This article argues that it is futile to try and treat the many serious mental disturbances now confronting society with individual psychotherapy. Only by preventing the occurrence of mental disturbance can headway be made in dealing with this source of human suffering. Prevention means confronting and ameliorating the major cause of mental disturbance: stress. The sources of stress include poverty, rampant sexism, being born unwanted, and other forms of social injustice. This article demands that those in the mental health field examine their moral and scientific beliefs and begin to take steps to change the existing unfair political and economic practices.
Keywords: prevention; social injustice; exploitation; patriarchy; socialism
It is an honor for me to address the International Center for the Study of Psychiatry and Psychology. I wish we had found each other sooner! I wrote my first paper emphasizing the necessity of prevention (Albee, 1959) of mental disorders nearly 50 years ago, and prevention has been my preoccupation ever since. In order to be sure that I get to say everything that I think is important in a talk on prevention around the world, I will make a few statements I believe are true based on scientific research, and on a personal, political position that favors equal social justice. I am prepared to revise the scientific statements, in the tradition of scientific respect for evidence, at any time. But I believe each of us must make conscious and public our personal beliefs about social justice. A major question here: Do you believe that each person in the world has the same value as each other person? Or are some people more valuable than others? (There is no scientific answer to this latter question, but it has profound consequences for our actions.)
Here are my statements. As my time permits I will try to support them briefly with evidence.
Individual one-on-one treatment, even if successful, is not prevention. This is true in medicine and also in psychotherapy. Public health teaches us that no mass disease or disorder has ever been controlled or eliminated through individual treatment or by increasing the number of therapists. (An important insight we obtain from successful individual intervention, however, is that individual emotional disorders can be reduced or eliminated through therapeutic relationships, often without medication.) They are, therefore, not "the same as other illnesses." I will come back to this fact.
Nearly 50 years ago, I did the first detailed study of the nation's professional resources (Albee, 1959) available for treatment of persons with emotional disorders. I concluded that even in a nation blessed with many university training programs producing mental health professionals, and with major training funds available, we would never come close to having enough mental health professionals available. The city with the largest number of mental health professionals (Boston), with five major universities, was incapable of offering help to the poor, to multi-problem families, to troubled adolescents, to the elderly, and to persons with emotional disorders released from state mental hospitals (Ryan, 1969). Every subsequent study has come to similar conclusions.
If only 7 million disturbed persons (of the alleged 40 million and more) are now being seen in all our American mental health facilities, why is no attention being paid to this reality? Why does no one recognize the impossibility of our current one-on-one system? Why have studies of commissions and conferences under both President Clinton and President Bush failed to take note of our lack of professional resources for treatment of disturbed people? (see Albee, 1990.)
Bush's New Freedom Commission's (2003) intention is to have psychiatrists screen all Americans, including infants, and to provide for mental illness treatment for all in need. Why can we not understand that we do not have the resources to do this, and that we never will? …