A fine balance: individualism, society and the prevention of mental illness in the United States, 1945–1968

In the introduction to a collection of his essays entitled Society as Patient (1950), American social scientist and Rockefeller Foundation administrator Lawrence K Frank (1890–1968) claimed that, to prevent the apparently escalating rates of mental illness: “The individual, instead of seeking his own personal salvation and security, must recognize his almost complete dependence upon the group life and see his only hope in and through cultural reorganization”. Americans, Frank continued, would have “to give up … time-honored beliefs in human volition and responsibility” and “replace them with a larger and humanly more valuable belief in cultural self-determination, social volition and group responsibility”. For Americans entering the 1950s, a decade of postwar prosperity, McCarthyism and free market capitalism, such communitarian thinking might have been anathema. But also arising out of the American experience of the Second World War were mounting concerns about mental health, due in part to the large number of American military recruits rejected on psychiatric grounds and American soldiers granted psychiatric discharge. In the face of affluence and contentment was alarm that many more Americans were mentally disordered than previously thought and that new preventive approaches to mental health were required. Addressing these concerns during the postwar period was a new approach to psychiatry: social psychiatry. Rooted in both the child guidance and mental hygiene movements of the early twentieth century as well as contemporary social scientific research, social psychiatry was “a preventive psychiatry”, an epidemiological approach to mental health dedicated to identifying the environmental causes of mental illness—ranging from overcrowding and poverty to social exclusion and racism—and eradicating them. In this article, I explore how the economic and social implications of social psychiatry were articulated. Did social psychiatrists believe that it was possible to re-balance American society, not merely in economic terms, but also with respect to counter-balancing the prevailing ideology of “rugged individualism” with a more communitarian outlook? To what degree were they willing to do this themselves, eschewing lucrative psychoanalytic practices for community psychiatry? I will suggest that, although many of the aspirations of social psychiatry were unrealistic and possibly utopian, they are worth re-considering. This article is published as part of a collection entitled ‘On balance: lifestyle, mental health and wellbeing’.