Australian and New Zealand Journal of Psychiatry (1975) 9 : 77
MENTAL HEALTH IN ISOLATED NEW MINING TOWNS IN AUSTRALIA* By P. W. BURVILL:k*
Many new towns have come into existence in Australia in recent years consequent upon the discovery of so many rich mineral deposits and an opportunity to market these. The biggest concentration of these towns is in the Pilbara district in the North-West of Western Australia, where two existing towns have expanded tenfold and many new towns, with populations of 3,000 to 14,000 have been built. In 1973 a conference was held in Kanibalda. a nickel mining town in W.A. under the auspices of U.N.E.S.C.O., entitled Man and New Towns im Isolated the Environment Settings. The speakers were from many disciplines including, architecture, botany, engineering, local government, sociology, town planning, and psychiatry. One of the foci of interest was health, especially mental health, in these settings.
-
As at that conference, I will deal with the psychiatric aspects of these towns with the emphasis on their being new and isolated.
- people living in caravans are the worst affected - their conditions are either hot and dusty, or hot and humid, and the women feel trapped in a small confined space all day. - people complain of the harsh unattractive terrain and climatic conditions, and of the large distance from the cities and large towns. - there are no job opportunities for adolescents. -
people are dissatisfied with the limited educational facilities at senior high school level.
-
in some towns there is an alleged high de-facto rate and promiscuity.
- people in company towns complain bitterly of the company’s unsympathetic attitude, of the high cost of living and of generally great dissatisfaction with the way the company is running the town. - some of the general practitioners ask for regular and frequent visits from a psychiatrist, acting as a consultant.
If one speaks to general practitioners in these towns they consistently report:- there are a disproportionately large number of neuiotic women. - there is a very high alcohol consumption among the men. - the women are bored, lonely, find living conditions difficult, they complain of a lack of social and recreational outlets, there are no job opportunities for women and they want to leave as soon as possible but usually can’t because in these towns their husbands have much higher paid jobs than would be available elsewhere.
being earned, and where one might expect the more adventurous, more psychiatrically stable people to take up work.
“Presented at the 1 I th Annual Congress, Australian & New Zealand College of Psychiatrists; Perth, October 1974. **Associate Professor of Psychiatry, University of Western Australia.
To my knowledge there is n o published Australian research work pertinent to this theme. Professor Kidd and myself undertook a comparative study of patients attending the general practitioner in one of these expanding North-West towns and a town of similar size in the South-West, which had a stagnant population growth and economy. This study
That is, they postriIn!c rrri iiicrerised L I ~ I O U I Iof I psyclriutric illrzess arid dissutisftrction heirig due to rlie enviror~n~enf in wliich these people l i v e , using the word environment in the broadest possible sense. A n r i i f ~ ~ r n u t i vview c was expressed by the late Professor Kidd, viz. that otie might expect a decreased urnoririi of p.syc1riatric illness in tliese booniirig nrirlirig towfzs (Burvill & Kidd 1975). where big wages were
78
MENTAL HEALTH IN AUSTRALIAN MININGTOWNS
showed a decreased amount of psychiatric illness in the North-West town, but it also revealed that psychiatric illness in women formed a disproportionately high percentage of all first consutations to the general practitioners in the North-West town. The caravan park findings in Burvill and Kidd’s study underline a recurrent theme of the remainder of this paper, viz; that it is not the harshness of the terrain, or the isolation, or any other adverse environmental problem which is the prime aetiological factor in the production of mental illness in these towns, but the individual’s personality and his/her prior life experiences. Next let us consider some of the factors possibly affecting the onset of psychiatric illness in these towns and some of the groups of individuals who are most “at-risk’’ of developing such an illness. These will be dealt with under two major headings: ( a ) the environment and characteristics of the town, and ( b ) the characteristics of the inhabitants.
THE TOWN Isolation, These towns are isolated geographically from each other and from the cities and large towns in Australia. The Pilbara area in the North-West of Western Australia contains the biggest concentration of such towns, varying in population from 3,000-14,000 people. The area is approximately 700 miles by air from Perth and 1100 miles by road with no large town remotely near the area. The surrounding terrain is dry, harsh and unattractive and the easiest form of transport between the various towns in the area is by aeroplane. Travel by aeroplane is relatively expensive. However, isolation is a very relative term and is a much more complex concept than distance measured in miles. Perth inhabitants are surprised when overseas visitors point out that we are probably the most isolated city in the world, there being no towns with a population of more than 25,000 people within a circle of 1200 miles radius centred on Perth. Many Oxford Dons would feel isolated, or at least intellectually isolated, in a red brick university 100 miles away, as I suspect would many academic psychiatrists from Sydney and Melbourne if placed in Perth. There is nothing new about isolated towns in Australia - Darwin, Catherine, Mt. Isa and Alice Springs, to quote a few, have been with us for a long time. When I spoke to a general practitioner in a Tasmanian Hydro-Electric Construction town, which was built in a rugged uninhabited uncultivated mountainous area with only one access road, I was impiessed by the great similarity to the mental health problems he encountered in that town and those described by general practitioners in new mining towns in the Pilbara. This was in spite of the fact that this town was only 120 miles from Hobart and 30 miles from a long established small rural community.
There are a number of well known psychiatric epidemiological studies conducted in isolated communities, e.g. Sjogren (1948) in Sweden, Bremer (1951) in Norway, and the Leightons (1959) in Stirling County in Canada. None of these studies focused on isolation, per se, as a parameter to be studied. Rather they utilised the isolation as an important factor id helping to define a fairly static population, e.g. when Bremer was confined as the only doctor in an isolated Northern Norwegian fishing village for five years during the Second World War, he utilised his unique opportunity to conduct an epidemiological study of all the inhabitants. The Canadian literature (Siemens 1973) refer to certain stress symptoms in isolated Northern Canadian Community residents. Those most frequently referred to are: (a) (b) (c) (d)
mental health problems especially depression alcoholism and drunkenness extreme loneliness feelings of insecurity and uncertainty resulting from a srate of “tentativeness” or “transiency”. (e) “cabin fever”, also called “housewife psychosis” and “crowding”. (f) promiscuity (g) suicide-accident-injury-violence. This list, with the exception of “cabin fever”, is very similar to that described by general practitioners in the isolated new Australian towns. As Professor Siemans pointed out at the U.N.E.S.C.0.-Kambalda Conference few of these problem areas have been methodically studied with a view to understanding their causes and relationships with other factors of community life in isolated settings.
Personally I suspect that, in the Australian setting, isolation alone, as opposed to people’s perception of it, is not a prime factor in mental health problems. However one effect of isolation in these new towns is that relatives and established friends are no longer within easy travelling distance, and hence positive efforts must be made to make social contact within the immediate community. Some personalities are not very successful in so doing and consequently become socially isolated. This obviously applies more to the non-working housewife, but can also be seen in any newly developing suburb in the city, and is to some extent the lot of every new immigrant or family which shifts interstate. Possibly pertinent to these towns in the latter regard is Sainsbury’s (1955) work on suicide in London, where he found much support for his thesis that “where social mobility and social isolation are pronounced, community life will be unstable, without order or purpose, and this will be reflected to a greater or less degree in the suicide rate, because men and women are more prone to commit suicide where they live in, but apart from a social group which neither acknowledges nor provides means for satisfying their needs”.
P. W. BURVILL New Towns and Shifting In the past it had often been suggested in Britain that the uprooting of urban working class populations and their transplantation to new housing estates. may result in difficulties and even in mental illness (Hall 1966). There have been three relevant recent studies. one in Baltimore (Wilner et al. 1960, 1962), and two in the United Kingdom, viz: Taylor and Chave in Harlon New Town (1964). and Hare and Shaw in Croyden (1965). These three studies all had one aim in common, VIZ: to compare the physical and mental health of people in a new town or new housing estate with that of a comparable population in an older urban area (Hare, 1966). They all reached the conclusion that there was no difference between the two populations in the prevalence of neurotic illhealth, in spite of the fact that the social and physical conditions in the compared areas differed widely. Chester (1965) in a sociological study of a new housing estate, has found that people who were lonely and dissatisfied tended also to have been lonely and dissatisfied before they moved. Hall (1966) in a Sheffield Ph.D. Thesis study of people who had moved house in the previous two years, was unable to demonstrate the precipitation of psychiatric illness by moving house in previously well adjusted personalities. He was of the opinion that some neurotics project their personal difficulties on to their housing and neighbours, and that possibly a new housing environment formed a more suitable matrix for such projection than a well structured and well known one. Much the same could be said of these new mining towns in Australia. However the Australian towns differ greatly from the cited studies in that the population in these new mining towns are demographically much more heterogeneous, the environmental conditions are vastly different from that experienced by the majority of people prior to moving, and their reasons for opting to live in these towns are more numerous. As such the number of possible relevant interacting factors in the mining towns are very much greater and more varied than in the United Kingdom studies.
Why people shift to these new towns is important. The reasons are legion, and include the following. - A good opportunity to make a large amount of money relatively quickly and so enable the family to eventually buy their own home in the city and adequately educate their children - i.e. the family is collectively aiming to better their lot in life. Sometimes the husband alone goes North for one or more spells, leaving the family in the city.
-Certain
personnel, such as policemen, postal workers and teachers are transferred, often involuntarily. These workers are often financially disadvantaged, by having much higher living expenses but the same pay as in the city.
- Men
running away from domestic, financial, occupational or legal difficulties.
79
- De-facto relationships are common and often the partners seek anonymity in these towns.
-The drifters, people, invariably men, who drift from job to job, town to town, State to State.
-In
the early stages of the construction of the town, or when a town is continuing t o expand, construction camps housing only men form a relatively large proportion of the population. Obviously such a heterogeneously motivated group of people differ greatly in their adequacy of settling into the new community. Instability of the population is a marked feature of all these towns. Some people, especially those without families, stay only for weeks or months. Very few come with the intention of staying more than two or three years. As such there is a relative lack of any semblance of civic pride and of taking responsibility for building up community facilities, as compared with established stable rural towns. Open v. Closed Towns These new towns can be classified as open or closed towns. Open towns are those which have their own elected shire or roads board councils, and the majority of houses and facilities are privately owned, or owned by companies or organisations other than mining companies. This is the situation in nearly every town or city in Australia. Closed towns are those built and almost completely owned, by the mining company operating in that particular area. As such the company is the landlord, the employer, the governing body and the benefactor of most community facilities. Thus any environmental factor, be it house, shops, hotel, schools, hospital or sporting facilities, is directly or indirectly associated with the company, and as such the company is always being blamed for any inadequacies in these facilities. This provides a ready situation for the personal difficulties and psychopathology of the inhabitants to be projected on t o the company everything is the company’s fault. One gets the impression of much more expressed dissatisfaction in these closed towns.
Housing in these new towns is prohibitively expensive. Very few can afford to buy their own home. Hence the possession of a well built modern company house at cheap rent is eagerly sought, but brings with it an employment-residential tie to a particular mining company, which is often felt to give the companies an unfair “lever” over the employeee. Some closed towns consist entirely of these houses and the single mens’ quarters. By contrast open towns have a number of S.H.C., private, mining and other company houses. However there are more people than houses, and thus many families either by absolute necessity, or for financial reasons, live in caravans in designated caravan parks. Living for any length of time in a caravan in the geographic and climatic conditions of these towns can be a very frustrating experience. The confined
80
MENTAL HEALTH IN AUSTRALIAN MININGTOWNS
spaces, the dust, the heat, the alternate dryness and humidity, and the flies produce very frustrating living conditions, especially for the women, most of whom are not working. The men “escape’’ from these conditions in working long hours, often six days a week, and often “escape” once again after work to the local pub. The general practitioners all comment on the large number of women consulting with neurotic problems who live in these caravans - they often feel frustrated in not knowing how to handle these situations. Hence some new mining towns have prohibited the establishment of caravan parks.
THE INHABITANTS There a number of factors associated with the individuals which make them more at-risk to develop a psychiatric illness, usually a non-psychotic illness, while living in these towns. -possessing certain personality characteristics -prior history of psychiatric illness -prior history of adverse reactions to shifting house, living away from relatives and close friends, or living in similar towns elsewhere -previous residency in the city as opposed to the country -being an immigrant -being a married woman with children but not working -current residency in a caravan park - current residency in the single men’s quarters -belonging to a group which feels relatively isolated, insecure, unable to fit into the milieu of the town, or which is too small to gain support from its own members.
Personality Characteristics Any weak, timid, insecure, anxiety prone person would be expected to react adversely to one or more of the stresses encountered in these towns unless much support was forthcoming from within the immediate family or friendship circle. Any difficulty in making friends and acquaintances would disadvantage inhabitants, especially the non-working woman who might then find herself lonely and socially isolated. Any person with a tendency towards projection of hidher difficulties to other people or to the environment, to paranoid types of reaction or towards pessimism, will easily find much to complain of and blame. The ability to socialise easily, to play sport, to resourcefulness, to take the initiative, and to have a wide range of interests and activities, would obviously greatly help in adjustment to the new community. Some introverted, rather schizoid single men, especially those immigrants or refugees from the Central and Eastern European countries easily find a nitch in the single men’s quarters, content in their regular working hours and relative isolation.
Prior History It would be expected that a person with a previous history of psychiatric illness, especially of a neurotic illness secondary to environmental stress, would be at greater risk to break down again if living in one of these towns. Similarly if there was a history of prior adverse reactions to shifting house, living away from relatives and close friends, or living in similar towns elsewhere. Such a prior history does not mean that they would necessarily develop a psychiatric illness, but merely that they would be at greater risk to d o so. There may have been other adverse factors operating before but not in the present situation, e.g. the death of a parent. Likewise the pressure of a close relative or friendship network in the present situation, but not present on the previous occasion (s), may help considerably in minimising any stress inherent in the new circumstances.
Sex and Marital State Enquiry in these towns suggests that single men living in the single men’s quarters have very few suitable social, sexual and recreational outlets, and that they spend much of their non-working hours drinking alcohol. Whether these develop into lasting alcoholic problems or are merely phases of very heavy drinking in their total life span with return to more normally acceptable levels once they return t o the city, is unknown. The general practitioners consistently comment on the large amount of neurotic and psychosomatic illness in the women who are unemployed, and apparently or allegedly, unable to reasonably occupy their time. Job opportunities for women are very limited. The general practitioners comment on the relatively low rate of similar neurotic and psychosomatic illness in men consulting them - they postulate that heavy alcoholic consumption caters for the control of any anxiety or other minor psychiatric symptoms. They also comment on the very few alcoholic problems with which they are consulted as opposed to the wives complaining of the sequelae of same. One can only conjecture as to what extent these observations are correct.
Migration Many of the various factors associated with the development of mental illness in immigrants have been discussed elsewhere (Burvill, 1973). Other factors being equal, there is no convincing reason to postulate that there is more likelihood of immigrants developing psychiatric illness in these towns than the Australian born. Nevertheless certain immigrant groups would possibly be at greater risk, especially those recently arrived. People from the United Kingdom form, by far, the biggest immigrant group in Australia. Richardson (1974) in describing the various factors involved in assimilation and adjustment of
P. W. BURMLI. British immigrants into the Australian community, states that for all immigrants the key to their future relations with Australia is the level of overall satisfaction they are able to achieve during the first 2-3 years of residence. It is very likely that if an overall unsatisfactory relationship has developed, or if an insufficient length of time has elapsed, before an immigrant moves into one of these mining towns, the chances of developing a psychiatric illness are greatly enhanced. The climatic contrasts between their land of origin and the Australian mining towns will be much less for immigrants from some of the Southern European countries and some of the Asian and African countries. Italian men have a long standing good record of hard work and good adaptation in many of the older established mining towns. Brief mention has been made of certain single, rather schizoid, immigrants from the Central and Eastern European countries who have worked for many years in various new development projects in isolated areas of Australia, being relatively content in the social and geographic isolation of these areas. The differential incidence of mental illness among various immigrant and refugee groups in Australia has been investigated by Krupinski and Stroller (1965) and Krupinski, Stroller and Wallace (1973). The female immigrant is obviously at much greater risk than her male counterpart, especially if her command of English is fairly deficient. The male is occupied in his working situation, learns the language and assimilates more rapidly. Evidence of possible relationships between internal migration and mental disorder does exist, but it is mixed and inconclusive with the weight in favour of migrants having raised rates of mental hospitalisation, but with no indication whether this would derive from self-selection or from the social change which is presumed to be experienced (Murphy, 1961). A person moving from another isolated or rural area, or from another mining town, would be less disadvantaged than an individual who has lived all his/her life in a large city. In fact moving from a suburb of Sydney to a new mining town in the Pilbara might be equally as stressful and as alien as a new immigrant moving to the same area. The findings of Kraus (1969a, b), Malzberg (1964) and Murphy (1965) are in line with the hypothesis that the larger the immigrant group the more likely it is to provide its nationals with a supportive, and hence psychologically prophylactic, socio-cultural milieu. A recent conference on mental health in foreign workers (Verhaegen, 1972) reported several investigations which revealed a sense of isolation among the immigrants. The reasons varied between homesickness, strange customs and diet, and lack of religious support. However, the most important factor seemed to be an unwelcoming and irresponsible behaviour on the part of the host country, which increased the sense of insecurity of the immigrants and forced them to remain in groups of their own.
81
Lie Experiences, Personality Characteristics and General Susceptibility to Illmess The relationship between life experiences, personality characteristics and general susceptibility to illness has been investigated in detail by Hinkle and Wolff (1957) and by Hinkle et d , (1958). It is instructive to document some of their conclusions:1. Member of an otherwise homogeneous adult population exhibit differences in their general susceptibility to illness, such that some persons experience a greater number of illnessess per unit time than do others. 2. Those persons exhibiting the greater susceptibility to illness exhibit a greater susceptibility to all forms of illness, such that the greater the number of episodes of illness which they experience, the greater the number of organ systems which are likely to be involved. Those having the greater number of body illnesses are likely to experience more accidents and more disturbances of moods, thought and behaviour. 3. In general, illnesses are not distributed at random over the life of a person, but often appear in “clusters”. A cluster is usually of several years’ duration, and includes a number of illnesses of various aetiologies involving a number of organ systems and appearing concurrently or consecutively. Such clusters alternate with periods of relatively good health which are of variable duration. 4. The clusters of illness most often appear when a
person is having difficulty adapting to his environment, as perceived by him. Those persons who exhibit a high susceptibility to illness are those who exhibit the greatest difficulty in adapting to their life situations. Differences in the amount of illness exhibited by different men appear to be in part the result of inherent differences in their adaptive capacities, and in part the result of differences in the environmental situations which they encounter. Man’s relation to his social environment appears to have small influence upon the form which illnesses will take, but a major influence upon the time and situation in which the illnesses will occur and the course which they will pursue. 5 . The findings suggest that the determinants of
general susceptibility to illness are both genetic and environmental, but that the actual life situations encountered are less important in this respect than the ways in which these situations are perceived. The differences in the number of illness episodes experienced by the members of these groups appear to be related in part t a the fact that the more frequently ill people perceived their life experiences as more challenging, more demanding, and more conflict-laden, and
MENTALHEALTH IN AUSTRALIAN MININGTOWNS
82
perceived more disturbances of bodily processes and of mood, thought and behaviour as a result of their efforts to adapt to a great number of perceived challenges.
CONCLUSION It may be felt that this paper has placed too little importance upon the effect of the immediate environment in the production of mental illness in these towns. I have said, in effect, that these factors are merely precipitating or aggravating factors in the production of psychiatric illness, and that the way the inhabitants perceive their environment, or react to it, is determined by factors and events which precede their shifting to these new towns. Really there is nothing new in such an idea. One of the drawbacks of most epidemiological studies in psychiatry and especially of large surveys, is that the results are expressed in such terms as 35% of the population with characteristic A, e.g. being single, have psychiatric illness compared with only 15% with characteristic B, e.g. being married. This is a rather sterile superficial approach. We all know that the majority, if not all, psychiatric illnesses have a multiplicity of factors involved in their aetiology, rarely just one single factor. Too few investigators explore in depth why the other 65% with characteristic A did not develop psychiatric il1nes.s and why the 15% with characteristic B did. In the author’s opinion no further major progress will be made in the aetiology of psychiatric illness using the epidemiological approach until questions of this type are studied in detail. After all we know that, although such an aetiologically clear cut illness as tuberculosis is caused by a specific bacillus, a variety of sociological and other factors can determine why some individuals develop it much more frequently than others. To me these new mining towns in Australia provide an excellent population laboratory i n which many of the recurrent aetiological themes in psychiatry can be studied in depth.
REFERENCES Bremer, J. (1951). A social psychiatric investigation of a small community in Northern Norway. Acta Psychiarrica et Nerrrologica Scandinavicu, Supplement 62. Burvill, P. W. (1973). Immigration and mental disease. Australian and N e w Zealand Journal of Psychiatry, 7 : 1. Burvill, P. W. and Kidd, C. B. The two town study: a comparison of psychiatric illness in two contrasting Western Australian mining towns. Arrstralian and New Zealand Joirrnal of Psychiatry 9: 85. Chester, J. (1965). Satisfaction and Rehousing. Institute of Social Research, London. Hall, P. (1966). Some clinical aspects of moving house as an apparent precipitant of psychiatric symptoms. Jorrrnal of Psychosomatic Research, 10: 59.
Hare, E. H. (1966). Mental health in new towns: what next? Jorrrnal of Psychosomatic Research, 10: 53. Hare, E. H. and Shaw, G . K. (1965). Mental Health on a N e w Housing Estate. Oxford University Press, London. Hinkle, L. E., Christenson, W. N., Kane, F. D., Ostfeld, A., Thetford, W. N. and Wolff, H. G. (1958). An investigation of the relations between life experience, personality characteristics, and general susceptibility to illness. Psychosomatic Medicine, 20: 278. Hinkle, L. E. and Wolff, H. G . (1957). The nature of man’s adaptation to his total environment and the relation of thi- to illness. A . M . A . Archives of International Medicine, 99: 442. Hughes, C. C., Tremblay, M., Rapoport, R. N. and Leighton, A. H. (1960). People of Cove and Woodlot. Basic Books, New York. Kraus, J. ( 1969a). Some social factors and rates of psychiatric hospital admissions of immigrants in New South Wales. Medical Journal of Australia, 2: 17. Kraus, J. ( 1969b). The relationship of psychiatric diagnoses, hospital admission rates, and size of age structure of immigrant groups. Medical Jorrrnal of Arrstralia, 12: 91. Krupinski, J. and Stoller, A. (1965). Incidence of mental disorders in Victoria, according to country of birth. Medical Journal of Australia, 2: 265. Krupinski, J., Stoller, A. and Wallsce, L. (1973). Psychiatric disorders in Eastern European refugees now in Australia. Social Science and Medicine, 7 : 31. Leighton, A. H. (1959). M y Name is Legion. Basic Books, New York. Malzberg. B. ( 1964). Mental disease among foreign born in Canada 1950-52, in relation to period of immigration. American Journal of Psychiatry, 120: 971. Murphy, H. B. M. (1961). Social change and mental health. Milbank Memorial Frrrid Qrrarterly, 39: 385. Murphy, H. B. M. (1965). Migration and major mental disorders: a reappraisal, in Mobility and Mental Health (Ed. Kantor, M. B.). Charles C. Thomas, Springfield, Illinois. Richardson, A. (1974). British Immigrants and A ristralia: A Psychosocial Inquiry. Australian National University Press, Canberra. Sainsbury, P. ( 1 9 5 5 ) . Suicide in London: A n Ecological Strrdy. Chapman & Hall, Maudsley Monograph No. 1 , London. Siemens, L. B. ( 1973). Single-enterprise community studies in Northern Canada, in Paper presented to U.N.E.S.C.O. Seminar on Man and the Environment: N e w Towns in Isolated Settings, Kambalda. Sjogren, T. (1948). Genetic statistical and psychiatric investlgations of a West Swedish population. Acta Psyckiatrica Scaridinavica, Supplement 52.
P. W. BURVILL Taylor, Lord and Chave, S. (1964). Mental Health and Environment. Longmans Green, London. Verhaegen, F. (1972). Mental Health in Foreign Workers. Proceedings of the 7th Annual Meeting of the International Committee on Occupational Mental Health, Leuven. Quote by - Leading Article (1972). Lancet, 1: 1276.
Reprint requests to: P. W. Burvill University Department of Psychiatry Perth Medical Centre Shenton Park, WA 6008
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Wilner, D. M., Walkley, R. P., Schram, J. M., Pinkerton, T. C. and Tayback, M. (1960). Housing as an environmental factor in mental health. American Journal of Public Health. 50: 5 5 . Wilner, D. M., Walkley, R. P., Pinkerton, T. C. and Tayback, M. (1962). The Housing Environment and Family Life. John Hopkins Press, Baltimore.
MENTAL HEALTH IN ISOLATED NEW MINING TOWNS IN AUSTRALIA* By P. W. BURVILL:k*
Many new towns have come into existence in Australia in recent years consequent upon the discovery of so many rich mineral deposits and an opportunity to market these. The biggest concentration of these towns is in the Pilbara district in the North-West of Western Australia, where two existing towns have expanded tenfold and many new towns, with populations of 3,000 to 14,000 have been built. In 1973 a conference was held in Kanibalda. a nickel mining town in W.A. under the auspices of U.N.E.S.C.O., entitled Man and New Towns im Isolated the Environment Settings. The speakers were from many disciplines including, architecture, botany, engineering, local government, sociology, town planning, and psychiatry. One of the foci of interest was health, especially mental health, in these settings.
-
As at that conference, I will deal with the psychiatric aspects of these towns with the emphasis on their being new and isolated.
- people living in caravans are the worst affected - their conditions are either hot and dusty, or hot and humid, and the women feel trapped in a small confined space all day. - people complain of the harsh unattractive terrain and climatic conditions, and of the large distance from the cities and large towns. - there are no job opportunities for adolescents. -
people are dissatisfied with the limited educational facilities at senior high school level.
-
in some towns there is an alleged high de-facto rate and promiscuity.
- people in company towns complain bitterly of the company’s unsympathetic attitude, of the high cost of living and of generally great dissatisfaction with the way the company is running the town. - some of the general practitioners ask for regular and frequent visits from a psychiatrist, acting as a consultant.
If one speaks to general practitioners in these towns they consistently report:- there are a disproportionately large number of neuiotic women. - there is a very high alcohol consumption among the men. - the women are bored, lonely, find living conditions difficult, they complain of a lack of social and recreational outlets, there are no job opportunities for women and they want to leave as soon as possible but usually can’t because in these towns their husbands have much higher paid jobs than would be available elsewhere.
being earned, and where one might expect the more adventurous, more psychiatrically stable people to take up work.
“Presented at the 1 I th Annual Congress, Australian & New Zealand College of Psychiatrists; Perth, October 1974. **Associate Professor of Psychiatry, University of Western Australia.
To my knowledge there is n o published Australian research work pertinent to this theme. Professor Kidd and myself undertook a comparative study of patients attending the general practitioner in one of these expanding North-West towns and a town of similar size in the South-West, which had a stagnant population growth and economy. This study
That is, they postriIn!c rrri iiicrerised L I ~ I O U I Iof I psyclriutric illrzess arid dissutisftrction heirig due to rlie enviror~n~enf in wliich these people l i v e , using the word environment in the broadest possible sense. A n r i i f ~ ~ r n u t i vview c was expressed by the late Professor Kidd, viz. that otie might expect a decreased urnoririi of p.syc1riatric illness in tliese booniirig nrirlirig towfzs (Burvill & Kidd 1975). where big wages were
78
MENTAL HEALTH IN AUSTRALIAN MININGTOWNS
showed a decreased amount of psychiatric illness in the North-West town, but it also revealed that psychiatric illness in women formed a disproportionately high percentage of all first consutations to the general practitioners in the North-West town. The caravan park findings in Burvill and Kidd’s study underline a recurrent theme of the remainder of this paper, viz; that it is not the harshness of the terrain, or the isolation, or any other adverse environmental problem which is the prime aetiological factor in the production of mental illness in these towns, but the individual’s personality and his/her prior life experiences. Next let us consider some of the factors possibly affecting the onset of psychiatric illness in these towns and some of the groups of individuals who are most “at-risk’’ of developing such an illness. These will be dealt with under two major headings: ( a ) the environment and characteristics of the town, and ( b ) the characteristics of the inhabitants.
THE TOWN Isolation, These towns are isolated geographically from each other and from the cities and large towns in Australia. The Pilbara area in the North-West of Western Australia contains the biggest concentration of such towns, varying in population from 3,000-14,000 people. The area is approximately 700 miles by air from Perth and 1100 miles by road with no large town remotely near the area. The surrounding terrain is dry, harsh and unattractive and the easiest form of transport between the various towns in the area is by aeroplane. Travel by aeroplane is relatively expensive. However, isolation is a very relative term and is a much more complex concept than distance measured in miles. Perth inhabitants are surprised when overseas visitors point out that we are probably the most isolated city in the world, there being no towns with a population of more than 25,000 people within a circle of 1200 miles radius centred on Perth. Many Oxford Dons would feel isolated, or at least intellectually isolated, in a red brick university 100 miles away, as I suspect would many academic psychiatrists from Sydney and Melbourne if placed in Perth. There is nothing new about isolated towns in Australia - Darwin, Catherine, Mt. Isa and Alice Springs, to quote a few, have been with us for a long time. When I spoke to a general practitioner in a Tasmanian Hydro-Electric Construction town, which was built in a rugged uninhabited uncultivated mountainous area with only one access road, I was impiessed by the great similarity to the mental health problems he encountered in that town and those described by general practitioners in new mining towns in the Pilbara. This was in spite of the fact that this town was only 120 miles from Hobart and 30 miles from a long established small rural community.
There are a number of well known psychiatric epidemiological studies conducted in isolated communities, e.g. Sjogren (1948) in Sweden, Bremer (1951) in Norway, and the Leightons (1959) in Stirling County in Canada. None of these studies focused on isolation, per se, as a parameter to be studied. Rather they utilised the isolation as an important factor id helping to define a fairly static population, e.g. when Bremer was confined as the only doctor in an isolated Northern Norwegian fishing village for five years during the Second World War, he utilised his unique opportunity to conduct an epidemiological study of all the inhabitants. The Canadian literature (Siemens 1973) refer to certain stress symptoms in isolated Northern Canadian Community residents. Those most frequently referred to are: (a) (b) (c) (d)
mental health problems especially depression alcoholism and drunkenness extreme loneliness feelings of insecurity and uncertainty resulting from a srate of “tentativeness” or “transiency”. (e) “cabin fever”, also called “housewife psychosis” and “crowding”. (f) promiscuity (g) suicide-accident-injury-violence. This list, with the exception of “cabin fever”, is very similar to that described by general practitioners in the isolated new Australian towns. As Professor Siemans pointed out at the U.N.E.S.C.0.-Kambalda Conference few of these problem areas have been methodically studied with a view to understanding their causes and relationships with other factors of community life in isolated settings.
Personally I suspect that, in the Australian setting, isolation alone, as opposed to people’s perception of it, is not a prime factor in mental health problems. However one effect of isolation in these new towns is that relatives and established friends are no longer within easy travelling distance, and hence positive efforts must be made to make social contact within the immediate community. Some personalities are not very successful in so doing and consequently become socially isolated. This obviously applies more to the non-working housewife, but can also be seen in any newly developing suburb in the city, and is to some extent the lot of every new immigrant or family which shifts interstate. Possibly pertinent to these towns in the latter regard is Sainsbury’s (1955) work on suicide in London, where he found much support for his thesis that “where social mobility and social isolation are pronounced, community life will be unstable, without order or purpose, and this will be reflected to a greater or less degree in the suicide rate, because men and women are more prone to commit suicide where they live in, but apart from a social group which neither acknowledges nor provides means for satisfying their needs”.
P. W. BURVILL New Towns and Shifting In the past it had often been suggested in Britain that the uprooting of urban working class populations and their transplantation to new housing estates. may result in difficulties and even in mental illness (Hall 1966). There have been three relevant recent studies. one in Baltimore (Wilner et al. 1960, 1962), and two in the United Kingdom, viz: Taylor and Chave in Harlon New Town (1964). and Hare and Shaw in Croyden (1965). These three studies all had one aim in common, VIZ: to compare the physical and mental health of people in a new town or new housing estate with that of a comparable population in an older urban area (Hare, 1966). They all reached the conclusion that there was no difference between the two populations in the prevalence of neurotic illhealth, in spite of the fact that the social and physical conditions in the compared areas differed widely. Chester (1965) in a sociological study of a new housing estate, has found that people who were lonely and dissatisfied tended also to have been lonely and dissatisfied before they moved. Hall (1966) in a Sheffield Ph.D. Thesis study of people who had moved house in the previous two years, was unable to demonstrate the precipitation of psychiatric illness by moving house in previously well adjusted personalities. He was of the opinion that some neurotics project their personal difficulties on to their housing and neighbours, and that possibly a new housing environment formed a more suitable matrix for such projection than a well structured and well known one. Much the same could be said of these new mining towns in Australia. However the Australian towns differ greatly from the cited studies in that the population in these new mining towns are demographically much more heterogeneous, the environmental conditions are vastly different from that experienced by the majority of people prior to moving, and their reasons for opting to live in these towns are more numerous. As such the number of possible relevant interacting factors in the mining towns are very much greater and more varied than in the United Kingdom studies.
Why people shift to these new towns is important. The reasons are legion, and include the following. - A good opportunity to make a large amount of money relatively quickly and so enable the family to eventually buy their own home in the city and adequately educate their children - i.e. the family is collectively aiming to better their lot in life. Sometimes the husband alone goes North for one or more spells, leaving the family in the city.
-Certain
personnel, such as policemen, postal workers and teachers are transferred, often involuntarily. These workers are often financially disadvantaged, by having much higher living expenses but the same pay as in the city.
- Men
running away from domestic, financial, occupational or legal difficulties.
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- De-facto relationships are common and often the partners seek anonymity in these towns.
-The drifters, people, invariably men, who drift from job to job, town to town, State to State.
-In
the early stages of the construction of the town, or when a town is continuing t o expand, construction camps housing only men form a relatively large proportion of the population. Obviously such a heterogeneously motivated group of people differ greatly in their adequacy of settling into the new community. Instability of the population is a marked feature of all these towns. Some people, especially those without families, stay only for weeks or months. Very few come with the intention of staying more than two or three years. As such there is a relative lack of any semblance of civic pride and of taking responsibility for building up community facilities, as compared with established stable rural towns. Open v. Closed Towns These new towns can be classified as open or closed towns. Open towns are those which have their own elected shire or roads board councils, and the majority of houses and facilities are privately owned, or owned by companies or organisations other than mining companies. This is the situation in nearly every town or city in Australia. Closed towns are those built and almost completely owned, by the mining company operating in that particular area. As such the company is the landlord, the employer, the governing body and the benefactor of most community facilities. Thus any environmental factor, be it house, shops, hotel, schools, hospital or sporting facilities, is directly or indirectly associated with the company, and as such the company is always being blamed for any inadequacies in these facilities. This provides a ready situation for the personal difficulties and psychopathology of the inhabitants to be projected on t o the company everything is the company’s fault. One gets the impression of much more expressed dissatisfaction in these closed towns.
Housing in these new towns is prohibitively expensive. Very few can afford to buy their own home. Hence the possession of a well built modern company house at cheap rent is eagerly sought, but brings with it an employment-residential tie to a particular mining company, which is often felt to give the companies an unfair “lever” over the employeee. Some closed towns consist entirely of these houses and the single mens’ quarters. By contrast open towns have a number of S.H.C., private, mining and other company houses. However there are more people than houses, and thus many families either by absolute necessity, or for financial reasons, live in caravans in designated caravan parks. Living for any length of time in a caravan in the geographic and climatic conditions of these towns can be a very frustrating experience. The confined
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spaces, the dust, the heat, the alternate dryness and humidity, and the flies produce very frustrating living conditions, especially for the women, most of whom are not working. The men “escape’’ from these conditions in working long hours, often six days a week, and often “escape” once again after work to the local pub. The general practitioners all comment on the large number of women consulting with neurotic problems who live in these caravans - they often feel frustrated in not knowing how to handle these situations. Hence some new mining towns have prohibited the establishment of caravan parks.
THE INHABITANTS There a number of factors associated with the individuals which make them more at-risk to develop a psychiatric illness, usually a non-psychotic illness, while living in these towns. -possessing certain personality characteristics -prior history of psychiatric illness -prior history of adverse reactions to shifting house, living away from relatives and close friends, or living in similar towns elsewhere -previous residency in the city as opposed to the country -being an immigrant -being a married woman with children but not working -current residency in a caravan park - current residency in the single men’s quarters -belonging to a group which feels relatively isolated, insecure, unable to fit into the milieu of the town, or which is too small to gain support from its own members.
Personality Characteristics Any weak, timid, insecure, anxiety prone person would be expected to react adversely to one or more of the stresses encountered in these towns unless much support was forthcoming from within the immediate family or friendship circle. Any difficulty in making friends and acquaintances would disadvantage inhabitants, especially the non-working woman who might then find herself lonely and socially isolated. Any person with a tendency towards projection of hidher difficulties to other people or to the environment, to paranoid types of reaction or towards pessimism, will easily find much to complain of and blame. The ability to socialise easily, to play sport, to resourcefulness, to take the initiative, and to have a wide range of interests and activities, would obviously greatly help in adjustment to the new community. Some introverted, rather schizoid single men, especially those immigrants or refugees from the Central and Eastern European countries easily find a nitch in the single men’s quarters, content in their regular working hours and relative isolation.
Prior History It would be expected that a person with a previous history of psychiatric illness, especially of a neurotic illness secondary to environmental stress, would be at greater risk to break down again if living in one of these towns. Similarly if there was a history of prior adverse reactions to shifting house, living away from relatives and close friends, or living in similar towns elsewhere. Such a prior history does not mean that they would necessarily develop a psychiatric illness, but merely that they would be at greater risk to d o so. There may have been other adverse factors operating before but not in the present situation, e.g. the death of a parent. Likewise the pressure of a close relative or friendship network in the present situation, but not present on the previous occasion (s), may help considerably in minimising any stress inherent in the new circumstances.
Sex and Marital State Enquiry in these towns suggests that single men living in the single men’s quarters have very few suitable social, sexual and recreational outlets, and that they spend much of their non-working hours drinking alcohol. Whether these develop into lasting alcoholic problems or are merely phases of very heavy drinking in their total life span with return to more normally acceptable levels once they return t o the city, is unknown. The general practitioners consistently comment on the large amount of neurotic and psychosomatic illness in the women who are unemployed, and apparently or allegedly, unable to reasonably occupy their time. Job opportunities for women are very limited. The general practitioners comment on the relatively low rate of similar neurotic and psychosomatic illness in men consulting them - they postulate that heavy alcoholic consumption caters for the control of any anxiety or other minor psychiatric symptoms. They also comment on the very few alcoholic problems with which they are consulted as opposed to the wives complaining of the sequelae of same. One can only conjecture as to what extent these observations are correct.
Migration Many of the various factors associated with the development of mental illness in immigrants have been discussed elsewhere (Burvill, 1973). Other factors being equal, there is no convincing reason to postulate that there is more likelihood of immigrants developing psychiatric illness in these towns than the Australian born. Nevertheless certain immigrant groups would possibly be at greater risk, especially those recently arrived. People from the United Kingdom form, by far, the biggest immigrant group in Australia. Richardson (1974) in describing the various factors involved in assimilation and adjustment of
P. W. BURMLI. British immigrants into the Australian community, states that for all immigrants the key to their future relations with Australia is the level of overall satisfaction they are able to achieve during the first 2-3 years of residence. It is very likely that if an overall unsatisfactory relationship has developed, or if an insufficient length of time has elapsed, before an immigrant moves into one of these mining towns, the chances of developing a psychiatric illness are greatly enhanced. The climatic contrasts between their land of origin and the Australian mining towns will be much less for immigrants from some of the Southern European countries and some of the Asian and African countries. Italian men have a long standing good record of hard work and good adaptation in many of the older established mining towns. Brief mention has been made of certain single, rather schizoid, immigrants from the Central and Eastern European countries who have worked for many years in various new development projects in isolated areas of Australia, being relatively content in the social and geographic isolation of these areas. The differential incidence of mental illness among various immigrant and refugee groups in Australia has been investigated by Krupinski and Stroller (1965) and Krupinski, Stroller and Wallace (1973). The female immigrant is obviously at much greater risk than her male counterpart, especially if her command of English is fairly deficient. The male is occupied in his working situation, learns the language and assimilates more rapidly. Evidence of possible relationships between internal migration and mental disorder does exist, but it is mixed and inconclusive with the weight in favour of migrants having raised rates of mental hospitalisation, but with no indication whether this would derive from self-selection or from the social change which is presumed to be experienced (Murphy, 1961). A person moving from another isolated or rural area, or from another mining town, would be less disadvantaged than an individual who has lived all his/her life in a large city. In fact moving from a suburb of Sydney to a new mining town in the Pilbara might be equally as stressful and as alien as a new immigrant moving to the same area. The findings of Kraus (1969a, b), Malzberg (1964) and Murphy (1965) are in line with the hypothesis that the larger the immigrant group the more likely it is to provide its nationals with a supportive, and hence psychologically prophylactic, socio-cultural milieu. A recent conference on mental health in foreign workers (Verhaegen, 1972) reported several investigations which revealed a sense of isolation among the immigrants. The reasons varied between homesickness, strange customs and diet, and lack of religious support. However, the most important factor seemed to be an unwelcoming and irresponsible behaviour on the part of the host country, which increased the sense of insecurity of the immigrants and forced them to remain in groups of their own.
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Lie Experiences, Personality Characteristics and General Susceptibility to Illmess The relationship between life experiences, personality characteristics and general susceptibility to illness has been investigated in detail by Hinkle and Wolff (1957) and by Hinkle et d , (1958). It is instructive to document some of their conclusions:1. Member of an otherwise homogeneous adult population exhibit differences in their general susceptibility to illness, such that some persons experience a greater number of illnessess per unit time than do others. 2. Those persons exhibiting the greater susceptibility to illness exhibit a greater susceptibility to all forms of illness, such that the greater the number of episodes of illness which they experience, the greater the number of organ systems which are likely to be involved. Those having the greater number of body illnesses are likely to experience more accidents and more disturbances of moods, thought and behaviour. 3. In general, illnesses are not distributed at random over the life of a person, but often appear in “clusters”. A cluster is usually of several years’ duration, and includes a number of illnesses of various aetiologies involving a number of organ systems and appearing concurrently or consecutively. Such clusters alternate with periods of relatively good health which are of variable duration. 4. The clusters of illness most often appear when a
person is having difficulty adapting to his environment, as perceived by him. Those persons who exhibit a high susceptibility to illness are those who exhibit the greatest difficulty in adapting to their life situations. Differences in the amount of illness exhibited by different men appear to be in part the result of inherent differences in their adaptive capacities, and in part the result of differences in the environmental situations which they encounter. Man’s relation to his social environment appears to have small influence upon the form which illnesses will take, but a major influence upon the time and situation in which the illnesses will occur and the course which they will pursue. 5 . The findings suggest that the determinants of
general susceptibility to illness are both genetic and environmental, but that the actual life situations encountered are less important in this respect than the ways in which these situations are perceived. The differences in the number of illness episodes experienced by the members of these groups appear to be related in part t a the fact that the more frequently ill people perceived their life experiences as more challenging, more demanding, and more conflict-laden, and
MENTALHEALTH IN AUSTRALIAN MININGTOWNS
82
perceived more disturbances of bodily processes and of mood, thought and behaviour as a result of their efforts to adapt to a great number of perceived challenges.
CONCLUSION It may be felt that this paper has placed too little importance upon the effect of the immediate environment in the production of mental illness in these towns. I have said, in effect, that these factors are merely precipitating or aggravating factors in the production of psychiatric illness, and that the way the inhabitants perceive their environment, or react to it, is determined by factors and events which precede their shifting to these new towns. Really there is nothing new in such an idea. One of the drawbacks of most epidemiological studies in psychiatry and especially of large surveys, is that the results are expressed in such terms as 35% of the population with characteristic A, e.g. being single, have psychiatric illness compared with only 15% with characteristic B, e.g. being married. This is a rather sterile superficial approach. We all know that the majority, if not all, psychiatric illnesses have a multiplicity of factors involved in their aetiology, rarely just one single factor. Too few investigators explore in depth why the other 65% with characteristic A did not develop psychiatric il1nes.s and why the 15% with characteristic B did. In the author’s opinion no further major progress will be made in the aetiology of psychiatric illness using the epidemiological approach until questions of this type are studied in detail. After all we know that, although such an aetiologically clear cut illness as tuberculosis is caused by a specific bacillus, a variety of sociological and other factors can determine why some individuals develop it much more frequently than others. To me these new mining towns in Australia provide an excellent population laboratory i n which many of the recurrent aetiological themes in psychiatry can be studied in depth.
REFERENCES Bremer, J. (1951). A social psychiatric investigation of a small community in Northern Norway. Acta Psychiarrica et Nerrrologica Scandinavicu, Supplement 62. Burvill, P. W. (1973). Immigration and mental disease. Australian and N e w Zealand Journal of Psychiatry, 7 : 1. Burvill, P. W. and Kidd, C. B. The two town study: a comparison of psychiatric illness in two contrasting Western Australian mining towns. Arrstralian and New Zealand Joirrnal of Psychiatry 9: 85. Chester, J. (1965). Satisfaction and Rehousing. Institute of Social Research, London. Hall, P. (1966). Some clinical aspects of moving house as an apparent precipitant of psychiatric symptoms. Jorrrnal of Psychosomatic Research, 10: 59.
Hare, E. H. (1966). Mental health in new towns: what next? Jorrrnal of Psychosomatic Research, 10: 53. Hare, E. H. and Shaw, G . K. (1965). Mental Health on a N e w Housing Estate. Oxford University Press, London. Hinkle, L. E., Christenson, W. N., Kane, F. D., Ostfeld, A., Thetford, W. N. and Wolff, H. G. (1958). An investigation of the relations between life experience, personality characteristics, and general susceptibility to illness. Psychosomatic Medicine, 20: 278. Hinkle, L. E. and Wolff, H. G . (1957). The nature of man’s adaptation to his total environment and the relation of thi- to illness. A . M . A . Archives of International Medicine, 99: 442. Hughes, C. C., Tremblay, M., Rapoport, R. N. and Leighton, A. H. (1960). People of Cove and Woodlot. Basic Books, New York. Kraus, J. ( 1969a). Some social factors and rates of psychiatric hospital admissions of immigrants in New South Wales. Medical Journal of Australia, 2: 17. Kraus, J. ( 1969b). The relationship of psychiatric diagnoses, hospital admission rates, and size of age structure of immigrant groups. Medical Jorrrnal of Arrstralia, 12: 91. Krupinski, J. and Stoller, A. (1965). Incidence of mental disorders in Victoria, according to country of birth. Medical Journal of Australia, 2: 265. Krupinski, J., Stoller, A. and Wallsce, L. (1973). Psychiatric disorders in Eastern European refugees now in Australia. Social Science and Medicine, 7 : 31. Leighton, A. H. (1959). M y Name is Legion. Basic Books, New York. Malzberg. B. ( 1964). Mental disease among foreign born in Canada 1950-52, in relation to period of immigration. American Journal of Psychiatry, 120: 971. Murphy, H. B. M. (1961). Social change and mental health. Milbank Memorial Frrrid Qrrarterly, 39: 385. Murphy, H. B. M. (1965). Migration and major mental disorders: a reappraisal, in Mobility and Mental Health (Ed. Kantor, M. B.). Charles C. Thomas, Springfield, Illinois. Richardson, A. (1974). British Immigrants and A ristralia: A Psychosocial Inquiry. Australian National University Press, Canberra. Sainsbury, P. ( 1 9 5 5 ) . Suicide in London: A n Ecological Strrdy. Chapman & Hall, Maudsley Monograph No. 1 , London. Siemens, L. B. ( 1973). Single-enterprise community studies in Northern Canada, in Paper presented to U.N.E.S.C.O. Seminar on Man and the Environment: N e w Towns in Isolated Settings, Kambalda. Sjogren, T. (1948). Genetic statistical and psychiatric investlgations of a West Swedish population. Acta Psyckiatrica Scaridinavica, Supplement 52.
P. W. BURVILL Taylor, Lord and Chave, S. (1964). Mental Health and Environment. Longmans Green, London. Verhaegen, F. (1972). Mental Health in Foreign Workers. Proceedings of the 7th Annual Meeting of the International Committee on Occupational Mental Health, Leuven. Quote by - Leading Article (1972). Lancet, 1: 1276.
Reprint requests to: P. W. Burvill University Department of Psychiatry Perth Medical Centre Shenton Park, WA 6008
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Wilner, D. M., Walkley, R. P., Schram, J. M., Pinkerton, T. C. and Tayback, M. (1960). Housing as an environmental factor in mental health. American Journal of Public Health. 50: 5 5 . Wilner, D. M., Walkley, R. P., Pinkerton, T. C. and Tayback, M. (1962). The Housing Environment and Family Life. John Hopkins Press, Baltimore.
