What IS Social Psychiatry?
By Eugenio M. Rothe, MD
Social Psychiatry is a paradigm that combines medical training with the perspectives of social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to the human condition and to mental distress and disorder. The discipline of Social Psychiatry emerged in the 20th Century placing its main focus on the person’s social milieu and economic circumstances.
During the late 19th. Century Freud began to develop the techniques of psychoanalysis, which served as a foundation to all the other psychotherapeutic modalities. Most of Freud’s patients were members of the upper classes of Viennese society, had significant Ego strengths and their problems were mostly intra-psychic. In contrast, many of the patients that are seen by psychiatrists and residents today also suffer from problems that are extra-psychic, such as poverty, social and political oppression and abuses of power in relationships that threaten to overwhelm their coping capacities. A new paradigm was needed to better serve these populations, so for these patients a social psychiatry approach is the treatment of choice.
Social psychiatry has been associated with highlighting the effect of socioeconomic factors on mental illness and issues that are pertinent to the current realities of the 21st. Century, such as the weight of stigma on the patients that suffer mental illness and on their families, as well as problems that result from poverty, wars, natural disasters, social and political oppression and the massive human migrations that often follow these crises. In 1965, the sociologist Oscar Lewis published the controversial document titled, “The Culture of Poverty” in which he argued that in order to adapt to their environment, people who live in poverty for a long periods of time develop a series of coping mechanisms that become engrained and paralyzing and that affect the individual, the family, the community and the community in relation to society. For these populations, social psychiatry provides a deeper understanding of their surrounding circumstances, which in turn leads to more holistic and effective therapeutic approaches.
Social psychiatry was the dominant form of psychiatry for the second half of the 20th century, but has sometimes been less visible than biological psychiatry. Some of the pioneers who brought attention to social psychiatry in the last century included Karen Horney, MD, Erik Erikson, Harry Stack Sullivan, MD, August Hollingshead, PhD, Frederick Redlich, MD, Alexander H. Leighton and Lloyd Rogler, PhD. In the field of child and adolescent psychiatry, Sir William Rutter, E. James Anthony, and Bertram Cohler opened new windows into the social circumstances that molded the lives of children. More recently the work of Arthur Kleinman MD and others have continued to expand the field. Social psychiatry was instrumental in the development of therapeutic communities and the social treatments for chronic schizophrenia focusing on the treatment of the socially disadvantaged and on vulnerable populations.
Studies demonstrating efficacy of social psychiatry approaches in these populations have been replicated in many countries around the world and the social inclusion of people with mental health problems continues to be a major focus of modern social psychiatry. On the world stage, pioneers such as Abraham Halpern MD, John Mack MD and Robert J. Lifton MD have also highlighted the role of social psychiatry in protecting patients from political oppression.
Social psychiatrists strive to pay close attention to their patient’s cultural milieus and to their “Idioms of Distress” which are the characteristic way in which members of different cultures describe what is wrong and which may differ from the expressions found in mainstream American culture. In addition, they also try to listen closely to the metaphors or therapeutic stories contained in their patient’s “life-meaning stories”, which oftentimes reveal past traumatic experiences that explain treatment resistance and can help avoid treatment failures. So, as long as human beings continue to be human, there will continue to be Social Psychiatry.