WHY ISN'T MENTAL HEALTH MORE FOCUSED ON PREVENTION?
Mental health has been declining recently, as many have pointed out.
Of course, the next natural question is, “What are we doing about it?”
Anxiety. Depression. Addictions. Stress. Toxic relationships. Various "disorders. General misery, and so on. The frequency and intensity of all of this doesn't seem to be trending in a good direction.
The above probably surprises no one.
So again: what are we doing to improve our overall mental health, or at least stop its decline?
When we ask this, we often hear many answers.
For example, we typically hear that the answer to mental health is often to expand more “mental health services” such as counseling or therapy.
Or we often hear that the answer lies in certain drugs or medications – either drugs that exist now, or others that pharmaceutical companies will invent in the future, we hope.
Beyond these are floods of additional answers, many contradictory. For example, we might hear that we need to affirm self-esteem more relentlessly, or to “be humble,” less narcissistic, or to get rid of “ego.” We might hear advice to sleep more or sleep less, digitize ourselves more or less, eat more or less of this or that, and so on.
There’s no shortage of advice that claims to point us in the direction of becoming “happier” or saner or to help ease our suffering. There’s so much, in fact, that it can be overwhelming. It's the self-help industrial complex.
But what are many of these approaches missing?
In a nutshell:
Many answers focus on fixing the problem after it’s arisen instead of preventing it from appearing in the first place.
They’re so busy putting out fires that they aren’t looking for the arsonist.
They’re often looking for better eyedrops instead of finding out who is squeezing grapefruit juice in our eyes, and stopping them.
They’re typically in cleanup mode. Once a certain condition comes about, then they take action.
"An ounce of prevention is worth a pound of cure” might be a tired cliché, but still, few professionals seem to keep it in mind when it comes to mental health. If there really is a “manufacture of madness” (a phrase coined by Thomas Szasz), the focus is almost entirely on searching for solutions to the madness that’s being manufactured instead of shutting down the manufacturing plant.
Some problems can’t really be solved, only prevented.
One clear example is one of the toughest to talk about.
Suicide rates have been rising lately.
Again: what are we doing to address this situation?
Well, we’re trying to do a lot, understandably. We’ve created suicide prevention hotlines, raised funds for suicide prevention, sponsored marketing campaigns, and have generally advised struggling individuals to “talk to someone” – and especially to avoid choosing permanent solutions to temporary problems.
These are all good efforts, and necessary.
But still, many of these approaches appear late in the process, and start working on the problem once someone is already in a dire situation. They don’t address the causes that created that dire situation to begin with.
There are plenty of other examples along these lines.
Many approaches are designed to relieve anxiety after someone experiences it.
Many are built to relieve depression after someone is suffering from it.
Other approaches are designed to help treat addictions, phobias, stress, relationship problems, and so on, after they become problems.
But few focus on preventing these problems from arising to start with.
An example even comes from the father of modern therapy.
Modern mental health services such as therapy and counseling can trace much of their origins back to Sigmund Freud.
Much of Freud’s thought traces back to one of his earliest cases, “Anna O.”
Anna O was a woman who suffered terribly from several symptoms. She went to a family physician for help – Josef Breuer (a friend of Freud’s) – and he started treating her.
What happened after that isn’t entirely clear. She apparently became worse, but then eventually recovered later in life. Much of her story remains controversial, including the question of whether Breuer’s treatment helped her recover or inadvertently made her worse.
At any rate, that case eventually led Freud to “the talking cure” (the genesis of modern therapy) and catharsis theory (the idea that unearthing and expressing repressed and forgotten emotions leads to relief from unpleasant symptoms). These are both key aspects of modern counseling and therapy.
But while Freud (and later psychoanalysis, and later therapies) naturally made great efforts building massive theoretical structures in hopes of understanding how to “cure” cases like Anna O’s, they didn’t seem to give much attention to how they could have been prevented in the first place.
Here, another question naturally arises.
Why isn’t the mental health industry more focused on prevention?
After all, the basic idea is common sense. Prevention works. It’s much better than solving a problem once it’s already arisen.
Why, then, aren’t we more focused on prevention?
There are several answers to this.
Here are seven.
1) Prevention often isn’t profitable.
It’s easy to sell aspirin to cure a headache. But how easy would it be to sell an aspirin that prevented headaches – especially to someone who had never experienced one?
Spoiler alert: it wouldn’t be easy at all.
Someone with a headache is in visceral pain, and therefore, is actively searching for a way to ease it. For anyone who isn’t in immediate pain, the idea is theoretical. That individual is less likely to seek out ways to solve a problem that might come about in the future.
In theory, we often know it’s good to plan ahead. In reality, we often focus on whatever’s in front of us right now. (Because of this, the more ruthless types will even deliberately cause problems in order to sell solutions.)
Solutions that cure immediate problems – and are then distilled down into specific, concrete products that are then packaged and marketed well – tend to be profitable.
Solutions that promise to cure future problems – even if they’re effective – but can’t be distilled down into specific products that get packaged or marketed easily – tend to go bankrupt, or are never funded to start with.
So we rarely hear about them.
Many of our worst diseases don't have cures - but they can be prevented. Why don't we hear more about that? Why, indeed.
2) Prevention requires foresight.
Foresight means the ability to predict the future.
Predicting the future means clearly understanding how things work right now.
Knowing how things work right now, in the big sense – especially when it comes to human nature – requires a lot of thought, study, and insight. (It’s an “everything problem.”)
Thinking, studying, and attaining insights usually require a lot of effort.
When we can, we tend to avoid things that require a lot of effort.
And so, we tend not to attain foresight.
And so, we tend not to prevent problems, and instead to just suffer from them.
3) We want “mental health” to be a hard science, and it isn’t.
One thing is certain about mental health: lots of people disagree.
We want science to be a safe, reliable, time-tested beacon of wholesome truth and sanity in a crazy world.
As a result, when it comes to science, naturally enough, we often demand hard proof, mathematical precision, and absolute certainty. If it doesn’t meet these criteria, we declare it to be unscientific – and therefore, probable nonsense or mere speculation.
But proof, precision, and certainty are luxuries. And in the messiness of real life, we often can’t afford such luxuries. Just because we want them doesn’t mean we’re going to get them.
Plenty of things are true that we can’t prove scientifically.
We can get “hard proof” when we’re working with geometry and logic, for example. We can achieve mathematical precision when we’re working with math. To the degree that absolute certainty is possible at all in the intellectual sense, it seems to appear almost exclusively:
- in proofs, when we’re dealing with logic
- in math, when we’re dealing with numbers and abstract concepts, and
- in physics and chemistry, when we’re dealing with physical matter
But when we deal with human beings, we aren’t restricted to any of these.
Just the opposite.
Human beings deal in these things, but also much, much more.
And more: when we’re trying to figure out human beings, we’re also trying to figure out ourselves. In this realm, the scientist is both the studier and the studied, the observer and the observed, the experimenter and the experimented upon.
In these matters, the detectives are also the criminals.
On these ground, those who study physics and chemistry have it easy. They’re studying mere physical objects and forces.
But us humans also aren’t mere lumps of meat and bones. We’re alive. We can think. We tend to be pretty frisky, unreliable, and unpredictable, unlike merely physical forces of nature. As a result, it can be easier to build a rocket than understand our own family members. Compared to math and physics, we’re more complex by orders of magnitude.
Yet still, we often try to base our understanding of human nature on hard science, having abandoned other approaches – and we wind up with mixed results, to be generous. We demand the same level of certainty that we get from our approaches to numbers, concepts, and rocks, and then we’re frustrated when we don’t get it with humans.
All to say, the study of human nature isn’t a hard science. And it never will be. There are no straight lines in nature, and hardly any lines at all in human nature. But that doesn’t stop us from demanding them.
4) We often demand direct and obvious causation.
We often want the connections between things to be obvious, immediate, and demonstrable.
To cure anxiety, we often want anxiety pills. To cure depression, we want depression pills. To cure phobias, we want phobia pills. To cure angst, we want angst pills. And so on. If only things were that simple.
In all of these, we want the line from A to B, from problem to solution, straight, obvious, and clear.
But life is messy. Lines from A to B are often anything but straight.
For example: around the 1840s, up to 18% of new mothers would die shortly after giving birth. A Hungarian physician named Ignaz Semmelweis recommended what many considered to be a crazy idea at the time: doctors should wash their hands before delivering babies. (Handwashing wasn’t a common practice then, and neither was germ theory.)
Semmelweis tested his hypothesis by having many of those he worked with wash their hands before attending to the mothers. It worked: more mothers survived.
In theory, that should have settled the matter. A scientific study yields clear results. Those results are analyzed, clarified, re-confirmed, and then communicated to others. And since scientists are always selfless, virtuous individuals who care about truth, they move forward with a fresh, revised understanding.
But when Semmelweis tried to tell others about his discovery, few believed him. Fellow doctors scoffed at the idea that they could be part of the problem. They were doctors, after all. Soon after, Semmelweis was “let go” from his position. He later wrote a book on his discovery, but hardly anyone read or reviewed it. He eventually went to an asylum and died at age 47 from a wound he received in the facility.
Eventually, of course, we figured out: he was right.
When it comes to cause-effect relationships, and figuring out what really works and what doesn’t, people can be pretty sensitive about it. We don’t like to be wrong.
As a result, even when cause-effect relationships seem direct and clear, we can refuse to see.
Trobriand Islanders, for example, insisted that there was no connection between sexual intercourse and reproduction (according to Bronislaw Malinowski). Pregnancy occurs, they claimed, when a spirit comes in the night and sits on the head of a sleeping woman, and later descends into her stomach and then belly, eventually emerging as a newborn child. (Sexuality and the World’s Religions by David W. Machacek and Melissa M. Wilcox, ed, xiii)
We can easily overestimate our understanding of how things work.
And if our understanding of cause-effect relationships can be this troubled when things are seemingly that simple – as simple as sex causing pregnancy or filthy hands causing medical problems – imagine how much more difficult it might be when cause-effect relationships aren’t obvious, or easily demonstrable, or are even complex and intricate.
And it gets worse. When certain ideas are less than flattering, we often want to kill the messenger, break the radio, or burn the letter. We often want to live out confirmation bias. We want to be right about our basic views of the world, and anything that suggests otherwise – correct or not – is often perceived as a threat. (A threat to what, exactly? “Ego”?)
This can all become an important factor when it comes to mental health.
Mental health problems are often “everything problems.” They’re difficult problems that are interconnected with other difficult problems. Yet we often try to avoid seeing these interconnections. We often insist on clean, fortressed, shrink-wrapped puzzles – well-contained situations with well-contained remedies.
After all, messy situations often eventually lead to Big Questions that test the limits of our worldviews and egos, and we often try to avoid those areas.
If we were to move toward real prevention, that might take us into territories with indirect, non-obvious causation that can’t be easily demonstrated.
And we often have little tolerance for that.
5) Prevention can always be second-guessed.
Imagine an emergency room doctor who scrambles frantically to save a patient – barking orders, trying this, that, and then something else, working furiously to solve multiple problems simultaneously. The doctor succeeds, and the patient lives.
Afterward, critics could easily chime in. “See? There was no reason to scramble around frantically, doing X and Y. After all, the patient survived.” Since there was no parallel universe scenario where the patient died, the critic can never be proven wrong.
Imagine a detective discovers a plot to blow up a building. He takes immense action to prevent it from happening, making multiple judgment calls in the heat of many moments, and eventually succeeds. The building doesn’t blow up.
But afterward, critics chime in with their criticism, toxic skepticism, and Monday morning quarterbacking. “There wasn’t really a plot to blow up a building. Can you prove it? Where’s your evidence? The evidence you’ve presented so far isn’t enough. And any evidence you present probably won’t be enough to persuade me. Your story seems highly unlikely. And, of course, the real kicker is, we’re fine! Nothing happened! The building didn’t blow up, did it? That entire plot only existed in your imagination. There probably wasn’t really a threat at all.” And so on.
People who weren’t there in the heat of the moment can easily declare, with the benefit of hindsight and the luxury of clarity from time and distance from the situation, “Well, you should’ve done X and Y and Z.”
And so, the doctors, the detectives, and those taking action wind up being criticized and looking imperfect while critics wind up looking smart and virtuous. This results in many critics and few heroes.
And it all discourages the study and implementation of even the best preventative measures.
6) Prevention often requires a commitment to a worldview.
Prevention raises Big Questions.
In mental health, especially, Big Questions are unavoidable, even when we try to avoid them deliberately.
Is there really such a thing as a “mind,” or only the “body” real? Is the world physical matter, or “Spirit,” or some combination of both, or neither? Is there such a thing as a “soul”? What is consciousness? Is there a “God,” or not? Is there meaning in life, or not? What is human nature, really? And so on.
These questions can get messy. Most scientists try to avoid mess. Therefore, they avoid these questions. As a result, they wind up sticking to questions they can answer more easily. And so, they wind up asking small questions and getting small answers. They sweat over details but miss the big picture. They measure inches while being off by miles. They sprint to first base as quickly as they can, but eventually realize they’re in the wrong stadium.
7) Psychology often tries to avoid committing to a worldview.
Science – and psychology, which strives to be scientific – tries to avoid answering questions like those mentioned above.
It tries to stay “neutral.” It tries to be “agnostic” on the Big Questions.
Because the Big Questions, to some degree, seem to exist outside of the realm of hard science. Hard science thrives in areas where things are easily measurable, quantifiable, open to experimentation, double-blind studies, null hypotheses, and so on. Anything beyond these city walls is banished as mere opinion. In this way, science confines itself. This isn’t necessarily the fault of science itself, but of anyone who expects science to provide answers to everything life asks us. The problem isn’t science, but our misuse of it.
Psychology often tries to stay in these areas of the hard sciences, which means avoiding philosophical-theological questions. In other words, science tries to dismiss the Big Questions as speculative theorizing. After all, “real” sciences live only in the realm of hard facts.
This approach can be effective in certain realms – math, physics, and chemistry, for example. But in the realm of human nature, facts require interpretation, and interpretations require theoretical frameworks, and those frameworks are exactly what have been either avoided or undermined.
The result is mandatory agnosticism.
This agnostic worldview results – in practical application – in an assumption of atheism, or the idea that only what is consistent with a materialist worldview is real. Everything else is dismissed as unreal. It strives to be a hard science while studying matters (humans) that exist outside of the reach of hard science. And as a result, it often fails on both fronts, and nullifies itself. It doesn’t work as a hard science or to explain human nature.
This results in mainstream psychology generating scattered piles of bare, naked “facts” and experimental results with no clear way to interpret them.
Interpretations, after all, depend on our worldview, and our worldview depends on our answers to the Big Questions.
Our answer to the question “what is reality?” for example, entails a particular view of human nature. But we often try to understand human nature without first having a firm grasp of (Big Picture) reality. Or, we try to solve a very specific feature of ourselves – depression, for example – without first having a sturdy framework of human nature. In this way, we focus on the details while ignoring the big picture. We try to understand a single, contained element without taking into account the greater context that surrounds and envelopes it.
It’s impossible to act without a worldview.
It’s impossible to avoid answering the Big Questions. If we don’t answer them consciously, we wind up answering them unconsciously, through our actions. We wind up presuming answers and baking them in, whether we realize it or not.
And this often keeps us from getting down to the level where real things are happening. We stay on the surface, where we’re safe but ineffectual – in the interface, but not the source code. Our efforts to stay neutral can mean we stay in the shallow end of the pool of life.
As a result, psychology often finds itself unprepared and unequipped to solve the problems it’s tasked with facing.
For many, science replaced religion as the authority when it comes to human nature.
(Notably, some later decided to replace science with “themselves” as the ultimate authority to trust, resulting in individuals bypassing both religion and science and heading straight to the self. This doesn't seem to have resulted in a widespread explosion of freedom, love, and bliss. Just the opposite, in fact: this path seems to result in widespread hostility, narcissism, and nihilism.)
But again, the long fingers of science only reach so far. Some problems just can’t be reduced to conditions that are measurable, quantifiable, open to empirical experimentation, and so on. On an everyday, practical level, to look for life advice solely from controlled studies might be like trying to cross a desert with a tiny, smudged, old, stamp-sized map. We want to assume – or hope – that enough flawless studies have been done by brilliant people somewhere that have revealed everything important that we need to know.
But that isn’t the case.
In this way, we’ve assigned psychology a profoundly problem while kneecapping its ability to solve them.
In other words, we’ve tasked psychology with helping us solve our most challenging existential riddles.
And at this point, it isn’t up to the task.
So, why isn’t mental health more focused on prevention?
In order for prevention to become a significant factor in our understanding of mental health issues, our entire approach would need some major overhauls.
For starters, we could avoid continuing to move in the wrong direction. This would be the assumption that we simply need to gather more data. The amount of data-gathering is endless. A better direction could mean doing the exact opposite: questioning our approach. The issue isn't a matter of simply gathering more information, but making sense of the data we already have. It's less finding some magical new data point, more backing away from nonsense we accepted several steps back. It would mean a kind of search for the elusive obvious.
What would this look like?
It would mean asking Big Questions, for example. We’d need to clarify worldviews or life philosophies, consciously examine them, understand how they work and what makes them sturdy or fragile, and how and why we use them, in incorporate them into our everyday language. We’d need to understand how our answers to the Big Questions are interconnected, and why that matters – and we’d need to understand how this is the only possible approach to solving everything problems.
And much more. These issues involve things like psychological and philosophical self-defense, inner strength, finding various "sweet spots," and existential fitness. One significant improvement in our mental health could come from getting rid of bad ideas about mental health. And more.
Foresight, clarity of thought, tolerance of uncertainty, big-picture understanding, indirect causation, and so on are factors in all this. These “messy” factors are baked into the cake when it comes to dealing with real life. Life doesn’t contain itself in our neat little categories, so we should stop trying to force it.
In a nutshell: mental health as a whole isn’t focused on prevention because we aren’t ready for it yet.
As the saying goes, there are clearly reasons justifying pessimism.
Few seem to be asking questions along these lines. Far fewer seem to be working on solutions.
The field of psychology often suffers from its own confirmation bias. It trains people by teaching them what to think, and then it’s surprised (or not) when they all think alike. Independent-minded mavericks who work along these lines (ahem), by definition, get zero institutional support. Since outsiders are ignored or even actively discredited or silenced, the momentum of organized psychology as a whole steers itself into a circular epistemology, a self-validating echo chamber. The general assumption is, “I am correct, and therefore anyone who thinks like me is correct, and therefore anyone who disagrees with me is incorrect.” And then they wonder why no one seems to have good solutions for a situation that is rapidly deteriorating on their watch. “If we’re charging up the wrong hill,” the thinking seems to go, “we’ll just charge faster.”
Do we really want to solve mental health problems? Do we really want individuals to have mental clarity and emotional strength, strong hearts and minds, real sanity and genuine happiness?
If we do, then maybe we need to overhaul our current approach.
If we sober up, take a breath, and look at all this with fresh eyes, maybe we could see it all more clearly, and understand what to do about it.
And our entire approach to mental health might vastly improve.