In 1987, a patient in a California psychiatric hospital wrote to the R.J. Reynolds tobacco company with a request: "We mentally ill, or allegedly mentally ill, smoke a lot. Most patients here are smokers and we buy a lot of your cigarettes. - Many of us like or are addicted to cigarettes -we are often too poor to buy them - then we have to share them - and suffer. Do you think your company could send us free samples? Any brand would do."'This letter, as well as others like it located in tobacco industry archives, speaks to the attachment that mentally ill patients have long had for their cigarettes, as well as their positive feelings toward the industry that makes them. Indeed, the mentally ill now constitute a significant portion of the remaining smokers in the United States, and they remain a population that has not been easily affected by the rapid growth of smoking cessation campaigns. As historian Allan Brandt has demonstrated, the rise and fall of the cigarette in America is a fascinating story - in particular because of the ongoing efforts of the tobacco industry to confuse issues around smoking and health. Yet relatively little is known about the history of smoking in one of the industry's most loyal groups: the mentally ill. My project will explore the history of three main areas relating to the connection between smoking and mental illness, particularly in the second half of the twentieth century. First, I will examine evidence regarding the role of smoking in mental institutions, a focal point for psychiatric care for the mentally ill for most of the century. Second, I will explore the activities of the tobacco industry around the biochemical and behavioral aspects of smoking, with a focus on the industry's awareness of mentally ill patients'attachment to cigarettes and the mental and emotional effects of nicotine. Finally, I will look at smoking cessation initiatives from the perspective of the mentally ill and their advocates who were often dubious - if not outright opposed -to the argument that smoking cessation would improve the lives of the mentally ill. This is an exciting topic that both gives voice to a marginalized population and addresses an important issue in public health policy.

Public Health Relevance

The mentally ill do not often get included in public health discussions around smoking. Yet the rate of smoking among the mentally is significantly higher than in the general population, and these smokers constitute a significant part of what some analysts have identifiedas a hard-core group who have not been touched by the existing tobacco control movement. In order to inform contemporary policy decisions about how to deal with the serious and deleterious effects of smoking on this already high risk population, we need more information about the long and deep connections between smoking and mental illness.

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
Health Sciences Publication Support Awards (NLM) (G13)
Project #
5G13LM010186-03
Application #
8304394
Study Section
Special Emphasis Panel (ZLM1-ZH-P (01))
Program Officer
Vanbiervliet, Alan
Project Start
2010-09-30
Project End
2013-09-29
Budget Start
2012-09-30
Budget End
2013-09-29
Support Year
3
Fiscal Year
2012
Total Cost
$49,000
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Hirshbein, Laura D (2014) Politics, profit, and psychiatric diagnosis: a case study of tobacco use disorder. Am J Public Health 104:2076-84