Capitalism and Psychiatry

FreshIdea/AdobeStock

COMMENTARY

A recent article published in Psychiatric Times, “On Climate, COVID, and Race,” by Robin Cooper, MD, and Beth Mark, MD, made a convincing case to link those 3 major crises and challenges for our times. I would add one more—burnout, especially physician burnout. What links all 4 challenges, I would submit, is capitalism that has run somewhat amok in the United States. Let’s see how capitalism fuels these fires, in historical order.

Racism

Having celebrated our country’s independence on July 4th, we must recall and remember that it was not freedom for all our people. For one, it was not independence for slaves. The chattel economy, especially of Southern states, spurred our economy.

But that is gone, right? Not really. The earnings gap between Blacks and Whites is as large today as it was in 1950 with 54% of Black men unemployed in May (not to mention all those who were incarcerated).¹ Inadequate finances makes one more vulnerable to developing mental health problems, let alone poorer access to health and mental health care and the resources available for their care.

The climate

It is well known that the ravages of climate instability adversely affects poor Black Americans and others of minority status. Their poor economic status hinders recovery from climate-related disasters, or even being able to leave town in the case of an incoming major hurricane, as in Hurricaine Katrina in New Orleans. The mental health repercussions include higher risk of getting posttraumatic stress disorder from such trauma.

COVID-19

In our current coverage of the coronavirus in Psychiatric Times, we have reflected on how Black Americans have a significantly increased risk of dying from the virus. That seems to stem from higher vulnerability because of racial-related medical illnesses and over-representation of frontline services workers who must work to survive. Having increased medical problems limits freedom in its own way. Interestingly, the hold on our fossil-fueled economy has significantly decreased carbon emissions.

Burnout

The fourth capitalistic crisis, the one that seems to harm the most physicians, is burnout. From the turn of the new millennium to now, as business in the form of for-profit managed care took over medical systems, burnout rose from virtually zero to the epidemic rate for about 50% in physicians.² To increase profits, these systems limit what physicians and other mental health caregivers can do to help others, as well as disengage them from policy decisions.

The result is worsening of our mental health and poorer outcomes for our patients. To come full circle, research indicates that non-Black physicians who are burning out tend to have more racial bias.³

Addressing the underlying capitalistic problem

I am not suggesting we practice Marxism; rather let us look at how capitalism can and should pull back and adjust for more equity. Not long ago, a focus was on the top 1%, but a case can also be made for the top 20%,⁴ which would include most psychiatrists. That means, despite our own burnout, we must strive to be part of the solution. Concern and compassion are the ethical way of the physician. Here are some strategies:

• For the climate, advocate to reduce fossil fuels as our economy recovers, as well as our own use of energy-saving online services;

• For COVID-19, address systemic racism and social determinants of health and mental health that break the principles of the Hippocratic oath by harming Black Americans and other minorities;

• For racism, support the essence of the Black Lives Matter movement, adding our knowledge and appreciation of unconscious and hidden racism;

• For burnout, monitor burnout during the pandemic to see if the rate is rising or falling; and

• For capitalism, advocate for a fairer and more equitable single payor system (eg, Medicare for All).

Let’s take this opportunity to improve the health (including mental health) for all.

Dr Moffic is an editorial board member and regular contributor to Psychiatric Times. He was a tenured Professor at the Medical College of Wisconsin until he retired in 2012. Since then he has functioned as a private community psychiatrist providing pro bono services locally, nationally, and internationally. Currently, Dr Moffic is focused on 5 major advocacy initiatives: physician burnout, climate instability, Islamophobia, Anti-Semitism, and racism. He is co-editor of Combating Physician Burnout: A Guide for Psychiatrists, with Sheila LoboPrabhu and Richard F. Summers.

References

1. Bayer P, Charles KK. Divergent paths: A new perspective on earnings differences between Black and White men since 1940. Q J Econ. 2018;133(3):1459-1501.

2. LooPrabhu S, Summers R, Moffic HS, Eds. Combating Physician Burnout: A Guide for Psychiatrists. American Psychiatric Association Publishing, 2020.

3. Dyrbye L, Herrin J, West C, Wittlin N, et al. Association of racial bias with burnout among resident physicians. JAMA Network Open. 2019;2(7):e197457. Accessed July 7, 2020. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2739043

4. Reeves R. Dream Hoarders. Brookings, 2017.