A Social Psychiatry Manifesto that Takes Social Context Seriously

A re-visioned approach to social psychiatry aims to understand the broad influence of social life on mental health.

Micah Ingle, MA
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A recent article published in World Social Psychiatry aims to construct a new definition of social psychiatry that addresses the limitations of existing biomedical psychiatric models focused on brain disorders. Specifically, the author, psychiatrist Vincenzo Di Nicola is interested in what is social about psychiatry, and in creating a manifesto which urges psychiatry in a more social direction. Current approaches, Nicola argues, fail to address many of the problems facing us in the 21st century, such as climate change, mass migration, and poverty.

“Social psychiatry is the ultimate apparatus for the study of the social context of human predicaments, the widest possible context. Understanding humans out of context is not only limited but also deeply misleading, as many contend, yielding pseudoproblems and the conundrums that psychiatry and the social sciences have created in their descent into the ‘spiral staircase of the self,’ in Montaigne’s memorable phrase,” writes Vincenzo Di Nicola of the University of Montreal. 

Photo Credit: Pixabay

Critical perspectives on psychiatry often emphasize the notion that psychiatry focuses too narrowly on individual brains, to the neglect of social factors and processes. The biomedical model of mental illness, even when it gives lip service to the “bio-psycho-social,” often relies on a model of psychiatry which locates suffering in the dysfunction of an individual rather than the broader social context, including factors such as poverty and intergenerational trauma.

On the contrary, many sociologists and historians of science have pointed to the inherently social nature of “mental illness,” or human suffering. Contemporary researchers have called for additional research into these social factors, such as housing instability and food insecurity.

Despite these developments, psychiatry often remains fundamentally conservative, and may require a theoretical and practical re-visioning if it is to be able to account for broader understandings of what constitutes “mental illness.”

The current paper seeks to offer new theoretical and practical insights for a social psychiatry that understands the individual as relational and contextual. The author argues that although “social” and “psychiatry” can seem at odds, drawing from disciplines such as medical anthropology and sociology can help us to reclaim and expand a version of psychiatry that is more sensitive to social context.

“Social psychiatry offers the specialty of psychiatry and all of medicine greater coherence through an integration of the biomedical model with the larger context of the social determinants of health and the relational aspects of all human interactions,” explains Di Nicola.

The paper argues that social psychiatry must concern itself not only with traditional psychiatric issues, but also “the natural environment (climate change and mental health), the built environment (homelessness, the housing crisis), and the social environment (identity, belonging, migration, and massive change).”

Toward this end, Dr. Di Nicola points to the need for a pluralistic foundation for social psychiatry which rejects simplistic binaries such as nature versus nurture, individual versus collective, subjectivity versus objectivity, and social versus biological. To fight these entrenched dichotomies, the paper argues for a pluralistic philosophy, an emphasis on interdisciplinarity, and a multi-method research program which includes the humanities as well as “transcultural psychiatry, cultural psychiatry, comparative psychiatry, crosscultural psychology, medical anthropology, medical sociology, and GMH [the Global Mental Health movement].”

The paper continues by describing what Dr. Di Nicola calls “psychiatry fast and slow,” adapted from Daniel Kahneman’s “thinking fast and slow” work on cognition. “Fast psychiatry” is concerned with many more traditional aspects of psychiatry, such as empirical research, pragmatic and technocratic solutions, thin descriptions of client experience, mastery, and experimental research. Examples of “fast psychiatry” can be found in cognitive-behavioral therapy, psychiatric pharmacotherapy, genetics research, and “the reductive use of biological psychiatry and neuroscience.”

“Slow psychiatry” on the other hand is concerned with broader rational thinking, thick “phenomenological” descriptions of experience, accumulation of comprehensive knowledge across disciplines, pluralism, and investigation. Dr. Di Nicola lists examples of “slow psychiatry” as psychoanalysis, family therapy, narrative psychology, transcultural and cross-cultural psychiatry, studies on the social determinants of health, social neuroscience, and more.

A rebranded social psychiatry would take all of these approaches and perspectives into account in an effort to meet the demands of psychiatry for the 21st century. 

Turning to his own definition of social psychiatry, Dr. Di Nicola points to social psychiatry as an envelope, a bridge, and a map. He describes an envelope as a broad context for understanding human struggles. A bridge refers to the need to develop dialogues between the natural sciences and the human and social sciences. A map, here, refers to the necessity of understanding human beings through an analysis of “affectionate bonds and family and social relationships.” 

In doing this work, social psychiatrists must avoid both “methodolatry” and “scientism,” or placing too strong an emphasis on traditional forms of research and narrow scientific investigation. Again, pluralism is key.

Describing the “minimal requirements” for a new social psychiatry, the paper states that it must develop a “theory of how humans work,” a “theory of psychiatry as both a branch of medicine and a social science,” and a “model of practice.” All of these requirements must be able to integrate the various findings and practices of different fields, including more traditional neuroscientific and psychiatric disciplines, but not being limited by them. 

Dr. Di Nicola argues for a “levels” approach to these issues, accepting that biomedical medicine can help explain biological phenomena, cognitive science can explain cognition, and in a more progressive direction, critical thinking from the humanities as well as relational forms of psychology have their own insights to offer, which cannot be reduced to the previous levels.

In discussing the need for a social psychiatry manifesto at this particular point in history, Dr. Di Nicola points to a variety of social issues that traditional psychiatry has not adequately addressed. Among these are the “hidden injuries” of economic class, rapid and massive change because of globalization, the social construction of many psychiatric categories, the need to dialogue with the “global south” and other non-western worldviews, issues of migration and border control, as well as natural disaster and war. All of these issues influence our individual and collective “mental health.”

Finally, Dr. Di Nicola argues for a new vocabulary. Concepts such as “self-esteem” must be understood as “social esteem” because of the link between self and society. The “self” must be understood as a “self-in-relation” or a “social self.” Psychiatric problems must be understood as “relational” problems. Health, the paper argues, is first social. Additionally, the paper criticizes the “client” and “consumer” forms of terminology as suggesting consumerism and exchange, preferring the older “patient” which signals a deeper sense of human suffering.

The author concludes:

“Social psychiatry upends much of the Western tradition that reasons from self to the society. Employing other strands in the Western tradition and supported by much wisdom and cultural traditions in other societies, Social psychiatry reasons from society to self. We are born with the capacity – properly nurtured – to become fully human, as we construct that notion in different places and different times. Social psychiatry focuses on attachment, on the caregiver bond, and lifelong social relations to create a sense of self and of belonging in the human community. Self emerges from social relationships and this social self is most properly seen as a selfinrelation. The “selfmade man” is a myth that found its avatar in the work of Ayn Rand where the heroic individual is responsible to no one. In the solipsistic Randian universe, social relations count for nothing, only the endless affirmations of the heroic self.”

 

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Di Nicola, V. (2019). A person is a person through other persons: A social psychiatry manifesto for the 21st century. World Social Psychiatry, 1, 8-21. (Link)

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Micah Ingle, MA
MIA Research News Team: Micah Ingle is a doctoral student in Psychology: Consciousness and Society at the University of West Georgia. He has published on therapeutic approaches centering the person-in-context, as opposed to the individualizing medical model, and on the characteristics of people high in empathy. His current interests include the intersection of sociopolitical/economic structures and mental health, individualism in psychology, gender, liberation psychology, and mythopoetic perspectives inspired by Jungian thought.

11 COMMENTS

  1. “Without metaphorical understanding, everything is only what it is and must be met on the simplest, most direct level. Everything then is a call to action and the hero is there to realize himself in a reality that serves his literal notion of it. A view of reality that does not recognize other views is of course delusional. In the heroic ego’s case, the delusion is self-divinization, the perspective of the human ego as the superior, indeed the only, actuality. The rest is not real. . . .

    Without imaginal understanding, we may expect killing, as if our culture cannot ever take down the wild Western ego until it has restored the ancient sense of image and recovered the imaginal from the broken shards of reformational literalism.”

    James Hillman, The Dream and the Underworld (NY: Harper & Row, 1979), p. 115.

  2. To Automatically Recover from “Severe Mental Illness” like “Schizophrenia” or “Manic Depression” a person needs to:-

    1. Taper from the drugs very carefully

    2. Join a Relevant Peer Support Group (To deal with the effects of Drug Withdrawal)

    3. Expect a Rocky Ride

    • But no one recovers from ~Mental Illness~ because there is no such thing.

      And their path will be far more rocky if they are led to believe in ~mental illness~ ~psychotherapy~ or ~recovery~.

      Those drugs should not exist. Those who have been prescribing them should be prosecuted for Crimes Against Humanity. Those who have been giving them to children should receive the ultimate penalty.

  3. This is all well and good for the unborn generations but there must be a day of reckoning in which all who have harmed by the authoritarian practice of bio psychiatry must be heard and those who harmed them must be held accountable for their crimes.

    • Yes, a day of reckoning,

      https://en.wikipedia.org/wiki/Doctors%27_trial

      Psychiatry, coerced treatment, and the bogus drugs all fall within Nuremburg Precedents. And likewise, it is wrong to use mental health questionnaires, or to write or publish articles based on them.

      Otherwise it is going to be just endless debate, as new violators figure out ways to use the horrors of Psychiatry and Psychotherapy to justify their new stuff. Abusing survivors is highly profitable, and survivors having been abused before, we are easy to abuse again.

      There have to be severe criminal penalties, for the doctors, and sometimes for the parents too. And where it fits, for Foster Care Systems.

  4. The unfortunate truths about psychiatry, and psychology, is that they are two sides of a, primarily child abuse covering up, “mental health” industry pendulum.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    https://www.madinamerica.com/2016/04/heal-for-life/

    And this is by DSM design:

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

    Also, none of the DSM disorders are valid illnesses.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    Does distress exist in this world? Of course it does. However, it’s insane to believe distress is caused by a “chemical imbalance” in a person’s brain, distress is caused by real life distressing events. For goodness sakes, our “mental health” workers believed distress caused by 9/11/2001 was “distress caused by a chemical imbalance in my brain” alone. How insane can the “mental health” workers be? And that is political abuse of psychiatry, which is illegal.

    Innately psychiatry/psychology are “blame the victim” or blame the client industries. Psychiatry and psychology attempt to destroy anyone they can get their hands on, at their weakest moment, after hypocritically promising to “first and foremost, do no harm.”

    Psychiatry/psychology also function as the proactive malpractice suit prevention team for the balance of the medical industry. While our medical community rapes the entire country for their malpractice insurance, but does not utilize it when they have committed malpractice.

    Psychiatry’s drugs cause the symptoms of their “serious DSM disorders.” The ADHD drugs and antidepressants can create the “bipolar symptoms,” as Robert Whitaker pointed out.

    The antidepressants and antipsychotics can both create the positive symptoms of “schizophrenia” – like psychosis and hallucinations – via anticholinergic toxidrome poisoning. And the antipsychotics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    But all the psychiatrists – who were taught about these psychiatric drug poisoning methods in med school – all claim ignorance of this reality. Merely because they neglected to include these medically known, psychiatric drug induced, syndrome/toxidrome in their DSM billing code “bible.”

    Psychiatry also voids the rule of law, since they can – without cause – incarcerate anyone they want for any reason they please. Which seems to be largely attacks on child abuse survivors, one of the few groups of people that our “mental health” workers may NOT bill ANY insurance company to help.

    And all of psychiatry’s/psychology’s child abuse covering up does also function to aid, abet, and empower the pedophiles. So we are now living in a pedophile controlled “empire.”

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

    Don’t get me started on the never ending war mongering and profiteering, bailout needing, fiscally irresponsible, “banks steal trillions worth of houses” globalist banksters’ crimes. Since they’re the ones who’ve funded the miseducation of all our DSM deluded “mental health” workers.

    Rather than trying to remake psychiatry, our society would be much better off if we eliminated the child abuse covering up industries (psychiatry and psychology), and started arresting the pedophiles instead. I’d like to see a return to the rule of law in the US.

    I’d also like to see an end to our modern day, on going, but unmentioned in the mainstream media, psychiatric holocaust, too.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    Coming up with new ways to market the same old crap, while not bothering to mention the egregious societal harms and crimes the psychiatric industry has, and still is participating in, sounds pretty. But, really, I think our societies should get rid of our, primarily child abuse covering up, DSM “bible” believing psychiatric and psychological religion instead.

    If the psychiatric and psychological industries had, as their primary actual societal function, and at their core, something that was legal (covering up child abuse is still illegal in America) or scientifically valid. i’d be for reforming those industries, but they don’t.

  5. The term “social psychiatry” appears to me to be an oxymoron. It fails to recognize the corrupt nature of the current biomedical model and suggests that it is feasible to “integrate” this model with more social/psychological views of emotional distress. This is in my view impossible, because the biomedical model is driven by profits and the interests of the APA to control the narrative, and is not in any way directed toward “health,” even in the metaphorical sense. It is directed toward profit and control, and as such, can’t be integrated into anything rationally focused on improving people’s lives. If you want a socially responsible and flexible approach to people’s emotional well being, don’t bother with the current model. You’d need to start over from scratch.