Southwyck House in South London is a block of flats so intimidating that it is often mistaken for a prison. Locally known as the Brixton 'barrier block,' it has a stark exterior of brick and concrete that literally looms over you, giving the impression that unseen people are staring down through the sparse rectangular windows.
It was built as a social housing project, designed to shield its residents from the noise of a phantom motorway that was intended to run from Blackheath to Battersea. The road was never built due to petty political squabbles, but the building now stands as a seven-story barricade against its illusory traffic.
If you're not used to the built-up environment of the inner city, the block can certainly feel unsettling. But here, urban alienation may run deeper than mere architecture. The area was found to have the highest rate of diagnosed schizophrenia in a large study of South London, even when compared with directly adjacent neighborhoods.
The research that found this striking variation was led by epidemiologist James Kirkbride, now at University College London. Kirkbride's work is but one in more than a century of studies that have found higher rates of psychosis in cities and which have sparked an intense debate over whether—to put it in its original terms —'cities cause madness' or whether those affected by 'madness' just tend to end up in cities.
The link between psychosis and city living was first noticed by American psychiatrists in the early 1900s who found that asylum patients were more likely to come from built-up areas. This association was sporadically rediscovered throughout the following century until researchers verified the association from the 1990s onwards with systematic and statistically controlled studies that tested people in the community as well as in clinics.
One particularly extensive study using health records for almost the entire population of Denmark found that the risk of being diagnosed with schizophrenia increased in a small but proportional way as people spent more time spent living in urban environments. Many studies have since replicated this finding, with neighborhood levels of social deprivation seeming to amplify the association and levels of social integration seeming to reduce it.
To many, this provides evidence that cities are universally bad for our mental health—something that chimes with a strong cultural belief that associates the natural world with tranquillity. It might seem like common sense that living in a run-down, inner-city neighborhood would wear away at your psychological wellbeing. But here is where the cultural cliché breaks down, because the effect is surprisingly selective.
The data shows that urban environments reliably increase the chances of being diagnosed with schizophrenia or having related experiences like paranoia and hallucinations. This is not the case for other mental health problems primarily caused, for example, by depression or mood instability. If it was a general effect on wellbeing, you would expect the chance of being diagnosed with any mental health problem to increase at an equal rate, but this isn't the case.