My social psychiatry manifesto, redefining social psychiatry for the 21st century, has just been published in the inaugural issue of World Social Psychiatry (see attached).

The next part of this project is to differentiate social psychiatry from cultural psychiatry. When I was training in psychiatry at McGill University, these two fields were joined together in the Division of Social and Transcultural Psychiatry, founded in the 1950s. "Transcultural psychiatry" has since morphed into "cultural psychiatry." For example, two major groups are called the Society for the Study of Psychiatry and Culture (SSPC) and the World Association of Cultural Psychiatry (WACP). Social psychiatry is in my view quite distinct and has at least three branches: (1) social epidemiology and public mental health which focuses on the social determinants of health and mental health, (2) the community mental health movement which is closely allied with the deinstitutionalization movement throughout the world, and (3) the family therapy movement closely allied with all relational therapies (couple, family, and group approaches). The first two branches have to some extent formed the inspiration for and basis of the Global Mental Health Movement which is extremely successful with support from the WHO, NIMH and the World Bank.

That said, all of these movements, traditions, and approaches have much in common with overlapping concerns, values, and methodologies and yet, there are also key differences.

One of the major differences is that social psychiatry addresses socio-economic status (SES) reflecting a general concern of the Left and liberals with social class. In spite of the emphasis on social class, there is something universal about the preoccupations of social psychiatry and sociology (and socialism) which cuts across all complex societies that create classes. Cultural psychiatry on the other hand seems to have supplanted social concerns in what appeared to be a larger envelope of contextual factors called culture. However, instead of creating bridges, cultural psychiatry's concentration on particular cultures while showing compassion and solidarity also tends to separate them.

For the record, I find both (all) fields compelling in their own ways but what is driving my concern is the ultimate impact of how we construct social relations on politics (defined as political philosophy, not in partisan terms, meaning the construction of the polis as the Greeks saw it). In other words, if we take the Kantian moral imperative to the social/cultural level, we may ask the question, What kind of world would we have if everybody thought and acted this way? To elaborate, what are the underlying moral principles of social psychiatry and cultural psychiatry and what kinds of worlds do they construct?

The thoughts of other researchers and thinkers would be most welcome as I develop this thread.

Vincenzo Di Nicola, MPhil, MD, PhD

University of Montreal &

The George Washington University