Leo Sher, M.D.

Today, we publish an interview with an eminent American psychiatrist, Dr. Robert G. Stern.

Robert G. Stern, M.D. is Professor of Psychiatry and Behavioral Health and Director of the Geriatric Psychiatry Fellowship Program at the Hackensack Meridian School of Medicine in New Jersey.

Leo Sher: What is the most important issue in contemporary psychiatry?

Robert Stern: The biggest challenge in contemporary psychiatry is anticipating the mental health crisis caused by AI-driven job displacement. As AI replaces millions of workers, many will face unemployment, loss of purpose, and deepening isolation—key drivers of depression, anxiety, and addiction. The erosion of meaningful roles and human connection could lead to widespread loneliness and societal despair. Psychiatry must adapt by addressing not only individual symptoms but also the broader social and existential fallout. Without proactive measures—such as building community, fostering resilience, and redefining the role of work, this wave of psychological suffering may overwhelm current systems of care.

References:

Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior, 74(3), 264–282. https://doi.org/10.1016/j.jvb.2009.01.001

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352

Patel, V., Saxena, S., Lund, C., et al. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553–1598. https://doi.org/10.1016/S0140-6736(18)31612-X

Leo Sher: How do you see the future of psychiatry?

Robert Stern: The increasing dominance of artificial intelligence, data analytics, and automated decision-making systems in psychiatry presents significant risks alongside potential benefits. While these technologies can enhance early diagnosis, personalize care, and improve efficiency, there is a growing concern that psychiatry could be repurposed as a tool for social conformity and control. Automated systems—such as predictive behavioral algorithms, emotion recognition via wearables, and social media monitoring—may flag individuals as mentally unstable based on opaque or biased criteria, raising the risk of unjust labeling and coercive interventions.

Ethical challenges include threats to patient autonomy, informed consent, and privacy, as well as the potential for surveillance and misuse of sensitive data. There is a risk that psychiatric practice could shift from prioritizing individual well-being to enforcing normative behavior, especially if diagnostic labels and treatment mandates are used to manage dissent or nonconformity in an AI-governed society. The World Psychiatric Association emphasizes the need for ongoing revision of ethical codes and robust safeguards to ensure that digital psychiatry remains patient-centered and respects human rights.

To mitigate these risks, medical literature highlights the necessity for transparency in algorithmic decision-making, unbiased model development, and the integration of human oversight in clinical care. Without these safeguards, the coercive potential of digital psychiatry could undermine trust, exacerbate stigma, and compromise the therapeutic alliance.

References:

AI in Mental Health: A Review of Technological Advancements and Ethical Issues in Psychiatry. Poudel U, Jakhar S, Mohan P, Nepal A. Issues in Mental Health Nursing. 2025:1-9. doi:10.1080/01612840.2025.2502943.

Ethical Dilemmas Posed by Mobile Health and Machine Learning in Psychiatry Research. Jacobson NC, Bentley KH, Walton A, et al. Bulletin of the World Health Organization. 2020;98(4):270-276. doi:10.2471/BLT.19.237107.

Commercial Use of Emotion Artificial Intelligence (AI): Implications for Psychiatry.

Monteith S, Glenn T, Geddes J, Whybrow PC, Bauer M. Current Psychiatry Reports. 2022;24(3):203-211. doi:10.1007/s11920-022-01330-7.

Ethical Challenges in Contemporary Psychiatry: An Overview and an Appraisal of Possible Strategies and Research Needs. Galderisi S, Appelbaum PS, Gill N, et al. World Psychiatry: Official Journal of the World Psychiatric Association (WPA). 2024;23(3):364-386. doi:10.1002/wps.21230.

Evidence, Ethics and the Promise of Artificial Intelligence in Psychiatry. McCradden M, Hui K, Buchman DZ. Journal of Medical Ethics. 2023;49(8):573-579. doi:10.1136/jme-2022-108447

Leo Sher: What needs to be done to improve psychological health and reduce suicide rates among the elderly?

Robert Stern: From a geriatric psychiatrist ‘s perspective, to improve psychological health among the elderly and reduce global suicide rates, it is essential to redesign communities, towns, and cities in ways that prevent social and physical exclusion. Modern urban environments often isolate older adults through car-centric layouts, inaccessible infrastructure, and age-segregated housing. This physical separation can lead to emotional isolation, loneliness, depression, and even suicide. Instead, urban planning must embrace adaptive, age-inclusive design—integrating mixed-use neighborhoods, walkable spaces, accessible public transport, and intergenerational housing. Architecture and public spaces should promote daily social interaction, autonomy, and a sense of purpose. Cities must evolve into environments that support aging in place, not exile. By embedding elderly individuals in the social and functional life of the community, we foster connection, dignity, and mental well-being. This shift in urban thinking is not just compassionate, it is a public health imperative.

References:

Aging, Urban Design, and Mental Health. World Health Organization (WHO). (2007). Global Age-friendly Cities: A Guide. https://www.who.int/publications/i/item/9789241547307

Buffel, T., Phillipson, C., & Scharf, T. (2012). Ageing in urban environments: Developing ‘age-friendly’ cities. Critical Social Policy, 32(4), 597–617. https://doi.org/10.1177/0261018311430457

Built Environment and Mental Health Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., & Allen, R. E. (2012). The meaning of “aging in place” to older people. The Gerontologist, 52(3), 357–366. https://doi.org/10.1093/geront/gnr098

Yap, M., & Thompson, S. (2018). Age-friendly cities and communities: The intersection of urban planning and public health. Journal of Aging and Environment, 32(1), 18–33. https://doi.org/10.1080/02763893.2017.1393486

O’Connell, H., Chin, A. V., Cunningham, C., & Lawlor, B. (2004). Recent developments: Suicide in older people. BMJ, 329(7471), 895–899. https://doi.org/10.1136/bmj.329.7471.895