This document summarizes a presentation on the intimate relationships between families, society, and mental health, with a focus on psychosis. It discusses three eras in understanding schizophrenia: classification, social context, and family studies. It emphasizes understanding psychosis at the intersection of families and society, highlighting cultural family therapy approaches. The presentation argues for adapting involvement of the family in psychosis treatment to their social and cultural backgrounds. It acknowledges the social determinants of health and importance of families in understanding humanity.

1. Families, Society & Mental Health
The Intimate Triad of
Social Psychiatry
Prof. Vincenzo Di Nicola
23rd WPA World Congress of Psychiatry
Vienna, Austria
September 29, 2023

2. WPA INTERORGANIZATIONAL SESSION
WORLD ASSOCIATION OF SOCIAL
PSYCHIATRY (WASP)
WORLD ASSOCIATION OF PSYCHOSOCIAL
REHABILITATION (WAPR)
Chair: Prof. Juan Mezzich
Prof. Vincenzo Di Nicola
Prof. Johannes Wancata
23rd WPA World Congress of Psychiatry
Vienna, Austria – September 29, 2023

3. Prof. Vincenzo Di Nicola
MPhil, MD, PhD, FRCPC, FCAHS, DLFAPA, DFCPA
Professor of Psychiatry
University of Montreal & The George Washington University
President
World Association of Social Psychiatry
Canadian Association of Social Psychiatry
Fellow
Canadian Academy of Health Sciences
Distinguished Fellow, Canadian Psychiatric Association
Distinguished Life Fellow, American Psychiatric Association

4. Conflicts of Interests
The presenter does not have any financial
conflicts of interest to declare

5. Family Intervention Programs Section
World Association of Social Psychiatry (WASP)
Leaders: Saïd Fattah, Mathew Varghese & Yann Hodé
Brings together mental health professionals, therapists
and other sources of support for families
Special interests in families with a member who suffers
from a mental disorder
Identify and support family interventions from
supportive care to therapy
Forthcoming special issue on “Families, Family
Interventions & Social Psychiatry,” World Social
Psychiatry, eds. V Di Nicola, S Fattah, O Falceto, Y Hodé

6. Family & Culture Special Interest Group
World Association of Cultural Psychiatry (WACP)
Co-chairs: Vincenzo Di Nicola & Riyadh Al-Baldawi
To bring together mental health professionals and
scholars in cognate fields
With special interests in the family and culture, how
they relate to and enrich each other, and
How to study, investigate, and promote research,
teaching, practices, advocacy and policy-making to
advance the study of the family in a cultural context

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. Without a family approach, without society …
something’s missing …

9. Families, Society & Psychosis
Should the involvement of the person’s
family in the treatment of psychosis
be adapted to their social and
cultural background?
And if so, how?

10. Not a rhetorical question
The answer should not be taken for granted
We may address it as an interface or interaction
Lived experience – anxiety, depression,
psychosis, or trauma – is best understood as
taking place at the crossroads of significant
social contexts and cultural processes
Let’s concentrate on psychosis
Families, Society & Psychosis

11. Three Lenses
Psychosis
Families
Society
Lived experience is at the crossroads

12. Schizophrenia has been called the “sublime
object of psychiatry” (Woods, 2011)
We may discern three eras in this history
Classification era: Emil Kraepelin (1893),
Eugen Bleuler (1908), Karl Jaspers (1913),
Kurt Schneider (1939)
Social context era: Norman Cameron, Gregory
Bateson, R D Laing, Silvano Arieti
Family studies era: Mara Selvini Palazzoli’s “Road
map to Schizo-land” (Di Nicola, 1984)
History of Schizophrenia

14. Emil Kraepelin
system of psychiatric classification (1893)
Eugen Bleuler
“the group of schizophrenias” (1908)
Karl Jaspers
phenomenological psychiatry (1913)
Kurt Schneider
First-Rank Symptoms of Schizophrenia (1939)
Classification Era

15. Norman Cameron
“paranoid pseudo-community” (1943, 1959)
Gregory Bateson
“double bind hypothesis” (1956)
R D Laing (1960, 1969)
“ontological insecurity”
“mystification,” “invalidation”
Silvano Arieti (1975)
“interpretation of schizophrenia”
“biopsychosocial approach”
Social Context Era

16. Three Lenses
Interaction of families and psychosis
Psychosis
Families
Society

17. Mara Selvini Palazzoli (1978, 1989)
“Road map to Schizo-land” (Di Nicola, 1984)
Paradox and Counterparadox: A New Model in
the Therapy of the Family in Schizophrenic
Transaction (1978)
“counterparadoxical interventions”
Family Games: General Models of Psychotic
Processes in the Family (1989)
“universal prescription”
Family Studies Era

18. Cultural Family Therapy

19. Three Lenses
Interaction of society and psychosis
Psychosis
Families
Society

20. George Brown – sociologist (1972)
Julian Leff (1985) – social psychiatrist
Five components
Critical comments
Hostility
Emotional overinvolvement (EOI)
Warmth
Positive regard
Cultural critique – Di Nicola (1988)
Expressed Emotion (EE)

21. Sir Michael Marmot (CSDH, 2008)
WHO Commission on the Social Determinants
of Health Health
“Social gradient for health”
“Treatment gap”
Vincent Felitti & Robert Anda
Adverse Childhood Experiences Study (2010)
Social Determinants of Health –
A New Era

22. Family
I see humanity as a family
that has hardly met.
– Theodore Zeldin
An Intimate History of Humanity

23. Acknowledgements
WPA, WASP, WAPR
Prof. Juan Mezzich
Prof. Johannes Wancata
Image courtesy of Jaswant Guzder

24. Bibliography
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.
Di Nicola VF. Road map to Schizo-land: Mara Selvini Palazzoli and the Milan
model systemic family therapy. Journal of Strategic & Systemic Therapies, 1984,
3(2): 50-62.
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 & Dresden: 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
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, eds. The Impact of Early Trauma
on Health and Disease: The Hidden Epidemic. Cambridge, UK:
Cambridge University Press; 2010:77-87.