A Blueprint for an ‘Ecosocial’ Person-Centered Psychiatry

New article pushes for a shift from a psychiatry centered on brain circuitry toward an 'ecosocial' view of mind, brain, and culture.

Hannah Emerson
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A new article, published in World Social Psychiatry, calls for a shift in perspective from a form of psychiatry founded in brain disorders towards one established on considering the effects of culture and social systems. The author, Laurence Kirmayer from McGill University, highlights how racism, discrimination, and economic inequality are among the most powerful determinants of global mental health, and encourages advancement in the field of social psychiatry to better understand the mechanisms of mental health.

“To advance the field, we need integrative theory and practical tools to better understand, assess, and intervene in the social-ecological cultural systems that constitute ourselves and personhood,Kirmayer writes. “This opens the door to creative engagement with human diversity in all its forms.”

Photo Credit: Joana Coccarelli, Flickr

Kirmayer illustrates the role of culture in social psychiatry through exploring the interchange of social psychiatry, culture, and the human mind. Social psychiatry is “grounded in the recognition that we are fundamentally cultural beings.Cognitive science supports a perspective that mainly considers culture, as it views circuits of the mind extending “out into the world, through our tools, discourse, practices, and institutions that enable cooperation.”

Culture can be understood as the “many ways in which the social world is configured by meaning and tradition.” It is identified as being both in the brain and in the world, e.g. “in embodied skills and dispositions to respond and in social institutions and practices.” Culture locates how we feel, understand, and respond to distress. The relationship between the brain and culture is central to reforming psychiatry, Kirmayer argues:

Crucial for psychiatry is the aspects of culture that constitute mind and brain across development and are therefore central to processes of psychopathology and healing, that contribute to discrimination, marginalization, and social disadvantage (and rationalize inequity), and that leads us to fail to recognize the other in the context of their life-world.”

The mechanisms of the mind integrate biochemical and narrative functions, shaping stories over time by “weaving webs of meaning through language, imagery, and performance.” Kirmayer explains that “memory, identity, and action are organized in terms of narratives that locate us in space and time.” The “many-storied mind” is pertinent to consider in psychiatric theory and practice as it constitutes our personhood. Kirmayer elaborates:

“In particular, narrative capacities, skills, practices, and specific content all can contribute to the causes, course, and outcomes of psychopathology as well as to processes of coping, resilience, healing, and recovery.”

The article concludes with implications for research, clinical practice, public health, and policy emphasizing how striving to incorporate an ecosocial perspective allows for person-centered psychiatry by considering the effects of social context and individual experience.

“We need innovative psychiatric theory, research, and modes of practice, as well as vigorous advocacy to work toward a world of greater equity and humanity. Social psychiatry has a crucial role to play in this- especially when it engages with diversity and recognizes the central place of culture in our being and becoming.”

 

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Kirmayer, L. J. (2019). Toward an ecosocial psychiatry. World Social Psychiatry 1(1), 30-32. DOI: 10.4103/WSP.WSP_9_19 (Link)

9 COMMENTS

  1. The real problem with all of these blogs about the social determinants of health and psychiatry is that the authors don’t seem to get the fundamental conflict between the two. Psychologists and social workers are in a perfect position to deal with social and cultural issues. Psychiatry is the medical discipline that treats the individual for illnesses it’s own bible has placed within the individual. If psychiatry were actually concerned with medical causes of extreme states, it would be looking at the body, not observing, judging and labeling behavior. DSM 5 doesn’t even require an interview with the patient!

    The notion that the medical discipline of psychiatry can reform itself to be concerned with SDOH would be laughable if not for the apparent sincerity of the few pushing for this.

    So again, if the cause isn’t medical but rather social and cultural, why would we expect DOCTORS to treat it. This is as absurd as expecting police to deal with domestic issues. Cops train to dispense threats with lethal force. Doctors train to treat medical illnesses. Therefore expecting doctors to act like social workers is as stupid as expecting cops to act like social workers.

    It’s time to end psychiatry as we know it to be a pseudoscience masquerading as medicine and compounding people’s problems by trying to address social issues by adjusting neurotransmitters. What on earth is there to reform or save? And why isn’t there instead a push to return these problems of living to the domain of those who train to understand human social dynamics?

  2. Interesting thoughts. But can it be morally and ethically done?
    This goes to the demise or restructure debate. Germany, Rwanda, and the United States after the Civil War are examples of the restructure approach with huge differences on how that was managed.
    Vietnam is also another country one can look to , in terms of handling hortorific trauma. That war was really the first ever time vets were really able to go back and process and meet with people who once they actively fought against. Some in WWII were able to meet with enemies as well but for many silent sufferings as in past military actions of all kinds throughout time.
    WWI showed Psychiatry actively working to put soldiers back into military action. We have the writings of many of the English writers who served on the frontlines to show us how it was accomplished. Tolkien was a WEI soldier and of course he came up with the creation of IRCs. One can see in a small way reading about his life where it originated.
    Of course if anyone today would talk of Orcs and night time fears they would be vanished and vanquished into the bowels of the MH industrial military medical complex/ and I paraphrase President Dwight D Eisenhower here in his last important speech. He was a General inWWII and lived out his retirement years on a farm in full view of Gettysburg Notional Park.
    What I find missing is the voice of survivors and any understanding or comprehension of restorative justice in the MH field.
    Any professional worth their salt is able to relate and accept their mistakes and errors. And if they don’t then. let us all show them the door.
    When involved with any type of professional helper I always admired the ones who knew and admitted to “ I really blew it this time or times.
    One doc said to me-“ When I was young, I thought I knew everything , now I listen to the mothers and follow their lead.”
    And for those reading this who were abused by their mothers and I am so sorry especially for those that ended up having help create even more or worse hurt- I believe that if one can see I am imperfect and I just want to help- they might be the ones to see all mothers are not perfect either. Atleast that is my hope.
    I will not trust those who do not admit errors and mistakes but I will try and give leeway to those who not only LISTEN and admit imperfection but also are willing to work together side by side despite ongoing disagreements.
    If that doesn’t evolve than demise is the only other solution. We never resolved the Civil War and look where that has led us.

  3. Another call for a “new” type of psychiatry ….

    1) Psychiatry has betrayed their clients. They have been turning millions of innocent people, including over a million children, into “bipolar” patients with their ADHD drugs and antidepressants, for decades.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    And they’ve been creating the “schizophrenia” symptoms in millions of innocent people for over 50 years, with their antipsychotics/neuroleptic drugs, which are being prescribed to people with many labels/stigmatizations now.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome (anticholinergic toxidrome)

    2) Both psychiatry and psychology are primarily child abuse covering up industries, which means their primary actual societal function is illegal.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    And these child abuse covering up crimes are by DSM design. No “mental health” worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, unless they first misdiagnose them with one of the billable DSM disorders.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    3) Psychiatry and psychology are anti-American, they do not believe “all people are created as equal.” That’s the opposite of their DSM’s theology. The psychiatrists and psychologists function as – outside the law – minion of the never ending war mongering and profiteering, bailout needing, fiscally irresponsible, “banks stole $trillion in houses,” globalist banksters. Albeit, they serve this function largely through the paternalistic religions. And the psychiatrists always have been the globalist central bankers’ minion, including in Nazi Germany and Bolshevik led Russia. Both central banks and psychiatry are part of the communist manifesto.

    4) Psychiatry has murdered millions historically, and their psychiatric drugs are killing 500,000 elderly a year today. And God knows how many younger people they’re killing today.

    https://breggin.com/peter-breggin-md-psychiatric-totalitarianism/
    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    5) Psychiatry’s DSM “bible” is “invalid” and “bullshit,” according to head of NIMH and the authors of the DSM.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
    https://www.wired.com/2010/12/ff_dsmv/

    6) When a society has a group of, primarily child abuse covering up and profiteering, “mental health” industries, which are – of course – also functioning to aid, abet, and empower the child molesters and child traffickers. You end up in a world where the pedophiles and human traffickers run amok, which is the disgusting world in which we now live.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines

    I’m quite certain, given the staggeringly destructive nature of the psychiatric industry, historically and still today, abolishing psychiatry would be wiser, than remaking this – technically unneeded – industry. But I also believe the central banking system, that creates the money our psychiatrists and psychologists worship out of thin air, should be abolished as well. America should abolish the systems which are of a communist origin.