Urbanization may not simply have been a factor in making Americans more wary of their mentally ill neighbors; it may have increased mental illness rates as well. While we do not know if this was true in the eighteenth century, some recent studies suggest that being born or growing up in an urban area increases one’s risk of developing schizophrenia and other psychoses. in the twentieth century, comparison of insanity rates revealed that urban areas had much higher rates of mental hospital admissions for schizophrenia and bipolar disorder – almost twice as high for New York City compared to the rest of New York State…older statistical examinations of mental hospital admissions argue that at least in the period from 1840 to 1940, while mental hospitalizations increased (because of increased availability) there was no large and obvious increase in insanity. A more recent study of mental illness data shows, much more persuasively, that psychosis rates rose quite dramatically between 1807 and 1961 in the United States, England and Wales, Ireland, and the Canadian Atlantic provinces. A study of Buckinghamshire, England shows more than a ten-fold increase in psychosis rates from the beginning of the seventeenth century to 1986. In 1764, Thomas Hancock left 600 pounds to the City of Boston to build a mental hospital for the inhabitants of Massachusetts. The city declined to accept the gift on the grounds that there were not enough insane persons to justify building such a facility. Massachusetts had a population between 188,000 and 235,000 in 1764; if the population of the time suffered the same schizophrenia rates as today, that would mean that there were about 2000 schizophrenics in the province. Even accounting for the greater tolerance of small town life for the mentally ill, this lends credence to Torrey and Miller’s claim of rising psychosis rates. Urban life today is not the same as urban life then, and even the scale of what constitutes “urban” is dramatically different – but it is an intriguing possibility that the increased rates of mental illness at the close of the Colonial period were the results of urbanization.Immigrants are still over-represented among the mentally ill; nobody is sure if this is because mentally ill people are more likely to emigrate or because emigration is a very stressful act.
Irish immigration may also have played a role in the increasing development of mental hospitals in America. It was widely believed in the 1830s that Irish immigrants were disproportionately present among the insane. More recent analysis shows that throughout the nineteenth and twentieth centuries, Ireland’s rates of insanity were twice or more than that of the United States, England, and Wales. Irish immigrants were also over-represented in insane asylums in the United States, England, Australia and Canada at the end of the nineteenth century.
Understanding mental illness in a cross cultural way is very difficult, because cultures understand and react to mental illness so differently. So perhaps it would be better express this finding by saying, not that more people are crazy, but that more people find it impossible to function in our society than in past societies.
But is that true? As even this little paragraph shows, different studies have produced widely varying numbers.
Is it even possible to compare rates of mental illness between different cultures? I absolutely do not think that mental illness is an invention of modern society; all of the cultures I know anything about recognize that people can be crazy. Some cultures think madness can be divine and have a habit of seeking spiritual meaning in the utterances of madmen and madwomen, but although they may consult crazy shamans and priests about the will of the gods they don't ask them to help arrange marriages for their children. But there certainly is a wide variance in what is defined as a serious mental illness. Plus, in the medieval world lunatics (as they were called) were mostly cared for by their families, and nobody bothered to count them.
So knowing whether mental illness has increased is a hard problem, perhaps unsolvable. On the other hand it seems undeniable that we perceive mental illness to be a much bigger problem than anyone before the nineteenth century did. Why is that? It could be because nobody thought about mental illness as a problem, just as nobody thought about how to achieve full equality of the sexes as a problem. Or it could be another side effect of our conquering hunger; when mass starvation was a regular occurrence, paranoia and excessive sadness did not seem like much to worry about.
At any rate, we have a problem with mental illness that seems to be a side-effect of modernity. As to why that should be, that is another hard problem. I can think of several possible causes: environmental poisons such as lead, urbanization, disease, separation from the natural world (people who grow up on farms have much healthier immune systems), the general increase in the complexity of economic and social life, the rapid pace of change; or, on the other hand, a changing definition of what life is all about that makes things like depression much bigger deals than they used to be.
It is something to ponder, when we consider the march of history; if we have made so much progress, why are we crazier than ever before?