The Use of Psychoanalytic Constructs in Preventive Psychiatry1

The development of the quest to find preventive methods in the field of psychiatry has been strong since the last war, when deliberate planning in the reduction in the rate of incidence of psychoneurotic casualties became a necessity and on a few occasions a reality. The remarkable success which psychiatrists have witnessed with the control of somatic diseases, especially contagious diseases, such as typhoid fever, in the larger field of preventive medicine added impetus to the field of psychiatry. In the field of organic brain disease the marked reduction in the incidence of general paresis since we have an organized program for the control of venereal disease is a striking example for such possibilities.

In the field of the psychogenic disorders, namely, the neuroses and behavior disturbances, we are still far from attaining such a goal, notwithstanding the fact that a relatively vigorous mental hygiene movement has been carried by interested citizens and professional people for almost fifty years. Kubie (1948) has recently pointed out how penetrating and systematic efforts at preventive work would have to be in order to assure noticeable effect.

We believe, as Kubie does, that the psychoanalyst is the logical person to initiate efforts in preventive psychiatry because from his clinical experience he has immediate acquaintance with the natural history of the neuroses and personality disorders and his theoretical orientation is directed to the early antecedents of neurotic development which might well be discovered and handled with relative ease if the proper machinery were developed to do so. On the other hand, the analyst is impeded by the relatively small number of patients whom he comes to know well. Moreover,