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| EDITORIAL |
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| Year : 2019 | Volume
: 1
| Issue : 1 | Page : 4-7 |
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Mens sana in societate sana… toward a wholesome world of social psychiatry
Debasish Basu1, Nitin Gupta2
1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| Date of Web Publication | 27-Sep-2019 |
Correspondence Address:
Prof. Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_19_19
How to cite this article:
Basu D, Gupta N. Mens sana in societate sana… toward a wholesome world of social psychiatry. World Soc Psychiatry 2019;1:4-7 |
Writing the first editorial for the inaugural issue of a new international journal, which is the official publication of an international learned society, is an onerous task, although perhaps just a shade less onerous than being “the editors” of “the Journal” itself!
The seminal idea of the World Association of Social Psychiatry (WASP) having its own professional journal was mooted almost 3 years ago by the Executive Council of WASP led by its then newly installed President Roy Abraham Kallivayalil. There were lengthy and intensive discussions, even debates, about the necessity, scope, and uniqueness of yet another publishing platform in the broad area of social psychiatry, especially when a number of well-established journals of high repute already existed in this and related areas.
Nevertheless, a consensus finally emerged that the new Journal – christened World Social Psychiatry – could indeed contribute to and further the cause of social psychiatry across the globe. Three major domains were identified as the defining mandates of this journal: analysis and dissemination of existing knowledge, encouraging new and innovative research, and promoting advocacy. Hence, the Journal would serve as a vehicle through this three-pronged approach to make social psychiatry a powerful and visible force worldwide. This is the proposed vision of the Journal.
After a long, arduous, and tortuous journey navigating various channels for over a year (we will spare the readers the boring details thereof), finally here we are: The WORLD SOCIAL PSYCHIATRY, official Journal of the WASP, 2019, Volume 1, Issue 1. And what a fitting occasion and place to launch it! The 23rd World Congress of Social Psychiatry, in Bucharest, Romania, the region where the founder of WASP, Joshua Bierer, came from. Among his many accolades and achievements, including the founding of the British Association of Social Psychiatry and the International Journal of Social Psychiatry which he edited for many years, he was also instrumental in organizing theFirst International Congress of Social Psychiatry in 1964, which later became the founding year of WASP. Thus, it appears somewhat more than mere coincidence that the official journal of WASP is being launched at such a historic place on this historic occasion! This is truly an example of serendipity!
Much has been written about social psychiatry – much debated, much activated, much forgotten, and much ignored. Time and space do not permit us to delve into the chequered, beleaguered, embattled but above all inspirational history of social psychiatry, or what all transpired by the name of social psychiatry. There are excellent texts, reviews, and perspectives dealing with this.[1],[2],[3] Suffice it to say, as Max Fischer put it boldly exactly 100 years ago (though in a very different context), “Without social psychiatry, there would be no psychiatry”.[4] After the post world war flourish of social psychiatry during the early 1950s through the late seventies and early eighties, it gradually started to take a back seat. Traditionally, the ascent of biological psychiatry is singled out as the main “culprit” leading to this onslaught. This is probably at least partly true. However, the issue is more complex, nuanced, and multifactorial.
One of the more fundamentally conceptual problems is the pitching of “biological” versus “social” psychiatry in an adversarial confrontation as if to declare the “winner” – and the winner is… (yes, you've guessed it right – depending upon which side you are on)!
Unfortunately, such an adversarial posturing does not help either. More importantly, it does not help psychiatry, mental health, and society at large.
Another, more “in-house,” problem is often the broad and at times confusing array of fields, concepts, activities, and applications that are covered under the term social psychiatry. Is social psychiatry a separate discipline, a “speciality area” within psychiatry? Other than the grand clinical psychiatry, we now have biological psychiatry, molecular psychiatry, translational psychiatry, computational psychiatry, precision psychiatry, cultural psychiatry, community psychiatry, and perhaps more. Where does social psychiatry fit into all this?
And what all does it include as its main methods and applications? Epidemiological methods focusing on the antecedents and consequences of mental illness? Therapeutic modalities focusing on groups, communities, milieus, and interactions? Structural inequities and their mental health consequences? Cultural and ecosocial forces shaping mental health and illness? Or moving on from nature-versus-nurture to nature-with-nurture?
Through this maze of boundary issues and multiplicity of theories, methods, and applications, however, there is one unifying theme – mental health (and illness) can never be a standalone, individually circumscribed phenomenon. In as much as “mind,” however defined, has its physical or brain substrates, the mind's properties, manifestations - indeed, its existence – are contingent upon the external world, with its sensory data, meanings, values, traditions, community, culture… in other words, people.
The age-old aphorism was mens sana in corpore sano (healthy mind in a healthy body). While this is true, we would venture to formulate an extension of this. The new aphorism is mens sana in societate sana (healthy mind in a healthy society). The influence, it is to be noted, is bidirectional: mind and society are mutually interdependent, and each is defined by the other in the context of mental health and illness. This, to our understanding, is the essence of social psychiatry.
It is interesting and heartening to observe that, after a period of relative lull, both the scientific world and international organizations are reawakening their focus on the mind–society continuum, this time in a more mature and nuanced contextualized manner rather than in the previous adversarial mode.
Top-notch medical journals such as the Lancet have been focusing on the social aspects of mental health for a number of years. In their recent publication, the Lancet Commission on Global Mental Health and Sustainable Development,[5] one of the four “Foundational pillars” of their reframed agenda is cited as: “the mental health of each individual is the unique product of social and environmental influences, in particular during the early life course, interacting with genetic, neurodevelopmental, and psychological processes and affecting biological pathways in the brain.” (Emphasis added). Even The New England Journal of Medicine, the highest rated medical journal of the world, has started a special series since last year, named “Case Studies in Social Medicine,” to “highlight the importance of social concepts and social context in clinical medicine. The series uses discussions of real clinical cases to translate theories and methods for understanding social processes into terms that can readily be used in medical education, clinical practice, and health system planning.”[6] The very first of this illustrious series started off with the story of a gravely disabled homeless man with a chronic psychotic illness and how social factors operated to medicalize or demedicalize his condition, with its serious consequences for his care.[7]
Leading from its important Commission on Social Determinants of Health, the World Health Organization published a seminal publication “Social Determinants of Mental Health” in 2014.[8] Most recently, in April 2019, the Special Report of the Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health categorically stated that:
“In the present report, submitted pursuant to Human Rights Council resolution 33/9, the Special Rapporteur elaborates on the critical role of the social and underlying determinants of health in advancing the realization of the right to mental health.
The Special Rapporteur outlines important opportunities and challenges associated with a human rights-based approach to actions on the determinants needed for mental health promotion. He argues that good mental health and well-being cannot be defined by the absence of a mental health condition but must be defined instead by the social, psychosocial, political, economic, and physical environment that enables individuals and populations to live a life of dignity, with full enjoyment of their rights and in the equitable pursuit of their potential.
The Special Rapporteur highlights the need for and States' obligations to create and sustain enabling environments that incorporate a rights-based approach to mental health and which value social connection and respect through nonviolent and healthy relationships at the individual and societal levels, promoting a life of dignity and well-being for all persons throughout their lifetimes.”[9] (Emphasis added).
Thus, the time is right and ripe to give a sustained and vigorous push to the cause of social psychiatry.
This inaugural issue of World Social Psychiatry brings together a galaxy of eminent personalities, with their own areas of interest and expertise, focusing not only on a wide range of issues germane to social psychiatry today but also with a futuristic, unparalleled vision about where it can be taken from here.
Following the Special Editorial[10] by the current president of WASP which sets the pace for the Journal with a flag-off, a comprehensive review article explores the historical and conceptual evolution of social psychiatry, defining its essential components, and laying out a 21st century agenda for social psychiatry.[11] Three senior experts provide their brief but incisive commentaries on this erudite article while sharing their own thoughts and wisdom.[12],[13],[14]
This is followed by a large and diverse section on the central theme of this issue: “Setting the Global Agenda for World Social Psychiatry.” In this collectible compilation, world leaders in the area of social psychiatry not only deliberate on their respective areas of choice but also focus where they would like the Journal to take a lead. These range from the need for building partnerships in global mental health,[15] need for an ecosocial framework for psychiatry,[16] need for ethical issues related to social psychiatry,[17] social inequity as a public health issue,[18] learning from the past so as not to repeat the mistakes,[19] role of globalization and epidemiological transitions with a special focus on sub-Saharan Africa,[20] social psychiatry and sustainable development,[21] migration and refugee problems,[22] and social psychiatry from the perspective of child and adolescent psychiatry.[23]
As if that was not enough, two brilliant “debates” should stoke the fire even stronger. The one by Rachid Bennegadi (incoming President of WASP) ponders over the role of digital cyber era on social psychiatry – friend, foe, or both?[24] The other one exhorts social psychiatry to rise from being simply an academic discipline to “empowering” the individual, family, and community, thus buttressing the advocacy component of the Journal.[25]
The final section has two original research articles, from two geographically far separated yet developmentally similar countries (Nigeria and India) which focus on the link between loneliness and depression in Ibadan,[26] and the value of a family psychoeducation package for caregivers of patients with schizophrenia in northern India via “task sharing”,[27] respectively. These are just two snippets from an unending arena where social psychiatry can provide a level playing field. We anticipate these to be just the “tip of the iceberg” and expect to see many more in the forthcoming issues of the Journal.
All in all, we believe that, with an improvised motto of mens sana in societate sana, together we can explore the wholesome world of social psychiatry! Let World Social Psychiatry provide a free, fearless, and exciting platform for this exploration by its three missions – analysis and dissemination of knowledge by incisive reviews and perspectives/debates/viewpoints, publication of high-quality and high-impact original research, and powerful advocacy for promoting the cause of social psychiatry in the world.
Acknowledgment
The editors are grateful to Prof. Vincenzo Di Nicola for correcting the Latin phrase used in the title and text.
| References | |  |
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