Lead presenter: Vincenzo Di Nicola (Montreal) “Convergent vs divergent trends in Social and Cultural Psychiatry” Presenters: Kam Bhui (Oxford): “Future of social-cultural nexus in personal, structural and syndemic care” Gabriel Ivbijaro (London): “Global Mental Health and primary care: A new approach” This symposium brings together leaders of three contemporary approaches situated on the social-humanistic side of the spectrum of contemporary psychiatric theory and practice. Following his manifesto for 21st-century Social Psychiatry (SP), Di Nicola contrasts convergent trends in SP and its call for an embracing and unifying approach with divergent trends of Cultural Psychiatry (CP) and its recognition of diversity and particularities of cultures. Bhui examines the future of the social-cultural nexus in domains of personal, structural and syndemic care. Ivbijaro presents a new approach integrating Global Mental Health (GMH) into primary care. At stake is whether these potentially complementary approaches mutually enrich each other or present competing and potentially incongruent visions of psychiatry today: a spectrum or isolated silos? GMH, for example, can be construed as an integration of socio-cultural psychiatry, social determinants of health, and a populational approach with global reach. While these approaches overlap and potentially enrich each other, they may serve contrasting, perhaps incompatible goals. Can CP’s emphasis on diversity be compatible with SP’s social solidarity? Can GMH’s populational approach to global priorities be responsive to the local concerns of communities? And finally, can health care values based in person-centred subjectivity be the clinical bridge to the rigorous aspirations of the scientific evidence base (EBM)?

1. Session 32 Cultural Psychiatry, Global Mental Health,
and Social Psychiatry
Wednesday, January 178, 2023
9:40 – 10:45 am

2. Overview
Cultural Psychiatry, Global Mental Health,
and Social Psychiatry
Vincenzo Di Nicola 15 mins
Kamaldeep Bhui 15 mins
Gabriel Ivbijaro 15 mins
Q & A 20 mins

3. CONVERGENT VERSUS DIVERGENT TRENDS IN
SOCIAL AND CULTURAL PSYCHIATRY:
A CONCEPTUAL ANALYSIS
Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS

4. Vincenzo Di Nicola
MPhil, MD, PhD, FRCPC, DLFAPA, FCPA, FCAHS
Professor of Psychiatry
University of Montreal & The George Washington University
Honorary Chair & Professor of Social Psychiatry
Ambrosiana University
Founder & President, CASP
President-Elect, WASP

5. Conflicts of Interest
The presenters has no financial conflicts of
interest to declare

6. The End of Meta Narratives
(Change)
– Philippe Dodard,
Haitian artist

7. Learning Objectives
Participants will be able to distinguish the underlying
assumptions and core features - and thus, the identity –
of cultural psychiatry (CP) versus social psychiatry (SP),
both historically and in contemporary theory and
practice.
Participants will be able to see how the assumptions and
features of social psychiatry (SP) and cultural psychiatry
(CP) translate into two increasingly differentiated
identities and paradigms for the social sciences and
medicine, highlighting “convergent” versus “divergent”
trends.

8. Guiding Questions
1. What are the identities and core missions of cultural
psychiatry (CP) and social psychiatry (SP)? Are they
distinct or do they still overlap?
2. What are the impacts of each approach (CP, SP) in the
domains of theory, practice, education, and policy-
making?
3. Are the differences in assumptions, theory, and
practice between CP and SP still congruent enough to
make a synthesis possible or have they diverged so far as
to create two clearly demarcated and differentiated
fields of practice?

9. What are we missing in our current approach to culture & psychiatry?

10. Background
Drawing on the history of Social Psychiatry (SP)
and Cultural Psychiatry (CP), the author offers a
way to discern the distinguishing features and
identity of each branch of psychiatry.

11. Issues
Are the histories and current practices of CP
and SP mutually compatible and enriching or
are they hiving off into separate domains?

12. Proposition
A schema is presented for differentiating
underlying assumptions and core features of
these two allied but increasingly differentiated
fields of psychiatry.

13. Schema: Key Domains
1. Core arguments/dynamics
2. Foci
3. Allied fields
4. Metaphors
5. Values
6. Research methods
7. Allied professional movements/outgrowths
8. Allied populist movements
9. Critiques

14. Key Domains
1. Core arguments/dynamics
CP’s critiques of Western psychiatry lead to
negation of its claim to universality
SP’s documentation of social determinants of
health (SDH/MH) affords the affirmation of
SDH/MH across societies and over time

15. Key Domains
2. Foci
CP addresses ethnicity and race
SP investigates class and social structure

16. Key Domains
3. Allied fields
CP – medical anthropology, cultural
anthropology (USA) or social anthropology (UK)
SP – medical sociology, epidemiology & public
health

17. Key Domains
4. Metaphors
CP – “prism”/refracting
SP – “creolization”/blending

18. Key Domains
5. Values
CP – diversity/equity/inclusiveness (“EDI”)
SP – solidarity/commonality (“the commons”)

19. Key Domains
6. Research methods
CP – ethnographies, CFI
SP – epidemiology, SDH/MH

20. Key Domains
7. Allied professional movements/outgrowths
CP – Global Mental Health
SP – Community Psychiatry

21. Key Domains
8. Allied populist movements
CP – “Black Lives Matter,” “Me Too”
SP – “Gilets jaunes”

22. Key Domains
9. Critiques
CP/GMH – “crazy like us” (Watters, 2010),
“decolonizing GMH” (Mills, 2013)
SP – “southern epistemologies” (Santos, 2016),
“the Global South” (Di Nicola, 2020)

23. Outcomes
Cumulative results of the two allied traditions,
sometimes practiced by the same/overlapping
research teams, are discussed under the rubric:
centripetal (convergent, unifying, integrating)
- versus -
centrifugal (divergent, separating, dispersing)
impacts

24. Implications
The disparate methods and results of CP/SP
reflect diverse foundational discourses of these
increasingly differentiated fields.
CP has morphed into a study of Dostoyevsky’s
the insulted and the injured imbued with a
liberal, progressive ideology, culminating in
identity politics.

25. Implications
Meanwhile, social class, the signal critical tool of
everything social, from sociology to socialism
and SP, is being supplanted by a focus on culture.
The author invites a debate on what this means
for the future of CP & SP and whether a synthesis
is still possible.

26. World Values Survey (2022)

27. “Pernicious polarization” (Edsall, 2022)

29. Questions
&
Comments

30. References
Antić, A. Transcultural Psychiatry: Cultural Difference, Universalism and Social
Psychiatry in the Age of Decolonisation. Cult Med Psychiatry 45, 359–384
(2021). https://doi.org/10.1007/s11013-021-09719-4
Di Nicola, V. “A person is a person through other persons”: A social psychiatry
manifesto for the 21st century. World Soc Psychiatry [serial online] 2019
[cited 2021 Oct 2];1:8-21. Available from:
https://www.worldsocpsychiatry.org/text.asp?2019/1/1/8/26795
Di Nicola, V. The Global South: An Emergent Epistemology for Social Psychiatry.
World Soc Psychiatry [serial online] 2020 [cited 2022 Apr 20];2:20-6. Available
from: https://www.worldsocpsychiatry.org/text.asp?2020/2/1/20/281130
Edsall, T.B. America Has Split, and Now It’s in ‘Very Dangerous Territory.’
The New York Times, January 26, 2022. Available from:
https://www.nytimes.com/2022/01/26/opinion/covid-biden-trump-
polarization.html

31. References
Mills, C. Decolonizing Global Mental Health: The Psychiatrization of the
Majority World. London: Routledge; 2013.
Santos, B. de Sousa. Epistemologies of the South: Justice Against Epistemicide.
New York: Routledge; 2016
Sloterdijk, P. “No Such Thing as the Global Village,” translated from his essay in
Handelsblatt Today, January 13, 2017.
Watters, E. Crazy like Us: The Globalization of the American Psyche. New York:
Free Press; 2010.
World Values Survey. Inglehart–Welzel Cultural Map: Findings and Insights
[cited 2022 Apr 21]; 2022. Available from:
https://www.worldvaluessurvey.org/WVSNewsShow.jsp?ID=428