Mental health, stress and the contemporary metropolis

Can contemporary developments in the life sciences help us understand the ways in which ‘adversity’ shapes mental health conditions in the heterogeneous conglomerations we call cities? Many have pointed to the evidence that those living in cities are more likely to be diagnosed with mild, moderate and severe mental disorders than those living in rural settings. But it has proved difficult to identify precisely what it is in the urban experience that leads to these elevated rates. The same is true of research that has addressed urban mental health in migrant and refugee populations, in the global north and in megacities such as Mumbai, Shanghai and São Paulo in the global south. Some rates are elevated in some migrants, sometimes only in the second generation, but the findings are equivocal, and migration itself does not seem to be a consistent causal factor for mental ill health – indeed sometimes quite the reverse. Can we link biomedical explanations with sociological and anthropological research to understand the ways in which the experiences of poverty, inequality, precarity, gender discrimination, racism, stigma, social exclusion, isolation, threat and violence lead many to mental distress? Can we extend such an analysis beyond these traditional ‘social factors’ to encompass such issues as the built environment, the capacities and limits to individual and collective life engendered by the urban infrastructure, and the urban ‘sensorium’ of noise, smell, touch and microbes? If we understood these mechanisms better would we be better able to advise on policies to mitigate mental distress in urban environments and on practices likely to promote recovery? Could such an approach inform strategies to create ‘healthy, safe and sustainable cities’1 through Mental health, stress and the metropolis