The metropolis and the mind: are big cities affecting our mental health?

This is not stressful at all. Image: Carl Court/Getty.

It is often said that we are living through another period of mass urbanisation: an age in which more and more people, in all regions of the world, are moving from rural towns and villages and trying to make their lives in cities – often megacities with upwards of 25m inhabitants. Indeed, the United Nations now predicts that by 2050 two-thirds of the global population will live in cities.

Policymakers have tended to concentrate on the economic and environmental consequences of this development. But there has been less attention to the effects that such a movement might have on mental health. Given that many experience urban stresses and strains – the hubbub, the noise, the competition, the density, the unnatural and frenzied atmosphere, the enforced proximity to strangers, the frequent combination of crowds and isolation – should we not be paying closer attention to the mental, and sometimes pathological, experience of city living itself?


This question of the “metropolis and mental life” occupied many who tried to make sense of the last great period of urbanisation – that enormous rural-to-urban migration that took place in industrialising Europe and North America during the 19th century. The German sociologist Georg Simmel was one of the first to describe what he called the “blasé” attitude of the city-dweller – a kind of psychological indifference that was necessary if a person’s nerves were to cope with the endless nose and stimulation of city life.

At the same time, the developing science of epidemiology found disproportionately large amounts of mental illness among those now dwelling in the city – from the alcoholic delirium of the uprooted rural immigrant to the mental breakdown that is often called schizophrenia.

Where are England's mental health problems concetrated? This map shows the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses. Areas in dark blue are below average, yellow areas are similar to national average, light blue areas are above average. Image: Public Health England, Community Mental Health Profiles.

Psychiatrists have long tried to make sense of such patterns. Is it that those most prone to mental collapse “drift” to certain parts of the inner city where they feel at home? Or does something in the stress of city life itself cause these breakdowns in persons who would be perfectly adapted to country or village life? If the latter, then we need to explore what it is about life in the city: density of housing, deprivation, poverty and unemployment and the dynamics of race and racism that get intensified in urban space, and so on.

But, on the other hand, maybe all of these act as precipitating factors, which affect those who are vulnerable because of a biological predisposition. Or maybe it’s both: are the roots of this urban mental disorder in the individual, in the city, or in the relation between?


Unanswered questions

Despite detailed demographic, epidemiological and sociological work, this question remains unresolved: no consensus has been formed about the relations between mental life and the metropolis. Given the rise of megacities, and the challenges of planning mental health services, that question is even more urgent than it was in the 19th and 20th centuries.

In a new paper, written for the Economic and Social Research Council’s (ESRC) Urban Transformations portfolio, and arising out of a series of interdisciplinary workshops funded by the ESRC, we argue that answering this question requires us to bridge the gulf between the social sciences and the biological sciences.

Incidence of mental health reporting in London. Areas in dark blue are below average reporting, yellow areas are similar to national average, light blue areas are above average. Image: Public Health England.

Recent developments in the biological sciences have shifted our understanding of organisms and their relations with their physical and social milieu. Organisms, including human organisms, can no longer adequately be understood as enclosed systems bounded by membranes of cell, organ and skin. The findings of research in biology – from genetics to neuroscience – require us to conceive of human beings as open and permeable, developing and transforming over time, in ongoing dynamic interactions at the level of molecules, genes, cells and brains with their physical and their social environments.


Of course, many of the problems of city living are rooted in social and economic relations, but those relations are also matters of bodies and brains. Similarly, while mental disorders are undoubtedly manifested in neurobiological processes, we need to move beyond a focus on isolated individual brains in addressing them, begin to understand – and research – the city as a “neurosocial” space and to look at how urban life penetrates deep into the mental and neural life of city dwellers.

The street and the skin

New research, new methods and new data offer some promising pathways for novel theories and concepts to understand how urban existence gets under the skin. For example, we could combine approaches from biological and social sciences to understand how the precarious social lives of rural migrants in contemporary Shanghai are implicated in the development of psychiatric disorders in that rapidly expanding urban environment.

It might mean combining decades of detailed epidemiological data from the streets and housing estates of south-east London with current research on the neuroscience of stress – and with anthropological work that zooms in on the micro-interactions of street-life.

The task for researchers is challenging. Are the same processes at work in cities as different as Shanghai and London? Will the number of variables and factors in these neurosocial pathways be so large as to defy our attempts to frame them into a coherent theory?

Nonetheless, if we are going to get to grips with the consequences of urbanisation for mental health today, we need to start thinking very differently about city living – not simply as a form of social organisation that has biological consequences, but as a form of life whose neurological and sociological aspects are quite inseparable from one another.

Nikolas Rose is head of social science health & medicine at King's College LondonDes Fitzgerald is a lecturer in sociology at Cardiff University.

This article was originally published on The Conversation. Read the original article.

A version of this article also appears on Urban Transformations.The Conversation

 
 
 
 

How the rise of anti-crime politics caused lasting harm to Black Americans

"I see an awareness that has developed in the Black community in the last 10 years or so about how deeply racist the criminal justice system has become," James Forman Jr. says. (David McNew/Getty Images)

The police killing of George Floyd, and the protest movement that emerged from it, has reinvigorated a national conversation around reinventing criminal justice policy in the United States.

At the same time, reports that violent crime is rising in many US cities have resurrected talk of the much-disputed “Ferguson effect,” a theory put forward by law enforcement professionals, and some researchers, who argued that police slowdowns in the wake of the first wave of Black Lives Matter protests resulted in elevated rates of violent crime. President Donald Trump is trying to weaponise this narrative, paired with images of federal officers clashing with protesters in the streets of Portland, to wage a 1968-style backlash election campaign.

“People who want to mobilise a lock-them-up style of either policing or prosecution have tried to weaponise those short-term increases,” says James Forman Jr., professor of law at Yale Law School. “Criminologists will say you have to be very, very cautious about short-term movement [in crime statistics]. We don't know whether or not what we're seeing right now [with violent crime increasing] is going to sustain itself. But the fact is, it's here and people are talking about it.”

In 2018, Forman won the Pulitzer Prize in nonfiction for his book Locking Up Our Own: Crime and Punishment in Black America. Drawing on his experience as a public defender in Washington, DC, he traced the emergence of anti-crime politics in late 20th century Black communities. Forman showed how newly empowered Black politicians fought for policies they believed would protect and uplift Black Americans, but inadvertently contributed to mass incarceration. 


CityMetric recently caught up with Forman to discuss crime trends, where he sees reason for hope in this moment and how the Black political class’s attitude toward crime and punishment has shifted since the latter part of the 20th century. 

This interview has been edited and condensed. 

There is talk right now about a resurgence of crime and violence in American cities. We saw similar, more localised concerns after the initial 2015 Black Lives Matter protests in Ferguson and Baltimore. Do you fear this could reinvigorate the kind of politics you describe in your book among segments of the Black community and political class?

I fear that it could be reinvigorated nationally and also in the Black political class. Look at the political conversations that are happening in Atlanta right now, for example, a city that also has seen a short-term uptick in crime as it is a site of a lot of protests about George Floyd and Breonna Taylor on the national level, as well as Rayshard Brooks and Ahmaud Arbery more locally in Georgia.

I think that you can already see in some of the language of the local elected officials this idea that we have to be very careful about pulling back. [They are saying] “while the protesters may make some valid points, we can't risk returning to the ‘80s and ‘90s.” Those decades really traumatised the United States, and particularly traumatised Black communities. There's a deep fear about returning to the levels of the violence that we saw in the crack years.

You write a lot about class divides among Black Americans, where middle income and elite Black people don't suffer as much from extremely punitive policies. They also have closer ties to the politicians who are creating these policies. There are very specific groups of people, even in marginalised communities, whose voices are heard.  As a result of these dynamics, you write about Black politicians fighting for things like mandatory minimum prison sentences or against decriminalising marijuana. Is there still that disconnect between those who suffer the most from criminal justice policies and those who are actually heard in political discourse?  

Let me just say a caveat, that when we talk about class divisions in the Black community it's important to hold two truths in our head at the same time. Bruce Western and others have shown the way in which class, educational status, income can dramatically reduce the likelihood of being hardest hit by the criminal system – namely incarcerated. Middle class and upper middle class Black people get some measure of protection. It's also true at the same time that Black people of all classes are worse off relative to their class counterparts in the white community. 

One area where class is least protective is policing and police stops. The police do not know how many degrees you have. They don't know how much money you have in your bank account. I want to be very clear that in making this point about class, I'm not making the argument that race or racism don't matter in this context. 

In terms of how it plays out now, I see an awareness that has developed in the Black community in the last 10 years or so about how deeply racist the criminal justice system has become. Twenty or 30 years ago they had a consciousness, but there's levels of understanding. Many of the people I write about in the book wanted to promote the interests of the Black community. They weren't motivated by indifference or callousness. When presented with mounting evidence of how awful this system has been in Black lives, they're reconsidering and recalibrating. 

Lots of former elected officials have said to me some version of “I didn't know at the time and I appreciate that you showed us in our full complexity. I appreciate that you showed the pressures we were under. If I had known then what I know now, maybe I would have been less quick to go along with some of these harsh measures.” 

The second thing that has affected the Black political class has been the emerging movements, led by Black people in particular and led by young people. They not only educated leaders, but pressured them and made them understand that there is a political cost. If you're not moved by the moral argument, then you'll be moved by the political argument. You'll be moved by the people protesting outside the office of District Attorney Jackie Lacey in Los Angeles, for example, where Black Lives Matter LA has held, I believe, a year of consecutive protests against a Black district attorney who has had really some of the worst practices.

From what I can tell, she's been pressured by the movement to change some of her positions on important issues like prosecution of low-level drug offenders, for example, and the aggressiveness with which she prosecutes police officers for acts of violence.

What do you make of the calls to defend or even abolish the police?

What I find so compelling about abolition, initially in the prison context and extended to the police as well, is that it shifts the conversation and forces us to go through experiments in which we imagine what it would take to build that world. I think that exercise is very important, because it pushes us further than we are naturally inclined to go. Cultivating a broader imagination is an incredibly important part of this work, because as you know from my book, often it was lack of imagination that caused people to fall back on [punitive policies]. 

That's what caused D.C. Councilmember David Clarke to call the police rather than public health experts when he was overwhelmed with letters about heroin addicts in public space. He was anti-drug war, but he couldn't imagine responding to a call for help with heroin addicts with anything other than police. That's a very common move from even really good and progressive people. 

People who are for defunding, for abolition, are absolutely right about reinvesting that money into alternative structures that support communities. But the reinvestment part doesn't follow naturally from the terms. We might want to come up with a term that captures the new stuff we want to do. I think that's particularly important because one of the reasons Black communities have ended up supporting more police is that Black communities have always wanted their fair share of the resources.

Then, the evidence suggests the United States has too many police officers doing prophylactic, preventative, or stop-and-frisk style policing. The style of policing that leads to district level harassment, pulling people over for no reason. But we have too little investment in the parts of police departments that investigate unsolved crimes. I'm talking about the investigator or the detective who comes to your house after there's been a robbery, an assault, a rape, or homicide. 

As compared to European countries, in the United States we actually underinvest in those parts of our police departments. Jill Leovy’s book Ghettoside shows this in dramatic detail. She describes an LAPD that's stopping and frisking Black drivers wantonly and yet the homicide detectives are still relying on a fax machine and the fax machine is broken. They have to go with their own money to Staples to buy a printer. Meanwhile, other aspects of the department are kitted out in this ridiculous riot gear that makes them look like they're in Fallujah. 

That under investment is particularly damaging to Black communities because we're disproportionately victimised by crime. Because of racism and this allocation of resources, the police are less likely to respond in Black communities. The kids I used to work with in the charter schools in DC, we talk about no snitching, but one of the reasons they would never call the police after they'd been victimised by crime is they would say, “They're not even going to come. You're wasting time.” 

I did a Q&A with Jill Leovy too and her argument is one I've struggled to articulate in our present moment. She argues the state doesn't have a monopoly on violence in low-income Black neighbourhoods, because investigations of violence are deemphasised and crime victims or their loved ones often take retribution into their own hands.  But right now, establishing or preserving the state's monopoly on violence isn't an appealing talking point. 

Yes, this is another thing nobody's talking about. Whatever we're going to do instead of the police has to be accountable to the public. The best, most direct way to have accountability is to have the individuals be public employees. As long as we have 300 million guns in this country at least some of those state employees are going to themselves be armed. It's unreasonable to ask them to do the job without it. Not as many need to be armed as are armed now, but some of them need to be. But they can't be hiding behind union contracts or civil service protections which make it impossible to remove even the worst performing, most abusive officers. 

We can not call them police if we want to. That's semantic, but maybe symbolism matters. But those people have to be state employees. They can work with community-based nonprofits, but there are also communities that don't have as robust of a nonprofit network, and they deserve protection too. These [community] groups have to be accountable to the state and, when they don't exist, the state has to be there. 

Progressives get all the points I just made when it's applied to education. The notion that things be public and accountable to the state is understood when it comes to schools. It's exactly why so many people on the left are opposed to charter schools, because they say they don't have public accountability. They want these things to be a state function. But this point about the difficulty in removing this entirely from the hands of the state is, I think, one that liberals and progressives understand from other contexts.

Jake Blumgart is a staff writer at CityMetric.