Terms of the Social IV: The Relational Self

IRINA/AdobeStock

SECOND THOUGHTS

From the Other to Self

I concluded my last column on the relational dialogue with 3 questions in the relational dialogue between self and other:

1. How are things with you?
2. How are things between us?
3. How am I doing?

And I described what they mean:

We start with the other, we examine our relationships, and only then do we come to see ourselves.

This covers a tremendous amount of theory and practice, from John Bowlby, MD’s attachment theory¹ to Murray Bowen, MD’s differentiation theory as one of the theoretical bases for family therapy,² along with much of social psychology and Gregory Bateson’s systems theory.³ From the other to self, and in that order—this is the fundamental concept of relational psychology which forms the basis for social psychiatry, relational therapy, social action, and in my synthesis of social philosophy.

RD Laing, MD, was a pioneering Scottish psychiatrist and psychoanalyst who became a family psychiatrist associated with the antipsychiatry movement, a term coined by his colleague David Cooper, MD (though Laing disavowed it). He wrote an indisputable classic, The Divided Self,⁴ followed by his study of Self and Others.⁵ Standing on his shoulders and others from that generation, I would argue that we do not need to walk through this journey again. We can and should pick up from where he left off.

In my view, Laing’s real achievement was to document how complex it is to start with the assumption of an atomized, unitary self, which subsequent research from psychoanalysis to neuroscience has shown is always divided in some form or another.⁶ This is why he was compelled to examine self and others, and yet, I think he never got to what is the heart of a social view of psychology and psychiatry and that is, self with others. There was always a tension in his theorizing because he stood on the shoulders of Freud and his analytic supervisor John Bowlby, MD. So, if we start with attachment theory, systems theory, and social psychology as a basis, we can see relational theory as core and we may construct the self in a vast variety of ways, where we see the complexity of the self not in pathological terms but as the embodied and enacted richness of socialization.

From Society to the Individual

As I never tire of saying, social psychiatry as “the science of Anthropos” as George Vassiliou, MD, and Eliot Sorel, MD, defined it,⁷ inverses the usual Western notion of identity as concentric circles radiating outward from the individual to family, community, and society and argues the opposite—from society to the individual7 (see my first column, “Social Psychiatry Comes of Age”).

This has practical impacts: as a child psychiatrist and relational therapist, my mantra is that I cannot understand individual children or their symptoms without understanding their family and social contexts. Family therapy calls these contexts “systems.” I acknowledge the value of systemic thinking as a steppingstone towards relational theory, but it has gaps and blind spots. How is individual identity created out of a family system? American psychiatrist Murray Bowen, MD,² argued that it was through differentiation from an undifferentiated family ego mass—and one of the most successful family therapists, Salvador Minuchin, MD,⁸ built his structural family therapy around this core concept.

Yet, the relative inattention of psychoanalysis to working directly with relationships (as opposed to individuals talking about them) is mirrored by the inattention of family therapy to individual identity and even to individual suffering. The concept of the “identified patient” as symptom bearer and family scapegoat, for example, brings into question whether mental illness even exists. While this can be a useful notion in practice, ignoring a problem by “reframing” it in the jargon of family therapy does not make it disappear. And it certainly does not heal anyone.

Deconstructing Pseudo Pathologies

This critique notwithstanding, there are pseudo pathologies we can deconstruct with a relational approach. With relational theory, we would not have had a false epidemic of so-called “multiple personality disorders.” It is not that the phenomenon of dissociation does not exist (as it clearly does, especially in the face of trauma), but rather that understanding it as a dispersal of the self into fragments and to call each one a distinct personality is unhelpful. Dissociation is rather an imperfect, shaky effort to integrate the social surround into a unified experience of the self. The so-called personality disorders can similarly be understood differently as imperfect or even failed attempts at integration.

Other examples include British child psychoanalyst Donald Winnicott, MD’s notion of the false self.⁹ And I am just as suspicious of positive versions of the self, such as the true self(American Catholic Thomas Merton, monk, and spiritual author)¹⁰ and the original self (American author Thomas Moore, former monk, and Jungian psychologist).¹¹ Midway between positive and negative versions of the self are the protean self (American psychiatrist Robert Jay Lifton),¹² the liquid self (Polish British sociologist Zigmunt Bauman),¹³ and the modular self (American social psychologist Kenneth Gergen).¹⁴ These midway positions get us closer to the self as a social construction, changeable (protean, liquid) and heterogenous (modular).

The Crucible of Consciousness

And yet, systems theory, the grounding theory of family therapy, is frustratingly vague on this. I believe that the family is not only the vehicle for the socialization of the child but something deeper. Socialization is not an added layer on top of some supposed more basic, intrinsic qualities of the child but the very core of consciousness or self-awareness:

The family and affiliated caregivers form the crucible of consciousness.

Canadian American Alexander Leighton, MD, defined social psychiatry as n > 1 as a methodological matter in psychiatric epidemiology.¹⁵ He defines the domain of social psychiatry without really explaining why we should throw our net as wide as society to ground psychiatric theory and practice. Most of the other social psychiatrists before and after him have followed suit. In other words, much of social psychiatry has been a practice without a theory or rationale.

Relational Theory

This triad of relational concepts—the relational dialogue, the relational self, and relational psychology—provide just such a theory, a relational theory of human being.¹⁶ With such a relational theory, we can elaborate relational therapies which include couple and family therapy, group therapy, and community therapy as generic forms and particular approaches such as Jacob Moreno’s psychodrama (see my column here).

In many ways, relational psychology and relational therapies such as family therapy¹⁷ and community therapy¹⁸ are what Freud’s vision looks and sounds like when you liberate him from his 19th century biological determinism and social physics based on the individual.¹⁶ Despite his later work on group psychology and the discontents of “civilization” (which we now call culture and society), psychoanalysis remains steadfastly focused on the individual patient. Yet, having dodged that reduction, we must avoid the 21st century trap of technopoly, which American social critic Neil Postman defined as the “surrender of culture to technology.”¹⁹ Technopoly is now evident in the guise of social media and artificial intelligence.

Arriving at the Relational Self

A richer, more embracing, more social and inclusive notion of the “self-in-relation” or the dialogical self is the relational self. The relational self is more than merely social, it implies a greater degree of mutual exchange, knowledge, and intimacy. If we accept that the self is constructed and expressed through relationships, we can view culture itself as a border or interface that runs through everything in society, as Russian theorist of dialogism Mikhail Bakhtin defines it.^20,21

This constructs society as the sum of these face-to-face encounters—and human relations at their best are face to face. That is something we need to remember as we face the impact of digital technologies as mediators of human relationships. American psychiatrist Richard Mollica's groundbreaking work on trauma reminds us that trauma is a “story that must be told”²² and, I would add, it must be told to another person, face to face, as opposed to being written or deposed as a document.

This approach to working with trauma places the relational self into a relational dialogue to conduct relational therapy. And that will be the subject of my next column on relational theory.

Acknowledgements

I want to acknowledge my debt to Maurizio Andolfi, MD, for our long relational dialogue on psychiatry, family therapy, and relational theory.¹⁷ Relational psychology and therapy are direct outgrowths of his work in Rome at the Accademia di Psicoterapia della Famiglia (APF) and his teaching in the Department of Psychology at the University of Rome. John Farnsworth, PhD, is a constant companion in this column who has sensitized me to the impacts of digital technologies (see his column on “Digital Worlds and the Fluid Social”).

Resources

Three interdependent and mutually related concepts have been elaborated throughout my work—the relational dialogue, the relational self, and relational psychology and therapy.

This is how Maurizio Andolfi, MD, a pioneer in family therapy and relational psychology,¹⁷ introduced my book Letters to a Young Therapist¹⁶:

It is relational psychology, that branch of knowledge still undeveloped at higher levels of the university, that allows us to reflect on and to experiment concretely with the dynamic of relationships: the lateral ones, like the couple, or the vertical ones, like the parent-child relationship that includes at least three generations. Furthermore and no less important are the friendly relationships such as those at work and in leisure and other social activities. You introduce in your book the relational dialogue that is far beyond the much-abused concept of circular questioning and affirm that, “The relational dialogue is to relational therapy what free association is to psychoanalysis.” The relational dialogue offers an important new direction of study to discover the deep basis of the therapeutic alliance, in order to understand the still too-little known phenomenon of “change.” What allows us to change? What are the times, the places and the modalities of change, and how can we distinguish personal change and relational change? All queries still without sure answers. Key words like conviviality (Illich’s term) and self-disclosure bring us to appreciate the profound exchange of emotions with the patient and the family, that become the basis for a genuine intersubjective experience (see the more recent works of an enlightened and original psychoanalyst like Daniel Stern, beyond the pioneering contributions of Virginia Satir and Carl Whitaker).

Here are the key definitions of relational theory, adapted and expanded from the glossary of my Letters to a Young Therapist¹⁵:

• Relational dialogue. A relational dialogue occurs between 2 or more interlocutors who alternate fluidly in the roles of listening actively, attentively and speaking quietly, respectfully. A relational dialogue includes the relationship of the interlocutors as an implicit or explicit subject of discussion. This was Freud’s great therapeutic discovery, which he called transference and countertransference. The interlocutors in a relational dialogue can create a relationship that is more than just reacting to the person in front of us on the basis of the past; and that is the real possibility of listening in the here and now.
• Relational psychology and therapy. The study of relationships requires a relational psychology and working with relationships requires a relational therapy. Relational psychology as a social science proposes: (1) the self-in-relation as the subject of social science; (2) socialization as the vehicle of unfolding and growth and dialogue and enactment as methods of inquiry; (3) social skills (conviviality or relational competence) as goals for relational therapies.
• Relational self. A richer, more embracing, more social, and inclusive notion of the “self-in-relation” or the dialogical self which I call the relational self. The relational self is more than merely social, it implies a greater degree of mutual exchange, knowledge, and intimacy. In this view, culture is a border that runs through everything in society, as Mikail Bakhtin defines it.²¹ This constructs society as an interface and human relations at their best are face to face. Richard Mollica’s groundbreaking work on trauma reminds us that trauma is “a story that must be told”²² and I would add, it must be told to another person, face to face, as opposed to being written or deposed as a document.
• Relational theory. The triad of relational concepts—the relational dialogue, the relational self, and relational psychology (and the relational therapy that follows from it)—provide a relational theory for social psychiatry and outline relational interventions such as family therapy^2,3,8,17 and community therapy.¹⁸
• Relational therapies. One of the branches of social psychiatry (see my column here), relational therapies include couple and family therapy, group therapy, and community therapy as generic forms and particular approaches such as Jacob Moreno’s psychodrama.⁶
• Self (see relational self). The subject of therapy, the isolated self of individual psychology or the relational self of relational psychology and therapy.

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-Elect 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 work includes: 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. Bowlby J. A Secure Base: Parent-Child Attachment and Healthy Human Development. Routledge; 1988.
2. Bowen M. Family Theory in Clinical Practice. Jason Aronson; 1978.
3. Bateson G. Steps to an Ecology of Mind. Ballantine Books; 1972.
4. Laing RD. The Divided Self: An Existential Study in Sanity and Madness. Tavistock Publications; 1960.
5. Laing RD. Self and Others. Tavistock Publications; 1961.
6. 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.
7. Di Nicola V. “A person is a person through other persons”: a manifesto for 21st century social psychiatry. In: RR Gogineni, AJ Pumariega, R Kallivayalil, et al, eds. The WASP Textbook on Social Psychiatry: Historical, Developmental, Cultural, and Clinical Perspectives. Oxford University Press; 2023:44-67.
8. Minuchin S, Fishman HC. Family Therapy Techniques. Harvard University Press; 1981.
9. Winnicott DW. Ego distortion in terms of true and false self. In: The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development. International UP Inc; 1965:140-152.
10. Merton R. New Seeds of Contemplation. Burns & Oates; 1962.
11. Moore T. Original Self: Living with Paradox and Originality. HarperCollins; 2000.
12. Lifton RJ. The Protean Self: Human Resilience in an Age of Fragmentation. University of Chicago Press; 1999.
13. Bauman Z. Liquid Modernity. Polity; 2000.
14. Gergen KJ. The Saturated Self: Dilemmas of Identity in Contemporary Life. Basic Books; 1991.
15. Leighton AH. An Introduction to Social Psychiatry. Charles C. Thomas; 1960.
16. Di Nicola V. Letters to a Young Therapist: Relational Practices for the Coming Community. Atropos Press; 2011.
17. Di Nicola V. A relational dialogue with Maurizio Andolfi: master family therapist and social psychiatrist. World Social Psychiatry. 2024;6(1):6-13.
18. 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 Soc Psychiatry. 2020;2(2):103-105.
19. Postman N. Technopoly: The Surrender of Culture to Technology. Vintage Books/Random House; 1993.
20. Matusov E, Smith M, Albuquerque Candela M, et al. “Culture has no internal territory”: Culture as dialogue. In: The Cambridge Handbook of Sociocultural Psychology. Cambridge University Press; 2007:460-483.
21. Bakhtin MM. The Dialogic Imagination: Four Essays by M.M. Bakhtin, Holquist M, ed, Emerson C, Holquist M, trans. University of Texas Press; 1981.
22. Mollica R. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. Harcourt; 2006.