What Is Foolish in Psychiatry?
Being a fool can run from being thought to be inappropriately silly to Shakespeare’s fools of creative wisdom. Where does psychiatry come in?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Tomorrow is our country’s annual April Fools’ Day, usually devoted to playing pranks upon one another. Being a fool can run from being thought to be inappropriately silly to Shakespeare’s fools of creative wisdom. Where does psychiatry come in?
Psychiatry has its critics who think that the field is foolish in many ways. As examples, such foolishness may include our diagnostic classification, an overuse of medication, and a relative neglect of social concerns. Examining these examples can lead to various considerations of foolishness, including whether some of the critics are not constructive, but foolish.
DSM-5
Probably every DSM diagnostic edition over my 55-year career has been criticized for one reason or another. This is a cookbook. Too psychoanalytic. What about the social variable? And more. Some might say that is due to a lack of firm consensus of what should go into the diagnostic process. Besides, the brain is so hard to examine that it makes the biological connections so challenging to connect to diagnoses.
No wonder then that DSM-5 has been criticized for its diagnostic criteria, scientific validity, and having too many diagnoses, among other things.1 In some of my columns for Psychiatric Times, I have even suggested we need another additional classification, one of what I call our social psychopathologies because they are so harmful and resistant to change. One goal of the next DSM edition is to make it more of a living one, that can be adjusted continually by ongoing online updates.
Psychopharmacology
Taking off from the profusion of mental disorders, the journalist Robert Whitaker wrote a controversial public best-seller, claiming that medication was also being overused.2 That even led to the establishment of what some considered as an antipsychiatry organization, Mad in America. Now, our federal government has voiced concern over the overuse of medication, especially for children.
On the other hand, there has been little dramatic advances in psychopharmacology for many years now. Psychedelics have the potential, it seems, yet research and legal approval have been slow.
There is also the ongoing question of the quality of psychopharmacology, not only by psychiatrists, but nonpsychiatrists. Nonpsychiatrists are prescribing 40% of antipsychotic medication for Medicare patients.3
Social Determinants
Our main ongoing medical model has been the bio-psycho-social one. However, the social has been relatively neglected until recently. The social could contain interactional processes from the clinician/patient alliance on up to international wars.4
However, research about the social has elicited concern over the basic concept of the “social.”5 Perhaps a clear understanding of the social is not even achievable, so is it foolish to even try?
The Media Messages About Mental Health
As Marshall McLuhan said back in the 1960s, the medium is the message. Given the historical stigma about mental disorders, how it is covered by the media is so important.6 If sensationalized, as it often has been in movies, television, and social media, that seems harmful. There is even direct concern and legal action about the adverse influence of social media on mental health, especially that of the youth.
On the other hand, ongoing creative media dramas about a psychotherapy process can be reassuring and educational. Of concern is that the American Psychiatric Association’s so-called Goldwater Rule has essentially removed psychiatrists from actual public coverage and discussion of the news and the opportunities to use our expertise to assess social risks.
The Future of AI
AI has recently developed so quickly that it is hard to know how it will influence mental health and illness—and even our human nature—over time. For one, AI chatbots have been used as substitute therapists, though they seem less relevant for severe psychiatric problems. AI and even large group political rallies can produce and reinforce feel good therapy that produces brief validation rather than ongoing change.7 Currently, there are also AI dangers like “hallucinations” and continuation of bias, as well as addictive usage.
What Kind of Fool Am I?
This is the title of a well-known 1962 Broadway song. Here is an excerpt:
“What kind of eyes are these?
That could not see
What could be seen
By everybody else but me?”
Are we wise, foolish, and/or naive? Really, at our best, in contrast to the song lyrics, we see things that other people cannot: deeper meanings and nonverbal information. Deeply caring for each patient as an individual, as well as addressing the larger social psychopathologies, may bring us to being what I would call Mindful Fools.
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.
References
1. Mehdi S, Meyers B, Devanand DP. Is DSM-5 a failure? Analyzing the controversies surrounding the current American mental health diagnostic manual. Psychiatric Annals. 2022;52(4):161-169.
2. Whitaker R. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Crown; 2010.
3. Ivanov I, Schwartz JM.
4. Kirmayer LJ.
5. Birk R, Manning N.
6. Zhang H, Firdaus A.
7. Alpert J. ‘No kings’: politics as bad group therapy. Wall Street Journal. March 26, 2026. Accessed March 31, 2026.
