and other structured psychotherapies alongside the enduring importance of the therapeutic alliance. He identified psychedelic therapies and artificial intelligence as the next potential inflection points in the field's evolution, and concluded by calling for psychiatrists to more actively reflect on and engage with these historical and conceptual dimensions of their discipline, characterizing the psychiatrist's role as that of a "freedom fighter of the mind" working to restore the autonomy that psychiatric illness erodes.

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. Farr CB. Benjamin Rush and American psychiatry. Am J Psychiatry. 1994;151(6 Suppl):64-73.

2. Drescher J. Queer diagnoses: parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual. Arch Sex Behav. 2010;39(2):427–460.