Leadership in Child & Adolescent Psychiatry: In Conversation With Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych

CLINICAL CONVERSATIONS

At the 2025 American College of Psychiatrists Annual Meeting, Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych, received the Award for Leadership in Child, Adolescent, and Young Adult Psychiatry. He gave his lecture, “‘Lay Not Thine Hand Upon the Lad’: Child Maltreatment, Social Determinants of Health, and Trauma-Informed Care” in Kauai, Hawaii, on February 22, 2025. Following the meeting, Psychiatric Times sat down with Di Nicola to discuss this achievement and his work in the field of child and adolescent psychiatry.

Psychiatric Times: What does being a leader—and this award—mean to you? What tenets would you ascribe to a good leader?

Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych: A leader is someone who is comfortable enough with their own vision to open new paths and inspire others to follow. And yet a real leader empathically recognizes other visions to integrate other paths into what we might call a “final common pathway,” to use Charles Sherrington’s key neurological notion as a metaphor. Now, my mentor, French philosopher Alain Badiou’s notion of a subject is someone who has experienced an event in their lives so large that it marks a “before and after.”^1,2 Such an event defines the person. In being faithful to that event, a new subject is born. He gives the example of the student uprising in May 1968 in Paris. It was an event in his life that changed his outlook. After such an occurrence, everything is refracted through the prism of the event. At the same time, fidelity to the defining event of your life does not preclude living with other subjects of other events. For this lecture, I chose to tell the story of my work on trauma, although I recognize that there are other compelling stories in psychiatry.

I hope to be a leader in child psychiatry, but when it comes to trauma, I see myself as an observer and a witness. I was a witness to the trauma of Jewish survivors of the Holocaust at the very beginning of my career and I owe it to them to testify to the story of their trauma. What this award means to me is that if you are faithful to a guiding vision—an event, if you will—and persist with it faithfully, you have a chance of being heard. Even if it takes a long time! That is all I could ask for.

PT: What leaders do you look up to? What have they taught you?

Di Nicola: In the psy disciplines, I would start with Leslie Solyom, MD (1921-2015).³ He was my research supervisor for my undergraduate thesis in psychology at McGill. A Hungarian Jewish survivor of Auschwitz, his clinic was populated by many of his fellow Holocaust survivors, which set the stage for my lifelong preoccupation with trauma. In spite of his lived experience, Dr Solyom was upbeat and positive, often quoting poetry to me in several languages (which I did not understand at the time). His constant exhortation in the face of life’s vicissitudes was: “Think beautiful thoughts.”³

My psychiatry mentor in medical school at McMaster University, Joel Elkes, MD (1913-2015), was the father of neuropsychopharmacology. When I was going through a painful predicament in my life, he advised me to deal with it, to face it: “You have to get into it to get out of it.” The current slogan is: If you are going through hell, keep going. Joel would have liked that. While he was doing biological research for the allied war effort at Porton Down in England as a registered alien, many members of his family died in the Holocaust. That irony and his indefatigable optimism are constantly with me.

Raymond Prince, MD (1925-2012), one of the founders of social and transcultural psychiatry at McGill, introduced me to English writer Samuel Butler and his novel Erewhon (“nowhere” backwards and a nod to Thomas More’s Utopia which means nowhere in Greek), a satire on Victorian society which is also a dystopia. I reread it every few years because I am taken with Butler’s notion that the Erewhonians gave illness and crime the opposite valence to traditional European values. For example, a banker who was guilty of embezzling money was visited with solicitous concerns for his condition which was treated like an illness. On the other hand, individuals who were so rash as to fall ill were met with contempt and scorn. I think we are pretty much living in Butler’s Erewhon. Ray Prince was very special in that he was a consummate physician and psychiatrist but also able to branch out into new areas such as the study of religion with a critical eye. He observed things that had escaped notice and managed to make them seem sensible. Ray was not antipsychiatry but probably changed psychiatry’s path towards social and cultural concerns more than any other mentor I have had.⁴

Richard Mollica, MD, director of the Harvard Program in Refugee Trauma, taught me 3 things about trauma: (1) to listen to the trauma story, (2) to create a healing environment for our work, and (3) to practice active, ongoing self-care. What Richard embodies and encourages is empathy as a healing practice. And trauma, for him, represents an empathic failure.⁵

In child psychiatry, Barton Blinder, MD, PhD, at UC-Irvine, is a man of extraordinary depth and breadth as a mainstream researcher and child psychoanalyst. I consider him a role model and a constant inspiration. To be with him is to feel that you are on a path of enlightenment and healing. If he was a Rabbi, there would be a movement following his every step. Bart was driving my wife and me to the Newport Harbor Yacht Club for my birthday dinner when he stopped to take a call from a patient to prescribe a medication. Lesson learned: patients come first.

And then there are people outside the psy disciplines. The 2 most important are Raymond Reed, MA (1927-2022), my high school English teacher, constant friend, and mentor until his recent death; and Alain Badiou, PhD, who supervised my doctorate in philosophy in Switzerland and challenged me to open a new vision for psychiatry. What they shared is an embracing, open-hearted vision of life and a relentless optimism about its possibilities.^1,2 What they all did for me was to challenge me to reach beyond my starting points, from my high school valedictory speech, “It Is Not So Much” (Ray Reed) to my dissertation in philosophy, Trauma and Event (Alain Badiou), spanning 40 years.⁶

PT: In a nutshell, what are the top 3 most pressing issues in child and adolescent psychiatry today?

Di Nicola: When Allen Frances, MD, who had headed up DSM-IV, visited my university department during the launch of DSM-5, he claimed that 3 child psychiatric disorders were being over diagnosed: attention-deficit/hyperactivity disorder, bipolar disorder (especially type II), and autistic spectrum disorder. Overdiagnosis easily leads to overprescription. I get that, but I have broader concerns as a child specialist.

One is that the more people talk about childhood, the less I understand about children. “Childhood” is too abstract. Beyond what pediatrics calls “ages and stages,” it does not mean much. For most individuals in the field, childhood is seen through the lens of development. In my synthesis of transcultural child psychiatry⁷ and other work, including my Slow thought manifesto,⁸ I have critiqued developmental thinking (see my column from Brazil) and replaced it with the notion of unfolding, inspired by a Brazilian poet, which is closer to Swiss child psychologist Jean Piaget’s “epigenetic epistemology.” Like many terms in the psy disciplines, words like development and resilience—and now, even trauma—are “plastic words” that can mean everything and nothing.⁹

In that spirit, these are my 3 concerns about children growing up today.

1. Stolen innocence—trauma. Children are now exposed to levels of violence, vulgarity, and an assault on the senses as never before in our lifetimes. They are being saturated with information, news, and publicity. Anecdote: Dalbir Bindra, chair of Psychology at McGill in the 1970s, said that in graduate school, he preferred someone raised on a farm in the Midwest who had time to think about things. Cleverness is not a substitute for curiosity and the accumulation of facts is not knowledge and does not lead to understanding, let alone wisdom. Neil Postman, my favorite American social critic, once said, “Don’t take in any new information after 7 pm.”Youth today are being saturated with too much information and starved for knowledge.

2. Precocious knowledge. When asked at the McGill Sex Symposium in 1974 about the right time to share sexual knowledge with children, Austrian American child psychologist-psychoanalyst Bruno Bettelheim quoted the Song of Solomon 8:4: “O daughters of Jerusalem, I adjure you: Do not arouse or awaken love until the time is right. Daughters of Jerusalem, I charge you: Do not arouse or awaken love until it so desires. Promise me, O women of Jerusalem, not to awaken love until the time is right.” We confuse the biological facts of life, which we should teach to children rather than fairy tales about storks, with explanations of human sexuality, attachment, and loving relationships. Children will tell us what they need to know and when, but first we need to understand their questions and their needs.

3. Growing up in a hurry. Oscar Wilde once quipped that youth is wasted on the young. That can be interpreted in many ways. What I draw from it is that people are in a hurry to get to another step, stage, or milestone. Anecdote: Joseph Campbell, the American scholar of mythology and religion, was lecturing on Dante’s Convivio and his stages of youth, maturity, wisdom, and old age. A woman in the audience stood up to say, “In America today, Mr Campbell, we go directly from youth to wisdom.” “That’s really wonderful,” he retorted, “All you’ve missed is life.” (See my Slow thought manifesto⁸ and my column about it.)

PT: What is the most difficult lesson you have learned over the course of your career?

Di Nicola: To listen to others, especially children. I think of 2 stories from my practice. One is about a child’s empathy for my work, “listening to children’s problems all day long,” as he put it.¹⁰ The other is a horror story of misdiagnosis, where the care system mistook a girl’s sexual trauma for psychosis, and I went along with it at the beginning. One story delights me and fills me with awe and the other one still haunts me. Nuclear physicist Leo Szilard’s commandment about children, is an antidote: “Honor children. Listen to their words with reverence and speak to them with endless love.”¹¹We need a “Me-Too” Movement for children!

PT: If you could change 1 thing about the practice of psychiatry today, what would it be?

Di Nicola: Slow down.Take your time. Marcel Hudon, MD, a very wise and compassionate psychiatrist-psychoanalyst in Montreal, listened to my first Grand Rounds presentation in French and stood up and said rhetorically, “Un moment …” – “Hold on, here, let’s think this through.” This triggered a long dialogue leading to the seminar we started on psychiatry and the humanities. This later led to my postgraduate course in psychiatry and the social sciences and also inspired my essay on Slow thought.⁸ We used to talk about the “50-minute hour” of psychotherapy. I will let readers decide for themselves what the 15-minute medication visit has done to American psychiatry.

PT: You have done a lot of work related to trauma. What advice would you give to young clinicians working with children/families who have trauma?

Di Nicola: Yes, trauma is the connecting thread throughout my career. The title of my American College of Psychiatrists award lecture is about the sacrifice of Isaac, called the Akedah in Hebrew, as a model for the problem of child maltreatment and trauma. As Abraham is about to sacrifice his son Isaac on God’s command, an angel intervenes to declare, “Lay not thine hand upon the lad.” This was the heart of my doctorate on trauma. In philosophical terms, following Foucault and others, I call the Akedah an apparatus, a kind of historical-cultural machine about the nature of trauma. “Isaac machine,” as I dubbed it, is a machine that means the destruction of experience and goes to the heart of trauma. Trauma does not just create harsh consequences for children, it destroys their capacity for certain kinds of experiences, as research in neuroscience has shown.

We now know from research as diverse as the ACE Study to neuropsychology that the growing brain is exquisitely sensitive to adversity and life stress events as we used to call them. Let us choose a less psychiatric word and call them “vicissitudes.” In my lecture, I did a little history about child maltreatment starting with the story of Isaac, a little epidemiology, and then went right into “Ten Takeaways About Trauma.” It actually covers a wide range of scholarship compressed into something like a TED talk. Trauma for dummies.

Now, I believe 2 things about trauma. First, that trauma has replaced schizophrenia as the emblematic subject of psychiatry. British historian Angela Woods wrote about schizophrenia as “the sublime object of psychiatry.”¹² That was in the last century.

Psychiatry is now in the age of trauma. Whereas all the social sciences and humanities expressed opinions about schizophrenia in the 20th century—eg, sociologist Erving Goffman, anthropologist Gregory Bateson, and philosophers Gilles Deleuze and Félix Guattari—today, trauma is the epicenter of such commentaries. From British American historian of science Ruth Leys’ Trauma: A Genealogy to French physician-anthropologists Didier Fassin and Richard Rechtman’s The Empire of Trauma. Canada’s trauma guru is Gabor Maté (The Myth of Normal; see my column, The Trouble with Normal), who sees trauma everywhere and reduces major social and psychiatric problems such as addictions and depression to trauma. This is the danger with “single-message mythologies” as Swiss psychiatrist and medical historian Paul Hoff has characterized such reductive and all-encompassing theories.¹³

The second thing is that in spite of the referential richness of my presentations and writing, my advice is almost embarrassingly simple: Listen to the trauma story. But to do that you have to create a healing environment and be ready to listen without interrupting the other person with your knowledge, experience, or even wisdom. Allow them dignity of their own lives as a witness to their suffering. And to do all of that (which sounds simple), you have to be able to take care of yourself. Not “once and done” as in a training analysis or personal retreat, and so on, but as ongoing self-care. Towards the end of his life, Michel Foucault wrote about the “care of the self,”¹⁴ which is tragically ironic since he did not take care of himself. In his search for “limit experiences,” he contracted a novel virus and unknown fatal disease in the sexual underworld while teaching at Berkeley in California. The virus was later identified as HIV, and the disease AIDS.

PT: As we hit the 5-year anniversary, how do you think the trauma of COVID-19 will continue to impact children and adolescents?

I have spoken on this many times in my talks about creating a clinical social psychiatry, which will be the theme of our 25th World Congress of Social Psychiatry in Marrakesh, Morocco, January 15-17, 2026. We cannot do everything, and overdiagnosis and overprescription are as potentially harmful as treatment gaps or lack of access to care. We knew what puts children and youth at risk from the SDH and ACE studies, yet the responses to COVID-19 tended to generalize to the whole population of children and youth, with little distinction (see my column on the COVID-19 syndemic). Those who were not at risk managed to get through the COVID-19 syndemic fairly well or even very well—even if they will remember it all their lives. Those who were at risk were and are continually impacted by confinement and isolation. Some of those kids are not getting back to school, not improving their social skills, and sinking into a solitary, solipsistic inner world fed by the pseudo community online.

Historians have demonstrated that epidemics—we call them pandemics when they go global—and the most recent innovative thinking calls them syndemics, or a series of conjoined biological and social epidemics, are more disruptive to society than wars or revolutions. I likened the cordon sanitaire or confinement we lived through to Plato’s Cave. We were imprisoned in a sensory deprivation experiment. And children and youth are more impacted by such isolation. So, we have this false standoff between right and left about COVID and vaccines. The real debate is about the translation of public health concerns into public policy. The results were debated in public, but the public had little access to what we do as medical specialists. This is the third rail of American medicine—dangerous and untouchable. If clinicians and politicians were a little more cultured in the humanities, especially the classics, they could have mined centuries even millenia of insights into the nature of epidemics and their impacts on society.^15-21

PT: You often view psychiatry through a cultural lens, as readers can probably tell from your column “Second Thoughts.” In your own words, how does this outlook impact your work with children and adolescents?

Di Nicola: I did my psychiatric training after postgraduate studies in clinical psychology at the Institute of Psychiatry in London, so I pretty much knew where I was going and my entire career right from my residency was to examine everything through 3 lenses: children, families, and culture.²² My work in psychiatry has been synthetic; I brought together disparate theories, research, and clinical models for child psychiatry. Two are: transcultural child psychiatry—all I did was to take 2 training tracks at McGill and asked cultural questions about children and youth.⁷ The second one for which I am most well-known is cultural family therapy—I brought together family therapy and transcultural psychiatry (see my column, The Web of Meaning).^23-25 Throughout, I have been involved in trauma as one of the 2 or 3 clinical challenges I worked on. So, I ended up in a small corner where children, families, and culture meet trauma, and this allowed me to elaborate specific work and that is what is being recognized.

Culture affects all of us, all the time. Some of us are more aware of the cultural context we find ourselves in and we can navigate it, make choices. Children are enculturated into the world they are raised in. We may call later exposures to other cultures acculturation. But like an accent shaped by our mother tongue, I believe we have behavioral accents too. The first society that we are enculturated into affects attitudes, behaviors, cognitions—casts of mind and habits of the heart. It is true on a large scale in the general culture, but I believe that each city, each neighborhood, each family is a little culture of its own. There is a beautiful passage from Italian novelist Natalia Ginzburg’s family memoir in which the family members say to each other that with their private language and shared memories, they would recognize each other anywhere just by certain words and phrases.²⁶

That is why in my model of cultural family therapy, I called to replace the notion of a family system with a family culture. At a recent international family therapy conference, I asked a series of critical questions about the field including: why do we still call them family dynamics (after Freud’s psychodynamics) and why do we still call them systems (from systems theory)? I have replaced dynamics with relational patterns and systems with culture.²⁷

PT: Is there anything else you would like to add to conclude our interview?

Di Nicola: While most of my career has been to create syntheses as I described them previously, I have always been very theoretically oriented. That comes from my academic psychology training at 2 of the better centers of psychological thought (McGill and London) and my first love, philosophy. Now, after my philosophical investigations and my doctorate on trauma, we are doing some foundational work in the psy disciplines. My first partner in this work was Drozdstoj Stoyanov, a brilliant Bulgarian psychiatrist-neuroscientist-philosopher. Our exchange produced the volume, Psychiatry in Crisis.^28,29And now, I am working with John Farnsworth, a senior psychotherapist from New Zealand with a background in sociology and who seems to know everything. I learn from him every day through our emails. Our first collaboration was published in Italian and is in press in English.²⁷ The working title of our forthcoming book is Changing the Subject: The Event in Psychology, Psychiatry and Psychotherapy.

PT: Thank you!

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. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011, winner of a prize from the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).

References

1. Di Nicola V. Badiou, the event, and psychiatry, part 1: trauma and event. Blog of the American Philosophical Association. November 23, 2017. Accessed March 3, 2025. https://blog.apaonline.org/2017/11/23/badiou-the-event-and-psychiatry-part-1-trauma-and-event/

2. Di Nicola V. Badiou, the event, and psychiatry, part 2: psychiatry of the event. Blog of the American Philosophical Association. November 30, 2017. Accessed March 3, 2025. https://blog.apaonline.org/2017/11/30/badiou-the-event-and-psychiatry-part-2-psychiatry-of-the-event/

3. Di Nicola V. Letter to young psychiatrists. “Small answers” – lessons for the left hand. Washington Psychiatrist Magazine. 2017:12-14.

4. Di Nicola V. Luminaries in Social Psychiatry: Raymond Harold Prince, MD: pioneer of social & transcultural psychiatry at McGill University. World Social Psychiatry. 2025;6(4).

5. Mollica RF. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. Harcourt, International; 2006.

6. Di Nicola V. Trauma and Event: A Philosophical Archaeology. 2012. PhD dissertation in philosophy, psychiatry and psychoanalysis. Europäische Universität für Interdisziplinäre Studien – European Graduate School, Saas-Fee, Valais, Switzerland. Awarded Summa Cum Laude.

7. 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.

8. Di Nicola V. Take your time: seven pillars of a slow thought manifesto. Aeon. February 27, 2018. Accessed March 3, 2025. https://aeon.co/essays/take-your-time-the-seven-pillars-of-a-slow-thought-manifesto

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

10. Di Nicola V. Letter to young psychiatrists. “rowing a rhino” – practicing the art of the possible in the impossible profession. Washington Psychiatrist Magazine. 2017:17-18.

11. Szilard L. The Voice of the Dolphins & Other Stories. Stanford University Press; 1992.

12. Woods A. The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory. Oxford University Press; 2011.

13. Fulford KWM. Foreword: beyond single message mythologies. In: Di Nicola V, Stoyanov D. Psychiatry in Crisis: At the Crossroads of Social Science, The Humanities, and Neuroscience. Springer Nature; 2021:vii-xix.

14. Westerink H. The obligation to truth and the care of the self: Michel Foucault on scientific discipline and on philosophy as spiritual self-practice. International Journal of Philosophy and Theology. 2020;81(3):246-259.

15. 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.

16. 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 Social Psychiatry. 2020;2(2):103-105.

17. Chadda RK, Bennegadi R, Di Nicola V, et al. World Association of Social Psychiatry Position Statement on the Coronavirus Disease 2019 Pandemic. World Social Psychiatry. 2020;2(2):57.

18. Di Nicola V. A Canadian perspective on the biomedical and psychosocial impacts of the COVID-19 pandemic on children and families. Global Mental Health & Psychiatry Review. 2020;1(2):6-7.

19. Di Nicola V. The Coronavirus epidemic as a modern morality play: challenges for social psychiatry. WASP E-Newsletter. 2020. Accessed March 3, 2025. https://waspsocialpsychiatry.org/wp-content/uploads/2021/02/WASP-Newsletter-Dec-2020-1.pdf

20. 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.

21. Di Nicola V. ‘The experimental child’: children and the COVID-19 syndemic. Psychiatric Times, June 20, 2024. https://www.psychiatrictimes.com/view/the-experimental-child-children-and-the-covid-19-syndemic

22. Di Nicola V. Borders and belonging, culture and community: from adversity to diversity in transcultural child and family psychiatry. J Am Acad Child Adolesc Psychiatry. 2018;57(10):S116.

23. Di Nicola VF. Family therapy and transcultural psychiatry: an emerging synthesis. I. The conceptual basis. Transcultural Psychiatric Research Review. 1985;22(2):81‑113.

24. Di Nicola VF. Family therapy and transcultural psychiatry: an emerging synthesis. II. Portability and cul­ture change. Transcultural Psychiatric Research Review. 1985;22(3):151‑180.

25. Di Nicola V. A Stranger in the Family: Culture, Families, and Therapy. W.W. Norton & Co; 1997.

26. Ginzburg N. Family Sayings. Low DM, trans. Arcade/Little, Brown; 1963.

27. Di Nicola V, Farnsworth J. Changing the subject: from system to culture to the event. In: Andolfi M, D’Elia A, Fraenkel P, eds. The Enduring Power of Families and Family Therapy: Perspectives and Practices from Around the World. Routledge, in press.

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

29. Stohlman-Vanderveen M, Di Nicola V. The crisis of psychiatry is a crisis of being: an interview with Vincenzo Di Nicola. Blog of the American Philosophical Association. October 8, 2021. Accessed March 3, 2025. https://blog.apaonline.org/2021/10/08/the-crisis-of-psychiatry-is-a-crisis-of-being-an-interview-with-vincenzo-di-nicola/