The Crisis of Psychiatry Is a Crisis of Being: An Interview with Vincenzo Di Nicola

Vincenzo Di Nicola is Professor of Psychiatry at the University of Montreal where he co-directs a postgraduate course on psychiatry and the humanities. His book, co-written with Drozdstoj Stoyanov, Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience, offers a critical survey of the history of modern psychiatry with transdisciplinary readings of the literature and practices of a field in crisis. In this interview, Di Nicola discusses what he and Stoyanov see as the dual crises of psychiatry, and how philosophy can improve the way we think about psychiatry.  

Interested in reading more of Di Nicola’s work? Check out this preview of Psychiatry in Crisis.

What is your work about?

This new volume emerged as a work-in-progress forged from a dialogue with Drozdstoj (Drossi) Stoyanov, a Bulgarian psychiatrist, neuroscience researcher, and philosopher of mind. My own areas of interest are in child and family psychiatry, psychotherapy, and the philosophy of psychiatry. As it happens, our collaboration highlights some of the paradoxes of contemporary philosophy and psychiatry. Drossi works in Bulgaria although his interlocutors are in the analytic tradition philosophically and in the emerging neurosciences, both of which are largely products of Anglo-American culture. I come from Italy but did my training in psychology and psychiatry in Canada and England, and after an early career in clinical and epidemiological research, shifted to socio-cultural psychiatry and psychotherapy in Canada and then philosophy in the Continental tradition. From these disparate starting points, we share a similar disquiet about the “state of psychiatry” (this echoes the title of a celebrated volume of essays by Aubrey Lewis of London’s Institute of Psychiatry, where I trained) and we recognize our respective commitments as complementary.

The prospectus of our volume on Psychiatry in Crisis (our title echoing Anthony Clare’s Psychiatry in Dissent, one of my profs at the IoP) starts with a survey of typical reactions to our investigations – psychiatrists on psychiatry, as it were. These reactions range from outright denial (“What crisis?”) to world-weary resignation (“Psychiatry has always been in crisis”). In between, some hold that through a plethora of diverse and competing approaches “psychiatry lost its way”, finding no common thread after the heyday of a series of dominant schools from phenomenology and psychodynamic psychiatry to psychopharmacology. The emergent paradigm now appears to be clinical neuroscience with the core notion that “mind is brain,” provoking a discussion of the reductive models of psychiatry and how this creates an impoverished language of psychiatry. We are well beyond dissent here and into a full-blown crisis.

The crisis of psychiatry is manifested in such questions as to whether psychiatry is a social science (like anthropology and psychology), whether it is better understood as part of the humanities (like history and philosophy), or if the future of psychiatry is best assured as a branch of medicine (based on genetics and neuroscience)? In fact, the question often debated since the beginning of modern psychiatry concerns the biomedical model so that part of psychiatry’s perpetual self-questioning is to what extent it is or is not a branch of medicine. My goal in this volume is to identify and avoid the blind alleys and asymptotes that distract us and defeat the construction of a theoretically coherent and broadly consensual psychiatry. (My work is full of implicit nods and overt shout-outs to others; “Chapter 8, Cleaning the House of Psychiatry” parallels Wittgenstein’s goals in his Philosophical Investigations).

From there, we then state our major leitmotifs. This was Drossi’s idea as he is a classical violinist and lover of Wagner’s music. Now, Stoyanov sees psychiatry’s crisis as a crisis of knowledge (epistemology in philosophical terms), while I see the crisis of psychiatry as a crisis of being (ontology in philosophical terms). These dual crises create a lack of confidence and clarity about psychiatry’s mission, obscuring three critical gaps: (1) the lack of a consensual psychology (or theory of persons); (2) the lack of an organizing consensual model of psychiatry (or theory of psychopathology, that many call the phenomenology of psychiatry); and (3) the lack of a consensual theory of change (as opposed to mere descriptions of change related to a given model). Conceptually, the issue of how psychiatry relates to its competing claims is framed as a problem of disciplines and subdisciplines, inspired by the work of Alain Badiou (2008) on philosophy and its conditions.

Finally, three philosophical avenues are identified to deal with this crisis: (1) the crisis as a “pseudo-problem” (Wittgenstein and Ryle in the analytic tradition of Anglo-American philosophy), resolvable by redefining or reframing the issues; (2) accept psychiatry’s plurality and incompleteness as a manifestation of “weak thought” (Vattimo, working in the continental tradition, in response to Heidegger, and echoing Gödel’s incompleteness theorems); or (3) a more promising approach to re-found psychiatry in a revisioning of phenomenology through ontology (Badiou’s tripartite theory of the subject, being, and the event; Badiou & Tarby, 2013), where the focus is on the centrality of human being and its vicissitudes.

How does it fit in with your larger research project?

The crisis in the field of psychiatry parallels debates in psychology and other social sciences and a crisis in the humanities which are losing their foothold in the academy with departments of history and philosophy shutting down – all of this against the rise of neuroscience as an all-embracing alternative.

Let me take as an example psychic trauma which has been a focus of my clinical work, research, and theorizing (Di Nicola, 1996). After postgraduate training with the Harvard Program in Refugee Trauma and my career-long involvement in trauma work as a psychiatrist, I concluded that we know a lot but understand too little about trauma so I turned to my first love, philosophy. The deeper I went in my philosophical investigations, the more I became convinced that psychiatry faces blind alleys and asymptotes at every turn. My doctoral dissertation, supervised by Alain Badiou, the philosopher of the Event, focused on the conceptual pairing of trauma and Event, that Badiou found fresh and original. For me as a psychiatrist, for whom trauma is one of the key aporias of 20^th century psychiatry, Badiou’s approach to the Event was the key that unlocked everything. What links trauma and Event is rupture, which can open possibilities for innovation and change leading to the Event or shut them down into trauma. My investigations grew apace and culminated in my dissertation called Trauma and Event (Di Nicola, 2012). The fruits of this were published in the lead chapter to a volume called Trauma and Transcendence where I concluded that trauma defeats every generation because of epistemological traps built into the foundational discourse of Western/Northern cultures and creates two dichotomous approaches that I dubbed clinical and cultural trauma communities (Di Nicola, 2018). More importantly, I maintain that the only sure way to grasp something as complex as psychic trauma is through an interrogation of being, not knowing.  

So my contribution to this volume on Psychiatry in Crisis is to examine psychiatry through the lens of ontology instead of psychology’s and psychiatry’s usual recourse to epistemology. In our neo-positivistic era, what investigators value is objectivity and questions of reliability and replication over the subjectivity of the phenomenological tradition which poses different questions about validity and truth. As Neil Postman (1992) wrote in his perceptive study of Technopoly, which he defines as the surrender of culture to technology, “technopoly is at war with subjectivity.”

Using this as my focus, I poured my preoccupations as a professor of psychiatry into my doctoral research and wrote my dissertation on trauma based on Badiou’s notion of the Event for which he gave me his blessing to call it Trauma and Event. When I was almost done, Badiou sharpened my focus when he made this philosophical diagnosis: You are at a crossroads: either you will declare the end of psychiatry or announce a new psychiatry, perhaps an evental psychiatry.

“The Case of Ellen West” – I took another year to examine Ludwig Binswanger’s (1958) case of “Ellen West” which is not only the foundational case of Daseinanalyse treated at his Bellevue Sanatorium in Switzerland but also a mirror of 20^th century psychiatry in which major psychiatrists, psychoanalysts, and philosophers saw their own reflections, from Mara Selvini Palazzoli and Sal Minuchin (founders of systemic or structural family therapy) to RD (Ronnie) Laing (the Scottish anti-psychiatrist) and Michael Foucault (who was a psychologist before turning to philosophy and history inspired by French physician-philosopher Georges Canguilhem).

The Ellen West case for me embodies the death of the phenomenological tradition in psychiatry not only because of the paradoxes built into the attempt to be “objective” about subjective experience which is what Binswanger argued, but because of a katechon, the withholding of the name of a consultant on the case – the only significant name withheld in his entire, lengthy documentation of the case. New research reveals that the consultant was German psychiatrist Alfred Hoche who had written a book in 1920 with fellow German, jurist Karl Binding, called, Die Freigabe der Vernichtung lebensunwerten Lebens—“The Permission to Annihilate Life Unworthy of Life,” justifying euthanasia, notably for the mentally ill, like Ellen West. It was later used in the Nazi justification for the annihilation of the mentally retarded and other people considered “unworthy,” from the Roma to the Jews of Europe. The key German phrase here – lebensunwerten Lebens, “life unworthy of life” – is Nazi language as any native German speaker would recognize. Diagnosed with schizophrenia by no less an authority than Eugen Bleuler, who had coined the term for this mental illness which was then considered an incurable disease, the chronically suicidal Ellen West is offered a transfer to institutional care or discharge home from the more pleasant Bellevue Sanatorium in which she resided. After three days at home, she kills herself, aided by her husband and possibly Binswanger such that a battle rages in the literature as to whether it was an “assisted suicide” or a “psychic homicide.” As Ronnie Laing (1983) acidly observed, Binswanger insists “no less than 17 times” that her suicide was “authentic,” reading this as a way for Binswanger to exculpate himself and his existential analysis.

Phenomenology, introduced by Karl Jaspers into psychiatry more than a century ago proved intriguing and fruitful for psychiatry but has now become a blind alley, covering no new ground nor offering new insights. If phenomenology was going to save psychiatry, it would have happened long ago. When I present the case of Ellen West (which I have done many times to academics and clinicians) as a kind of metaphysical detective story replete with serious philosophical aporias, today’s psychiatrists react with impatience and want to diagnosis her and solve the case! (The small cottage industry on this case reveals a panoply of diagnostic opinions and even family therapist Minuchin who eschewed diagnoses wrote a one-act play about her in which he called her an anorexic. Most psychiatrists today see her as a “borderline” – so much for schizophrenia as “the sublime object of psychiatry” in Angela Woods’ resonant phrase, 2011).

So, I have to agree with Tom Sparrow who declared the end of phenomenology which has come to mean everything and nothing. Badiou argues that if we are to understand human phenomena, we must eschew Husserl’s intentional or subjective phenomenology and radically redefine being and the subject in light of the Event.

“Psychiatry Against Itself” – From there, I turned to four critical psychiatrists known as anti-psychiatrists – Franco Basaglia, Frantz Fanon, Jacques Lacan, and Ronnie Laing. All of them, who were conversant with psychoanalysis and phenomenology in psychiatry, the dominant European model of the time, rejected it in acts of negation of some aspect of psychiatry. For this reason, I have reframed anti-psychiatry as “psychiatry against itself” – an internal debate of psychiatric radicals, rebels, reformers and revolutionaries who wanted to change psychiatry rather than abandon it. This is what Clare meant by “psychiatry in dissent” – and again, we are now beyond mere dissent, and in a time of warring factions.

My reframing of anti-psychiatry as “psychiatry against itself” was strongly influenced by Badiou’s notion of philosophy and anti-philosophy (echoing Richard Rorty’s notion of systematic and edifying philosophers that I read as structurally equivalent). Now, I invoke the philosophical notion of negation to understand the operative gesture of anti-psychiatry. Each of the four “anti-psychiatrists” I discuss negated a key aspect of psychiatric theory and practice. Scotsman Ronnie Laing was a psychiatric radical who wanted to return psychiatry and psychoanalysis to it roots; Italian Franco Basaglia was a psychiatric reformer who first opened the doors of a regional psychiatric hospital in Northern Italy, then entered politics to close down Italy’s asylums; Frenchman Jacques Lacan was a subversive psychoanalyst and psychiatric rebel, “returning to Freud” and jettisoning all biologism or recourse to the adaptation of the ego to society’s demands (these were general tendencies among French critiques of psychiatry and psychoanalysis in the 20^th century); and finally, Martinican Frantz Fanon whose Black Skin, White Masks (1952) set him on a revolutionary course, first against colonial psychiatry, and then against colonial politics, notably in Algeria where he became a figure in their revolution against the French colonial project (see his A Dying Colonialism, 1959). In retrospect, they all have a powerful presence in my work in spite of the fact that they were barely on the syllabus in my psychology and psychiatry training in pre-eminent centers at McGill University in Montreal and the Institute of Psychiatry in London.  

These two studies are integrated into my contribution in “Part II – Psychiatry in Crisis as a Human and Social Science” and serve as a prolegomenon to evental psychiatry, which is my response to Badiou’s challenge. I am now actively constructing what that looks like both theoretically and in practice with other psychologists, psychiatrists, and therapists.

How do you relate your work to philosophical traditions?

As I mentioned, Drossi and I work in two contrasting traditions both in philosophy and psychiatry – the Anglo-American and the Continental. This is nowhere clearer than in Anglo-American philosophy of science represented by Karl Popper and Thomas Kuhn and supported by a large cast from Gilbert Ryle to Daniel Dennett and Patricia Churchland who rally what the film “Casablanca” called “the usual suspects” – Galileo and Newton followed by the story of modern theoretical physics with Bohr, Einstein, and Schrödinger and their controversies.

Against this neo-positivist and progressivist view of philosophy of science, I would invoke Paul Feyerabend’s Against Method (2010) and The Tyranny of Science (2011). More significantly, French philosopher of science Georges Canguilhem was a physician who, unlike the “usual suspects” in Anglo-American philosophy of science, investigated biology and medicine, in contrast to Mario Bunge, a physicist-philosopher who wrote a philosophy of medicine through the neo-positivist lens typical of philosophy of science that is unencumbered by any experiential knowledge of medicine or any evident engagement with physicians. So I would argue for a philosophy of psychiatry informed by the relevant life sciences, along with social sciences and the humanities. Reading a biologist like Conrad Waddington who coined the term epigenetics or immunologists Macfarlane Burnet and Peter Medawar on self-nonself and tolerance is informative and edifying, along with psychoanalysts John Bowlby on attachment, Donald Winnicott on the good-enough mother, Ronnie Laing on the divided self and self and other, anthropologist Mary Douglas on Purity and Danger, jurist-sociologist Boaventura de Sousa Santos on southern vs. northern epistemologies, philosopher Thomas Nail on the figure of the migrant, and sociologist Zygmunt Bauman on liquid modernity. (The parallel notions about self, other, difference and change across these disciplines are striking, but that’s another thesis that needs to be developed.)

Nonetheless, I reject arbitrary divisions that I predict will dissipate just as the feud between Kuhn and Feyerabend has faded into a more nuanced understanding of the history of science. We can now perceive parallel and synchronous notions developed by thinkers who appeared as diverse as Kuhn and Foucault (whose épistémé functions very much like Kuhn’s “paradigm”) or Feyerabend who was a methodological anarchist.

A more instructive way of classifying thinkers emerges from a comparative reading of American humanist Richard Rorty and Badiou. Again, Rorty sees systematic or foundational philosophers who build arguments and edifying philosophers who entertain and ironize. Badiou calls them philosophers (who are ontologists in his view, as in Heidegger’s) and anti-philosophers. In either view, both types of thinkers are worth reading and engaging, even when they are anti-foundational (like Rorty himself) or trivial. As Wittgenstein (1980, p. 26) said about philosophy – it may be trivial but the sum of these trivialities is very important:

What we find out in philosophy is trivial; it does not teach us new facts, only science does that. But the proper synopsis of these trivialities is enormously difficult, and has immense importance. Philosophy is in fact the synopsis of trivialities.

Now, I see a third group that I call methodologists who put theories in brackets and offer tools for examining theories and ideologies such as Occam’s razor, Hume’s fork, and Wittgenstein’s ladder. In my research, I identified what I call Badiou’s scythe which separates philosophy from its conditions or a discipline from its subdisciplines which is what psychiatry needs to do, separating itself from its many competing theories and schools. Calling some thinkers methodologists looks beyond arbitrary divides such as analytic/continental, e.g., Nietzsche, Foucault, Derrida, and Agamben all offer a series of methodologies: genealogy, archaeology, problematization, deconstruction, and philosophical archaeology.  

If I may add a humorous note, when I presented my notion of Badiou’s scythe at my oral defense with Badiou, Slavoj Žižek immediately quipped, If Badiou is the scythe, then I insist on being the hammer, invoking the symbol of social solidarity. And of course, Žižek proceeded to hammer away at my thesis until Badiou gently interceded to defend the thesis that I had carefully developed with him. Nothing like having two intellectual giants do the heavy-lifting at your oral defense!

Who has influenced this work the most?

For my contribution to this volume, there is a group of thinkers and practitioners who share reciprocal influences. Above all, Agamben, Badiou, and Foucault in philosophy. In psychiatry: psychiatrist-philosopher Karl Jaspers who influenced Ludwig Binswanger and Ronnie Laing.

It is quite striking how this group functions as a kind of hermeneutic circle. Within this circle are two semi-autonomous circles of philosophy and psychiatry like a Venn diagram with cascading and porous influences. (See Figure 1: Phenomenology in Philosophy and Psychiatry). In philosophy, it starts with Franz Brentano who taught Sigmund Freud and Edmund Husserl, the latter who taught Martin Heidegger (who influenced Binswanger with whom he had a lengthy correspondence), who influenced Jean-Paul Sartre (who wrote Forewords to the works of two influential psychiatrists – Frantz Fanon and Ronnie Laing), who influenced Badiou (who was my mentor and doctoral supervisor). In psychiatry and psychoanalysis, the tradition again starts with Brentano, who taught Freud and Husserl, the latter who founded phenomenology in philosophy and influenced Jaspers in psychiatry, who then influenced Binswanger and Laing (whose Reason and Violence, 1964, summarizes Sartre’s philosophy for which Sartre wrote the Preface; and whom I consulted in London).

In the case of three major figures in 20th-century philosophy, the emphasis is on ontology as reflected in the titles of their major works: Heidegger (Being and Time), Sartre (Being and Nothingness), and Badiou (Being and Event), each having interlocutors in psychiatry.

A close reader of my contribution will also sense Agamben front and center and Wittgenstein constantly in the background. As a European living in North America, my models are those independent thinkers from Stanley Cavell (Must We Mean What We Say?) and Richard Rorty (Philosophy as the Mirror of Nature and Contingency, Irony, Solidarity) to Simon Critchley (Continental Philosophy) who straddle traditions in philosophy and the psychiatrists who integrate philosophy into psychiatry starting with Karl Jaspers and the tradition he initiated but also the more recent work in the subdiscipline of philosophy of psychiatry by Bill Fulford who is a professor of both psychiatry and philosophy at Oxford.

How is your work relevant to the contemporary world?

Well, I talked about the blind alleys and asymptotes I observe in psychiatry today.

My invocation of the asymptote refers to the law of diminishing returns: the returns for the efforts required become slimmer and slimmer. Both mainstream academic philosophy and psychiatry, which together hold significant sway over the theory and practice of mental health care the world over, are stymied by several asymptotes. The theoretical models for cognitive science include the computational model of the mind, now in contention; the very notion of “mind” is dismissed by neuroscience which has reduced these questions to brain mechanisms and evolutionary psychology with the slogan, “mind is brain.” Asked to explain everything in cognitive neuroscience in five words, psychologist Steven Pinker of Harvard didn’t miss a beat: Brain cells fire in patterns. I prefer anthropologist Gregory Bateson’s slogan: “The pattern that connects,” so my five words would be: Mind makes sense through context. I mean “making sense” in two ways: it is understandable in relational context (whether the context is the neurological one of the brain, the mystery of consciousness, dialogic interaction, or family and social relations) and in developmental psychologist Jerome Bruner’s research in Making Sense (meaning that the mind actively strives to make sense of experience).

In clinical psychiatry, the DSM (Diagnostic and Statistical Manual of the American Psychiatry Association) project is at an asymptote. As far as I’m concerned Allen Frances, Past Chair of DSM-IV, not Tom Insel of the National Institute of Mental Health (NIMH), put an end to the DSM project with his incisive criticisms of its overreach. While Insel and the NIMH offered an alternative that is a non-starter (Research Domain Criteria as opposed to the clinical criteria of DSM), Frances working from within the traditional classification framework showed us its limits. In order to “save psychiatry,” as he puts it, we need another approach. Drossi and I were delighted when Frances agreed to write a cautiously optimistic Afterword to our volume called “Saving Psychiatry.” As I stated in this interview and document in our book, phenomenology is at an asymptote. Computational models of mind, the meager clinical results of neuroscience, DSM, phenomenology: all diminishing returns. And yet their adherents soldier on.

A more fruitful way to talk about this is to ask how we get stuck in blind alleys and asymptotes. Getting stuck creates a crisis of confidence that reflects a lack of clarity about the mission of psychiatry. This in turn obscures three critical gaps: (1) the lack of a consensual psychology (or theory of persons); (2) the lack of an organizing consensual model of psychiatry (or theory of psychopathology, that many call the phenomenology of psychiatry); and (3) the lack of a consensual theory of change (as opposed to mere descriptions based on some privileged model). 

As I believe that psychiatry’s aporias cannot be resolved through empirical research or ideological commitment to one more “single message mythology,” as German psychiatrist and medical historian Paul Hoff has observed about 20^th century psychiatry, we must turn to philosophy to sort out our thinking. I see three theoretical options:

• Declare psychiatry’s crisis as a “pseudo-problem” (Wittgenstein). We can give up trying to create a foundation for psychiatry and dismiss psychiatry’s difficulties as “pseudo-problems” (like Wittgenstein, 1922, 1953) and simply continue with descriptive projects like the DSM (APA, 2013) that NIMH’s former director Insel (2013) dismissed as a mere “dictionary.” This is the major approach taken in 20th century academic philosophy, psychology, and psychiatry in the Anglo-American sphere led by Gilbert Ryle’s (1966) ordinary language philosophy at Oxford, John Watson, BF Skinner and Hans Eysenck in behavioral psychology in the US and UK, and the neo-Kraepelinian project of American empirical psychiatry (Guze, 1992). 

• Such dismissive attitudes can lead to the impoverishment of theory and limit practice in all areas. For example, faith and religion are dismissed by the neo-atheists who define themselves as “progressive.” So much for the long history of faith communities fighting for their place in the sun – one of the founding discourses of the French and the US republics. Aesthetics are not so much dismissed as trivialized by neuroscience (see literary journalist Adam Kirsch’s critique of Nobelist Eric Kandel’s clumsy efforts). To use the analogy of cognitive psychology’s critique of physiological psychology from the 1970s, you can’t understand the music on a record by examining the grooves in the vinyl. Of course, if the grooves are degraded by scratches, the fidelity of the music will be compromised but a pristine vinyl pressing (like a healthy brain) doesn’t guarantee the quality of the music, only its sound reproduction. Similarly, a healthy brain creates capabilities but doesn’t determine the contents of our minds. And yes, I’m aware of the arguments from evolutionary psychology about innate tendencies reinforced by evolutionary advantage over time. Our human evolution includes cultural evolution which is why Richard Dawkins coined the term meme (akin to “gene”) to describe the elaboration of cultural adaptations to deal with challenges beyond the more basic genetic ones. And memes are more rapid, more responsive, and more supple than genes.

• Opt for “weak thought” (Vattimo). We can argue that foundational theories of the mind are “weak” (like Italian philosopher Gianni Vattimo; see Vattimo and Rovatti, 2012), meaning that they are doomed to be pluralistic and incomplete, lacking specificity and coherence, like the vaunted but now much-criticized eclectic biopsychosocial model (propounded by American psychiatrist George Engel, 1977, 1980; and criticized by another American academic psychiatrist Nassir Ghaemi, 2010). Weak thought is akin to Gödel’s incompleteness theorems and has made psychiatry centrifugal—dispersed and incoherent. This ironically describes the state of psychiatry today: strong on pluralism and diversity, weak on conceptual coherence and completeness.
• Re-found psychiatry on being (Badiou). Finally, we can reach for a new foundation for psychiatry based not on what kinds of questions we have the tools to sort out, using computational models, genetics or neuroscience, but on the very nature of human being. That means ontology, the study of being, and French philosopher Alain Badiou offers just such a foundation for psychiatry, with a theory of the subject (Badiou, 2009b), the nature of being (Badiou, 2005, 2009a), and with the Event, a theory of change (Badiou, 2005, 2009a; Badiou and Tarby, 2013). This speaks to contemporary psychiatry’s three critical conceptual gaps, noted above.

I sketch out what that would be like in my critique of Binswanger’s foundational case of Daseinanalyse, Ellen West, and my call for Evental psychiatry in Part II of the book.

How does this work affect your practice, including your teaching?

In terms of teaching, there are encouraging signs here. My faculty of health sciences which was a rather traditional, conservative one when I was recruited more than 20 years ago now supports a postgraduate course I founded and co-direct on psychiatry and the humanities, where I presented our arguments in this book. Our course is interdisciplinary and attracts students with many backgrounds and interests. And I now discuss these topics and include excerpts from my work even with undergraduate medical students whose response has been gratifying, with students grateful for introducing them to psychiatry, philosophy, and the literature of the humanities.

Greater encouragement comes from people who are committed to thinking beyond boundaries, that is, the usual disciplinary boundaries. Artists, anthropologists, humanists, psychotherapists, theologians, even people in other areas of medicine are becoming receptive to renewing psychiatry in light of the Event. For example, I’ve been invited to present my work to “Project 2050: Radical Futures,” part of an interdisciplinary program at McGill University called Building 21.

On the other hand, my clinical practice is bounded by the parameters of the public health system we have in Quebec. To make a radical change in my practice would require a break with the public system, which would limit access to my work to a privileged few. Structural or institutional change is slow and militates (perhaps wisely) against the kind of 180-degree changes that are possible with political power, such as Basaglia’s deinstitutionalization of psychiatry in Italy by passing laws in the Italian Parliament.

What’s next for you?

I am working on three allied projects – my Slow Thought Manifesto, Evental Psychiatry, and the Global South.

Slow Thought. Three years ago I launched my Slow Thought Manifesto as a prologue to Evental Psychiatry that is getting traction in various disciplines and was cited in Julian Hanna’s Manifesto Handbook. Curiously, the greatest attention comes from Latin countries, with summaries or full translations in French, Italian, and Portuguese, and a forthcoming volume in Italy on Slow thought with commentaries from a spectrum of contributors from anthropology to philosophy and psychotherapy.

Evental Psychiatry. The major project that emerges from this which I have announced in this book and elsewhere is to sketch out what a psychiatry of the Event would look like. I have written about this previously in a two-part post on the Blog of the APA. Part one can be found here, part two here

I will outline a general theory for evental psychiatry and psychology and a more specific adaptation for evental therapy in my work with Maurizio Coletti, a psychologist and a pioneer in systemic family therapy in Rome, Italy. This will take us even farther from the psychiatric mainstream although there are encouraging new approaches, such as Oxford’s Values-Based Practices in Health and Social Care with which I am affiliated.

This project requires a delicate balancing act between the boldness of philosophy (as Badiou, 2010, asserted, “Philosophy is reckless or it is nothing”) and the necessary balance of psychiatry that the Greeks called sophrosyne. I am preparing the ground for evental psychiatry in a slowly-unfolding, deliberate manner, elaborating a theoretical rationale while working on the margins of the system employing all the theories and practices that would be congruent with it such as systems theory, the social determinants of health, and my call for recognizing the Global South. And yet, sooner or later, for real change to come about, this will require a rupture with the past, as any Event always requires.

The Global South. Last year, my socio-political essay was published in our new journal, World Social Psychiatry, calling for social psychiatrists and our transdisciplinary collaborators to move away from a Northern- and Western-centric hegemony to rally around a new focus for both theory and practice: the conceptual geography of the Global South, captured by Boaventura de Sousa Santos’ “southern epistemologies.”

So, if Slow Thought is the path, and the Event is the process, the Global South is the place where we will arrive. And if I had to give one name to all my activities, integrating my roles as a social psychiatrist with my calls for Slow Thought and the Event, I would call that social philosophy.

Key Works Mentioned:

Alain Badiou, Conditions, trans. by Steven Corcoran, London: Continuum, 2008.

Alain Badiou, Second Manifesto for Philosophy, trans. by Louise Burchill. Cambridge, UK: Polity Press, 2011.

Alain Badiou and Fabien Tarby, Philosophy and the Event, trans. by Louise Burchill. Cambridge, UK: Polity Press, 2013.

Ludwig Binswanger, “The case of Ellen West: An anthropological-clinical study” (trans. Werner M. Mendel & Joseph Lyons), in: Existence: A New Dimension in Psychiatry and Psychology (Rollo May, Ernest Angel & Henri F. Ellenberger, eds.), New York: Basic Books, 1958, pp. 237-364.

Anthony W. Clare, Psychiatry in Dissent: Controversial issues in thought and practice, London: Tavistock, 1976.

Boaventura de Sousa Santos, Epistemologies of the South: Justice Against Epistemicide, Milton Park, UK: Routledge, 2014.

Vincenzo F. Di Nicola, “Ethnocultural aspects of PTSD and related stress disorders among children and adolescents,” in AJ Marsella, M Friedman, E Gerrity & R Scurfield (Eds), Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications, Washington, DC: American Psychological Association Press, 1996, pp. 389‑414.

Vincenzo Di Nicola,   “Badiou, the Event, and Psychiatry, Part 1: Trauma and Event,” Blog of the American Philosophical Association, November 23, 2017.

Vincenzo Di Nicola, “Badiou, the Event, and Psychiatry, Part 2: Psychiatry of the Event,” Blog of the American Philosophical Association, November 30, 2017.

Vincenzo Di Nicola, “Two trauma communities: A philosophical archaeology of cultural and clinical trauma theories, in: PT Capretto & E Boynton (Eds), Trauma and Transcendence: Limits in Theory and Prospects in Thinking, New York: Fordham University Press, 2018, pp. 17-52.  

Paul Feyerabend, Against Method, Fourth Ed., Introduced by Ian Hacking, London: Verso, 2010.

Paul Feyerabend, The Tyranny of Science, Edited, and with an Introduction, by Eric Oberheim, Cambridge, UK: Polity Press, 2011. 

Julian Hanna, The Manifesto Handbook: 95 Theses on an Incendiary Form, San Francisco: Zero Books, 2020.

Ronald David Laing, The Voice of Experience: Experience, Science and Psychiatry, 1983.

Ronald David Laing and David Cooper, Reason and Violence: A Decade of Sartre’s Philosophy 1950-1960, with a foreword by Jean-Paul Sartre, 1964.

Neil Postman, Technopoly: The Surrender of Culture to Technology, New York: Random House, 1992

Ludwig Wittgenstein, Remarks on the Philosophy of Psychology, Vols. 1 and 2 (1980), Oxford: Basil Blackwell, 1980.

Angela Woods, The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory, Oxford, 2011.