The First Resort: The History of Social Psychiatry in the United States

Author: Matthew Smith Publisher: New York: Columbia University Press Year: January 2023 Pages: 424 Format: Paperback List Price: $30.00/£25.00 ISBN: 9780231203920 (hardcover) ISBN 13: 9780231203937 (trade paperback) ISBN: 9780231555289 (ebook) Image: The First Resort book cover Photo Source: Publisher’s page https://www.degruyterbrill.com/document/doi/10.7312/smit20392/html In this important history of social psychiatry, Canadian health historian Matthew Smith of Strathclyde University in Scotland addresses the rise and fall of social psychiatry, focused on a detailed study of community psychiatry in the USA. In seven chapters following a useful introduction that sets out the objectives of this study, Smith offers an overview of the rise and fall of social psychiatry with detailed case studies of four classic social psychiatric studies. Three took place in US cities: Chicago (University of Chicago sociologists Robert Faris and Warren Dunham, Mental Disorders in Urban Areas, 1939); New Haven (Social Class and Mental Illness by Yale psychiatrist Frederick Redlich and sociologist August Hollingshead, 1958); New York (the Midtown Manhattan Study, published as Mental Health in the Metropolis, 1962, by a large interdisciplinary team led by anthropologist Leo Srole and psychiatrist Thomas Rennie); and the fourth in rural Nova Scotia, a Canadian province (The Stirling County Study led by Dorothy and Alexander Leighton, a husband–wife team of dually qualified psychiatrists–anthropologists, and associates, My Name is Legion, 1959, People of Cove and Woodlot, 1960, and The Character of Danger, 1963). The reviews have been strongly favourable. This one, featured on the back cover of the book, by Mary Travis Bassett, commissioner of the New York State Department of Health, sums up its value and relevance: “Matthew Smith has done a great service by restoring to us the vanished history of social psychiatry. The pandemic uncovered social fissures, including large racial and ethnic divides. These should clear the way for a renaissance of social psychiatry: To have good mental health, people need decent lives.” Other reviews applaud the book as “a fascinating, well-researched, and beautifully written history of social psychiatry,” “carefully contextualized and urgently relevant,” and “a compelling history of social psychiatry in the United States.” HISTORIANS AND PSYCHIATRY Historians who examine psychiatric history and practice offer us an invaluable perspective on our profession, examining historical documents critically and revealing patterns of thought and practice to us.[1,2] French psychologist, historian, and philosopher Michael Foucault penned one of the most influential perspectives on the history of psychiatry, Madness and Civilization, which offers a philosophical-poetic view of the history of psychiatry.[3] Well-researched and well-written, I recommend Smith’s study for students, practitioners, and academics of the psy disciplines for insights into the roots of social psychiatry in the US and the lessons we can learn from such a detailed study. It is a useful adjunct to our own history of social psychiatry and for associations such as the World Association of Social Psychiatry (WASP).[4] There are, inevitably, other areas I should have liked to see included or developed in greater detail: The academic study and research into sociocultural factors in psychiatry parallels and richly intertwines with the four classic social psychiatric studies detailed in Smith’s history. The McGill University Division of Social and Transcultural Psychiatry in Montreal, Canada, pioneered social and cultural psychiatric research and trained many of the early leaders in this field, including those from the USA or who ended up working there. Alex Leighton, who led one of the four classic studies, the Stirling County Study in Canada, was a significant mentor and exerted a large influence on the development of the division at McGill The significant spur toward a form of social therapy which has a reciprocal relationship with community and social psychiatry – marital and family therapy. Pioneers in family or relational therapy were often socially-oriented psychiatrists such as Salvador Minuchin, who worked in inner-city communities in the US. Nonetheless, these are cavils from me as a Canadian social psychiatrist and do not undermine the importance of this study, which focuses on a history of US community psychiatry, public health, and epidemiology. There is a profound need to take the social in psychiatry and social psychiatry as a field seriously, and that is this: to see the relationship between the social structures and systems of a society, and how social suffering is experienced (lived), framed (understood), and responded to (treated). Community psychiatry was part of the effort to get out of the asylum and the psychiatric hospital, but it was not always a social psychiatry per se, and Smith does allude to that. Furthermore, I would argue that community work was a significant and critical branch of social psychiatry, but not the only one, and we should recognize the Social Determinants of Health and mental health as our basic science and the relational therapies as a form of social therapy.[5–7] The author’s survey of the rise and fall of community psychiatry makes for bracing reading and a cautionary tale about what we abandon and forget, notably community context, social factors, and the need for prevention. To conclude, the history of social psychiatry merits a close reading to understand and apply the lessons this can teach us. Smith has written a detailed, scholarly, and comprehensive account of one branch of social psychiatry in one country: Community psychiatry in the USA. Here are the author’s closing words: “One lesson we can learn from psychiatry’s proclivity for rise-and-decline narratives is that of the desirability of plurality, interdisciplinarity, and open-mindedness with respect to how mental illness is conceptualized and addressed” (p. 268). Smith goes on to insist that “social psychiatry’s emphasis on prevention should be rehabilitated” and that “social factors contribute to mental illness and that prevention should and must be at the heart of mental health policy.” Arguing for a holistic view that situates people in their “cultural, socioeconomic, ecological, and biomedical context,” Smith calls for integrating insights from all psychiatric disciplines along with the humanities and the social sciences. Rather than “lurching from one paradigm to another,” Smith exhorts psychiatry to reaffirm the biopsychosocial (BPS) approach. Finally, he notes that history can explain why paradigm shifts in psychiatry occur while making the case for “more integration, collaboration, and nuance.” While I suspect that he is preaching to the choir among social psychiatrists and readers of this journal, nonetheless, in a world where social psychiatry in North America was marginalized by the transformation of the BPS model into “bio-bio-bio” and all of psychiatry faces sometimes harsh critiques and outright dismissal, this nuanced, thoughtful, and scholarly study carefully documents part of the history of social psychiatry and, after more than 60 years of the founding of WASP by Joshua Bierer in London, UK, demonstrates the continuing relevance of a social approach to psychiatric illness and mental health care.[8] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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