Commissioned Book Review: Matthew Smith, The First Resort: A History of Social Psychiatry in the United States
| Published date | 01 May 2024 |
| DOI | http://doi.org/10.1177/14789299231189983 |
| Author | Matthew Thomas Johnson,Elliott Elliott Aidan Johnson |
| Date | 01 May 2024 |
Political Studies Review
2024, Vol. 22(2) NP1 –NP2
journals.sagepub.com/home/psrev
Commissioned Book Review
1189983PSW0010.1177/14789299231189983Political Studies ReviewCommissioned Book Review
book-review2023
Commissioned Book Review
The First Resort: A History of Social
Psychiatry in the United States by Matthew
Smith. New York: Columbia University Press,
2023. 396 pp., £25, ISBN 9780231203937
In contemporary debates on public health in
industrialised countries, there is a tendency to
apply qualitatively distinct assessments of
impact to those applied in low- and middle-
income countries. Whereas in the latter, mate-
rial development and increases in income are
accepted as fundamental means of improving
population health, in the former, there is often
methodologically complex debate about the
direction of causality between income and
health. Some four decades after the release of
the Black Report (Working Group on
Inequalities in Health, 1980) that established
the notion of social determinants of health and
presented clear socioeconomic means of pro-
moting population health, public health research
seems trapped in inward-focused technical que-
ries that speak to trees, not forests.
Matthew Smith’s The First Resort serves as
a timely reminder that research examining the
social determinants of mental health goes back
almost a century. Linking poverty, inequality,
community disintegration and social isolation
with mental illness is not a new concept. In that
regard, The Black Report merely articulated a
long-standing research tradition. Like today,
Smith demonstrates that many who conducted
research in the United States were reluctant to
articulate and advance the implications of their
findings. The social psychiatrists, who were
simultaneously psychiatrists and social scien-
tists, saw themselves primarily as academics,
not activists, even though some had been activ-
ists earlier in their careers. With clear implica-
tions for current debate, Smith notes that this
circumscribed the way in which scholars pre-
sented their work. In Mental Health in the
Metropolis (Srole, 1962), for example, 50 pages
are spent outlining methods, but only 50 words
on the implications, with no space devoted to
advancing specific policy. The key implication
is that researchers today need to do better, not
just than their forebears, but than they currently
do. We need to be bolder, more political and
more insistent about how our findings form the
foundations for evidence-based progressive
reform. We need to do this not just to produce a
4* REF Impact Case Study, but because there is
a compelling social need for such work. When
we do that well, the instrumental impact in aca-
demia follows naturally.
Smith’s second contribution, made at a time
in which the UK Government is committed to
Prevention in public health, is to remind us that
governments have legislated for preventive
mental health policies in the past. The US
Community Mental Health Center Act of 1963
was intended, not just to transfer care from asy-
lum to community, but to prevent mental illness
itself. In this regard, Smith highlights a related
problem for governments who do recognise
social determinants: ideology. The obstacle to
effective implementation in the United States in
the 1960s may be the same obstacle for effec-
tive deployment of Prevention today: a mis-
placed belief in deserving and undeserving
poverty, in which causality in the relationship
between, say, income and health is presented as
the latter to the former. Here, Smith highlights
the way in which an admirable policy agenda
could actually exacerbate harm: the war on pov-
erty was really a war on the poor. Rather than
empowering the poor by mitigating social
determinants, the solution was seen to be edu-
cating the poor to bring themselves up by their
bootstraps, transforming themselves from unde-
serving to deserving poor in the process. This
did not work and never has worked at popula-
tion level. Community mental health quickly
lost its preventive ethos and function and the
state increasingly relied upon the criminal jus-
tice system to deal with people with mental
health conditions. By 1980, the Diagnostic and
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