She was born Patti Lee Smith in Chicago, Illinois and raised in New Jersey. Her father was an atheist and her mother was a devout Jehovah's Witness. The family was not wealthy and, her formal education over at 16, Smith went to work in a factory – an experience she found excruciating. She also bore a child whom she gave up for adoption. In 1969 she left New Jersey for good. When Smith first arrived in New York City, she lived in the Chelsea Hotel with Robert Mapplethorpe. The two were lovers for a time, in spite of Mapplethorpe's homosexuality, and they remained close friends until Mapplethorpe's death from AIDS in 1989. (Among Smith's other well-known lovers were poet Jim Carroll and Television member Tom Verlaine). She spent the early 1970s painting, writing, and performing spoken-word poetry—frequently at St. Mark's Poetry Project. In 1971 she performed – for one night only – in the play Cowboy Mouth, a collaboration with the playwright and actor Sam Shepard (the published play's notes call for "a man who looks like a coyote and a woman who looks like a crow"). Smith subsidized her career in these years by publishing rock journalism, especially in Creem magazine. She also wrote songs during this period in connection with Allen Lanier of the Blue Öyster Cult, who recorded several songs to which Smith contributed, including "Career of Evil," "Fire of Unknown Origin," "The Revenge of Vera Gemini," and "Shooting Shark."

By 1974, however, Patti Smith was performing rock music herself, initially with guitarist and rock archivist Lenny Kaye, and later with a full band comprising Kaye, Ivan Kral (guitar), Jay Dee Daugherty (drums) and Richard Sohl (piano). Financed by Robert Mapplethorpe, the band recorded a first single, "Piss Factory/Hey Joe," in 1974. The A-side describes the helpless anger Smith had felt while working on a factory assembly line and the salvation she discovered in the form of a shoplifted book, the 19th-century French poet Arthur Rimbaud's Illuminations. The B-side was a version of the rock standard with the addition of a spoken-word piece about fugitive heiress Patty Hearst. The Patti Smith Group was signed by Clive Davis of Arista, and 1975 saw the release of Smith's first album Horses, produced amidst some tension by John Cale, formerly of The Velvet Underground. The record fused rock and roll, proto-punk rock with spoken poetry and is widely considered one of rock's greatest debuts. The album begins with a cover of Van Morrison's "Gloria," and Smith's opening words are some of the most famous in rock: "Jesus died for somebody's sins ... but not mine." The austere cover photograph by Robert Mapplethorpe has become one of rock's classic images. As the Patti Smith Group toured the United States and Europe, punk's popularity grew. The rawer sound of the group's second album, Radio Ethiopia, reflected this. Considerably less accessible than Horses, Radio Ethiopia received poor reviews. However, several of its songs, notably "Pissing in a River, " "Pumping," and "Ain't It Strange," have stood the test of time, and Smith still performs them regularly in concert. While touring in support of the record, Smith accidentally danced off a high stage in Tampa, Florida, falling 15 feet into a concrete orchestra pit and breaking several neck vertebrae. The injury required a period of rest and an intensive round of physical therapy, during which time she was able to reassess, re-energize and reorganize her life, a luxury which had been denied her in her swift rise to fame. The Patti Smith Group produced two further albums before the end of the 1970s. Easter (1978) was her most commercially successful record, containing the hit single "Because the Night" – co-written with Bruce Springsteen – which rose to #13 on the Billboard Hot 100. Wave was less successful, with "Frederick" and "Dancing Barefoot" receiving only minor radio airplay.