Smoking is an entrenched,insidious and neglected problem for the mentally ill and the systems which care for them. International research confirms that they often smoke more heavily, for more years and in greater proportions than the general population. This book reports on an extensive ethnographic study of barriers to quitting by community-based and institutionalised psychiatric populations. Client and staff interviews were triangulated with extensive participant observation of inpatient and community sites. Significant barriers to quitting for clients and staff as a consequence of a culture that reinforced smoking emerged. Once a person was socialized into the culture, quitting was most unlikely. Important systemic factors reinforcing smoking were use of cigarettes to manage symptoms of mental illness, to cope with feelings of helplessness, stigma and despair, to control client behaviour, and to facilitate and regulate staff- client interactions The historical context for current clinical practices and their consequences within mental health settings are explored. From a sociological viewpoint, then, smoking was found to be a necessary addiction.