Address of the Incoming President of WASP Conference: “Recovery from Mental Illness: Challenges and Solutions from Across the Globe” Joint Congress of the World Association of Social Psychiatry (WASP) and the Faculty of Rehabilitation and Social Psychiatry, Royal College of Psychiatrists (RCPsych, UK) London, UK, January 17, 2023

1. Address of the Incoming President of WASP
Tuesday, January 17, 2023

2. Attachment, Family and Social Systems
London’s ‘Cradle to Grave’ Contributions
As a Model for Social Psychiatry
Professor Vincenzo Di Nicola
Incoming President
World Association of Social Psychiatry
Founder & President
Canadian Association of Social Psychiatry

3. Attachment, Family and Social Systems
Professor Vincenzo Di Nicola
MPhil, MD, DipPsych, FRCPC, PhD, FCAHS, DLFAPA, DFCPA
Professeur titulaire, Université de Montréal
Clinical Professor, The George Washington University
Honorary Chair & Professor of Social Psychiatry, Università Ambrosiana

4. Conflicts of interest
•The presenter has no financial conflicts of interest to
declare

5. How Canadians are seen …

6. Introduction
•I am a child & adolescent psychiatrist, a family
psychotherapist and a socio-cultural psychiatrist
•And I would like to speak to the systems that connect
these domains:
•attachment
•family
•social systems

8. Joshua Bierer (1901-1984)
• Founder & Chairman (1964-1968)
• International Association of Social Psychiatry
(IASP) in London (1964)
• Later renamed WASP
• Organizer of the first three World
Congresses of Social Psychiatry
• London (1964, 1969)
• Zaghreb (1970)
• Founder & Editor
• International Journal of Social Psychiatry
(1954)
• Founder & Chairman
• Institute of Social Psychiatry
• British Association of Social Psychiatry

9. Society & culture
“Kitchen-sink dramas”

10. Society & culture
Francis Bacon

11. Society & culture

12. Society & culture
Lucien Freud

13. Society & culture
Henry Moore

14. Society & culture

15. Society & culture
Damien Hirst (1991)

16. Society & culture
Benjamin Britten (1962)

17. Society & culture
Sociology (1957)

19. Attachment
• John Bowlby’s trilogy
• Attachment, Separation, Loss (1969, 1973, 1980)
• A Secure Base: Parent-Child Attachment and Healthy Human
Development (1988)
• Michael Rutter – Maternal Deprivation Reassessed (1972)

20. John Bowlby (1907-1990)

23. Behavior (B) is a function (f) of personal characteristics (P)
and environmental characteristics (E)

25. Attachment
• Dominant model for the study of early social development
Features
• Toddlers form emotional attachments to familiar caregivers
• Establishing a lifelong “secure base”
• Foundation of later behaviour, emotions and personality

26. Attachment
• Events that interrupt or interfere with attachment have consequences
• Separation of a toddler from attachment figures
• Caregivers’ lack of sensitivity, responsiveness or consistency when interacting
with toddlers

27. Attachment
• Life stress events scale (43 stressful life events in the past year)
• Yields “Life Change Units”
• Adult and childhood versions
• Changes in individuals and their families are most stressful, followed by changes
at work or school
Ref: Holmes TH, Rahe RH (1967). The Social Readjustment Rating Scale.
J Psychosom Res, 11 (2): 213–8.

28. Attachment
Life Event Life Change Units
Death of parent 100
Unplanned pregnancy/abortion 100
Getting married 95
Divorce of parents 90
Acquiring a visible deformity 80
Fathering a child 70
Jail sentence of parent for over one year 70
Marital separation of parents 69
Death of a brother or sister 68
Change in acceptance by peers 67

29. Attachment
• Adverse Childhood Experiences (ACEs – Felitti, et al, 1998) are strongly
associated with negative health outcomes
• Physical, emotional and sexual abuse, neglect and household dysfunction
• Linear gradient between the number of ACEs and worsening health outcomes
Ref: Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. (1998).
Relationship of childhood abuse and household dysfunction to many of the leading
causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American
Journal of Preventive Medicine, 14 (4): 245–258.

30. Couples & families
• Relational psychology and therapy
• This represents nothing les than a
rethinking of psychology based on
relationships and therapies that
follow from such a psychology
• Minuchin articulated a coherent
model with a theory of family
functioning, a theory of change, and
techniques for therapy

35. Conclusion: From society to the individual
Three branches of Social Psychiatry:
• Psychiatric epidemiology – SDH/MH
• Community psychiatry & mental health – this includes social
rehabilitation and recovery
• Relational approaches from family therapy to Moreno’s psychodrama
and Brazil’s Integrative Community Therapy (ICT)(Barreto, et al, 2020)
Ref: Di Nicola V (2019). “A person is a person through other persons”: A social psychiatry
manifesto for the 21st century. World Soc Psychiatry, 1(1): 8-21.
Barreto AP, Filha MO, Silva MZ, Di Nicola V (2020). Integrative Community Therapy in the
Time of the New Coronavirus Pandemic in Brazil and Latin America. World Soc Psychiatry,
2(2): 103-5

36. Belonging
• What connects these three branches of SP is a sense of belonging and a
sense of community
• It’s called the “commons” in the British tradition
• The commons may be defined in fact as a social practice of governing a
resource not by the state or the market but by a community of users that
self-governs the resource through institutions that it creates
Ref: Forsyth T, Johnson C (2014). Elinor Ostrom’s legacy: Governing the commons
and the rational choice controversy. Development and Change, 45(5): 1093-1110.

37. Belonging
• Ostrom was the first and only woman to win a Nobel Prize in economics (2009)
• She opened a bridge between economics and political science
• Ostrom’s (1990) work on the “tragedy of the commons” should be studied by
social psychiatrists
• Along with other sociologists –
• Vilfredo Pareto in Italy, Talcott Parsons and Robert Putnam in the USA
• Young and Willmott here in London, in their classic study, Family and Kinship in East London
(1957)
Ref: Ostrom E (1990). Governing the Commons: The Evolution of Institutions for
Collective Action. Cambridge, UK: Cambridge University Press.
Della Porta D (2022). Progressive social movements and the creation of European
public spheres. Theory, Culture & Society, 2022. doi:10.1177/02632764221103510

38. Belonging
Belonging is to social psychiatry
what attachment is to child psychiatry
Belonging is the glue that holds together
the social determinants of health and mental health (SDH/MH)
and gives them structure and meaning

39. Expanding what we mean by health
• If there is no health without mental health as the Global Mental
Health Movement declared and was adopted as the slogan of the
Royal College of Psychiatrists here
• Then there is no mental health without a healthy body in a
healthy community

40. Expanding the medical medical
• Rather than debating what is primary or more important in
psychiatry, let us put forward the notion that we must expand a narrow
view of the “medical model” to include the social surround and that
the definition of health must necessarily include its social context
• As a social psychiatrist, I inverse the Western view that starts with the
individual and moves out in expanding concentric circles to
attachment, family, community, culture and finally to society:
I reason from society to the individual

41. Social dynamics
• I was more influenced by my countryman, sociologist Vilfredo Pareto in his
seminal Mind and Society (1916) than by the Romantic individualism of Jean-
Jacques Rousseau in The Social Contract (1762)
• I elaborated this in my re-appraisal of Indian psychiatrist JS Neki’s gurū-
chelā relationship as a model for social psychiatry and psychotherapy (Di
Nicola, 2022) in which the individual is guided and nurtured through a
trusting relationship, reflecting the social dynamics of Indian society
Ref: Di Nicola V (2022). The Gurū-Chelā relationship revisited: The contemporary relevance
of the work of Indian psychiatrist Jaswant Singh Neki. World Soc Psychiatry, 4(3): 182-6.

42. The myth of the atomistic individual
• Against the assertion of your former British PM Margaret Thatcher –
if “there is no such thing as society” – then there is no such thing as an
individual
• Children who are not raised in abiding attachments (Bowlby,
Rutter), who are not nurtured by family ties (Laing, Leff, Skynner) and
supported by social networks (Brown & Harris, Lewis, Sheppard) …
do not become optimally functional human beings who might share
the happy illusion of autonomy and independence
Ref: Di Nicola V (2021). “There is no such thing as society”: The pervasive myth of
the atomistic individual in psychology and psychiatry. World Soc Psychiatry, 3(2):
60-4.

43. The social origins of depression
• The pioneering studies of George Brown & Tirrell Harris (1978) on the
social origins of depression in women compellingly demonstrated that
confiding partners and social relationships are critical in protecting
women against depression
• So – the truth is that we are richly socially interdependent and that
not only health, but recovery and rehabilitation too, depend on a
shared sense of belonging and reciprocal social obligations

44. “Being-with”
• French Philosopher Jean-Luc Nancy (2000) put this brilliantly in his Being
Singular Plural:
• there is no being without “being-with”
• that “I” does not come before “we” (Dasein does not precede Mitsein)
• and that there is no existence without co-existence

45. How we become persons
• As the Zulu saying puts it so well –
“A person is a person through other persons”

46. Guiding values
• Inspired by London’s social psychiatry, I want to promote
convergence, integration, and social solidarity
as the guiding values of Social Psychiatry

47. Proposed themes for the WASP triennium
I. Attachment, family and social systems
• Overarching theme: Belonging
“Belonging is to social psychiatry
what attachment is to child psychiatry”

48. Proposed themes for the WASP triennium
II. Intergenerational transmission of family, communal and social
systems and structures
• Connecting thread: The mechanisms of such transmissions will be
represented by the Social Determinants of Health and Mental Health
(SDH/MH) and Adverse Childhood Experiences (ACEs)

49. Proposed themes for the WASP triennium
III. From populations to patients, from social to personal being
• Methodology: Translational research of SDH/MH to ground level
• Social Psychiatry has been “cruising at 35,000 feet”
• It’s past time to bring it down to the ground –
• at the clinic (therapy)
• in the community (outreach)
• with public information & professional training (education)
• for health care planning (policy making)

50. Introducing myself
• So now that you know about the society in which my commitments
and critiques were formed, I may introduce myself as an individual
• I have been involved in attachment, family and social systems all of
my career since my salad days at the Institute of Psychiatry and the
Tavistock Institute here in London
• My name is Vincenzo Di Nicola and I am a social psychiatrist

51. Acknowledgements
I would like to express my gratitude to:
• WASP and CASP
• WASP Past Presidents I have known:
• Antonio Guilherme Ferreira (Portugal, 1988-1992)
• Jorge Alberto Costa e Silva (Brazil, 1992-1996)
• Eliot Sorel (USA, 1996-2001)
• Shridhar Sharma (India, 2001-2004)
• Tsutomu Sakuta (Japan, 2004-2007)
• Julio Arboleda-Flores (Canada, 2007-2010)
• Driss Moussaoui (Morocco, 2010-2013)
• Thomas Jamieson-Craig (UK, 2013-2016)
• Roy Kallivayalil (India, 2016-2019)
• Rachid Bennegadi (France, 2019-2022)
• WASP President-Elect: Rakesh Chadda (India, 2025-2028)
• World Social Psychiatry Editors: Debasish Basu & Nitin Gupta (India, 2019- )