|Year : 2020 | Volume
| Issue : 1 | Page : 20-26
The Global South: An Emergent Epistemology for Social Psychiatry
Vincenzo Di Nicola
Department of Psychiatry, Montreal University Institute of Mental Health; Department of Psychiatry and Addictions, University of Montreal, Montréal, Québec, Canada; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA
|Date of Submission||05-Jan-2020|
|Date of Acceptance||16-Jan-2020|
|Date of Web Publication||21-Mar-2020|
Prof. Vincenzo Di Nicola
Department of Psychiatry, Institut universitaire en santé mentale de Montréal (IUSMM), 7401, rue Hochelaga, Montréal, Québec,H1N 3M5
Source of Support: None, Conflict of Interest: None
This essay introduces the sociopolitical notion of the Global South as a bridge between globalization and the global mental health (GMH) movement that offers an emergent apparatus or conceptual tool for social psychiatry. A brief history of the Global South reveals that it is wider and deeper than economic and geopolitical notions such as the Third World, the developing world, and the nonaligned movement across a broad swathe of history and culture. I then turn to globalization and its critics, examining critiques of economics, human rights, and problems associated with humanitarian services. A feature of GMH, “the health gap,” is contrasted with “the epistemic gap,” a divide between the epistemologies of the North and emergent Southern epistemologies. Three key features of the Global South – conviviality, porosity, and syncretism – are discussed with examples from my practice of social psychiatry with consultations in child psychiatry and family therapy in Haiti and Brazil. Finally, the Global South is affirmed as a conceptual and clinical apparatus for social psychiatry.
Keywords: Conviviality, global mental health, globalization, porosity, Southern epistemologies, syncretism, the Global South
|How to cite this article:|
Di Nicola V. The Global South: An Emergent Epistemology for Social Psychiatry. World Soc Psychiatry 2020;2:20-6
El sur está aquí al lado.
The South is here, at our side.
– Boaventura de Sousa Santos
Globalization encompasses paradoxes. On the one hand, its very definition is large, suggesting movements that circle the globe. Common to many definitions of globalization are worldwide interactions both private and public, personal and commercial, migration and movement of people, trade and transactions, and dissemination and transfer of knowledge and skills. The trend is toward international connectedness, with “intensification of social relations” (sociologist Anthony Giddens), “incorporated into a single society” (sociologists Martin Albrow and Elizabeth King), a “flattening” of international rules and barriers (journalist Thomas Friedman), leading to “compression of the world,” and “consciousness of the world as a whole” (sociologist Roland Robertson). While cutting across many domains of human activity, often positive as in the transfer of knowledge, both analyses and critiques usually center on socioeconomic and sociopolitical factors. After the fall of the Soviet Union and its sphere of influence around the world, globalization has been cast as the triumph of liberal democracy with Fukuyama venturing so far as to declare this combination of open trade with democracy as “the end of history.” This triggered sharp responses from both the left and right of the political spectrum. In Specters of Marx, Jacques Derrida dismissed Fukuyama's declaration of the “death of Marx” as the “New Gospel” of “Christian eschatology.” Samuel Huntington argued that a temporary reprieve from the conflicts of the Cold War ideologies would revive a more ancient “clash of civilizations,” citing Islam in a clash with the West as an example.
On the other hand, these same global trends trigger local and regional reactions in what we may call a desire to differentiate the local and the particular from the global and the universal. In this essay, I would like to outline the history and scope of one of these efforts to differentiate peoples with the emergent notion of the Global South, using with examples from my work as a social psychiatrist, encompassing transcultural child psychiatry,, cultural family therapy,,, and Global Mental Health (GMH).
| Defining the Global South|| |
Writing during the Viet Nam war, political activist Carl Oglesby first used the term “the Global South,” arguing that centuries of US “dominance over the Global South … have converged … to produce an intolerable social order.” Since then, the term has accrued many meanings and nuances and is now a touchstone in transnational and postcolonial studies. Here are some of the historical associations with the Global South:
- A geographic designation – the Southern Hemisphere
- Development studies – “the Third World” and “the developing world”
- Population shifts – from rural to urban, from North to South
- The nonaligned movement (founded in 1956) – Yugoslavia, India, Indonesia, Egypt, and Ghana
- The excluded and the invisible, for example, the sem terras in Brazil, the 99% of Occupy Wall Street
- Cultural affirmations – négritude (Martinique, Senegal, and French Guiana)
- A political consciousness – the Cuban and other socialist revolutions (Latin and South America) – expressed in other domains as “Liberation theology” (Peru and Brazil) and “Pedagogy of the oppressed” (Brazil)
- Globalization – GMH.
| Meanings of the Global South|| |
Kaul describes some of the economic and policy implications of this new reality. However, this is to limit the Global South as just another way of instrumentalizing culture into a set of needs and services. I have a much broader view of the historical associations and meanings of this term across a wide variety of domains of theory and practice:
The négritude movement by Aimé Césaire in Martinique, Léopold Senghor in Senegal, and Léon Damas in French Guiana created a sensation, prefiguring the “Black is Beautiful” movement in the US. In Mexico, Ivan Illich created a language and intercultural exchange center focused on his key notion of “conviviality,” which he defined as “individual freedom realized in personal interdependence.” The Global South is particularly rich in the arts, with fresh new vistas provided by the “magical realism” of Colombia's Gabriel García Márquez (Nobelist, 1982) and Mexico's Carlos Fuentes, along with the trenchant essays and poetry of Mexican Octavio Paz (Nobelist, 1990) and Caribbean poet Derek Walcott (St. Lucia, Nobelist, 1992). In music, Brazil's Tropicalismo movement by Gilberto Gil and Caetano Veloso suavely resisted the military dictatorship there.
History, education, and politics
Brilliant polemics on négritude and colonialism by Martinicans Aimé Césaire and Frantz Fanon, Liberation theology by Peruvian Gustavo Gutiérrez and Brazilian Leonardo Boff, and Uruguayan Eduardo Galeano's lightning-rod jeremiad, Open Veins of Latin America, created powerful grassroots resistance movements. Above all, it was this resistance that Oglesby named “the Global South.” In education, Brazilian Paolo Freire, created a veritable revolution with his Pedagogy of the Oppressed, congruent with Ernesto Che Guevara's work on pedagogy in the Cuban Revolution. Working in his Centro Intercultural de Documentación in Cuernavaca, Mexico, Ivan Illich launched a similar critique of schooling.
Nowhere has the North been more at odds with the emergent South than in the area of religion. In the Christian world, the center of gravity has undoubtedly shifted to the Southern Hemisphere where the majority of practicing Christians, both Catholic and Protestant, notably in Africa and Latin and South America, now live. When the Polish Pope John Paul II who grew up under communism was asked by the exponents of Liberation theology in Latin and South America about the dialogue between Christianity and Marxism, he basically asked, what dialogue? Now, with the election of Pope Francis, the first pope from the Americas and the Southern Hemisphere, comes a compassionate voice for the poor and marginalized, supported by all the progressive movements of the Global South, whose contemporary emblem is the World Social Forum in Porto Alegre, Brazil.
Mental health and psychiatry
The field of mental health and psychiatry saw penetrating analyses of colonization by Martinican psychiatrist Frantz Fanon who later led the revolution against the French in Algeria, the socially engaged psychoanalysis of Erich Fromm working in Mexico, and such pioneers as Nise da Silveira, a Brazilian psychiatrist who used Jungian psychology to unlock the creative capacities of chronic psychiatric patients in her care, and her student, physician, actor, and activist Vitor Pordeus, who founded the “Madness Hotel” in Rio de Janeiro. Jamaica's Frederick Hickling (1988) documented the legacy of colonialism and slavery and their impacts on the mental health of Caribbeans.
| Globalization and Its Critics|| |
Let us turn now to globalization to see how the Global South fits in before we turn to it as a bridge between globalization and GMH. As should be clear to everyone of all economic, social, and political persuasions, globalization has its critics. I will briefly identify three streams of criticism and disquiet about globalization: Joseph Stiglitz's economic critique, David Kennedy's critique of human rights which are deployed as the humanitarian justification for globalization, and Slavoj Žižek's ideological critique combined with Didier Fassin's anthropological critique.
“Globalization and Its Discontents”: Joseph Stiglitz's economic critique
This Nobelist in economics has been one of the most important students and critics of globalization and the institutions of late capitalism such as the International Monetary Fund (IMF) as well as of market socialism., In comments pertinent to the Global South, Stiglitz argues that so-called “developing countries” are not developing at all and much of the blame falls on the shoulders of the IMF. Due to inequalities, the Global South suffers from “information asymmetry” which means that laissez-faire economic models will be inefficient and lead to economic failure. A supposed “invisible hand” guiding markets productively is a myth. If globalization is based above all on global trade, then this critique from a leading economist is chilling and should be at the heart of our preoccupations with the Global South.
“When Rights Go Wrong”: David Kennedy's critique of human rights
Kennedy,, is a key theorist of international law at Harvard University who documents the unforeseen consequences, blind spots, and biases of humanitarian work, or, to put it colloquially, “ when rights go wrong.” The human rights tradition focuses on participatory as opposed to economic or distributive justice issues and on legal rather than social, religious, and other remedies. Human rights conflate rights with social justice, whereas it is only one way to think about it. The human rights movement, Kennedy argues, has established a veritable monopoly over the idea of justice, which is more protean. In positing a universal truth, this remedy discounts the plurality of global cultures rather than heightening our sense of plural and heterogeneous moral possibilities.
“The Ideological Crack of Neoliberalism”: Slavoj Žižek's philosophical critique and Didier Fassin's moral anthropology
Philosopher Slavoj Žižek and anthropologist Didier Fassin both struggle in their work to reconcile a new humanitarian vision of society against what I characterize as the ideological crack of neoliberalism. The thrust of these critiques is not only to question globalization in its narrowly economic, technocratic sense but also the movements that attempt to humanize it, especially human rights with its attendant identity politics and humanitarian services. Žižek, has been most vocal in criticizing identity politics in the guise of multiculturalism and human rights as superficial and facile masks for the underlying defects of capitalism. This view sees globalization as simply capitalism under another name and humanitarian efforts as insufficient to address inequality and injustice in the face of migration and refugees, poverty and disease, and disaster and war. Thomas Nail, calls for limology (the study of threshold people) and kinopsychology, a new psychology based on the movement and migration of peoples, and kinopolitics that sees the migrant as the constitutive condition of contemporary politics, radically altering current views of borders as normative and migrants as outliers. Congruent with Nail's critique, Fassin calls for a political and moral anthropology that can address both the inequalities of globalization and the humanitarian reason that attempts their redress.
| A Personal Engagement as a Social Psychiatrist|| |
For decades, I have been consulting and teaching in Brazil, from the favelas of Rio de Janeiro and Salvador da Bahia to the progressive clinics of colleagues in the Southern state of Rio Grande do Sul. In Porto Alegre, I consult with colleagues like psychologist Sandra Fagundes and psychiatrist Abraham Turkenicz who are committed to social change. While all my Brazilian friends express their social solidarity, few leave their comfortable urban practices and private institutes to venture onto the streets like anthropologist Claudia Fonseca whose practice includes sex workers in Porto Alegre. To walk the streets with her and her informants is to enter a parallel world that is materially poor yet rich in narrative resources. Fonseca and others create safe spaces and cultural security to advocate harm reduction for addicts and basic salaries and access to health care for sex workers.
This kind of work is now the focus of an innovative program at the Federal University of Rio Grande do Sul (UFRGS) called the Integrated Multiprofessional Residency in Collective Mental Health. Trainees in various professions from physiotherapy to teaching and social work engage in community projects that are transdisciplinary in scope and collective in their reach. Meeting such engaged community workers is a bracing experience after being surrounded for 40 years by institution-based teaching and clinical practice (notwithstanding my own community-based practice of child psychiatry and family therapy). Ironically, I want to invoke the conservative American President Reagan in his plea to the Soviet President: “Mr. Gorbachov, tear down this wall!” I plead with my colleagues from North and South to tear down the walls of the institution and get out onto the streets of their communities. The students of UFRGS work all over the state in communities large and small, in the capital and far afield.
| The Global Mental Health Movement|| |
In spite of the significant contributions of social and cultural psychiatry, including his own, Harvard psychiatrist and cultural anthropologist Arthur Kleinman has argued for an urgent “rebalancing of academic psychiatry” in the wake of “psychiatry's identity crisis,” an opinion that we elaborate as a profound crisis of the field. Out of this crisis, the GMH movement arose. The founders of this movement assert that “Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.” Moreover, the mantra of the GMH movement is, “No health without mental health.”
While I agree with these goals, we must go further. By invoking the globe and globalization, GMH appears embracing and inclusive but is, in fact, narrowly focused on concepts derived from the international public health. GMH proposes itself as the solution for improving worldwide health, but we need a deeper analysis of how to intervene socially and why social interventions have been stymied even in high-income countries., Another problem is how to adapt global ideas locally. Failing to do so is not only ineffective but also dangerous. The way forward is to broaden the field of study to encompass all social variables through social psychiatry, which I argue is “the ultimate apparatus for the study of the social context of human predicaments, the widest possible context.”
The GMH movement insists on seeing mental health as integral to our notion of health and exhorts us to practice this at all levels. Yet, this begs the question of how we are to imagine the broader notion of health itself against its economic, social, and political contexts., Against the current biologism and reductive neuroscience in mental health, the social determinants of health are more well-established, more durable, and more salient factors of health, including mental health, as I demonstrated in my overview of the family, psychosocial, and cultural determinants of health:
“Today, research into the social determinants of health leads us to reformulate health as first social, where identity is plural (in a continuum from persons to dyads to networks), expression (of needs and suffering) is dialogic, and community action (health and human services from prevention to intervention) is relational.”
Thus, I conclude that there is no personal health, including mental health, without community, family, and social health. Furthermore, the Global South – with its demand to consider other epistemologies, other ways of knowing, its implicit ethical imperatives for communal solidarity and justice, and other ways of being – is the bridge between the discontents of globalization and the rise of the GMH movement. To anticipate my conclusion, the Global South adds a human dimension to globalization by bringing it down to the local and the regional level and gives a human face to GMH by acknowledging that identity and belonging are founded on family and community relations. This human face is precisely the face of social psychiatry.
| Is There an Epistemic Gap?|| |
The GMH movement proposes the key concept of the health gap – the gap between a known health problem and access to care. The Global South poses another more fundamental problem – that of an epistemic gap – between what we know and what we need to know.
Working in Brazil, Portuguese sociologist Boaventura de Sousa Santos proposes different epistemologies. Santos asks of the Global North – Is another epistemology possible? Moreover, he proposes alternative epistemologies of the South, which he defines as:
A set of inquiries into the construction and validation of knowledge, born in struggle, of the ways of knowing developed by social groups as part of their resistance against the systemic injustices and oppressions are caused by capitalism, colonialism, and patriarchy.
| Toward a New Epistemology|| |
Taken together, these considerations point to the need to understand and embrace the emerging characteristics of the Global South that I define as syncretism, conviviality, and porosity. Syncretism is the co-contemporaneous practice of different religious traditions such as Catholicism and Afro-Brazilian candomblé to create new syntheses of belief and practice. I am applying this more generally as the capacity in the Global South to embrace plurality and difference to create a more harmonious and inclusive syncretic culture. Conviviality is a similar term invoked by Illich emphasizing relational interdependence, which I have adopted in my practice. Porosity is an idea I adopted from Walter Benjamin's and Asya Lacis' essay on Naples about the fluidity of cultural categories there. What these three notions have in common is a more fluid, less categorical approach to culture, medicine, and politics.
Let me focus on porosity as a key characteristic of the emergent Global South. As I shared in an essay on Haiti, porosity is a quality that is evident everywhere in Port-au-Prince. Benjamin's and Lacis' description of Naples applies there with even greater force: “Porosity is the inexhaustible law of the life of this city, reappearing everywhere. A grain of Sunday is hidden in each weekday, and how much weekday in this Sunday!” I deploy this term as a Foucauldian dispositif or apparatus, as elaborated by Agamben: “an apparatus [is] literally anything that has in some way the capacity to capture, orient, determine, intercept, model, control, or secure the gestures, behaviors, opinions, or discourses of living beings.”
In my work in Brazil and Haiti, I use porosity as an apparatus to grasp another epistemology and to soften borders and boundaries in the daily work of culture, as Benjamin and Lacis recognized:
“The stamp of the definitive is avoided. No situation appears intended forever, no figure asserts its “thus and not otherwise” (…) one can scarcely discern where the building is still in progress and where dilapidation has already set in. For nothing is concluded. Porosity results (…) from the passion for improvisation, which demands that space and opportunity be at any price preserved.”
In Port-au-Prince, everything is incomplete – either falling apart or under construction. Nothing is fixed, nothing is permanent. Moreover, the people respond with robust resourcefulness and unshakeable faith. During my first visit, I participated in a workshop on postdisaster planning with a group of ecumenical faith leaders. Although I had access to leaders in the business, political and medical communities, the pastors struck me as the most willing and capable to engage and adapt. They were responsible for their parishes and had created resilient and responsive networks of social and spiritual support. True to their mission, what caught their attention was my sharing of my own spiritual journey as much as my expertise as a child psychiatrist. Moreover, this was reflected everywhere on the streets of Port-au-Prince – every bus and truck has a religious sign: “Faith. Hope. Trust in Jesus. God is Good.”
| Social Psychiatric Tools for a New Epistemology and Ontology of the Global South|| |
How can we transform Northern epistemologies based on categories and neoliberalism to the fluid new epistemologies of the Global South? Santos argues for a radical departure: “the adequate recognition of injustice and the possible overcoming of oppression can only be achieved by means of an epistemological break.” The break is with a Western – here, we can say “Northern” – understanding and transformation of the world as universal as opposed to local and particular. This Northern epistemology “sees itself as a vanguard that excels in knowing about, explaining, and guiding rather than knowing with, understanding, facilitating, sharing, and walking alongside.” In its place, Santos proposes a teoria povera or “poor theory” which he describes as “a rearguard theory based on the experience of large, marginalized minorities and majorities that struggles against unjustly imposed marginality and inferiority.” Santos rejects both radical pessimism and radical hope, opting for a “tragic optimism.”
In my work with children and culture, I have always held the notion of “development” in reserve due to the crucial differences in how childhood is constructed and lived across cultures. The time has now come to broaden my critique of “developmental thinking.”, We need to redefine what we mean by two worn-out notions –”development” and “change.” In his scholarly commentaries on culture and society, Williams demonstrated that development is one of the most complex words in contemporary cultures. The epistemological break that Santos describes means a departure from everything we associate with the notion of development – from pediatrics and child psychiatry to economics and politics and certainly in health care. Moreover, since the core underlying thought of development involves moving systematically through hierarchical “ages and stages” of individuals and groups, cultures, and economies, we must also radically interrogate what we mean by “change.” What we mean by change in such domains as education and health care is even more complex than development as it is at the core of all notions of growth and progress.
“Change” in the Global South is almost always translated by international agencies as economic growth rather than a recognition of the unique strengths and characteristics of the Global South – conviviality, porosity, and syncretism. These characteristics are rooted in intimate family relationships and shared community and social relations that are the crucible for the construction of personal identity and relational belonging. They add a human dimension to the technocratic tenor of globalization and give GMH a human face. A convivial, porous, syncretic Global South augurs an emergent “Southern epistemology” or as I characterize it in my call for a “psychiatry of the Event,”,, a new science of being based on Alain Badiou's philosophy of the Event. This new epistemology for social psychiatry, which is a different way of knowing, is an apparatus that also opens up a radical new ontology, a different way of being, rooted in the emergent Global South.
This essay is based on my Grand Rounds Presentation, Department of Psychiatry and Behavioral Sciences, The George Washington University, December 21, 2017.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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