“Until you make the unconscious conscious, it will direct your life and you will call it fate.” - Carl G. Jung
There are many ways in which psychiatry illuminates societal dynamics, and it is already in an active exchange with sociology, anthropology, religion, law, and public health, among other fields. Research points to the benefits of understanding the psychological dynamics underlying all human affairs, and the usefulness of connecting the biological, psychological, and social spheres in ways that psychiatry is uniquely equipped to do. Not only can psychiatrists deepen the discourse on matters most intimate to us, but they can also fulfill an ethical obligation to promote the public’s health and well-being.
Shifts in international norms regarding nuclear weapons have occurred due to bragging, threatening their use, and desiring to increase their stockpile in unprecedented ways. China, Russia, India and Pakistan have renewed their investments in nuclear weapons programs alongside North Korea, while last Friday, the U.S. issued a policy that signals a new kind of nuclear arms race with Russia (Sanger and Broad, 2018).
It is tempting to believe that these are purely policy-driven decisions and not problems of our own making. Recognizing the role of psychology in these affairs, however, can help us to direct our course in more life-affirming ways. Mental health professionals specialize in interpreting behavioral and thought patterns and can extrapolate these skills to understand the behavior of whole societies.
Furthermore, psychiatrists are supposed to “participate in activities contributing to ... the betterment of public health” (American Psychiatric Association, 2013, Section 7). Guidelines make clear that a neat separation between individual patients and the public is not possible (Sections 3, 6, 8 and 9). Accordingly, the overarching principle of medical ethics states that: “a physician must recognize responsibility to patients first and foremost, as well as to society” (American Medical Association, 2016, Preamble; emphasis added).
One of the most crucial contributions mental health professionals can make is to distinguish between what is normal and what is malignantly not. When there is a terminally ill individual at end stage, everyone can see that the person is not well. However, it may take a professional to recognize the illness in its early stages, when there is still time to do something about it.
Professionals bring to bear their knowledge of human behavior, patterns of pathology, and how impairment can “work” in masterful ways—not to mention their experience of innumerable similar cases or case studies. Furthermore, the majority in society will miss critical pathology by interpreting it in terms of what they know—that is, variations of the normal. For example, a lack of control can be interpreted as honesty, tendencies for attack can be seen as strength (when it is actually the opposite), and the intense desire to ”sense” others in order to overpower them through deceiving and manipulating can be mistaken for empathy (when the intention is to harm, not to help).
Human beings are indeed capable of immensely wide variations within the normal, with as many personalities as there are cultures. When mechanisms go awry and enter a state of disease, however, this capacity for variety and diversity diminishes. Predictability follows a decline in flexibility. Another characteristic of pathology is the loss of ability to recognize that something is wrong (or “loss of insight”). Still another is an attraction to pathology, or courses that are damaging, destructive, or even causing of death (or “loss of judgment”). The deeper the disorder, the poorer the insight and judgment, and the greater the destructive propensity. Mental health professionals can hence be a gauge for a person or a society as it enters into a drive toward destruction amid defense and denial.
Still, there are many misconceptions about psychiatry. First, a popular notion is that psychiatrists deal exclusively with mental illness. Yet they are capable of detecting considerable amounts, far before reaching any diagnosis, or quite apart from treating a diagnosable illness. When approaching a threat to public health, for example, diagnosing an individual from afar is not only impossible (though science points to it being increasingly feasible) but irrelevant. A clinician has no need to “diagnose” a person’s private condition unless responsible for his prognosis and treatment. If there are ramifications for the public’s health and security, on the other hand, then the health professional must act, regardless of diagnosis. This enters into a professional’s obligation to society: the health professional has a duty to report, to warn, and to take steps to protect potential victims, including the public.
Secondly, another common misconception regards what it means to diagnose. Assessing dangerousness, for example, is not diagnosing; it is about the situation, not the person. Signs of dangerousness can become apparent outside of a personal interview—in fact, a personal interview is of very little value when assessing dangerousness—and one only needs to have sufficient information to raise alarms about it. The health professional is expected to err, if at all, on the side of safety, and to push for an urgent evaluation—which can then yield diagnoses or lack thereof. Risk of danger based on available information is an emergency, and one is dangerous until proven otherwise through a thorough examination. Making a diagnosis, on the other hand, is about the person and requires all relevant information, including a personal interview, medical records, additional testing, and collateral information. The clinician may certainly have a “differential” or a running list of possible diagnoses but does not declare them without certainty, as they would mislead the public.
Thirdly, dangerousness itself has nothing to do with mental illness. Most individuals who are violent are not mentally ill, and most mentally ill individuals are more likely to be victims than perpetrators of violence. Mental illness, furthermore, has little to do with the inability to serve in a certain capacity; there are plenty of people who suffer illnesses but function fine at work, or even access unique strengths as a result. Rather, the silence and secrecy surrounding mental health matters perpetuate the exclusivity of mental illness and increase stigma. Mental impairment is treated differently than physical impairment because of a lack of knowledge: by medical standards, it is no less real, no less debilitating, and no less objectively observable. Psychiatric diagnoses are among the most reliable in medicine, and a consensus is not difficult to reach.
Finally, mental illness does not automatically exonerate one from criminal responsibility. Mental illness in itself, like physical illness, is neutral and in most cases does not interfere with a person’s agency. Nevertheless, a combination of mental impairment and criminal-mindedness can make one particularly dangerous.
There is a lot to be informed about regarding psychiatric issues, and we should not fear knowledge or block opportunities to educate. Correct awareness is a large part of public mental health promotion. An open discussion might rather help dispel myths as well as mitigate the use of psychiatric terms as insults, epithets, or a partisan ploy—a situation that does not have to be.
American Medical Association (2016). AMA Code of Medical Ethics. Chicago, IL: American Medical Association. Retrievable at: https://www.ama-assn.org/sites/default/files/media-browser/principles-of-medical-ethics.pdf
World Medical Association (2017). WMA Declaration of Geneva. Ferney-Voltaire, France: World Medical Association. Retrievable at: https://www.wma.net/policies-post/wma-declaration-of-geneva/
Sanger, D. E., and Broad, W. J. (2018). To counter Russia, U.S. signals nuclear arms are back in a big way. New York Times. Retrievable at: https://www.nytimes.com/2018/02/04/us/politics/trump-nuclear-russia.html