Timeless for
of country but it is a hard,
scenes
simplicity
Not
life?harvesting and rescuing sheep from harassing existence.
so
the snow?may make us yearn Photo: Syndication International
idyllic
widely thought that life in the country involves less strain than life in a city. Dr. Alexander Mitchell works in the Fens where he^sees the problems and pressures of rural life which, although different from those in a city, can be just as severe and damaging. It is
we
will
all have sung at
one
time
or
another
'Nymphs and shepherds come away', or read of 'Sport with Amaryllis in the shade', or listened to Beethoven's Pastoral Symphony. All this builds up in us a conditioned picture of the idyllic countryside in which rustic swains pass away the idle hours in innocent country pleasures. Most of us live in big, smoky, noisy cities and we like to think of the wide open sky, the green
and the meandering rivers; for me the word 'water-meadow' conjures up the essence of the English country scene. Most of us need this fantasy but it leads to a false appreciation of the true
fields,
situation. We see the Scottish Highlands on our summer holidays when the sun shines, the mountains tower above still, blue lochs and we conveniently forget about the winter months when the clouds come
down onto the hills, the rain pours down and the wind howls with a never-ending ferocity. We only see or think of one aspect of country life and this gives birth to all kinds of false generalisations and beliefs among which is the idea that country life is less 'stressful' than town life and that there is therefore less mental disorder in the country than the city. I would like to examine this belief in more detail. The most obvious difference between town and country is that in the country areas there are less people and more room. I am involved in running a psychiatric district service in what was the old historic Isle of Ely in East Anglia?an area of about 3,750 square miles with a population of 90,000 (a population density of 25 per square mile) compared with the Greater London Council area where there are up to 1,200 people per square mile. There is a greater variety of facilities in the Urban areas, but not necessarily an overall better standard of living?there are slums in the centre of large cities as bad as, if not worse than, the poorest housing areas in the villages. There is very much less industrial pollution in the countryside clearer air, fresher rivers?but the country has its difficulties too?pests such as rats, destruction of wild life by artificial insecticides, erosion of the soil: we have what are called Fen Blows in which the dry, crumbly topsoil, the result of constant drainage, can be blown away overnight taking the Precious spring sowing with it. There are greater educational and recreational facilities in the towns, but do people make full use of them? In the rural areas they are fewer but well supported?Rural Institutes, Young Farmers Clubs, Adult Education Classes. One thing the town and country share is lhe Pub as the centre of community life. What we are concerned with are the pressures ?n people which can lead to emotional breakdown; Pressures which are either physical or psychological or both. In the towns there are now undoubtedly well documented sources of stress: high density living whether in packed estates or blocks ?f flats; the isolation of the nameless individual in lhe anonymous crowd; the loss of clear cut personal and group identity?people keep very much fo themselves in isolated family units; the increas'fg cost of living especially for the elderly and ^?r those who live on their own; industrial pollution?smoke filled air, filthy rivers and canals, noise, adulterated foodstuffs; the pace of 'keeping UP with the Joneses' either at work or at home? lhe need to keep up with the rat race, and keep up
appearances. Recent experiments with rats have shown that an optimum popui?r a given living space theretheis rats are threatened lation density below which the empty space, and huddle together in small
groups, and above which they trample each other, many showing signs of nervous breakdown?quivering, fixation in one place, loss of appetite, diarrhoea and frequent urination, loss death. This is of weight and?in the extreme an analogue of what is happening to many people in our large, overpopulated cities. Overspill schemes could be a help, but there are other difficulties in helping town people to adjust to a new life in the country. Lord Taylor and Sidney Chave in their book 'Mental Health and Environment' showed that when a population was moved from London to a New Town, the incidence of psychosis remained about the same, but there was a development of 'New Town Blues', an increase in neurotic and preneurotic condiAlso tions. Young and Wilmott in their book 'Family and Kinship in East London' described similar disruption of traditional ways of life in Bethnal Green when people were moved out to the new and better housing conditions in 'Greenleigh'. In the early days of the move people broke down because they were so lonely in the country. They could not stand the lack of noise, the lack of neighbours intruding upon their personal space. The country is not necessarily the peaceful haven some would believe it to be. People still nourish, because I believe it meets a need in them, the idealised image of the countryside which includes the following elements: life is good, because it is lived in the clean open air; geographic isolation forces people into a healthy togetherness; you belong in the country because you can put your roots down in to the underlife of the village, where people still have a role and a function; living is cheap and derived directly from a closeness to the soil: life is healthy because it is good to be close to living and growing things; and life is meaningful because it takes on the rhythm and pace of nature itself. Each of these statements is potentially correct but each contains an idealised component. If we look at a rural area and see it as it really is, we will find a number of problems and pressures which can give rise to emotional distress and psychiatric disorder. There is a selective emigration out of the country into the town by young people and those who want to get on. This steadily depletes the area of the very people which it needs to keep it viable. Whole islands in the North of Scotland are derelict because the young went off to the big cities and the old could not maintain themselves but remained on to die. For those who choose to remain behind, or have no opportunity to leave, there are restricted employment outlets. Rural areas depend on agriculture. The expense of transportation precludes much light industry moving out into the country,
protective over
even
if there
are
the skills and labour force to
support it.
Being an agricultural worker is very hard, taxing work. It means working long hours, many in darkness, in the damp, in the mud, against pests and plant diseases. The farmer depends very heavily on the weather and government subsidies: if either fails, he may be bankrupt. Failure of the strawberry crop is a well recognised causative factor in our area in the origin of depression in the middle-aged wives of small-holders. The strawberries grown by the women and sold for jam, or to the passing tourists, pay for the rent and clothe her and her family, and give her that little extra to
spend
on
herself.
With only about 25 people to the square mile there is a lot of geographic and psychological space between them. This leads to social isolation unless there is transport and routes of communication. Public transport is usually infrequent and roads go the long way round skirting the dykes, ditches and the ploughed fields. There are limited recreational facilities and when you have to travel far to get them in the winter, it is often easier to sit at home and look at a world and a culture on television in which you cannot share, and this increases your frustrations. The standard of individual houses, especially in the isolated areas, can be very poor, still with no running water, no electricity and no indoor sanitation. Food will cost a lot more if it has to be delivered by van once a week and there is not such a wide choice of goods. Lack of refrigeration means food will be bought in small amounts which
again is expensive. The country districts are steeped in folklore about disease and death. There are strict ways of life to be observed otherwise misfortune, in the guise of illness, is likely to result. These folk beliefs are based on primitive fears of considerable strength which can lead to emotional disorder if accompanied by chronic tension and guilt. It is these very feelings which feed the notion of black magic and witchcraft, often very strong in the collective unconscious of country folk. Finally, there can be a kind of demoralisation in the country areas when the traditional agricultural ways of life have been ousted by the ways of so-called progress, without a new ethic being developed in their place. At least in the towns, making money and being a success in competition with one's neighbour provides some kind of meaning and purpose to the endless round of days. There are two special mental health problems in my own area. The first concerns subnormality. As I have said, the brighter people emigrate out of the area chasing better opportunities, leaving the less bright behind. The people who remain then inter-
and, together with a greater chance of a marriage between relatives because there is not such a wide field of choice, any recessive condition is perpetuated and the incidence of subnormality marry
rises. Even if there were not a true increase in the numbers of the subnormal, the condition would still be a greater problem because there are not the facilities available to take the burden off the family. In the town there may be the hospital, clinic or training centre, to help. On the other hand there is the one consolation that you are more likely to fit into a rural community if you are less bright than you would in the town where people have less time to be understanding and accepting when there is so much of a premium set on achievement and productivity. The other problem is the dilemma of the family in which there is a psychotic member. We see a number of families in which a young person appears, in the Laing sense, to have been driven mad by her family and there is no respite because there are not the number of other people around to dilute the effect of the nuclear family. Social isolation is one of the hallmarks of the schizophrenogenic family. This produces a condition which we call 'Fen Family Madness' in which there are very disturbed and pathological family relationships, often including incest, and in which it seems that the only way for the young person to escape is by becoming mad. As soon as this happens they are brought to the notice of the mental health services and are usually admitted to hospital, where, within 24 hours, the psychogenic psychosis resolves and they emerge as normal people once more. Their only plight is that the whole process is likely to be set in motion again once they have returned home, unless there is some radical change in family dynamics in the meanwhile. The important question is to what extent this is a variant of schizophrenia, or whether this is a condition in its own right with a different expectation of the course it will run. Mental disorder arises out of the human condition. Each one of us is the victim of our own fears and of our own failings. Each of us needs to build up a sense of confidence and self respect whicb come from the way we relate to others and they to us. Each of us has the need to work and the need to relax. Each of us needs to be in a right with our neighbour whether he lives next door in the town or two miles away over the fields in the country. Mental disorder arises i? both town and country because people have to live in both these places. The patterns may differ be-
relationship
in each area there are different pressures, but disorder arises because each human being is capable of anxiety and capable of despair.
cause
of country but it is a hard,
scenes
simplicity
Not
life?harvesting and rescuing sheep from harassing existence.
so
the snow?may make us yearn Photo: Syndication International
idyllic
widely thought that life in the country involves less strain than life in a city. Dr. Alexander Mitchell works in the Fens where he^sees the problems and pressures of rural life which, although different from those in a city, can be just as severe and damaging. It is
we
will
all have sung at
one
time
or
another
'Nymphs and shepherds come away', or read of 'Sport with Amaryllis in the shade', or listened to Beethoven's Pastoral Symphony. All this builds up in us a conditioned picture of the idyllic countryside in which rustic swains pass away the idle hours in innocent country pleasures. Most of us live in big, smoky, noisy cities and we like to think of the wide open sky, the green
and the meandering rivers; for me the word 'water-meadow' conjures up the essence of the English country scene. Most of us need this fantasy but it leads to a false appreciation of the true
fields,
situation. We see the Scottish Highlands on our summer holidays when the sun shines, the mountains tower above still, blue lochs and we conveniently forget about the winter months when the clouds come
down onto the hills, the rain pours down and the wind howls with a never-ending ferocity. We only see or think of one aspect of country life and this gives birth to all kinds of false generalisations and beliefs among which is the idea that country life is less 'stressful' than town life and that there is therefore less mental disorder in the country than the city. I would like to examine this belief in more detail. The most obvious difference between town and country is that in the country areas there are less people and more room. I am involved in running a psychiatric district service in what was the old historic Isle of Ely in East Anglia?an area of about 3,750 square miles with a population of 90,000 (a population density of 25 per square mile) compared with the Greater London Council area where there are up to 1,200 people per square mile. There is a greater variety of facilities in the Urban areas, but not necessarily an overall better standard of living?there are slums in the centre of large cities as bad as, if not worse than, the poorest housing areas in the villages. There is very much less industrial pollution in the countryside clearer air, fresher rivers?but the country has its difficulties too?pests such as rats, destruction of wild life by artificial insecticides, erosion of the soil: we have what are called Fen Blows in which the dry, crumbly topsoil, the result of constant drainage, can be blown away overnight taking the Precious spring sowing with it. There are greater educational and recreational facilities in the towns, but do people make full use of them? In the rural areas they are fewer but well supported?Rural Institutes, Young Farmers Clubs, Adult Education Classes. One thing the town and country share is lhe Pub as the centre of community life. What we are concerned with are the pressures ?n people which can lead to emotional breakdown; Pressures which are either physical or psychological or both. In the towns there are now undoubtedly well documented sources of stress: high density living whether in packed estates or blocks ?f flats; the isolation of the nameless individual in lhe anonymous crowd; the loss of clear cut personal and group identity?people keep very much fo themselves in isolated family units; the increas'fg cost of living especially for the elderly and ^?r those who live on their own; industrial pollution?smoke filled air, filthy rivers and canals, noise, adulterated foodstuffs; the pace of 'keeping UP with the Joneses' either at work or at home? lhe need to keep up with the rat race, and keep up
appearances. Recent experiments with rats have shown that an optimum popui?r a given living space theretheis rats are threatened lation density below which the empty space, and huddle together in small
groups, and above which they trample each other, many showing signs of nervous breakdown?quivering, fixation in one place, loss of appetite, diarrhoea and frequent urination, loss death. This is of weight and?in the extreme an analogue of what is happening to many people in our large, overpopulated cities. Overspill schemes could be a help, but there are other difficulties in helping town people to adjust to a new life in the country. Lord Taylor and Sidney Chave in their book 'Mental Health and Environment' showed that when a population was moved from London to a New Town, the incidence of psychosis remained about the same, but there was a development of 'New Town Blues', an increase in neurotic and preneurotic condiAlso tions. Young and Wilmott in their book 'Family and Kinship in East London' described similar disruption of traditional ways of life in Bethnal Green when people were moved out to the new and better housing conditions in 'Greenleigh'. In the early days of the move people broke down because they were so lonely in the country. They could not stand the lack of noise, the lack of neighbours intruding upon their personal space. The country is not necessarily the peaceful haven some would believe it to be. People still nourish, because I believe it meets a need in them, the idealised image of the countryside which includes the following elements: life is good, because it is lived in the clean open air; geographic isolation forces people into a healthy togetherness; you belong in the country because you can put your roots down in to the underlife of the village, where people still have a role and a function; living is cheap and derived directly from a closeness to the soil: life is healthy because it is good to be close to living and growing things; and life is meaningful because it takes on the rhythm and pace of nature itself. Each of these statements is potentially correct but each contains an idealised component. If we look at a rural area and see it as it really is, we will find a number of problems and pressures which can give rise to emotional distress and psychiatric disorder. There is a selective emigration out of the country into the town by young people and those who want to get on. This steadily depletes the area of the very people which it needs to keep it viable. Whole islands in the North of Scotland are derelict because the young went off to the big cities and the old could not maintain themselves but remained on to die. For those who choose to remain behind, or have no opportunity to leave, there are restricted employment outlets. Rural areas depend on agriculture. The expense of transportation precludes much light industry moving out into the country,
protective over
even
if there
are
the skills and labour force to
support it.
Being an agricultural worker is very hard, taxing work. It means working long hours, many in darkness, in the damp, in the mud, against pests and plant diseases. The farmer depends very heavily on the weather and government subsidies: if either fails, he may be bankrupt. Failure of the strawberry crop is a well recognised causative factor in our area in the origin of depression in the middle-aged wives of small-holders. The strawberries grown by the women and sold for jam, or to the passing tourists, pay for the rent and clothe her and her family, and give her that little extra to
spend
on
herself.
With only about 25 people to the square mile there is a lot of geographic and psychological space between them. This leads to social isolation unless there is transport and routes of communication. Public transport is usually infrequent and roads go the long way round skirting the dykes, ditches and the ploughed fields. There are limited recreational facilities and when you have to travel far to get them in the winter, it is often easier to sit at home and look at a world and a culture on television in which you cannot share, and this increases your frustrations. The standard of individual houses, especially in the isolated areas, can be very poor, still with no running water, no electricity and no indoor sanitation. Food will cost a lot more if it has to be delivered by van once a week and there is not such a wide choice of goods. Lack of refrigeration means food will be bought in small amounts which
again is expensive. The country districts are steeped in folklore about disease and death. There are strict ways of life to be observed otherwise misfortune, in the guise of illness, is likely to result. These folk beliefs are based on primitive fears of considerable strength which can lead to emotional disorder if accompanied by chronic tension and guilt. It is these very feelings which feed the notion of black magic and witchcraft, often very strong in the collective unconscious of country folk. Finally, there can be a kind of demoralisation in the country areas when the traditional agricultural ways of life have been ousted by the ways of so-called progress, without a new ethic being developed in their place. At least in the towns, making money and being a success in competition with one's neighbour provides some kind of meaning and purpose to the endless round of days. There are two special mental health problems in my own area. The first concerns subnormality. As I have said, the brighter people emigrate out of the area chasing better opportunities, leaving the less bright behind. The people who remain then inter-
and, together with a greater chance of a marriage between relatives because there is not such a wide field of choice, any recessive condition is perpetuated and the incidence of subnormality marry
rises. Even if there were not a true increase in the numbers of the subnormal, the condition would still be a greater problem because there are not the facilities available to take the burden off the family. In the town there may be the hospital, clinic or training centre, to help. On the other hand there is the one consolation that you are more likely to fit into a rural community if you are less bright than you would in the town where people have less time to be understanding and accepting when there is so much of a premium set on achievement and productivity. The other problem is the dilemma of the family in which there is a psychotic member. We see a number of families in which a young person appears, in the Laing sense, to have been driven mad by her family and there is no respite because there are not the number of other people around to dilute the effect of the nuclear family. Social isolation is one of the hallmarks of the schizophrenogenic family. This produces a condition which we call 'Fen Family Madness' in which there are very disturbed and pathological family relationships, often including incest, and in which it seems that the only way for the young person to escape is by becoming mad. As soon as this happens they are brought to the notice of the mental health services and are usually admitted to hospital, where, within 24 hours, the psychogenic psychosis resolves and they emerge as normal people once more. Their only plight is that the whole process is likely to be set in motion again once they have returned home, unless there is some radical change in family dynamics in the meanwhile. The important question is to what extent this is a variant of schizophrenia, or whether this is a condition in its own right with a different expectation of the course it will run. Mental disorder arises out of the human condition. Each one of us is the victim of our own fears and of our own failings. Each of us needs to build up a sense of confidence and self respect whicb come from the way we relate to others and they to us. Each of us has the need to work and the need to relax. Each of us needs to be in a right with our neighbour whether he lives next door in the town or two miles away over the fields in the country. Mental disorder arises i? both town and country because people have to live in both these places. The patterns may differ be-
relationship
in each area there are different pressures, but disorder arises because each human being is capable of anxiety and capable of despair.
cause
