There are approximately 400 million people in the world who suffer from mental disorders. These disorders should be treated with psychotherapy and psychotropic drugs, but it is also necessary to know what are the social causes that cause a person to manifest psychopathology.
This intention to know about these causes has a clearly preventive purpose, because knowing the social factors that affect mental health would prevent them from occurring.
Social psychiatry has sought to achieve this goal by defending the idea that knowledge of the social can work on psychopathology.. Let us go further in this branch of psychiatry.
What do we mean by social psychiatry?
Social psychiatry was a preventive current within the branches of health which had a lot of influence in the United States after the Second World War. She focused on identifying the social factors that may influence the emergence of psychopathology.
Among the factors he studied were poverty, inequalities and social exclusion, understood not only as socio-economic phenomena, but as promoters of psychopathology.
Social psychiatry was an interdisciplinary stream, as it worked alongside social science researchers, especially sociologists and anthropologists. Thanks to the work of different disciplines, it has been possible to study and determine the relationships between society, in particular the fact of living in its most disadvantaged, and the occurrence of mental disorders.
The origins of social psychiatry can be found in early 20th century mental hygiene movements. This movement emphasizes prevention and the role that the social environment plays in the health of the individual, especially with regard to the mind. Moreover, it is from this approach that mental health professionals, such as social workers with psychiatric knowledge, were introduced.
The background to the formation of this branch lies in the fact that in the middle of the twentieth century psychiatry had a very good reputation and in the 1920s and 1930s there was a boom in the social sciences.
The combination of psychiatry and sociology has resulted in a half-clinical, half-social branch that has been strongly supported by scientific findings.. It was also the awakening of the psychiatric community which invited it to take an interest in the social sciences which could offer so much in the prevention of psychopathology.
Interestingly, the first research in social psychiatry was conducted by sociologists. These were Robert Faris and H. Warren Dunham of the Chicago School, a sociological current focused on understanding to what extent social injustices have affected the health of individuals. In their 1939 book “Mental Disorders in Urban Areas”, the two researchers establish a relationship between poverty and mental disorders.
Their job was to analyze 30,000 hospital admissions in the city of Chicago, and they used maps to demonstrate, graphically, how different were the disorders diagnosed by the professionals in different parts of the city?. They were struck to note that in Hobohemia chicagüense, corresponding to the district of Tower Town, many cases of paranoid schizophrenia have been reported.
The Hobohemia of this city, that is to say the artistic and alternative district, had a large population of poor people, pickpockets and people begging for charity. As the region was extremely poor, its people lived very unstable lives. Their existence was practically anonymous and they were very isolated from their relatives or from society in general, although they lived in the most populated area of the city. They felt frustrated, confused, and had a chaotic lifestyle.
Interestingly, while in Chicago’s Hobohemia, paranoid schizophrenia was the most common, catatonic schizophrenia was the featured diagnosis in the slum areas of the city populated by foreign and African American immigrants. In wealthy areas, unlike the previous two diagnoses, the most common was to detect people with manic depression.
Although with their differences, other similar studies have been conducted in other parts of the United States, finding similar trends between rich areas, poor areas, and poor populations.
Likewise, there were those who criticized these results arguing that people who suffer from disorders such as schizophrenia, if they have been raised in a rich environment, not being able to function properly in it, end up going into it. wealthier neighborhoods. Which means they consider that it is not the social factors which contribute to the mental disorder, but it is the disorder that makes it poor..
Faris and Dunham criticized this criticism, which was worth the redundancy. They argued that parents of poor neighborhood patients very rarely came from wealthier neighborhoods. They also claimed that younger patients would not have had enough time or permissiveness from their parents to be able to leave their father’s house and end up in a worse neighborhood.
These two authors showed how poverty, combined with psychological problems such as stress, isolation and a disorganized life were predisposing factors for poor mental health.
Research in New Haven
Another study on the influence of social factors on mental health was conducted in the city of New Haven, Connecticut. The city was founded in 1638 by English Puritans and was smaller than Chicago. Its urban structure was perfect for seeing the extent to which class influenced the mental health of its citizens, a study conducted by sociologist and psychiatrist August Hollingshead and Fritz Redlich respectively.
In their research, they divided the city of New Haven into five zones based on their class.. Class 1 was the area inhabited by the descendants of the oldest inhabitants of New Haven, the “new home havens”. These families have resided in the city since its founding in the 17th century.
Class 5 is the most disadvantaged, made up of poorly trained people who often have seasonal jobs. While some were immigrants from Europe and Quebec, others were the so-called “swamp of the Yankees,” a population that had existed on the fringes of New Haven society for centuries.
Hollingshead and Redlich analyzed mental health by city class, revealing significant differences. People in class 5 were three times more likely to be treated for a mental disorder than people in classes 1 and 2 combined. In fact, this was very striking considering the fact that in class 1 there were serious problems accessing psychiatric treatment.
In addition, the type of treatment between the disadvantaged classes and the better-off classes was very different. While in the lower classes very invasive treatments were received, such as somatic therapies which included psychotropic drugs, electroconvulsive therapy, and lobotomy, those in the upper classes used to receive psychoanalysis. It is not surprising, since psychoanalysis, being a more expensive therapy, the upper classes might see it as a status symbol to go to the psychoanalyst.
The United States after WWII
After World War II, interest in psychology and psychiatry developed mainly due to the large number of traumatized soldiers. of what is seen in the contest. Because of this, the United States, knowing that treating thousands of ex-soldiers with psychopathology was expensive, wanted to know how to avoid psychopathology and save a few million dollars. The focus was on designing prevention programs and methods, rather than finding the perfect treatment.
It is for this reason that the social psychiatry was gaining so much strength after WWII, and in 1949, the American National Institute of Mental Health (NIMH) was established. The first objective of such a recent institution was to create prevention programs, and they were able to take into account the studies of social psychiatrists.
But what definitely contributed to the rise of social psychiatry was neither more nor less than the help of US President John F. Kennedy. Inspired by a personal tragedy and the fact that in the United States there were 600,000 asylums in which patients were not precisely treated well due to oversaturation and lack of media, Kennedy invests in the creation prevention programs, underscoring this idea in a speech to the United States Congress in February 1963.
Thus, around 800 mental health centers have been created to they had psychiatrists, social workers, psychologists and other health professionals in their ranks to work with the mental health of the local community. It was revolutionary, ending the era of psychiatric hospitals in North America and reducing the stigma of mental health, promoting a more preventive than non-therapeutic view and contributing to a better vision for going into therapy.
The fall of social psychiatry
Although the creation of these 800 mental health centers with preventive treatments would be beneficial, they had the disadvantage that they it didn’t work on the social factors behind mental disorders. Moreover, preventive treatments were rather rare and were in practice treated in patients already suffering from chronic mental disorders.
Although social psychiatry helped to understand where many mental disorders came from, its inaction on social factors made knowledge of the theory useless as it was not applied in a practical way.
Outraged, the therapeutic goal for the moment changedAs the United States relived the ghosts of war, this time with the worsening Vietnam War (1955-1975), and the country’s political situation was tense, with changes from President Kennedy to Lyndon B. Johnson and Richard Nixon. the health of the soldiers, this time with post-traumatic stress disorder. American citizens in the poorest regions have been left behind.
It should be noted that the implementation of an improvement of the most disadvantaged population from the point of view of social psychiatry was difficult, because one of the main assumptions of this discipline was that the social improvement would come from the hand of a better distribution of goods. Many social psychiatrists were in favor of a better redistribution of money which, in a context like the 1970s, in the midst of the Cold War against the Soviet Union, was considered a communist manifesto, contrary to the American spirit.
But what certainly ended social psychiatry was a strengthening of the organicist view of mental disorders. With the publication of the third edition of the DSM, which set aside the psychoanalytic view to focus on a more scientific view, more attention was paid to the supposed biological causes behind psychopathology.
The boom in psychotropic drugs in the 1980s, particularly antidepressants and anxiolytics, gave strength to biological theories of disorders, so that the social causes that could explain them were abandoned.
- Marconi, J. (2001). Psychiatry at the turn of the century: social psychiatry. Chilean Journal of Neuro-Psychiatry, 39 (1), 10-11. https://dx.doi.org/10.4067/S0717-92272001000100004.
- EL Faris, R. and Warren Dunham H. (1939). Mental disorders in urban areas. Journal of Social Services 13, no. 3,545-546.
- Pols H. (2007). August Hollingshead and Frederick Redlich: Poverty, socioeconomic status and mental illness. American Journal of Public Health, 97 (10), 1755. https://doi.org/10.2105/AJPH.2007.117606.
- Black-smith. M. (2020). Social psychiatry could slow the rise of mental illness. United States: The Conversation. Retrieved from https://theconversation.com/social-psychiatry-could-stem-the-rising-tide-of-mental-illness-138152.