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CAMH Stories Centre for Addiction
and Mental Health

How the city gets under our skin

CAMH and Wellesley co-host Mental Health and the Megacity

By Samantha DeLenardo, Communications Coordinator

Addressing his 300-person audience at the Royal Ontario Museum, Professor Nikolas Rose raises his voice to be heard over the roar of a passing subway train below.  It seems the city is alive in the room; a fitting soundtrack for CAMH and the Wellesley Institute’s second event in a series exploring the role of cities in mental health.

Dr. Nikolas Rose
Dr. Nikolas Rose at the Mental Health and the Megacity event on September 6th.

Dr. Rose is an international expert on the topic, which may seem odd given his self-professed aversion to the cacophony of city life. When he looks out his fifth storey apartment window in London, England, he’s amazed to see throngs of people deliberately flocking to the noise, lights, and smells that tend to overwhelm him.

It’s that dynamic interplay of environments and human beings that Dr. Rose has come from King’s College London to Toronto to speak about. He is a social and political theorist with a particular interest in the relationship between social science and life sciences, and he has a 50-year involvement in psychiatry and mental health.

“To understand the question of how urban settings affect mental health,” he says, “we must understand cities as complex ecological environments where humans make their lives. They are not passive creatures, not mere recipients; they struggle to make sense of their lives, almost always in relation with others.”

The subway train roars below as the audience nods in agreement.

New era of urbanization

The United Nations predicts that two-thirds of the world will live in cities by 2050. 200 years of evidence shows that urban inhabitants face higher rates of mental illness than those living in rural settings. While those numbers tell us there is a problem and geo-mapping tells us where to look, says Dr. Rose, we still don’t know exactly what it is about urban living that is generating this impact.

There are well-established links between ill-health and risk factors like poverty, overcrowding, racism, violence and trauma, but it is no longer sufficient to only look at those correlations.

“We need to go beyond correlations to understand mechanisms – how does the city get under our skin?” asks Dr. Rose.

A new biology?

Dr. Rose points to recent opportunities for life sciences and social sciences to work together – a collaboration that begins “to place the whole organism back in its environment.”

Epigenetics, for example, recognizes that the most important thing for the development of humans is not genetic makeup given at birth, but rather the way those genes are activated or deactivated across the life course. Similarly, the brain is plastic and ever-changing, not just at critical points in youth, but throughout a person’s life.

“Human beings are not single organisms,” he says. “We are inhabited by millions and millions of microbes, and the state of those microbes is exquisitely shaped by your environment and fundamentally related to your physical and mental health.”

He also points to impacts of exposure to the atmosphere and the pollutants on the development of human beings.

“We have moved from a situation where people think of biology as destiny, to where people begin to see that understanding biology is also the basis for opportunities for intervention.”

Megacity panel
Dr. Kwame McKenzie, CEO of the Wellesley Institute, Elliot Cappell, City of Toronto Chief Resilience Officer, and Dr. Nikolas Rose answer questions from the audience.

Stress and a ratty diversion

Along with the roaring subway train below, the evening had its fair share of rats. Dr. Rose highlights research done with rats to show how organisms, when placed in situations they perceive to be stressful and with no opportunity to ‘fight or flight’, can experience illness.

Stress is the repeated triggering of the adrenal hormonal system, which can alter gene expressions and our brains. But, says Dr. Rose, stress is subjective.

“Their stress is not my stress,” he remarks, referring to the crowds he observed reveling in London’s busy metropolis. “Stress is the way in which a human who is equipped with language and culture codes an experience.”

Stress is also one of the largest contributors to poor mental health in cities, but the notion that not everyone responds to stress in the same way is an important one.  A closer look can provide insight into improving resilience in people and communities. In particular, peers, social networks and informal spaces seem to play an important role in creating resilient communities, helping to buffer stress.

“The thing we find again and again is the way people negotiate their way around these urban spaces, how they domesticate and manage their stress, how they learn to live in situations of insecurity, in combination with others,” says Dr. Rose. “Resilience is not an individual characteristic; it is something that grows out of these transactions amongst others.”

In light of this, relying solely on formal treatment systems may not be the best approach.

“Should we perhaps recognize what is at the roots of these collective forms of resilience and seek to make use of those people themselves and their peers who are perhaps best placed to give one another support?” Dr. Rose argues.

That’s an important consideration for CAMH, the Wellesley Institute and policy-makers in the audience like Elliot Cappell. Cappell is Toronto’s Chief Resilience Officer and shared with those in attendance the main focus areas for the city’s resilience strategy, including climate change adaptation, emergency preparedness and management, and neighbourhood-level resilience. The strategy will be developed over two years as part of the 100 Resilient Cities initiative.

To watch Mental Health and the Megacity event video, click here. To view the first event in this series, Mobilizing Cities for Mental Health, click here.


Published on September 15, 2017

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