Centripetal versus Centrifugal Trends in Social and Cultural Psychiatry: A Conceptual Analysis

Background: Drawing on the history of social psychiatry (SP) and cultural psychiatry (CP), the author offers a way to discern the distinguishing features and identity of each branch of psychiatry. Issues: Are the histories and current practices of CP and SP mutually compatible and enriching or are they hiving off into separate domains? Proposition: A schema will be presented for differentiating underlying assumptions and core features of these two allied but increasingly differentiated fields of psychiatry. Key domains include: _core arguments/dynamics_ (CP’s critiques of Western psychiatry lead to negation of its claim to universality; SP’s documentation of social determinants of health (SDH/MH) affords the affirmation of SDH/MH across societies and over time); _foci_ (CP addresses race and ethnicity; SP investigates class and social structure); _allied fields_ (CP – medical anthropology; SP – medical sociology, epidemiology & public health); _metaphors_ (CP – “prism”/refracting; SP – “creolization”/blending); _values_ (CP - diversity/equity; SP - solidarity/commonality); _research _(CP - ethnographies, CFI; SP - epidemiology, SDH/MH); _allied professional movements/outgrowths_ (CP - Global Mental Health; SP - community psychiatry); _allied populist movements_ (CP - Black Lives Matter; SP – “Gilets jaunes”); and, _critiques_ (CP/GMH - eg, China Mills; SP – “southern epistemologies,” the Global South).  Outcomes: Cumulative results of the two allied traditions, sometimes practiced by the same/overlapping research teams, are discussed under the rubric “centripetal” (convergent, unifying, integrating) versus “centrifugal” (divergent, separating, dispersing) impacts.  Implications: The disparate methods and results of CP/SP reflect diverse foundational discourses of these increasingly differentiated fields. CP has morphed into a study of Dostoyevsky’s “the insulted and the injured” imbued with a liberal, progressive ideology, culminating in identity politics. Meanwhile, social class, the signal critical tool of everything social, from sociology to socialism and SP, is being supplanted by a focus on culture. The author will invite debate on what this means for the future of CP & SP and whether a synthesis is still possible.