Electing to Make America Sane Again: Addressing Governmental Oppression

doganmesut/AdobeStock

PSYCHIATRIC VIEWS ON THE DAILY NEWS

We covered some specific mental health concerns from oppression in our last column. However, the biggest threat of oppression is governmental, whether that is from either political extreme. That is because such governments can institutionalize oppression by more easily producing laws that unduly limit behavior and speech. Although that kind of governmental control makes it almost impossible to research and monitor accompanying changes in mental disturbances adequately, inevitably there will be increases in trauma, anxiety, certain depressive disorders, and personality disorders.¹

It even seems likely that governmental oppression is already escalating. If there is fear of opponents being attacked after an election, some will self-censure in what is called “anticipatory obedience.” That may even be true of psychiatry. Whether from the Goldwater Rule or fear of retribution of a would-be tyrant,² we have been passive and relatively silent, despite our expertise in the psychology of leadership and conflict resolution. Later, such fear can result in compliance with the government that can harm patients, as in hospitalizing political dissidents in the old Soviet Union.

Fortunately, 2 eminent psychiatrists have written overviews about how medicine and psychiatry was adversely influenced in Nazi Germany. Early in the Nazi rise to power, the Hippocratic Oath to do no harm was increasingly broken. In reviewing the literature of the collaboration of physicians, especially psychiatrists, with Nazi policy, Mary V. Seeman, MD, who we recently eulogized, noted experimentation, sterilization, and killing of patients with psychiatric disorders before and during World War II.³ Robert Jay Lifton, MD, personally interviewed Nazi physicians and how they justified following governmental orders that harmed patients.⁴ Both confirm the medical and psychiatric dangers of putting the well-being of the nation over that of patients, including participation in medical atrocities.

In our time, for-profit managed care companies are allowed to put profit over patients, with complicit governmental approval.⁵ Those working in the armed forces or incarceration institutions also must struggle with dual ethical allegiances. Sometimes there is implicit oppressive control even in medical schools.

Silence is not golden when it endangers the health and mental health of people. Let us be inspired to speak out from the models of Drs Seeman and Lifton.

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 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. Moffic HS. The mental health implications of dictatorships. Psychiatric Times. December 7, 2023. https://www.psychiatrictimes.com/view/the-mental-health-implications-of-dictatorships

2. Snyder T. On Tyranny: Twenty Lessons from the Twentieth Century. Crown; 2017.

3. Seeman M. Psychiatry in the Nazi era. Can J Psychiatry. 2005;50:(4):218-225.

4. Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books; 1988.

5. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.