|Year : 2021 | Volume
| Issue : 1 | Page : 14-21
Biology's Contributions to Social Psychiatry's Future
Robert E Becker
Department of Drug Design and Development, National Institute on Aging, Baltimore, Maryland; Aristea Translational Medicine Corp., Park City, Utah, USA
|Date of Submission||08-Oct-2020|
|Date of Acceptance||03-Dec-2020|
|Date of Web Publication||29-Apr-2021|
Dr Robert E Becker
Aristea Translational Medicine Corp., 3435 Cedar Drive, Park City, Utah 84098
Source of Support: None, Conflict of Interest: None
Objective: To create conditions favorable to social psychiatry overcoming constraints on the range of interventions that psychiatry makes available to patients and communities. Methods: The author reviewed the history of psychiatry's range of practices, research, and training from mid-20th century to present and social concerns with future risks to mental health and well-being. Using Medline, Google, legislative sources, and major news reports, he ascertained the relationships among psychiatric activities, social policies, community resources, and public attitudes toward sciences relevant to health care. Results: Since mid-20th century, psychiatry has become increasingly evidence based in molecular and related fields of biology. After mid-20th century, this biological turn eclipsed social psychiatry functions quickly in the United States with the withdrawal of federal public funding and a constriction of commercial funding for patient care. By the 21st century, professional priorities and governmental federalist funding priorities precluded most psychiatric activities beyond office and hospital-based patient care. With these shifts, American psychiatry did not support social psychiatry practices and other international needs for mental health services. Modern biologically oriented psychiatry limits its future abilities to meet national and international social psychiatry needs by not calling upon 21st century evolutionary biological. By fostering balance and integration among individuals, populations, environments, and a group's historical cultural heritage, Darwin's biology validates social psychiatry adapting a full range of primary, secondary, and tertiary preventive mental health-care services, training, and research resources to meet individual and population's needs. Conclusions: A community's needs define psychiatry's social role in health care. Evolutionary biology promises social psychiatry a comprehensive conceptual grounding focused on how an individual and population affect and are affected by their environments and histories. Without this broad scientific foundation, psychiatry may forfeit the opportunity to gain public trust of how science comprehensively informs and supports human health and well-being.
Keywords: Evolutionary biology, public policy, social psychiatry
|How to cite this article:|
Becker RE. Biology's Contributions to Social Psychiatry's Future. World Soc Psychiatry 2021;3:14-21
”Psychiatry's past can be psychiatry's future”
| Introduction|| |
Today, psychiatry struggles to escape economic and theoretical constraints that blunt its contributions to medicine, society, and patients. As a modern, evidence-based, diagnostic, therapeutic, and public health science, psychiatry finds itself responsible for the mental health and well-being of individual patients and populations living under widely differing economic, political, cultural, and social conditions. Insufficient numbers of specialists, outdated facilities, confining patient care reimbursements, sparse public financial supports for services to populations, restricted research funding, medical schools looking to faculty as income sources, confounding of psychiatry's biological sciences in clinical translations, and disregard for historical social psychiatry practices tie the hands of researchers, practitioner, and teachers worldwide. This is psychiatry's past and present. It need not be our future. It is time for psychiatry to unshackle itself from what is dysfunctional for patients, the public, communities, nations, its own health and well-being, and its worldwide development over the 21st century.
| Methods|| |
The author reviewed, from mid-20th century to present, the history of psychiatry's range of practices, research, and training and social concerns with future risks to mental health and well-being. Using Medline, Google, legislative sources, and major news reports, he ascertained the relationships among psychiatric activities, social policies, cultural traditions, and public attitudes toward sciences relevant internationally for psychiatric health care.
| Results|| |
In the mid-20th century, psychiatry turned decisively toward becoming an evidence-based science. Psychiatry found grounding in the then emerging molecular and accompanying biological advances. Simultaneously, spurred by America's state governments' economically motivated discharges of long-term mental hospital patients into unprepared communities, a reenergized social psychiatry movement looked to the social sciences to structure a response. Over the remaining 20th century decades, primarily due to advances in biological psychiatry, molecularly oriented sciences and technologies flourished. Psychiatry refined its nosology. Pharmacological treatments became capable of symptomatically managing most psychiatric disorders, psychiatry became evidence based, and the durations and intensities of patients' treatments declined for many disorders. Psychiatrists, using their new resources, could more quickly and effectively control the illnesses being experienced by patients. This Western medical model proved difficult if not impossible to implement effectively in developing countries and economically depressed communities. There more efficient, economical, flexible, and effective social psychiatry preventively inclined practices proved more culturally and medically promising.,
In the Western world, within these same decades, social psychiatry briefly prospered. Then, even more quickly, social and community psychiatry waned. In the United States, the Reagan administration, with public support for its New Federalism, shifted social responsibilities from Federal to state governments. That shift dramatically reduced or terminated funding for the various social psychiatry service, research, and training activities. With states unable to assume these expenses, psychiatry no longer could deliver its developing therapeutic and preventive interventions in community settings using home visits, interdisciplinary teams, supportive employment, supervised housing, consultations with social agencies, and other services to severely mentally ill and to police. In America, police and jails became the caretakers of frequently homeless severely mentally ill. American psychiatry lost its memories of the past ravages from the institutionalization historically visited on the severely mentally ill. International needs have largely gone unaddressed., Advances in recent decades, a more rigorous nosology, brain imaging, drug treatments, sophisticated clinical trial methodologies, concentration on office based practices, have brought commercial benefits to developed countries but challenges to developing countries and impoverished communities. Psychiatrists have now largely subsumed Sullivan's problems of living under nosological entities and no longer regard them as targets for social interventions able to reduce mental illness. Psychiatry, overcommitted to technological solutions without regard to the social limitations that will undermine their utility, does not have resources to provide an internationally relevant, public health-oriented, socially mediated, preventively focused, and community-based programming., A 21st century psychiatrist's training often neglects the fates of severely mentally ill experiencing institutionalization in the justice system., Today, young psychiatrists startle at the ravages from incarceration of severely mentally ill, now not in asylums but in jails and prisons. Western training for psychiatrists as caregivers does not successfully prepare then to work in either the developed or the developing world. Worldwide, the demands for a diverse range of psychiatric services require public health-oriented, professionally supported teams of indigenous workers.,
Following the lead of America's New Federalist publicly popular cost-containment strategies, federal and commercial insurers reduced reimbursements for patient care without studies of effects on quality. Yet, restricting reimbursements for psychiatric services to 15 or fewer minutes allotted to each patient undermines the psychiatrist–patient relationship confined by the economically sustainable “medication check.” Medically questionable consequences from health-care policies imposed additional questionable compromise onto psychiatry., A flowering and diversely inquisitive and responsive 20th century social psychiatry had its legs cut out from under it. In America, disheartened leaders reassessed, as poorly conceived, earlier community-based efforts to respond to the severely mentally ill and to community needs. Psychiatry's emerging, comprehensive research, practice, and teaching balances between waxing molecular scientific advances and waning social sciences preventive, therapeutic, and rehabilitative sciences collapsed. “The program regressed to right back where it started” and lost relevance both for the developed and developing worlds. For a profession unevenly distributed geographically and in short supply already internationally, inpatient units and office visits became the primary modes for delivery of patient services, student experiences, resident training, and clinical research. Lack of both trained skills and opportunities to practice as consultants, teachers, and interdisciplinary team leaders came to limit the contributions that a preventively focused social psychiatry is capable of providing to the public. Yet, high levels of unserved persons, in developed and developing countries, seem to underline the importance of preventive, team structured, economical, and community social psychiatry-based services for the 21st century.
By the 21st century, publicly supported political realities had swallowed up practice sectors important to psychiatry's rich past. There remained few hopes for a restoration of balanced, adequately funded preventive population, therapeutic, and rehabilitative psychiatric services. Medicine and psychiatry continue to have general support from the public; yet, as an array of sciences and practices, over recent decades, psychiatry and its patients have lost traction with sectors of the public., Patient care receives high regard without public or governmental memory for other areas of psychiatric interventions: in communities; with severely mentally ill; through teams; and so forth. With medicine, psychiatry feels the effects as the public becomes increasingly mistrustful of science and experts; follows misinformation promulgated by political, government, and other leaders; refuses vaccinations, rejects using masks and social distancing to counter COVID-19; and regards climate change, human-induced environmental deteriorations, and future virus risks as alarmist distortions. Like medicine, psychiatry either currently does not have or cannot communicate an underlying science able to dissuade the disbelievers, governments, and others, who, by omission and commission, undermine social psychiatry, a science of individual and population mental health, well-being, and social participation, as a core biologically evidenced grounding for psychiatric research, training, and practice.
A mistaken challenge
In the pressure chamber created by COVID-19, a common fallacy has gained increased favor as an explanation for the public distrust that undermines health-care applications of biological sciences. In the July 26, 2020, Sunday New York Times, Charlie Warzel concluded that “Public health experts cannot force public trust. They have to earn it.” Yet, it would be ridiculous to contend that physicists have to earn public trust for people to observe the law of gravity. Experience naturally forces the public compliance that science confirms mechanistically. Scientific explanation serves, thereby earning public trust. Communication of the relevant science and its certainties and uncertainties characterizes medical expertise that a scientifically persuaded international public can trust. Both developed and emerging countries share misunderstanding and skepticism of science. Both deserve knowledge of how science earns the respect of individuals and governments.
Biology, although unique and thereby distinguishable from physics in specific ways, explains equally consequential human outcomes. Psychiatrists must be prepared to convey to the public and governments how some mechanisms operating in public health and social psychiatry are not subject to the unconditional laws that govern physics and its inevitable consequences. As biologists we explain how the mechanisms affecting public health's populations and psychiatry's patients are conditioned by the biological diversity present in groups and among individuals. Predictions for biological individuals and groups, as biological children of diversity, have probable, not certain, outcomes. One is mistaken to reject the implications from biological probabilities or from the laws of physics. Each governs the mechanisms providing personal and group lives.
Physic's Second Law of Thermodynamics importantly and definitively explains for patients and the public how our lives are continually at risk. Any organism will die if it incurs a sufficient functional loss of its internal or external environment. It is fatal for any organism or species to become unable to recovery energy from the environment in amounts needed to counter the inevitable entropy or disorder that threatens all life. This physics explains why all biological life is not individually independent but subservient to and has a requirement for and an interest in preserving a hospitable environment. This core principle governing evolutionary biology bonds psychiatry, patients, environments, their interactions, and human health and well-being with the glue of science. Individuals and groups must adapt to the fact that humans survive, flourish, wither, and even die at the whim of their environments. Just as patient care psychiatry confronts patients with reality, social psychiatry's broader interventions must convey their underlying biological realities to persons and governments.
Public health and social psychiatry cannot force or earn public trust. Like gravity, the life sciences warn the public and governments against taking choices that are worrying or potentially fatal. Social psychiatry needs expert, team, working, trusting relationships with patients, governments, and societies if it is to use biological science in the best interests of others. Social psychiatry, to serve the best interests of the public, requires public compliance with the laws of the sciences governing our practices. We protect and build communities because environments affect persons and populations. As experts, our task is to develop and then to explain to those we serve across the world, the relevant, robust mechanisms in our sciences. For example, like chimpanzees and unlike bonobos, humans naturally extend trust only to those not strangers., “Just like us, monkeys and apes strive for power, enjoy sex, want security and affection, kill over territory, and value trust and cooperation.” Like humans, chimpanzees can be assumed to kill others because they find pleasure in doing so. Our patients must understand their biology for us to help them help themselves. Evolutionary biology teaches patients how our genetic inheritance burdens us with our pre-Homo sapiens ancestors' adaptations to living that, for humans are dysfunctional for living in our environments.
The psychiatrist internationally is an unknown at risk of being seen as a threatening and unpredictable stranger rather than as a peace loving bonobo. Patients hope but cannot confidently expect the psychiatrist to give priority to the patient's best interests. Expected to be an expert in science and a servant of her scientific insights, the psychiatrist more objectively gains the lasting trust of strangers through her communicated knowledge of science and of how this science serve humans' best interests. Why the public in different ethnic and cultural traditions across the world neglects these best interests is an important and valid research question for social psychiatry. Rooted in science, social psychiatry seeks to understand and remove, not pander to, disapprove of, skate around or disregard, public rejections of science.
| Discussion|| |
Toward a solution through understanding
Since the time of Hippocrates, medicine has struggled to gain public recognition and support. The Hippocratic physician in Ancient Greece could not turn to professional qualifying examinations or governmental licensing to gain public trust. Jacque Jouanna, Hippocrates' biographer, cites demonstrations of confidence, eloquence in public speaking, professional verbal jousting in public, and before patients as required of the physician hoping to be seen as credible and skilled by the public. He writes how, of necessity, “The private physician was a public man.”
These theatrical aspects for gaining professional qualification haves receded. Status accrues with training, licensing, quality of services, memberships in professional societies, academic affiliations, word of mouth, and mastery of the sciences. Yet, these are not winning internationally for psychiatry the required public and governmental regard. As America's experience with New Federalism and economic realities in emerging economies support, disregard of social psychiatry's past contributions to society can be incidental to unrelated political and economic priorities and not specifically intended., Population surveys document the public's acceptance of psychiatric patient care, but without consideration for the full range of psychiatry's interventions. The public internationally may be insufficiently informed to support and protect a full range of psychiatric services, training, and research from legislative indifference and the fiscal restraints imposed by the still active Western New Federalism policies and developing world economic realities.
Psychiatry could usefully aim to establish, with the public and governments, how psychiatry is in the public interest. This understanding has historically been disregarded by an inherited international civil tradition. This tradition subjects medicine to civil control that is often uncritically compliant with unrelated public priorities and political leadership. With evolutionary biology, social psychiatry can provide the public and their governments a biologically grounded social science that elicits compliance equal to everyday respect for the consequences from gravity. History anticipates that renewed efforts to force or earn public trust are doomed to fail. We must educate the public how our evolutionary biology both provides the best available solutions to issues of health and how public investments in these sciences serve humanity's best interests. The public and civil authorities become responsible to ensure that social psychiatrists practice these sciences in the public best interest. It is in social psychiatry's best interests to gain and, by its professional standards, maintain this public and governmental trust.
Darwin's biology serves the public's best interest
Molecular and other biological sciences still comprise the foundations for psychiatry's 20th century biological turn. These foundations spotlight disease and their therapeutics' mechanisms. They do not scientifically ground social psychiatry's broader Hippocratic-rooted, individual patient- and population-focused, preventive, rehabilitative, consultative, and other medical responsibilities. They do not scientifically ground preventive and restorative interventions required in developing countries and among the healthy and disabled at risk in developed countries A much needed 21st century appeal by social psychiatry for public support will be strongest, more favorably received and scientifically immune to criticism, if, with fundamental evolutionary biological principles, it comprehensively supports the full range of public needs. Social psychiatry requires this scientific grounding of a widely balanced primary, secondary, and tertiary preventive scope of health-care activities, able to respond to and prevent overmedicalization of the international public's stressful problems of daily living, and fitted to the needs of each community., A consensus among biologists, initiated in modern biology's mid-20th century Evolutionary Synthesis, matured across the century's following decades. With this consensus, evolutionary biology now provides social psychiatry access to a more broadly conceived biology. Evolutionary biology, as the science of life surviving in environments, fully integrates the modern, evidence-based sciences within Hippocrates' wide conceptual scope of health care.
Across the last half of the 20th century, as the biological molecular and other sciences became integrated under Darwin's influence, biology became a unique science. By consensus on the mechanisms of natural selection, evolutionary biologists reorganized the evolutionary, molecular, and other biological sciences. The molecular and other biological sciences that provided psychiatry's 20th century foundations became a methodologically theoretical group of sciences contributing to but not comprising biology or late 20th century psychiatry. The traditional, theoretically organized sciences now inform a new, unique, and Darwinian inspired biology that regards the biological individual, affecting and affected by her environment, as the methodological vector in evolution and the organizing focus for all life sciences.
As Darwin discovered after his publication of On the Origin of Species, his 19th century evolutionary biology and 5th century B.C. Hippocratic medicine share a distinct methodology. Each field is committed to study of the biological individual, living dependent on her or his environment, affected by his or her inherited characteristics, health, well-being, fitness for survival in the environment, and affecting his or her environment. As a result, evolutionary biology organizes psychiatry's basic sciences to support and integrate fully the diverse applied preventive, treatment, and rehabilitative activities that comprise Hippocratic medicine and inform social psychiatry. Evolutionary biology's concept of the person validates social psychiatry addressing individuals, populations, and environments as interdependent, complex and often unacknowledged factors relevant to health, disease, well-being, and human survival through reproduction across generations. The social psychiatrist cannot be confined by an office, her office is her community and its environment.
Hippocrates' practices become psychiatry's scientific methods
The quest to explain evolution forced Darwin to develop methods able to study individuals surviving in environments. To understand disease and health, Hippocrates studied individuals and the populations they form in relation to the environments in which they live. This Hippocratic assumption, that organisms such as humans are fully individual, is millennia old. Yet, it was not until the 1950's that Hippocrates' and Darwin's assumption, that organisms were individuals and therefore irreversibly unique, could be confirmed by molecular genetics. Now evolutionary biology confirms that individuals are inextricably interdependent with environments.
Humans, as sexually reproducing, evolutionary derived organisms, live and function as socially aware individuals affecting and affected by their environment. As a result of the uniqueness present in being an individual, humans comprise diverse populations. Darwin's new unique individualizing science of biology confirms Hippocrates experiences of medicine as, in its artful care of the person across millennia, a uniquely humanistic science. The individualizing humanistic Hippocratic arts of patient care complement the theoretically formulated aspects of medicine Hippocrates observed as shared across organisms and their diseases. Medicine and social psychiatry are each a humanistic applied Hippocratic science. As applied evolutionary biologists, social psychiatrists, by intension or intuition, address patients and populations, their health and disease, in a personal context that grasps the life of a person and a population, inextricably intertwined with earth's environment.
This biologically expanded horizon opens for social psychiatry new research, teaching, and service responsibilities. Evolutionary biology scientifically commits psychiatry to address the mental health and well-being of individuals and populations in relation to their environments. Treatments of diseases, preventive medicine interventions, health-related social welfare concerns, and modes of practice respect the uniqueness of each individual and population. The population sets the priorities that psychiatry must meet. Evolutionary biology supports psychiatry to justify its relevance to society with a comprehensive science able to explain Homo sapiens' problems of living and surviving in Earth's environment [Table 1]. Evolutionary biology orients psychiatry to adapt its priorities and resources to meet the needs and respect the practices of the population it will serve. Evolutionary biology contextualizes molecular psychiatry within social psychiatry's range of responsibilities.
A future for psychiatry supported by evolutionary biology
Various authors have found an integration of evolutionary biology with medicine as potentially beneficial for each field., As an applied science, social psychiatry reveals new meanings and social consequences for evolutionary biology. Public health preventive interventions will inform the evolution of disease mechanisms and their expressions as responses to their environments. Of value to social psychiatry, an increased access to preventive interventions will operationalize the Hippocratic tradition that every sick person represents a failed preventive intervention. Conceptually, behavioral characteristics of humans that are dysfunctional and identified in other species can be understood as blind evolutionary inheritances of our species.
Evolutionary biology clarifies how the individual and populations are inextricably unique-in-an-environment, affecting and being affected by the environment cumulatively over time. This concept usefully structures patient and population assessments and balances preventive-curative interventions. Informed by evolution's concepts of biology as a historical science, work with individuals and populations become more naturally contextualized by past history, future hopes, environmental features, stabilities and changes, and their dynamic interactions over time.
These dynamic evolutionary responses to environmental stressors set out for psychiatry and society how, with regard to organisms and populations, one is mistaken to address other than an integrated whole organism, in her life, and in her environment. In an evolutionary informed science, “an imbalanced concentration on (a) limited feature” becomes inappropriate with any patient or population. Each comprises a whole or the unique sum, not an averaged distribution, of the individuating features present in the individual, population, environment, and across the lives of the patient and our species ancestors. Psychiatry can average and theoretically formulate specific features shared across organisms or groups or across time. These relationships predict future observations. The future is completely different dealing with an individual human, primate, or other species. Frans de Waal muses how “My own team typically cajoles, bribes, and sweet talks its primate partners. …Peony (an elderly chimpanzee)…ignored a task…I sat down right next to her and told her, in a calm voice, that I didn't have all day and it would be great if she would get going. She slowly got up, glancing at me, and…sat down for the task.” We do no less for a human being or community when we acknowledge its uniqueness.
Evolutionary biology brings its historical structure into social psychiatry. This imprint of past on present reinforces the interplay between the mechanisms affecting patients and populations and the roles played by evolutionary history or the origins, present adaptational utility, interactions, and individuality that the subject imprints on her life. For the biological psychiatrist, each individual and community becomes, historically and currently, an enigma, to self and the physician. Each is a whole, combining, through its genes, the adaptations from distant ancestor species. These adaptations dynamically evolve and interactive with a changing environment to benefit and complicate an individual's or population's life. Scientifically, there is too much for a psychiatrist to know a person or population. With the psychiatrist, the patient or population must choose the problems, which social psychiatry will organize using its diverse diagnostics and interventions. For the individual or population, as with Peony, earlier behaviors do not always predict future behaviors. Humans, at different times or under changed conditions, may voice different causes for a change from past behavior. Yet, today's behaviors may be overdetermined by inherited evolutionary or personal patterns of behavior from the past. Natural chimpanzee like distrust of strangers or socialization or an interaction of both may fuel a person's or population's racism.,,, An evolutionary biological psychiatry would aim to free individuals and populations from dysfunctional stereotyping, either evolved or personal in origin.
Primatologists see these same dynamics in our cousin species. Primatologists, following David Hume, ascribe, for behaviors explained in humans, equivalent mental operations to their speechless subjects. To the theoretical methodologies used in psychiatry's current sciences, evolutionary biology adds what social psychiatry can learn from individual fellow primates and other species and from Hippocrates' innovative, unique observational, conceptualizing methodologies given extended development in evolutionary science.
Evolutionary biology's subject, the person- or population-in-its-environment, orients social psychiatry with “perhaps the most basic scientific theory…the most powerful…yet…vastly underutilized.”, Life, expressed in individuals, persists solely at the discretion of its immediate environment., As a science, psychiatry traditionally is responsible to diagnose and treat its patients with the full and balanced range of complexities found in the reality of their individual lives. All of psychiatry will benefit from balances informed by evolutionary biology. Evolutionary biology documents how an individual or population cannot effectively be understood without knowing the context of her interdependence with her environments. Evolutionary biology provides for psychiatry and justifies to the public the balance of sciences that psychiatry unfortunately lost in the 20th century.
Darwin expands the methodological horizons for modern medicine's biology. With the concepts in evolutionary biology, Darwin broadly contextualizes psychiatry for the profession and for the public. Darwin's dynamic grasp of life and of an organism's experiences surviving at the whims of her environments promise to awaken the public and governments to the individual's and population's vulnerabilities and adaptive resources. Informed by how evolutionary biology contextualizes all human life, social psychiatry can more effectively help both psychiatry and the public to judge their responsibilities and expectations for Homo sapiens future. A biologically informed psychiatry can interpret for society the future that evolutionary biology predicts for individuals and populations. Social psychiatry can better assist individuals, groups, and governments to cope with a biological reality they can understand. Armed with evolutionary biology, social psychiatry gains a conceptual grasp of what it is to be a biological individual. Knowledgeable of evolved humans as individuals, of the benefits from the diversity that troubles biological social life, of our biological inclinations, resources, achievements and foibles, social psychiatry will serve as an important source of scientific support to others in medicine and other health and human welfare professions.
Darwin credits his generalization of Hippocrates' biology to his appreciation of the methodological roots and priorities that Hippocrates set out for his medicine. With this same understanding, the public and psychiatry can unite to fully integrate modern psychiatric practices consistent with their original and nascent 5th century B.C. roots. As commentators on possible uses of evolutionary biology in medicine recently stated, evolutionary biology “replaces the prevalent view of bodies as machines with a biological view of bodies shaped by evolutionary processes.” Commitments to preventive population directed interventions puts important new applied science tools in the hands of psychiatrists: biostatistics, epidemiology, health services administration, health education, social–behavioral sciences, and environmental sciences.
In the 19th century, public health's population-focused interventions brought medicine its first major scientifically based successes overcoming disease and impediments to well-being. In the 20th century, population-focused interventions were found to be tools useful for overcoming epidemic, socially precipitated psychiatric disorders. To provide these community services, social psychiatry must become much more “a system of care comprised primarily by integrated interdisciplinary teams.” The current interregnum, precipitated in America by New Federalism, “exposes (for psychiatry, as COVID-19 has for medicine) the shortcomings of a de-contextualized intervention based on single factors.” The failure to coordinate the complex interventions required to contain a threatening epidemic with COVID-19 cautions all of medicine. It is in the best interests of psychiatry's patients and populations to consider how evolutionary biology helps social psychiatry internationally to master the “plurality of determinants (dominate) in any particular health condition.”
| Conclusions|| |
A community's needs properly define social psychiatry's role in the community's health care. Evolutionary biology promises social psychiatry a comprehensive conceptual grounding focused on how an individual and population affect and are affected by their environments and histories. Without this broad scientific foundation, social psychiatry may forfeit the opportunity to gain public trust of how its science can inform and support health and well-being. In the 20th century, psychiatry failed to serve the severely mentally ill in developed and developing countries. Its biological psychiatry has not been translated by an effective social psychiatry to have an international application. Internationally, psychiatry's past is foundational, not irreversibly insular or parochial and not past, unless psychiatry and the public and governments across the world choose to allow it to remain past.
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Conflicts of interest
There are no conflicts of interest.
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