Psychiatry and Public Affairs

Group for the Advancement of Psychiatry

Chaiwat Satha-Anand, Leo H. Bartemeier

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351496025
• Topic: Medicina
• Subtopic: Psichiatria e salute mentale

This stimulating collection bears witness to the insight that psychiatrists, with their special training and background and concern for human relationships, can contribute solutions to major problems of public affairs and public policy. The contributors represent the summation and distillation of the best thinking of psychiatry's leaders. They represent a variety of experiences and viewpoints, making possible a many-faceted approach to problems of national and international concern.

Based on completely documented reports of individual members and symposium discussions, Psychiatry and Public Affairs examines four major areas of public interest: the social responsibility of psychiatry, emphasizing the psychiatric aspects of school desegregation; psychiatry's role in international relations and understanding cross-cultural communication and working abroad; studies of forceful indoctrination or "brainwashing" and the social and psychiatric implications of the threat of nuclear war.

Contributors and contributions included here are "Physical and Social Isolation," Jack Vernon; "Psychiatric Aspects of Chinese Thought Reform," Robert J. Lifton; "Patterns of Reactions to Severe Chronic Stress in American Army POWs to the Chinese," Edgar H. Schein; "The Coming Struggle for More Responsibility," Pare Lorentz; "Some Implications of the Fall-Out Problem," Maurice B. Visscher; "Psychological Aspects of the Nuclear Arms Race," Franklin C. McLean; "Solitary Confinement," Milton Meltzer; and "Sleep Deprivation," David Tyler. Psychiatry and Public Affairs explores ideas and problems on the advancing edge of psychiatry.

The Group for the Advancement of Psychiatry (GAP) envisages a continuing program of work according to the following aims: to collect and appraise significant data in the field of psychiatry, mental health, and human relations; to re-evaluate old concepts and to develop and test new ones; and to apply the knowledge thus obtained fo

1
Introduction: The Social Responsibility of Psychiatry

The GAP reports and symposia that comprise this volume were selected because they all concern the application of psychiatric principles to broad social problems. Despite their wide variations as to form, style and date of publication (the first two reports reprinted here appeared in 1950 and the last was written in 1964), a consistent guiding principle is discernible throughout this span of years: that of the social responsibility of psychiatry. Since this is so basic to GAP’s entire program, Report #13, “The Social Responsibility of Psychiatry, A Statement of Orientation,” can also serve as an introductory statement pertinent to all the other parts of this book. It is therefore the first of the reports to be presented here; those that follow may be viewed as a series of endeavors toward fulfilling the social responsibility of which Report #13 is an initial declaration.

GAP’s commitment to this orientation was reconfirmed when it re-evaluated Report #13 in March, 1957, and added the following note to it:

Editor’s Note. Since the writing of this report in 1949 many events in our country have further illustrated the importance of informed participation by psychiatrists in the social changes of our time. For example, before rendering its decision on the desegregation of schools in 1954, the United States Supreme Court heard testimony from social scientists bearing on the psychological aspects of segregation. This precedent has since been followed by lower courts, legislatures, and school administrators who have frequently appealed to psychological principles in support of their decisions and actions. This places on psychiatrists (among other social scientists) some of the obligation of clarifying and interpreting the psychological aspects of social issues. The growing awareness by psychiatrists of their role in the community mental health and of the ways in which social changes affect the well-being of their patients has to some extent reduced the urgency which motivated the writing of Report #13. Nevertheless, the need to support the principles described in this report remains.

Toward the discharge of its responsibility in this connection the Committee on Social Issues of the Group for the Advancement of Psychiatry has published two studies of psychological aspects of current social issues. These are “Considerations Regarding The Loyalty Oath as a Manifestation of Current Social Tension and Anxiety” (GAP Symposium #1) and “Psychiatric Aspects of School Desegregation” [chapter 2 of this volume]. Other committees of GAP have published additional reports which relate to social aspects of psychiatry.^*

And so, we consider it fitting for setting the tone of this series of writings about “Psychiatry and Public Affairs” to start with our statement of orientation, written fifteen years ago, on “The Social Responsibility of Psychiatry.” The continued timeliness of this report is well demonstrated by its concluding sentence: “This, in a true sense, carries psychiatry out of the hospitals and clinics and into the community.” Psychiatry today is indeed engaged on an unprecedented scale, in moving into the community. September, 1965

THE SOCIAL RESPONSIBILITY OF PSYCHIATRY

A Statement of Orientation^*

The Committee on Social Issues, since the beginning of its function as a unit of GAP, has faced the need to define its purposes more clearly and to establish a frame of reference within which those purposes could effectively be pursued. The achievement of a clear orientation to its functional position was difficult, but indispensable to progress. Two factors immediately complicated this task: (1) the tremendous role played by prejudice — individual and class prejudice —in determining attitudes toward social problems; and (2) the incompleteness of scientific knowledge regarding the relations between society and personality.

The establishment by GAP of a Committee on Social Issues carried with it the tacit admission of the principle that the psychiatrist has a pertinent role in the study of social problems. Beyond this, however, no more specific definition of this role was provided by GAP. Here and there, individual psychiatrists and other social scientists offered conjectures on the significance of that role; but no standard had as yet been formulated.

Additional impetus toward clarification came from a series of discussions in the general meetings of GAP. These discussions reinforced the conviction of the Committee on Social Issues that the mission of GAP itself in large part was a social one; that the very birth of GAP was motivated not only by the pressing need for study of mental health problems, but also by a sense of urgency in the application of valid psychiatric knowledge to the critical problems of a changing society. All the issues raised in GAP had an immediate bearing on problems of mental health, but also had a wider relevancy to problems of human welfare, as shaped by the patterns of our own social organization.

Accordingly, it seemed important for GAP to take a valid and explicit position on the social responsibility of psychiatry. At one pole, psychiatry is linked to biology and medicine; at the other pole, it is linked to the social sciences. To meet the challenge of some problems of present-day psychiatry, an implicit reference to the question of social responsibility is simply not sufficient. This means that two things are needed: a clear formulation of a set of values and scientifically derived and tested principles appropriate to the task of applying the knowledge of psychiatry to the ills and shortcomings of present-day society; and, secondly, an explicit hypothesis regarding the relationship between society and personality.

GAP found it necessary to attempt a better understanding of some aspects of the relationship between mental health and certain types of social phenomena. The social phenomena which GAP considered were: the relation of prejudice and civil rights to mental health; the emotional effects of certain types of mass communication (radio, screen, press) ; the mental health principles disseminated through schools, books, advertising media; the problems of censorship and “loyalty” tests; trends of ill will, suspicion and other evidences of mental ill-health among those who determine public policy; universal military training; the backwardness of social and educational legislation in some parts of our country; and, finally, the whole problem of education for living.¹

When one views this range of psycho-social phenomena, it becomes evident that any rigorous attempt to modify their pathogenic aspects would be affected not only by the large role played by prejudice and by the handicap of insufficient knowledge regarding the interaction of society and personality, but especially by the difficulty of defining the specific connections between social forces and community mental health.

In this report the Committee on Social Issues attempts to establish a working hypothesis for the relations between society and personality. In the present state of limited knowledge, we can achieve at best only a set of tentative principles, to be amended as the tested knowledge grows. Such an effort is a necessary prerequisite for delineating the social responsibility of psychiatry.

In assuming this task, the Committee on Social Issues is aware that certain trends inherent in our current social structure tend to encourage emotional sickness. It believes that many of the warps and twists of our society have significant relevance for the issues of mental health, viewed from the standpoint of both the individual and the group. It believes that certain changes in the pattern of interaction between individual and family, and individual and society, may provide a more nourishing matrix for the cultivation of mental health.

Relationship Between Personality and Society

Personality and society are viewed here not as closed systems but as continuously interacting. Each influences the other selectively toward change.² While the intactness of personality is reflected in relatively fixed propensities of behavior, it is simultaneously in continuous interaction with, and is influenced by, the environment. Behavior is determined both by stimuli derived from the internal organization of the person and the external organization of the social environment. Constitution sets limits to behavior potentials, but structured behavior is always conditioned by social experience. The development of personality is influenced both by biological make-up at birth and by the process of internalization of elements of the social environment. All behavior, beginning with birth, therefore, is bio-psycho-social.

Individual Personality and “Social Role”

As the person matures, he achieves an identity that is at once both individual and social. Individual identity is represented in the organized behavior characteristics of the intact self, as determined by a particular set of biological dispositions and early social experience. The individual component of a person’s identity reflects his specific biological tendency patterned in its expression through his total character, which is socially conditioned. It is the core of the personality; it is relatively the more personal, more private, more fixed aspect of self. On the other hand, in a strict sense, individual identity is an abstraction, highly useful, to be sure, but an abstraction nevertheless. In growth and maturation, the process of individuation is never complete or absolute. The phenomena of social dependence run parallel with those of biological dependence. The full development of individuality does not imply isolation from or immunity against social influence; rather, it connotes an increasing sense of responsibility for social participation.

The “social role”³ of a person, or the “social self,” is by contrast, more variable, less private, less personal. “Social role” is conditioned by the phenomena of group belongingness and by temporal factors. “Social role” represents a component of the total identity of a person brought into action at a given time by a special set of group phenomena. At a given time, certain aspects of the total self are mobilized into action by the elements which prevail in a given social situation, while other aspects of the total self are temporarily subordinated. Thus it is possible for a particular person to express himself in a variety of “social roles.” This is a phase of the phenomenon of social adaptation, involving compliance with some group forces and protest against others. Inevitably, this process of social adaptation activates changing patterns of defense against anxiety, which have variable expedient value. The vicissitudes of a particular group situation determine whether one or another “social role” will be activated, within which the more individual aspects of self are called into play in greater or lesser part.

These principles apply to each phase of individual development, first within the family group, and, after that, the school, the neighborhood, and finally, in the relations of the adult person with wider society. In this sense, the dynamics of personality are conceived in terms of a bio-psycho-social continuum, beginning with birth and continuing through all the vicissitudes of social conditioning throughout the course of life. In each phase of personality maturation, the pattern of interaction between biological and social forces varies, thus imparting certain unique characteristics to social behavior in each era of development.

“Social Reality”

By “social reality” we mean the prevailing social institutions and the standards of interpersonal relationship which shape the adaptive efforts of each individual growing up in this society.

“Social reality” patterns the opportunity either for satisfaction or frustration of individual need. It influences the kind and degree of possible self-expression and self-fulfillment. It plays a critical role in determining the balance between self-expression and conformity to social compulsion. It conditions the capacities of persons for recognition and respect of the needs of others. Finally, it determines the specific content of dangers which the individual must face in his struggle for successful adaptation.

Social institutions are the expression of group customs, standards and goals. These provide avenues along which the individual can adapt to the group. They determine selectively the channels into which individuals may release emotion, as well as those standards which determine the inhibition of emotion. Within the frame of these social institutions, the person succeeds or fails in the assertion of his mastery drives. Within the frame of these social institutions, unconscious drives may be irrationally “acted out.” A continuous impact with group experience (family, school, civic, others) is the experiential matrix in which the person grows and develops his sense of reality. In a similar manner, the individual tests and assimilates selectively the moral and ethical standards of his environment, through a process of observing responses of environmental approval or dissapproval to the spontaneous expression of his urges.

When a person feels unequal to the situation with which he must cope, anxiety is aroused. The degree of anxiety activated is in inverse proportion to the degree of skill acquired in understanding and mastering reality.

“Social reality” not only influences channels chosen for release of inner drives and the quantity of anxiety generated with that release, but also exercises a selective influence on the choice of defense against anxiety (projection, reaction-formation, symptom formation, sublimation and others).⁴

“Social reality” is the matrix in which the individual identity of all persons is strengthened or weakened. A “give and take” process characterizes the individual’s relatedness to his group. Social participation of a responsible kind is one measure of maturity of personality. This implies the capacity of the healthy person to contribute to his group. Conversely, he requires from his group a measure of emotional support. On the negative side, the weaker a person’s sense of individual identity, the greater the need for support of the self from the group. Identification with groups, an extension of the childhood identification with parents, is a necessary part of healthy adaptation. Acceptance by the group, vital for emotional security, should not be achieved at the prohibitive price of excessive tension, self-destructive conformity, or denial of the opportunity for maturation of personality.

Opportunity for Self-Fulfillment

The patterns of self-expression and self-fulfillment are shaped by the coincidence of social opportunity and the individual’s inner disposition to fulfill a given “social role.” Choice of mate, occupation, membership in a variety of social groups, all contribute to shaping the “social role” of the individual in the manner indicated. Conflict between social opportunity and inner disposition is one ready source of anxiety. Instability or unpredictability of the patterns of social opportunity have the same anxiety-provoking effects. Under unfavorable circumstances, conflict between the person and the environment may become progressively internalized and thus contribute quantitatively to the intensification of psychopatholog-ical dispositions.

The Role of Social Danger

“Social reality” patterns the dangers against which the forces of personality must be mobilized. These dangers may be direct threats to life or limb, or they may represent economic privation, or frustration of basic personality needs. These needs may relate to security strivings, pleasure drives, sexual expression, or they may represent aspects of the striving for self-fulfillment in society. If such dangers and frustrations are excessive, the adaptive energies of the person may be absorbed in the negative task of counteracting such threats. In such instances, the pathological defense reactions of the personality may be so strongly mobilized as to leave the positive aspects of emotional living and self-fulfillment relatively impoverished. The greater the psychic energy required for this negative aspect of the task of adaptation, the less the emotional capacity to enjoy the positive aspects of living. Thus, the constructive drives become progressively subordinated to the compulsory need to counteract anxiety. The sicker the personality, the more do these defensive responses to external danger correspond to the symbo...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface
• 1. Introduction: The Social Responsibility of Psychiatry
• Part I. PSYCHIATRY AND DESEGREGATION
• Part II. PSYCHIATRY AND INTERNATIONAL RELATIONS
• Part III. FORCEFUL INDOCTRINATION
• Part IV. THE THREAT OF NUCLEAR WAR
• Statement of Purpose of GAP
• List of Members and Committees of GAP