Keywords

Introduction

Damascus surpasses all other cities in beauty, and no description, however full, can do justice to its charms

Ibn Battuta (Battuta and Lee 2013) (Travels of Ibn Battuta 1325–1354)

The world has had cities and towns since at least 4,000 years BC. Damascus, described by Ibn Battuta in the fourteenth century, is, in 2016, perhaps popularly best known as the embattled capital of war-torn Syria. Yet, the beautiful city of Damascus was established in the third millennium BC and is one of the few cities in the world that has been continuously inhabited since this time until 2016. Thus, for millennia there have been urban societies, and, since these early cities, diverse philosophers and intellectuals have tried to make the urban space an articulation of the aspirations of each culture and society, including aspects of moral, spiritual, and material well-being. When Al-Farabi wrote his Treatise on the Views of the Residents of the Virtuous City in roughly 948 AD, he was synthesizing Arabic and Greek philosophical ideas of urban human society, and, as an admirer of Plato and Aristotle, he was thinking of how humans can live together in happiness, peace, and harmony in the urban space (Tanabayeva et al. 2015).

Ibn Battuta’s fourteenth-century perspective is also a fascinating reflection on the city for our understanding of today’s urban world (Battuta and Lee 2013). Starting in Tangiers in 1325, at the age of 21, Ibn Battuta travelled 73,000 miles over a period of 24 years, visiting the major cities of the equivalent of 40 present day countries of the near East, Africa, and Asia. He travelled to amazing and diverse ancient cities such as Damascus, Delhi, Constantinople, Tangiers, Isfahan, Samarkand, Timbukt u, and Kabul: he describes the cities he saw as the locus of cultural advancement, architectural sophistication, and the epitome of human cultural, spiritual, and social “development.”

In the globalized twenty-first century, with its everyday images of the often violent, unequal, and polluted towns and cities of the world, it is easy to forget that cities and towns may still hold cultural and spiritual appeal – and part of the puzzle of urbanization is the fostering of urban spaces that do and will nurture both material and mental well-being.

Historical and Twenty-First Century Urbanization

Why is it important to bring the wisdom of the past to debates about our current mental health situation? Perhaps because we, as a species, are at a turning point: in 2008, we reached a milestone of human demography, history – and culture – when the United Nations (UN) calculated that the world’s population had become more urban than rural, and predicted that from this moment, the future home of the world’s human population would be principally urban (United Nations DoEaSA, Population Division 2014).

The World Health Organization (WHO) also put a previously under-recognized health problem on the policy map in the twenty-first century – for the first time, after centuries of struggle to achieve physical health and well-being, mental health problems have emerged as a new major cause of ill health and disability (World Health Organization 2014a). In May 2013, the 66th World Health Assembly formally adopted the first-ever Mental Health Action Plan of the World Health Organization (World Health Organization 2014a). This does not mean that the only issue to be dealt with is mental health in cities – most cities and towns have severe burdens of disease and death related to the physical conditions of the urban space, but it does mean that attempts to create healthy cities must include in their definition of health the broad sense of mental and spiritual well-being.

In the twenty-first century we have both new and old urban challenges, some the same as those faced by the ancient thinkers and designers of cities, but some different. Cities and towns are now the locus of the world’s most stark inequities (UN Habitat 2010). Inequities in urban living conditions have been a feature of urban life since towns and cities were developed. Now in the twenty-first century only a minority live in what could be described as “healthy” conditions, conducive to physical and mental well-being, and UN Habitat calculates that 863 million people live in “slums” (UN Habitat 2010). “Slum” is the pejorative term used to describe low-income informal settlements in the European past and is still the derogatory word used to describe settlements of millions of low-income urban citizens of Asia, Africa, and Latin America.

Cities also concentrate the world’s wealth and the wealthy – we have the extremes of poverty and wealth concentrated in the city and townscapes of the world (UN Habitat 2010). Urban inequity may seem unconnected to mental well-being, but there is evidence that inequity is linked to levels of insecurity and violence in cities and towns – which have significant impacts on mental well-being (Decker et al. 2014; Dinizulu et al. 2014; Echeverria et al. 2014).

Two global challenges that past thinkers did not know, or have to face, are climate change and massive natural resource depletion. The effects of environmental changes on urban health and well-being are likely to be severe (McMichael 2005). Paradoxically, cities, or rather city dwellers, are largely responsible for these new risks they will face: the move from rural to urban corresponds with a growing problem of industrialization and material consumption, and cities and towns are a significant driver of human-induced climate change and resource depletion (UNEP 2012). Cities are the generators of environmental change, but also people in cities may be the hardest hit by these two environmental challenges: by climate change impacts as sea levels rise and extreme weather events batter towns and cities, and by resource scarcity as cities, often dependent on imported food, water, and other resources, find themselves without access to vital resources. In terms of climate change, coastal cities are particularly at risk, and large-scale disasters, displacement, and severe health impacts are predicted by the UN (UNEP 2012).

This chapter looks at urban mental health from the perspective of the past and future – considering particularly the evidence in the urban centers of Asia, Africa, and Latin America; learning from the architects, planners, and philosophers of the past; and looking at how these thinkers can help us face our newer challenges.

It is important to realize that there are widely different types of “urban” – and the complex social, material, and economic matrix of each urban setting can have a unique effect on its inhabitants’ lives and mental well-being. For example, “urban” can mean anything from living in a small urban settlement of 50,000 or less to living in a megacity of over ten million, perhaps covering up to 100 km2 – and the impacts of the urban experience are very different depending on the type of urban center involved. To put this in a historical context, it is notable that few cities in the past had more than 50,000 inhabitants, and, even today, many countries have smaller populations than the megacities we see of ten million and more inhabitants. The challenges and opportunities of urban life today are simply at a completely different scale.

Current urbanization patterns are also important. It is Asian, Latin American, and African cities that concentrate the majority of the world’s urban population now, and will in future. Therefore, the specific conditions of the towns and cities of these regions will determine the overall urban mental health and well-being profile of the world. Particularly significant is the speed of change – African and Asian cities are the most important demographically, but they are also growing more rapidly than other cities with a subsequent massive pressure on resources.

The presence and magnitude of low-income urban settlements and the pattern of inequality between people in any city will also determine urban health patterns overall and the mental health problems within these patterns.

Summarizing the Evidence on Urban Mental Health

It is important to be clear about the term “mental health and illness.” The WHO argues that mental health is an integral part of health, that mental health is more than the absence of mental disorders, and that mental well-being is determined by socioeconomic, biological, and environmental factors (World Health Organization 2014a). It then follows that the specific urban social, economic, and environmental context – the risk factors for health disorders or the protective factors for mental well-being – of each town and city will influence overall health profiles – and mental health profiles of a city, but also will influence distribution of mental health disorders and of mental well-being within each city.

To understand urban mental health we need to understand a wide range of disorders that include “depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism”(World Health Organization 2014a). The extreme end of this spectrum also includes suicides, and for some authors it is valid to interpret violence as a mental health issue (World Health Organization 2014b).

Urban mental health disorders, unlike most other infectious or noncommunicable illnesses, do not necessarily have the same socioeconomic or environmental determinants in all cases and may not manifest in the same way. For example, “depression” for a wealthy and culturally privileged person in a city may have very different determinants to “depression” for a person living in a low-income, informal settlement or an urban minority person or an urban refugee. The depression of these different urban dwellers may also manifest itself in different ways, and its prevention or treatment may also need to be different.

The evidence base of urban mental health is extensive, but incomplete. In summary:

  • While over 50% of the urban population lives in Asia, and the fastest growth is in Asia and Africa, almost all of the large-scale national studies of urban mental health, and most systematic reviews of mental health overall, are based on studies of European and North American populations (Walker et al. 2015).

  • There are limited data on mental health in towns and cities of Asia, Africa, and Latin America (Cortina et al. 2012).

  • While over half the world’s urban population lives in towns of less than 500,000, there are few studies on mental health in smaller towns and cities.

  • While some cities may have up to 60% of their population in low-income settlements, there are few studies of mental health patterns within cities, nor specific studies of mental health in low-income settlements (Fryers et al. 2003).

  • Almost all studies are cross-sectional studies of mental health. There are very few data on long-term trends in mental health in towns and cities (Richter et al. 2008).

In terms of evidence, one of the main debates is about whether living in towns and cities is better or worse for mental health than living in rural areas. There is a huge split in academic opinion (Breslau et al. 2014; Reeves et al. 2013; Paykel et al. 2003; Nepomuceno et al. 2016). Perhaps the problem is that analysts ask the wrong question: when urban areas are so big and conditions within cities vary so widely, these huge aggregations of “urban-rural” make little sense. Studies of intra-urban health differentials expose evidence that both mortality and morbidity indicators for the urban poor are worse than those for their wealthier urban neighbors and are often worse than rural indicators (Stephens and Satterthwaite 2008; Stephens 2012; UN Habitat 2010).

Evidence from Systematic Reviews

Systematic reviews, which are scientific reviews that compile all the current evidence on any theme, are often the most helpful summary of current evidence. This is also true of evidence on urban mental health, with the caveat that most urban mental health systematic reviews accessible in English are based on studies in wealthier countries with larger databases and often miss studies published in other languages or exclude studies from poorer regions on the grounds of quality.

Recent systematic reviews suggest the following trends and patterns in common mental disorders such as depression, addictions, and anxiety.

  • Trends in urbanization and trends in mental health: There is a strong trend towards urbanization over time, but does that translate into evidence of increasing mental disorders over time? A recent systematic review of long-term trends in mental health disorders pooled data from 44 major international studies and found that “neither general mental disorders nor specific disorders such as depression, anxiety, addictions or eating disorders showed a clearly increasing trend. Child and adolescent psychiatric disorders also failed to show an increasing trend” (Richter et al. 2008).

  • Urban-rural patterns of mental health disorder: There is a major debate about urban-rural differences in mental health, but there is little evidence of a genuine independent effect of “urban” living on mental health disorders. A recent systematic review of urban-rural differences in common mental health disorders looked at 20 large-scale population studies, principally from mostly urban Europe and North America (with two studies from other countries: Australia and South Korea). Researchers found that, in pooled analysis, and after controlling for confounders (such as age and sex, socioeconomic conditions or relationship status), there was a slight increase in prevalence in overall mental disorders in urban areas compared to rural areas. Interestingly, the majority of the studies showed no significant urban-rural difference for mood disorders (66% of studies showed no difference), anxiety (67%), or substance abuse (69%). Intriguingly, Belgium showed an opposite trend to other countries with significantly higher prevalence of mental health disorders in rural areas (Peen et al. 2010).

  • Urban poverty , mental health, and social inequality: A recent systematic review, again of large databases covering the urban European population, looked at the links of social inequality and mental health disorders and found that social conditions within cities were more important than the actual “urban” effect: “evidence of an association between one or more markers of less privileged social position and higher prevalence of common mental disorders … the more consistent associations were with unemployment, less education and low income or material standard of living” (Fryers et al. 2003).

  • Urban disasters and mental health: The future threats to urban health from climate change are predicted to involve extreme weather events and increased risk of disaster. There are several systematic reviews looking at the impacts of disasters on mental health disorders, particularly post-traumatic stress disorders (PTSD), depression, and anxiety. A wide-ranging systematic review looking at responses to community disasters found that “many (11%–38%) distressed individuals presenting for evaluation at shelters and family assistance centers have stress-related and adjustment disorders; bereavement, major depression, and substance use disorders were also observed, and up to 40% of distressed individuals had preexisting disorders” (North and Pfefferbaum 2013). Looking specifically at mental health responses of elderly people to disaster, a recent systematic review found that “older adults were 2.85 times less likely to experience post-traumatic stress disorder (PTSD) symptoms following a disaster (95% CI: 1.42–5.70) when compared with younger adults. There was no statistically significant difference in terms of anxiety and depressive symptoms” (Siskind et al. 2016; Parker et al. 2016).

Evidence from Asia, Africa, and Latin America

Given the focus of most systematic reviews on large-scale surveys from wealthier countries, it is important to look at data from regions that are less represented in the literature, and particularly from cities and towns in Asia, Africa, and Latin America.

Urban-Rural Differences

One recent study in Northeast Brazil looked at urban-rural differences in common mental disorders. Researchers found “significant differences between the inhabitants of the rural and urban communities regarding well-being and the prevalence of common mental disorders (CMD), with a higher average well-being score in the rural context; the urban sample had a higher average regarding the prevalence of CMD” but also found that income was an important confounder of the rural/urban difference (Nepomuceno et al. 2016). A study of urban-rural differences in depression in Nigeria found significantly higher rates of depression in rural than urban areas, again with links that suggest the importance of socioeconomic conditions in each area, which are more important than measures of “urbanicity” or “rurality” (Amoran et al. 2007). Interestingly, a study looking at urban-rural differences between a low-income rural and low-income peri-urban community in South Africa, that “a high prevalence of mental health and substance abuse problems was observed in both communities, with highest rates in the peri-urban township” (Havenaar et al. 2008). These findings, on the importance of the context of socioeconomic conditions in either rural or urban settings, are supported by studies in Europe, for example, “there are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments” (Paykel et al. 2003).

Impacts on Different Age Groups

In terms of urban-rural mental health disorders in different age groups, there is some evidence that urban adolescents and the urban elderly are particularly vulnerable to disorders such as depression, but evidence suggests that the urban-rural difference is often explained by sociodemographic factors (Mojs et al. 2012; Hesketh and Ding 2005). For example, a study in Japan found that both rural and urban elderly experienced depression linked to living alone, being unemployed, sleep disturbance, suicidal ideation, financial strain, and poor social support (Abe et al. 2012). A recent study of mental health in the rural and urban elderly in India found that urban residence, female gender, higher age, nuclear family, poverty, and functional and cognitive impairment were significantly associated with depression (Sengupta and Benjamin 2015). A study in Korea of the rural and urban elderly found that mental social support deficits were most strongly associated with depression in people with a lifetime rural residence, followed by urban residents with a rural birthplace (Kim et al. 2004).

Urban Violence and Mental Illness

Perhaps the indicators of the most extreme mental distress can be seen from both personal and interpersonal violence (Middleton et al. 2003). Interpersonal urban violence is one of the leading causes of death in some cities, particularly in Latin America and Africa. There is also evidence that levels of interpersonal violence in cities and towns have a profound impact on mental well-being and on levels of mental disorders, particularly post-traumatic stress, not just for the victims and the witnesses but also for the perpetrators of violence (Kadra et al. 2014; Kliewer and Lepore 2015). Street children and disadvantaged young men are particularly at risk (Diez Roux et al. 2007).

Urban Suicide?

Suicides are an expression of extreme mental distress. In 2015, WHO released a major global report on suicide and reports “Risks linked to the community and relationships include war and disaster, stresses of acculturation (such as among indigenous peoples or displaced persons), discrimination, a sense of isolation, abuse, violence and conflictual relationships … risk factors at the individual level include previous suicide attempts, mental disorders, harmful use of alcohol, financial loss, chronic pain and a family history of suicide” (World Health Organization 2014b). This implies that urban areas might pose a particular set of suicide risks for vulnerable individuals, but studies from multiple settings internationally indicate that, at present, rural areas have significantly higher rates of suicide, particularly for young or working age men, and the elderly (Razvodovsky and Stickley 2009; Law et al. 2014; Wallis 2015).

Policy Approaches to Urban Mental Health: Learning from the Past and Looking to the Future

Looking at the diverse cities and towns of the world and their seeming chaos, it would appear that planners and architects have never thought about the mental well-being of urban citizens and that they have failed to think about inequality or environmental change. Yet, any health specialist with this assumption needs to understand that the fundamental aim of urban philosophers, planners, and architects has always been to conceptualize, plan, and manage towns and cities for the fulfillment of both mental and physical health of urban citizens. The challenge has always been to marry this aim with the reality of the urban space and the people who live in it.

As Anthony Churchill reflected (Box 1), when writing the preface to a major conference on Cities in Conflict (Lea and Courtney 1985) – in his then role as head of the World Bank’s urban program in Asia – cities are created by people and each city is a creation of the interaction of social, economic, cultural, and political imperatives of each moment of city development. In this context, the role of planners and architects is profoundly linked to the historical and cultural context of the cities in which they live.

Box 1 Cities Are Built by People

This is an obvious but often forgotten statement. When we see the cities of the developing world, we cannot help but be impressed by the restless energy of their teeming millions. Dwellings and places of work rise in an endless and apparently unstructured fashion, almost before our very eyes. Yet what urban professionals – whether they be architects, planners, or economists – can look upon this chaotic scene without the almost compulsive urge to impose their own sense of order? Fortunately for these cities, however, the professionals usually fail.

What we have all forgotten is that the city is a creation of economic, political, and social necessity. It is the way it is for very good reasons, and unless we are prepared to address the underlying rationale for the existence of urban areas, attempts to bring order and reason into the processes of urbanization will fail – if we are lucky. If we are unlucky, we may well damage the urban fabric that we are so anxious to improve.

Anthony Churchill in (Lea and Courtney 1985) Preface speech Cities in Conflict Conference.

Learning from Architects, Philosophers, and Planners of the Past

What we have to learn, if anything, from history? Two ideas may illustrate this.

The first is the concept of the Ideal or Utopian City – combining spiritual and material well-being – a political philosophy and practice developed over centuries and put into practice in cities throughout history (Fourier 1902; Steiert 2002). The second is another utopian ideal – the Garden City – which conceives the city as a place at one with nature – first articulated centuries ago in the ancient cities such as the Persian city of Isfahan (Akhouchekian 2009).

Ideal and Utopian Cities

The Ideal or Utopian City has been an aspirational way of addressing urbanization almost since the genesis of the most ancient cities.

Essentially an Ideal or Utopian City planner looks at the architectural form of the city but most importantly explores how urban form can be designed to social and spiritual goals. In terms of urban mental health, the Utopian City philosophers and architects are important because they were perhaps the deepest thinkers about the need for city forms to generate mental and spiritual well-being, and many of these thinkers explicitly addressed issues of happiness, work, the use of color and form to create peaceful spaces, and the ideas of virtuous and congenial living (Arjmandi et al. 2011). The Virtuous City, conceived by Al-Farabi in the first century, is one of the earliest explorations of this idea, but architects and planners have drawn on the same ideas for centuries.

Philosophers of ancient western Asia have been among the most influential thinkers about ideal design of cities. Persia has centuries of historical development of urban spaces and has been one of the most important civilizations to think about specific urban design as the creation of a spiritual urban space, inspired of religious and philosophical ideologies, which either created energy or decreased environmental stressors. Their view was linked to Islamic principles: Persian philosophers such as Abu Nasr Farabi (872–950), Avi Sina (980–1037), and Nasir al-Din Tusi (1201–1274) explored the characteristics of an Ideal Spiritual City (Akhouchekian 2009). The essential elements of this design aimed to create:

  • A place which ensures social security for its inhabitants

  • A place where the virtuous live

  • A place that is governed by wise individuals

  • A place which contributes to spirituality and religion

  • A place that ensures urban harmony of all environmental, social, and cultural conditions

  • A place with an emphasis on public spaces and services

  • A place where all citizens have and observe equal human rights

In the fifteenth century, several centuries after the Persian philosophers, Filarete, an Italian architect–philosopher was commissioned to design the ideal city of Sforzinda (Lang 1972). Filarete centered his ideas on the inhabitants’ physical protection from external (human) threats: This idea of security defined the shape of the city and part of its internal structure. He developed a star-shaped, walled scheme surrounded by a moat, with all the entrance gates observed by two watchtowers. But Filarete was not only interested in the provision of security, he also created spaces where human activities (leisure, commerce, and spiritual) would take place in an organized and calm manner (Steiert 2002).

Four centuries later, the Phalanstère, designed by the nineteenth-century French architect Charles Fourier, followed these ideas of ideal spiritual design. Fourier’s aim was to create an ideal of urban design and social well-being. Social happiness and success would come from cooperative work of organized communities. These communities would not exceed 1500–1600 inhabitants, occupying a one-league square piece of land, in which a multipurpose building, called the Phalanstery would sit (Fourier 1902). Utopian philosophical groups welcomed the idea of the Phalanstery, and several Phalansteries were built and inhabited in the USA in the late nineteenth century. This idea was then adapted by le Courbusier, in the mid-twentieth century, when he designed the Unité d’Habitation, a self-contained commune, at Marseilles (Coleman 2005).

Nature, Spiritual Well-Being, and Mental Health in Cities

The second key idea, again from another branch of Utopian philosophy and architecture, is the idea of the Green or Garden City. There is considerable evidence that access to urban green spaces has a positive impact on both urban mental well-being and urban violence (Toronto Public Health 2015). This idea also has a long history and again comes from some of the most ancient inhabited regions and cities of the world. This idea is perhaps not only important for mental well-being but also for the challenge of environmental sustainability – where Garden cities are seen as a potential solution to this newer problem.

One of the most ancient cities of the world, Isfahan, was already a Garden City by the early part of the first millennium. Isfahan is important as an example because it has been seen as an icon of religious and social tolerance and also was conceived and developed as a city of natural and man-made beauty. It is one of the highest-ranking examples of Islamic-Iranian architecture inspired from philosophic Utopia (Rostami et al. 2015). Other cities in Persia were modeled on the same ideas. Using natural areas such as green space, water, soil (as places of identity, memory, and belonging), the philosophers, and planners of Persian cities believed that “green” design facilitated positive psychological and social effects in the city inhabitants.

Several centuries later, these concepts reemerged with the European Garden City idealists, including the UK Garden City movement, conceived and implemented by the late nineteenth/early twentieth century architect Ebenezer Howard (Howard 1965). These cities were developed in response to the late nineteenth-century pollution and poverty within cities, which were regarded as a major concern by most urban planners (Box 2). Ebenezer Howard believed that “The garden cities were to be slum-less and smoke-less, with good-quality housing, planned development, large amounts of open space and green belts separating one settlement from another” (Howard 1965).

Box 2 The Birth of UK Garden City Movement

“We are becoming a land of great cities. Villages are stationary or receding; cities are enormously increasing. And if it be true that great cities tend more and more to become the graves of the physique of our race, can we wonder at it when we see the houses so foul, so squalid, so ill-drained, so vitiated by neglect and dirt?” Ebenezer Howard 1902 Garden Cities of Tomorrow.

Nine garden cities were built in the UK, and there are now over 40 garden cities in countries as diverse as Finland, Japan, Canada, the USA, Australia, India, South Africa, Malaysia, Argentina, and Venezuela (Toronto Public Health 2015).

We chose a tiny snapshot of the wealth of human thought applied over centuries to create spiritually and mentally healthy urban spaces (Rostami et al. 2015; Leach 1997; Coleman 2005). Do these effects persist today? A recent study in four of these ancient Iranian cities found that their historical Persian gardens still promote social attachment, increase public gatherings, as well as facilitating public services, employment, and local economic activities. Garden cities are regarded as having among the best quality of life indicators for residents (Toronto Public Health 2015).

Conclusions

The modern myth that “urban” life inexorably causes mental illness continues and is likely to persist (Barber 2011). But the world is still urbanizing and people are still moving to towns and cities, particularly in Asia and Africa – and many people move to improve their lives. The important thing then becomes the urban experience. Evidence suggests that complex factors such as poverty, social relations, and employment are critical determinants of mental illness or well-being, overriding the simple “Urban = Unhappiness” analysis.

With the massive challenges of towns and cities today, it is easy to see how the practical issues of urban shelter, water, sanitation, and transport may overwhelm modern urban planners. It is also easy to see how modern urban health professionals get overwhelmed with urban illness, and urban mental illness becomes just another thing to worry about.

But it is also the scale of today’s urban challenges that demands that we look for all the ideas and wisdom, including from all periods of urban thinking. Do thinkers from the past take us forward? Of course – if we are prepared to look back, learn, and move forward. What does this mean in practice?

We avoid reinventing the wheel – Every new generation likes to think that they are inventing something new, and this is true of the modern rediscovery of green cities or the rediscovery of the links of urban design and mental health. Yet, both the Utopian and Garden City movements experimented with the same ideas, and learning what worked and why, and what did not work and why, is invaluable for the improvement of today’s versions of these concepts. For example, garden cities have become a worldwide phenomenon and are very popular with those who live in them. But in many contexts they have also become home to the wealthiest urbanites, and the challenge has always been to make these as inclusive as Howard and his predecessors originally intended.

We gain the courage to dream big – In the context of today’s challenges, perhaps one of the most significant things to draw from urban thinkers of the past is their vision – their ambition and courage of vision about the urban space. They were not afraid to think big. They too were living with massive urban inequalities, with “slums” and, in most towns and cities, in terms of health – shorter life expectancies, and constant threat of epidemics, illness, and violence. Yet these urban thinkers had the courage to design the Virtuous City, the Utopian City, and the Garden City. They had the sagacity to see the urban space not just as a physical planning challenge but also as a challenge of the city of spiritual, mental, and moral well-being, and it was this that guided their overarching vision of urban design.

Ancient thinking for a modern dilemma – Creating equitable and sustainable cities is cast as a uniquely twenty-first-century dilemma, and mental well-being is a key part of this. Yet over 1000 years ago, Al-Farabi was already considering this very modern predicament. In his view “authentic happiness” in the Virtuous City is found in ethical, modest living, and in congenial, honest interaction with other people. Inauthentic happiness stems from greed, arrogance, material wealth, and ostentation. This resonates with the evidence of the underlying causes of mental ill health in cities and speaks to the solution of the social inequality that we see so starkly in our cities. Al-Farabi’s view on authentic human happiness is also highly relevant for our currently unsustainable cities – we seem trapped in a development model of unquenchable material consumption, which promises happiness for all, but so far has delivered happiness for the few, and planetary destruction for all.

Avoiding Hubris – Finally, learning from history involves humility – we are not the first generation to think about the city as a space for mental well-being or illness, and we will not be the last. Learning from past urban thinkers means that we take the best of the lessons from the past, learn what to adapt, and move forward. People in the future may do the same with our experiments.

In the context of our planetary crisis and our urban future, there has never been a better time to take every lesson we can from the brave experimenters of the past. We go full circle when we realize that the urban future needs to be both socially and environmentally sustainable – quite simply because our human future depends on it. We go full circle too because Al-Farabi along with many philosophers teaches us also what we have known for thousands of years: beyond a certain point of basic necessity, material “well-being” has no link to either individual or community mental health or well-being – or human happiness.

Cross-References