"What would we say of a psychiatrist who undertook to heal the mad in a place that was itself the creation of madness? What would it mean to ‘cure’ in such a place? What would it mean reconciling the inmates to their condition, soothing away their fears, talking them out of their nightmares?”– Roszak, 1992, p. 221
Humans have been living in cities for more than 5,000 years, with the first cities founded following the birth of agriculture. In contrast to previous living conditions, cities are characterised as having a large population in a small area, a surplus of goods for trade, and specialisation that allows for expert craft. Although there is no standard international definition of ‘urban’, typically these environments include a high-population density with a significant amount of built infrastructure. The proportion of the world’s population living in urban environments has increased dramatically over the past 200 years, from just three per cent in 1800 to 55 per cent at present, with projections to increase to 68 per cent by 2050. For the first time in human history, most of the world’s people live in urban environments. Australia ranks among other nations as one of the most urbanised in the world, with more than two-thirds of our population now living in major cities.
Stress and the city
Cities provide benefits that attract individuals to both live in and travel to them, with associated positive impacts on mental health. These include greater availability of services, specialists, jobs and opportunities for socialisation. Urban living can also have a lower environmental impact, not only by reducing encroachment on wilderness areas, but also due to the energy efficiencies associated with high-density living and greater reliance on public rather than private transport.
However, city environments also contain many problems that increasingly impact on the psychological wellbeing of Australians, particularly as the proportion of the population in these settings increases. Some of these issues include stressors associated with crowding, disturbance due to noise, the impact of traffic, pollution, exposure to crime and traumatic incidents, housing costs and pressures related to apartment living, as well as less access to restorative natural environments.
In Australia, individuals living in urban areas are more likely to report the onset of depression and anxiety (Wilkins, Laß, Butterworth, & Vera-Toscano, 2019). Other studies also highlight that more time spent living in urban settings results in a higher risk of mental health problems (Gruebner et al., 2017), and detectable brain differences related to social stress processing between those who have grown-up in urban as opposed to rural areas (Lederbogen et al., 2011). Although the cause of these differences is currently unclear, some of the possible stressors noted above might be responsible.
Chronic overexposure to social interactions, for instance, has a significant impact on physiological stress (Park & Evans, 2016), and in urban environments crowding can be present in work, commuting, residential, public and school settings. In order to cope with crowding, individuals often respond by withdrawing from social interaction, which can ironically lead to greater loneliness and isolation in densely populated environments.
Pros of city living
- services
- specialists
- jobs
- cultural and social opportunities
- lower environmental impact
- housing not encroaching on wilderness areas
- energy efficiencies of higher density living
- more public vs private transport
Cons of city living
- crowding
- noise
- traffic
- pollution
- crime and trauma exposure
- high housing costs
- less access to restorative nature areas
Noise, traffic and pollution problems
Exposure to noise is one of the most frequently cited problems for individuals living in urban environments and can impact on sleep quality, physiological stress, and result in poorer educational outcomes for children at home and school. For children, exposure to more noise at home and school, particularly from aircraft and street traffic, has been related to poorer reading and mathematics skills (Stansfield & Clark, 2015).
Driving through traffic in urban environments is also linked to stress, particularly where travel times are unpredictable due to accidents. Previous research suggests that extended time in road traffic can impact on relationships, with higher rates of separation among couples when one partner has to travel more than 45 minutes to work (Sandow, 2013) as well as increased rates of domestic violence – a crime often precipitated by emotional cues – on days with major traffic incidents (Beland & Brent, 2018). In cities around Australia with lagging transport infrastructure, and disruptions associated with road and building works, the stress associated with traffic is a systemic problem that will increasingly impact a significant majority of our population.
Although the air quality in Australian cities is cleaner than many other countries, more recent research suggests that even low levels of pollution, such as that emitted from vehicle traffic, can impact on mental health and child development. Exposure to air pollution has been linked to higher rates of anxiety and depression, lower cognitive performance and development, and higher use of psychiatric medications among children (Clifford, Lang, Chen, Anstey, & Seaton, 2016). A recent review suggests that exposure to common pollutants also increases the risk of dementia (Peters et al., 2019). Greater population density, increasing vehicle traffic and higher residence in urban areas will likely mean more exposure to pollutants.
To stay or go?
For most people it is neither possible nor advisable to move away from the city, though psychologists can assist individuals to build resilience and adapt to these environments, drawing from the available research. Some strategies psychologists may offer clients include the following:
- Encourage clients to be discerning regarding their living environments, noting the impact of noise, pollution, traffic and crowding.
- Assist clients to think about how to improve home, work and educational environments to increase privacy, reduce noise and access spaces that are important for recovery.
- Support clients to develop healthy and creative ways of coping with urban life, such as listening to audio books when travelling in congestion.
- Highlight the value of spending time in natural environments, including public parks and gardens.
- Suggest the use of realistic images of nature, possibly virtual nature, where access to restorative environments is impossible or limited.
- Recommend an escape to rural and wilderness environments on occasion to relax and recover.
- Provide additional support to individuals moving to the city from rural areas, who may need assistance to develop new ways of coping with stress.
Multiple studies also highlight the psychological benefits of visiting and viewing natural environments, which allow individuals to recover from stress and restore their capacity to focus attention. In urban settings, access to these environments is more limited, and they are typically of a lower quality and diversity than in non-urban/rural areas. This reduces available opportunities to recover from stress for those who live in high-density urban settings, and can result in less healthy ways of coping. Our research highlights the potential for virtual nature to support individuals to recover from stress (McAllister, Bhullar, Schutte, 2017; Schutte, Bhullar, Stilinović, and Richardson, 2017; Snell, McLean, McAsey, Zhang, & Magges, 2018), though where possible it is preferable that individuals are able to access real, natural environments.
High-density dilemmas
Due to rising housing costs in most major cities, apartment living has become increasingly necessary for many Australians, particularly young couples and families. The building and supply of apartments has increased dramatically over the last decade to try and meet housing demands, with planning regulations struggling to catch up, resulting in poor quality buildings and inadequate public services. Smaller apartments can result in greater residential crowding, and possibly more limited access to natural light. Exposure to crowding in interior environments, such as small apartments, is also linked to higher physiological stress among children (Rollings & Evans, 2019).
Although there are excellent examples of well-constructed apartments, typical apartment living in Australia often means greater exposure to noise from neighbours, as well as traffic and noise from adjacent roads and public spaces. All of these have potential negative impacts on psychological wellbeing.
The high-population density of urban environments also means that individuals are more likely to be exposed to crime, and witness or experience a traumatic incident such as a vehicle accident. In Australia, like much of the rest of the world, the rate of violent and sexual crimes per capita is significantly higher in urban environments. Reasons for this include higher numbers of potential targets and offenders, as well as greater exposure to economic inequality and social disadvantage (Hipp & Kane, 2017). Experiences of trauma are therefore more likely in urban environments, which can precipitate mental health symptoms.
As the proportion of Australians moving to cities continues to increase, psychologists play an increasingly important role in supporting individuals to become resilient to the stress of urban living. So too, psychologists can make a valuable contribution regarding the mental health impacts of urban development policies.
The first author can be contacted at [email protected]