This is my 4th column in my new series in Psychiatric Times, "Second Thoughts About ... Psychiatry, Psychology and Psychotherapy" This column is about polarization in social and political life and the slippery slope from what is to what ought to be, from facts to values. https://www.psychiatrictimes.com/view/polarization-on-the-threshold-between-political-ideology-and-social-reality

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Psychiatric Times
Column: Second Thoughts
Link: https://www.psychiatrictimes.com/view/polarization-on-the-threshold-between-political-
ideology-and-social-reality
Polarization: On the Threshold between Political Ideology and Social Reality
April 10, 2024
Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA
This column is based on my Foreword to the forthcoming volume by Marcos de Noronha, MD on
polarization, to be published in both Portuguese and Spanish and appears with his permission.
Dr. Marcos de Noronha is a noted Brazilian ethno-psychiatrist who conducts social therapy in
Florianópolis, Santa Catarina. His analysis focuses on Brazil but the general argument holds for
all Western democracies and liberal societies.1
From Description to Prescription
The “is-ought” problem was articulated by the Scottish philosopher David Hume in the 18th
century (1739-40).2
He noted that thinkers make claims about “what ought to be” based on
claims about “what is.” The “is-ought” problem is a critical issue in both moral philosophy and
social science. It is so fundamental that the great British liberal thinker Isaiah Berlin asserted
that, “No man has influenced the history of philosophy to a deeper or more disturbing degree,”
and US philosopher of mind Jerry Fodor claimed that Hume’s treatise is “the foundational
document of cognitive science.”3
In trying to distinguish science from religion a century ago,
German sociologist Max Weber drew the “fact-value” distinction (1917),4 proposing that science
deals with facts while religion addresses questions of value.

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What should be a distinction often becomes a slide, the famous “slippery slope” from good
intentions to bad outcomes. And this slide – confounding the “is” and the “ought,” facts and
values – is precisely the opposite of what Hume and Weber wanted to distinguish. In their
footsteps, I offer a gloss on the slide, filling in some steps: From description to explanation to
justification to prescription.
In my gloss, I add some nuances to this slide, using poverty as an example:
• We start with a description of “reality” or facts – what “is.” We define and establish
operational criteria for poverty in each area, accepting that the salience of those criteria will
differ in different places. Indeed, the judgment of what is poverty can be deeply subjective
and has a social context.
• But how do we get from facts to values – what “ought” to be? We can assert the value that
in a higher-income country like Canada, we shouldn’t have the kind of poverty where people
starve to death.
• After description, we search for explanation, to answer the question, “How are things the
way they are?” That’s natural and understandable: given description, we search for
explanations. How is it that in Canada we tolerate a certain level of “food insecurity” when
there is enough food and food wastage is a regrettable fact of life?
• What is less understandable or acceptable to everyone is the next jump to justification. In
our example, here is where values diverge most. The right will say, poor people “choose to be
poor and stay poor” by misusing their resources, squandering them on non-essentials, like
drugs and alcohol. The left will say, that’s a trivial part of the problem since poverty also
often means not having the models and skills for the best use of resources, including food,
and in any case, other factors like the housing crisis are pushing people into poverty and
onto the streets.
• Now, the slide from justification to prescription is also easy to understand and to follow.

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Once we have a justification, it’s easy to reach for a prescription. If we believe that food
insecurity and poverty are part of the structural inequalities of our society (justification),
then social interventions (prescriptions) like meal programs in schools (common in Brazil, for
example, where tragically, keeping children out of school during the COVID-19 syndemic
meant that millions of children missed their one reliable meal of the day), food banks,
homeless shelters and “soup kitchens” are not only justifiable but social justice demands
them.
• It’s how we go from explanation to justification that is truly slippery and threatens social
and political cohesion!
• And we can pair them: description calls for explanations and justification calls for
prescription.
• Again, the critical and divisive step is from description-explanation (is/facts) to justification-
prescription (ought/values). Even if we agree about how to define poverty and its impacts
(description-explanation), there will be divergence as to who is responsible for its
remediation (justification-prescription). In the Reagan (US) and Thatcher (UK) era, there was
an acknowledgement of the facts of poverty and besides blaming people for being poor,
conservative governments encouraged neighborly actions in the private sector (such as
charity and volunteerism) and philanthropy by big business. Liberals on the other hand
believe in more direct government interventions, ranging from protecting the health of
workers, to parental leave, and child subsidies (Canada offers “child benefits,” monthly
stipends for school-age children, and well-funded public schools; in Quebec, we have
government subsidized affordable daycare, and generous parental leave).
Other examples? Fill in your own – abortion, gun control, euthanasia, capital punishment,
decriminalizing drug use, transgender youth, state-sponsored assassinations, reparations for
past injustices – and try to sort out facts from values, descriptions versus prescriptions.

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Rationality versus Subjectivity
That is my analysis of how a key aspect of polarization comes about. It is partly a consequence
of poor thinking and the lack of a critical perspective. Daniel Kahneman, PhD, who recently died,
was a psychologist who won a Nobel Prize in behavioral economics for his research into our
imperfect human judgment and irrational choices.5
Yet, even his insights can only partly explain
polarization. What Kahneman’s research does is to clarify the vagaries of human judgment
about what is – and exhorts us to live without illusions and ungrounded intuition.
However, an analysis of distortions in judgment and the illusions they engender cannot explain
our values. Facts do not trump values; they are two different spheres that influence each other
like reason and emotion. Attempting to reduce social problems to bad judgments reveals the
prejudice that complex human predicaments have solutions based solely on a proper
understanding of the facts. My friend Steven Pinker, PhD, a cognitive scientist at Harvard,
promotes rationality.6
Along with Austrian philosopher Ludwig Wittgenstein, I agree that we
should be as clear as possible about those things that can be understood rationally, logically.
The concluding proposition to Wittgenstein’s famous treatise is: “Whereof one cannot speak,
one must consign to silence.”7
That’s great – all you’re missing is aesthetics, morality, religion
and spirituality, philosophy, the arts, and literature.
Pinker’s appeal to rationality and Kahneman’s research on how it is limited by irrational human
judgments are valuable to sort out the facts – meaning the best evidence available about those
things susceptible to our current methods of proof – to eliminate cognitive distortions,
misinformation, and cultish groupthink. What rationality cannot do is either explain or combat
polarization alone because it is also driven by a divergence in values.
All of these aspects of human society are bathed in personal subjectivity which generates
innovation that may lead to a shared consensus of values about their worth. That consensus
nonetheless remains subjective and cognitive scientists opine that even science is a shared

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illusion.8
As US educator and social critic Neil Postman declared in Technopoly, which he defined
as the surrender of culture to technology, “Technopoly is at war with subjectivity.”9
“Single-message Ideologies” versus Pluralism
Polarization privileges utopian “single-message ideologies” over the pluriverse of the actual
world we live in.10
That is not only driven by getting the facts wrong through misinformation and
poor judgment but also by values which may be manipulated in the service of politics that we
may not approve of. And that is the slippery slope I am describing. “From description to
prescription” ultimately means sliding from a consensual social reality balancing facts and
values to a divisive political ideology privileging its own narrow view. That is the chasm and the
abyss we are living in now in liberal democratic societies.
And why, the reader will ask, are you somehow protected from these errors of judgment and
extremes of ideology? Why doesn’t Marcos de Noronha, the author of Polarization – or indeed
myself – also fall into the abyss?
To be aware of the abyss of polarization is already to be forewarned and forearmed. That
knowledge encourages compromise based on an understanding of the shared tasks of social life.
As one of my supervisors once said about another staff person during my psychiatric residency,
“It’s a narcissistic injury for him to agree with anybody else about anything.” Not surprisingly,
the person in question held strong convictions about psychiatry which made him a passionate
partisan while alienating others.
One of the greatest authorities on religion, race, and social justice was Martin Luther King, Jr.,
who understood that, “Science deals mainly with facts; religion deals mainly with values.” Yet,
he saw them as “complementary” rather than rivals. Science keeps religion from “crippling
irrationalism and paralyzing obscurantism,” while religion prevents science from “falling into ...
obsolete materialism and moral nihilism.”11
Words to live by!

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Speaking for myself, I have straddled dual realities all my life – born in Italy, raised in English
Canada, I have now spent half of my life in Quebec, working and teaching in French. For me, it’s
not “either/or” – it’s “and/and.” Canada was founded on the lands of the indigenous people,
AND colonized by the English and the French four centuries ago, AND now accommodates
people from all over the world. Almost a quarter of Canadians in the 2021 Census were foreign-
born. Close to a third of children under 15 had at least one foreign-born parent.12
To refuse to
acknowledge and celebrate our present pluralism is to make a partisan choice. As Leonard
Cohen wryly observed, “There is no present in Montreal. Only the past claiming victories.”13
And for 30 years, I have been visiting and working in Brazil, part of the Global South, embracing
what Portuguese sociologist Boaventura de Sousa Santos calls southern epistemologies14
and
Brazilian musician Caetano Veloso’s tropical truth.15
These are calls for refounding the idea of
the good society, based on their own histories, traditions, and values. Living with and
understanding pluralism is a bulwark against monocultural or single-message ideologies. My
self-definition is that I have an Italian heart, an Anglo-Saxon brain, a Jewish soul, and a Brazilian
family.
A Dialogue about Power
A final consideration in my analysis of polarization concerns the recourse to power. Here is a
dialogue about power between a teacher and a student:
Mara Selvini Palazzoli, MD, the teacher, a family therapist, is talking about power in families.
Student: “But, Professor, power is an illusion.”
MSP: “Power may be an illusion but the struggle for power is a fact.”

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That student was me. My statement was both a statement of fact and the affirmation of a
personal value. Selvini Palazzoli’s riposte was a clinician’s answer – power struggles within the
family are a fact of social life. Nonetheless, on a larger canvas, do we want to build our view of
human relations on an illusion? We need to deal with illusions without being seduced by their
allure of a better, more beautiful world or succumbing to the cynicism of Machiavellian power
struggles. In sociopolitical terms of once popular but now discredited political philosophies, that
would translate into Francis Fukuyama’s “end of history” (liberal democracies won the day and
all that is left is to sort out the winners and the losers)16
or Samuel Huntington’s “clash of
civilizations” (in which we are doomed to an endless Hobbesian war of “all against all”).17
Founding our psychology, society and politics on the struggle for power creates polarization. I
understand that aggrieved groups seek power to affirm themselves and fight for a place in the
sun. It explains a lot about their struggles. Yet, justifying violence or prescribing it, as
philosopher Jean-Paul Sartre did in his Foreword to psychiatric revolutionary Frantz Fanon, MD’s
The Wretched of the Earth is unacceptable.18
It might even work for a time – but it will never
lead to a just world. If for no other reason, because of the trauma that political violence leaves
in its wake, as did the Red Brigades and the IRA, two movements I encountered in my native
Italy and in London at the time of “The Troubles” in the 1970s.
This became painfully clear to me when I visited Che Guevara’s mausoleum in Santa Clara, Cuba.
Among other artefacts of his life, I saw the revolver with which he killed people. I understand
that Comandante Guevara was fighting a revolutionary war. What I neither understand nor can

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justify is that Dr. Ernesto Guevara would do such a thing. These roles are incompatible. And that
was the end of one of my youthful idealizations. The film of the young Che, touring South
America with fellow medical student Alberto Granado on his motorcycle and confronting the
appalling poverty there is moving as is their founding of a medical school in Cuba.19
The older
Che, the physician, killing people in the name of the revolution is not.
Against Mao’s famous dictum that “political power grows out of the barrel of a gun,” the
revolution I can believe in will happen spontaneously, contingently, and organically, as Italian
political philosopher Antonio Gramsci described it. Along with a mistrust of binary oppositions
and the polarization they create, I reject a society based on polarizing power, whether in
personal, economic, political, sexual or social relations. In every sphere of my theory and
practice as a social psychiatrist and philosopher, I start with a convivial and interdependent
collective (family, community, society) and construct the individual as a subject based on his or
her family and social relationships, always seeking the Buddhist “middle way” or the Greek
“golden mean” and, in modern terms, “win-win” solutions.20, 21
Resources
Here is a layered list of contemporary approaches to reason, progress and subjectivity:
• Steven Pinker, a cognitive scientist, makes the case for reason in Rationality6
• Daniel Kahneman, a behavioral economist, and associates point out the limits of reason in
Noise: A Flaw in Human Judgment.5

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• Those who champion reason hold that it is the engine of social progress which is challenged
by historian and social critic Christopher Lasch in The True and Only Heaven: Progress and Its
Critics.22
• Finally, educator and cultural critic Neil Postman argues compellingly in Technopoly9
that in
our technocratic society, reason is tied to objectivity which is “at war with subjectivity.”
Dr Di Nicola is a child psychiatrist, family psychotherapist and philosopher in Montreal, Quebec,
Canada, where he is Professor of Psychiatry & Addiction Medicine at the University of Montreal
and President of the World Association of Social Psychiatry (WASP). He has been recognized with
numerous national and international awards, honorary professorships and fellowships, and was
recently elected a Fellow of the Canadian Academy of Health Sciences and given the
Distinguished Service Award of the American Psychiatric Association. Dr Di Nicola’s work
straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr
Di Nicola’s writing includes: A Stranger in the Family: Culture, Families and Therapy (WW
Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011, winner of the Camille Laurin
Prize of the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social
Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021); and, in
the arts, his “Slow Thought Manifesto” (Aeon Magazine, 2018) and Two Kinds of People: Poems
from Mile End (Delere Press, 2023, nominated for The Pushcart Prize).
References
1. de Noronha M. Polarização: Sintoma de uma Doença Social [Polarization: Symptom of a Social
Disease]. Editora Letras Contemporâneas; 2024. Link to his video and blog in Portuguese:
https://doencasocial.my.canva.site/blog

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2. Hume D. A Treatise of Human Nature: Being an Attempt to Introduce the Experimental Method
of Reasoning into Moral Subjects. John Noon; 1739–40.
3. Wikipedia contributors, “A Treatise of Human Nature,” Wikipedia, The Free Encyclopedia,
https://en.wikipedia.org/w/index.php?title=A_Treatise_of_Human_Nature&oldid=120810360
8 (accessed April 1, 2024).
4. Weber M. Science as a Vocation. Trans. & ed. Gerth HH, Mills CW. Free Press; 1946.
5. Kahneman D, Sibony O, Sunstein CR. Noise: A Flaw in Human Judgment. William Collins; 2021.
6. Pinker S. Rationality: What It Is, Why It Seems Scarce, Why It Matters. Viking; 2021.
7. Wittgenstein L. Tractatus Logico-Philosophicus. Trans. Moore GE, Ramsey FP, Wittgenstein L.
Routledge & Kegan Paul; 1922.
8. “Why Some Scientists Think That Science is an Illusion.” Mind Matters. August 6, 2019.
https://mindmatters.ai/2019/08/why-some-scientists-think-science-is-an-illusion/
9. Postman N. Technopoly: The Surrender of Culture to Technology. Vintage; 2011.
10. Kothari A, Salleh A, Escobar A, et al., eds. Pluriverse: A Post-Development Dictionary. Tulika
Books/Columbia University Press; 2019.
11. Wikipedia contributors, “Fact–value distinction,” Wikipedia, The Free Encyclopedia,
https://en.wikipedia.org/w/index.php?title=Fact%E2%80%93value_distinction&oldid=121372
7402 (accessed April 1, 2024).
12. Statistics Canada, “Immigrants make up the largest share of the population in over 150 years
and continue to shape who we are as Canadians.” Released October 26, 2022.
https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026a-
eng.htm#:~:text=The%20share%20of%20second-
generation%20Canadians%20%28children%20of%20immigrants%29,from%2026.7%25%20in
%202011%20to%2031.5%25%20in%202021 (accessed April 1, 2024).
13. Cohen L. The Favourite Game. Secker & Warburg; 1963.
14. Santos B de S. Epistemologies of the South: Justice Against Epistemicide. Routledge; 2016.
15. Veloso C. Tropical Truth: A Story of Music and Revolution in Brazil. Bloomsbury; 2003.
16. Fukuyama F. The End of History and the Last Man. Free Press; 1992.

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17. Huntington SP. The Clash of Civilizations and the Remaking of the World Order. Simon &
Schuster; 1996.
18. Fanon F. The Wretched of the Earth. Trans. Philcox R. Foreword Bhabha HK. Preface Sartre J-P.
Grove Press; 2004.
19. Wikipedia contributors, “The Motorcycle Diaries (film),” Wikipedia, The Free Encyclopedia,
https://en.wikipedia.org/w/index.php?title=The_Motorcycle_Diaries_(film)&oldid=121516569
4 (accessed April 1, 2024).
20. Di Nicola V. A Stranger in the Family: Culture, Families, and Therapy. W.W. Norton & Co.; 1997.
21. Di Nicola V, Stoyanov DS. Psychiatry in Crisis: At the Crossroads of Social Science, the
Humanities, and Neuroscience. Springer Nature; 2021.
22. Lasch C. The True and Only Heaven: Progress and Its Critics. W.W. Norton & Co.; 1991.