V Di Nicola, “Social Psychiatry and Person-centered Medicine: Integrating Social Determinants (SDH) of Health and Adverse Childhood Experiences (ACE) with Clinical Practice,” The Paradigm Change in Medicine: The Epistemological and Scientific Basis of Person-centered Medicine, Scuola Medica di Milano, Università Ambrosiana – Milan School of Medicine, Ambrosiana University, Milan, Italy, June 21-22, 2023. Abstract Prof. Di Nicola’s Honoris causa docendi eloquentia (inaugural honorary speech) for the Licentia Docendi ad Honorem (LD) (the Honorary Chair) Magister ad Honorem (MA Sc) (Honorary Professor) in June 2021 was entitled, “The Place of the Person in Social Psychiatry: A Synthesis of Person-centered Medicine with Social Psychiatry in the Time of the New Coronavirus Syndemic,” addressed three themes: (1) the place of the person in social psychiatry linking it with the person-centered paradigm for medicine, health, and social care; (2) the struggle for a person-centered vision of health and social care; and (3) the challenges of the coronavirus syndemic or combination of biological and social epidemics, for both medicine and society. Prof. Di Nicola concluded with a call for a synthesis of social psychiatry with person-centered medicine, balancing evidence-based medicine with values-based practice (Fulford, 2008), by embracing the emerging epistemology of the Global South (Di Nicola, 2020) and an eco-social perspective. This presentation elaborates three more areas to promote the integration of Social Psychiatry (Di Nicola, 2019) with Person-centered Medicine: (1) how to integrate Social Psychiatry’s epidemiological data base – the Social Determinants of Health (SDH)(CSDH, 2008) and the Adverse Childhood Events (ACE) Study (Fellitti, et al., 2010) – with clinical psychiatry; (2) how to reconcile the collectivist approach of Social Psychiatry (Di Nicola, 2021) and epidemiology with the individual perspective of Person-centered Medicine and clinical practice using the insights of social science (e.g., the distributed self, Gergen, 2001) and neuroscience (e.g., mirror neurons, Gallese, 2008); (3) presentation of social and clinical vignettes from the COVID-19 syndemic about isolation and loneliness (Di Nicola & Daly, 2020; Di Nicola, 2021; Jeste, et al., 2020) and another social plague of Intimate Partner Violence (IPV)(Oram, et al., 2022) - and the antidote: belonging, which is to Social Psychiatry what attachment is to Child Psychiatry (Di Nicola, 2023).

1. Social Psychiatry and
Person-centered Medicine
Integrating Social Determinants of Health (SDH)
and Adverse Childood Events (ACE) with
Clinical Practice
Prof. Vincenzo Di Nicola
Honorary Chair and Professor
of Social Psychiatry

2. Prof. Vincenzo Di Nicola
Licentia Docendi atque Magisterium ad Honorem
Honorary Chair and Professor of Social Psychiatry
Scuola Medica di Milano
Founder & President (2019-2023)
Canadian Association of Social Psychiatry
President (2022-2025)
World Association of Social Psychiatry
Email: wasp.president@gmail.com

3. Ad Giambattista Vico (1668–1744)
Verum esse ipsum factum
“What is true is precisely what is made”
Father of constructivist epistemology
which sees knowledge as
a social construction rather than
a discovery of the natural world

4. Conflicts of Interest
The presenter has no financial conflicts of interest
or relationship with the pharmaceutical industry

5. Overview
My inaugural speech (Di Nicola, 2021b) addressed three
key themes:
1. The place of the person in social psychiatry;
2. The struggle for a person-centred vision of
health and social care;
3. The challenges of the new coronavirus
syndemic

6. The place of the person
The place of the person in Social Psychiatry
linking my call for a manifesto for a 21st century
Social Psychiatry through WASP
- and -
the person-centered paradigm for
medicine, health, and social care at the
Scuola Medica di Milano

7. V Di Nicola
Review article –
“A person is a person
through other persons”:
A social psychiatry
manifesto for the 21st
century.
World Social Psychiatry
2019; 1(1): 8-21.

8. Three branches of Social Psychiatry
Three branches of Social Psychiatry
signaled a shift in psychiatry from the
individual to groups …
Epidemiological studies
Community psychiatry
Relational therapies

9. Three branches of Social Psychiatry
Social psychiatry is at the interface
Relational
therapies
Community
psychiatry
Epidemiology

10. Person-centered vision of medicine
The struggle for a person-centered vision of
health and social care in a time that Neil
Postman (1993) characterized as technopoly,
defined as “the surrender of culture to
technology”
Reference: Postman N. Technopoly: The Surrender of Culture to Technology. New York:
Vintage, 1993.

11. Technopoly
The struggle for a person-centered
vision of health and social care is the
struggle of the person against a
faceless technopoly
Reference: Postman N. Technopoly: The Surrender of Culture to Technology.
New York: Vintage, 1993.

12. Person-centered vision of medicine
Psychiatry in Crisis (Di Nicola & Stoyanov, 2021)
Psychiatry’s crisis is a crisis of ontology –
how we define human being and the person –
not merely a crisis of epistemology or knowledge
as the technocrats of medicine and psychiatry
would have it

13. Person-centered vision of medicine
Child development (Di Nicola & Daly, 2020)
Reductivism and positivism come in many guises
– child psychiatry which is centered on human
development is threatened by disease specialists
Children’s adaptation and growth are integral to
their humanity and cannot be reduced to their
components parts as in modular psychology

14. Person-centered vision of medicine
Family Therapy (Di Nicola, 1997, 2011) began as
a challenge to academic psychiatry’s limitations
Placing the person in the context of family and
community, society and culture
Yet Family Therapy itself risks obscuring the
individual behind a screen of impersonal
“systems” and “structures” – so FT too needs to
recover the person in the family system or
social structure

15. Cultural Family Therapy
NY: WW Norton, 1997
Porto Alegre: ArtMed, 1998

16. Letters to a
Young Therapist
Relational Practices for
the Coming Community
New York: Atropos, 2011
Awarded annual prize
Quebec Psychiatric
Association, 2012

17. Defining a syndemic
A syndemic or synergistic epidemic is the aggregation of two or
more concurrent or sequential epidemics or disease clusters in a
population with biological interactions, which exacerbate the
prognosis and burden of disease
The term was developed by medical anthropologist Merrill Singer
in the mid-1990s
Syndemics develop under health disparity, caused by poverty,
stress, or structural violence and are studied by epidemiologists
and others concerned with public health, community health,
and the social determinants of health
References: Horton R. Offline: COVID-19 is not a pandemic. Lancet. 2020;396:874.
Syndemic (n.d.). In Wikipedia. Retrieved March 27, 2021, from
https://en.wikipedia.org/wiki/Syndemic

18. Cascade of consequences
The impact on children is part of a cascade of
consequences affecting societies at large
(Agamben, 2020; Chadda, et al., 2020), smaller
communities & the multigenerational family,
which impinge on children & youth as the lowest
common denominator (Di Nicola & Daly, 2020)
Reference: Agamben G. A Che Punto Siamo? L’Epidemia Como Politica. Quodlibet, 2020.
Barreto AP, Filha MO, Silva MZ, Di Nicola V. Integrative Community Therapy in the time of the new
Coronavirus pandemic in Brazil and Latin America. World Soc Psychiatry. 2020;2 (2):103-5.
Chadda RK, Bennegadi R, Di Nicola V, Molodynski A, Basu D, Kallivayalil RA, Moussaoui D. World
Association of Social Psychiatry position statement on the Coronavirus disease 2019 pandemic. World
Soc Psychiatry. 2020;2(2):57.
Di Nicola V, Daly N. Growing up in a pandemic: Biomedical and psychosocial impacts of the
COVID-19 crisis on children and families. World Social Psychiatry, 2020, 2(2): 148-151.

19. Overview
This presentation elaborates three areas to promote the integration
of Social Psychiatry with Person-centered Medicine:
1. How to integrate Social Psychiatry’s epidemiological
data base with clinical psychiatry;
2. How to reconcile the collectivist approach of Social
Psychiatry with the individual perspective of Person-
centered Medicine;
3. Presentation of vignettes about isolation during the
coronavirus syndemic and the social plague of
Intimate Partner Violence (IPV)

20. 1. Integrating SP’s epidemiological data base
with clinical psychiatry
1. How to integrate Social Psychiatry’s epidemiological
data base with clinical psychiatry

21. 1. Integrating SP’s epidemiological data base
with clinical psychiatry
1. How to integrate Social Psychiatry’s epidemiological
data base with clinical psychiatry
SP’s epidemiological data base:
Social Determinants of Health (SDHs) (CSDH, 2008)
Adverse Childhood Events (ACE) Study (Fellitti, et al., 2010)
References: CSDH. Closing the gap in a generation: Health equity through action on the social
determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva,
Switzerland: World Health Organization; 2008.
Felitti VJ, Anda RF. The relationship of adverse childhood experiences to adult medical disease,
psychiatric disorders and sexual behavior: Implications for health care. In: Lanius RA, Vermetten E, Pain
C, editors. The Impact of Early Trauma on Health and Disease: The Hidden Epidemic.
Cambridge, UK: Cambridge University Press; 2010. p. 77-87.

22. 2. Reconciling SP’s collectivist approach with the
individual perspective of PCM
2. How to reconcile the collectivist approach of
Social Psychiatry (SP) and epidemiology with the
individual perspective of Person-centered
Medicine (PCM) and clinical practice

23. 2. Reconciling SP’s collectivist approach with the
individual perspective of PCM
2. How to reconcile the collectivist approach of
Social Psychiatry (SP) and epidemiology with the
individual perspective of Person-centered
Medicine (PCM) and clinical practice
Social Science (e.g., the “distributed self,” Gergen,
2001), and
Neuroscience (e.g., “mirror neurons,” Gallese, 2008)
References: Gallese V. Mirror neurons and the social nature of language: The neural exploitation
hypothesis. Soc Neurosci 2008;3:317-33.
Gergen KS. The Saturated Self, Dilemmas of Identity in Contemporary Life. New York: Basic Books. 1991;
2nd. ed. 2001.

24. Community/individual
The community stagnates without
the impulse of the individual.
The impulse dies without
the sympathy of the community.
– William James
The Will to Believe (1896)

25. The social
brain is
constructed
through
personal
relationships

26. 3. Reconciling SP’s collectivist approach with the
individual perspective of PCM
3. Social and clinical vignettes from the
coronavirus syndemic about isolation and
loneliness and the social plague of Intimate
Partner Violence (IPV)

27. 3. Reconciling SP’s collectivist approach with the
individual perspective of PCM
3. Vignettes from contemporary society
The coronavirus syndemic:
Isolation and loneliness (Di Nicola & Daly, 2020;
Di Nicola, 2021; Jeste, et al., 2020)
Isolation and its impacts is now being identified as a
major social concern and vector for mental and
relational distress
References: Di Nicola V. From Plato’s cave to the Covid-19 pandemic: Confinement, social distancing, and biopolitics.
Global Mental Health & Psychiatry Review. 2021;2(2):8-9.
Di Nicola V, Daly N. Growing up in a pandemic: Biomedical and psychosocial impacts of the COVID-19 crisis on children
and families. World Soc Psychiatry. 2020;2(2):148-51.
Jeste DV, Lee EE, Cacioppo S. Battling the modern behavioral epidemic of loneliness:
Suggestions for research and interventions. JAMA Psychiatry 2020;77:553-4.

28. 3. Reconciling SP’s collectivist approach with the
individual perspective of PCM
3. Vignettes from contemporary society
The social plague of conjugal and family distress:
Intimate Partner Violence (IPV)
Reference: Oram S, Fisher H, Minnis H, Seedat S, Walby, S, Hegarty K, et al. The Lancet
Psychiatry Commission on intimate partner violence and mental health: Advancing mental
health services, research, and policy. The Lancet Psychiatry 2022;9:487-524.

29. Belonging
The antidote is belonging
Belonging is to Social Psychiatry what attachment is
to Child Psychiatry (Di Nicola, 2023)
Reference: Di Nicola V. Belonging is to Social Psychiatry what
Attachment is to Child Psychiatry. World Soc Psychiatry 2023;5:4-6.

30. Concluding call for a synthesis
Person-centered medicine brings to Social
Psychiatry, child psychiatry, and family therapy an
insistence on the centrality of the person:
Social Psychiatry can be cruising at 35,000 feet
with a global perspective yet miss the action at
ground level where persons live
Child Psychology & Psychiatry have much to say
about development and too little about children
Family Therapy can get lost in patterns and
systems and forget that it is about persons

31. Concluding call for a synthesis
Call for a synthesis of Social Psychiatry with
Person-centered Medicine
balancing evidence-based medicine with values-
based practice,
embracing the emerging epistemology of the Global
South (Di Nicola, 2020) and an eco-social perspective
Reference: Di Nicola V. The Global South: An Emergent Epistemology for Social
Psychiatry. World Soc Psychiatry 2020;2:20-6.

32. Concluding call for a synthesis
Just as the focus is shifting from generic and
vague systems and structures to person-centered
medicine …
The center of gravity in world affairs has shifted
from the Global North to the Global South
Reference: Di Nicola V. The Global South: An Emergent Epistemology for Social
Psychiatry. World Soc Psychiatry 2020;2:20-6.

33. Acknowledgements
I wish to express my gratitude for this honour to:
Professor Giuseppe R. Brera,
Rettore dell’Università Ambrosiana
La Scuola Medica di Milano e
l’Università Ambrosiana

34. Bibliography
Agamben G. A Che Punto Siamo? L’Epidemia Como Politica. Quodlibet,
2020.
Barreto AP, Filha MO, Silva MZ, Di Nicola V. Integrative Community Therapy
in the time of the new Coronavirus pandemic in Brazil and Latin America.
World Soc Psychiatry. 2020;2 (2):103-5. Available from:
https://www.worldsocpsychiatry.org/text.asp?2020/2/2/103/292135
Chadda RK, Bennegadi R, Di Nicola V, Molodynski A, Basu D, Kallivayalil RA,
Moussaoui D. World Association of Social Psychiatry position statement on
the Coronavirus disease 2019 pandemic. World Soc Psychiatry.
2020;2(2):57. Available from:
https://www.worldsocpsychiatry.org/text.asp?2020/2/2/57/292111
CSDH. Closing the gap in a generation: Health equity through action on the
social determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva, Switzerland: World Health Organization;
2008.

35. Bibliography
Di Nicola V. A Stranger in the Family: Culture, Families and Therapy. New
York: W.W. Norton & Co., 1997.
Di Nicola V. Letters to a Young Therapist: Relational Practices for the
Coming Community. New York: Atropos Press, 2011.
Di Nicola V. Review Article – “A person is a person through other persons:”
A social psychiatry manifesto for the 21st century. World Social Psychiatry
2019; 1(1): 8-21. Available from:
https://www.worldsocpsychiatry.org/text.asp?2019/1/1/8/267958
Di Nicola V. The Global South: An emergent epistemology for social
psychiatry. World Soc Psychiatry. 2020;2(1):20-6. Available from:
https://www.worldsocpsychiatry.org/text.asp?2020/2/1/20/281130
Di Nicola V. From Plato’s cave to the Covid-19 pandemic: Confinement,
social distancing, and biopolitics. Global Mental Health & Psychiatry
Review. 2021;2(2):8-9.

36. Bibliography
Di Nicola V. Invited speech on the occasion of being named Honorary Chair
and Professor of Social Psychiatry at the Milan School of Medicine, “The
Place of the Person in Social Psychiatry: A Synthesis of Person-centred
Medicine with Social Psychiatry in the Time of the New Coronavirus
Syndemic,” The Person-centered Paradigm Change of Health and Medicine
Paradigms, Scuola Medica di Milano, Università Ambrosiana – Milan
School of Medicine, Ambrosiana University, Milan, Italy, June 26, 2021.
Di Nicola V, Daly N. Growing up in a pandemic: Biomedical and
psychosocial impacts of the COVID-19 crisis on children and families.
World Soc Psychiatry. 2020;2(2):148-51. Available from:
https://www.worldsocpsychiatry.org/text.asp?2020/2/2/148/292140
Di Nicola V, Stoyanov D. Psychiatry in Crisis: At the Crossroads of Social
Sciences, the Humanities, and Neuroscience. Springer; 2021. Available
from: https://link.springer.com/book/10.1007/978-3-030-55140-7
Gallese V. Mirror neurons and the social nature of language: The neural
exploitation hypothesis. Soc Neurosci 2008;3:317-33.
Gergen KS. The Saturated Self, Dilemmas of Identity in Contemporary Life.
New York: Basic Books. 1991; 2nd. ed. 2001.

37. Bibliography
Horton R. Offline: COVID-19 is not a pandemic. Lancet.
2020;396:874. Available from:
https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(20)32000-6/fulltext
Jeste DV, Lee EE, Cacioppo S. Battling the modern behavioral epidemic of
loneliness: Suggestions for research and interventions. JAMA Psychiatry
2020;77:553-4.
James W. The Will to Believe. The New World, Volume 5 (1896): 327-347.
Oram S, Fisher H, Minnis H, Seedat S, Walby, S, Hegarty K, et al. The Lancet
Psychiatry Commission on intimate partner violence and mental health:
Advancing mental health services, research, and policy. The Lancet
Psychiatry 2022;9:487-524.
Postman N. Technopoly: The Surrender of Culture to Technology. Vintage,
1993.
Syndemic (n.d.). In Wikipedia. Retrieved March 27, 2021, from
https://en.wikipedia.org/wiki/Syndemic