I also appreciate this piece and find it very on-point. I think what the Trump administration is effectively doing is acutely honing in on every crack and inconsistency (there are some legitimate problems in medicine or psychiatry, Harvard does have a huge endowment and tax-free status) and splitting them wide open to cast aspersion on the entire premise. He's phenomenally good at this.
I do think psychiatry and mental health began, after a long delay, to take a political stand with support of trans rights, and I think the rights of trans youth became a lighting rod for this administration.
I appreciate that you find yourself not knowing what to do. I've been wondering how I as a psychiatrist have any impact, other than signing letters through the APA. Trump has shown a capacity to destroy the credibility of people like judges, and heads of universities, who are ordinarily regarded with respect; he can easily destroy whatever credibility we have as a profession. But we also can't in good conscience not act.
Sorry- I meant that I think our embrace of a more liberal gender ideology, generally, and in particular applied to youth, has been viewed as political. And in a way it is, because at times it puts kids at odds with parents. Trump is exploiting this tension point.
I do feel inclined to push back when you say “Congress couldn’t even save the expanded child credit that had cut child poverty in half. So what can physicians do in a situation like that? We simply do not possess the political authority to offer anything beyond policy guidance”
There are examples of physicians and other health professionals engaging through advocacy and direct activism, like Doctors for XR/Health for XR, and Physicians for Social Responsibility. Some medical schools and residency programs even train doctors to engage in advocacy and organizing. And we have plenty of physicians who have stepped up and run for elected office.
As somebody who has worked in both health and climate spaces I think it can be helpful for health professionals to work in coalition with all sorts of interest groups to tackle issues like housing and income inequality that can exacerbate mental health issues.
Thanks John! Yes, I don’t mean to suggest that this excludes “advocacy” in the sense you are mentioning. I’m all for it. My only concern is that when it comes to issues where public opinion is fiercely divided along partisan lines (gun violence, various issues around COVID, health insurance, social welfare, etc), a) does physician activism result in medical community being seen as a partisan actor, and b) does it actually lead to meaningful political action that has bipartisan support.
PS I tried to find examples of psychiatrists in public office and couldn’t come up with a single example, but I’m really curious if there are any of them out there!
This is such an elegant synthesis of the many thoughts that arise when we think about the current climate. American psychiatry, put on the defensive, and tasked with setting the record straight on “the science” yet has too often lacked the pluralism and nuance to do so. The deprioritizing of structural determinants in establishment psychiatry for so long, and when finally emphasized, there is little power to do much about it.
I appreciate your perspective on the limitations of Reinhart’s calls too. Things just seem so bleak when all that organized medicine aspires to be is a trade guild for physicians professional interests, not a real vehicle for social change. I do feel like for me there *was* activist tendencies before I’ve gradually been succumbing to cynicism. Still reflecting on where I go from here
I really appreciate this piece. It resonates (kind of) by extension, while also being personal. More than that, it’s very important. I’m so glad I subscribed, here. Thank you.
So disheartening yet invigorating. I appreciate the honesty in this piece. I will save it for the references to share with students I come across. There is a message here that needs an audience to build momentum.
This morning, as I was doom scrolling Reddit, I found myself thinking “ I wonder what psychiatry thinks about all of this craziness?” A few minutes later, this post appeared in my Substack feed. Thanks for writing this. I intend to read a few of the pieces you cited.
'Scientific and academic institutions' cease to be such when they stop utilizing scientific and academic methodologies.
Merely wearing a white lab coat and declaring "I am the science" does not make one a scientist.
The Scientific Method has specific components that must be present in order for something to be considered actual Science. A failure to include those components and then emotionally demand that such opinions be called 'science' is nothing more than a narcissistic appeal to authority and, in some cases, religious zealotry.
Merely being appointed to and holding a position at an academic institution does not make one an academic. One's title and degrees hanging on the wall of a once-great Ivy League institution are not evidence of that individual's ability, or their intent, to disseminate useful knowledge to the members of the society.
Scientific and academic institutions are critical components of a highly advanced civilization.
Therefore, when those entities are no longer being administered in a way that produces the positive results envisioned by their founders, fundamental and, sometimes aggressive, actions must be taken to right the course.
Look at the fruits of the scientific and academic industrial complex in the United States.
Morbid obesity, drastically decreasing IQ, and a perennial dropping of the nation's academic and economic rankings among developed nations are now the expected outcomes in America.
Although one could attempt to make the argument "Well, they're doing the best they can," a better and stronger argument would be that the results achieved, shoved right in our faces every day, were the intended consequences of a very well-planned and implemented agenda.
One only needs to read 'The Deliberate Dumbing Down of America: A Chronological Paper Trail' by Charlotte Iserbyt to see exactly how such an agenda was devised and deployed. Not by some shadowy organization, but by elements within the government of the United States of America.
Although there are most definitely some sincere and talented individual contributors in the scientific and academic arenas, the overwhelming mass of participants are those who just want to make a living. That is their primary objective.
Honest scientists and academics who tell the truth and provide logical and inexpensive solutions to the world's biggest problems are shunned because they threaten the profit and power objectives of those who write the checks for research grants and have the power to get professors fired.
No decent argument can be made that the system, as currently run, should continue.
And it is those who benefit greatly from this corrupt system who run around shrieking "the tyranny!!! but the science!!! but Harvard!!! Fascists!!! Nazis!!!"
Any reasonable person who objectively and rightfully associates the rotten fruit produced by this system with those who are fighting tooth and nail to preserve it, must come to the conclusion that forced change is necessary at this juncture.
The dirty birds who built their own dysfunctional nest will not vacate it without some very strong urging.
Please remember that concerned Americans see and remember those who profit greatly from perpetuating this corrupt kakastocracy.
It’s time to start from a place of humility: medicine has helped many, but it has also harmed many. That harm may be systemic and unintended, but it’s real—and denying it is both delusional and disrespectful to those who feel failed by the system. People turn away from medicine not just because they’re misled, but because they’ve been dismissed, coerced, overmedicated, or ignored.
Movements like MAHA don’t emerge in a vacuum. They grow in the gaps we’ve left behind. Figures like RFK Jr. offer a narrative that resonates: mistrust of corporate capture, skepticism of overmedicalization, and a desire for sovereignty over one’s body. That narrative may be flawed and even dangerous—but it responds to real grievances we haven’t addressed with honesty or imagination.
Instead of reacting with contempt or scientific righteousness, we need to ask: What are people seeking that the system hasn’t given them? Meaning? Control? Safety? Belonging? Often, pseudoscientific beliefs emerge not from ignorance, but from wounds. If we respond only with correction and not compassion, we entrench the divide.
We also need to admit that many “science advocates” have their own blind spots. The original critique of MAHA, for instance, rightly calls out disinformation—but it fails to turn the mirror around. Much of modern medicine has reflexively dismissed traditional knowledge, nutrition, and environmental health concerns that are now increasingly supported by evidence (as sites like Examine.com show). Entire generations of lived experience have been written off—until they’re conveniently repackaged by mainstream institutions. That’s not science. That’s gatekeeping.
People are tired of being lectured by experts who won’t acknowledge their own fallibility. How many people’s living rooms can medical scholars really sit in? How many stories of medical trauma, dismissal, or quiet desperation are heard—not just studied—by the professionals who write about them?
We don’t need to choose between science and belief, between public health and personal freedom. We need to build something new—an honest, relational, and humble medicine that’s as committed to listening as it is to evidence. One that acknowledges the values that draw people to MAHA and offers something better: rigorous, transparent, human-centered care that doesn’t make people choose between trust and truth.
I also appreciate this piece and find it very on-point. I think what the Trump administration is effectively doing is acutely honing in on every crack and inconsistency (there are some legitimate problems in medicine or psychiatry, Harvard does have a huge endowment and tax-free status) and splitting them wide open to cast aspersion on the entire premise. He's phenomenally good at this.
I do think psychiatry and mental health began, after a long delay, to take a political stand with support of trans rights, and I think the rights of trans youth became a lighting rod for this administration.
I appreciate that you find yourself not knowing what to do. I've been wondering how I as a psychiatrist have any impact, other than signing letters through the APA. Trump has shown a capacity to destroy the credibility of people like judges, and heads of universities, who are ordinarily regarded with respect; he can easily destroy whatever credibility we have as a profession. But we also can't in good conscience not act.
Sorry- I meant that I think our embrace of a more liberal gender ideology, generally, and in particular applied to youth, has been viewed as political. And in a way it is, because at times it puts kids at odds with parents. Trump is exploiting this tension point.
Really appreciate this!
I do feel inclined to push back when you say “Congress couldn’t even save the expanded child credit that had cut child poverty in half. So what can physicians do in a situation like that? We simply do not possess the political authority to offer anything beyond policy guidance”
There are examples of physicians and other health professionals engaging through advocacy and direct activism, like Doctors for XR/Health for XR, and Physicians for Social Responsibility. Some medical schools and residency programs even train doctors to engage in advocacy and organizing. And we have plenty of physicians who have stepped up and run for elected office.
As somebody who has worked in both health and climate spaces I think it can be helpful for health professionals to work in coalition with all sorts of interest groups to tackle issues like housing and income inequality that can exacerbate mental health issues.
Thanks John! Yes, I don’t mean to suggest that this excludes “advocacy” in the sense you are mentioning. I’m all for it. My only concern is that when it comes to issues where public opinion is fiercely divided along partisan lines (gun violence, various issues around COVID, health insurance, social welfare, etc), a) does physician activism result in medical community being seen as a partisan actor, and b) does it actually lead to meaningful political action that has bipartisan support.
PS I tried to find examples of psychiatrists in public office and couldn’t come up with a single example, but I’m really curious if there are any of them out there!
This is such an elegant synthesis of the many thoughts that arise when we think about the current climate. American psychiatry, put on the defensive, and tasked with setting the record straight on “the science” yet has too often lacked the pluralism and nuance to do so. The deprioritizing of structural determinants in establishment psychiatry for so long, and when finally emphasized, there is little power to do much about it.
I appreciate your perspective on the limitations of Reinhart’s calls too. Things just seem so bleak when all that organized medicine aspires to be is a trade guild for physicians professional interests, not a real vehicle for social change. I do feel like for me there *was* activist tendencies before I’ve gradually been succumbing to cynicism. Still reflecting on where I go from here
Thanks. Your reflections - and the sense of powerlessness they appear to express - filled me with sadness. A bit at a loss of words right now.
This shadow too shall pass. In the mean time, take care and keep sane.
🙌🏻 A very balanced, insightful take!!
I really appreciate this piece. It resonates (kind of) by extension, while also being personal. More than that, it’s very important. I’m so glad I subscribed, here. Thank you.
So disheartening yet invigorating. I appreciate the honesty in this piece. I will save it for the references to share with students I come across. There is a message here that needs an audience to build momentum.
This morning, as I was doom scrolling Reddit, I found myself thinking “ I wonder what psychiatry thinks about all of this craziness?” A few minutes later, this post appeared in my Substack feed. Thanks for writing this. I intend to read a few of the pieces you cited.
'Scientific and academic institutions' cease to be such when they stop utilizing scientific and academic methodologies.
Merely wearing a white lab coat and declaring "I am the science" does not make one a scientist.
The Scientific Method has specific components that must be present in order for something to be considered actual Science. A failure to include those components and then emotionally demand that such opinions be called 'science' is nothing more than a narcissistic appeal to authority and, in some cases, religious zealotry.
Merely being appointed to and holding a position at an academic institution does not make one an academic. One's title and degrees hanging on the wall of a once-great Ivy League institution are not evidence of that individual's ability, or their intent, to disseminate useful knowledge to the members of the society.
Scientific and academic institutions are critical components of a highly advanced civilization.
Therefore, when those entities are no longer being administered in a way that produces the positive results envisioned by their founders, fundamental and, sometimes aggressive, actions must be taken to right the course.
Look at the fruits of the scientific and academic industrial complex in the United States.
Morbid obesity, drastically decreasing IQ, and a perennial dropping of the nation's academic and economic rankings among developed nations are now the expected outcomes in America.
Although one could attempt to make the argument "Well, they're doing the best they can," a better and stronger argument would be that the results achieved, shoved right in our faces every day, were the intended consequences of a very well-planned and implemented agenda.
One only needs to read 'The Deliberate Dumbing Down of America: A Chronological Paper Trail' by Charlotte Iserbyt to see exactly how such an agenda was devised and deployed. Not by some shadowy organization, but by elements within the government of the United States of America.
Although there are most definitely some sincere and talented individual contributors in the scientific and academic arenas, the overwhelming mass of participants are those who just want to make a living. That is their primary objective.
Honest scientists and academics who tell the truth and provide logical and inexpensive solutions to the world's biggest problems are shunned because they threaten the profit and power objectives of those who write the checks for research grants and have the power to get professors fired.
No decent argument can be made that the system, as currently run, should continue.
And it is those who benefit greatly from this corrupt system who run around shrieking "the tyranny!!! but the science!!! but Harvard!!! Fascists!!! Nazis!!!"
Any reasonable person who objectively and rightfully associates the rotten fruit produced by this system with those who are fighting tooth and nail to preserve it, must come to the conclusion that forced change is necessary at this juncture.
The dirty birds who built their own dysfunctional nest will not vacate it without some very strong urging.
Please remember that concerned Americans see and remember those who profit greatly from perpetuating this corrupt kakastocracy.
It’s time to start from a place of humility: medicine has helped many, but it has also harmed many. That harm may be systemic and unintended, but it’s real—and denying it is both delusional and disrespectful to those who feel failed by the system. People turn away from medicine not just because they’re misled, but because they’ve been dismissed, coerced, overmedicated, or ignored.
Movements like MAHA don’t emerge in a vacuum. They grow in the gaps we’ve left behind. Figures like RFK Jr. offer a narrative that resonates: mistrust of corporate capture, skepticism of overmedicalization, and a desire for sovereignty over one’s body. That narrative may be flawed and even dangerous—but it responds to real grievances we haven’t addressed with honesty or imagination.
Instead of reacting with contempt or scientific righteousness, we need to ask: What are people seeking that the system hasn’t given them? Meaning? Control? Safety? Belonging? Often, pseudoscientific beliefs emerge not from ignorance, but from wounds. If we respond only with correction and not compassion, we entrench the divide.
We also need to admit that many “science advocates” have their own blind spots. The original critique of MAHA, for instance, rightly calls out disinformation—but it fails to turn the mirror around. Much of modern medicine has reflexively dismissed traditional knowledge, nutrition, and environmental health concerns that are now increasingly supported by evidence (as sites like Examine.com show). Entire generations of lived experience have been written off—until they’re conveniently repackaged by mainstream institutions. That’s not science. That’s gatekeeping.
People are tired of being lectured by experts who won’t acknowledge their own fallibility. How many people’s living rooms can medical scholars really sit in? How many stories of medical trauma, dismissal, or quiet desperation are heard—not just studied—by the professionals who write about them?
We don’t need to choose between science and belief, between public health and personal freedom. We need to build something new—an honest, relational, and humble medicine that’s as committed to listening as it is to evidence. One that acknowledges the values that draw people to MAHA and offers something better: rigorous, transparent, human-centered care that doesn’t make people choose between trust and truth.