Hot Times: Rediscovering American Social Psychiatry in the Summer of 2016

by Ken Thompson, MD

Kenneth Thompson, MD.JPG

It’s the dog days of summer…. It’s mid-day.  I am on my porch in Pittsburgh, watching people stroll by.  Those that are jogging are glistening in sweat. That makes sense.  Any effort on my part leads me to start sweating, too.  With an iced tea in hand, the scene is conducive to contemplation.

But contemplation seems a strange dog this summer.  It feels too hot out there even to take stock.  And there is thunder off in the distance.  The friction generated by events so far this summer feels like it’s growing and the catalogue of those events is getting longer.  It feels like a cascading drum beat. Our civic turmoil of police violence begetting violence against the police has caused grief unending and is rending the country. Terrorist attacks at home and in Europe are accomplishing their goals.  Refugees from the hell of Syria languish while countries turn their backs. Voters in the UK opt to leave the EU despite the myriad reasons not to, including the threat of the breakup of the UK itself.  And then there is the scalding politics of our own upcoming election.  Trump is running on the fear out there while Clinton is running on the fear of Trump.

Fear is everywhere.  Violence is everywhere.  Guns are everywhere.  Terrorists are everywhere.  Change is everywhere.   

Of course change has been everywhere for years.  All my life there have been terrorists, either domestic or foreign.  Guns have been everywhere and violence, too.  Why does the fear seem worse?

To my mind this is a question for social psychiatry that attends to how people think and feel and to the relationships between them. In this era of finance, I keep imagining that not only is there an economy based on goods and services, there is an additional economy based on  emotions, where actions and words generate feelings and then these feelings are exchanged between peoples.  Each emotion generates another in reaction.  There is a microeconomic level of production and exchange of feelings, and a macroeconomic level in which whole groups of people are caught up in their production and exchange.  From this perspective, it’s not the message that’s the message and—contrary to McLuhan—the media isn't either.  The message is the feeling.  Thinking and talking about the socially generated web of feelings is perhaps something on which social psychiatry should spend more time focusing.  

This would be a (re)extension of our field.  Most recently we have focused on how society approaches psychiatric disorders. It has been a delimited view, fit for an era when the politics of the time were mostly settled, or perhaps better, constrained.  The epoch of neoliberalism got exactly the kind of social psychiatry it could tolerate, which is not much.  

But times change and eras end.  The neoliberal era appears to be ending.  This may be the answer to the question of why the level of fear is worse now.  Its production and exchange keep mounting because the challenges to the neoliberal order (terror in all its forms, mass migration, climate change, inequity and political stalemate, to name a few) have been unrelenting and their solutions very uncertain.  At the same, the feeling of hope necessary to counteract the fear is in short supply. So far it is not being produced or exchanged at anywhere the scale necessary. All of this is now on a timeline in the US as the future is being put to a vote. It’s clear that whatever the outcome, it won’t be a vote for the status quo.  Time is moving on, we are turning a corner.  These are not the ordinary times we have grown accustomed to—it’s time to change.

The end of the era may enable the current constraints on social psychiatry to disappear.  Since we are charged with helping people to stay healthy and when ill, to heal, it’s reasonable to ask what might we contribute to this economy of emotions on the micro and macro level that will help people stay healthy or heal.  I don’t fully know the answer.  Time will tell.  But I do have a story a colleague told me.  Last week an African American patient of hers (she is European American) came in for his 3-month followup appointment.  He spoke at length about the fear and the division he saw in the community and the nation.  She agreed that it was a very tough summer so far and told him she was glad he came in.  He noted that he often didn't feel safe talking about what was happening and thanked her for being someone he could talk to in a safe place.  She told him to come back in 3 months.  Unless he needed to come sooner.  They both agreed they hoped that wouldn't happen.   I hope so too.

How can we create millions of safe conversations and generate much more hope?

The ice in my tea has long since melted.  Time to move on.