An Ounce of Prevention: A History of Social Psychiatry, 1939-Present

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In 2010 I attended an international conference, entitled 'The Social Determinants of Mental Health' and held in Chicago. Its focus was to address the socioeconomic factors, ranging from poverty to violence, believed to cause mental illness. The participants, including David Satcher, the former US Surgeon General, not only advocated a more socially-informed approach to understanding mental health, but also wanted to launch a political movement that would place prevention at the heart of mental health policy and clinical practice.Such an approach to mental health was not new, but its history has not been written and so was unknown to most of the conference participants. Building on the mental hygiene and child guidance movements of the early twentieth century, and reaching its peak during the 1950s and 1960s, the psychiatric and political movement known as social psychiatry similarly advocated a preventive approach to mental illness, which stressed alleviating social deprivation and inequality. But, although social psychiatry would become a major force within American psychiatry and politics, influencing both presidents of the American Psychiatric Association and the legislation of Presidents Kennedy and Johnson, it faded away in the subsequent decades, as biological approaches to mental illness became the dominant force in American psychiatry.Given the World Health Organisation's recent warnings that mental illness will become the world's most common malady within twenty years (Mental Health Atlas, 2011) - not to mention the escalating social and economic cost of such conditions - it is not surprising that preventive approaches to mental illness are again attracting attention. This project seeks not only to analyse a neglected chapter in the historiography of psychiatry, but also to inform current attempts to address the social determinants of mental health by examining the successes and failures of social psychiatry. The project is divided into three sections. The first examines the intellectual origins of social psychiatry, including its roots in the mental hygiene and child guidance movements of the early twentieth century. Widespread interest in social psychiatry escalated not only because it addressed concerns about the rising rates of mental illness, but also because it represented an interdisciplinary collaboration between psychiatrists and social scientists that inspired a wide audience in academic and public policy circles. The project will address the historical factors involved in this cooperation, and assess both the benefits and disadvantages of such an interdisciplinary approach to mental health. The second section of the project examines the zenith of social psychiatry, as it threatened to eclipse psychoanalysis and biological psychiatry (which stressed neurological explanations of and pharmaceutical treatments for mental illness) during the 1960s. Unfortunately for social psychiatrists, however, the interest in preventive approaches waned during the 1970s and 1980s, as psycho-pharmacology became more popular amongst both psychiatrists and their patients, and economic and political pressures deflated the socially progressive zeal of American politicians and mental health professionals. The third section of the project will examine not only the decline of social psychiatry, but also explore why preventive approaches to mental illness have once again found favour in both the US and elsewhere.