PREVENTION OF MENTAL ILLNESS

Unfortunately, few forms of mental illness are preventable. General paresis (syphilitic encephalitis) can be prevented by giving adequate anti-syphilitic treatment during the early stages of the disease: alcoholic psy­chosis can be prevented by treating the problem drinker; and the psychosis associated with pellagra can be prevented by assuring an adequate intake of vitamin B.

As with the prevention of somatic disease, there are several measures for the promotion of sound mental health. The provision of support in times of stress, the prevention of parental deprivation, improvements in child-rearing practices, adequate prenatal and postnatal care, reduction in exposure to ionizing radiation, and genetic counseling—all fall within the promotion of optimal mental health.

To a significant extent, the senile psychosis can be prevented or, at least, postponed or minimized. It now seems quite clear that senility may develop when older people lose interest in their surroundings, in their friends and families, and finally in themselves. Prevention requires that susceptible older people be kept active and interested in what goes on about them. Improved housing, which makes it possible for the elderly to continue to play a role in the community, "Golden Age" clubs, and recre­ational programs for older adults, all have preventive value. It is the older person living alone in social isolation and lacking funds for outside activi­ties who rapidly deteriorates in the senile state.

The pathogenesis of some psychoses (schizophrenia, manic-depressive psychosis, involutional psychosis) is so incompletely understood that it is not yet possible to prevent their occurrence. Nevertheless, as Lemkau has stated: "The unique objective of mental hygiene as part of preventive medicine is to insure that the personality structure is as sound, as healthy, as its genetically determined base permits. It is the influencing of the process of assimilating or integrating experiences to the end that healthy personalities eventuate that is the aim of programs for the promotion of mental health."

The promotion of mental health extends far beyond the field of psy­chiatry. It involves a home life that provides acceptance, security, and happiness; and it requires appropriate adjustments in school, at work, in marriage, and in community living. To these ends, communities have edu­cational programs in family living and in marital and other human rela­tions and services in schools and industries.

Suicide prevention is important, for in many areas suicide appears on the list of the ten most common causes of death. In many instances it is possible to identify persons who are potential suicides. Most often such persons are deeply depressed (to the point where they do not eat and do not sleep), and usually they either have threatened suicide or have made an abortive attempt to take their own life. Such situations constitute a psychiatric emergency that should be handled without delay.

Some communities have "flying squads" of specially trained psychiatric personnel who are sent by ambulance to help persons who threaten to commit suicide. One of their useful techniques is to "smother" the patient with tender, loving care. There is evidence that such emergency care is highly