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Primary Care, Mental Health and Public Health Integration WPA Bucharest Congress “Innovation & Excellence” April 10, 2013

Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

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Page 1: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Primary Care, Mental Health and Public Health

Integration

• WPA Bucharest Congress

• “Innovation & Excellence”

• April 10, 2013

Page 2: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging Without Boundaries: Social Psychiatry in the

21st Century

Co-chairs:

Vincenzo Di Nicola

Rachid Bennegadi

Page 3: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Panelists:

Vincenzo Di Nicola Ileana-Mihaela Botezat-AntonescuDrozdstoj StoyanovAnnelle Primm

Page 4: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Panelists:

Vincenzo Di Nicola: “Belonging Without Boundaries: Settlers, Sojourners and Travellers in the 21st Century”

Page 5: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Panelists:

Ileana-Mihaela Botezat-Antonescu:“Belonging to the Group of Psychotherapy Professionals: Between Interdiction and Proliferation in Different Political Contexts in Romania”

Page 6: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Panelists:

Drozdstoj Stoyanov:“Belonging Dimensions in Psychological Climate and Personality as Predictors of Vulnerability to Burn-out”

Page 7: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Panelists:

Annelle Primm:“Belonging by Bridging Divergent Worlds”

Page 8: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

A Symposium on Belonging

Discussant:

Rachid Bennegadi

Page 9: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Special Thanks

Eliot Sorel

Pierre Loebel

Page 10: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Geopoliticus child watching the birth of the new man

– Dali

Page 11: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging Without Boundaries: Social Psychiatry in the 21 st Century

It takes so little, so infinitely little, for a person to cross the border beyond which everything loses meaning: love, convictions, faith, history.

Human life—and herein lies its secret—takes place in the immediate proximity of that border, even in direct contact with it; it is not miles away, but a fraction of an inch.

– Milan Kundera, The Book of Laughter and Forgetting

Page 12: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging Without Boundaries: Settlers, Sojourners and Travellers in the 21 st Century

Vincenzo Di Nicola

Page 13: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging …

Page 14: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging Without Boundaries: Settlers, Sojourners and Travellers

in the 21 st Century

Vincenzo Di Nicola MPhil, MD, PhD, FRCPC, FAPA

• Psychologist (McGill/London)• Child Psychiatrist (McGill/Ottawa)• Philosopher (McMaster/McGill/EGS)

• Professor – Université de Montréal/UFRGS – Brazil

• Chief – Hôpital Maisonneuve-Rosemont

Page 15: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging Without Boundaries: Settlers, Sojourners and Travellers

in the 21 st Century

Vincenzo Di Nicola

• Mid-career child psychiatrist and early-career philosopher

• Tender-minded vs tough-minded –William James

• An Italian heart, an Anglo-Saxon brain and a Jewish soul

Page 16: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Key words

• Belonging

• Social psychiatry

• Relational being vs individual identity

Page 17: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Pedagogical objectives

1. To propose belonging as a key notion for social psychiatry

Page 18: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Pedagogical objectives

2. To offer an overview of the aporias* imbricated in thinking about belonging

* Aporia – Gk: impasse, confusion, puzzlement

Page 19: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

“The Church of God sojourning in Rome to the Church of God sojourning in Corinth.” — Clement’s

Letter to the Corinthians

• paroikousa – Gk: a provisional abode,“sojourning”

• katokein – Gk: the citizen with a residence

• parokein – to sojourn like a stranger• katokein – to reside like a citizen

Page 20: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

“The Church of God sojourning in Rome to the Church of God sojourning in Corinth.” – Clement’s

Letter to the Corinthians

Message:

• The Church itself was not a permanent structure but a sojourn

• Christians live in messianic time

Page 21: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

20th Century

• Displacements across borders, languages and cultures

• Emigrants, immigrants, migrants

• From displaced persons (DPs) to refugees

• From law to literature, from politics to philosophy, and from psychiatry to psychoanalysis

Page 22: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

20th Century

• “Global flows” – Rand Corp

• Social psychiatry & social medicine• Public health & epidemiology

• Transcultural psychiatry & medical anthropology

• Ethnicity & culture

• Multiculturalism

Page 23: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

21st Century

• From a bipolar world and the Cold War rhetoric of the end of history (Francis Fukuyama) to a multicentric world of liquid modernity (Zygmunt Bauman)

• Where culture has replaced class as the

dominant signifier

• Language as the major expressive vehicle of this shift

Page 24: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

21st Century

• From multiculturalism to globalization

• From diversity to pluralism

• From transcultural psychiatry to global mental health

Page 25: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Whither belonging?

Belonging is now a critical issue for

• Sociocultural psychiatry • Global mental health

Page 26: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

What is belonging?

• Belonging has a bi-valent, ambiguous, deeply unresolved/unresolvable quality

• What philosophy calls an aporia – a puzzle

Page 27: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Sojourners vs settlers

• We can begin to describe this puzzle with the dichotomy settlers or sojourners

• Katokein – those who are “here” to settle

• Parokein – those who sojourn for work or other reasons, for shorter or longer periods, but do not make their home “there”

Page 28: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Liminality

Third state of being-in-the-world …

• Intermediate between sojourners who are passing through and settlers who plant roots

• Those still on the journey, in transit –“betwixt and between” (Victor Turner)

• Neither here nor there – travellers on the threshold

Page 29: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Liminality

Travellers on the threshold …

• Stato di eccezione, state of exception

Page 30: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

State of exception

• Giorgio Agamben (b. Rome, 1942)

Page 31: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

State of exception

• Giorgio Agamben (b. Rome, 1942)

• Key notions:

• Homo sacer/Sacred Man (1998)• Stato di eccezione, État d’exception, State of Exception (2005)

Page 32: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Liminalitas vs communitas

Liminality(threshold being/state of exception)

vs

Community(settler/citizen)

Page 33: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

What is belonging?

• Whether it accompanies a language, a nation, a profession, or other organizing system of meaning

• The construct of belonging can be more than

an aporia for imagining identity

• To achieve the definition of subject and subjectivity

Page 34: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

What is belonging?

• “Belonging” is a way of rethinking relational and social being

• How we define mental health

• How we understand the expression of its vicissitudes

• How we organize care and healing for sufferers

Page 35: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

What is belonging?

To do this …

• We need to recognize how belonging is experienced and negotiated

• Free of the constraints of our habitual patterns of practice and thought

• To imagine belonging without borders for settlers, sojourners and travellers in the 21st century

Page 36: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging is not identity(belonging is not simply part of personal

being, cf. Rom Harré)

Cf. Amin Maalouf, Les Identités meurtrières/In the Name of Identity: Violence and theNeed to Belong (1998/2000)

Page 37: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging cannot be bounded by geographic or any other kind of boundaries

(eg, nation-state)

• Nor reduced to home, physically defined(cf. house/home; patria, homeland, heimat)

Page 38: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging cannot be disembodied(virtual reality, the internet or other

simulacra; cf. Jean Baudrillard)

• Corollary: Neither metaphor nor metonymy can instantiate or describe belonging

(ie, belonging is neither a metaphoric nor a metonymic relation, neither a

displacement nor a condensation of affects and cognitions, and cannot be described as such)

Page 39: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging cannot be exhausted, explained or contained by notions of ethnicity or other associations(eg, race, religion/system of belief,

ideology, profession, gender, sexuality, or intellectual/other cultural traditions)

Page 40: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging cannot be defined by essentialist, reductive, deterministic or other

causalistic models

Page 41: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some negations

What belonging is not and cannot be …

• Belonging is not ownership(regardless of the lexical origins or deconstructive meanings of the term in

English or other languages, belonging cannot be conflated with ownership and must be specifically separated from any notion of ownership, slavery or any other materialistic enterprise)

Page 42: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging is part of social being (cf. Rom Harré)

Page 43: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging is proposed as a key notion of social and cultural psychiatry

(not a subset of psychiatry but a larger and more embracing definition of psychiatry)

Page 44: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging is a critically important aspect of developmental psychology (cf. Jerome

Kagan) and child and adolescent psychiatry

• With implications for developmental psychopathology (cf. Sir Michael Rutter)

Page 45: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging can embrace and contextualize such specific approaches as attachment theory and systemic or family therapy

(belonging has no parentheses or brackets)

Page 46: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging can address the irreducibly philosophical* question of defining the subject

* philosophical = metaphysical or ontological

Page 47: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

What belonging is and possibly must be …

• Belonging is contingent (ie, chance, not fate),non-essentialist, non-deterministic, non-causalistic, and fundamentally irreducible

Page 48: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Some affirmations

As a result …

• Belonging is synonymous with fidelity to an Event, which generates both subject and belonging

Page 49: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

The science of being: Ontology

• Alain Badiou (b. Rabat, 1937)

Page 50: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

The science of being: Ontology

• Alain Badiou (b. Rabat, 1937)

• Key notions:

• Theory of the Subject (1982/2009)• Being and Event (1988/2005)• Logics of Worlds (2006/2009)

Page 51: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Reflexions

Belonging is to social psychiatry what attachment is to child psychiatry

Page 52: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Reflexions

Belonging is a bridge between the individual and the community

(ie, between personal being and social being)

Page 53: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Belonging …

Page 54: Belonging Symposium - World Psychiatric Association Bucharest, Romania Congress - 10.04.2013

Contact Vincenzo Di Nicola

• Blog – Trauma & Event:

http://philoshrink.blogspot.ca/

• Facebook:https://www.facebook.com/dinicola.vincenzo