The Metropolis and Mental Health: Are Big Cities Making Us Sick?

By Nikolas Rose and Des Fitzgerald



It is often said that we are living through another period of mass urbanisation – an age in which more and more people, in all regions of the world, are moving from rural towns and villages and trying to make their lives in cities – often megacities with upwards of 25m inhabitants. Indeed, the United Nations now predicts that by 2050 two-thirds of the global population will live in cities.

Policymakers have tended to concentrate on the economic and environmental consequences of this development. But there has been less attention to the effects that such a movement might have on mental health. Given that many experience urban stresses and strains – the hubbub, the noise, the competition, the density, the unnatural and frenzied atmosphere, the enforced proximity to strangers, the frequent combination of crowds and isolation – should we not be paying closer attention to the mental, and sometimes pathological, experience of city living itself?

This question of the “metropolis and mental life” occupied many who tried to make sense of the last great period of urbanisation – that enormous rural-to-urban migration that took place in industrialising Europe and North America during the 19th century. The German sociologist Georg Simmel was one of the first to describe what he called the “blasé” attitude of the city-dweller – a kind of psychological indifference that was necessary if a person’s nerves were to cope with the endless nose and stimulation of city life.


At the same time, the developing science of epidemiology found disproportionately large amounts of mental illness among those now dwelling in the city – from the alcoholic delirium of the uprooted rural immigrant to the mental breakdown that is often called schizophrenia.

Psychiatrists have long tried to make sense of such patterns. Is it that those most prone to mental collapse “drift” to certain parts of the inner city where they feel at home? Or does something in the stress of city life itself cause these breakdowns in persons who would be perfectly adapted to country or village life? If the latter, then we need to explore what it is about life in the city: density of housing, deprivation, poverty and unemployment and the dynamics of race and racism that get intensified in urban space, and so on.

But, on the other hand, maybe all of these act as precipitating factors, which affect those who are vulnerable because of a biological predisposition. Or maybe it’s both: are the roots of this urban mental disorder in the individual, in the city, or in the relation between?