Prevention of mental illness

Prevention of mental illness

Public Health The Journal of The Society of Community Medicine (Formerly the Society of Medical Officers of Health) Volume 93 Nmnber 3 May 1979 Pre...

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Public Health The Journal of The Society of Community Medicine (Formerly the Society of Medical Officers of Health) Volume 93

Nmnber 3

May 1979

Prevention of Mental Illness Dr Woodmansey's controversial and stimulating paper on page 131 should make us think carefully about what we are doing and how we should be doing it. If his assumptions about causation and about the effectiveness of analytic psychotherapy were correct his argument would be irrefutable. Unfortunately the position is far more complex. We do not know dae causes of mental illness and there is substantial doubt as to the effectiveness of analytic psychotherapy. So far n o form of psychiatric treatment has proved effective in the treatment of psychopaths, and society is slowly learning that some people are "'bad" rather than "mad". Dr Woodmansey's suspicions that foundations of mental health or ill health are laid in the neonatal period are probably correct, if so the recent revival in breast feeding and realization of the importance of bonding should result in better mental health in the next generation. But what can we do for those low birth weight babies which have to be placed straight in an incubator in the special care unit? Baby ducklings, puppies and kittens have been shown to "imprint" on the first object with an "eye" which they see. Ducklings hatched by a hen identify themsdves a~s chicks, but if incubated in a machine and shown a box with an eye painted on they adopt the box as a parent, and follow it if it is towed by a string. Does the human neonate sometimes "~imprint" on an incubator instead of a human? Could this be the basis of autism and childhood schizophrenia? These children who can relate to objects, and cannot form human relationships could well be the result of faulty imprintingand a consequence o~" modern technology. If so, training health visitors as psychotherapists would not solve the problem. It is the neonatal paediatrician, .the obstetrician and the midwife who must change their ways and ensure that no baby, however critical its physical health, goes into the incubator until it has been nursed and cuddled by a human. Is the assumptiort that behaviour problems are due t o emotional stress and preventable by simple psychotherapy valid ? Psychotherapy does not appear to be effective in treatment of established delinquency, but this does not mean that at an earlier stage it might not have prevented it. But there is no proof that it would. Without evidence to suggest at least a high probability of benefit would we be justified in diverting resources to developing this type of service? 129

130

Editorial

X,Ve may agree that health visitors should be wetl trained and have an understanding o f human relationships and psychology, but would we be warranted by existing evidence in subjecting them to psychoanalysis and turning them into therapists? How many of them would be willing to undergo psychoanalysis anyway? It is easy to ask such questions, but difficult to answer them. It is all too easy to ridicule and dismiss proposals. Anyone who attempts the formidable task of devising schemes to prevent or minimize mental illness deserves encouragement and respect. Mental illness probably accounts for more misery than is occasioned by all other illnesses together. We need people with ideas just as much as we need resources with which to test them. Collaboration between community physicians and psychiatrists to design and conduct a properly controlled trial to assess the value of schemes for the prevention of mental illness is surely essential, and long overdue. The need for a 25 to 30 year observatio'n period before results cart be assessed is however a major disincentive to the conduct of a prospective study. However if good hospital and community records allow identification of suitable subjects whose early experiences are appropriate, a study which was partly retrospective and partly prospective could provide valuable evidenc~ much more quicldy.