Terms of the Social: Updating the Lexicon of Social Psychiatry

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SECOND THOUGHTS

The smallest indivisible human unit is two people, not one; one is a fiction. From such nets of souls societies, the social world, human life springs.”

― Tony Kushner¹

This column on “Second thoughts about psychiatry, psychology, and psychotherapy” will focus for the next 18 months, the rest of my term as President of the World Association of Social Psychiatry (WASP), on social psychiatry. In a series of essays, I will offer an updated lexicon for social psychiatry, interspersed with related reflections. “Terms of the Social” covers the words social and society; the complex history of social class and socialism; the terms sociopetal and sociofugal from socio-architecture, coined by British-Canadian psychiatrist Humphrey Osmond, MD, and the related social space from American anthropologist Edward Hall’s proxemics; how to understand the social sciences from sociology to social psychology to social work, and such philosophical-clinical notions as R.D. Laing, MD’s social phenomenology and social construction versus social constructivism in understanding social reality as part of social philosophy; and, finally, the place of social psychiatry in all of this.

“One Is a Fiction”

Not mind then society; but society first and then minds arising within that society.

– Ellsworth Faris²

All will agree with Faris that Mead propounded the thesis that selves and minds emerge in individuals from society, out of social interactions, that there can be societies without minds and selves but not the reverse.

– David Miller³

My contention as a social psychiatrist and social philosopher is that the foundations of psychology and psychiatry—and the edifices that are built upon them, from theories to research paradigms to therapeutic interventions—are precisely upside down. Starting with the self, the individual, person, and mind is to start building the roof rather than the foundations of a structure. In the social sciences (such as anthropology, psychology, sociology) and the humanities (from literature to philosophy) it is wiser to start with society, the group, the collective, and relations, then move to the individual, mind, and self.

The philosophers of the 18th century, the Britons Thomas Hobbes and John Locke, as well as the Swiss Jean-Jacques Rousseau, proposed social-contract theories by debating “Man in the state of nature,” a hypothetical state before or outside of society and politics. I would argue, as American anthropologist Clifford Geertz did, that this is not imaginable—“there is no such thing as a human nature independent of culture,” meaning there is no “Man” bared to a primitive state in nature.⁴ As Geertz points out, such creatures would be “unworkable monstrosities with very few useful instincts, fewer recognizable sentiments, and no intellect.”⁴

Without accommodation, without society, as Shakespeare’s King Lear complains:

Unaccommodated man is no more but such a poor, bare, forked animal…

The nature of “nature” is itself to be questioned radically unless we magically subtract human history and our impact on the planet, which is a purely philosophical speculation. You have heard of alternative history—this is speculative philosophy. Yet this speculative philosophy is the one that we are saddled with in the West since the Enlightenment, which enshrined individual liberty. From the point of view of social science (its very name states the paradox), founding society on the individual was the first and gravest error of the Enlightenment.

So, to the theme of this column on “second thoughts.” With a series of essays on terms of the social, I want to offer my first thoughts. Here is an overview.

Starting with the Social: First Thoughts

As a social psychiatrist and social philosopher, I see darkness rather than light across the psy disciplines—psychology, psychiatry, psychoanalysis, and psychotherapy. Freud famously wrote about 3 blows to human vanity.⁵ The blow to our vanity that the truly social sciences pose is not only that are we not the center of the universe (Copernicus’ heliocentric system), the center of creation (Darwin’s evolution), or the masters of our own minds (Freud’s unconscious), but that even our cherished “self” is not the center of the psy disciplines.

Systems theory and family therapy have already delivered this message to create relational therapies based on relational psychology⁶ (See my column on family therapy and social psychiatry). Social psychiatry attempted to re-vision our field based on a more social conception of psychiatry⁷ (See my first column, “Social Psychiatry Comes of Age”)—but it was overshadowed by other revolutions in psychiatry (biological psychiatry, psychopharmacology, and neuroscience) and paradigm shifts in psychology (cognitive psychology, evolutionary psychology) and the individual self remains the starting point of much theorizing, research, and clinical practice rather than their endpoint. The history of the psy disciplines in the West clearly shows that individual and biological explanations (even when these 2 perspective are at odds with each other) are privileged over social ones.⁸

Becoming an individual is a process of differentiation from attachment figures and other social relations to the construction of a coherent sense of self. This perspective was stated repeatedly in different guises for at least a century, from Russian psychologist Lev Vygotsky’s social origin of mind (1920s), to American psychiatrist-family therapist Murray Bowen, MD’s differentiation theory of family functioning (1950s), to British psychiatrist-psychoanalyst John Bowlby, MD’s attachment theory (1950s-1980s), to Austrian-American child psychiatrist-psychoanalyst Margaret Mahler, MD’s separation-individuation theory of child development (1970s), and to the “relational turn” in psychoanalysis associated with American psychologist-psychoanalyst Stephen Mitchell (1980s-1990s).

In this view, even Canadian experimental psychologist DO Hebb’s “cell assembly theory,” one of the foundations of neuroscience, is a social or relational notion. It is not the single cell but a collective or assembly of such cells in Hebb’s theory that is the basis for neuropsychology.⁹ As Steven Pinker, a fellow student of Hebb, replied to Stephen Colbert’s challenge to explain cognitive neuroscience in 5 words: “Brain cells fire in patterns.”¹⁰ It is the pattern that forms the basis of neural functioning and consciousness itself, not the structure of the cell alone; in any case, the cell can no more function alone than can a human child raised in the wild—the so-called “wild child” of the 18th century philosophers.

In fact, a hallmark of all that is social is a meaningful pattern of collective organization, evolution, collaboration, communication, and response. On a broader scale than Hebb’s cell assemblies, British anthropologist Gregory Bateson¹¹ proposed to bridge “how nature works” and “how people think” by discovering “the pattern that connects”across diverse social phenomena, while sociologists and systems theorists see patterns in the structures, scripts, and systems of a society. In my address to the WASP as incoming president, I observed¹²:

What distinguishes social psychiatry is attention to these patterns, taking them seriously to re-vision how we think about determinants and influences of mental and social health, and to construct new approaches in psychiatry from research to pedagogy to clinical practice. If the key words of psychoanalysis and psychodynamic psychiatry are introspection and insight; for family therapy they are process, structure and systems; and for child psychology and psychiatry they are attachment and development; then for social psychiatry they are: context, class and society.

Second Thoughts About Key Concepts in the Psy Disciplines

The consequences of such a social perspective trigger second thoughts about key concepts in the psy disciplines, from neuropsychology to personality theory to self-esteem:

• Sensory deprivation: In light of his theorizing, how could Hebb, a pioneering 20th century psychologist and a founder of neuropsychology, not have predicted that his sensory deprivation experiments with normal subjects would create severe distress and even psychosis in his subjects? He proved the hypothesis that the brain only functions normally in a bath of perceptual stimuli coming from the social surround—everything from light, sound, and tactile stimuli to meaningful social interactions—but his experimental subjects paid a predictably high price for that knowledge.¹³

• Personality theory in psychology and personality disorders in psychiatry: Philosophers still debate how to define a person and personal being, let alone personality which went in the history of English from being an adjective (“the quality of being a person”) to a thing. Intriguingly, while it was “once an outward sign,” it has been “internalized as a possession.”¹⁴ Here is the British social scientist Raymond Williams: “This is … an extreme of possessive individualism, but it is even more a record of the increasing awareness of ‘freestanding’ and therefore ‘estimable’ existence, which … gave us [the concept] individual itself.”¹⁴ The jump to personality disorders poses even more complex questions (to be addressed in a future column).

• Social anxiety is another upside down notion. In most cases in my child psychiatry clinic, it is not the child’s temperament alone (such as sensitivity) that creates interpersonal anxiety or even negative relational experiences; it is rather the lack of socialization and prosocial skills that creates the experience of apprehension of the social surround.

• Self-esteem. It follows from this social perspective that self-esteem starts with and is maintained by social interactions. Accordingly, we should call it social esteem.

Rethinking Public Health, Politics, and Philosophy

There are also consequences for public health, politics, and philosophy, as these examples show:

• Syndemics: The COVID-19 coronavirus triggered a synergistic series of pandemics. The cumulative effects cannot be wholly understood in narrow biological terms.¹⁵ In a future column, I will explore why we must rethink pandemics in social terms and call them syndemics.

• Social distancing: Italian philosopher Giorgio Agamben took exception to the notion of social distancing during the COVID-19 syndemic. He asked why we call it social distancing rather than physical distancing?¹⁶ As many have complained, it was an antisocial collective policy of social isolation, with a cascade of consequences from delayed and distorted development in children to an increase in domestic violence and social withdrawal syndromes such as separation anxiety disorder, school absenteeism, and social anxiety.¹⁷ In a future column, I will explore the terms social space from proxemics and sociopetal and sociofugal from socio-architecture.

• Social conformity: In the visionary 1960s British TV series, “The Prisoner,” a rebel British intelligence agent is imprisoned in an isolated location called “The Village” where the residents who are assigned numbers move and interact freely while under constant surveillance and control. The protagonist, “Number Six,” protests that he is “not a number! I am a free man!” but his resistance is labelled “un-mutual,” a synonym for antisocial, and one of the most convoluted notions of our field. (Later, I will explore the changing meanings of psychopath, sociopath, and antisocial.) “The Prisoner” explores the tensions between society and the individual, collectivism vs liberty.¹⁸  

Social Alternatives, Social Syntheses

• Sociality: What we need as an alternative and connecting thread to these disparate problems is not the construct of personality but sociality. American philosopher and social theorist, George Herbert Mead (1863-1931), invoked the “Principle of sociality”—characterizing “mind as an evolution in nature, in which culminates that sociality is the principle and the form of emergence.”¹⁹

• Sociobiology: Harvard entomologist Edward O. Wilson proposed a new synthesis of sociology and biology with his call for a new discipline, sociobiology as a “branch of biology” ranking with “such disciplines as molecular biology and developmental biology.”²⁰ This synthesis triggered robust scientific debates as part of the discourse of evolutionary psychology and the modern synthesis of evolutionary biology (an update on Darwin), but it cannot be dismissed as a potential bridge between biological and social sciences.

• Social horizon: Children need a “social horizon,” including British-American developmental psychologist Jerome Bruner’s “narrative resources,” role models for prosocial skills, and supervision of social activities from classrooms to sports to summer camps. This is the cornerstone of John Bowlby, MD’s attachment theory, which is psychoanalysis translated into dyadic relationships.

• Collective intelligence: Developmental biologists Patrick McMillen at Tufts and Michael Levin at Harvard recently published a unifying concept congruent with the patterns of biology, neuroscience, and psychology²¹:

We explore the hypothesis that collective intelligence is not only the province of groups of animals, and that an important symmetry exists between the behavioral science of swarms and the competencies of cells and other biological systems at different scales.

Life and Society Start With Two

Whether it is patterns in the brain, collective intelligence at all scales of biology, the social organization of ants, attachment theory in child development, systems theory of family functioning, relational therapy, social esteem, or sociality—one is truly a fiction. From the crucible of consciousness to the social construction of the self, from Socrates’ dialogues (and my therapeutic use of the relational dialogue²²) to Bakhtin’s dialogism (and narrative therapy), life and society start with two, and that is where we should start with social psychiatry.

Resources

For a deeper dive into the seminal work of American social theorist, George Herbert Mead, see:

• Mitchell Aboulafia, Scott Taylor. “George Herbert Mead.” The Stanford Encyclopedia of Philosophy (Summer 2024 Edition), Edward N. Zalta & Uri Nodelman, eds, forthcoming. https://plato.stanford.edu/archives/sum2024/entries/mead/

For 3 philosophical perspectives on social distancing during the COVID-19 syndemic see:

• Christopher Caldwell. Opinion: Meet the Philosopher Who Is Trying to Explain the Pandemic. Giorgio Agamben criticizes the “techno-medical despotism” of quarantines and closings. The New York Times. August 21, 2020. https://www.nytimes.com/2020/08/21/opinion/sunday/giorgio-agamben-philosophy-coronavirus.html?unlocked_article_code=1.w00.wTMJ.EHLnIAcF6YtD&smid=url-share
• Tim Christiaens and Stijn De Cauwer. The Biopolitics of Immunity in Times of COVID-19: An Interview with Roberto Esposito. Antipode. June 16, 2020. https://antipodeonline.org/2020/06/16/interview-with-roberto-esposito/
• Vincenzo Di Nicola. From Plato’s cave to the Covid-19 pandemic: confinement, social distancing, and biopolitics. Global Mental Health & Psychiatry Review. 2021;2(2):8-9.

For a scholarly biological exposition of collective intelligence, see:

• Partick McMillen, Michael Levin. Collective intelligence: a unifying concept for integrating biology across scales and substrates. Commun Biol. 2024;7(378). https://doi.org/10.1038/s42003-024-06037-4

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addiction medicine at the University of Montreal and President of the World Association of Social Psychiatry (WASP). He has been recognized with numerous national and international awards, honorary professorships, and fellowships, and was recently elected a Fellow of the Canadian Academy of Health Sciences and given the Distinguished Service Award of the American Psychiatric Association. Dr Di Nicola’s work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s writing includes: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011, winner of a prize from the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021); and, in the arts, his “Slow Thought Manifesto” (Aeon Magazine, 2018) and Two Kinds of People: Poems from Mile End (Delere Press, 2023, nominated for The Pushcart Prize).

Acknowledgements

Both the title and core concept of this essay were inspired by Italian political philosopher Roberto Esposito’s Terms of the Political: Community, Immunity, Biopolitics.²³ His original work on communitas is particularly salient for social psychiatry.¹⁵ My engagement with a lexicon of the social dates to my readings of Ivan Illich,²⁴ Uwe Poerksen,²⁵ and especially Raymond Williams whose Keywords¹⁴ was expanded by the extraordinary work of Barbara Cassin in her Dictionary of Untranslatables.²⁶

References

1. Kushner T. Thinking About the Longstanding Problems of Virtue and Happiness: Essays, A Play, Two Poems, and a Prayer. Theatre Communications Group; 1995.

2. Faris E. Review of Mind, Self and Society by George H. Mead. American Journal of Sociology. 1936;41:809-813.

3. Mead GH. The Individual and the Social Self: Unpublished Work of George Herbert Mead. Miller DL, ed. University of Chicago Press; 1982.

4. Geertz C. The impact of the concept of culture on the concept of man. In: The Interpretation of Cultures: Selected Essays. Basic Books; 1973:33-54.

5. Freud S. A General Introduction to Psychoanalysis. Horace Liveright; 1920.

6. Di Nicola V. Luminaries in social psychiatry—a relational dialogue with Maurizio Andolfi: master family therapist and social psychiatrist. Special Issue on “Families, Family Interventions and Social Psychiatry.” World Soc Psychiatry. 2024;6(1):6-13.

7. Di Nicola V. “A person is a person through other persons”: a manifesto for 21st century social psychiatry. In: Gogineni RR, Pumariega AJ, Kallivayalil R, et al, eds. The WASP Textbook on Social Psychiatry: Historical, Developmental, Cultural, and Clinical Perspectives. Oxford University Press; 2023:44-67.

8. Di Nicola V. Perspective – “There is no such thing as society”: the pervasive myth of the atomistic individual in psychology and psychiatry. Follow-up and reply to commentaries on “A social psychiatry manifesto for the 21st century.” World Soc Psychiatry. 2021;3(2):60-64.

9. Hebb DO. The Organization of Behavior. John Wiley & Sons; 1949.

10. Walker R. Steven Pinker’s “Ideas on the Fringe.” The Harvard Gazette. October 25, 2007. Accessed June 4, 2024. https://news.harvard.edu/gazette/story/2007/10/steven-pinkers-ideas-on-the-fringe/

11. Bateson G. Steps to an Ecology of Mind. Chandler Publishing; 1972.

12. Di Nicola V. Special Communication—Attachment, family, and social systems: London’s “cradle to grave” contributions as a model for social psychiatry. World Soc Psychiatry. 2023;5(1):21-28.

13. McCoy AW. A Question of Torture: CIA Interrogation, From the Cold War to the War on Terror. Metropolitan Books/Henry Holt; 2006.

14. Williams R. Keywords: A Vocabulary of Culture and Society. Flamingo/Fontana Paperbacks; 1983.

15. Di Nicola V. Book Review: Immunity or Impunity? The Origins of Biopolitics and the Coronavirus Syndemic. An essay-review of Roberto Esposito’s trilogy Bios – Communitas – Immunitas. Global Mental Health & Psychiatry Review. 2021;2(3):16-17.

16. Caldwell C. Opinion: Meet the Philosopher Who Is Trying to Explain the Pandemic. Giorgio Agamben criticizes the “techno-medical despotism” of quarantines and closings. The New York Times. August 21, 2020. Accessed June 4, 2024. https://www.nytimes.com/2020/08/21/opinion/sunday/giorgio-agamben-philosophy-coronavirus.html?unlocked_article_code=1.w00.wTMJ.EHLnIAcF6YtD&smid=url-share

17. Di Nicola V. From Plato’s cave to the Covid-19 pandemic: confinement, social distancing, and biopolitics. Global Mental Health & Psychiatry Review. 2021;2(2):8-9.

18. The Prisoner. Wikipedia. Accessed June 4, 2024. https://en.wikipedia.org/w/index.php?title=The_Prisoner&oldid=1226197248

19. Mead GH. The Philosophy of the Present. Open Court Publishing; 1932.

20. Wilson EO. Sociobiology: A New Synthesis. Harvard University Press; 1975.

21. McMillen P, Levin M. Collective intelligence: a unifying concept for integrating biology across scales and substrates. Commun Biol. 2024;7(378).

22. Di Nicola V. Letters to a Young Therapist: Relational Practices for the Coming Community. Atropos Press; 2011.

23. Esposito R. Terms of the Political: Community, Immunity, Biopolitics. Fordham University Press; 2012.

24. Illich I. Medical Nemesis: The Expropriation of Health. Calder & Boyars; 1975.

25. Poerksen U. Plastic Words: The Tyranny of a Modular Language. Mason J, Cayley D, trans. The Pennsylvania State University Press; 1995.

26. Cassin B, Apter E, Lezra J, Wood M, eds. Dictionary of Untranslatables: A Philosophical Lexicon. Randall S, Hubert C, Mehlman J, Stein S, Syrotinski M, Apter E, Lezra J, Wood M, trans. Princeton University Press; 2014.