Search

The study explores the common effort of social psychiatrists in Eastern and Western Germany to help people suffering from mental health issues to gain more self-determination and social participation and to make mental health care more humane from the 1960s onwards. At the same time, it provides a contrastive analysis of the social psychiatric concepts developed by the psychiatrists Karl Peter Kisker, Klaus Weise and the philosopher Achim Thom. A thorough analysis of literature reveals differences in the theoretical approaches in the East and West. Kisker, who was a representative of the West German social psychiatric movement, had a phenomenological-anthropological background. By contrast, Weise and Thom even though following the same subject orientation, established a socialist social psychiatry clearly integrating Marxist views into their concept. This contrastive also elaborates common viewpoints in understanding the social dimensions of mental health conditions in the two concepts., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The Eromin Center was founded in Philadelphia in 1973, aiming to provide lesbian, gay, bisexual, and transgender (LGBT) affirmative mental health treatment 6 months before the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM-II; American Psychiatric Association, 1968). This study of archival records and oral histories with Eromin Center staff and volunteers reveals an iterative and improvisational approach to community-based affirmative care. Rather than waiting for national leadership or institutional change, they aimed to respond directly to otherwise unrecognized needs of LGBT people through psychotherapy and social services-what we are calling clinical activism. Without training or guidance from research, they tended to base their work on their own experiences, an approach with inherent limitations in particular because most of the staff were White, cisgender, and identified as gay and lesbian. They attempted to address these limitations until Eromin's closing in 1984. Largely overshadowed by the broader policy changes in mental health care, Eromin's work provides a crucial case study in community-based clinical activism and affirmative practice with continuing salience today. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

In 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

Early experiences and indications are reported that psychopharmacotherapy, particularly as prophylactic long-term medication for prevention of relapses, has led to an increased recognition of social determinants of the course of illness, especially in schizophrenic patients. As a result, institutions combining both social and psychopharmacological treatment have developed, e. g., in Berlin beginning with "Phönix" a transition home ("Übergangsheim") in 1956 to a catamnesis for long-term outpatient treatment of schizophrenic patients in 1957, a social service in 1960, a day and night hospital in 1962 up to a university department of social psychiatry in 1972 with a rich spectrum of facilities for a step by step rehabilitation of mentally ill patients. In comparison with well-known humanistic sources of German psychiatric reform, some less well-known sources based on psychopharmacotherapeutic experiences that need further historical elaboration are considered. Questions include: 1. how psychiatric pharmacotherapy has influenced the development of social psychiatry in Germany, 2. whether the pioneering spirit of the 1950s, initiated by new treatment with psychotropic drugs has influenced or fostered the development of social psychiatry in Germany, 3. whether retardation of the development of social psychiatry in Germany (as opposed to England, France, and Canada and possibly related to its post-war international isolation) has been overcome not least by the new scientific development of psychopharmacology that has encouraged renewal of international contacts. In any case the possible influence of psychopharmacotherapy should not be missing in an overall view of the development of social psychiatry in Germany.

pro mente OÖ is one of the biggest organisations offering psycho-social care and treatment. It is a crucial part of the differentiated system of social psychiatric services in Austria. First, the article describes the organization pro mente OÖ, its history and services. Then, a selection of framework conditions of social psychiatric supply is presented. In this respect some existing strengths and weaknesses of the Austrian psycho-social supply system are discussed.

This article identifies two major traditions that drive the mandate for a community mental health care system-community protection and individual healing. It discusses the historical antecedents of these two traditions and how these traditions relate to different visions of what the "common good" means. It then discusses how they both operate in the current US-based system, creating inherent conflicts and tensions, and gives specific examples from the personal and professional experiences of the authors. The article proposes ways to reduce the tension and discusses what sacrifices and compromises this resolution would entail for the US community mental health system. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

This is the first of a 2-part study on the history of psychiatry in Eastern Germany, i. e. the Soviet Occupied Zone and later German Democratic Republic. It mainly covers the years post World War II up until the beginning of the 1970s. The first post-war years were determined by the new power holders' attempts to overcome National Socialist (Nazi) heritage and to re-organize mental health and care in general. The doctrine of a strict denazifization in East Germany must, however, be regarded as a myth. Promoted by centralized organization, there was an increase in communist party-ideological influence and harassment as well as aligning scientific views and research with Soviet paradigms (Pavlovization) during the 1950s and early 1960s. This, however, led to an enormous rise in exodus of skilled labor to West Germany, which in turn further increased the notorious lack of staff. After the erection of the inner-German wall, this problem was mitigated, yet never fully solved over the 40 years of the existence of the GDR. Despite adverse conditions, East German psychiatrists made major original contributions to the development of psychiatry in general, at least up until the 1960s. Academic psychiatry was mainly based on biological concepts that were further promoted by new somatic and psychopharmacological therapeutic options. In the 1960s, social psychiatric reformist forces emerged, primarily in the large psychiatric hospitals. The improvements achieved by these forces, however, were not implemented on a nation-wide scale, but mainly restricted to one particular or several institutions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive., (Copyright © 2015. Published by Elsevier Masson SAS.)

This paper examines the relationship between 'world citizenship' and the new psychiatric research paradigm established by the World Health Organization in the early post-World War II period. Endorsing the humanitarian ideological concept of 'world citizenship', health professionals called for global rehabilitation initiatives to address the devastation after the war. The charm of world citizenship had not only provided theoretical grounds of international collaborative research into the psychopathology of psychiatric diseases, but also gave birth to the international psychiatric epidemiologic studies conducted by the World Health Organization. Themes explored in this paper include the global awareness of mental rehabilitation, the application of public health methods in psychiatry to improve mental health globally, the attempt by the WHO to conduct large-scale, cross-cultural studies relevant to mental health and the initial problems it faced., (© The Author(s) 2015.)

Karl Jaspers, in his book "General Psychopathology", argued for methodological pluralism rather than theoretical dogmatism. He formulated a methodological order of psychopathology with a distinction between "explanation" (objective psychopathology) and "understanding" (subjective psychopathology, psychopathology of meaning). The latter approach focused on patients' subjective experience and biographical issues. Karl Jaspers emphasised social factors in the genesis and course of mental disorders. Following a multiperspective concept, from Jaspers' viewpoint social psychiatry should consider itself of equal importance with biological and psychotherapeutic psychiatry. Therefore, uncritical generalization of one of these perspectives should be avoided. Personalized psychiatry, apart from searching biological markers to tailor treatment should identify psychosocial factors and subjective meaning. Concepts of recovery should not ignore biological foundations in mental disorders., (© Georg Thieme Verlag KG Stuttgart · New York.)

This article uses narrative analysis to understand how mental health professionals working in a pilot experiment in community psychiatry in France between 1960 and 1980 made sense of their work experiences. Based on a collection of essays written by these professionals as part of their training as well as on other archival materials, the article explores writing practices in post-war French psychiatry as ways of constructing and negotiating moral commitments to work. The first three sections of the article give some background on mental health nursing in France in the immediate post-war period. The subsequent three sections examine how the professionals elaborated on their experiences in their writings, focusing on three different levels: first, the narrative voice used in the essays; second, the learning processes described by trainees; and finally, the ways in which they negotiated discursively the requirement to do emotionally well at work.

Mervyn Susser's contributions to community psychiatry from 1957-1968 comprised a creative and significant phase of his career, though less well known than his other work. This included work in Salford, a town next to Manchester, where he developed a programme to improve community health (including mental health care), as well as a programme of research on mental disorders. The publication of his book, Community Psychiatry: Epidemiologic and Social Themes (1968) attempted to set the stage for the practice of psychiatry in the community and to establish a future direction for development of the field., (© 2014 John Wiley & Sons Ltd.)

This article uses archival as well as published materials to trace the development of psychiatric epidemiology in France from 1945 to 1980. Although a research programme in this field was launched in the early 1960s at the National Institute of Medical Research (INH, later renamed INSERM), psychiatric epidemiology remained an embryonic field in France during the next two decades. French researchers in this field were hampered by limited resources, but their work was primarily characterized by a deep engagement with the epistemological challenges of psychiatric epidemiology. The history of French psychiatric epidemiology in the 1960s and 1970s can be seen as an attempt to create a specifically French way of doing psychiatric epidemiology research. In the first part of this article, the author relates this unique history to internal professional dynamics during the development of psychiatric research and, more broadly, to the biomedical institutional context in which epidemiological work was being done. The next part of this article examines the conditions under which the INH research team framed epidemiological research in psychiatry in the 1960s. The last part focuses on INH's flagship psychiatric epidemiology programme, developed in cooperation with pioneers of French community psychiatry in Paris's 13th arrondissement in the 1960s., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The so-called Rodewisch Theses of 1963 demonstrate East German psychiatry's attempts to implement social-psychiatric reforms. To mark their 50th anniversary, this article analyses their emergence, drafting and implementation. It has been known that key requirements could only be fulfilled on a regional basis, the Leipzig University Department of Psychiatry being an outstanding example, although its staff worked rather autonomously of the Rodewisch Theses. The reasons for the different degree of success of these developments in individual areas are manifold, key reasons being the lack of stark political support and of opportunity to discuss shortcomings in mental health care, as in Western Germany, due to political circumstances in particular. There was no strong social basis and support as in Western democracies., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In 1966 the Leipzig neuropsychiatrist and psychotherapist Christa Kohler qualified as a university lecturer on social-psychiatric problems in patients aged 40 + suffering from psychoses and neuroses. This paper acknowledges this habilitation thesis in its historical context as an early contribution to East German social psychiatry., Methods: First the thesis itself is searched for points characteristic of Kohler's approach to social psychiatry. Parallel to that, her views are contextualised with other primary sources from or secondary sources about GDR psychiatry at that time. Finally archival sources and oral testimonies of eye witnesses have been considered to substantialise the study., Results: The habilitation thesis is based on data from several hundreds of patients with regard to their demographic, medical and sociological features. Her approach to how older patients suffering from mental illnesses should be treated and rehabilitated is still highly relevant. Yet one must critically assess that many of Kohler's results as well as her psychotherapeutic treatment were ideology-based or oriented on the GDR system., Conclusions: Kohler's approach shows a clear, yet improper amalgamation of medical science and political ideology. Future research must show in how far this is typical for her concept only or for the whole of GDR social psychiatry., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose of Review: The overview focuses on publications relating to the history of social psychiatry and the mental health movement, respectively., Recent Findings: The selected works show fundamental developments within psychiatry, which can be conceived in the broadest sense as sociomedical in nature. Main emphases are the criticism of large institutions, reform movements and antipsychiatric movements, the search for alternative therapeutic methods, and the question of the resocialization of the mentally ill. Furthermore, it is important to demonstrate the influences of other scientific disciplines., Summary: Although social psychiatric approaches can be discerned as early as in the 19th century, the focus of the works lies on the development of social psychiatry in the 20th century. Only from the 1950s onwards did social psychiatry establish itself as an integral part of psychiatric practice and later of research. Accordingly, the main focus of the studies is on the development after the Second World War, not least because processes that began at that time have not yet been concluded. Happily, a trend is apparent in this respect: the one-sided view of physicians and their actions is being increasingly complemented by further professional groups and is consequently broadened by important dimensions.

On the basis of archival sources and primary literature the study exemplifies the history of one form of extramural social psychiatric care on the example of one particular institution, the town asylum of Leipzig-Dösen. Family care was introduced in Leipzig in 1904 by Georg Lehmann, primarily as an alternative treatment option. After initial opposition among the local population had been defeated, this form of treatment was soon quite accepted. Due to the socioeconomic changes as a result of World War I, the extent of family care was downsized. From 1940 family care in Dösen was abolished, due to a change in ideology. Part of the patients previously in family care fell victim to the National socialist T-4 programme to murder chronically mental ill. However, this study could also prove that at least one third of these patients survived. It can only be presumed to which extent this was due to their physical work being needed as a result of war shortages., (© Georg Thieme Verlag KG Stuttgart · New York.)

Between 1900 and 1939 the regional government in Catalonia discussed a complete reform of the psychiatric institutions inherited from the nineteenth century. The debate was centred on the Spanish government's lack of interest in mental health policies and the growing demand for services. The projects developed between 1900 and 1939 opened a wide-ranging discussion on the role of ethnic and cultural factors in shaping mental illness, and the need to adapt the new facilities to the ethnic features of Catalonia. This study explores the production of Catalan psychiatric discourses and their ideological roots, and the development of public policies up to the end of the Spanish Civil War (1936-39). The paper concludes with a discussion of the influence of pre-war Catalan mental health policies on the wartime practice of psychiatry and, later, on the development of the French psychothérapie institutionnelle after World War II.

This article reviews the life and work of Dr Ravi L. Kapur, a seminal figure in the fields of social and community psychiatry in India. Kapur made significant contributions to the understanding of the role of spirituality in psychology and psychotherapy and the psychological dynamics of sectarian violence.

Harald Frøshaug received training in scientific research by Rolv Gjessing (1887-1959), who was well known for his research on schizophrenic periodic catatonia. The Second World War brought new challenges for psychiatrists, and there was a pressing need for new treatment procedures and theories. Harald Frøshaug was inspired by English and American psychiatry, especially the psychoanalytic traditions. When he became head of the ward for women at Dikemark hospital in Asker in 1949, time was ripe to put new theories and methods into practice.

Summary: Between 1946 and 1958, Harlem was home to a small psychiatric facility, the Lafargue Clinic. An interracial institution run entirely by volunteers, the clinic helped expand mental health care into underserved African American communities. Relying upon extant case files, this article examines how the Lafargue staff handled clinical situations with African Americans. In its attempt to forge a new antiracist approach, the staff struck a balance between viewing Harlem patients as psychological products of their unique social context (social psychiatry) and applying modern psychiatric principles to African Americans without adjusting for racial or sociological difference (race-blind universalism).

Ludwig Meyer worked as resident psychiatrist, scientist and university teacher in Berlin, Schwetz, Hamburg and for the longest time in Göttingen. He promoted social psychiatry, i. e. extramural treatment, "Milieutherapie" within the institution and especially the non restraint system. Mention should be made of the casuistic works, in which Meyer connected clinical and neopathological methods, morphologic studies of progressive paralysis and--beyond psychiatry--the discovery of "Progenie" in anatomy. Forensic psychiatry he saw as an expert task as well as a medical task. In the training of psychiatrists Meyer broke new ground. Ludwig Meyer is the most important representative of the late 19th century. His work was mainly influenced by Griesinger's concepts (1868). Within the following thirty years Meyer further developed these concepts and added ideas of his own. In Meyers works Kraepelin's clinical methods and pluralistic psychiatry already shine through., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

In 1946, the Lafargue Mental Hygiene Clinic, a small outpatient facility run by volunteers, opened in Central Harlem. Lafargue lasted for almost thirteen years, providing the underserved black Harlemites with what might be later termed community mental health care. This article explores what the clinic meant to the African Americans who created, supported, and made use of its community-based services. While white humanitarianism often played a large role in creating such institutions, this clinic would not have existed without the help and support of both Harlem's black left and the increasingly activist African American church of the "long civil rights era." Not only did St. Philip's Church provide a physical home for the clinic, it also helped to integrate it into black Harlem, creating a patient community. The article concludes with a lengthy examination of these patients' clinical experiences. Relying upon patient case files, the article provides a unique snapshot of the psychologization of postwar American culture. Not only does the author detail the ways in which the largely working class patient community used this facility clinic, he also explores how the patients engaged with modern psychodynamic concepts in forming their own complex understandings of selfhood and mental health.

Social psychiatry and education for mentally retarded people is by no means an achievement of the last 50 years. Influenced by the Enlightenment, some physicians thought and acted 150 years ago consistently with today's insight. The mental hospitals of Erlenmeyer senior and junior in Bendorf near Koblenz, Germany, serve as an example. In contrast to large and mostly governmentally led or supported institutions, smaller private institutions treated mentally retarded people more personally, lovingly, and attentively.

Emil Kraepelin (1856-1926) whose hundred and fiftieth birth anniversary we are celebrating this year, is one of the most renowned figures of psychiatry. His Memoirs published in 1983 provide insight on the individual. In his early career he lived in Würzburg, Munich, Leipzig, Leubus, Dresden, and then in Dorpat in 1886 (as visiting professor) where he stayed for five years, in Heidelberg (as regular professor) from 1891 to 1904, and lastly in Munich. Kraepelin ranks among the great clinical medicine forerunners who followed in Kahlbaum's footsteps. For him, the foremost task of scientific psychiatry was to circumscribe pathological entities. At the foundation of Kraepelin-inspired scientific psychiatry lies the notion of the <> of disease, as opposed to the <> approach (5th edition of the Treatise), whereby it is no longer concerned with the study of mental disorder in terms of symptoms but rather in terms of conditions of occurrence, evolution and outcome thereof. This method produced two well-known results: the unification and recognition of <>, and the definition of <> (dementia praecox). These results are described in the Treatise of Psychiatry which has had eight editions during the author's lifetime (from 1883 to 1915), and which presents Kraepelin's systematic nosography covering the entire field of mental illness. Such an innovative method required special tools capable of exploring not only the symptoms, as had been done previously, but the pathological process per se: therefore, Kreapelin created a systematic method to conduct psychiatric research and founded a Research Establishment divided into different sections (histopathology, topographic histology, serology, genealogy). Alois Alzheimer and Franz Nissl, among others, were closely associated with his work. Kreapelin's thought was not set, however, and by the end of his career it took a turn toward a more comprehensive type of psychiatry (1920) taking into account the social aspects (<>). From the therapeutic and institutional viewpoints, Kraepelin remained faithful throughout his life to the no-restraint practice by abolishing any restraint methods wherever he worked; by establishing a trust-based relationship with the patients; by allowing the patients to correspond and by opening the institution to visitors. Additionally, he participated actively in the struggle against alcoholism and syphilis. He is also one of the initiators of cross-cultural psychiatry (<>). Although he lead a medical career, Kraepelin was also interested in experimental psychology, and he thought of his works in that area as more important than his clinical achievements. He was closely connected with Wilhelm Wundt with whom he worked (at the Institute of Psychology of Leipzig where Kraepelin was one of the first medical doctors to collaborate with Wundt) and then exchanged letters. Some of his experimental works, including the elaboration of series of tests aimed at studying the psychic effects of certain substances, herald the advent of psychopharmacology. Lastly, his Memoirs and Poems give insight on the intimate person of Kraepelin, as well as putting his affective life in perspective.

Some studies in the sociology of stress conceptualize their outcome variables as distress, while others treat the same outcomes as mental disorder. This article focuses on the importance of distinguishing between the two. It argues that there are fundamental differences between distress that arises in non-disordered persons and genuine mental disorder but that studies of stress typically fail to distinguish between these conditions. The article outlines the historical developments that led the field to conflate distress and disorder. Finally, it indicates some advantages for research, treatment and policy that can accrue when distress that is initiated and maintained by social conditions is distinguished from mental disorders that are dysfunctions of internal psychological mechanisms.

The study of the relationship between psychiatry and religion has become an issue of increasing importance for both research and clinical practice. This article presents the history of the R. M. Bucke Memorial Society for the Study of Religious Experience, established by Raymond Prince in Montréal in 1964 as one of the first scientific societies whose aim was to investigate those characteristics of religious experience of interest to psychiatry. It also describes some of Prince's own studies on religious experience.

About 1800, psychiatry was established as a medical discipline with special institutions (madhouses). Therefore, historiography of psychiatry focuses generally on the last 200 years. This contribution will also illustrate aspects of medical and cultural history, which nowadays are mostly supposed to be less important: the premodern concept of melancholy and hypochondria between humoral pathology, demonology, and psychology; the assessment of psychiatric illness as a "creative malady," even complementary to genius; the dialectics of psychiatric therapies between suppression and emancipation, which is especially prominent in the early nineteenth century in regard to "moral treatment" ( psychische Kur in German), a topic stressed vigorously by the "antipsychiatry" movement around 1970; the denunciation of patients and sections of the population by eugenics ( Rassenhygiene in German) and racism (especially toward the Jews) by psychiatrists. Finally, the miraculous mechanisms of mass hysteria of "normal" individuals are questioned.

Background: The Social, Genetic and Developmental Psychiatry Centre was established by the Medical Research Council, in partnership with the Institute of Psychiatry, King's College London, in 1994., Method and Results: The paper describes the origins of the Centre; the reasons why a new initiative was needed in the early 1990s; the thinking that led to the proposal for a major interdisciplinary research centre that integrated social, genetic and developmental research perspectives; the approach to international recruitment of world leaders; and the initial research accomplishments with respect to the basic goal of understanding nature-nurture interplay., Conclusions: The structure and interdisciplinary approach of the Centre have proved a success and the initial accomplishments have begun to meet the objectives of showing how nature-nurture interplay is involved in the development of psychiatric disorders.

The article provides a historical reconstruction of the period leading up to what has become known as Brazil's Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazil's official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.

This paper discusses tensions and contradictions experienced by a group of psychologists in post-1994 South Africa as we struggled to develop an MA program in community psychology. Situating our work within the history of the subdiscipline and the historical context confronting South Africans in the "wake of apartheid," we explore models of community psychology that informed praxis under apartheid and contemporary challenges confronting a country in transition. We discuss three tensions that inform the ongoing program development. These include (1) the construction and deconstruction of Western and indigenous knowledge systems; (2) assessment and intervention at multiple levels and from differing value perspectives; and (3) paradoxes experienced by a team of university-educated, primarily White academic staff committed to challenging oppression. We conclude our discussion by suggesting that, within these shifting sands of economic, political, cultural, and institutional change community psychology must, of necessity, resist rigid self-definition and seek to position itself as a "work-in-progress." We suggest that this seemingly anomalous self-description may be suggestive for other community psychologists-in-the-making facing similar challenges within the majority world.

American sociologists and psychiatrists have often characterized cities as sites of social disintegration conducive to insanity. Small-town rural life, by contrast, has been presented as ideally suited for fostering mental health. Early research in psychiatric epidemiology confirmed these views. After World War II, psychiatrists and sociologists collaborated in influential research projects on mental illness in the community. Although these studies were guided by theories of social stratification, which ignores location, cities remained problematic for psychiatrists because they contained high concentrations of poverty and social problems and, consequently, mental health problems.