Against “The Myth of Independence”: For a More Convivial and Interdependent Society

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SECOND THOUGHTS

“No more fiendish punishment could be devised … than that one should be turned loose in society and remain absolutely unnoticed by the members thereof.”

– William James¹

In my first column in this series, “Social Psychiatry Comes of Age,” I promised to take up the contributions of the 3 branches of social psychiatry. Stay tuned.

First, some groundwork is necessary for us to establish a social psychiatric framework in which to define and test our contributions. A leader in cultural psychiatry asked me why I dismissed the biopsychosocial (BPS) model in my first column. Another leading social psychiatrist pointed out that a spiritual dimension should be added to BPS. Why not add developmental or relational dimensions, as I understand there were discussions to add them to the multiaxial system of DSM-III and IV? And why not epigenetics or exposomics, which cut across and integrate “bio” and “social”? Most compelling for me, the socio-economic dimension which is at the heart of the social determinants of health and mental health. It risks ballooning into an endless regress.

Many problems arose with the BPS model. First, it was constructed as a rejection of the formulation of psychodynamic psychiatry and it became a cover for biological psychiatry to claim it was comprehensive. More important than BPS’s flawed starting point and reductive finale, in any eclectic or multiaxial approach, the social context is bound to be just another add-on, icing on the cake. This is upside down: in psychiatry, we should start with social context and add everything else to that framework (the task and hence the starting point would be different in neuroscience, but I am talking about psychiatry). Social context is baked into the cake. As the pioneering neuropsychologist Donald Hebb, PhD, at McGill demonstrated with his sensory deprivation experiments, the brain can only function in a rich bath of internal and external stimuli.²

The neurophysiological nature of the brain is relational. Hebb’s cell assemblies are little communities of neurons working through a rich interplay of messengers. This gave rise to Hebb’s Law: “Neurons that fire together wire together.” The discovery of mirror neurons by neuroscientist Vittorio Gallese, MD, at the University of Parma has provided the link between events in the external environment and their mirroring in the brain as the basis for embodied simulation theory (a theory of social cognition) with implications for everything from empathy to autism.³

Now, I want to do some gardening in the palace of psychiatry. As I walk around the untended gardens of the “psy disciplines”—the palace of psychiatry, the psychology campus, and psychotherapy’s big circus tent—I see an awful lot of buzz words and viral memes crowding out the carefully cultivated plants like weeds. Some of them risk killing the plants around them altogether like bougainvillea encroaching a tree. The flowering bougainvillea is beautiful, but it chokes the tree of life.

Plastic Words

I will name these buzz words and put them in quotes to signal that I want to examine them and come to terms with them. Uwe Poerksen, a German scholar, called them “plastic words” because of their malleability and uncanny capacity to fit any circumstance.⁴ Plastic words start as scientific words with specialized meanings but then migrate into everyday usage, stripped of their specialized meanings. If we are to have an encompassing theory of persons—my definition of psychology—we must sort out these plastic words like so many weeds in the garden.

As a child and adolescent psychiatrist, family therapist, and social and cultural psychiatrist, I toil in exactly those areas of the garden that are filled with plastic words—“development, family, culture, and society”—and of course, everything relating to “mind” and “mental states.” All of these are notoriously difficult to nail down. And sometimes we do not want to. In legal philosophy, for example, there is the notion of “fuzzy concepts”—you want to express a principle that is “fuzzy” or elastic enough to anticipate future possibilities.⁵ In our field, if we define “family” too narrowly, we will not only offend sensibilities (What about same-sex parents? What about polyamory, polygamy, or polyandry? What about communes?) but leave out all kinds of actually lived family forms. As to “child development,” I have a simple remedy to the conundrum of defining it—instead of referring to this slippery construct about growth, just think of real children. As I have written, we think too much of the concept of development and too little of actual children.⁶ I am critical of the notion of development across the board, from developmental psychology to economics and politics (see my Slow Thought Manifesto⁷ and my socio-political essay on the Global South⁸). More about that in later columns.

The Invisible Man: 21st Century Versions

For now, walking around my garden, I stumble over “loneliness,” “happiness,” “burnout” and “trauma.” To follow media accounts, it would seem that the world is either filled with the search for happiness or people are walking around like emotional zombies struggling to express themselves and to be seen. The 2024 World Happiness Report shows that Finland stayed at the top of country rankings for the seventh year, the USA fell out of the top 20 while Canada’s steady in 15th place, and Israel dropped only one place to 5th place from last year despite being at war—go figure!⁹

Meanwhile, “loneliness” and “burnout” are seen to be stalking young and old alike, creating 21st century versions of The Invisible Man (I am referring both to H.G. Wells’ 1897 science fiction version and Ralph Ellison’s more disturbing racial version from 1952), presciently described by William James, MD, in my opening epigraph from his Principles of Psychology.¹

A worrisome social phenomenon concerns young men who identify as “incels”—or involuntary celibates—an online support community of young males who are unable to have the heterosexual relationships they desire.¹⁰ Incels, ironically first named by an anonymous Canadian female calling herself Alana, are estimated to number in the tens to hundreds of thousands and are perceived as an extremist, supremacist group of men imbued with a sense of predestined personal failure and nihilism. Such attitudes and beliefs may lead to suicide and various forms of sexual violence, from “catfishing” (creating a fake online identity in order to deceive) to femicide. The case of Marc Lépine here in Montreal of the École Polytechnique massacre of 14 women in 1989 has been linked to this movement. As with repressed faith, society eventually pays a big price for invisibility in the form of repressed sexuality. And “trauma,” which is “everywhere” in our “toxic culture,” according to Canada’s trauma guru Gabor Maté, MD,¹¹ is nonetheless somehow unspoken and unheeded. What does all of this actually mean? To cite Facebook’s ambivalent option about relationships, “It’s complicated”!

I will be spiraling around these themes repeatedly in this column, taking up definitions, controversies, trying theories on for size, and discarding them when better ones come along. That is the real spirit of science—constant experimentation, questioning and innovation—not certainty or convictions. Belief, certitude, even fidelity are the stuff of faith, not of science. That said, faith may be the most repressed and neglected aspect of contemporary social and political life. To evoke Freud’s most poetic phrase, the US is now experiencing “the return of the repressed” with Evangelical Christians and other religious groups demanding their say. A future column will celebrate H. Steven Moffic, MD’s remarkable series of volumes on religion, spirituality, and psychiatry, from Christianity to anti-Semitism and from Islam to Eastern religious and spiritual traditions.

The I’s of Western Psychotherapy

Now, let me take on some of the most divisive notions in the Western world and the Global North: individualism and independence. [I harbor the comforting hope—maybe an illusion(?)—that this is not true everywhere.] Raymond Prince, MD, my mentor in social and transcultural psychiatry at McGill, elaborated the notion that psychotherapy in the West revolves around several “I” words: the individual as the focus of therapy, personal independence as a therapeutic goal, and introspection and insight as a therapeutic method. Therapy with individuals is undergirded by Murray Bowen, MD’s “differentiation theory,” implying that the goal of personal development and hence of therapy should be independence. Meanwhile, 2 of the most successful versions of family therapy in the hands of people like Salvador Minuchin, MD (structural family therapy which employed differentiation theory) or Jay Haley, MA (strategic family therapy) was to put parents in charge of rebellious children and teens. They went so far as to minimize their suffering by calling them “identified patients” who were merely manifesting conflicts of the family system. So much for independence, so much for respecting each child’s developmental pathway. The ironies abound.

When I constructed my model of cultural family therapy, my motivation was to challenge what I called “the myth of independence.”12 In this myth, the goals of therapy are to work on individuals, isolated from their family, communal and social contexts. As Minuchin once complained, psychoanalysis deals with “man out of context.”

This plays out in society and in politics as well. Conservative British Prime Minister Margaret Thatcher infamously declared that, “There is no such thing as society,”¹³ while conservative critics argued that in socialist societies like the Soviet Union, there was no such thing as the individual. Like most binary oppositions, these extremes do not describe lived reality. Not only is society real but the very British tradition of “the commons,” defined as the “social practice” of governing a resource not by the state or the market but by a community of users that self-governs that resource through institutions that it creates, was the basis for democracy and progressive movements. Economists and social theorists have analyzed the “tragedy of the commons” which describes what happens when people struggle for their individual demands against the common good.^14-16

And not only is the individual real but it takes almost totalitarian coercion to disabuse people of the sense of their own individual consciousness and need for agency (control of their own lives) and the search for meaning (which is the subtext of the humanistic and positive psychology and psychiatry movements). We must consider the possibility that the nature of this coercion has become subtler and more pervasive through social media. Critical theory in philosophy and sociology with thinkers like Theodor Adorno of the Frankfurt School is one long interrogation of these subtle and almost invisible coercive tools available to convince people that they are free when in fact their choices are highly constrained and predetermined.¹⁷

Ultimately, independence is a myth because we are all richly interdependent upon each other. In his class-busting play, Pygmalion, George Bernard Shaw wrote: “Independence? That’s middle class blasphemy. We are all dependent on one another, every soul of us on Earth.”¹⁸ Some of us can live the illusion of being independent because the people, systems, and structures around us serve our interests (as we serve theirs). Children, older adults, and the infirm are more obviously dependent, but so is anyone who has a team and a series of institutions, rules, and regulations in place to support what appear to be professional and personal choices. In fact, I am more interdependent as a child psychiatrist than most of the children I see because I am reciprocally acting in accordance with the child’s needs and wishes; their parents, school and other communities; as well as all the other systems we are embedded in—my clinical team, hospital, health care system, university department, various professional orders and associations, and so on.

As a consequence, the comforting construction of an individual “self” has as many facets as the social roles we have and is only as stable as the social structures and systems allow: “Properly speaking,” William James, MD, wrote, “a man has as many social selves as there are individuals who recognize him and carry an image of him in their mind (emphasis in original).”¹

Just as we have as many “social selves” as the number of individuals we interact with, human social life requires a recognition of our mutual interdependence in the spirit of what social critic Ivan Illich defined as conviviality—“individual freedom realized in personal interdependence.”¹⁹ As usual, William James, MD, the pioneering American psychologist and pre-eminent philosopher of pragmatism, said it best²⁰:

Thus social evolution is a resultant of the interaction of two wholly distinct factors, – the individual, deriving his peculiar gifts from the play of physiological and infra-social forces, but bearing all the power of initiative and origination in his hands; and, second, the social environment, with its power of adopting or rejecting both him and his gifts. Both factors are essential to change. The community stagnates without the impulse of the individual. The impulse dies away without the sympathy of the community (emphasis added).

Resources

Here is a descending spiral staircase into how to deconstruct words in our time:

• Start with Uwe Poerksen, Plastic Words.⁴ You want to go deeper?
• Raymond Williams, Keywords.²¹ More time on your hands, like Dr Arthur Conan Doyle writing detective tales about Sherlock Holmes while waiting for patients to show up at his practice?
• Barbara Cassin, et al, Dictionary of Untranslatables: A Philosophy Lexicon²²

Deeper than that and you are into the ultimate rabbit hole—the rhizomatic rabbit warren called philosophy. What is a rhizome you will ask? That is a philosophical question that will take us on a tour of Gilles Deleuze’s and Félix Guattari’s work, A Thousand Plateaus,²³ a work of philosophy bordering on psychiatry, where they invoke the rhizome as a metaphor for processes that do not arise from a single origin, like Chomsky’s generative grammar or the Freudian unconscious, all implying interconnectedness, like fungi sprouting everywhere above ground and connected by their rhizomatic structure underground.

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. James W. Principles of Psychology. Holt; 1890.

2. Hebb DO. Essay on Mind. Psychological Press; 1980.

3. Gallese V. Bodily selves in relation: embodied simulation as second-person perspective on intersubjectivity. Philos Trans R Soc Lond B Biol Sci. 2014;369(1644):20130177.

4. Poerksen U. Plastic Words: The Tyranny of a Modular Language. Trans. Mason J, Cayley D. Pennsylvania State University Press; 1995.

5. Posche R. Ambiguity and vagueness in legal interpretation. In: Solan LM, Tiersma PM, eds. The Oxford Handbook of Language and Law. Oxford University Press; 2012:128-144.

6. Di Nicola VF. Review‑essay: on the rights and philosophy of children. TransculturalPsychiatric Research Review. 1995;32(2):157‑165.

7. Di Nicola V. Take your time: Seven pillars of a slow thought manifesto. Aeon. February 27, 2018. Accessed March 25, 2024. https://aeon.co/essays/take-your-time-the-seven-pillars-of-a-slow-thought-manifesto

8. Di Nicola V. The Global South: an emergent epistemology for social psychiatry. World Social Psychiatry. 2020;2(1):20-26.

9. Helliwell JF, Layard R, Sachs JD, et al, eds. World Happiness Report 2024. University of Oxford, Wellbeing Research Centre; 2024.

10. Incel. Wikipedia. Accessed March 25, 2024. https://en.wikipedia.org/w/index.php?title=Incel&oldid=1214636070

11. Maté G, Maté D. The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture. Alfred A. Knopf Canada; 2022.

12. Di Nicola V. Stones and bridges: the myth of independence. In: A Stranger in the Family: Culture, Families, and Therapy. W.W. Norton & Co; 1997:194-211.

13. Di Nicola V. “There is no such thing as society”: the pervasive myth of the atomistic individual in psychology and psychiatry. World Social Psychiatry. 2021;3(2):60-64.

14. Ostrom E. Governing the Commons: The Evolution of Institutions for Collective Action. Cambridge University Press; 1990.

15. Forsyth T, Johnson C. Elinor Ostrom's legacy: governing the commons and the rational choice controversy. Development and Change. 2014;45(5):1093-1110.

16. Della Porta D. Progressive social movements and the creation of European public spheres. Theory, Culture & Society. 2022;39(4).

17. Tyson L. Critical Theory Today: A User-Friendly Guide. 4th ed. Routledge; 2023.

18. Shaw GB. Pygmalion. Dodd, Mead & Company; 1916.

19. Illich I. Tools for Conviviality. Fontana/Collins; 1975.

20. James W. Great men, great thoughts and the environment. Atlantic. 1880. Accessed March 25, 2024. https://www.theatlantic.com/magazine/archive/1880/10/great-men-great-thoughts-and-the-environment/632282/

21. Williams R. Keywords: A Vocabulary of Culture and Society. Flamingo/Fontana; 1984.

22. Cassin B, Apter E, Lezra J, Wood M. Dictionary of Untranslatables: A Philosophy Lexicon. Princeton University Press; 2014.

23. Deleuze G, Guattari F. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Massumi B. University of Minnesota Press; 1987.