Social psychiatry: what is it and what were its characteristics?

Summary about what social psychiatry was, and what were its claims and proposals.

In the world there are about 400 million people suffering 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 of knowing such causes has a clearly preventive objective, since knowing the social factors that affect mental health would make it possible to avoid their occurrence.

Social psychiatry has tried to fulfill this objective by defending the idea that by knowing the social aspect, it is possible to work on the psychopathological aspect.. Let us deepen more on this branch of psychiatry.

What do we understand by social psychiatry?

Social psychiatry was a preventive stream within the branches of health care that was very influential in the United States after World War II.. It focused on identifying social factors that were thought to influence the onset of psychopathology.

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

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

The origins of social psychiatry can be found in the mental hygiene movements of the early twentieth century .. This movement emphasized prevention and the role of the social environment on the health of the individual, especially in mental health. Moreover, 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 the social sciences.

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

Research 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 stream focused on understanding the extent to which social injustices harmed the health of individuals. to what extent social injustices damaged the health of individuals.. In their 1939 book "Mental Disorders in Urban Areas" the two researchers established a relationship between poverty and mental disorders.

Their work consisted of analyzing 30,000 hospital admissions in the city of Chicago, and they used maps to demonstrate, graphically, how different the disorders diagnosed by professionals were in different parts of the city.. They were struck by the fact that in Chicago's Hobohemia, corresponding to the Tower Town neighborhood, many cases of paranoid schizophrenia were reported.

The Hobohemia of this city, i.e., the artistic and alternative quarter, had a large population of homeless, pickpockets and people begging for charity. Because the area was extremely poor, its inhabitants lived very unstable lives. Their existence was virtually anonymous, and many were isolated from their families or society in general, despite living in the most populated area of the city. They were frustrated, confused and had a chaotic lifestyle.

Curiously, if paranoid schizophrenia was most common in Chicago's Hobohemia, catatonic schizophrenia was the star diagnosis in poor areas of the city populated by foreign immigrants and Afro-Americans. In wealthy areas, in contrast to the two previous diagnoses, the most frequent was to detect people suffering from manic depression.

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

Likewise, there were those who criticized these findings, arguing that people who suffer from disorders such as schizophrenia, if they have grown up in a wealthy environment, are unable to function properly there and end up going to wealthier neighborhoods. In other words, they they believed that it was not social factors that contributed to mental disorder, but rather that it was the disorder that caused one to end up poor..

Faris and Dunham were critical of this critique, to make it redundant. They argued that the parents of patients in poor areas very rarely came from wealthier neighborhoods. They also stated that the younger patients would not have had enough time or parental permissiveness 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 predisposing factors for poor mental health..

Research in New Haven

Another study on how social factors influence mental health was conducted in the Connecticut city of New Haven. 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 conducted by August Hollingshead and Fritz Redlich, a sociologist and psychiatrist, respectively.

In their research they divided the city of New Haven into five areas according to class. Class 1 was the area inhabited by the descendants of the oldest New Haveners, the "full-blooded New Haveners". These families had resided in the city since its founding in the 17th century.

Class 5 was the most disadvantaged, made up of people with little education and who often worked seasonal jobs. 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 looked at 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 gaining access to psychiatric treatment.

In addition, the type of treatment between the disadvantaged and wealthier classes was very different. While the lower classes received very invasive treatments, such as somatic therapies including psychotropic drugs, electroconvulsive therapy and lobotomy, the upper classes tended to receive psychoanalysis. It is not surprising, since psychoanalysis, being a more expensive therapy, could be seen as a status symbol for the upper classes to go to a psychoanalyst.

The United States after World War II

After World War II, interest in psychology and psychiatry grew, mainly due to the enormous number of soldiers traumatized by the war. by the events of the war. For this reason the United States, knowing that treating thousands of ex-soldiers with psychopathology was expensive, 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 the focus.

It is for this reason that social psychiatry was gaining so much strength after World War II, and in 1949 the National Institute of Social Psychiatry was created. the National Institute of Mental Health (NIMH) was created in 1949.. The first objective of this 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 none other than the help of U.S. 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 overcrowding and lack of resources, Kennedy invested in the creation of prevention programs, highlighting this idea in a speech to the U.S. Congress in February 1963.

Thus, nearly 800 mental health centers were created, with psychiatrists and psychiatrists among their 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 insane asylums in North America and reducing the stigma of mental health, promoting a more preventative rather than treatment approach and contributing to a better view of going to therapy.

The decline of social psychiatry

While the creation of these 800 mental health centers with preventive treatment was beneficial, they had the disadvantage that they did not really work on the social factors of mental health. did not work on the social factors behind mental disorders.. Moreover, preventive treatments were rather scarce and in practice treated patients who already had chronic mental disorders.

Although social psychiatry had helped to understand where many mental disorders came from, its inaction on the social factors meant that knowing the theory was useless because it was not applied in practice.

Moreover, the therapeutic objective of the time changedThe United States was once again experiencing the ghosts of war, this time with the worsening of the Vietnam War (1955-1975), and the country's political situation was tense, with changes of president from Kennedy to Lyndon B. Johnson and Richard Nixon, and therapeutic efforts were once again focused on the health of soldiers, this time suffering from post-traumatic stress disorder. American citizens in poorer areas were largely neglected.

It must be said that implementing an improvement of the most disadvantaged population from a social psychiatric perspective was difficult, since one of the main assumptions of this discipline was that social improvement would come from a better distribution of goods. Many social psychiatrists were in favor of a better redistribution of money, something that in the context of the 1970s, in the midst of the Cold War against the Soviet Union, was seen as a communist manifesto, contrary to the American spirit.

But what undoubtedly put an end to social psychiatry was the 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 one, more attention was paid to the Biological causes that were supposedly behind psychopathology.

The boom of psychopharmaceuticals in the 1980s, especially antidepressants and anxiolytics, gave strength to biologistic theories of disorders, so social causalities that could explain them were abandoned.

Bibliographical references:

• Marconi, J. (2001). La psiquiatría en el cambio de siglo: psiquiatría social. Revista chilena de neuro-psiquiatría, 39(1), 10-11. https://dx.doi.org/10.4067/S0717-92272001000100004.
• E. 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. Estados Unidos: The Conversation. Extraido de https://theconversation.com/social-psychiatry-could-stem-the-rising-tide-of-mental-illness-138152.