Martti Olavi Siirala - Social Pathology

Social Pathology

In modern psychiatry there is a tradition of returning patient's illness back to one specific reason. Sometimes this cause is to be found in genetics, sometimes elsewhere. From Siirala's point of view there is not a single cause but rather a net of causes: hence his opposition to what he called 'the delusion that we have reduced diseases to mere object-things, entities that can be studied in isolation...the delusion of reductive reification'. Tracking these causes starts from man, but leads to his social environment, in the end to the whole society.

Freud thought psychological symptoms to be overdeterminded. It can be said that Siirala took the idea but expanded it to social field. For some patient we may think maybe of genetic fault or traumatic childhood. But we must think also patients parents childhood, the phenomena of transgenerational transmission, the teachers and social workers who have ignored the problem and so on.

Siirala distinguishes two major factors in this collective pathology. The first is the delusional possession of reality. By that Siirala means an attitude where one's own assumptions are considered the only one, a position where things are already known - so there seems to be no real need to orientate towards the subject. Thus for Siirala 'a central feature of the delusions of the healthy seems to be the unconscious assumption that they possess reality, the criteria of what is worth notice'.

The second is often latent despair, a hopelessness attitude. These factors can be seen for example in the history of psychiatry. Some decades ago it was already known that schizophrenia is an incurable state or condition. Therefore no real therapeutic actions were done, and patients stayed ill: a Self-fulfilling prophecy.

Siirala wrote here about transfer, a social pathological formation of non-articulated life. When there is no room to people to react to problems they encounter, it has effects that harm the whole society. However, these transfers or burdens are not delivered equally. On the contrary, they often fall on the shoulders of this or that particular person, who then becomes ill. Here, Siirala maintains, the mentally or physically ill one - the Identified patient - gets ill for his society. In Siirala's view, then, 'many symptoms of schizophrenia may be precipitated by...the people around him, in an attempt to overcome tendencies in him which disturb their view of reality. This, as with many of Siirala's writings, is disturbing and provocative... can never be healthily ignored'. The corollary is that the real subject of illness is not therefore the particular individual who is driven into isolation - "placelessness" - but the society that has driven him there.

Siirala has accordingly been linked with figures like Harold Searles or Harry Stack Sullivan in his belief that the delusions of patients are 'expressions that reflect what has been dissociated, hidden, and overlooked in life'. A similar link appears in 'the psychological literature on Invisible Loyalties (Boszormenyi-Nagi & Spark 1973) and anonymous social burdens (Siirala, M. 1983)'.