Medicine, Psychiatry and Process Work: Individual and collective dimensions of working with embodied experiences and men

1. Medicine, Psychiatry and Process Work: Individual and collective dimensions of working with embodied experiences and mental states Pierre Morin, MD, PhD

2. Main Points Studies over the last 25 years have found significant relationships between inequality in a society and various health outcomes. Processes of social marginalization, rank & relative poverty in populations may be a critical risk factor for physical and mental health. Psychology, including the way we process or internalize cultural dynamics has a big impact on our health.

3. Health is both an individual and a cultural or group process What makes us healthy or sick depends both on individual and social factors. Research shows that social conditions – the jobs we do, the money we’re paid, the schools we attend, the neighborhoods we live in – are as important to our health as our genes, our behaviors and even our medical care.

4. Medical Models Bio-medical model Social determinant model Bio-psycho-social model Balance/Holism model Psychodynamic model Positive psychology (Seligman), Positive health model (Antonovsky) Indigenous model Recovery/Self-management model

5. Current Roles/Polarities Victim Healer/Expert Nature Nurture Biology/Genes Society Body Mind Pathology Positive Health Disease management Recovery Evidence based Care Efficiency

6. Health Disparities Available studies show the US to have the most mental illness, of any country. Trends show mental distress increasing in the US over the last decades. Studies over the last 25 years have found significant relationships between inequality in a society and various health outcomes, including self-assessed health, mortality measures, teenage birth rates. It also correlates with rates of violent crime. Relative poverty in populations may be a critical risk factor for mental health. The escalating rates of mental illness observed may represent an adaptive response to the increasing hierarchy in the US.

7. Health Disparity Relative poverty Disparity between the rich and the poor: High gap correlates with poor population health. Social comparison: Feelings of humiliation, resignation and shame affect our stress physiologies.

10. Somebodies and Nobodies Sense of being a nobody in social comparison to others. Loss/lack of status/rank because of marginalizing processes. Sense of shame and humiliation, loss of respect and dignity. Independent of individual psychology. Power of internalized social values.

11. Competition outcomesthrough dominance / attraction PSYCHOPATHOLOGY comes from failure in attachment and rank Bowlby: person's self concept influenced by early experiences Attachment bond: physical proximity and social communication STABLE attachment gives emotional security, giving & receiving affection UNSTBLE leads to anxious attachment Adequate mothering tends to produce adequate mothers RANK: leads to ritual agonistic behavior, measure resource holding power (R complex) with defeated state leading to involuntary subordiante strategy Postulates: Successful affiliation tends to be associated with social adjustment and mental health Failure in affiliation tends to be associated with schizoid personality disorder, schizotypal or schizophreniform illness and an introverted inner-directed mode of personality adjustment Submission tends to be associated with low self-esteem, feelings of shame and humiliation, dependent personality disorder, anxiety, depression, masochism and a liability to be victimized or abused Dominance tends to be associated with high self-esteem, type A personality, hypomania, sadism, and a liability to victimize and abuse others If insiders get psychiatric disorder, it will tend to be a disorder of attachment and rank If an outsider gets a psychiatric disorder it will tend to be a spacing disorder those in between will get a borderline state PSYCHOPATHOLOGY comes from failure in attachment and rank Bowlby: person's self concept influenced by early experiences Attachment bond: physical proximity and social communication STABLE attachment gives emotional security, giving & receiving affection UNSTBLE leads to anxious attachment Adequate mothering tends to produce adequate mothers RANK: leads to ritual agonistic behavior, measure resource holding power (R complex) with defeated state leading to involuntary subordiante strategy Postulates: Successful affiliation tends to be associated with social adjustment and mental health Failure in affiliation tends to be associated with schizoid personality disorder, schizotypal or schizophreniform illness and an introverted inner-directed mode of personality adjustment Submission tends to be associated with low self-esteem, feelings of shame and humiliation, dependent personality disorder, anxiety, depression, masochism and a liability to be victimized or abused Dominance tends to be associated with high self-esteem, type A personality, hypomania, sadism, and a liability to victimize and abuse others If insiders get psychiatric disorder, it will tend to be a disorder of attachment and rank If an outsider gets a psychiatric disorder it will tend to be a spacing disorder those in between will get a borderline state

14. SES, Social Class, Inequality Gender, age, race, SES, sexual orientation, health are sources of inequality that form inter-locking webs of disadvantage power, resources are differentially distributed within and between these status positions we do not occupy single status categories Double or Triple Jeopardy Hypothesis

15. Marginalization Overt or covert trends within societies whereby some qualities/behaviors/traits are given more centrality and those perceived as deviating from the group norms tend to be excluded by wider society. Marginalized groups: racial or ethnic minority groups, the poor, the elderly, the sick, the disabled, the obese, homosexuals etc…

16. Levels of Influence Dispositional/personal power/rank – an individual’s capacity to influence their actions or those of others Psychological Spiritual or transpersonal Social Situational/contextual power/rank – derives from one’s momentary roles in a given situation: as a teacher, health care provider, parent, bank teller etc.... Systemic power/rank – the complex of powerful forces that create situations/environments

17. Rank Rank reflects the underlying power differences of the many hierarchies we use on a daily basis to compare ourselves (Fuller, 2003). Conscious or unconscious, social or personal ability or power emerging from areas of socio-cultural influence, personal psychology, and/or spiritual ties (Mindell, 1995) .

18. Subjective Rank and Health

19. Relative Poverty "When everyone is poor together, there is no shame in being poor." (Gilligan) "A house may be large or small; as long as the surrounding houses are equally small, it satisfies all social demands for a dwelling. But if a palace rises beside the little house, the little house shrinks into a hut" (Karl Marx)

20. Process Work Approach Individual FIELD Community