First Resort

Social psychiatry was a mid-twentieth-century approach to mental health that stressed the prevention of mental illness rather than its treatment. Its proponents developed environmental explanations of mental health, arguing that socioeconomic problems such as poverty, inequality, and social isolation were the underlying causes of mental illness. The influence of social psychiatry contributed to the closure of psychiatric hospitals and the emergence of community mental health care during the 1960s. By the 1980s, however, social psychiatry was in decline, having lost ground to biological psychiatry and its emphasis on genetics, neurology, and psychopharmacology.

The First Resort is a history of the rise and fall of social psychiatry that also explores the lessons this largely forgotten movement has to offer today. Matthew Smith examines four ambitious projects that investigated the relationship between socioeconomic factors and mental illness in Chicago, New Haven, New York City, and Nova Scotia. He contends that social psychiatry waned not because of flaws in its preventive approach to mental health but rather because the economic and political crises of the 1970s and the shift to the right during the 1980s foreclosed the social changes required to create a more mentally healthy society. Smith also argues that social psychiatry provides timely insights about how progressive social policies, such as a universal basic income, can help stem rising rates of mental illness in the present day.

Matthew Smith is professor of health history at the University of Strathclyde’s Centre for the Social History of Health and Healthcare. His books include Another Person’s Poison: A History of Food Allergy (Columbia, 2015) and Hyperactive: The Controversial History of ADHD (2012).