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Struggle and Solidarity

Seven Stories of How Americans Fought for Their Mental Health Through Federal Legislation

Edited by Michael T. Compton, M.D., M.P.H., and Marc W. Manseau, M.D., M.P.H.

  • ISBN 978-1-61537-238-6
  • Item #37238

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Mental health does not exist in a vacuum. The context in which an individual is born, grows, lives, and works has a profound impact on their mental and physical well-being. But although the powerful effects of these social determinants of mental health are not in question, how to affect them in actionable ways is.

Struggle and Solidarity addresses that gap in a compelling manner. By taking a case study approach to seven key pieces of federal legislation—among them, the Agricultural Adjustment Act of 1933, the Social Security Act of 1935, the Civil Rights Act of 1964, and the Housing and Urban Development Act of 1965—it demonstrates how public policies, even when not explicitly mental health–related, can shape social determinants and improve mental health in the United States.

For each of the seven laws, the book describes

  • The crisis in society that spurred the law's inception
  • Some of the key individuals and groups who drove its passage
  • How the law has evolved over time—including its shortcomings
  • How the law can continue to influence mental health in the future

Forgoing academic language in favor of a more approachable style and including photographs of some of the key players involved in each piece of legislation, this volume is accessible to all audiences while still making vivid and rigorous connections between national policymaking and the social determinants of mental health, summarizing the literature linking key social determinants affected by each law to mental health outcomes.

In sharing real examples of how individuals and groups have successfully advocated for policy changes, the authors of this book illustrate how important advocacy work can be accomplished and inspire readers to get involved in similar work to improve mental health today and in the future.


  • Chapter 1. A Glance at Our Rags Would Tell You More
  • Chapter 2. Saving Farmers and Striving for Food Security
  • Chapter 3. From Worker Exploitation to Union Solidarity
  • Chapter 4. A Stay Against Financial Catastrophe
  • Chapter 5. Clearing the Air for Mental Health
  • Chapter 6. Still on the Road to Freedom
  • Chapter 7. The Times They Are A-Changin'
  • Chapter 8. Remodeling and Breaking New Ground
  • Chapter 9. Learning from History's Lessons


    Taiwo P. Alonge, M.D., M.P.H.
    Caroline L. Bersak, Esq.
    Flavio Casoy, M.D.
    Michael T. Compton, M.D., M.P.H.
    Brie A. Garner, M.P.H.
    Elizabeth Haase, M.D.
    Jacob M. Izenberg, M.D.
    Benson S. Ku, M.D.
    Marc W. Manseau, M.D., M.P.H.
    Daniel Neghassi, M.D.
    Rebecca A. Powers, M.D., M.P.H.
    Julie C. Suarez, M.A.
    Andrew T. Turk, M.D., A.M.
    Matthew Wolfe, B.A., M.A.

About the Authors

Michael T. Compton, M.D., M.P.H., is Professor of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons and Research Psychiatrist at New York State Psychiatric Institute.

Marc W. Manseau, M.D., M.P.H., is Clinical Assistant Professor of Psychiatry at New York University Grossman School of Medicine.

The stories in this volume are presented in fascinating and engaging vignettes about ordinary people and their struggle for dignity and a better life. Social needs such as freedom from poverty, food insecurity, climate change, racism, and exploitation are elaborated to draw the reader to an inevitable conclusion. Mental health suffers because of these preventable social determinants. Policy-level change is imperative for impacts on large populations. This is a must-read historical review for anyone interested in advocating for the rights of populations and improving mental health.—Vivian B. Pender, M.D., DLFAPA,President, American Psychiatric Association, Clinical Professor of Psychiatry, Weill Cornell Medical College

I love to read and tend to prefer reading fiction in my spare time. This volume, edited by Michael Compton and Marc Manseau, is a notable exception. It tells the human stories of seven pieces of federal legislation that have improved the mental health of Americans. And these are not seven stories of the development of new treatments or even changes in insurance coverage. They are stories that focus on the social determinants of health. Food, employment, income, clean air, race equity, education, and housing matter for mental health. The book concludes with lessons learned from these quintessentially human narratives about how each of us can make a difference in advancing public health and mental health through policy change.—Lisa Dixon, M.D., MPH, Edna L. Edison Professor of PsychiatryNew York State Psychiatric InstituteColumbia University Vagelos College of Physicians and Surgeons and NewYork-PresbyterianDirector, Division of Behavioral Health Services and Policy Research & Center for Practice Innovations

This volume provides a fascinating historical journey into federal legislation of the United States and the impact these legal decisions have had on social determinants of mental health. The authors help us to step out of the medical model of treating illness and into a better understanding of how social factors must be addressed to gain and maintain mental health.
The authors begin by introducing the reader to Jack Geiger, M.D., and his lifelong dedication to treating the whole person, in their community, rather than just focusing on illness. This first chapter sets the stage for the remaining ones, which eloquently retell the history of significant legislation that had impacts on each of several identified social determinants of mental health. The chapters cover farming and access to food, labor and employment, income security, clean air, civil rights, education, and housing,. The authors of each chapter describe the impacts of the legislation on these social and environmental systems and the resulting effect the laws had on public and individual mental health.
In each chapter, the balance between fiscal, political, and social needs is played out through the advocacy of great leaders and affected communities. This book tells the story of social rights, or lack thereof, and it is a must-read for mental health providers, policy makers, and advocates.—Stephanie Le Melle, M.D., Director of Public Psychiatry Education, Associate Professor of Clinical Psychiatry, Columbia Univ Medical Center, New York State Psychiatric Institute

Struggle and Solidarity, edited by Compton and Manseau, is a brilliant exposition of the relationship between key national policies and social determinants of health and mental health. Focusing their lens on seven pivotal laws (passed during the Roosevelt and Johnson administrations) affecting policies on food and farming, labor, economic assistance, environmental regulation, civil rights, education, and housing, the authors tell compelling stories about how the needs for such policies became critical public concerns. They chronicle inspiring champions of the respective issues, emphasize the need for collaboration and compromise to secure legislative success, and highlight unintended and insidious intended consequences that threaten to undermine the putative aims of the policies. They further sharpen the focus to underscore the positive and negative mental health impacts on affected populations. These analyses are finally linked to the recognition that psychiatrists and other mental health professionals can and must act individually and collectively to facilitate positive outcomes of such policies. This is what effective and responsible community and public psychiatry at the highest levels is all about.—David A. Pollack, M.D., Professor Emeritus for Public Policy, Oregon Health and Science University

Struggle and Solidarity is a ground-breaking and inspirational book that shows readers how others have successfully advocated in the past for seven federal non-health-related laws—public policies—that impacted social determinants of health and mental health for the entire population.—Francis Lu, M.D., DLFAPA, Kim Professor in Cultural Psychiatry, Emeritus, UC Davis

The authors of Struggle and Solidarity narrate stories that mark some of the most important milestones in the history of American mental health, and the prowess of the editorial team—Dr. Michael T. Compton and Dr. Marc W. Manseau—shines through in comprehensive yet succinct chronological chapters that make for an easy read. It is hard to set down the book once you start reading it—it is logical and flows easily, and you find yourself coming away from each chapter, unique in its own content, having learned a lot by putting pieces of history together. A remarkable amount of work has gone into decoding and studying the various laws and eloquently elucidating the events and circumstances that led to their enactment. The book shows how history, advocacy, and politics collectively wove the tapestry of the societal structures in which Americans lived, learned, and worked, and created and then sought to address racial and ethnic divides.
After setting the stage in the first chapter by informing readers how federal laws affect basic social determinants and thus directly mental health, the authors take us chapter by chapter through the stories behind seven major federal laws. Interspersed are pictures of the tireless advocates who dedicated a significant chunk of their lives to enacting these laws, and illustrations that depict change spanning decades. The book beautifully wraps up with a concluding chapter summarizing the lessons one can learn from history, with an unmissable commentary on systemic racism.
The concept is brilliant, the organization immaculate, the presentation uniform, and the execution seamless. Let us use the knowledge contained in this book to inform policies and drive the change that the American public is in desperate need of today. The book is a must-have for just about any bookshelf in any American household.—Sanya Virani, M.D., M.P.H., Forensic Psychiatry Fellow, Alpert Medical School at Brown University, and American Psychiatric Association Resident-Fellow Member Trustee

Drs. Compton and Manseau and the many chapter authors have done the field of psychiatry and the world of mental health an extraordinary favor by removing our blinders and locating us in the world we inherited and can help to recreate. They take the concept of Health in All Policies, no doubt obscure to many, if not most, psychiatrists, and firmly locate it in the historic actions of passionate advocates for change. Beginning with a eulogy for Dr. Jack Geiger, a leading activist physician of the last 60 years, they then lead us through the dramatic stories of seven legislative victories outside of health care, from the Agricultural Adjustment Act of 1933 to the creation of the Department of Housing and Urban Development in 1965, that changed American lives, including their mental health, for the better. Their argument is simple. When faced with societal challenges to their health, mental health, and well-being, regular Americans have found ways, through legislation and policy, though not always perfect, to move forward. It is tempting to ask if there is a need for psychiatry and psychiatrists to join these efforts. Compton and Manseau make a convincing argument that our profession's voice matters. They point to the emerging concept of mental health impact assessments and the need for psychiatric input in policy development. In the challenging world we live in, we have a choice to be silent, or to follow the example of those before us who struggled to make it better. The stories in Struggle and Solidarity represent an excellent launching point for psychiatry's renewed engagement with our society and its future.—Dr. Kenneth Thompson, MD

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