Beside Suicide and Homicide, We Have the Challenge of Ecocide and Genocide

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

We in psychiatry are fortunate as compared with some other medical specialties in that we are not so often confronted with life and death challenges. However, when we do, they often take on even greater emotional power and meaning. That is true for a patient who dies by suicide, even if the saying “you are not a real psychiatrist until you have patient suicide” has some merit for what it uniquely can teach you. Patients who kill others by homicide are much rarer, but when to notify potential victims per the Tarasoff Case can be anguishing, with the potential breakdown in treatment or even then becoming a target oneself.

If we expand our concern beyond individual patients, then we get into larger realms of life and death, as in both ecocide and genocide. Our responsibility is less, though the ramifications more.

Take ecocide. Ecocide refers to large-scale human-drive damage to the environment that supports human beings and other life. That can result from our manmade toxins and our influence on adverse climate change. Ecocide can then be considered to be the planetary correlate to individual suicide. As such, all individuals have the possibility—and psychiatric professionals the ethical responsibility—to try to help establish a sustainable environment. That is why I have recommended expanding our model to bio-psycho-social-eco.

Genocide, an uncountable victimization of homicide, has been of global concern since the Nazi-led Holocaust. In 1944, Raphael Lemkin defined genocide as the “destruction of essential foundations of the life of national groups.” A narrower definition emerged from the 1948 Genocide Convention as “acts committed with intent to destroy, in whole or in part, a national, ethical, racial or religious group,” a definition which still has prominence. Within the definition is where psychiatrists start to come in. “Intent” is a key word, but how do we know intent? We can know it when it is written down or spoken, but intent can be hidden for a variety of reasons, just as patients often hide important motivation, and why we can be of help in assessing that. “In part” is another ambiguous criterion. How much of the part, whether that be the population or the destruction, qualifies for genocide. When genocide, such an evocative term, is thrown around in the current major wars, search for verification of intent and whether “in part” seems significant enough.

Our more obvious and common role in genocide is to be available to help the mental harm done to the loved ones of those killed and recovery from any environmental losses and destructive. Inevitably, posttraumatic stress disorder and prolonged grief will emerge at higher rates over time.

Our individual and small group treatment is certainly our key licensure and professional responsibility, but we have the expertise to go beyond that in trying to avoid ecocide, and through a sustainability focus, and avoid genocide by preventive methods like ceasefires and sustained peace.

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.