Social psychiatry and social medicine are fields of research that existed in the late 20th century without becoming a major field that significantly influenced the mainstream. At the same time, a great deal of research is being conducted in the field of social psychiatry (Topor, 2017), which collectively suggests that the dominant biomedical model is not sufficient to support service users (Topor, 2017). Social psychiatry as a field has identified several factors that support recovery: “the material basis for recovery”—including, for example, the impact of social security systems; treating the person as a human being and a citizen rather than merely a patient; the relationship between professionals and service users in which the service user feels valued and recognized; social relationships such as family and friends; breaking social isolation; not reducing a service user to their problems; drawing on both the service user’s and the professional’s experiential knowledge; and viewing the person within a life history and social context (Topor, 2017).
One social thinker who was also a psychiatrist and historically part of this school of thought is Frantz Fanon. Fanon termed his approach “social psychiatry,” a term he coined because he was a psychiatrist (Adams, 1970). Fanon was a critic of what he called “bourgeois psychiatry,” which neglected “sociogenic” factors in its analysis and practice. Fanon’s work focuses on psychological violence as an effect of racism and colonialism. Fanon criticized psychology for “psychologism”, the tendency to treat real problems as fantasies that could be eliminated, for example, through CBT (Adams, 1970). Fanon argued that the goal of successful psychiatry should be primarily to reduce alienation, whereas current psychiatric practice actually increases it. Fanon draws on psychodynamic concepts, Marxist thought, and the work of Sartre, among others.
The article “Why Do We Need Social Psychiatry?” points out that social and cultural factors have repeatedly been shown to play a role, but have been neglected by mainstream psychiatry or incorporated in an inadequate manner (; Ventrilgio, Gupta, and Bhugra, 201 6). However, social and cultural factors seem to have recently begun to make a clearer inroads into mainstream psychiatry. One sign of this is that Bhugra, who co, authored “Why We Need Social Psychiatry,” is the lead author of the report by the “Commission on the Future of Psychiatry,” in which biological, biopsychosocial, and cultural perspectives are integrated (Rose, 2019, 176). There remains a strong movement within psychiatry to prioritize biology and biomarkers, even though there is criticism of how this is done (Insel, 2013, in Rose, 2019). Insel argues that one should look for “brain circuits” to identify the biological basis of psychiatric diagnoses, a project that the historian of psychiatry and sociologist Andrew Scull demonstrates is currently fraught with significant problems (Scull, 2022, 339).
Sociologists such as Nikolas Rose lead the field of social psychiatry and argue that a sophisticated combination of biology, psychology, and social and cultural factors is the way forward, one that is genuinely sensitive to these various factors and their interactions: a biopsychosociocultural paradigm (Rose, 2019; Bracken & Thomas, 2005). Rose opposes the bio, psycho, social model in which biology takes precedence and the other factors are secondary, a model that could be described as the BIO, psychosocial model (Rose, 2019). Social psychiatry does not take the stance adopted by certain critics, such as Thomas Szaz, of completely rejecting psychiatric diagnoses; however, it requires well, founded research, research that, for example, does not assume that depression and schizophrenia are objective facts but rather treats them as heuristic constructs, and does not view these conditions as “brain disorders” (Rose, 2019, 184, Scull, 2022). Social psychiatry, however, is critical of psychiatry as it currently stands, and highly critical, as evidenced by Rose’s view that the “Global South” should learn more from the failures of psychiatry in the “Global North” than from its successes (Rose, 2019, 185). Rose argues that within psychiatry there has been a “lip service” to cultural factors (Rose, 2019, 186). Rose, drawing on Foucauldian language, argues that a different kind of psychiatry is possible, one that would create a different biopolitics, by 1. replacing diagnoses with “formulations” that begin by analyzing the social situation and how society shapes these life circumstances. 2. Biological reductionism must be replaced with a research program that more clearly situates the individual within their environment, recognizing that social factors are not facts that affect everyone in the same way but are influenced by cultural expectations and understandings (Rose, 2019, 190). 3. A new role for the psychiatric profession that involves better collaboration with non, professionals and other stakeholders to fulfill the ideal of community practice, which, following deinstitutionalization, has today led to another form of neglect of individuals (Scull, 2022, 286; Rose, 2019, 191). Psychiatry should also refrain from labeling its patients as suffering from an “illness,” while still taking their condition seriously and giving them a genuine voice that has often been neglected (Rose, 2019, 193, 194). 4. A new perspective on the purpose of psychiatry, which should not be about conformity or attempts at “normalization”, such as “silencing the voice”, “feeling good,” and achieving “happiness”, but rather about broadening the “bandwidth” of what is considered normal and drawing inspiration from the capabilities approach (Rose, 2019, 197).
Postpsychiatry (Bracken & Thomas, 2001) is a perspective that goes beyond the dichotomy of psychiatry and antipsychiatry. Postpsychiatry focuses on creating “space” for diverse interpretations that foster greater responsiveness, pluralism, and exploration from various perspectives, and argues that the voices of service users should be at the center. They argue that they are proposing an “ethical paradigm” in contrast to the dominant “technological paradigm” (Bracken & Thomas, 2001).
Social psychiatry differs from social constructivist analyses of psychiatric diagnoses, which argue that these are entirely socially constructed (Scull, 2022). Social psychiatry holds that certain processes occur in the brain, but that these are closely intertwined with social and cultural factors (Rose, 2019).