What It Means to Be a Humanitarian Celebrating the Work of H. Steven Moffic, MD

H. Steven Moffic, MD, with the Abraham L. Halpern Humanitarian Award, presented by John H. Halpern, MD; and Aida S. Mihajlovic, MD.

At the 2024 American Psychiatric Association (APA) Annual Meeting, the American Association for Social Psychiatry (AASP) bestowed H. Steven Moffic, MD, with the Abraham L. Halpern Humanitarian Award for his achievement in advancing human rights. Psychiatric Times asked Moffic to share his thoughts on humanitarianism and psychiatry.

PT: What does “humanitarian”—and this award— mean to you?

H. Steven Moffic, MD: When I heard that I was nominated for this award, I wondered what “humanitarian” meant and why I was chosen for it. Those questions went beyond the usual sense that when one receives an award, you know that many others were well qualified, too. Humanitarian was not a term I ever used much, nor heard about much in psychiatry other than this AASP award.

Like anyone whose career was in academics, I did some academic research. First, what did it mean to the AASP? The website states that the award is bestowed “for extraordinary achievement in advancing human rights,” and that nominees should “inspire our idealism and persistence and remind us to do some good is woven into the very soul of what it means to be a doctor.” How aspirational and inspirational!

But then, what are human rights, as they are a key aspect of the award? The United Nations [UN], following the most extreme inhumanity of World War II…stated in its Universal Declaration of Human Rights that they “range from the most fundamental—the right to life—to those that make life worth living, such as the rights to food, education, work, health, and liberty.”

That definition brought me right back to psychiatry and Abraham Maslow’s theory of the hierarchy of psychological needs, published first in 1943 during World War II, titled A Theory of Human Motivation. Because they predated the UN declaration, did the UN know about them and adapt them so there was a psychiatric basis to this declaration of human rights? Maslow ingenuously used the image of a triangle with a long base and pointed top to illustrate the original 5 levels.

For me, that meant asking myself: Did my career have some useful emphasis on being sure that patients had those needs met in the outcome of their treatment? Being a medical director of a psychiatric hospital, for physiological needs, safety, and security; president of the AASP, for love and belonging; president of the board of our local clubhouse for those with mental illness, for self-esteem; and clinically asking patents what gave their life the most meaning, for self-actualization, were among the most influential opportunities I had to progress toward the pointed top of the triangle. The validation of those activities included the Administrative Psychiatry Award from the APA in 2016, a Hero of Public Psychiatry designation in 2002, and the Exemplary Psychiatrist Award from…the National Alliance on Mental Illness in 1991.

PT: There are many in the field that look up to you as a role model. Who was your role model early in your career, and who is your role model now?

Moffic: As I do not think about wanting others to consider me their role model, I am honored whenever others feel that I am one, especially if they include my wife and family, given the importance of both our professional and personal aspects of life.

My early role model was psychiatrist Robert Jay Lifton, MD, who was on the faculty at Yale University when I was a medical student there. He helped defuse student riots when Bobby Seale was on trial in New Haven, Connecticut. Dr Lifton was also willing to be jailed in protest of the Vietnam War. (In the recognition of history repeating itself in some ways, here we are now with college student protests regarding the war in Gaza.) His groundbreaking research was on Nazi doctors and what made people vulnerable to be brainwashed into cultish thinking—such important social psychiatric problems and challenges. Dr Lifton also exemplifies the Jewish value of Tikkun Olam, trying to make the world a better place.

It was no surprise to me that Dr Lifton was the first awardee of the AASP’s humanitarian award, and I was honored to be asked to introduce him. I also did a review of his memoir for Psychiatric Times. In recent years, both of us have become climate instability activists.

Toward the middle of my career, psychiatrist James Sabin, MD, was an essential role model. I was asked to develop a not-for-profit managed care system at the Medical College of Wisconsin in 1988, the first of its kind in the country. Managed care was a new system and full of ethical controversy for its control over what was paid for in providing care. I searched for someone who could guide me in the ethical way and found Sabin at Harvard Pilgrim Health Care. He focused on the concept of rationing, which was already present in other systems of care and could ethically be applied to managed care. I followed his lead and advice. He eventually recommended I write my book, The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare.

As to a recent role model, that is tough, because we usually consider role models who are older than us, and I am getting pretty old. It would seem to need to be a psychiatrist who did a lot of writing and speaking, often on controversial topics, like mine on social psychopathologies. Perhaps the psychiatrist who models that best nowadays is John Peteet, MD, with whom I have coedited all our religion and psychiatry books. We have been described as the “odd couple,” because he is so gentlemanly and formal, whereas I am more or less the opposite.

But to prove that it is never too late to get a role model, I recently got many from the book being released in June by Mo Rocca and Jonathan Greenberg, Roctogenarians: Late in Life Debuts, Comebacks, and Triumphs. I aspire to be or become a roctogenarian.

In looking back on these 4 particular role models, they all seem to have had a humanitarian concern for certain mental health challenges: Dr Lifton with cultish thinking that supplants normal moral principles, Dr Sabin about how best to respond to scarcity in certain areas for certain populations, Dr Peteet for spiritual and religious beliefs that are important for one’s purpose in life, and Mo Rocca’s roctogenarians, who model how to age well in late life and counter the social psychopathology of ageism. They also all seemed to have grace under opposition, which was a model for me to follow.

But if you take “role model” in its widest implications, there are countless ones in our lives, such as family, like my wife Rusti, who I learned so much from and is a master of socializing with sunshine; friends; colleagues; students; mentees; editors; rabbis, especially my son; career counselors, especially my daughter; teachers, especially my high school English teacher who taught me how to write; artists; athletes; and more who you want to learn from and emulate in some, often small, but important ways.

And patients—thousands of them over 40 years, specializing in those with posttraumatic stress disorder, the most serious and chronic mental disorders, and underserved ethnic minority and transgender individuals. How do I thank them for all they and their families taught me over the years? They taught me so much about the fragility of our identity, of courage, of maintaining hope for the future, and about the worse and best that human beings can do to each other.

For this award, it is also important to mention my colleagues who contributed to my selection and their live contributions to the award session, where so much of what they said about me startled me in the best way: Aida Mihajlovic, MD, president of the AASP, for her unwavering support and teaching medical students; Rama Rao Gogineni, MD, who I understand pushed the nomination, brought my present back from a synagogue shop in South India, and all around is a paragon of goodness; Dilip Jeste, MD, the kindest psychiatrist I have recently come to know, an expert on the wisdom we all hope to achieve, and former president of the APA; and Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, the current president of the World Association of Social Psychiatry, for the connection to our American organization and for his stimulating ideas about social psychiatry.

PT: Have there been occasions in your career when your professional role contradicted a humanitarian approach?

Moffic: Yes, there have been inevitable ethical conflicts between my professional roles and a humanitarian approach. Sometimes that is called trying to satisfy 2 masters, or the challenges of 2 required allegiances. I have done much work in considering psychiatric ethics, including developing ethical guidelines for psychiatric administrators. I have come to feel that choosing between 2 ethical “goods” or 2 ethical “bads” is the hardest—not choosing between an apparent good or bad.

The first time it happened was in the US Army between 1975 and 1977, when I was asked to provide verification of homosexuality to justify a soldier’s dishonorable discharge. Homosexuality, at the time, was still in our DSM diagnostic classification. For the patients’ needs—and patient needs are the No. 1 priority in our psychiatric ethical principles—I had to look for alternative explanations of their situation, such as an adjustment disorder. At the same time, I had to follow Army regulations.

Or, for example, when for-profit managed care became dominant in medicine and psychiatry, profit became a priority over quality of patient care needs, as I described in my book. The ethical resolution was to reduce unnecessary and ineffective treatment as well as unnecessary and ineffective administration. Our academic managed care system did have documented better outcomes than the public system it replaced.

There were other situations where I felt money outweighed medical ethics, and I tried to stay away from them, being an expert witness unless I could be objective and speaking on behalf of pharmaceutical companies unless I could write my own text.

PT: What lesson(s) have you learned from your humanitarian efforts?

Moffic: One lesson learned is that our basic human nature makes humanitarian efforts difficult. We tend to initially be fearful of the other, selfish in times of scarcity, power hungry, put ourselves above nature and other living things, and even self-destructive, as Sigmund Freud maintained in his death drive theory. The key, I think, is to do whatever possible to treat patients equitably and lovingly, adding evidence that unity, in the long run, is better than divisiveness.

PT: You have done a lot of work on burnout. Do you think having a humanitarian approach is protective?

Moffic: If medicine and psychiatry took burnout as seriously as it should, it would seem that a humanitarian system approach would prevent or reduce burnout. Why? Because then the system would support the basic healing goals and capabilities of physicians and thereby, in terms of Maslow’s triangle, provide psychological safety.

Instead, there are currently too many obstacles and disengagement put into place by system administrations. Personal well-being activities—exercise, diet, family time—are all good in themselves but will have limited effect in reducing physician burnout. Although burnout has spread to the rest of society, it remains highest among physicians, at epidemic rates.

PT: If you could go back in time and change anything about your career, what would it be?

Moffic: This is such an important closing question because it connects to the tendency to look back on one’s life for its themes and meaning, especially at my age as I near the inevitable close of my life. I have no major career regrets. I tried to get the best out of any situation or change. I have found that often one learns more from failures and betrayals than successes.

One of my early special interests was in cultural psychiatry, which—at least in that time—focused on value systems of various ethnic cultures. Religion and spirituality were relatively ignored—as it was in general psychiatry due to Freud’s critical views on religion—until more recently. I could have earlier and more overtly pushed for a recognition of humanitarian psychiatry. The humanitarian approach is essential to the goals of positive social psychiatry. Although this humanitarian approach can be criticized for focusing on us humans and not the rest of living things and the earth, the fact that our fate is intertwined with our ecology requires our concern for our entire earth.

But perhaps it is not too late for me to pay more attention to the humanitarian approach, and this honor kick-starts the process. Possibly, as a roctogenarian would say, now is even the best or most important time. As artificial intelligence takes over mathematical and collating skills, the humanities will likely be needed even more. The humanities explore what it means to be human, including the arts, philosophy, religion, and more. Humanism puts those foci into a value system but leaves out the divine. Humanitarianism can include the divine religious beliefs and tries to address the obstacles, including mental challenges, to our human potential. Though often causing some terminology confusion, the humanities, humanism, and humanitarianism all together are connected to humans and our quest to find meaning in our lives.

Perhaps I am embarking on being a humanitarian futurist. Perhaps the greatest gift of this humanitarian award and your focus on it, for me, is that it emphasizes and reminds us of the importance of the humanitarian in psychiatry. In retrospect, humanitarianism was always there for me and psychiatry, but we did not seem to know it. Now I do. May psychiatry know it, too.

PT: Thank you!

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in 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 L. Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the 1-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 on Mental Illness 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 also serves on the editorial board of Psychiatric Times.