Tuesday, August 18, 2009

Can We Teach People How To Avoid Mental Illness?

Prevention is an interesting word in psychiatry. It's hard to prevent mental illness-- we believe a lot of it is about genetics-- and when we think about prevention, we think about things like avoiding drugs and excess alcohol, getting enough sleep, growing up in a kind, safe, and loving environment with a reasonable amount of stability. Those are good things. When it comes to preventing Post-Traumatic Stress Disorder, we think about avoiding trauma, to the extent that we are able. Roy has written about the hypothetical idea of giving people medications to prevent the hard-wiring of traumatic memories and we talked about it in our My Three Shrinks Podcast #46 :Fugetaboutit!

But can you teach people not to get ill -- an insurance plan, if you will, or extra-protection-- before they get exposed to extreme trauma? Can you teach them not to get depressed? Not to get PTSD? It's a great idea, but as far as I know, people vary in their vulnerability and resilience, perhaps even tempermentally, and I'm not aware of research that shows you can teach people resilience in the fact of horror. It doesn't mean it can't be done, it just means I don't know of any research proving it. And if you can teach this, I want to be in the class, and I'd like to invite all the folks who live in the inner city to join me.

So Benedict Carey writes in today's New York Times about how the military intends to require emotional resiliency training for every soldier. Wow!

The new program is to be introduced at two bases in October and phased in gradually throughout the service, starting in basic training. It is modeled on techniques that have been tested mainly in middle schools.

Usually taught in weekly 90-minute classes, the methods seek to defuse or expose common habits of thinking and flawed beliefs that can lead to anger and frustration — for example, the tendency to assume the worst. (“My wife didn’t answer the phone; she must be with someone else.”)

Carey goes on to note:

“It’s important to be clear that there’s no evidence that any program makes soldiers more resilient,” said George A. Bonanno, a psychologist at Columbia University. But he and others said the program could settle one of the most important questions in psychology: whether mental toughness can be taught in the classroom.

So what's the downside? I'm not sure there is one-- except the price tag-- $117 million dollars for an unproven experiment? Couldn't we do some pilot studies first? Obviously I'm a bit of a skeptic-- perhaps we can teach people to be more adaptive in mildly stressful places, but I'm wondering if anything shields you from the extremes and the trauma our soldiers experience in combat. Funny to be spending so much for an unproven intervention in an arena where there aren't funds for treatment of those who give so much and come back so damaged.