Mixed Bag #10: George Ikkos on the Social in Psychiatry

“Mixed Bag” is a series where I ask an expert to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item, they have to explain why they selected it and what it signifies. — Awais Aftab

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George Ikkos is Honorary Fellow of the Royal College of Psychiatrists, Consultant Liaison Psychiatrist at the Royal National Orthopaedic Hospital NHS Trust UK, and Clinical Fellow of the international Neuropsychoanalysis Association (NPSA). He was the first president of the Pain Medicine Section and President of the Psychiatry Section of the Royal Society of Medicine. George studied psychology at the University of Toronto, qualified as Group Analytic Psychotherapist at the Institute of Group Analysis (London) and was medical advisor to the Scotsman Fringe First award-winning play “The Shape of the Pain”. He has published on pain, liaison psychiatry, psychiatric training and psychosomatic, psychodynamic, interpersonal, and social aspects of psychiatry. He has coedited two books. Psychiatry’s Contract with Society: Concepts, Controversies and Consequences (2010) (Bhugra, D., Malik, A., Ikkos, G. eds) and Mind State and Society: A Social History of UK Psychiatry and Mental Health 1960-2010 (2021, available open access) which received the runner up award in the History of Science Technology and Medicine section of the 2021 Annual PROSER Awards by the Society of American Publishers.

Paper — Pessoa L, Medina L, Desfilis E. (2021) Refocusing neuroscience: moving away from mental categories and towards complex behaviours. Phil. Trans. R. Soc.

Ikkos: Pessoa, Medina and Desfilis’ paper is part of a collection of invited contributions under the general title ‘Systems neuroscience through the lens of evolutionary theory’. I can do no better in introducing their complex argument than quote its abstract in full:

Abstract: “Mental terms—such as perception, cognition, action, emotion, as well as attention, memory, decision-making—are epistemically sterile. We support our thesis based on extensive comparative neuroanatomy knowledge of the organization of the vertebrate brain. Evolutionary pressures have moulded the central nervous system to promote survival. Careful characterization of the vertebrate brain shows that its architecture supports an enormous amount of communication and integration of signals, especially in birds and mammals. The general architecture supports a degree of ‘computational flexibility’ that enables animals to cope successfully with complex and ever-changing environments. Here, we suggest that the vertebrate neuroarchitecture does not respect the boundaries of standard mental terms, and propose that neuroscience should aim to unravel the dynamic coupling between large-scale brain circuits and complex, naturalistic behaviours”.

Amongst other things, Pessoa et al. object that “textbooks often present ‘cognitive’ and ‘emotional’ systems as if they were separate entities (this is especially the case in clinically oriented materials). In particular, textbooks still discuss the ‘limbic brain’, a concept that has no stable meaning, and essentially is used as an amorphous synonym for a putative ‘emotional brain’. What is more, the purported ‘emotion/cognition’ separation continues to generate ideas of wide public appeal, such as the notion of ‘System I/System II’ popularized by Kahneman”.

They argue that traditional mental categories, like emotions or thoughts, are not helpful for studying the brain's behavior. For example, they describe how the amygdala, a part of the brain, works with other brain regions to process a wide range of signals and support many different functions, like emotion, cognition, and action. They suggest that the amygdala is not just a “fear center,” but a hub that participates in multiple brain networks. They conclude that the brain's architecture is different from what we might expect for specific mental functions, and instead, brain circuits work together to solve problems. They also suggest that different brain regions can work together in flexible and dynamic ways, forming functional units without a strict hierarchy. To get ahead in neuroscience we need to study organisms in vivo, in dynamically changing and constantly evolving interaction in their natural environment.

Pessoa et al.’s decoupling of brain neuroscience from our everyday vocabulary is consistent with Adolphs and Aronson’s views in their “The Neuroscience of Emotion” (2018). To my mind, what all these authors effectively do is demarcate the limit of neuroscience’s ability to explain what we, in ongoing-experience-reflecting everyday-language, call and live through as emotions and emotional distress. But if neuroscience is limited in helping us understand these, where should we turn to so we can do so more? “To the Things Themselves!”¹ That is words, feelings, images, the environment and our interface with it. Not only interpersonal but also material environment: architectural, transport, communications etc.  Something poetic, I would suggest. At least in part.

Importantly, in terms of Pessoa et al.’s suggested way forward, for humans the most consequential natural environment is interpersonal relations and, increasingly, with the march of technology and urbanization, what we may call our creativity (and destructiveness), and our civilization. Now this includes artificial intelligence too.² In other words, our extended mind.

Concept — The Social Unconscious

Ikkos: The concept of Social Unconscious appears in Konvolut (bundle) K³, one of 36 alphabetized folders in German/Jewish/ Marxist cultural critic Walter Benjamin’s (1892-1940) unfinished “Arcades Project.” The project attempted to understand the promise and lived experience of capitalism through study of the cultural and material life of Paris, “Capital of the 19th Century.” The arcades, constructed with the then technologically cutting-edge building materials of glass and steel, were prime contemporary venues for commerce and entertainment. The same materials were also used to socially mesmerizing effect for London’s Crystal Palace when it showcased the British empire’s colonial globalization during the first commercial World Exhibition in 1851. By century’s end the arcades had declined, and the palace disappeared. Benjamin was fascinated by technology and fashion but also concerned about the loss of tradition, shock experience (Chockerlebnis) of the new and the stymieing of technology’s social fulfilment by exploitation of labor and mechanized wars.    

Baron Hausmann’s (1809-1891) massive and autocratic transformation of Paris during France’s Second Empire (1841-1870) was enabled by technological progress and shaped by too often corrupt, imperial and commercial interests. Researching in the Bibliothèque Nationale de France during 1930’s, Benjamin formulated the changing face of the city as “social unconscious” with “Old railroad stations, gasworks, bridges” as “phantasmagorical” dream images. He commented: “Task of childhood: to bring the new into symbolic space. The child, in fact, can do what the grownup absolutely cannot: recognise the new once again. For us, locomotives already have symbolic character because we met with them in childhood. Our children, however, will find this in automobiles, of which we ourselves see only the new, elegant, modern, cheeky side.” His generationally dynamic social unconscious differs from Jung’s “collective unconscious” whose content has been fixed by the Darwinian environment of evolutionary adaptiveness and offers a conceptual tool for understanding the changing subjective experience of the “social” in the “biopsychosocial”.

Benjamin’s generationally dynamic social unconscious differs from Jung’s “collective unconscious” whose content has been fixed by the Darwinian environment of evolutionary adaptiveness and offers a conceptual tool for understanding the changing subjective experience of the “social” in the “biopsychosocial”.

Benjamin’s “Arcades Project” also examines the social unconscious of 19^th century Paris through the experience and poetry of Charles Baudelaire (1821-1867) (Konvolut J). During the last couple of years, I have been fortunate to collaborate with Giovanni Stanghellini (Florence), now with Thomas Becker (Ulm/Leipzig) and Paul Hoff (Zurich) too, on our project “The Precision of Images: Emil Kraepelin (1856-1926), Walter Benjamin (1892-1940) and the History of Psychiatry 1926-2026”. One of our joint publications is “Images of depression in Charles Baudelaire: Clinical understanding in the context of poetry and social history” We argue that “Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the ‘social’ as part of the biopsychosocial constellation”.

Gio is a highly innovative psychiatrist and psychopathologist who has recently published “The Power of Images and the Logics of Discovery in Psychiatric Care.” Here, “in the context of today’s socio-cultural transformation processes and related forms of psychopathological conditions, which can no longer be comprehended using the categories of existing knowledge systems”, he offers a method of coproduction in understanding psychopathology through “linking dots” as opposed to “ticking boxes” and “drawing arrows”.

Another exploration of the social unconscious of Paris, this time in early 20^th century and specifically in relation to madness, may be found in Andre Breton’s surrealist “Nadja” [Cohen, M. (1995) Profane Illumination: Walter Benjamin and the Paris of the Surrealist Revolution].

Book — Walter Benjamin: Berlin Childhood around 1900 (tr. 2006)

Ikkos: Drawing on psychoanalysis, Benjamin approached the nineteenth century as spacetime (Zeitraum) (city) and dreamtime (Zeit-traum) (ideology) in the service of “nowtime” (Jetztzeit) (politics). Proclaiming his “Copernican revolution in historical perception” he argued that “Formerly it was thought that a fixed point had been found in “what had been”, and one saw the present engaged in tentatively concentrating the forces of knowledge on this ground. Now this relation is to be overturned, and what has been is to become the dialectical reversal—the flash of awakened consciousness… The facts become something that just now first happened to us, first struck us”.

Benjamin’s view of historical perception has clinical implications for everyday practice too, as our motivation in clinical dialogue is not reconstruction of a “fixed” past but it’s “destruktion” to clear way for recovery (“awakening”). Unfulfilled promises and repressed traumas survive as unconscious memory traces and resurface in social phantasmagorias and personal dreams as well as symptoms and parapraxes. Benjamin distinguishes between memory and reminiscence. Memory serves “to protect our impressions; reminiscence aims at their dissolution.” Often necessary for recovery, reminiscence does not rest on voluntary recall, he says, but on reverie and chance encounters with sometimes forgotten and obsolete objects which awaken in us the true significance of “what is closest, tritest, most obvious”, French novelist Marcel Proust’s (1871-1922) mémoire involontaire.

“Berlin Childhood around 1900” was written after the Nazi 1933 ascent to power in Berlin, hometown of Benjamin. Already exiled and living in poverty in Paris, he quickly realized that he would never go back. The book was an attempt at reminiscence. His aim was to dissolve rather than hold on to and be traumatized repeatedly by his memories. It consists of a series of short pieces ranging from a paragraph to a few pages long. Titles such as “The Sock” or “The Telephone” confirm his emphasis on the materiality of experience, including the experience of technological innovations like the telephone. Titles such as “Butterfly Hunt” and “Sexual Awakening” highlight the parallel attention to corporeality.  They offer what I call “social-affective-cognitive bundles”. Read slowly and one at a time, they are perhaps best understood as prose poems, a form of writing initiated by Charles Baudelaire in his ground-breaking “Le Spleen de Paris” or “Petits Poèmes en prose” (1869).

In homage to Walter Benjamin, I have attempted to create social-affective-cognitive bundles of my own through several short pieces about him and his circle. This way, I aim to evoke something about the importance of place, time and experience and relate these to psychiatry:

• Ikkos, G. (2020). An almost preventable suicide: Walter Benjamin (15 July 1892–26 September 1940) – psychiatry in literature. The British Journal of Psychiatry.

• Ikkos, G. (2021). Fulfilling experience: Walter Benjamin – psychiatry in philosophy. The British Journal of Psychiatry.

• Ikkos, G. (2021). Saturn: Star of melancholy – psychiatry in literature. The British Journal of Psychiatry.

• Ikkos, G., & Stanghellini, G. (2022). Walter Benjamin: Brooding and melancholia. The British Journal of Psychiatry.

• Ikkos, G. (2022) Non-Sensuous Similarities: Language, Poetics, and Psychiatry, Psychiatric Times. 

• Ikkos, G. (2023). Anna ‘Asja’ Lācis (1891–1979): Drama, trauma and neuropsychiatry – Psychiatry in Theatre. The British Journal of Psychiatry.

Person—Emile Durkheim (1858-1917)  

Ikkos: In Marcel Fournier, Emile Durkheim has been fortunate in his biographer;⁴ I must not have read many other 730-page books and, if I have, certainly not another that flowed so smoothly. In part this reflects the very character, clarity of thinking and life of the man, who together with Karl Marx (1813-1883) and Max Weber (1864-1920) founded European Sociology. His efforts, infused with the spirit of the Enlightenment and the best secular democratic ideals of the French Revolution (1789), were dedicated in monk-like fashion to his discipline. Fournier traces in highly readable prose his integrity, personal intellectual development, scholarly expressiveness, and the professional and institutional establishment of the discipline of sociology in the French speaking world.

He is best known to psychiatrists for his book on “Suicide” (1897).  In fact, his work and output were very diverse, and some have argued that The Elementary Forms of Religious Life (1912) is the greatest book of sociology ever written. Durkheim defined religion in secular terms and considered it the foundation of both society and science. With my friend and close colleague Daniel McQueen (London) we have tried to capture something of this and the man and their relevance to psychiatry in our very brief Reflections on The Elementary Forms of Religious Life.

By now the reader will not be surprised to learn that I have had a persistent interest in the “social” in relation to psychiatry throughout my career. The most obvious fruit of this has been open access “Mind State and Society: Social History of Psychiatry and Mental Health in Britain 1960-2010” coedited in 2021 with Nick Bouras (London). Nick is a close friend, mentor and collaborator and in 2017, writing with academic social psychiatrist Tom Craig (London), we proposed in the Lancet Psychiatry that sometime after 1990, because of neoliberalism, globalization, IT and the rise of social media, British Psychiatry entered a new era beyond community psychiatry: meta-community psychiatry. In Greek, meta means after. We explored the concept in more detail a year later in another publication. If there has been some legitimate doubt about our thesis before, there can be none now after the Covid 19 pandemic and the rise of AI and machine learning. Even Facebook renamed itself as META, but only sometime after we first used the prefix!

Surprise Item — Anna Akhmatova (1889-1966)

Ikkos: Reading Orlando Figes’ “Natasha’s Dance: a Cultural History of Russia” (2003) exposed my ignorance of that country. There followed several years of further reading to fill some of the gap. Eventually I found myself trying to understand the lived experience of ordinary people during Soviet times.  In part, such focus was a response to Figes’ masterful “Tragedy of a People: The Russian Revolution 1892-1924” [1997] which refers extensively to diaries and letters home of ordinary citizens and soldiers during this period. Other books I found particularly illuminating in this respect were Stephen Kotkin’s “Magnetic Mountain: Stalinism as a Civilization” (1997), Karl Schlögel’s “Moscow 1937” (2014) and William Taubman’s “Khrushchev: The Man and his Era” (2005).

Reading Elaine Feinstein’s fine biography “Anna of All the Russias: The Life of Anna Akhmatova” (2005) filled me with admiration for this exceptional poet’s character. Anna Akhmatova (1889-1966), born Anna Andreyevna Gorenko, was of mixed Ukrainian and Russian descent, grew up during the final decades of the Romanov Empire and spent most of her adult life during the Soviet period. She adopted the name Akhmatova after her father chastised her that being a poet would bring dishonor to the family name. Khan Ahmat, a descendant of Genghis Khan [1162-1227], was a distant ancestor on the mother’s side.

Akhmatova was a leading figure in Acmeism. In reaction to the vagueness of symbolism, Acmeists emphasized clarity of expression. This is indeed one of the remarkable features of her poetry. She brought a luminosity to whatever she wrote about, however dark. This included sensation, feeling, friendship, love, religion, betrayal, loss, and the circumstances of her time. For me, Akhmatova is a prime example of personal resilience in the face of severe social adversity and poetry was key in what sustained her.

Before the Soviet revolution Akhmatova had travelled to Paris where she met the sculptor Amedeo Modigliani who sketched her portrait. There are some notable paintings of her too, including Nathan Altman’s striking “Portrait of Anna Akhmatova” (1914) and Kuzma Petrov-Vodkin’s “Akhmatova and her muse”. Anna had a complex relationship with “The Muse”:

How can I live with this burden?

And yet they call it the Muse.

They say: ‘You and she are in a meadow…’

They say: ‘The divine babble…’

More savagely than fever she attacks you,

Then for a year, not a syllable.                                                      

We see here poetry as involuntary, an experience affine to Walter Benjamin’s reminiscence and Marcel Proust’s mémoire involontaire, which may explain its healing potential both for the poet and her community.

The volume “Anna Akhmatova Complete Poems” [2000], evocatively translated by Judith Hemschemeyer and elegantly edited by Roberta Reeder, includes photographs of her across the years and she looks consistently melancholy and dignified. She married three times and divorced her first and second husbands. Not long after the first divorce, her ex-husband was executed for involvement in a monarchist anti-communist conspiracy. The third died in a Gulag labor camp and her son Lev survived fifteen years in another. Hemschemeyer paints Akhmatova’s picture in words in her translator’s notes: “As time elapsed, I learnt about her not only through her poems, but through the writings of her contemporaries, and the more I learned, the more I admired her courage, her moral integrity, her wit and, yes, her sense of humor under the direst of circumstances.” I think the successful handling of her melancholy through her poetry underpinned her resilience.

Akhmatova’s poetry was primarily personal not political but in the circumstances of Stalin’s Russia this made her a political target. Some of her friends emigrated, others were internally exiled, executed, or died by suicide. Intensely patriotic, though not nationalistic, there was no question of emigrating. Here she is in still Tsarist Russia during WWI in a “Little Song” (1917):

When in suicidal anguish

The nation awaited its German guests,

……

……

A voice came to me. It called out comfortingly,

It said, “Come here,

Leave your deaf and sinful land,

……

……

But calmly and indifferently,

I covered my ears with my hands,

So that my sorrowful spirit

Would not be stained by those shameful words.

“Requiem” (1940) was her long poem in response to mothers’ experience of waiting outside prisons for news of their arbitrarily detained sons during Stalin’s terror, including her own. It portrays dissociative tendencies in the face of overwhelming social threat and psychological trauma:

No, it is not I, it is somebody else who is suffering.

I would not have been able to bear what happened,

Let them shroud it in black,

And let them carry off the lanterns…

                                                               Night.

Akhmatova suffered with her people and contributed her poetry to the USSR’s resistance to the Nazi invasion (Operation Barbarossa, 1941). Nevertheless, latching on a hostile literary reviewer’s characterization of her poetry, Stalin’s commissar for culture Andrei Zhdanov [1896-1948] denounced her in the national press as “half nun, half harlot.” Her poems were banned for “ideological errors,” and she was expelled from the Writers Union in 1946. The sensitivity around them was so great that friends would memorize them so that they need not remain written down. Regardless, they became widely known to her contemporaries. She was eventually “rehabilitated” and allocated a state dacha at Komorovo on the Russian side of Finland near Leningrad/ St Petersburg. Literature of all kinds was enormously popular in the Soviet Union, much more than in the West, and the 1960 edition of her poems ran to 1,700,000 copies.

We can safely say that through poetry, this exceptional, noble, reticent, glamorous, passionate, spiritual, mystical and resilient woman captured both the social unconscious and the imagination of her people. This way, with words, images and feeling, she shared resilience and achieved deep community.

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See previous posts in the “Mixed Bag” series

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1. Stanghellini, G., Ikkos, G., (2023) Images of Care: “To the things themselves!”, Ch. in Musalek, M. et. al. eds The Oxford Handbook of Mental Health and Contemporary Western Aesthetics, in press.

2. Gates, B. (2023) The Age of AI has begun: GatesNotes: the blog of Bill Gates,  March 21, https://www.gatesnotes.com/The-Age-of-AI-Has-Begun

3. Benjamin, W., (1999) Konvolut K: “Dream City and Dream House, Dreams of the Future, Anthropological Nihilism, Jung”, ch. in Benjamin, W. The Arcades Project

4. Fournier, M. 2013, tr David Macey, Emile Durkheim: A Biography