World Social Psychiatry

: 2022  |  Volume : 4  |  Issue : 1  |  Page : 1--3

Us and Them: Can Social Psychiatry help in an Intolerant, Xenophobic World Afflicted with “Social Autoimmune Disorders”?

Debasish Basu 
 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh - 160 012

How to cite this article:
Basu D. Us and Them: Can Social Psychiatry help in an Intolerant, Xenophobic World Afflicted with “Social Autoimmune Disorders”?.World Soc Psychiatry 2022;4:1-3

How to cite this URL:
Basu D. Us and Them: Can Social Psychiatry help in an Intolerant, Xenophobic World Afflicted with “Social Autoimmune Disorders”?. World Soc Psychiatry [serial online] 2022 [cited 2022 Jul 6 ];4:1-3
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Full Text

Us (us, us, us, us) and them (them, them, them, them)

And after all we're only ordinary men.....

“Forward!” he cried from the rear

And the front rank died

And the General sat

And the lines on the map

Moved from side to side.....

Waters GR, Wright RW (1973). “Us and them”. In, The Dark Side of the Moon. Music album by Pink Floyd.

It's the ordinary men (and women, and children) who are dying.

Ever since Russia wilfully and militarily breached the borders of Ukraine, a sovereign country recognized by the United Nations, on the fateful day of 24th February 2022, in an act of what it called “special military operation” but what is clearly a war declared by one country unilaterally against another, nearly 3000 civilians have died and more than 4 million have been forcefully displaced as on 12.4.2022.[1] Not to speak of the unspeakable atrocities committed in Bucha and elsewhere, which warrants a war crime investigation, though Russia denies its role in the perpetrated killings.

While such an act committed by one sovereign country against another, due to whatever stated or unstated rationalizations, is not only disturbingly unfortunate but also clearly and strongly condemnable, it is important, as mental health professionals concerned with the central importance of social-ecological factors in shaping both the wellness and the illness of the human race, to try to make sense of this mess.

Further, while the conflict in Ukraine is the ongoing exemplar playing out at a macro and macabre scale at present, there are many, many other examples of such or similar conflicts happening in different parts of the world on a daily basis. Is there a “one word” to characterize the nature of these conflicts, which are based on a perplexingly wide variety of such bases as religion, nationality, race, ethnicity, colour, caste, class, creed, gender identity, political preference, so on and so forth?

Intolerance is the word. The world is progressively becoming more intolerant.

Intolerance against them, leading to anger, hatred, rage, destruction. Intolerance against people who are not like us, in one of the myriad ways that we choose to define our own characteristics and identify with. But why such widespread intolerance?

In an attempt to find the putative answer, apart from the obvious geopolitical and economic factors in shaping both human wellness and illness, it might be imperative to focus on issues more central to the human core of existence. What does intolerance stem from?

Insecurity. We can't tolerate those who scare us, who make us feel anxious, defensive, on our guard. Who, we feel, may cheat us, deprive us, rob us, and harm us.

And who are we scared of?

Those who are not like “us”. The “them”.

Xenophobia (“Fear of the stranger”) has been inbuilt in the human system – indeed, in much of the animal system – for millennia.[2] And, amazingly, at a cellular and organismic level, it is inbuilt in our immune system. For our own protection and self-preservation, the immune system has learnt to differentiate “self” from “non-self”. The essential function of the immune system is preserving/protecting self by tolerating those elements perceived as self, and destroying/inactivating those elements perceived as non-self. These non-self elements could be either from external source (classically, the pathogens) or from internal sources (e.g., cells undergoing neoplastic transformation, products of cell degeneration), which the body needs to get rid of. Innate immunity mechanisms can recognize these biological molecular patterns of a wide variety of molecular structures as foreign ('xenobiotic'), pathogens, or otherwise signalling danger, through the pattern recognition receptors, especially the Toll-like receptors. These innate pattern recognition mechanisms are fixed through germ line and evolution; in other words, there is no “learning” involved. The adaptive immunity system, on the other hand, through its elaborate cellular and humoral mechanisms, “learns” to identify elements as self or non-self, and is equipped to mount its 'attack' against the latter. It is interesting to note that, while innate immunity system exists in virtually all forms of life and especially in the pre-vertebrate forms, the learning-based adaptive immunity system is found only in the vertebrate animal kingdom.[3],[4]

It is important to consider two vital points here. First, the heuristic and pragmatic value of this self-non-self discrimination, it must be understood, lies in its goal, and ability, to discriminate what is potentially harmful for the organism versus what is not; thus, it is a teleological concept based on utility (which can vary from time to time and context to context) and not a sacrosanct inherent all-time 'truth' based on validity.[3]

Second, and more importantly as a corollary of the first, the self vs. non-self discrimination can go awry! The adaptive immunity system being a learning-based system (as opposed to the innate immunity system), it can potentially 'mislearn' to identify parts of actual self (non-harmful; needs preservation/protection) as non-self (potentially harmful; needs biodestruction, inactivation and/or elimination) and hence mounts the learned immune effector mechanisms against the latter. This is, indeed, the basis of the autoimmune diseases.[4]

The society-level application of this self vs. non-self distinction may be seen as in-group vs. out-groupidentification, which is hence an inherent and potentially adaptive property of vertebrate animal societies, found widely in mammals and since the prehistoric human times. Nothing wrong in this, because the early group-forming humans needed mechanisms for their own survival and propagation and for the safety from potential invaders. Indeed, it has been argued that the advancement of humans as a species depended as much on their inherently superior cognitive abilities as on their ability to form larger and larger social-cultural groups based on cooperation.[5]

However, at the heart of this advancement lay this ability – and its vicissitudes – of the distinction between self and non-self, a teleological distinction based on group utility, which was not absolute and which could go wrong. Especially for many of the constructs which are construed as an abstraction, the distinction (and hence laying the grounds for discrimination, prejudice and xenophobia) may turn out to be fallible and may eventually harm the societal 'self' which is, mistakenly, perceived by a section of the society as 'non-self', 'others', 'foreign', or 'them'.

To hijack an analogy from immunology, this faulty self vs. non-self discrimination is much at the root of generating threat/insecurity, leading to intolerance, leading to conflict. Somewhat like an autoimmune disease, a society can turn against parts of itself, erringly recognizing it as non-self.

So, in this admittedly fanciful formulation....

Intolerance may be conceptualized as an expression of “social autoimmune disorders” playing out at the macro level, where human beings, as individuals, communities, societies, nations or any other such congregations of 'cells', learn – or are taught, by vested nefarious interests of many types – to misrecognize parts of “us” as “them”, parts of “in-groups” as “out-groups”, parts of “self” as “non-self”, hence potentially threatening, harmful or dangerous, hence playing on our insecurity, especially during times of an actual external threat (like the COVID-19 pandemic), and hence giving rise to xenophobia and thence to intolerance, rejection, rage, anger, violence, destruction, with all its mental health consequences.[6],[7],[8]

The remedy, then, must begin elsewhere. It must begin in identifying and researching the causes – at a societal or macro level – that foster such faulty 'self vs. non-self' pattern recognition.

Role of social psychiatry?

As espoused above, intolerance and xenophobia are societally learned self vs. non-self responses. As such, they can, at least potentially, be unlearned. Since this faulty learning is at the root of so much of human suffering with its mental health consequences, socially oriented psychiatrists and allied mental health professionals have an important role to raise awareness about this issue, at multiple forums, starting from schools and colleges to workplaces, clubs and other meeting places, to medical and socio-political circles. Advocacy is also important.

In this regard, it is particularly concerning and vitally important to remind ourselves, that, some of the most important early roots of both social psychiatry and psychiatric genetics were laid in eugenics, a dubious discipline based on self-nonself philosophy (“us vs. them”, so as to selectively breed “good people with good genes” and breed out the “bad ones”).[9] Social psychiatry needs to be careful about its past dark shades of gray!

Along with this, a lot of research can be, and needs to be, conducted in the area of 'social autoimmunity' phenomena. How did something (people, attributes, characteristics), which was considered a useful part of the existing society and hence as societal 'self', came to be identified as potentially harmful, dangerous, 'pathogenic' and hence 'non-self', needing to be marked and hit? We do have glaring examples from say, the nazification of Germany, where a previously inherent and useful part of the German society was engineered to be perceived as dangerous and non-self, but there are many, many other examples of such nazification in symbolic manner throughout history, geography and cultures. It is important to research these phenomena from the prism of social psychiatry.

Finally, last but not the least, it is imperative for us to catering to the mental health needs of those afflicted by such conflicts worldwide. We need mental health workers sans borders. At the end of the day, it's about one social being caring about another. Otherwise, in the all-encompassing world of hatred emanating from the allegory of social autoimmune mechanisms, we would soon start justifying all injustice being meted out on our fellow humans, simply because we think they are not “us”, and ordinary men would be led to attack “them”, by some Generals sitting in the rear; the lines on the map will move from side to side, while ordinary people from both the sides will die, be maimed for life, or develop severe mental health issues.

Note: This editorial reflects the personal views of the editorialist and not a position statement of the World Association of Social Psychiatry.


1Conflict in Ukraine. In, Global Conflict Tracker (, last accessed on April 12, 2022).
2Rahim RA. The neuroevolutionary roots of xenophobia. Accessed at: (last accessed on April 12, 2022).
3Cohn M. The evolutionary context for a self-nonself discrimination. Cell Mol Life Sci. 2010 Sep;67(17):2851-62.
4Gonzalez S, González-Rodríguez AP, Suárez-Álvarez B, López-Soto A, Huergo-Zapico L, Lopez-Larrea C. Conceptual aspects of self and nonself discrimination. Self Nonself. 2011 Jan;2(1):19-25.
5Boyd R, Richerson PJ. Culture and the evolution of human cooperation. Philos Trans R Soc Lond B Biol Sci. 2009 Nov 12;364(1533):3281-8.
6Suleman S, Garber KD, Rutkow L. Xenophobia as a determinant of health: an integrative review. J Public Health Policy. 2018 Nov;39(4):407-423.
7Brodziak A, Różyk-Myrta A, Wolińska A. Does the recent intensification of nationalistic and xenophobic attitudes in Eastern European countries adversely affect public mental health? BMC Public Health. 2016 Oct 24;16(1):1115. doi: 10.1186/s12889-016-3785-3.
8She Z, Zhou N, Li D, Ren S, Ji W, Xi J. Does COVID-19 threat increase xenophobia? The roles of protection efficacy and support seeking. BMC Public Health. 2022 Mar 11;22(1):485. doi: 10.1186/s12889-022-12912-8.
9Pilgrim D. The eugenic legacy in psychology and psychiatry. Int J Soc Psychiatry. 2008 May;54(3):272-84.