Mental Health in the Metropolis: The Midtown Manhattan Study

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

How can we improve urban health? That is one of the missions of the New York Academy of Medicine, and a question public health professionals have been asking for decades. One of the landmark urban health studies, Mental Health in the Metropolis: The Midtown Manhattan Study, was published more than half a century ago.1 The study was intended to be a deep and exhaustive look into the mental health of residents in one of the most urban environments in the country, Midtown Manhattan. In many ways it was to be a model of the state of urban health throughout the country.2 And it was shaped by the medical experience of World War II.

Title page of Mental Health in the Metropolis, 1962.

Title page of Mental Health in the Metropolis, 1962.

Many veterans developed mental illnesses over the course of the war. Dr. Thomas A. C. Rennie, associate professor of psychiatry at Cornell University Medical College, saw many cases directly. He organized rehabilitation services for veterans during the war, and in 1944 published When He Comes Back and If He Comes Back Nervous.3 This booklet was followed by Mental Health and Modern Society,4 a professional discussion of the effects of war on society. In his war and postwar experience, Rennie encountered many people suffering from mental difficulties, and concluded that the long and extended psychoanalytic approach would never treat them effectively, for lack of time and resources.

Dedication of Mental Health in the Metropolis to Thomas A. C. Rennie.

Dedication of Mental Health in the Metropolis to Thomas A. C. Rennie.

Instead, Rennie began to look at the relationship between mental health and the social community.5 In the process he created a new field—social psychiatry. In 1950, he was appointed the first professor of social psychiatry at Cornell, arguably holding the first position of this kind anywhere in the United States.6 He conceived the Midtown study this same year, and launched it in 1952. Upon Rennie’s sudden death from a cerebral hemorrhage in mid-1956, the program was continued by Dr. Alexander Leighton, a colleague, medical sociologist, and psychiatrist at Cornell. The study ended in 1960, with publication of its results in 1962.7 It was a large undertaking; overall, the project utilized the services of some 200 people.

What did the study look like? In the words of the lead author, sociologist Leo Srole of SUNY Medical Center Brooklyn (SUNY Downstate), “An investigation focused upon Midtown can, in a special sense, be likened to an intensive case study. Here a community, rather than an individual, is the case.”8 Mental health was investigated as an outcome of community function and dysfunction, as much as or even more so than of the individual. That community was studied along many lines: age, sex, marital status, socioeconomic status, “generation-in-the-U.S.,” and various frames of origination: rural or urban, nationality, and religious affiliation. Researchers also assessed access to and outcomes of mental health and psychiatric care by surveying community residents and treatment workers. Their work seemed to show that Midtown held large numbers of untreated ill individuals, most of whom still functioned at an acceptable level. But definitive results were difficult to come by, and more studies were called for.

Correspondence between sick-well ratios for 12 socioeconomic status strata, reported in 4 groups, with highest SES marked “1” and lowest “12”. The “sick-well” ratio is found by comparing the numbers of “impaired” persons in a particular grouping, with the number of “well” persons. Two other rankings lie between these designations: “mild symptom formation” and “moderate symptom formation.” Mental Health in the Metropolis, Figure 5, p. 231. Click to enlarge.

Correspondence between sick-well ratios for 12 socioeconomic status strata, reported in 4 groups, with highest SES marked “1” and lowest “12”. The “sick-well” ratio is found by comparing the numbers of “impaired” persons in a particular grouping, with the number of “well” persons. Two other rankings lie between these designations: “mild symptom formation” and “moderate symptom formation.” Mental Health in the Metropolis, Figure 5, p. 231. Click to enlarge.

Mental Health in the Metropolis was the report of a large and complex analysis, marrying the different disciplines of psychiatry and sociology to understand and address medical problems using social means. As such it was a child of the war—the war that created mass problems, and suggested ways towards solving them. And it was the harbinger of studies to come.

References

1. Authored by Leo Srole, Thomas S. Langner, Stanley T. Michael, Marvin K. Opler, and Thomas A. C. Rennie, volume 1 in the Thomas A. C. Rennie Series in Social Psychiatry (New York: Blakiston Division, McGraw-Hill, [1962]).

2. Mental Health in the Metropolis, p. 338. The precise boundaries of the study area were not disclosed for reasons of confidentiality; it was described as “more or less midway up the length of Manhattan Island,” bounded by the business district, two major thoroughfares, and a river, and “almost wholly residential in character,” with 175,000 inhabitants (p. 72, and fn 14). Using the name “Midtown” to describe this community was surely inspired by the famous “Middletown” studies of Muncie, Indiana, done by Robert Staughton Lynd and Helen Merrell Lynd, and published in 1929 and 1935.

3. With Luther E. Woodward: New York: The National Committee for Mental Hygiene, [c1944].

4. Also with Luther E. Woodward: New York: Commonwealth Fund, 1948.

5. He was not the first to explore this connection, of course, and he profited from his work with Adolf Meyer of The Johns Hopkins Medical School from 1931 to 1941, Oskar Diethelm, “Thomas A. C. Rennie, February 28, 1904 — May 21, 1956,” Cornell University Faculty Memorial Statement, https://ecommons.cornell.edu/handle/1813/17813, accessed March 18, 2016.

6. Mental Health in the Metropolis, pp. viii.

7. Mental Health in the Metropolis, pp. 336–37.

8. Mental Health in the Metropolis, p. 28.

Treating Mad Men: Harry Levinson’s Men, Management, and Mental Health

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

Image courtesy of AMC.

April 5 saw the return of Mad Men for the conclusion of its television run. The show, of course, evokes the work world of 50 years ago: its style and flair, as well as its misogyny and racism, its messiness and dysfunction. To address that dysfunction, psychologist Harry Levinson would apply a strong dose of medicine.

In an era of paternalist corporate life and long-term employment, managers increasingly saw the workplace as a nexus for in human health, with corporate consequences. Industrial psychologists began championing the idea of organizational health. The result of good management, organizational health led directly to individual health, both physical and mental; healthy workers built successful companies.

Title page of Men, Management, and Mental Health, 1962.

Title page of Men, Management, and Mental Health, 1962. Click to enlarge.

One of the first of these psychologists was Harry Levinson (1922–2012). His Men, Management, and Mental Health (1962)1 portrayed the workplace as anything but a neutral space. A native of New York and trained at Emporia State University (B.S., 1943; M.S., 1947) and the University of Kansas (Ph.D., 1952), he became associated with the Menninger Foundation of Topeka. There, with a grant from the Rockefeller Brothers Fund, he founded the Division of Industrial Mental Health.2 For Men, Management, and Mental Health, he conducted almost 1,000 interviews and made site visits to more than 40 work locations at a Kansas power company over the course of 2 years. Levinson and his team delved deeply into the workings of the company, considering specific examples of tension and conflict, using case studies to flesh out his theories, and, as he put it, “specifying more fully our conception of mental health.”3

In his work, Levinson brought to bear the full panoply of psychoanalytic theory. He saw in the workplace the playing out of dependency needs and transference mechanisms; he traced the clash of rivalries, and viewed conflicts as arising out of deep psychological wells. Yet all this was comprehensible in terms of the psychoanalytical view of human nature. Chief among Levinson’s insights was that workers wanted, or even needed a psychological contract in addition to a labor contract, not based on specific rewards for services, but rather on such intangibles as security, job growth, mutual respect, and fairness. He called the bundle of these concerns “reciprocation” and held they were crucial for organizational success—and for the mental health and physical safety of employees.4

Chart on page 159 of Men, Management, and Mental Health, , showing the key concepts of the psychological contract and reciprocation.

Chart on page 159 of Men, Management, and Mental Health, showing the key concepts of the psychological contract and reciprocation. Click to enlarge.

True to his psychoanalytical training, he saw executives and managers as having crucial roles, which he put into medical terms. When working well, the executive was “diagnostic, remedial, and preventive.” When failing, he was “iatrogenic”: illness-causing! Finally, he maintained that mental health was not a humanitarian add-on in American business, but an integral part of “getting the job done.” American management needed to move beyond psychological manipulation: “psychological understanding cannot fail.”5

In the late 1960s, Levinson joined Harvard Business School and Harvard Medical School, and founded The Levinson Institute, a consulting firm and his base until the early 1990s. He wrote numerous books and introduced workplace concepts familiar to this day, among them the employee assistance program, performance feedback, and coping with loss in workplace change.6

How would Harry Levinson deal with Don Draper? For Levinson, the most important goal is alleviating workplace stress, which Don does through alcohol—as well as other outlets. Levinson’s means were solidarity and leadership, with the aim of re-establishing a creative balance. How well Draper would have responded to this message is up for grabs: my guess is that he’d be out the door!

References

1. Harry Levinson, Charlton, R. Price, Kenneth J. Munden, Harold J. Mandl, and Charles M. Solley, Men, Management, and Mental Health (Cambridge, MA: Harvard University Press, 1962).

2. Levinson, Men, Management, and Mental Health, p. viii.

3. Levinson, Men, Management, and Mental Health, Appendix 1, “Research Team Operations,” pp. 173–82, quotation from page 179.

4. Levinson, Men, Management, and Mental Health, passim, but for those terms, see pp. 21 and 122.

5. Levinson, Men, Management, and Mental Health, chapter 10, pp. 157–72.

6. See also Diana Gordick, “Leader Speak: A Conversation with Harry Levinson,” The Consulting Psychologist: Spotlight on Consulting Issues, http://www.apa.org/divisions/div13/Update/2003Fall/Spotlight2Fall2003.htm. Accessed April 2, 2015.