Scand J Soc Med 4: 45-51, 1976

Mental Health and Housing Onni Kari-Koskinen and Pentti Karvonen From the Department ofPublic Health, Oulu University, Oulu, Finland

Mental health and housing. Kari-Koskinen, O. and Karvonen, P. (Dept. of Public Health, Oulu University, Oulu, Finland). Scand J Soc Med 1976, 1 (45-51). With the present trend away from the designing of individual buildings and towards the systematic planning of whole residential communities, it should be possible to take mental health requirements into account at the planning stage. At present, sociologists are all too seldom consulted on matters of residential planning. When discussing the relationship between housing and mental health one cannot restrict oneself only to the external aspects of the house, but rather one must also consider the opportunities available for the members of the family to satisfy their own needs, both within the home and in its immediate surroundings. Factors which may affect residential requirements include geographical location, type and standard ofdwelling and time and continuity of occupation. A move between two districts or groups representing different housing norms and values may lead to withdrawal symptoms in the individual. This may arise equally well from the remoteness of the country districts as from the conflicting pressures brought on by the abundance of contacts available in the large towns. Town life tends to heighten susceptibility to neuroses and personality conflicts. The character of a residential area may affect the mental health of its occupants. Faris & Dunham (4), in studying the incidence of various types of mental illness with an urban population, observed that schizophrenia was most common among people who were in some way isolated from social involvement. The striving for spaciousness in residential areas and the creation of a "summer city" or "garden city" image or a "family-centred way of life" may lead to unexpected problems and have a variety of social consequences. Mental health difficulties have been noted. for example. among housewives in "dormitory" towns or suburbs ( II). The institutions required by a community may be grouped into four categories. representing the basic needs of its members. These are (I) economic institutions. (:!) social and political organizations. (3) leisure-time clubs and (4) societies and institutions for promoting social integration. including educational. advisory and assistance bodies.

The study of satiation processes offers an interesting approach to the relationship between housing and mental health. Man requires new stimuli to motivate him. Boredom and satiation serve to induce passivity and may provoke destructive behaviour and escapism. Finland has the highest percentage of dwellings constructed in the immediate post-war period of any country in Europe, and in respect of the functions of housing many aspects are still apparent which are detrimental to mental health.

Housing is one of the necessities of life. According to research (6), an American spends an average of 18 hours a day in his home. In the time budget, housing is the most important environmental factor affecting our activities. Results of social psychology and housing sociology research are good guides to housing problems for sociologists who give advice after mistakes have been made. In 'Finland. the Board of Health inspects the housing to be used but, presumably, mental health problems are disregarded by housing inspectors. The present trend is towards planned residential communities instead of individual buildings; America already has business enterprises engaged in "rnass building". Mental health requirements should be taken into account in construction plans. But sociologists and experts on human mental needs are too seldom consulted when housing is planned. Even then. though the plans may have been made with care and expertise. the municipal authority will look at a general planning proposal-a result of years of work-and decide almost in a matter of minutes. Is the municipal authority 'superhuman'? The concept of mental health comprises comfort. satisfaction. a balanced mind. mental faculties. a feel ing of freedom. gaiety. etc. Men tal health. therefore. is not only absence of illness. but mental wellbeing. Mental health is hard to distinguish from Scant! J Soc A/ed oj

46

O. Kari-Koskinen and P. Karvonen

Table I. Housing Geographically Qualitatively

Chronologically

Country Province Rural- urban

Fixed and mobile living Migratory

Residential district Type of building multistorey semi-detached private house Size of dwelling number of rooms floor area Equipment level amenities

social success, since both mental health and mental diseases depend largely on relations between family members. The interconnection between housing and mental health is not only based on factors such as size of dwelling, light, colour of walls, and the edifying effects of the paintings on the walls, i.e, not on constructional factors alone. A great deal of thought should be given to other details: how the activities within the family can be arranged within this dwelling, and how every family member can satisfy his or her individual needs in the immediate neighbourhood of the home. RURAL VERSUS URBAN DWELLING

The country and district where we live (in contrast to choice of actual residence) is often an 'inheritance' from our parents, and can be disregarded here.

However, rural versus urban life is worth discussing. M3:0Y urban dwellers are in reality country people who have moved into towns -"sheep in wolves' clothing". When rural parents in an urban environment try to bring up their offspring according to country principles, the children easily develop mental health problems because their upbringing differs so greatly from urban values and requirements. These parents are often unable to make use of the opportunities of urban life but suffer all the disadvantages. Furthermore, the parents often find themselves isolated, becoming estranged and anxious. It has been found that in migration between places or groups representing different values and standards, the latter tend to isolate the migrants from social activities. There are certain characteristics peculiar to rural and urban communities, although the antagonisms, are on the wane. What causes these differences? Is rural life simply 'lagging behind the times'? Are those moving to towns peculiarly different from those staying in the countryside? What of the role of economic life? Distances? Mental health

Some differences of interest from the point of view of mental health may be worth discussing. Rural isolation is a result of long distances, whereas urban isolation is caused by conflicting tensions due to the wealth of contacts available. The low rural divorce rate is partly due to strict standards and intolerance (5). A rural couple, despite serious

Table II. Characteristics peculiar to rural and urban communities Rural life style

Urban life style

Static: safe Static: calm Static: slow Work and personal life are intertwined Isolation: long distances Large families Homogeneous standards Control by personal relations, gossip, disapproval Intolerance Upbringing is more religious, threatening, moralising .Ernotional ties Mentally reactionary attitudes caused by lack of stimuli

Dynamic: complexity of phenomena Impassioned rhythm of life Advanced division of work Working life and personal life are separate Heterogeneous standards Tolerance and freedom Social control is impersonal More contradictions Isolation (conflicting tensions) Emotional impoverishment, lack of profound participation Higher intelligence level More rational upbringing Higher ambitions High rate of crime and divorce Higher incidence of mental disorders

Scand J Soc Med 4

Mental health and housing

disagreement, can continue their family life only because the close environment morally disapproves of divorce. The lower rural crime rate may be because crimes, especially minor offences according to prevailing custom, are not easily found out by authorities. A big city increases the possibility of neuroses and personality conflicts but is not their initial cause. Experiments on mental disorders have shown that imbalance grows with an increasing number of potential choices, owing to the variety of stimuli.

RESIDENTIAL DISTRICT The residential district also affects mental health. Important studies have been made into mental disease rates in the different parts of Chicago (Faris & Dunham, 1939 (4». It was found that the rate was highest in the centre of Chicago and decreased peripherally. The so-called 'zone of changes' , usually in the centre, is a poor residential area where no one is willing to build new living quarters, since everybody expects it gradually to become a central city zone. These poor dwellings are occupied by people who cannot afford to live elsewhere (2). Faris & Dunham (4) also studied the incidence of the various types of mental disease. Schizophrenia, according to them, was most common among people in some way barred from social participation. The paranoid form of schizophrenia was common in such tenement houses in the centre, where tenants often changed. The other form (catatonic schizophrenia) was frequent where a section of the population (immigrants from abroad, Negroes) had to live as a minority with another, earlier population group. Schizophrenia, therefore, was relatively frequent among the Whites living in Negro environment. In all these environments, the individual really was isolated from his 'natural' group. It can be concluded that certain geographical factors in big cities tend to isolate people from mutual interaction, which again may disturb the personality balance. A Finnish example

To throw more light on these problems, let us take an example from Finland: Tapiola seen by a sociologist. Successful social functions are perhaps the most influential factor in the comfort of living environment. What is the town like as a functional unit, as a social system? What is the social framework that a

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given urban solution places around people's lives? A mimeograph on Tapiola, based on an article by Heikki von Hertzen in Arkkitehti in 1956 (8), says: "The purpose has been to plan Tapiola on a human scale, based on individualism of man and vicinity of nature. The beauty values of nature, the trees and original shapes of the landscape are untouched, as far as possible. Unlike ordinary urban milieu, nature predominates in Tapiola. A second principle is that all collective servicing that can be foreseen at the time of construction, is planned and usually also carried out immediately and automatically financed in connection with the construction. When inhabitants arrive services are ready to start operation." The idea of space has also been adopted in Tapiola; the standard was 65 inhabitants per hectare. The sociologist will answer: no matter what the purposes of ambitions and planning, practical implementation always has its social effects-possibly of a kind never imagined at the outset. (1) The concept of space in planning has had several consequences: (a) distances are long, (b) points of service are assembled into service centres relatively far from dwellings, (c) service points are, at close quarters, one-sided-the northern centre has no post office, the central one no bookshop. (2) Another objective inherent in the garden city ideal is a mental image of a summer city. The residential environment meets expectations usually only when flowers blossom, trees are in leaf.and grass is green. The short summer, and a summer holiday spent away from home are responsible for the fact that one of the best characteristics of a garden city is available to the inhabitants for only a relatively short period in the year. There is the risk that expectations imposed by winter are inadequately met. (3) A third ideal associated with a garden city, also visible in Tapiola, is perhaps best expressed by "family-centred way oflife" . Tapiola is a community emphatically concentrated on residential considerations, for (i) Tapiola is far from self-sufficient jobwise, (ii) services are not adequate, (iii) leisure time occupations depend greatly on other communities. These drawbacks are worse for the adults. Wide lawns and flower beds please the eye but are planned for passive admiration and not active work. More emphasis ought to be placed on activities at home or, alternatively, outside Tapiola altogether. The ideal realized in Tapiola reminds me of a nursery rhyme which says, roughly: you may look if you are nice, but never touch. ScandJ Soc Med4

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O. Kari-Koskinen and P. Karvonen

Table III. Social grouping, percentage-wise, according to the 1965 census Social group

Tapiola

Espoo

Finland

I II III IV

42.5 26.0 25.5 6.0

16.5 23.0 45.0 15.5

5-10

Middle-school completed by % the over -25 age group

50

20

(4) Tapiola is a community of the upper middle class, a town of university graduates (Table 111). If the way of life and sphere of experience of the upper middle class were ideal, this might be the best situation for children. But this is by no means certain. Uniformity, furthermore, tends to make the living environment one-sided, and where little or nothing happens it is not good for growing children. A garden city is definitely not the only ideal solution in planning. A compact city idea has been much discussed in this decade. Both residential buildings and varied activities in the same area are essential components among the factors creating an ideal urban environment. They promote interaction between people, and enable an efficient and continuous use of the various activity spaces.

So-called dormitory cities Housewives in the suburbs and especially so-called dormitory cities are reported to have mental health problems. Alcoholism, depression, lack of purpose, boredom and even suicides have increased. What are the factors responsible? A professor of sociology at Helsinki University (1) said in his speech on the 75th anniversary celebrations of the Finnish Architects Association: "Man needs to be a member of a local, sharply defined community (village, town, or the like). With some individuals, the geographically bounded communities can be replaced by other types of communities. Dormitory cities which either are not a part of a larger entity or operate very few establishments essential for society, may bejustified from a geographical or economic aspect, but sociologically they are mistakes. Communities which are entities and with which their members can identify themselves, usually have a number of institutions representing its inhabitants; if not, they will probably not feel at home and the threat of Scand J Soc Med 4

alienation and destructive behaviour, is very great." The institutions a community needs can be classified into four basic needs which must be met, for the community to function satisfactorily: (i) Resources must be coordinated to achieve objectives, e.g. economic institutions: mills and factories, etc. (ii) Pooled resources, and the commodities thereby produced must be shared: political institutions. (iii) Preservation of continuity and release of social tensions: family, school, leisure time organizations. (iv) Creation of social integration, today preferably called educational, supportive and advisory institutions: church, sexual clinic, library. Symbolically, we can say that every community must have a church in the centre of the village. Great caution should be observed in creating towns or areas in which these four types of institutions do not exist. It is unwise to create towns without economic enterprises, industries and business establishments providing jobs for at least some of the inhabitants. The problem of dormitory cities is often exemplified by that of the housewives, sitting at home. Proposals for business enterprises employing mainly female labour force have been put forward, but this would not solve the problem, since it is important to create primary industry employing a variety of groups, and not only jobs for women. SA TIATION PROCESSES It is interesting to review the relations between housing and mental health on the basis of satiation processes, which have been fairly thoroughly studied both by psychologists and by physiologists. Consequences of the satiation processes have recently been discussed by the Swedish sociologist Johan Asplund in his book Om miittnadsprocesser, Presumably no one has tried systematically to apply to architecture and town planning the psychological and sociological theory formation concerning satiation processes. It is evident that such an application might prove of great importance. The theory of satiation processes is based on the assumption that man needs stimuli and that the novelty of the stimulus is the motivation factor. Furthermore, the novelty of stimulus releases activity and prompts reactions involving orientation. If the stimuli are overfilled with novelties, the result is a defensive reaction (attitudes to new pictorial arts, modern literature, revolutionary architecture).

Mental health and housing Table IV. Distribution ofowner-occupied dwellings in Scandinavia

Total, % Urban Rural

Finland

Sweden

Norway

Denmark

60.5 42.5 74.4

36.0 20 65

52.8 24.6 68.9

45.0 29.2 82.0

Source: A Statistical Survey of the Housing Situation in European Countries around 1960. United Nations, New York, 1965.

Absence of new stimuli creates boredom, and satiation itself can produce a new type of reaction besides pulling down the corners of the mouth. Boredom and satiation reduce human activity. But it is obvious that, having become too strong, boredom can produce destructive behaviour and escapism, such as suicides and alcoholism (cf. dormitory cities). In a community where the choice of available experiences is initially small and where the rate of wear is also high, alienation (mental disorders) and apathy are soon observed. These, above all, are mental health problems. From the theory of satiation processes we can conclude that the existence of institutions means that new challenges- are always available for community members, including housewives. Buildings and towns must not be too one-sided in their construction; a moderate degree of new stimulus must be permitted in order to create the necessary variation. For the sake of contrast, the image of the older civilization should be retained in certain areas even though it may be impractical and uneconomic. A business street gives more new stimuli than a shopping centre, where the box shape of the buildings kills the novel stimuli presented by window displays. Residential areas must be planned so that members of different social strata can live close to one another. This brings variety in the amount of experiences and stimuli, and agrees with the demands of democracy. If there is no old cultural environment, an equivalent should be created. Age groups should not be segregated-that makes life one-sided. Children's playgrounds should be .sited in the immediate neighbourhood of dwellings. Dwellings should have space enough to allow the aged to live there instead of in old people's homes. Finland should have more family restaurants in addition to the ordinary go-inns, to allow whole families to gather there.

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HOUSING Housing situation in Finland One-eighth of the existing housing was destroyed during the war or remained in territories ceded after the war. For this reason, the proportion of housing built since 1945 in Finland, in relation to the total housing stock available, is the highest in Europe-43.5% (Sweden 33.0%, Norway 41.9%, Denmark 24.1 %). The mean floor area of dwellings in 1960 was 51 sq.m. A special characteristic of Finland is the large number of summer cottages and sauna-huts. The latter numbered one per 7.5 inhabitants, the same as motor cars. 60% of the housing produced in 1964 was of multistorey type. In 1964, 34% of the dwellings were built of wood. Housing in Finland is extremely expensive compared with the other Nordic countries. An industrial worker moving into an ARA VA (State Housing Board) flat of three rooms and kitchen (80 sq.m.) had to invest, in 1958, from his own capital, the equivalent of 206% of his annual income (in Sweden.45 %, Norway 65 % and Denmark 19%) (Table IV). The number of rooms per dwelling in Finland in 1960 was 2.7, in Sweden 3.2, Norway 4.2 and Denmark 4.4. Smaller dwellings are found in Europe only in West Germany, Poland, Hungary and Bulgaria. In 1960, Finland also had the largest number of inhabitants per room in the Nordic countries (Table V). In Lapland the situation is even worse. The housing situation in Finland is tightening, because since the Tax Relief Acts have expired, private investment in housing has decreased, money become tighter, banks more reluctant to grant credits, and the land problem is unsolved: meanwhile, costs decrease, land prices are soaring. Table V. Inhabitants per room in the Nordic countries in 1960

Rooms per dwelling Inhabitants per dwelling Persons per room

Finland

Sweden

Norway

Denmark

2.7

3.4

4.2

4.4

4.0 1.52

2.8 0.99

3.3 0.77

3.0 0.69

Source: A. M. Salonen. Asunto ja kansantalous. Tammi, Helsinki, 1961. Scand J Soc Med 4

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O. Kari-Koskinen and P. Karvonen

Table VI. Functions ofhousing I. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Physical protection Opportunity to rest Personal and clothes hygiene Preparation and ingestion of food Upbringing of children Work Reception of information Social contacts Recreation Cosy and beautiful surroundings

laundry premises and sauna-baths. Noise .can be abated by amending the gaps in the law, by increasing acoustic teaching and by creating an acoustic laboratory (particularly one for building technology). RESEARCH RESULTS

To counterbalance the various theories and views presented above, I can report on two investigations directly dealing with the problems of housing and mental health. The following aspects are essential ingredients of At an international hospital congress in Paris in the good housing: the esthetic, the practical, the social, summer of 1963, Dr van der Drift (3), a Dutch and those of health. Bearing in mind mental health hospital psychiatrist, presented the results of his problems; it is better to base one's conceptions on study carried on for about one year, concerning dynamic activities. It is worthwhile specifying the more than a hundred chronic mental patients, mostly functions of a dwelling (7), which in the Finnish schizophrenics, resistant to therapy but almost all climate is not just a place to sleep at night, as often showing some degree of improvement. A few dozens is the case in warmer climates, especially for the of them had improved so much that they could be destitute. discharged from hospital. During the study, the patients were living under hospital supervision in suitShortcomings ofhousing from the point able groups of five, with specially trained personnel, of view ofmental health and in bungalow-type dwellings with all modern The small size of dwellings interferes with many comforts. They were required to look after household functions. It hampers mental work requir- themselves with the least possible interference, and ing concentration, and day-time rest for a family their daily programme usually consisted of activatmember doing shift-work (9). Social contacts are ing group work. Another interesting study (14) of the effect of difficult (12), especially for the young, who must gather on the streets and in cafes. It is difficult to find housing on mental health has been made in the space for the aged in a small flat or house. Nursing at United States (The Johns Hopkins University). The home is also made difficult. Family members are experimental series comprised 400 Negro families often in each other's way. Privacy is disturbed; it is (2000 persons) and a control group of 600 Negro not possible to retire into silence. Married couples families (3000 persons). A comparative study was are, in many homes, obliged to retire to the bathroom carried out first to make sure that the initial situation for their sexual intercourse. was approximately the same. The families in The high cost of housing (10) adds to the bread- the experimental series were transferred to new winner's cares, and overtime work is a stress. The housing, and both groups were observed for 18 housewife too is often compelled to go to work in months. The following results were obtained: order that new housing can be obtained. (i) activity within the family increased; (ii) cooperation with neighbours, and contacts outside home, The lack of or inconvenience of home comforts hampers household work and adds to the strain of especially between neighbours, increased; (iii) the psychological status improved: moods were better, such chores. Noise is an undesirable intrusion. It increases satisfaction increased, nervousness and depression stress, prevents work and rest, may cause head- decreased; (iv) a part of the control group also aches, nausea, tremor of hands, absent-minded- moved into new houses during the period of observaness and mental imbalance. Noise is produced tion, and a comparative study was carried out within by the following factors in houses: the plumb- this subgroup, based on the changed housing ing system, the ventilation system, staircase, traffic standard. The results obtained agreed with the findnoise, tinplate roof, adjoining homes, business ings made concerning the original experimental premises downstairs, boiler rooms, communal group. Scand J Soc Med 4

Mental health and housing

REFERENCES 1. Allardt, E.: Kuluvat arsykkeet, kyllastyva yhteiskunta. Uusi Suomi, Nov. 4, 1967. 2. Allardt, E. & Littunen, Y.: Sosiologia. WSOY, Porvoo-Helsinki, 1972. 3. van der Drift, H.: Allgemeine Betrachtungen tiber eine therapeutische Wohngemeinschaft. Psychiatria, Neurologia, Neurochirurgia. Vol. 68, May-June, pp. 169-174, 1965. 4. Faris, R. E. L. & Dunham, H. W.: Mental Disorders in Urban Areas. Chicago, 1939. 5. von Fieandt, K.: Maaseudunja suurkaupungin sosiaalipsykologia. Psykologian peruskysymyksia, WSOY, Porvoo-Helsinki, 1965. 6. de Grazia, S.: Of Time, Work and Leisure. Twentieth century fund. New York, 1962. 7. Heinonen, V.: Asunto psykologisena arsyke- ja reaktioyrnparistona. Oulun Rakennusseminaari. Oulu 1965. ' 8. von Hertzen, H.: Planeringen av tradgardsstaden Tapiola (Hagalund). Arkkitehti 1-2: 1--4, 1956. 9. Lemkau, P. V.: Community Planning for Mental Health. Publ Inth Rep, Wash 76: 489-497, 1961.

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10. Salonen, A. M.: Asunto ja kansantalous. Tammi Helsinki, 1961. ' 11. Seppanen, P.: Tapiola sosiologin silmin. Arkkitehtiuutiset 18:20, 1967. 12. Slide, H.: Mentalhygieniska problem vid bebyggelseplanering. Socialmed tidskr 42: 153-156, 1965. 13. A Statistical Survey of the Housing Situation in European Countries around 1960. United Nations, New York, 1965. 14. Willner, D. M., Walkley, R. P., Schram, J. M., Pinkerton, T. C. and Taybock, M.: Housing as an environmental factor in mental health: the Johns Hopkins longitudinal study. Am J Publ Hlth 50: 55-63, 1960.

Address for reprints: Onni Kari-Koskinen Dept. of Public Health Oulu University Oulu Finland

SC{/Ild J Soc .\led..J

Mental health and housing.

With the present trend away from the designing of individual buildings and towards the systematic planning of whole residential communities, it should...
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