From Quebec’s “Two Solitudes” to the Global South

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SECOND THOUGHTS

I am writing this column in Marrakesh, Morocco where I am participating in the 20th World Congress of Dynamic Psychiatry, which took place from April 16-20, 2024, sponsored by the World and the Moroccan Associations of Dynamic Psychiatry. And isn’t that a story in itself? Psychoanalysis and psychodynamic psychiatry once so powerfully present in the United States and the Global North are now being rescued and reinvigorated beyond their cloistered institutes by the Global South in psychiatric and psychological practices as well as in academic departments.

Of course, psychoanalysis and psychodynamic psychiatry has been there all the time in the Latin countries of Western Europe, notably Italy and France, and throughout Latin and South America. The Moroccan Association of Dynamic Psychiatry, founded by Hachem Tyal, MD, a Moroccan from Casablanca who trained in psychiatry and psychoanalysis in France, is its President. You can feel an engagement about it here as powerful as the North African sun.

I would like to share 2 presentations I gave here—one was about more local matters in Quebec, the other touches on much more global questions. And this frames my message this week about the tensions between Global North and the Global South.

Quebec’s “Two Solitudes”

Love consists in this: that two solitudes protect and touch and greet each other.

– Rainer Maria Rilke¹

I gave the first presentation in French, as part of a francophone symposium sponsored by the World Association of Social Psychiatry Section on Family Interventions. I presented the mixed English-French family life of a young Québécois poet, Émile Nelligan (1879-1941), whose mother was a French-speaking Québécoise and whose father was an English-speaking British soldier from Ireland, representing the famous “two solitudes” of the Canadian province of Quebec.² Raised in both languages, Émile (named after his mother, Émilie) became a precocious poet unlike anyone who was writing in Canada at the time, having been influenced by the French poètes maudits like Paul Verlaine and Arthur Rimbaud. At the height of his productivity and with growing fame as a young poet, Nelligan suffered symptoms of severe mental distress and was brought to an asylum in Montreal by his father against his mother’s wishes in 1899. His illness was diagnosed as démence précoce in French (dementia praecox in medical Latin), a condition renamed schizophrenia by Eugen Bleuler in 1908. He was later transferred to the Hôpital St-Jean-de-Dieu and spent the rest of his life there. That hospital is now the Institut Universitaire en Santé Mentale de Montrèal with which I am affiliated, marking its 150th anniversary.³ Nelligan’s legacy is that he was at once Quebec’s most celebrated French poet and our most famous psychiatric patient, all before he completed the age of 20!

I explored what his illness and internment means to us today and examined him from several points of view:

• Childhood, family, and social determinants of mental health;
• His life and work as a liminal person seen in the light of transcultural child psychiatry and cultural family therapy (given his mixed parentage and family cultural conflicts);
• The relationship between madness and creativity;
• Quebec society torn between its famous “two solitudes” of English and French cultures.

Nelligan’s predicament has given rise to various polemical interpretations, from seeing him as a gay or bisexual victim of a repressive society, as a victim of psychiatric labeling and coercion by the antipsychiatry movement, and finally, as a symbol of Quebec nationalist politics. It is impossible to choose or decide among these interpretations. Between the two solitudes and other polarities, the best we can do is to read his poetry and let him speak for himself:

I write! I write and the world changes! I write and the world becomes beautiful! Everything becomes beautiful! My pain of living, my fear, everything gets blurred! … I fly over Montreal, I am a stream of water that brings life! But who wants me? Who wants my joy? Who wants my pain?

– Michel Tremblay (1990, my translation)⁴

The metaphor of “two solitudes” was introduced by Canadian novelist Hugh MacLennan to describe the two colonialist cultures of Quebec (English and French) in his novel of that name taken from German poet Rainer Maria Rilke’s famous aphorism about love.¹ As MacLennan’s student at McGill, Montreal poet-songster Leonard Cohen wrote in his coming of age novel, The Favourite Game (1964): “There is no present in Montreal. Only the past claiming victories.”⁶

The famous conundrum of Canadian identity was reframed by Canadian literary critic Northrop Frye not so much as who we are but as “Where is here?”⁷ Are we still living in some outdated version of the British or French empires or can we make our own reality here? If we want to live in the present, we must create our own identity, not one borrowed from the past and elsewhere.

What Is Called Therapy? A Novel Approach

In my second presentation, I ranged out from the particular and local cultural questions of a famous case in Quebec of my first presentation to more general and global matters. My keynote lecture, “What Is Called Therapy: Towards a Unifying Theory of Therapy Based on the Event,” sets out the minimal criteria for a comprehensive theory of therapy and calls for a new foundation of therapy.

My proposal is to address the crisis in psychiatry and related fields by going to the foundations of all the “psy disciplines” from psychology to psychiatry to psychotherapy.⁸ Briefly, this crisis reflects that we lack coherent, congruent, and above all consensual answers to 4 fundamental questions: (1) how to understand persons (“psychology,” or a science of persons), (2) how problems arise (“psychopathology,” or mental, relational, and social suffering), (3) how to explain change (“therapy,” or how innovation arises), and (4) how to conduct therapy (“technique,” or the interventions that are congruent with the answers to these criteria).

These questions set out the minimal criteria for a comprehensive approach to our field. To be sure there are many competing approaches—in therapy, for example, some 400 forms of psychotherapy have been documented! As an illustration, I presented a complex case of an adolescent caught in a cross-cultural predicament, torn between the cultures of her North African father, her Québécoise mother, and her own choice of English culture. I explored 7 well-established approaches to therapy from psychoanalysis to cultural family therapy, highlighting their relevance as well as their limitations. Then I offered a new approach that recognizes these and adds something new—evental therapy based on the philosophy of the event by Moroccan-born French philosopher, Alain Badiou.⁹

An event is an unpredictable, nondeterministic, and contingent innovation. An event is an occurrence that marks a change, something new. An event marks a before and an after, representing the emergence of a radical change (that occurs randomly), which engenders a new identity (name) and a commitment to such a powerful event (fidelity). Refounding therapy on a philosophy of the event is an ambitious goal and an answer to the crisis of psychiatry.

The Global South

El sur está aquí al lado.

The South is here, at our side.

– Boaventura de Sousa Santos¹⁰

An even larger question—working here in Morocco—is once again: “Where is here?” It is located in Northwest Africa, called le Maghreb in French, from the Arabic al-Maghrib, “the west.” Here too, this was a colonized land, several times over. The first peoples here, called the Berbers, known by their endonym or native name, Amizagh, were first colonized by the Arabs bringing their Islam faith and later by the Portuguese, while Spain and France carved out protectorates until Morocco declared independence in 1957. So we are in Northwest African, Amizagh, Muslim Morocco where 3 languages are spoken: Arabic, Amizagh, and French.

I have both longstanding and emerging working relationships with 4 countries of the Global South: Brazil where I have been consulting and teaching for 30 years, Haiti where I was the first person to teach child psychiatry and family therapy 10 years ago,¹¹ Mexico where I recently began to collaborate with the CRISOL Centro de Postgrado en Terapia Familiar,¹² and Morocco where I have been collaborating for the past 5 years. Of course, I work with these and other cultural communities from the Global South in my home base in Montreal.

The Global South is not a geographical designation encompassing the Southern hemisphere and not even one torn from the pages of globalization. The Global South is no longer the “Third World” or the “Developing World.” Neither is it the Nonaligned Movement (founded in 1956 by Yugoslavia, India, Indonesia, Egypt, and Ghanaas a bulwark against the bipolar Cold War world of East and West), although all of these were signposts along the way to the Global South. The Global South may be characterized not as a reaction (to the Global North, often characterized as the “Western world”), a withdrawal or a negation (against Northern or Western geopolitics) but rather as the affirmation of a new epistemology.

It is an alternative—or better—a different foundation for thinking about being. The Global South is to geopolitics what ontology (the science of being) is to philosophy. If we had to summarize it in a slogan, I would choose 2 thinkers from the Global North who worked in the Global South. Erich Fromm, a German Jew working in Mexico, posed the question, “To have or to be?” Should life be about having or being, what we have or what we are?¹³ Boaventura de Sousa Santos, a Portuguese sociologist working in Brazil, where he founded the World Social Forum in Porto Alegre as an alternative to the World Economic Forum in Davos, Switzerland, asks if another epistemology or way of knowing is possible. He proposes alternative “southern epistemologies”which he defines as¹⁴:

A set of inquiries into the construction and validation of knowledge, born in struggle, of the ways of knowing developed by social groups as part of their resistance against the systemic injustices and oppressions caused by capitalism, colonialism, and patriarchy.

Global Flows

In order to situate the realities of the Global South, we need to think about global flows. In the 1960s, the Rand Corporation coined the term “global flows” for the international exchange of goods and services, people, and ideas. A recent update “Global flows: The ties that bind in an interconnected world,” by the McKinsey Global Institute, observed that we now live in an “interdependent world, connected by global flows of goods, services, capital, people, data, and ideas.”¹⁵ Two key insights from this key study are worth quoting:

1. While global trade has stabilized, flows linked to knowledge and know-how are driving global integration. Growth in global flows is now being driven by intangibles, services, and talent. They have picked up the baton from goods trade whose growth as a share of the global economy stabilized around 2008 after 30 years of rapid expansion. Flows of services, international students, and intellectual property grew about twice as fast as goods flows in 2010–19 while data flows grew at nearly 50% annually. Most flows have proved robust in the face of recent disruption [the COVID-19 pandemic].

2. No region is close to being self-sufficient. Every region imports more than 25% of at least 1 important type of resource or manufactured good that it needs, and often much more. Latin America, Sub-Saharan Africa, and Eastern Europe and Central Asia are net importers of manufactured goods; they import more than 50% of the electronics they need. The European Union and Asia–Pacific import more than 50% and 25%, respectively, of their energy resources. North America has fewer areas of very high dependency but relies on imports of both resources, notably minerals, and manufactured goods.

Syncretism, Conviviality, Porosity

From my perspective after working in the Global South for some 30 years, I observe 3 key characteristics—syncretism, conviviality, and porosity.¹⁶ Syncretism is the co-contemporaneous practice of different religious traditions such as Catholicism and Afro-Brazilian candomblé to create new syntheses of belief and practice. I apply this more broadly as the capacity in the Global South to embrace plurality and difference to create a more harmonious and inclusive syncretic culture. Conviviality is a similar term invoked by Ivan Illich¹⁷ emphasizing relational interdependence, which I have adopted in my practice. Porosity is an idea I adopted from Walter Benjamin's and Asya Lacis' essay on Naples about the fluidity of cultural categories there.¹⁸ What these 3 notions have in common is a more fluid, less categorical approach to culture, medicine, and politics.

Against Developmental Thinking

Finally, the new epistemologies of the Global South—“southern epistemologies”¹⁴—require a radical critique of the notion of development and what a recent compelling synopsis of these critiques calls developmentalism or developmental thinking.^19,20 These authors take on the proposed solutions such as “sustainable development” and make mince-meat of them. New realities require new epistemologies which will offer new and radical innovations, not old wine (from the Global North) in old bottles (developmentalism) with recycled labels (sustainable development).

There is a link here between the cultural clashes of the Global North (in both of the cases I presented in Marrakech) and the new and different realities of the Global South. A convivial, porous, syncretic Global South augurs an emergent “southern epistemology” congruent with my call for an evental psychiatry and therapy, which is a new science of being based on Alain Badiou's philosophy of the event.⁹ This new epistemology, which is a different way of knowing, is close to social psychiatry’s vision of the multiple (n > 1) as a starting point. It serves as an apparatus that opens up a radical new ontology, a different way of being, rooted in the emergent Global South.

Resources

This report on global flows by the McKinsey Global Institute is worth inhaling wholesale and applying judiciously in each domain of the psy disciplines¹⁵:

• Seong J, White O, Woetzel J, et al. Global flows: the ties that bind in an interconnected world. McKinsey Global Institute; 2022.

This scholar updated the notion of “global flows” with his “global cultural flows”²¹:

• Appadurai A. Disjuncture and difference in the global economy. Public Culture. 1990;2(2):1-24.

The international innovators in this volume offer both a critique of where we have been, the failed attempts to resolve global problems, and set out numerous maps for a more convivial and healthy future¹⁹:

• Kothari A, Salleh A, Escobar A, Demaria F, Acosta A, eds. Pluriverse: A Post-Development Dictionary. Tulika Books/Columbia University Press; 2019.

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. Rilke RM. Letters to a Young Therapist. Norton H, trans. W.W. Norton & Co; 1993.

2. Di Nicola V. De l’enfant sauvage à l’enfant fou: a prospec­tus for transcultural child psychiatry. In: N Grizenko, L Sayegh, P Migneault, eds. Transcultural Issues in Child Psychiatry.Éditions Douglas; 1992:7‑53.

3. Di Nicola V. “Émile Nelligan (1879-1941) notre contemporain: Entre liberté et contrainte” [Émile Nelligan our contemporary: Between liberty and constraint]. Special issue on the occasion of the 150th anniversary of the Hôpital St-Jean-de-Dieu. Santé Mentale au Québec. In press.

4. Tremblay M. Nelligan, livret d’opéra. Leméac Éditeur; 1990.

5. MacLennan H. Two Solitudes.Macmillan of Canada; 1945.

6. Cohen L. The Favourite Game. Secker & Warburg; 1963.

7. Frye N. The Bush Garden: Essays on the Canadian Imagination. House of Anansi; 1971.

8. Di Nicola V, Stoyanov D. Psychiatry in Crisis: At the Crossroads of Social Science, The Humanities, and Neuroscience. Springer Nature; 2021.

9. Badiou A, Tarby F. Philosophy and the Event, Burchill L, trans. Polity Press; 2013.

10. de Sousa SB. Interview with Enrique Díaz Álvarez: the south is here, at our side. Rev Metropol (Barc). 2011;82:109-111.

11. Di Nicola V. “So much trauma so close to home”: seeing beyond the Bidonvilles to porosity in Port-au-Prince. Global Mental Health & Psychiatry Newsletter. 2015;I(1):8-11.

12. Di Nicola V. Sin Magia ni Maestros: para las prácticas sistémicas y sociales mexicanas [Without Magic or Masters: For Mexican Systemic and Social Practices]. Boletín CRISOL. 2024;1:4-6.

13. Fromm E. To Have or To Be? Harper & Row; 1976.

14. de Sousa SB. Epistemologies of the South: Justice Against Epistemicide. Routledge; 2016.

15. Seong J, White O, Woetzel J, et al. Global flows: the ties that bind in an interconnected world. McKinsey Global Institute; November 2022. https://www.mckinsey.com/~/media/mckinsey/business%20functions/strategy%20and%20corporate%20finance/our%20insights/global%20flows%20the%20ties%20that%20bind%20in%20an%20interconnected%20world/global%20flows%20in%20an%20interconnected%20world_vf.pdf?shouldIndex=false

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

17. Illich I. Tools for Conviviality. Harper & Row; 1973.

18. Benjamin W, Lacis A. “Naples.” In: Reflections: Essays, Aphorisms, Autobiographical Writings, Jephcott E, trans. Schocken Books; 2007:163-173.

19. Kothari A, Salleh A, Escobar A, Demaria F, Acosta A, eds. Pluriverse: A Post-Development Dictionary. Tulika Books/Columbia University Press; 2019.

20. Di Nicola V. Development and its vicissitudes – a review of Pluriverse: A Post-Development Dictionary. In: A Kothari, A Salleh, A Escobar, F Demaria, A Acosta, eds. Global Mental Health & Psychiatry Review. 2023;3(1):17-19.

21. Appadurai A. Disjuncture and difference in the global economy. Public Culture. 1990;2(2):1-24.