Early landmarks in social psychiatry included: Karen Horney, M.D., who wrote about personality as it interacts with other people (1937); Erik Erikson, who discussed the influence of society on development (1950); Cornell University's Midtown Manhattan Study, which looked at the prevalence of mental illness in Manhattan; August Hollingshead, Ph.D., and Frederick Redlich, M.D., looked at the influence of social class on psychiatric conditions (1958); Alexander H. Leighton, M.D., looked at the relationship between social disintegration and mental illness (1959); Burrow was an early pioneer of the social causes of mental disorder and suggested `Sociatry` as the name for this new discipline.
Over the years many sociologists have contributed theories and research which has enlightened psychiatry in this area (e.g. Avison and Robins); The relationship between social factors and mental illness was demonstrated by the early work of Hollingshead and Readlich in Chicago in the 1930s, who found a high concentration of individuals diagnosed with schizophrenia in deprived areas of the city has been replicated numerous times throughout the world, although controversy still exists as to the extent of drift of vulnerable individuals to these areas or of a higher incidence of the disorder in the socially disadvantaged; The Midtown Manhattan Study conducted in the 1950's by Cornell University hinted at widespread psychopathology among the general population of New York City (Srole, Sanger, Michael, Opler, and Rennie, 1962); The Three Hospitals Study (Wing JK and Brown GW, Social Treatments of Chronic Schizophrenia: a comparative survey of time mental hospitals, 1961, Journal of Mental Science, 107, 874-861) was a very influential work that has been replicated, that demonstrated forcefully that the poverty of the environment in poor mental hospitals lead to greater handicaps in the patients;
Social psychiatry was instrumental in the development of therapeutic communities. Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill 1958; Rapoport 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al. 1957, Stanton and Schwartz 1954) and the sociopolitical influences that permeated the psychiatric world, the concept of the therapeutic community and its attenuated form - the therapeutic milieu - caught on and dominated the field of inpatient psychiatry throughout the 1960’s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other's mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. 'TC's have often eschewed or limited medication in favour of psychoanalytically-derived group-based insight therapies.
Social psychiatry has been important in developing the concept of major 'life events' as precipitants of mental ill health, including for example bereavement, promotion, moving house, having a child.
Originally inpatient centres, many therapeutic communities now operate as day centres, often focused on borderline personality disorder and run by psychotherapists or art therapists rather than psychiatrists.
Social psychiatrists help test the cross-cultural use of psychiatric diagnoses and assessments of need or disadvantage, showing particular links between mental illness and unemployment, overcrowding and single parent families.
Social psychiatrists also work to link concepts such as self-esteem and self-efficacy to mental health, and in turn to socioeconomic factors.
Social psychiatrists work on social firms in regard to people with mental health problems. These are regular business in the market that employs a significant number of people with disabilities, who are paid regular wages and work on the basis of regular work contracts. There are approximately 2,000 social firms in Europe and a large percentage of people with disabilities who work in social firms have a psychiatric disability. Some are specifically for people with psychiatric disabilities.(Schwarz, G. & Higgins, G: Marienthal the social firms network Supporting the Development of Social Firms in Europe, UK, 1999)
Facilitating the Social Inclusion of people with mental health problems is a major focus of modern social psychiatry.