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Social Psychiatry and Psychiatric Epidemiology

28-09-2024 | Review

The place of the social in psychiatry: from structural determinants to the ecology of mind

Author: Laurence J. Kirmayer

Published in: Social Psychiatry and Psychiatric Epidemiology

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Abstract

Purpose

Social psychiatry considers the ways in which mental disorders are shaped by particular social environments. This paper outlines a cultural-ecosocial approach that emphasizes the ways in which cultural meaning and practices mediate the effects of the social determinants of mental health on the mechanisms of illness, disorder, and disease.

Methods

Selective review of literature and conceptual synthesis.

Results

“The social” in psychiatry stands for the structures and dynamics of groups of people interacting on multiple scales from the intimate sphere of couple and family to neighbourhoods, communities, societies, nations, and transnational or global networks. These interactions create social contexts, niches, forms of belonging, identities, institutions, and larger systems that influence the causes, expression, course, and outcome of mental disorders. Characterizing these systems requires theory that considers the ways in which social systems constitute dynamical systems that configure material, energetic, and informational flows that give rise to human experience. Unpacking the health consequences of these local and extended systems requires an interdisciplinary approach that considers: (1) the social psychological, psychophysiological, and sociophysiological processes that mediate the impact of the environment on body, mind, and person; (2) the interactional dynamics of social systems that give rise to structural adversity and inequity as well as resilience; and (3) the recursive effects of self-understanding, agency and subjectivity.

Conclusions

In the cultural-ecosocial view, “the social” is shorthand for interactional processes that constitute material and symbolic structures that provide cultural affordances, constraints, and challenges as well as resources for healing, recovery, and adaptation.
Footnotes
1
A serviceable distinction between culture and social structure is provided by House [53]: “A culture is a set of cognitive and evaluative beliefs—beliefs about what is or what ought to be—that are shared by the members of a social system and transmitted to new members. A social structure is a persisting and bounded pattern of social relationships (or pattern of behavioral interaction) among the units (that is, persons or positions) in a social system. Culture and social structure are closely related—shared values and beliefs shape the definition of social positions and the relations between them (that is, the social structure), whereas the nature of actual social relationships, even if these are primarily responses to physical or biological imperatives, influences our values and beliefs. The correspondence between the two is, however, never perfect. We need to distinguish, therefore, both theoretically and empirically, between what members of a social system collectively believe and what they collectively do. Culture and social structure are generated and maintained by somewhat different forces and they influence individuals in somewhat different ways.” (pp. 542–543).
 
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Metadata
Title
The place of the social in psychiatry: from structural determinants to the ecology of mind
Author
Laurence J. Kirmayer
Publication date
28-09-2024
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-024-02772-5