What I Didn’t Psychiatrically Understand in 2024. Did You?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

I am not talking and asking about the usual things I do not understand, but some of the big social psychiatric events and issues in society that have major mental health implications. In likely my last column for 2024, here are some of those.

The Processes of the Biden Administration

Here, I am not trying to provide any Goldwater Rule exception about my psychiatric interpretation of his psychology, but having questions about how his administration seemed to run. What I have been wondering about for months was how his decision to drop out of the Presidential race jived with his continuing presidential responsibilities. After all, he apparently continued to make major decisions and did travel the world. Was it just an energy challenge, that at his age he did not have enough energy to do both? We never did get clarity about his overall mental status after his halting responsiveness in the June 27 debate with Trump. Although there were numerous pundits and a few psychiatrists who conveyed public concern about President-elect Trump, little concern was conveyed about Biden.

Finally, I got a little more sense of the answers via the Wall Street Journal article yesterday “How the White House Functioned with a Diminished Biden in Charge.”¹ Apparently, his long-term aides and advisors were managing his limitations since at least the 2020 primaries. As time went on, he reportedly was kept in more isolation, had more gatekeeping, more cancellations, and a voice coach.

Were there negative outcomes, especially psychiatric, as an outcome if his capabilities were indeed “diminished”?Perhaps someday there will be books that assess that concern in depth, as there has been for such presidents as Wilson, FDR, and Reagan. However, for examples, there was a disastrous withdrawal from Afghanistan in 2021 despite warnings, the telescoped invasion of Ukraine by Russia in 2022, and the invasion of Israel and consequent Mideast war from October 7, 2023. All produce increased losses, trauma, and fears for the future.

What is needed? Perhaps a psychiatrist at top levels of the administration, like the Surgeon General. How about a formal psychiatric evaluation by a panel of objective experts starting when someone enters the race formally, begins the presidency, and yearly thereafter?

Treating Grief from Relationship Breakups

Recently, in the December 9 issue of The New Yorker, Jennifer Wilson wrote an article titled “The New Business of Breakups.”² She described her own personal quest for healing as she examined options that she discovered. I was astounded to hear about perhaps 20-25 of them, depending on how they are counted. Some were historical, others current. Most of the healers, though not all, seemed unlicensed or trained coaches at best. Here are some examples:

• Around 1 C.E., the Roman poet Ovid in his book Cures of Love, recommended diversions such as a hobby or travel.
• StrIVeMD, in which Syed Ali, MD, provides ketamine.
• A retreat run by Amy Chan using experts on men’s emotionality, a movement specialist, and a dominatrix to help with being too helpless.

And all these are just on the front page. By the end, the author had decided to restart an old hobby a la Ovid, running.

Clearly, such therapies generally do not go through any research double-blind studies as new medications do. It is more like the business warning: “buyer beware.” Organized mental health care has been quiet and passive about assessing such innovations.

The Mental Health of Recent Gun Violence Perpetrators

Psychiatry continually tries to clarify that individuals with major psychiatric disorders like schizophrenia are not more—and probably less—violent and more victims of violence, than the general public. However, when the personal history of those that have perpetrated killings that grab the public’s attention, some sort of mental “disturbance” almost must be there by definition. Individuals in their right mind do not plan and deliberately kill.

This question is coming up again with 2 prominent killings. One is that of a health care executive in New York. Here the perpetrator seemed to be a high functioning young man until disappearing from family and friend over the last year, along with having some known back problems. His current attorney mentioned that this must represent some sort of major mental change for the worst.

Then there was the high school female student who killed another student and teacher in a Christian school in Madison, Wisconsin. Her history is starting to emerge with indications of a chaotic parental relationship of divorce and remarriages, as well as her own therapy. Whether that will represent a full-blown DSM diagnosis or not, something mentally is amiss.

It would seem to me that we in psychiatry should pivot from denial to helping to understand such risky mental deviation from the norm.

How Much is 2024 Shaping Up Like 1968?

One advantage of living so long is comparing historical eras for, as the saying goes, if we do not learn from history, we will be doomed to repeat it. In that sense, I am left wondering what parallels we are having in 2024 compared to 1968-69. That will be part of my holiday research. I will report back in the New Year. Your own answers would be appreciated.

In the meanwhile, have a happy and meaningful holiday season.

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. Linskey A, Ballhaus R, Glazer E, Hughes S. How the White House functioned with a diminished Biden in charge. The Wall Street Journal. December 19, 2024. Accessed December 20, 2024. https://www.wsj.com/politics/biden-white-house-age-function-diminished-3906a839

2. Wilson J. The new business of breakups. The New Yorker. December 2, 2024. Accessed December 20, 2024. https://www.newyorker.com/magazine/2024/12/09/the-new-business-of-breakups