PSYCHIATRIC PROBLEMS IN NEW COMMUNITIES by ancient
city of Naples, Greek colonists in the 7th century B.C., is still called by its original name of "New Town" (Neapolis) and this may serve to remind us that new towns, and the problems they present, are as old as civilisation. What is new, however, and dates only from the mid-20th century, is the systematic study of how far the conditions of life in a new town may affect the mental health of people who live there. The study of mental health in new towns has developed for two reasons. Firstly, advances in medicine and in general standards of living have greatly reduced the amount of illfrom such obvious disorders ness as fevers, tuberculosis and malnutrition. This has given medical men more time and opportunity to study the less obvious, but not always less distressing conditions of mental disorder. Secondly, a vast number of new houses were needed in all belligerent countries after the second world war, and in Britain we wisely avoided the ribbon development of the inter-war years?"the spreading of the hideous town"? The and built new towns instead. result is that a sizeable proportion of our population now live in new towns or new housing estates, and the possible effects of this on their of become a matter has health
THE founded
by
general importance. From the
of
Hare, M.D.,
D-^
of the geographic or commer ^ attributes which ordinarily lead ^ the development of human c?m munities. That God made the and man made the town is truer ^ Moreov ; ever of the new towns. the people who live there are ( 3 representative of the population J but are whole, mostly young couples with growing families, have all moved there within a years of each other.
coU^;
and disadvant^. far as a new town has tages, these may be expected to to improvements in health. cleaner air, better ventilation, J crowding and adequate toilets combine to reduce the prevalent c respiratory infections, and of ^ municable diseases such as who^P ^ cough, gastro-enteritis and tube losis. Better washing facilities freedom from accumulated grime should mean less skin dise and home accidents should be &
Health In
advantages
so
-
indus^ ,
^
because of better lighting, and bec3 ^ of stairways less steep and tor. flt3 than in many old houses. [i health, too, might be expected ; improve. Houses that are ? J designed and easier to run, x more privacy for adults and t( space and quiet for the homework, should be less induce resentment fatigue,
^ likely^
chil^
irritability. ti>; Yet against this must be sQ\J disadvantages common to new life. Many families have moved .{
towns of view of health, have new towns advantages and disadvantages. The advantages are that the houses and the amenities have been planned?or should have been planned?with all the skill and experience gained over centuries. The disadvantages stem from the fact that a new town is not a natural growth but an artificial product, conceived on a planner's drawing-board and born in a place having none
Artificiality
E. H.
new
point
from choice, but because re-housed from buildings. They are in a sense J placed persons, and people* |, plants, do not always take not
were
being uprooted.
,
condefl1^,1
vve^,j
Young wives
find themselves a long way. $ their old homes, and sorely experienced help and advice of j mothers. The bad old slum w/ have been dirty and overcrop 58
1
it had
community spirit and a neighbourliness which the la,Ung housewife, who grew up to uKe. these things for granted, is to find missing in her new ^ildered Because the pressing need has ei* t
a
Vo
for
t0rvices Wait
houses to live in, other in the new towns have had their turn. So the housewife
fj ds the shops not so many nor so ?d, and prices higher because of t ttsport costs; if they are not formate enough to get employment in new town the men have further travel to work, and so are more a ay from home; and there are not e ?ugh clubs, cinemas or sports to keep the teenagers out *f0llnds .
.
toe
Mischief.
and TV reports ^spaper fhus there
are reasons why health ?ht be expected to improve in new and other reasons why it Ujj be expected to become worse. in fact do we find? In Britain du ,at the 1950s, newspaper articles television interviews often drew to the complaints of people 0 jjj Were bored, lonely and unhappy new towns and wanted to move a ?
?s? ^?ht
a:[,lng
^,ention aV-
b
ays
Such reports, however, must be taken with caution.
look for news, Igi^ters u.s opinions about
p
and in the
new
ticularly
towns,
when strongly expressed, news- Yet it might have been the proportion of complainants ty Srnall and that a similar propor?f people in old towns or \yL anye'Se woui^' if they had been have made equally adverse 0n| ^ents on their own communities.
thai6 tj0f
c0J:
?
studies?that systematic is, sUid" Pon ?S on random samples of the
healtk i-on anc* a comParison of -^n new towns with that in ^stricts?can 8ive a trustworthy
?th
s
er
studies ^tematic systematic studies
^a,ut
asking questions about "nerves", depression and irritability; they also studied the records of general practitioners and the local mental hospital. Comparing their findings with those of national surveys, they concluded there was a rather high rate of disorder
on the estate, and this to the loneliness and isolation caused by lack of social amenities. Dr. Chave, in collaboration with Lord Taylor, has recently completed a study of mental health in a new town.* The largest and certainly the most expensive study of this type (it cost $500,000) was made in Baltimore, U.S.A., by Wilner and his colleagues (1962). They measured the health of 600 families who were poorly housed, but half of whom were shortly due to be re-housed on a new estate. They then continued over a period of two years to measure the health both of the families who moved and of those who stayed. They were thus able to compare the health of the two groups of families. As regards physical health, they found that for the first few months after moving to better houses, there was an increase in nervous
they attributed
and
respiratory
are
hard to
Not only are they laborious but it is neither simple nor eas c?stly, to Revise methods of measuring the .Cental health of a population. lhatln' manyin studies have shown People good houses tend to ?
aijj
have better physical health than those in bad ones, but this doesn't necessarily mean that the good housing is responsible for the better health. It might be due to any of a dozen factors, such as differences in income, age or heredity. However, in spite of these difficulties, a number of attempts have been made in the past ten years to measure the mental health of people in new towns and new housing estates. The earliest of such studies was made by Martin, Brotherston and Chave (1957) on an estate in North London. They interviewed a random sample of the estate population,
digestive
diseases
among children?which was due, they considered, to the change of neighbours and hence to an initial lack of "group immunity". After two years, however, there was less physical illhealth among the children who moved *See review
on
page 68.
who remained the accident rate among the re-housed children was only two-thirds that of the others. This benefit to health was also apparent, though to a less extent, for young adults, but for adults aged 35 or over, there was no obvious benefit. Adults on the new estate were more ready to invite friends into their houses, more interested in keeping the house and garden neat and tidy, and more optimistic in their outlook on life. On the other hand, there was no difference at all between the new estate and the slum in the amount of friction and quarrelling among members of a family, or in the amount of irritability, nervousness and depression. In collaboration with Dr. K. Shaw, I recently studied the health of people on a new housing estate in Croydon, and compared it with that of people living in an older district Our results (not of the same town. yet published) are in agreement with those of the Baltimore study. We found the physical health of children and young adults was slightly better A higher proporon the new estate. tion of the new estate population were satisfied with their surroundings, while the proportion who expressed themselves as thoroughly dissatisfied was no higher than in the old district. For mental health, as measured by the number who said they suffered with nerves or depression, or who were diagnosed as neurotic by their general practitioners, or who had been under psychiatric care, there was no appreciable difference in the two districts.
by somewhat different methods; a", in the measurement of mental slight differences in definition have a large effect. On the whole>1 seems probable that although movt^ to a new house may cause a tei? ' porary exacerbation of symptoms $ persons who are already neurotic, conditions of new town life have long-term influence on the health of adults who move there, v recent study from Sheffield (Hal; 1964) on psychiatric illness people who moved house suppof! this view. Finally, we may consider the fuWr mental health of children who &
Conclusions
towns
than among In behind.
those
heal^
particular,
Thus the earlier survey found
c3(
^
amo^ ,
born in the new towns. If we it that the mental health of adu1.; who have moved to a new town no different from that of adults where, this lends support to the that a person's mental health is to large extent determined by his c?, stitution and is not much influent, he has grown up, by sU
city of Naples, Greek colonists in the 7th century B.C., is still called by its original name of "New Town" (Neapolis) and this may serve to remind us that new towns, and the problems they present, are as old as civilisation. What is new, however, and dates only from the mid-20th century, is the systematic study of how far the conditions of life in a new town may affect the mental health of people who live there. The study of mental health in new towns has developed for two reasons. Firstly, advances in medicine and in general standards of living have greatly reduced the amount of illfrom such obvious disorders ness as fevers, tuberculosis and malnutrition. This has given medical men more time and opportunity to study the less obvious, but not always less distressing conditions of mental disorder. Secondly, a vast number of new houses were needed in all belligerent countries after the second world war, and in Britain we wisely avoided the ribbon development of the inter-war years?"the spreading of the hideous town"? The and built new towns instead. result is that a sizeable proportion of our population now live in new towns or new housing estates, and the possible effects of this on their of become a matter has health
THE founded
by
general importance. From the
of
Hare, M.D.,
D-^
of the geographic or commer ^ attributes which ordinarily lead ^ the development of human c?m munities. That God made the and man made the town is truer ^ Moreov ; ever of the new towns. the people who live there are ( 3 representative of the population J but are whole, mostly young couples with growing families, have all moved there within a years of each other.
coU^;
and disadvant^. far as a new town has tages, these may be expected to to improvements in health. cleaner air, better ventilation, J crowding and adequate toilets combine to reduce the prevalent c respiratory infections, and of ^ municable diseases such as who^P ^ cough, gastro-enteritis and tube losis. Better washing facilities freedom from accumulated grime should mean less skin dise and home accidents should be &
Health In
advantages
so
-
indus^ ,
^
because of better lighting, and bec3 ^ of stairways less steep and tor. flt3 than in many old houses. [i health, too, might be expected ; improve. Houses that are ? J designed and easier to run, x more privacy for adults and t( space and quiet for the homework, should be less induce resentment fatigue,
^ likely^
chil^
irritability. ti>; Yet against this must be sQ\J disadvantages common to new life. Many families have moved .{
towns of view of health, have new towns advantages and disadvantages. The advantages are that the houses and the amenities have been planned?or should have been planned?with all the skill and experience gained over centuries. The disadvantages stem from the fact that a new town is not a natural growth but an artificial product, conceived on a planner's drawing-board and born in a place having none
Artificiality
E. H.
new
point
from choice, but because re-housed from buildings. They are in a sense J placed persons, and people* |, plants, do not always take not
were
being uprooted.
,
condefl1^,1
vve^,j
Young wives
find themselves a long way. $ their old homes, and sorely experienced help and advice of j mothers. The bad old slum w/ have been dirty and overcrop 58
1
it had
community spirit and a neighbourliness which the la,Ung housewife, who grew up to uKe. these things for granted, is to find missing in her new ^ildered Because the pressing need has ei* t
a
Vo
for
t0rvices Wait
houses to live in, other in the new towns have had their turn. So the housewife
fj ds the shops not so many nor so ?d, and prices higher because of t ttsport costs; if they are not formate enough to get employment in new town the men have further travel to work, and so are more a ay from home; and there are not e ?ugh clubs, cinemas or sports to keep the teenagers out *f0llnds .
.
toe
Mischief.
and TV reports ^spaper fhus there
are reasons why health ?ht be expected to improve in new and other reasons why it Ujj be expected to become worse. in fact do we find? In Britain du ,at the 1950s, newspaper articles television interviews often drew to the complaints of people 0 jjj Were bored, lonely and unhappy new towns and wanted to move a ?
?s? ^?ht
a:[,lng
^,ention aV-
b
ays
Such reports, however, must be taken with caution.
look for news, Igi^ters u.s opinions about
p
and in the
new
ticularly
towns,
when strongly expressed, news- Yet it might have been the proportion of complainants ty Srnall and that a similar propor?f people in old towns or \yL anye'Se woui^' if they had been have made equally adverse 0n| ^ents on their own communities.
thai6 tj0f
c0J:
?
studies?that systematic is, sUid" Pon ?S on random samples of the
healtk i-on anc* a comParison of -^n new towns with that in ^stricts?can 8ive a trustworthy
?th
s
er
studies ^tematic systematic studies
^a,ut
asking questions about "nerves", depression and irritability; they also studied the records of general practitioners and the local mental hospital. Comparing their findings with those of national surveys, they concluded there was a rather high rate of disorder
on the estate, and this to the loneliness and isolation caused by lack of social amenities. Dr. Chave, in collaboration with Lord Taylor, has recently completed a study of mental health in a new town.* The largest and certainly the most expensive study of this type (it cost $500,000) was made in Baltimore, U.S.A., by Wilner and his colleagues (1962). They measured the health of 600 families who were poorly housed, but half of whom were shortly due to be re-housed on a new estate. They then continued over a period of two years to measure the health both of the families who moved and of those who stayed. They were thus able to compare the health of the two groups of families. As regards physical health, they found that for the first few months after moving to better houses, there was an increase in nervous
they attributed
and
respiratory
are
hard to
Not only are they laborious but it is neither simple nor eas c?stly, to Revise methods of measuring the .Cental health of a population. lhatln' manyin studies have shown People good houses tend to ?
aijj
have better physical health than those in bad ones, but this doesn't necessarily mean that the good housing is responsible for the better health. It might be due to any of a dozen factors, such as differences in income, age or heredity. However, in spite of these difficulties, a number of attempts have been made in the past ten years to measure the mental health of people in new towns and new housing estates. The earliest of such studies was made by Martin, Brotherston and Chave (1957) on an estate in North London. They interviewed a random sample of the estate population,
digestive
diseases
among children?which was due, they considered, to the change of neighbours and hence to an initial lack of "group immunity". After two years, however, there was less physical illhealth among the children who moved *See review
on
page 68.
who remained the accident rate among the re-housed children was only two-thirds that of the others. This benefit to health was also apparent, though to a less extent, for young adults, but for adults aged 35 or over, there was no obvious benefit. Adults on the new estate were more ready to invite friends into their houses, more interested in keeping the house and garden neat and tidy, and more optimistic in their outlook on life. On the other hand, there was no difference at all between the new estate and the slum in the amount of friction and quarrelling among members of a family, or in the amount of irritability, nervousness and depression. In collaboration with Dr. K. Shaw, I recently studied the health of people on a new housing estate in Croydon, and compared it with that of people living in an older district Our results (not of the same town. yet published) are in agreement with those of the Baltimore study. We found the physical health of children and young adults was slightly better A higher proporon the new estate. tion of the new estate population were satisfied with their surroundings, while the proportion who expressed themselves as thoroughly dissatisfied was no higher than in the old district. For mental health, as measured by the number who said they suffered with nerves or depression, or who were diagnosed as neurotic by their general practitioners, or who had been under psychiatric care, there was no appreciable difference in the two districts.
by somewhat different methods; a", in the measurement of mental slight differences in definition have a large effect. On the whole>1 seems probable that although movt^ to a new house may cause a tei? ' porary exacerbation of symptoms $ persons who are already neurotic, conditions of new town life have long-term influence on the health of adults who move there, v recent study from Sheffield (Hal; 1964) on psychiatric illness people who moved house suppof! this view. Finally, we may consider the fuWr mental health of children who &
Conclusions
towns
than among In behind.
those
heal^
particular,
Thus the earlier survey found
c3(
^
amo^ ,
born in the new towns. If we it that the mental health of adu1.; who have moved to a new town no different from that of adults where, this lends support to the that a person's mental health is to large extent determined by his c?, stitution and is not much influent, he has grown up, by sU
