A fine balance: individualism, society and the prevention of mental illness in the United States, 1945–1968

Abstract

In the introduction to a collection of his essays entitled Society as Patient (1950), American social scientist and Rockefeller Foundation administrator Lawrence K Frank (1890–1968) claimed that, to prevent the apparently escalating rates of mental illness: “The individual, instead of seeking his own personal salvation and security, must recognize his almost complete dependence upon the group life and see his only hope in and through cultural reorganization”. Americans, Frank continued, would have “to give up … time-honored beliefs in human volition and responsibility” and “replace them with a larger and humanly more valuable belief in cultural self-determination, social volition, and group responsibility”. For Americans entering the 1950s, a decade of postwar prosperity, McCarthyism and free market capitalism, such communitarian thinking might have been anathema. But also arising out of the American experience of the Second World War were mounting concerns about mental health, due in part to the large number of American military recruits rejected on psychiatric grounds and American soldiers granted psychiatric discharge. In the face of affluence and contentment was alarm that many more Americans were mentally disordered than previously thought, and that new preventive approaches to mental health were required. Addressing these concerns during the postwar period was a new approach to psychiatry: social psychiatry. Rooted in both the child guidance and mental hygiene movements of the early twentieth century as well as contemporary social scientific research, social psychiatry was “a preventive psychiatry”, an epidemiological approach to mental health dedicated to identifying the environmental causes of mental illness—ranging from overcrowding and poverty to social exclusion and racism—and eradicating them. In this article, I explore how the economic and social implications of social psychiatry were articulated. Did social psychiatrists believe that it was possible to re-balance American society, not merely in economic terms, but also with respect to counter-balancing the prevailing ideology of “rugged individualism” with a more communitarian outlook? To what degree were they willing to do this themselves, eschewing lucrative psychoanalytic practices for community psychiatry? I will suggest that, although many of the aspirations of social psychiatry were unrealistic, and possibly utopian, they are worth re-considering. This article is published as part of a collection entitled ‘On balance: lifestyle, mental health and wellbeing’.

Mentalizing, Epistemic Trust and the Phenomenology of Psychotherapy

“…There is unequivocal evidence that social and economic inequality is strongly connected with mental ill health [39][40][41], and poverty is one of the best documented risk factors for both internalising and externalising problems [42]. It has been argued that the dominance of biological and individual psychological perspectives may have distracted from considering broader social perspectives [43,44]. And indeed, we are increasingly of the view that the role of these wider social systemic experiences -while abundantly clear to many clinicians working on the front line of mental health care -is theoretically under-accounted for in existing conceptualisations psychopathology.…”

Stanley Cobb, the Rockefeller Foundation and the evolution of American psychiatry

“…Psychoanalysts Grinker and Menninger noted the importance of social and environmental factors in mental illness in the post-war period. Increasing numbers of inpatients in American psychiatric asylums spurred the idea of community mental health centres as alternatives (Smith, 2016). President Kennedy signed the Community Mental Health Act in 1963.…”

On balance: lifestyle, mental health and wellbeing

“…These concerns are reminiscent of those put forward much earlier, during the early and mid-twentieth century, by proponents of the social medicine movement who were critical of rising consumerism, the breakdown of traditional values and kinship ties, and who were keen to reduce the burden of sickness by pressing for social improvements (for example: Taylor, 1938; Halliday, 1948; Engel, 1977). As Smith (2016) illustrates in his article on the post-war community mental health movement in the United States, these ideas were also salient during the Kennedy and Johnson administrations, where social welfare reforms not only moved to tackle poverty, but also mental illness—the cause of which was seen to be in “harsh environmental conditions”.…”

“…Smith’s (2016) paper explores the wider issue of how societies have attempted to “balance” individualism with the needs of the broader population. As he rightly notes, we often think of balance in terms of “individual” responsibility, whether it be balancing humours, a balanced diet or work-life balance.…”