PREVENTION OF MENTAL ILLNESS

How can mental illness be prevented? This is a large order, which used to go under the label of mental hygiene. This movement took form in the United States in 1907, following the publication of Clifford Beer's famous book, A Mind That Found Itself. Mental health must be considered not only a personal prob­lem but also a family, community, and public health problem. As an individual, you can make conscious efforts toward leading a well-balanced life, including work, play, love, and worship, and toward understanding your­self, which means accepting the fact that there is a worse side to your own nature, as there is indeed to everyone's.

As a parent, you can help prevent mental illness in your children by bringing them up wisely with a balance of tender loving care and consistent discipline that sets limits for action. Some roots of mental illness are set in childhood; emotional patterns are crystallized before intelligence takes over. Hence mental health becomes a family affair.

As a citizen you can support the mental health movement, lend a voice toward ade­quately staffed and supported mental hospi­tals, mental health clinics, and child guidance centers, both within and without the school system. You can speak up for an intelligent, well-informed attitude toward mental illness and break down prejudices against the men­tally ill. If a relative, friend, employee, or fellow worker seems to be "losing his grip," you can urge professional psychiatric atten­tion. Mental illness is, after all, an illness, not a shame or disgrace. Since recreation is a defense against mental illness, you can also support recreational facilities.

SUICIDE

Mental illnesses are not in themselves fa­tal, like pneumonia and heart disease, though it has often been observed that the life span of individuals suffering from severe forms is usually shorter than might otherwise have been expected. There is, however, one fatal termination of mental illness that occurs more commonly than generally supposed suicide. Every so often a college campus is shocked by this event, and the question arises, "Why did he do it?"

Suffice it to say that the "obvious reasons" are never the basic reasons. As Karl Men-ninger, one of the great students of the sub­ject, points out: individuals always in a measure create the unconscious environment in which they exist. Long before the final act, the suicide is helping to create the very trap of circumstances from which, by suicide, he takes flight. He has reached a delicate point, of psychic maladjustment where he at one and the same time (1) wishes to kill (anger), (2) wishes to be killed (expiation for guilt feelings), and (3) wishes to die (find peace without struggle). Fortunately for potential suicides, this delicate imbalance cannot be long maintained. If the suicidally inclined individual can be helped through his darkest moments or months, the fatal mood is not too likely to recur.

Rare, indeed, is the individual who has never entertained the ghostly thought of sui­cide. There are times in every life when, as Mark Twain put it, we would like to die -temporarily. But these wisps of a passing thought are not to be confused with the dan­gerous drive toward self-destruction that may occur in the deeply depressed, unconsciously troubled individual, who is a "man against himself."

Mental Health: Mind and Body

  

Mental health is another name for person-al happiness insofar as this illusory and dif­ficult goal can be attained A mentally healthy person is generally comfortable with himself and behaves acceptably in the eyes of his fellow men. The phrase "mental health" and its adjunct "mental hygiene" are com­paratively new to the English language, but the topic they cover has been the concern of poets, preachers, and philosophers in all ages and languages.

Many verbal definitions of "mental health" have been attempted. When they go beyond the portrait of the "happy man," they end in a tangle of words. As simple and sensible a con­cept as any is that proposed by Frud, namely: a person is mentally healthy to the extent that he can love and work Conversely, he is mentally ill to the degree that he cannot love or work. This concept leaves a wide range for normal behavior It also suggests that, just as perfect happiness comes to no one, even so no one is ever in perfect mental health all the time Imperfection is the distinctive badge of the human race, and we are wise when we acknowledge this about ourselves.

We must not think of mental health as a sheer abstraction. It has a locale in the body and mind of each separate individual. You included. But problems, still unresolved, arise if we attempt to assign exact bodily lo­cations to the multitudinous functions of the mind and emotions. The best we can say is that these functions occur in or are mediated by the human nervous systems, sometimes assisted by the endocrine system. We shall seek later in this chapter to provide a brief description of the human nervous systems and, beyond that, to offer some explanation of the physiology of thought and feeling.

Mental health is a 24-hour a day posses­sion. It is present during sleep as well as waking. Indeed one of the positive indications of lack of mental health is constantly dis­turbed sleep sleeplessness or insomnia. In the mentally healthy man or woman there is a regular cycle of sleep and wakefulness. Throughout all of this the unconscious mind remains in operation- Since sleep and rest are critical factors in mental health, we shall also deal with these subjects later in this chapter.

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