In the past 15 years or so, there has been a change in social form
that is impacting virtually everyone, including psychiatrists.
It is a change from hierarchies, which dominated most of the 20th century,
to social networks, which are much more decentralized organizations in which
people come together to share knowledge.
So argued Janice Stein, Ph.D., a professor of political science at the
University of Toronto and a television commentator, at the annual meeting of
the Canadian Psychiatric Association in Vancouver in November. Her talk was
titled "Changing the Fabric of Social Networks: Local and Global
"We are moving away from an era that emphasized order and
control" to one of "dispersed networks," said Stein. We are
moving away from an era of rules, of "how the game is played," to
One of the reasons for this shift, Stein said, is technology. For example,
the Internet, which was created by Pentagon researchers, has only been
commercially available since 1995.
This trend is presenting itself in a number of negative ways, she
continued. For example, in the 20th century, there were specific, visible
enemies to combat—say, Nazi Germany or the Soviet Union. Today, the
enemies are "terrorists," who are linked by social networks and
hard to identify.
Moreover, the enemy now is us—people in communities who are alienated
and angry. "It's as if we are turning against ourselves," Stein
asserted. "As psychiatrists, think about how frightening that
For example, recently Stein visited France during an explosion of unrest
and violence in various ethnic communities. "It is a much more
frightening place than North America," she said.
"Terror has no boundaries. That is what makes it so frightening for
people... .Threats are free-floating. That is not something you would
recommend for mental health."
Nonetheless, the shift toward "dispersed networks" has some
positive aspects, Stein continued. For example, Doctors Without Borders
networked with the United Nations and pharmaceutical companies to bring
medications to AIDS victims in Africa. A group of researchers at the
University of Toronto developed a product called Sprinkles to eradicate iron
deficiency in infants. Various nongovernmental organizations have helped
distribute the product in developing countries, where it is helping numerous
Stein foresees this trend away from hierarchies and toward networks as
continuing for at least the next decade. She also recommends ways people
should conduct their lives under this new social network system.
For instance, it will be very important to find good people, step back, and
not micromanage what they are doing—that is, to have a "capacity
to enable people" rather than to direct and control them. It is the same
for raising one's children—enabling them, but not managing them. And it
is similar for psychiatrists—they too should try to enable rather than
manage their patients, although it will not always be easy, since this is a
time when fear is rife.
Also at this juncture, Stein said, people who are willing to take risks
will be very important to society, as will those who are capable of crossing
over to neighboring disciplines. Most of the problems that need solving today
involve not one discipline, but numerous ones; this is evident in neuroimaging
Whereas accountability may have been an asset in a hierarchy, it is less so
in a social network environment. Here, we should be more concerned about
responsibility. "If we are locked into accountability and structure and
hierarchy," we will not do well in a world that is more difficult to
navigate than the former one was.
Yet, "there is a huge opportunity now," Stein concluded. This
is an age that will give us more autonomy, a greater chance to experiment, a
greater chance to create, and a greater chance to be responsible. ▪