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| PERSPECTIVE |
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| Year : 2021 | Volume
: 3
| Issue : 2 | Page : 60-64 |
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“There is No Such Thing as Society:” The Pervasive Myth of the Atomistic Individual in Psychology and Psychiatry
Vincenzo Di Nicola
Department of Psychiatry, Institut Universitaire en Santé Mentale de Montréal; Department of Psychiatry and Addiction Medicine, Université de Montréal, Montreal Canada; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; President, Canadian Association of Social Psychiatry (CASP), Canada; President-Elect, World Association of Social Psychiatry (WASP)
| Date of Submission | 04-Aug-2021 |
| Date of Acceptance | 05-Aug-2021 |
| Date of Web Publication | 31-Aug-2021 |
Correspondence Address:
Prof. Vincenzo Di Nicola
Institut Universitaire en Sante Mentale de Montreal, 7401, rue Hochelaga, Montreal, Quebec H1N 3M5, Canada
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_36_21
The author follows up and replies to the three invited commentaries on his social psychiatry manifesto published in the first issue of World Social Psychiatry, emphasizing points of agreement with three practical examples of how research, practice, and policymaking can benefit from social psychiatry – or falter without implementing its powerful and relevant insights.
Keywords: Social determinants of health, social mind, social psychiatry, social therapy
How to cite this article:
Di Nicola V. “There is No Such Thing as Society:” The Pervasive Myth of the Atomistic Individual in Psychology and Psychiatry. World Soc Psychiatry 2021;3:60-4 |
Follow-up and reply to commentaries on "A social psychiatry manifesto for the 21st century" by Vincenzo Di Nicola[1]
| Introduction | |  |
To paraphrase anthropologist Clifford Geertz,[2] a scholar can hardly be better employed than in combatting a myth. As social psychiatrists, we have to confront two myths that are two sides of the same counterfeit coin. One is the myth that mind does not exist – British philosopher Gilbert Ryle infamously dismissed mind as “the ghost in the machine”[3] so that we need to counter the reductive trend of neuroscience, which erases all that is mental with the slogan that “mind equals brain” (for a detailed critique[4]). The other myth is that society does not exist – as Britain's Prime Minister Margaret Thatcher once fatuously declared, “There is no such thing as society.” What she meant – and it goes to the heart of her conservative political vision – is that “there are individual men and women and there are families” who should take care of themselves without relying on a social contract.
Most practicing psychiatrists and researchers in the human sciences will not go so far as to deny the existence of society, but many of their theories and practices imply precisely that. They knowingly or unknowingly subscribe to the pervasive myth of the atomistic individual which comes in many forms, from its expression in the novels of Ayn Rand whose heroic individuals resist collectivist society (she was traumatized by the Soviet Union) to the hermetic practices of literally millions of mental health practitioners who never talk to the parents, families, and networks of people in individual therapy in the name of confidentiality and a belief that patients alone are able to effect changes in their lives. Despite the critique of family therapy pioneer Salvador Minuchin, trained in psychoanalysis at one of its redoubtable US institutions, that psychoanalysis treats people “out of context,” and even a “relational turn” in psychoanalysis itself, the vast majority of all therapies and indeed all mental health treatments are with individuals alone. The community mental health movement in the 1960s has been efficiently abandoned by what I call a “return to the asylum” – the psychiatric hospital (see my reply to Craig[5]).
That this is true even in child psychiatry where parents are excluded in the name of theories of development, confidentiality, or child protection makes my point even more acutely. And this with a studied disregard for the best of relational theorizing from Bowlby's Attachment Theory[6] to Brown and Harris' Social origins of depression in women[7] and Leff and Vaughan's Expressed emotion paradigm[8],[9] (intriguingly all from London, UK), documenting the impact of family relations on everything from anorexia nervosa to schizophrenia, not to mention the durable findings of the effectiveness of family interventions for these conditions. We could add group therapies such as Moreno's psychodrama and community therapy developed by our Brazilian WASP Colleague Barreto et al.[10],[11]
Hence, we are fighting a battle on two fronts: to resignify what we mean by mind and to affirm what we mean by society – and how to translate the powerful data and insights of social psychiatric research into practice, advocacy, organization and delivery of health and social care, and policymaking. In my work as a family therapist and social psychiatrist, I have a similar answer to both myths that hinge on family and social relations: The family is the crucible of consciousness[12] and mind is best understood in relational and social contexts.[1],[12],[13]
To Eliot Sorel's “Social brain,”[14] I would add “social mind,”[4] which is strongly supported in Thomas Craig's arguments about the social in psychiatry and the relevance of social therapy.[5] For those who are of this caste of thought, this is a given, but academic psychiatry, which teeters from one “single-method mythology” to another (German psychiatrist and historian Paul Hoff[15]), now needs a serious rebalancing.[16]
Hence in following up and replying to the three commentaries published along with my Social Psychiatry manifesto,[1] I am compelled to restate the stakes for a social psychiatry by fighting against the reduction of mind to brain by neuroscience and the dismissal of society and much else by an increasingly operational psychiatry speaking to the atomistic individual.
First, I want to acknowledge the richness of the three brief but authoritative interventions by these pioneers and leaders of social psychiatry, noting large areas of commonality and agreement, while identifying what is new in my manifesto. As manifestos go, this one is much too long as I tried to do sufficient deep burrowing while ranging broadly enough to identify the richness of a tradition I wish to renew. To repeat my call, supported by the commentaries of my three distinguished colleagues, let us adapt both strategies – the deeply-burrowing hedgehog and wide-ranging fox[17] – reaching ever deeper into medicine and more broadly across to other disciplines. This means more syntheses of allied approaches, more interdisciplinarity across professions, and more translational research of our core research base – the social determinants of health and mental health.[18],[19],[20]
Let me highlight my social psychiatry manifesto with three real-world examples in response to each of the commentaries:
Sorel – “The Social Brain: Wired to Connect and Belong”[14]
Noncommunicable diseases (NCDs), including mental disorders and their comorbidities, lead in the global burden of disease. Social psychiatry may play a healing and catalytic role in addressing NCDs across economies. Ample scientific evidence, including adverse childhood experiences, documents the impact of social factors on the prevalence of NCDs.
- Eliot Sorel[14]
Here is a case in point since my article appeared – the new SARS-CoV-2 coronavirus. Moreover, Sorel's commentary was prophetic and outlines what we can offer to understand the broader impacts of COVID-19 and how to intervene as social psychiatrists.
This worldwide health and social predicament triggered not one but several challenges – encompassing two different categories of disease – an infectious disease (COVID-19) caused by the new coronavirus (SARS-CoV-2) and an array of socially propagated NCDs. This congery of pandemics is conceptualized as a syndemic.[21] A syndemic or synergistic epidemic is the aggregation of two or more concurrent or sequential epidemics or disease clusters in a population with biological interactions that exacerbate the prognosis and burden of disease. The term was developed by medical anthropologist Merrill Singer in the mid-1990s – a superb example of the interdisciplinary cross-pollination of ideas. Together, these conditions cluster within specific populations following deeply-imbedded patterns of inequality and vulnerability.[21]
Confinement and social distancing are preventive strategies based on the biological vector of transmission for COVID-19, yet they imposed serious and potentially prolonged social consequences for the development and maintenance of healthy minds and bodies.[22],[23],[24],[25]
Again, mind and identity – the very sense of self – are radically social which is why the impact of COVID-19 cannot be understood in isolation and is best understood by the more complex notion of this global threat as a syndemic. And that is why social psychiatry can help redefine not just psychiatry but also medicine and public health and contribute to their relevance and effectiveness.
Di Nicola[1] appropriately reminds the reader of the need for developing valid, specific, and reliable criteria for research in social psychiatry, implementation science, and their applications to education and training, health systems and services, and health policy and advocacy.
- Eliot Sorel[14]
That is the real challenge in front of us now, and I will apply Sorel's model in the rest of my comments.
Sartorius – “Medicine is Medicine Through its Disciplines”[26]
The creation of social psychiatry was a reaction to the neglect of social factors, of the environment in which people with mental illness become ill and have to live, and of the powerful role which social factors may play in the course of illness and in its outcome. Di Nicola is proposing a social psychiatry manifesto for our century: I think that he is right to do so because the many dangers through which psychiatry passed in the past are re-emerging.
- Norman Sartorius[26]
Sartorius – longtime director of the WHO Division of Mental Health (1977–1993) – makes salient points which raise a crucial question: What is social?
Distinguished British psychiatric researcher Robin Murray[27] had the honesty to admit that he had ignored the psychosocial perspective on schizophrenia and that the biological approach he privileged had skewed our research and our understanding of this important group of psychiatric experiences. “The truth was that my preconceptions,” Murray acknowledged, “had made me blind to the influence of the social environment.”[27] Unlike the dismissive attitude of neuroscience toward mind by Insel and others,[28],[29],[30] social psychiatry has an embracing understanding of what anthropologist and theologian Pierre Teilhard de Chardin called “the human phenomenon.” In my plea for a psychology in psychiatry,[1],[4] not only do we need to maintain the idea that there is both brain and mind but also to expand psychology and psychiatry to include relationships.
If language is (one of) the defining characteristics of mind (and has not been reduced to brain neurophysiology or neuroanatomy), then social relations are the defining characteristics of being human.
Medicine is defined by its disciplines: The values and skills which social psychiatry contains can contribute to medicine (and the promotion of health) and are essential for its success.”
- Norman Sartorius[26]
This is both true and dangerous! True because we cannot do without the subdisciplines, protocols, and procedures of medicine. Complex and dangerous because in a technocratic age, we always risk becoming overly identified with the available technology in ways that overwhelm the mission of medicine. While we hope that what the social psychiatrist does will have a foothold in academic psychiatry and in medicine overall, in fact, as Craig[5] points out, we constantly have to remind our psychiatric colleagues of the “relevance of social therapy,” which even the best among us overlook – as the case of Murray[27] and schizophrenia research sadly attests.
Craig – “The Importance of the Social in Psychiatry”[5]
Perhaps the biggest contribution of social psychiatry in the last century was the closure of the hospital asylum and the introduction of community care. This has not been an unqualified success. Expectations that community care should lead to better social integration were met in early hospital closure programs in England but have not been sustained; many patients are now living impoverished lives in sheltered environments with little social contact and little to do in the day.
- Thomas Craig[5]
What Thomas Craig bemoans in England is the rule rather than the exception around the Western world. The argument for closing asylums was made by sincere psychiatric reformers led by charismatic figures such as Franco Basaglia in Italy with positive conceptions of the therapeutic community adopted in England by the likes of RD Laing, Maxwell Jones, and Joshua Bierer, the founder of WASP. And yet, as Craig laments, “the relevance of social therapy keeps getting lost.”[5]
Let us examine this from the organization of healthcare and delivery and policymaking. Health authorities everywhere used these sincere psychiatrists (who are among my heroes) as “useful idiots,” co-opting their reforms and innovations in the guise of deinstutionalization to disinvest in mental health with empty promises of transferring those funds into community programs. Sometimes, the promises were kept, but community programs turned out to be very easy to underfund and shut down.
Even worse, as distinguished US psychiatrist and critic of psychiatry Allen Frances has argued, there was a massive transfer of mental patients from healthcare to the carceral system in the USA,[31] where they get substandard care if at all. What has come into the breach in great part are private institutes of family therapy which is why family therapy thrived in Italy after Basaglia's reforms and is still strong there. Family therapy is also very powerfully present in Brazil, but it does not reach enough people. Part of the solution is in community and one of our WASP partners in Brazil is a pioneer in Integrative Community Therapy (ICT),[10],[11] which his associates have developed online in response to the COVID-19 syndemic.
[T] he study of social data … has made the most significant contribution to the understanding of mental illness; but, paradoxically, it has been less exploited than these insights would suggest.
- Thomas Craig[5]
As I argued in my manifesto, we need translational research to turn those social psychiatric insights into clinical practices and healthcare policies. My experience with social epidemiological researchers is that they are much too reticent to advocate and militate for such translations. And yet, our colleagues in more impactful branches of psychiatry have been more forthright and demanding and have successfully translated biological research into research teams and clinical units everywhere. Social psychiatric data have construct and face validity, are proven durable, and form the backbone of the Global Mental Health movement with the Social Determinants of Health and Mental Health.[18],[19],[20]
| Conclusion: Healthy Bodies and Minds Need Healthy Societies | | |
I am a social psychiatrist first and foremost because of values and vision. The observations, arguments, studies, and practices follow from that – not the other way around. To paraphrase a famous formulation about faith: Research walks behind, not in front of a humanistic and values-based approach to Social psychiatry. Social psychiatry is a values-based practice[32] that valorizes all that is social, communal, and relational and privileges social context over isolated individuals and process over outcome.
It may be true that mind cannot be understood without the brain, as limited as such knowledge is, yet it is much more the case that brain is meaningless to psychology and psychiatry with Ryle's concept of mind as “the ghost in the machine.”[3] And, mind cannot be understood outside a context of family, community, and social relations. Not only has Ryle's ghost come back to haunt the machine but also that ghost – i.e., mind – is the engineer and the navigator that knows how to steer it and where it will go. And, even more important, what gives it value in human life which is nothing if not social.
Hence, let us forget Rousseau and the 18th century's absurd questions about “Man in the State of Nature” – there is no “Man” in nature – it is a social construction. (And “nature” itself is socially perceived.) Without society, we would not be human in any recognizable form except as animals. The contemporary version of this is philosopher Giorgio Agamben's bare life – human life reduced to the narrowest form of biological survival,[33] an update on Shakespeare's mad King Lear on the heath, reduced to a “Poor, Forked Animal” (Act III, 109-110).
While cognitive psychologist Steven Pinker[34] dismisses the “blank slate” as a model of our endlessly malleable human nature, I see the evolutionary psychology and psychiatry that he privileges as a reductive model of bare life, not of human being. As biologist Richard Dawkins[35] has argued cultural evolution, for which he coined the term “meme,” supplements the glacial pace of biological evolution based on the gene. And, human cultural evolution takes place within the broader envelope that we call society. And that broader, more encompassing envelope should be the framework for social psychiatry.
Against the neuromania and Darwinitis of neuroscience and evolutionary psychology,[30] I hold that it is demonstrable that the social is the crucible of consciousness, starting in the parent–child relationship supported by an extended kinship network and related communities that make up a society. I would further argue that rather than going further down the rabbit hole of neural mechanisms, we should expand our interests outward and account for human behavior that matters and that demands our attention – as I outlined in my sociopolitical essay on the Global South.[36]
What areas in the brain light up when we plan an action have been the object of speculation since Canadian psychologist DO Hebb proposed his cell assemblies. My rejoinder (I was a student of Hebb) is, what parts of our lives light up in interpersonal interactions? And would it belabor the analogy too far to say that our societies are sending SOS signals from the lifelong consequences of early gaps and assaults on infants and youth, including attachment and interpersonal trauma that cast a lifelong shadow, because of how little attention we have paid to early childhood care and education, and access to safe and healthy environments propitious for the healthy growth of brains, minds, and communities, from intrauterine life to social relations?[6],[19],[25]
If the slogan of the Global Mental Health movement is “No health without mental health,” then the slogan of Social psychiatry must be that healthy bodies and minds need healthy societies.
Acknowledgments
I am grateful to the three distinguished psychiatrists for their thoughtful commentaries on my Social psychiatry manifesto and for their mentorship and guidance: WASP Past Presidents Eliot Sorel (1996–2001) and Thomas KJ Craig (2013–2116) and Norman Sartorius, Past President of the World Psychiatric Association (WPA, 1996–1999), and the European Psychiatric Association (EPA, 1999-2000) and currently, President, Association for the Improvement of Mental Health Programmes.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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