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The First Resort: The History of Social Psychiatry in the United States
Matthew Smith
Columbia University Press / Softcover / Jan 2023
9780231203937 (ISBN-10: 0231203934)
price: $39.00
424 pages
In Stock (Ships within one business day)

Social psychiatry was a mid-twentieth-century approach to mental health that stressed the prevention of mental illness rather than its treatment. Its proponents developed environmental explanations of mental health, arguing that socioeconomic problems such as poverty, inequality, and social isolation were the underlying causes of mental illness. The influence of social psychiatry contributed to the closure of psychiatric hospitals and the emergence of community mental health care during the 1960s. By the 1980s, however, social psychiatry was in decline, having lost ground to biological psychiatry and its emphasis on genetics, neurology, and psychopharmacology.

The First Resort is a history of the rise and fall of social psychiatry that also explores the lessons this largely forgotten movement has to offer today. Matthew Smith examines four ambitious projects that investigated the relationship between socioeconomic factors and mental illness in Chicago, New Haven, New York City, and Nova Scotia. He contends that social psychiatry waned not because of flaws in its preventive approach to mental health but rather because the economic and political crises of the 1970s and the shift to the right during the 1980s foreclosed the social changes required to create a more mentally healthy society. Smith also argues that social psychiatry provides timely insights about how progressive social policies, such as a universal basic income, can help stem rising rates of mental illness in the present day.


Matthew Smith has done a great service by restoring to us the vanished history of social psychiatry. The pandemic uncovered social fissures, including large racial and ethnic divides. These should clear the way for a renaissance of social psychiatry: to have good mental health, people need decent lives.
— Mary Travis Bassett, commissioner of the New York State Department of Health

The challenges and debates that animated social psychiatry echo in today’s conversations about the “social determinants” of health. Smith’s engaging description of the successes and, ultimately, the failures of this past attempt to ground mental health in social conditions offers important lessons to those who strive to do so now.
— Sherry Glied, coauthor of Better But Not Well: Mental Health Policy in the U.S. since 1950

Matthew Smith has written a compelling history of social psychiatry in the United States. He expertly charts its origins, evolution, and decline over the course of the twentieth century, forcing us to reckon with the ways that our society’s glorification of the individual and the profit motive ultimately undermined the noble effort to use mental healthcare to address social inequality.
— Martin Summers, author of Madness in the City of Magnificent Intentions: A History of Race and Mental Illness in the Nation's Capital

Carefully contextualized and urgently relevant to the exigencies of today, The First Resort is required reading for anyone seeking to understand how social disparities contribute to mental health disparities—and to rediscover a forgotten range of solutions for building a more equitable approach to treatment, prevention, and recovery.
— Jeremy A. Greene, author of The Doctor Who Wasn’t There: Technology, History, and the Limits of Telehealth

The First Resort is a fascinating, well-researched, and beautifully written history of social psychiatry. As the COVID-19 pandemic has dramatically exposed the ongoing costs of mental health disparities, Smith’s history is highly relevant.
— Anne Kveim Lie, University of Oslo

For far too long historians have written dismissively—or, worse, entirely ignored—of the contributions made by social psychiatry to the evolution of thought on mental health in the twentieth century. The First Resort explains the conditions that allowed social psychiatry to emerge and addresses the reasons it ultimately failed, highlighting both the strengths and limitations of the social psychiatry movement.
— Mat Savelli, coeditor of Global Transformation in the Life Sciences, 1945–1980

About the Author:

Matthew Smith is professor of health history at the University of Strathclyde’s Centre for the Social History of Health and Healthcare. His books include Another Person’s Poison: A History of Food Allergy (Columbia, 2015) and Hyperactive: The Controversial History of ADHD (2012).

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