2023-07-25 15:21:00
Matthew Smith | Translated by: Arab 48
Decades of groundbreaking research have linked mental illness to economic deprivation, and it’s time we took the findings seriously. A 1965 article titled “Poverty and Social Change” appeared in the American Journal of Science, and the article introduced readers to a small rural community in Nova Scotia, Canada, called The Way.
Way is one of the poorest in his county, and was part of the Sterling County Study, one of the largest and longest psychiatric epidemiological studies ever conducted. The article’s author, Alexander Leighton, co-founded the Stirling County Study in 1948 with his then-wife, Dorothea Cross Leighton. By assessing residents of The Way and a few other communities, the researchers hoped to link social and economic factors with mental health.
The inhabitants of the way have long occupied the bottom of the social ladder. Their society was characterized by fights, heavy drinking, marital breakdown, neglect of children, and substandard and poorly maintained homes, as illustrated in Layton’s article. Teams of sociologists and psychiatrists such as Leighton and his wife, who later became known as social psychiatrists, found that rates of mental illness were higher in disadvantaged communities such as the “Way” community. The Sterling County Study and similar studies have shown that mental illness is associated with poverty, inequality, social isolation, and community disintegration (which included factors such as crumbling civic infrastructure and lack of groups). [الاجتماعية] that strengthen [أواصر] community together). People from the “Way” community and other similar communities revealed in interviews how their lack of financial resources and low socioeconomic status made them feel anxious, depressed, and hopeless. The poor, compared to the well-to-do, were also more likely to develop psychosis, and were prescribed surgical treatments such as electroconvulsive therapy, insulin shock therapy, and even abortive surgery, rather than psychotherapy.
Focusing their work on the social environment, the work of social psychologists contrasted with two other approaches to mental health that were prominent at the time: psychoanalysis, which focused on psychotherapy, and biological psychiatry, which focused on medication and other physical therapies. Social psychiatry emerged in North America during the mid-twentieth century, building on earlier “mental health” and “child guidance” movements, which also emphasized the role of social and economic factors, but lacked a foundation of scientific evidence.
The foundations of the forgotten story of social psychiatry, in large part, are due to various factors. His goal was not only to determine the impact of social and economic factors on mental health, but also to produce policy recommendations that would lead to the prevention of mental illness, and here mental health research collided with politics. Social psychologists have excelled at demonstrating the link between social and economic problems and mental health problems, but they have been less responsible in advising what to do regarding the findings of their research.
This was sometimes a result of social psychiatrists’ unwillingness to make such political statements. They wanted to “get it right,” which is what happened in the “Midtown Manhattan Study” that examined mental health in New York City during the 1950s. While Mental Health in Urban Centers (1962) discussed the project’s methodology in 50 pages, it wrote less than 50 words regarding the implications of the study. Others felt that it was inappropriate to draw researchers into policy discussions, let alone political ones. Most social psychiatry research coincided with the height of McCarthyism in the United States, where if there was any smell of socialism on any issue, it became subject to scrutiny and condemnation, including the kinds of social and economic policies seeking to reduce poverty and inequality, which were among the findings of social psychologists.
In some cases, psychiatrists simply missed the point and blamed the poor themselves, which Leighton did with the “Wayway” society, attributing the problem to the poor, not to poverty. People of the “Way” were constantly insulted by people of other communities, who were assumed to be “mentally retarded”. The researchers working on the Sterling County Study also used vile words and vocabulary to describe the residents of the “Way” community, portraying them as dirty, rude, lecherous, reckless, suspicious, and hostile. Middle-class and highly educated scholars wrote regarding these people as if they were not just a separate class, but a completely different kind of human being.
When the “Way” residents were first studied in the early 1950s, they were shown to have much worse mental health problems than other residents of the county. However, the situation improved significantly in the early sixties.
Although the new job opportunities had alleviated chronic poverty in the community, Layton downplayed this factor, noting that the people themselves had changed. He added that the introduction of an adult education program and the consolidation of the “Way” school with another of a more affluent community raised adults and children alike, providing them with skills and decency, and adding clothing choices that allowed them to function in the community more effectively. The ball at the time was that these developments transformed the inhabitants of the “road” from people who ignore the value of work and do not trust the authorities into good citizens. Leighton emphasized that this is the reason for their improved mental health.
While educational improvements may have made a difference, Leighton’s decision to emphasize other external improvements rather than the impact of economic improvements shows how reluctant he and other social psychiatrists were to propose (let alone demand) radical social and economic change. His interpretation suggested that something was fundamentally wrong with the poor themselves, something that went beyond social and economic conditions. His view here mirrors the “war on poverty” approach declared by US President Lyndon Johnson in 1964, which included waging a “war” once morest the so-called culture of poverty. This kind of thinking suggests that you can’t just lift the poor out of poverty by giving them more material resources, because they will simply squander whatever you give them.
Social psychological research contributed to the shift to community mental health. Pressure was growing by the 1950s to move mental health care from psychiatric hospitals or asylums to community mental health centers. These centers were not intended to be mere treatment clinics, but were portrayed as centers of preventive psychiatry, helping to eliminate the root causes of mental illness, protect those at risk, and prevent relapse. Some community mental health centers have developed innovative approaches aimed at preventing mental illness. One notable example was the employment of so-called “domestic assistants” in the South Bronx in New York City during the 1960s, which involved integrating poor black community members, and psychiatric caregivers who were predominantly white, middle-class. These “localists” helped work with patients’ families and authorities to address their community’s root problems.
However, such interventions help in addressing some of the socio-economic challenges facing some members of society, and they cannot keep the doors of factories open, or prevent deductions from the funds of the social welfare system. The drive to take preventive measures to improve mental health has been hampered by the unwillingness or inability of politicians to address factors that psychiatrists have identified as contributing to increasing rates of mental illness. What is really needed is the eradication of poverty, the reduction of inequality and racism, and the improvement of societal inclusion.
By the 1980s, biological psychiatry was overshadowed by social psychiatry, which emphasized genetic and neurological explanations, and prioritized psychotherapy. With the spread of medicines, the belief in the need for preventive measures has disappeared.
Social psychologists missed an opportunity to articulate the real political implications of their research, namely that gradual social change is required to prevent mental illness. Historians who have studied social psychiatry have often underestimated its importance. I argue, on the other hand, that we need to reconsider the findings of social psychologists, and that if we want to prevent today’s psychological epidemics, we need to act.
Experts have turned once more to social factors in the field of mental health in recent years. The financial crisis of the late 2000s and the COVID-19 pandemic, coupled with dissatisfaction with psychopharmacology, made social psychiatry relevant once more, although we no longer refer to “social psychiatry” as a field, but rather to its research on “social determinants of mental health.”
Today’s mental health researchers are less likely to respond judgmentally to their subjects, yet they are still afraid to often point out the political implications of their findings. This may be because they want to do more research, but we already have more than enough evidence to know that social and economic deprivation is bad for mental health. In addition to the classic studies, later research, such as that conducted and published by Richard Wilkinson and Kate Beckett, has strengthened this link. Mental health researchers, clinicians, and activists now need to do what social psychologists have failed to do: address poverty, inequality, racism, community disintegration, and social isolation.
One possible approach to solving the problem is to introduce the concept of a “uniform basic income” that would lift people out of poverty, provide opportunities for social mobility, and allow people to re-enter their communities. This solution was put as a recommendation in a number of researches that talked regarding preventive mental health strategies during the sixties, such as the study “Children’s Mental Health Crisis: The Challenge of the Seventies (1969)” which was published by the American Joint Committee on Children’s Mental Health. Health economist Evelyn Forget later found that mental health improved during a basic income pilot project in Manitoba during the 1970s. A recent meta-analysis also indicated that guaranteed income programs often lead to improvements in mental health. The standard basic income is just one of many preventative mental health initiatives, and some of them can benefit physical health as well, such as:
• Today, medical researchers are rediscovering the links between food and mental health. Policies to support the provision of healthy, locally produced food can not only reduce food poverty, but also improve people’s well-being.
• Dramatically reducing the cost of post-secondary education (or eliminating tuition fees altogether), along with investing in education in disadvantaged communities, can promote social change and reduce the sense of hopelessness that many young people experience.
• Finally, research has shown that allowing people of all backgrounds to spend time in nature can improve their mental health. This can be achieved by improving public transport networks, providing bicycles to those who cannot afford them, putting more bike paths in the roads, and building and expanding parks and natural areas in and around the city.
The real priority is to change our mentality and the way we deal with the issue, that is, we have to confront mental health policies more confronting, and more than psychiatrists did in the past. And if we don’t think regarding mental health in political terms, we don’t think regarding it at all. Finally, if we are serious regarding preventive measures for mental illness, we should think regarding political solutions first and foremost.
The article was translated from Physique magazine, by Matthew Smith.
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