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45-4 What is the rationale for preventive mental health programs, and why is it important to develop resilience?

Psychotherapies and biomedical therapies tend to locate the cause of psychological disorders within the person. We infer that people who act cruelly must be cruel and that people who act “crazy” must be “sick.” We attach labels to such people, thereby distinguishing them from “normal” folks. It follows, then, that we try to treat “abnormal” people by giving them insight into their problems, by changing their thinking, by helping them gain control with drugs.

There is an alternative viewpoint: We could interpret many psychological disorders as understandable responses to a disturbing and stressful society. According to this view, it is not just the person who needs treatment, but also the person’s social context. Better to prevent a problem by reforming a sick situation and by developing people’s coping competencies than to wait for and treat problems.

A story about the rescue of a drowning person from a rushing river illustrates this viewpoint: Having successfully administered first aid to the first victim, the rescuer spots another struggling person and pulls her out, too. After a half-dozen repetitions, the rescuer suddenly turns and starts running away while the river sweeps yet another floundering person into view. “Aren’t you going to rescue that fellow?” asks a bystander. “Heck no,” the rescuer replies. “I’m going upstream to find out what’s pushing all these people in.”

Preventive mental health is upstream work. It seeks to prevent psychological casualties by identifying and alleviating the conditions that cause them. As George Albee (1986; also Yoshikawa et al., 2012) pointed out, there is abundant evidence that poverty, meaningless work, constant criticism, unemployment, racism, and sexism undermine people’s sense of competence, personal control, and self-esteem. Such stresses increase their risk of depression, alcohol use disorder, and suicide.

We who care about preventing psychological casualties should, Albee contended, support programs that alleviate these demoralizing situations. We eliminated smallpox not by treating the afflicted but by inoculating the unafflicted. We conquered yellow fever by controlling mosquitoes. Preventing psychological problems means empowering those who have learned an attitude of helplessness and changing environments that breed loneliness. It means renewing fragile family ties and boosting parents’ and teachers’ skills at nurturing children’s competence and belief in their ability to grow. In short, “Everything aimed at improving the human condition, at making life more fulfilling and meaningful, may be considered part of primary prevention of mental or emotional disturbance” (Kessler & Albee, 1975, p. 557). Prevention can sometimes provide a double payoff. People with a strong sense of life’s meaning are more engaging socially (Stillman et al., 2011). If we can strengthen people’s sense of meaning in life, we may also lessen their loneliness as they grow into more engaging companions.

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Among the upstream prevention workers are community psychologists. Mindful of how people interact with their environment, they focus on creating environments that support psychological health. Through their research and social action, community psychologists aim to empower people and to enhance their competence, health, and well-being.

We have seen that lifestyle change can lessen psychological disorders. Might such change also prevent some disorders by building individuals’ resilience—the ability to cope with stress and recover from adversity? Faced with unforeseen trauma, most adults exhibit resilience. This was true of New Yorkers in the aftermath of the September 11 terror attacks, especially those who enjoyed supportive close relationships and who had not recently experienced other stressful events (Bonanno et al., 2007). More than 9 in 10 New Yorkers, although stunned and grief-stricken by 9/11, did not have a dysfunctional stress reaction. By the following January, the stress symptoms of those who did were mostly gone (Person et al., 2006). Even most combat-stressed veterans, most political rebels who have survived torture, and most people with spinal cord injuries do not later exhibit posttraumatic stress disorder (Bonanno et al., 2012; Mineka & Zinbarg, 1996).

Struggling with challenging crises can even lead to posttraumatic growth. Many cancer survivors have reported a greater appreciation for life, more meaningful relationships, increased personal strength, changed priorities, and a richer spiritual life (Tedeschi & Calhoun, 2004). Out of even our worst experiences, some good can come, especially when we can envision new possibilities (Roepke & Seligman, 2015). Through preventive efforts, such as community building and personal growth, fewer of us will fall into the rushing river of psychological ^-disorders.

* * *

If you just finished reading this book, your introduction to psychological science is completed. Our tour of psychological science has taught us much—and you, too?—about our moods and memories, about the reach of our unconscious, about how we flourish and struggle, about how we perceive our physical and social worlds, and about how our biology and culture shape us. Our hope, as your guides on this tour, is that you have shared some of our fascination, grown in your understanding and compassion, and sharpened your critical thinking. And we hope you enjoyed the ride.

With every good wish in your future endeavors,

David G. Myers

www.DavidMyers.org

Nathan DeWall

www.NathanDeWall.com

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