A Societal Psychiatry for Survival

Society's mental health needs now exceed the traditional bounds of psychiatry.

Posted Aug 10, 2018

“I think that atomic bombs were dropped not just on our cities, but on ... whole human beings.... if the next one, the third A-bomb is to be dropped, then the earth will be annihilated.”  - Koji Hosokawa (Hiroshima survivor)

The Atomic Age book, One World or None (Masters and Way, 1946), has a new preface that quotes the presidential adviser and financier Bernard Baruch, who starkly stated: “We are here to make a choice between the quick and the dead…. We must elect World Peace or World Destruction.”  He was addressing the United Nations Atomic Energy Commission on behalf of the U.S. government. What was considered to be a technological issue at the time, however, has turned out to be a psychological one. We see this from what has occurred in the intervening time, during which we survived an era of even greater technology through the curbing of our own destructiveness. Now, by choice, we are creating new dangers through a renewed nuclear arms race and the neglect of our natural habitat. This recognition should encourage us to realize the importance of a healthy mind for a healthy society—if it is to survive. Hence, we might dub our era the Mental Health Age.

Our awareness has not yet caught up with our critical need. We are at a point in human evolutionary history where mental health has become crucial for our own survival as a species. The question is no longer whether we have the technology to destroy human civilization in an instant, or whether we have the ability to despoil our environment to the point at which it will be unlivable. The question, rather, is: Will we finally make use of the infinite capacities within the human mind to create, rather than to destroy?  Will we halt in the middle of our own course toward self-destruction, to embrace the wonders of human life? 

Fortunately, mental health deals precisely in changing destructive courses (Basch, 1988). We know individually how to change behavior and to intervene in disorder; developments of the past century in human psychology rival the developments in technology (Leahey, 1997).

Societally, however, we have yet to develop a system for applying that knowledge. The vast populace is left vulnerable to the manipulative use of psychological knowledge for politics or profit (such as through propaganda or advertising), but the psychological professions have no way of using that same knowledge to intervene for the improvement of societal mental health.

Many misconceptions abound, such as that mental health is a purely individual problem and that professionals in this realm are confined to their private offices. Another misconception is that mental health interventions are irrelevant to the public sphere; yet, as recently as August 8, 2018, the American Psychological Association voted on whether to change its policy to allow military psychologists back on sites of human rights abuses like the naval base in Guantánamo Bay, Cuba (the policy came about because of its past capitulation to governmental pressure that they engage, allowing cover for torture) (Democracy Now, 2018). Why would the government have actively recruited psychologists to participate in the first place, if their engagement were not important to public perception?  Why would the American Psychiatric Association have to gag an entire profession with respect to the current, unprecedented mental health crisis arising from a presidency, in order not to lose government funding? (Gersen, 2017).

Psychiatry has not prepared itself for mental health issues at larger scale, and the entire nation, if not the world, is suffering as a result. Yet it is not for lack of knowledge. Psychologist Erich Fromm (1964) and psychiatrist Otto Kernberg (1970) have each articulated the destructive mental traits that have shown themselves capable of bringing the world to the brink of collapse over two World Wars.

When a mentally impaired leader is either elected or given power, it may be an indication of a deeper public health urgency, partly in terms of the conditions such a leader might invoke, but also in terms of the collective state of mental health that allowed such a leadership to arise in the first place. Furthermore, toxic conditions that give rise to stress, suffering, and poor mental health are well-known in the mental health field and apply also to societies when the conditions are widespread. This is one of the reasons why it is important to consider the mental health of society as a whole and not just as a collection of individuals.

There are three principal areas within psychiatry, among many, that have tried to tackle aspects of this problem. The first is social psychiatry, which is the branch of psychiatry that focuses on the social dimensions of mental disorder (Alexander and Selesnick, 1968). It deals broadly with the impact of social structures and experiences on the onset, course, and outcome of mental disorders, to the development and evaluation of complex social interventions and service delivery (Morgan and Bhugra, 2010). While its scope is perhaps the widest and most admirable, it nevertheless focuses on the societal contexts of individual mental disorder, not the mental disorder of societies.

Another notable area is systems psychiatry, based on the view of human behavior and experience as belonging within the units of complex systems. Inspired by systems theory and the works of biologist Ludwig von Bertalanffy (1969), anthropologist Gregory Bateson (1972), psychiatrist Murray Bowen (Papero, 1990), and others, this branch of psychiatry addresses people not only on the individual level but also in relationship, dealing with the interactions of groups and their dynamics as a whole. From this perspective, systems function as irreducible units, and therefore a family, a community, and a society are systems just as much as an individual or, in biology, an organ or a cell. While the conceptual underpinnings allow for treatment of society in theory, in practice it has not much progressed beyond the family unit.

A third area with great potential is psychohistory, which is the study of the psychological origins of the social and political behavior of groups and nations. Psychoanalyst Sigmund Freud started with his well-known Civilization and Its Discontents (1929), while Fromm (1950) and sociologist Theodor Adorno (1950) took it much further. However, as of now, the field remains more a descriptive subdiscipline of history than a clinical field with its own experimental methods and practical implementation.

We might propose a new area of societal psychiatry that can deal primarily with the mental health of societies. Given the societal mental health conditions of our day, diagnoses, interventions, and preventions at the societal level, with the capacity to collaborate with social, political, and legal institutions, would no doubt prove useful.

References

Adorno, T. W., Frenkel-Brunswik, E., Levinson, D., and Sanford, R. N. (1950). The Authoritarian Personality. New York, NY: Harper and Brothers.

Alexander, F. G., and Selesnick, S. T. (1968). The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York, NY: New American Library.

Basch, M. F. (1988). Understanding Psychotherapy: The Science behind the Art. New York, NY: Basic Books.

Bateson, G. (1972). Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. Chicago, IL: University of Chicago Press.

Democracy Now (2018). APA rejects proposal to reverse rules barring psychologists from interrogations. Democracy Now. Retrievable at: https://www.democracynow.org/2018/8/10/headlines/apa_rejects_proposal_to_reverse_rules_barring_psychologists_from_interrogations

Fromm, E. (1950). Fear of Freedom. London, U.K.: Routledge and Kegan Paul.

Gersen, J. S. (2017). How anti-Trump psychiatrists are mobilizing behind the Twenty-Fifth Amendment. New Yorker. Retrievable at: By https://www.newyorker.com/news/news-desk/how-anti-trump-psychiatrists-are-mobilizing-behind-the-twenty-fifth-amendment

Masters, D., and Way, K. (1946). One World or None. New York, NY: McGraw-Hill.

Leahey, T. H. (1997). A History of Psychology: Currents in Psychological Thought. Upper Saddle River, NJ: Prentice Hall.

Morgan, C., and Bhugra, D. (2010). Principles of Social Psychiatry. New York, NY: Wiley and Sons.

Papero, D. V. (1990). Bowen Family Systems Theory. Upper Saddle River, NJ: Prentice Hall.

Von Bertalanffy, L. (1969). General systems theory and psychiatry—An overview. General Systems Theory and Psychiatry, 32(4), 33-46.

Fromm, E. (1964). The Heart of Man. New York, NY: Harper and Row.

Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18(1), 51-85.