Are cities bad for our mental health?

Are cities bad for our mental health? The question of cities and mental health was once a key topic for sociologists and psychiatrists. In the 1930s, sociologists Faris and Dunham argued that the prevalence of schizophrenia in Chicago was caused, in part, by the presence of social disorganization. Fitzgerald, Rose and Singh claim this question then disappeared for a number of years from the mainstream of psychiatric and sociological concerns. However, in recent years, it has been resurrected. This resurgence of interest has been more marked in discussions around epidemiology, but is also, if more slowly, happening within the broader social sciences. Yet, despite this resurgence, there are still many outstanding questions about the complex relation between living in cities and mental health. The question of whether cities are bad for our mental health, in short, needs more careful sociological attention.

A number of studies over the last two decades have consistently documented that urban life raises the risk of developing mental disorders. In broad strokes, the finding is this: “urbanicity” seems to have a strong, potentially causal, effect on one’s chance of developing mental disorders. This has specifically been linked to diagnoses of schizophrenia.

Of course, causality is difficult to ascertain. But some studies have claimed “dose-response” effects of urbanicity on the risk of schizophrenia. That is, the longer one is exposed to an urban environment, the apparently, the higher one’s risk of a diagnosis of schizophrenia.

A central issue for these studies is how to measure urban life. The term “urbanicity” is often used, and functions as a shorthand for population density. But living in a city can be many different things. The density and varied forms of city hides countless forms of life and modes of living, which makes these troubling findings pose more questions than clear answers.

Interestingly, the findings that link cities to ill mental health seem to be specific to Northern Europe. The strongest evidence is from countries like Denmark, the Netherlands and the UK. One recent study looked specifically at levels of diagnosis of psychosis and urban living in six different countries and found something rather counter-intuitive. In this study, urban living did indeed relate strongly to levels of diagnosis of psychosis in Amsterdam and in (Southeast) London. But it did not for Spain, nor for France. In Italy the research team found an inverse effect – urban living here seemed to protect against a diagnosis of psychosis. To make this even more complex, another study indicates that the link between psychiatric diagnoses and urban life is not found in low- and middle-income countries. So, cities seem to be potentially bad for people’s mental health, but primarily for inhabitants of Northern European cities such as London, Copenhagen and Amsterdam. And this risk is strongest for diagnoses schizophrenia, although one study has found (in Denmark) increased risk for almost all psychiatric diagnoses.

The idea that cities are bad for our mental health latches onto a much older intellectual undercurrent, wherein the city is named (and shamed) as the epitome of modernity, for good and for ill. This stream of thought has also been deeply concerned, for at least a century, with the psychology of the urban inhabitant. For the sociologist Ferdinand Tönnies, for example, the social relations in cities were impersonal and distanced (reflecting capitalist society). In a similar vein, Georg Simmel argued that the barrage of stimuli in cities would create a particular “metropolitan” way of being a person, prone to a form of distanced rationality. This was famously taken up by Louis Wirth in his essay “Urbanism as a Way of Life” from 1938. Today, these insights still resonate with many. Cities can be stressful. Their intensity can be overwhelming, as Simmel argued long ago, and so can their many different sounds, smells, and constant confrontations with strangers.

Of course, more contemporary thinkers argue that cities are not so easily described. Cities surely offer both opportunities for close social relations (“community”) and solidarity, as much as they offer many forms of ruthless precarity. In an excellent essay, Fran Tonkiss argues that the impersonal distanced social ties available in cities also provides crucial freedom: anonymity. This is often forgotten in febrile debates over the importance of community. Cities offer the freedom of blending in with the crowd, the freedom of others being indifferent towards you. A freedom which, Tonkiss points out, is at its heart ambivalent. For some, the freedom of anonymity may also be the despair of loneliness and isolation. In short: the social life of the urban dweller is not easily described and categorized.

Yet the disparity between even Northern and Southern European cities seem to cement that the explanation must lie in social life. Which, of course, returns us to the old and difficult questions of how one should understand social life (and social life in cities!) at all.

To ask what cities are, what they do to us, and who has the right to them, is to enter an old and complicated territory.

A prime challenge is to go above and beyond the many (old) ideas we have about “urbanism as a way of life”. For example, the idea that the city is stressful sits so deeply in many that it is hard to disentangle from the actual effects of urban life. Such ideas about urban life and distress pose troubling questions because they are also ways in which people understand and organize their own experiences. That is to say, the stress of the city is both an experience that many of us, myself included, experience. And it is also a way in which we understand and interpret the city. It is a way in which we (collectively) talk about the city and its effects. A way of narrating oneself and narrating one’s experience in the city: but this makes the experience no less real.

Another issue at stake in all this is the question of psychiatric diagnoses as such. The psychiatric categories used in epidemiological research have often been criticized. These categories have changed drastically since the early work of Faris and Dunham. For example, some leading psychiatrists no longer believe in schizophrenia as a unified psychiatric construct. Entangled in the question of cities and mental health, then, is also the question of what mental health and illness is.

In sum, the question of whether cities are bad for the mental health of their inhabitants is a difficult, and complex one. What is it about cities that relates to the development of ill mental health? And why does this relation seem to persist from 1930s Chicago to contemporary Copenhagen or London, yet not in places outside Europe? There is probably not a simple explanation for this. But there is considerable scope for more, and more fine-grained, sociological attention to the complex relations between urban life and mental health and illness.

About the Author: Rasmus Birk is Visiting Postdoctoral Researcher at King’s College London, Department of Global Health & Social Medicine, and Assistant Professor in psychology at Aalborg University, Denmark. His current work uses qualitative methods to explore the relationship between city life and mental health, focusing specifically on South East London. He is on twitter @rasmushbirk