Social psychiatry: what is it and what were its characteristics

In the world there are about 400 million people who suffer from mental disorders. These disorders must be treated with psychotherapy and psychotropic drugs, but it is also necessary to know what are the social causes that make someone manifest psychopathology.

This intention to know such causes has a clearly preventive objective, since knowing the social factors that affect mental health would prevent them from occurring.

Social psychiatry has tried to fulfill this objective by defending the idea that knowing the social, one can work on the psychopathological. Let's go deeper into this branch of psychiatry.

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What do we understand by social psychiatry?

Social psychiatry was a preventive current within the health branches that had a lot of influence in the United States after the Second World War. It was focused on identifying the social factors that were believed to influence the onset of psychopathology.

Among the factors he studied were poverty, inequality and social exclusion, understood as not only socioeconomic phenomena, but as promoters of psychopathology.

Social psychiatry was an interdisciplinary trend, since it worked side by side with social scientists, especially sociologists and anthropologists. With works from different disciplines it was possible to study and determine the relationships between society, especially living in its most disadvantaged classes, and the occurrence of disorders mental.

The origins of social psychiatry can be found in the movements for mental hygiene in the early 20th century. This movement emphasized prevention and the role played by the social environment on the health of the individual, especially with regard to the mental. Furthermore, it was from this approach that mental health professionals, such as social workers with psychiatric knowledge, were introduced.

The context of formation of this branch lies in the fact that in the mid-twentieth century psychiatry had a very good reputation and during the 1920s and 1930s there had been a boom in science social.

Combining psychiatry with sociology, a half-clinical, half-social branch was obtained that was strongly supported by scientific findings.. It was also the wake-up call for the psychiatric community, inviting them to pay attention to the social sciences that could offer so much in the prevention of psychopathology.

Investigation in Chicago

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 the extent to which social injustices harmed 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 graphically demonstrate how different were the disorders diagnosed by professionals in different parts of the city. They were struck by the fact that in Chicago Hobohemia, corresponding to the Tower Town neighborhood, many cases of paranoid schizophrenia were reported.

The Hobohemia of this city, that is, the artistic and alternative neighborhood, had a large population of homeless people, pickpockets and people asking for charity. Since the area was extremely poor, its inhabitants lived very unstable lives. Their existence was practically anonymous, and many were isolated from their relatives or from society in general, despite living in the most populated area of ​​the city. They were frustrated, confused, and led a chaotic lifestyle.

Interestingly, if in Chicago Hobohemia the most common was paranoid schizophrenia, schizophrenia catatonic was the star diagnosis in poor areas of the city populated by foreign immigrants and African Americans. In rich areas, in contrast to the two previous diagnoses, the most common was to detect people who suffered from manic depression.

Although with their differences, other similar studies were conducted in other parts of the United States, finding similar patterns between rich areas, poor areas and the indigent population.

Likewise, there were those who criticized these findings, arguing that those people who suffer from disorders such as schizophrenia, if they have grown up in a rich environment, not being able to function properly in it they end up going to neighborhoods more rich. That is They considered that it was not the social factors that contributed to the mental disorder, but that it was the disorder that caused them to end up being poor.

Faris and Dunham were critical of this criticism, forgive the redundancy. They argued that parents of patients in poor areas very rarely came from wealthier neighborhoods. They also stated that the younger patients would not have had the time or the permissiveness of their parents to be able to leave the parental home and end up in a worse neighborhood.

These two authors showed how poverty, combined with psychological problems such as stress, isolation and living a disorganized life were factors predisposing to poor mental health.

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Research in New Haven

Another study on how social factors influence 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 to see to what extent class influenced the mental health of its citizens, a study that was carried out by August Hollingshead and Fritz Redlich, sociologist and psychiatrist, respectively.

In their research they divided the city of New Haven into five areas according to their class. Class 1 was the area inhabited by the descendants of the oldest New Havenians, the "full-blooded new haveners." These families resided in the city since its founding in the seventeenth century.

Class 5 was the most disadvantaged, made up of people with little training and who performed seasonal jobs on many occasions. While some were immigrants from Europe and Quebec, others were the so-called “swamp 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 that in class 1 there were serious problems in accessing psychiatric treatment.

Furthermore, the type of treatment between the underprivileged and the wealthiest classes was very different. While in the lower classes very invasive treatments were received, such as somatic therapies in which included psychotropic drugs, electroconvulsive therapy, and lobotomy, those in the upper classes tended to receive psychoanalysis. It is not surprising, given that psychoanalysis, being a more expensive therapy, the higher classes could see it as a status symbol to go to the psychoanalyst.

The United States after World War II

After the Second World War, interest in psychology and psychiatry grew due, above all, to the huge number of traumatized soldiers apparently in the race. For this reason the United States, knowing that treating thousands of ex-soldiers with psychopathology was expensive, he was interested in knowing how to avoid psychopathology and save a few million Dollars. Designing prevention programs and methods, rather than finding the perfect treatment, was what was in the spotlight.

It is for this reason that social psychiatry was gaining so much strength after the Second World War, and in 1949 the American National Institute of Mental Health (NIMH) was created. The first objective of such a recent institution was to create prevention programs, and they knew how to take into account the studies of social psychiatrists.

But what definitely helped the rise of social psychiatry was neither more nor less than the help of American 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 exactly well treated due to the oversaturation and lack of means, Kennedy invested in the creation of prevention programs, highlighting this idea in a speech to the United States Congress in February from 1963.

Thus, about 800 mental health centers were created that had among their ranks psychiatrists, social workers, psychologists and other health professionals to work with the mental health of the local community. This was revolutionary, ending the era of the asylum in America and reducing the stigma of health mental, promoting a more preventive vision than not treatment and contributing to a better vision to go to therapy.

The fall of social psychiatry

Although the creation of those 800 mental health centers with preventive treatments was beneficial, they had the downside that they really no work was done on the social factors behind mental disorders. Furthermore, preventive treatments were rather scarce and in practice patients who already had chronic mental disorders were treated.

Although social psychiatry had helped to understand where many mental disorders came from, its inaction towards social factors made knowing the theory useless as it was not applied in a practice.

What's more, the therapeutic objective of the moment changed, as the United States relived the ghosts of war, this time with the worsening war of Vietnam (1955-1975), in addition to the political situation in the country was tense, with changes of president from Kennedy to Lyndon B. Johnson and Richard Nixon. Therapeutic efforts refocused on the health of the soldiers, this time suffering from post-traumatic stress disorder. North American citizens from the poorest areas were largely left out.

It should be said that putting into practice an improvement of the most disadvantaged population from a social psychiatry perspective was difficult, given that one of the main assumptions of this discipline was that social improvement would come from the hand of a better distribution of the goods. Many social psychiatrists were in favor of a better redistribution of money, something that in a context such as the In the 1970s, in the midst of the Cold War against the Soviet Union, it was seen as a communist manifesto, contrary to the spirit American.

But what undoubtedly ended social psychiatry was a strengthening of the organicist view of mental disorders. With the publication of the third edition of the DSM, which put aside the psychoanalyst vision to focus on a more scientific, more attention was paid to the biological causes that were supposedly behind the psychopathology.

The boom in psychotropic drugs in the 1980s, especially those antidepressants Y anxiolytics, gave force to the biological theories of the disorders, so the social causes that could explain them were abandoned.

Bibliographic references:

• 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.
• AND. L. Faris, R. & Warren Dunham H. (1939). Mental Disorders in Urban Areas. Social Service Review 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.
• Smith. M. (2020). Social psychiatry could stem the rising tide of mental illness. United States: The Conversation. Taken from https://theconversation.com/social-psychiatry-could-stem-the-rising-tide-of-mental-illness-138152.