Social psychiatry is a branch of psychiatry that focuses on the
interpersonal and cultural context of mental disorder and mental
wellbeing. It involves a sometimes disparate set of theories and
approaches, with work stretching from epidemiological survey research
on the one hand, to an indistinct boundary with individual or group
psychotherapy on the other.
Social psychiatry combines a medical
training and perspective with fields such as social anthropology,
social psychology, cultural psychiatry, sociology and other
disciplines relating to mental distress and disorder. Social
psychiatry has been particularly associated with the development of
therapeutic communities, and to highlighting the effect of
socioeconomic factors on mental illness.
Social psychiatry can be
contrasted with biopsychiatry, with the latter focused on genetics,
brain neurochemistry and medication.
Social psychiatry was the
dominant form of psychiatry for periods of the 20th century but is
currently less visible than biopsychiatry.
2 Current work
3 See also
5 External links
The events of the first half of the 20th century brought the issue of
the relationship between the individual and the community to the fore.
Psychiatrists who showed a willingness to confront these issues at
home, after the war, called themselves social psychiatrists.
Psychoanalytic psychotherapy and all its offshoots were grounded in an
approach to the patient that focused almost exclusively on the
individual—the relational aspects of therapy were implicit in the
relationship between therapist and patient, but the main source of
problem and motivation for change was seen as being intrapsychic
(within the individual). The social and political contexts were
largely disregarded. Sarason observed in 1981, that "it is as though
society does not exist for the psychologist. Society is a vague,
amorphous background that can be disregarded in one's efforts to
fathom the laws of behavior" (Sarason 1981).
Early landmarks in social psychiatry included: Karen Horney, MD, who
wrote about personality as it interacts with other people (1937); Erik
Erikson, who discussed the influence of society on development (1950);
Harry Stack Sullivan's (1953) integration of sociological and
psychodynamic concepts, and his work on the role of early
interpersonal interactions in the development of the self; Cornell
University's Midtown Manhattan Study, which looked at the prevalence
of mental illness in Manhattan; August Hollingshead, PhD, and
Frederick Redlich, MD, looked at the influence of social class on
psychiatric conditions (1958); Alexander H. Leighton, MD, looked at
the relationship between social disintegration and mental illness
(1959); Burrow was an early pioneer of the social causes of mental
disorder and suggested "Sociatry" as the name for this new discipline.
Over the years many sociologists have contributed theories and
research which has enlightened psychiatry in this area (e.g. Avison
and Robins); The relationship between social factors and mental
illness was demonstrated by the early work of Hollingshead and
Readlich in Chicago in the 1930s, who found a high concentration of
individuals diagnosed with schizophrenia in deprived areas of the city
has been replicated numerous times throughout the world, although
controversy still exists as to the extent of drift of vulnerable
individuals to these areas or of a higher incidence of the disorder in
the socially disadvantaged; the Midtown Manhattan Study conducted in
the 1950s by
Cornell University hinted at widespread psychopathology
among the general population of New York City (Srole, Sanger, Michael,
Opler, and Rennie, 1962); the Three Hospitals Study (Wing JK and Brown
GW, Social Treatments of Chronic Schizophrenia: a comparative survey
of three mental hospitals, 1961, Journal of Mental Science, 107,
847-861) was a very influential work that has been replicated, that
demonstrated forcefully that the poverty of the environment in poor
mental hospitals lead to greater handicaps in the patients.
Social psychiatry was instrumental in the development of therapeutic
communities. Under the influence of Maxwell Jones, Main, Wilmer and
others (Caudill 1958; Rapoport 1960), combined with the publications
of critiques of the existing mental health system (Greenblatt et al.
1957, Stanton and Schwartz 1954) and the sociopolitical influences
that permeated the psychiatric world, the concept of the therapeutic
community and its attenuated form—the therapeutic milieu—caught on
and dominated the field of inpatient psychiatry throughout the 1960s.
The aim of therapeutic communities was a more democratic, user-led
form of therapeutic environment, avoiding the authoritarian and
demeaning practices of many psychiatric establishments of the time.
The central philosophy is that clients are active participants in
their own and each other's mental health treatment and that
responsibility for the daily running of the community is shared among
the clients and the staff. "TCs" have often eschewed or limited
medication in favor of psychoanalytically-derived group-based insight
Social psychiatry can be most effectively applied in helping to
develop mental health promotion and prevent certain mental illnesses
by educating individuals, families, and societies.
Social psychiatry has been important in developing the concept of
major "life events" as precipitants of mental ill health, including
for example bereavement, promotion, moving house, having a child.
Originally inpatient centers, many therapeutic communities now operate
as day centers, often focused on borderline personality disorder and
run by psychotherapists or art therapists rather than psychiatrists.
Social psychiatrists help test the cross-cultural use of psychiatric
diagnoses and assessments of need or disadvantage, showing particular
links between mental illness and unemployment, overcrowding and single
Social psychiatrists also work to link concepts such as self-esteem
and self-efficacy to mental health, and in turn to socioeconomic
Social psychiatrists work on social firms in regard to people with
mental health problems. These are regular businesses in the market
that employ a significant number of people with disabilities, who are
paid regular wages and work on the basis of regular work contracts.
There are approximately 2,000 social firms in Europe and a large
percentage of people with disabilities who work in social firms have a
psychiatric disability. Some are specifically for people with
psychiatric disabilities.(Schwarz, G. & Higgins, G: Marienthal the
social firms network Supporting the Development of Social Firms in
Europe, UK, 1999)
Social psychiatrists often focus on rehabilitation in a social
context, rather than "treatment" per se. A related approach is
Facilitating the social inclusion of people with mental health
problems is a major focus of modern social psychiatry.
American Association of Community Psychiatrists
Structured Clinical Interview for DSM-IV (SCID)
Relational disorder (proposed DSM-V new diagnosis)
^ Bhugra, D., & Till, A. (March 2013). "Public mental health is
about social psychiatry". International Journal of Social Psychiatry.
59 (2): 105–106. CS1 maint: Multiple names: authors list (link)
S Moffic (1998) Social Psychiatry, Managed Care and the New
Millennium. Psychiatric Times. December 1998 Vol. XV Issue 12
L. Srole, T. Sanger, S. Michael, M.K. Opler, and T.A.C. Rennie, Mental
Health in the Metropolis: The Midtown Manhattan Study, McGraw, 1962
Mohan, Brij. 1973. Social
Psychiatry in India: A Traetise on the
Mentally Ill. Calcutta: Minerva.
Faculty of Rehabilitation and Social
Psychiatry of the Royal College
of Psychiatrists in the UK.
Social psychiatry and public mental health: present situation and
future objectives. Time for rethinking and renaissance?
Child and adolescent psychiatry
American Board of
Psychiatry and Neurology
American Neuropsychiatric Association
American Psychiatric Association
Campaign Against Psychiatric Abuse
Chinese Society of Psychiatry
European Psychiatric Association
Global Initiative on Psychiatry
Hong Kong College of Psychiatrists
Independent Psychiatric Association of Russia
Indian Psychiatric Society
National Institute of Mental Health
Royal Australian and New Zealand College of Psychiatrists
Royal College of Psychiatrists
Working Commission to Investigate the Use of
Psychiatry for Political
World Psychiatric Association
Taiwanese Society of Child and Adolescent Psychiatry
Philosophy of psychiatry
Political abuse of psychiatry
Psychiatric survivors movement
Outline of the psychiatric survivors movement
by condition treated
Borderline personality disorder
Dimensional models of personality disorders
Impulse control disorders
Trauma model of mental disorders
Symptoms and behaviors
Feelings of emptiness
Idealization and devaluation
Dialectical behavior therapy
Dynamic deconstructive psychotherapy
Transference focused psychotherapy
BPDFamily (support group)