Prevention in Mental Health
Prevention in Mental Health
Hosman & Van Doesum
Part I – Prevention history and concepts
Chapter 1. Naïve prevention
1.1 Introduction
Proto-professionalization: progressive professionalization, more dependent on professional
knowledge. Thinking that prevention was invented by public health specialists and not recognizing
true preventive nature of human beings, communities and societies.
Structural iatrogenesis: decline of non-professional or natural health care and self-care in a society.
1.2 Preventive behavior in animals
Like camouflage color, frightening pattern or squirrel gathering nuts for winter. Not only preventive
behavior when in danger, but before threatening situation becomes reality.
Natural selection: statistically unequal chance to contribute to the next generation. Better-adapted
individuals produce more fertile offspring.
1.3 Naïve prevention
Preventive behavior: behavior that prevents harm or exposure to harmful situations. Like
adaptation, self-defense, avoiding danger.
1.4 Humans as prevention-oriented beings
Reflexes: acquired through biological selection processes during evolution.
Pain: prevent direct damage and long-term prevention.
Reactive prevention: in response to an exciting stressor, i.e. feeling pain.
Proactive prevention: response to signals of future dangers and show anticipatory behavior to avoid
or prepare.
Parenting: everything to do with prevention.
1.5 Prevention in primitive cultures
With masks, sculptures. In religion and magic.
Taboos: something that needs to be avoided. Something that may possess a threat or dangerous
powers. For example, taboo on pork in Jewish culture because there use to be a bacterium often
present.
Myths and legends: to prepare for possible disaster as well as education on coping with common life
issues such as illness and death.
1.6 Preventive meaning of rituals
Rituals: habits with some extra: the acts refer to something else. Prescribed symbolic acts that need
to be performed in a certain way and in a certain order- whether or not accompanied by verbal
formulas.
Multiple functions:
1
, Prevention in Mental Health
Adaptive and economical function: Rituals are the carrier of important learning experiences
form the past that make them available for the present. But when it is not a good solution
anymore, it can be a drawback.
Social functions: functions of rituals within groups, communities and the society.
Perceptual function: offer an interpretational framework that helps people understand and
calculate their situation. What is and what is not important in a situation.
Emotional function: emotional dealing with problems or transitional situations.
Behavioral function: offers behavioral reactions in time of stress. It offers an effective
response and a reduction of choices among the many possible reactions.
Religious or magical function: think they can evoke supernatural forces to support and
protect them.
Transition rituals: important supporting role in coping with a crisis: by restoring a lost balance and
developing a new identity. They offer framework that invites those who are affected to express and
process their grief or fear.
Mourning rituals: opportunity to pay the last respects, to express emotions and little occasion to
escape confrontation with death.
Daily life social taboo on death, few rituals left to express sorrow and mourning. Replaced by social
reward for controlling feelings of sadness and getting back to normal asap.
Decline or rituals: no longer effective, become outdated and have no function.
Chapter 2. History of preventive mental health care
2.1 Introduction
1. Knowledge on the history of prevention in mental health offers insight into social and
scientific roots and the theoretical paradigms and ideologies that have influenced preventive
thinking.
2. The differentiation in primary, secondary and tertiary prevention is strongly grounded in the
subsequent historical stages of this field.
3. Offers better understanding of the social and political conditions under which prevention
could flourish.
4. Insight into the mistake made early in the development of prevention.
2.2. Treatment of mental illness before 1800
- Greek: causes were sought in natural and therefore should be left in the care of doctors.
- Medieval: family affair.
- No institutionalized care for mentally ill, naïve prevention.
- Insane asylums: madhouses. Linked to rise of capitalist society in which families had no
longer opportunities to look after.
2.3 The nineteenth century
- Reform movement for the ‘insane’ 1790-1850 with Moral treatment approach. Later known
as the tertiary prevention. Phillipe Pinel. Three goals:
1. Change the inhuman situations in the workhouses and institutions.
2. Plea for state appointed advocates who would monitor the human situation and the
institutions.
3. Optimistic view on the possibility of treating mental illness.
Moral treatment failed; institutions could barely cope with large influx of patients
(because of social and economic developments) and lack of scientific foundation.
2
Prevention in Mental Health
Hosman & Van Doesum
Part I – Prevention history and concepts
Chapter 1. Naïve prevention
1.1 Introduction
Proto-professionalization: progressive professionalization, more dependent on professional
knowledge. Thinking that prevention was invented by public health specialists and not recognizing
true preventive nature of human beings, communities and societies.
Structural iatrogenesis: decline of non-professional or natural health care and self-care in a society.
1.2 Preventive behavior in animals
Like camouflage color, frightening pattern or squirrel gathering nuts for winter. Not only preventive
behavior when in danger, but before threatening situation becomes reality.
Natural selection: statistically unequal chance to contribute to the next generation. Better-adapted
individuals produce more fertile offspring.
1.3 Naïve prevention
Preventive behavior: behavior that prevents harm or exposure to harmful situations. Like
adaptation, self-defense, avoiding danger.
1.4 Humans as prevention-oriented beings
Reflexes: acquired through biological selection processes during evolution.
Pain: prevent direct damage and long-term prevention.
Reactive prevention: in response to an exciting stressor, i.e. feeling pain.
Proactive prevention: response to signals of future dangers and show anticipatory behavior to avoid
or prepare.
Parenting: everything to do with prevention.
1.5 Prevention in primitive cultures
With masks, sculptures. In religion and magic.
Taboos: something that needs to be avoided. Something that may possess a threat or dangerous
powers. For example, taboo on pork in Jewish culture because there use to be a bacterium often
present.
Myths and legends: to prepare for possible disaster as well as education on coping with common life
issues such as illness and death.
1.6 Preventive meaning of rituals
Rituals: habits with some extra: the acts refer to something else. Prescribed symbolic acts that need
to be performed in a certain way and in a certain order- whether or not accompanied by verbal
formulas.
Multiple functions:
1
, Prevention in Mental Health
Adaptive and economical function: Rituals are the carrier of important learning experiences
form the past that make them available for the present. But when it is not a good solution
anymore, it can be a drawback.
Social functions: functions of rituals within groups, communities and the society.
Perceptual function: offer an interpretational framework that helps people understand and
calculate their situation. What is and what is not important in a situation.
Emotional function: emotional dealing with problems or transitional situations.
Behavioral function: offers behavioral reactions in time of stress. It offers an effective
response and a reduction of choices among the many possible reactions.
Religious or magical function: think they can evoke supernatural forces to support and
protect them.
Transition rituals: important supporting role in coping with a crisis: by restoring a lost balance and
developing a new identity. They offer framework that invites those who are affected to express and
process their grief or fear.
Mourning rituals: opportunity to pay the last respects, to express emotions and little occasion to
escape confrontation with death.
Daily life social taboo on death, few rituals left to express sorrow and mourning. Replaced by social
reward for controlling feelings of sadness and getting back to normal asap.
Decline or rituals: no longer effective, become outdated and have no function.
Chapter 2. History of preventive mental health care
2.1 Introduction
1. Knowledge on the history of prevention in mental health offers insight into social and
scientific roots and the theoretical paradigms and ideologies that have influenced preventive
thinking.
2. The differentiation in primary, secondary and tertiary prevention is strongly grounded in the
subsequent historical stages of this field.
3. Offers better understanding of the social and political conditions under which prevention
could flourish.
4. Insight into the mistake made early in the development of prevention.
2.2. Treatment of mental illness before 1800
- Greek: causes were sought in natural and therefore should be left in the care of doctors.
- Medieval: family affair.
- No institutionalized care for mentally ill, naïve prevention.
- Insane asylums: madhouses. Linked to rise of capitalist society in which families had no
longer opportunities to look after.
2.3 The nineteenth century
- Reform movement for the ‘insane’ 1790-1850 with Moral treatment approach. Later known
as the tertiary prevention. Phillipe Pinel. Three goals:
1. Change the inhuman situations in the workhouses and institutions.
2. Plea for state appointed advocates who would monitor the human situation and the
institutions.
3. Optimistic view on the possibility of treating mental illness.
Moral treatment failed; institutions could barely cope with large influx of patients
(because of social and economic developments) and lack of scientific foundation.
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