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A Reexamination

David A. Adler, MD; Daniel J. Levinson, PhD; Boris M. Astrachan, MD

Arch Gen Psychiatry. 1978;35(6):786-789.

Abstract
• We examine current concepts of prevention and offer a new approach. Prevention has different meanings and functions in the four major task areas of psychiatry: (1) medical tasks, (2) rehabilitative tasks, (3) social control tasks, and (4) humanistic tasks. Constructs of primary and secondary prevention are most useful in the medical task area. However, efforts at primary prevention of mental illness can have only limited effectiveness when we know so little about etiology. Secondary prevention is central to the medical caring tasks, where early diagnosis and treatment may lead to successful outcome. Tertiary prevention of disease and primary prevention of developmental defect are the work of the rehabilitative task area. The application of models of prevention in the social control and humanistic task areas has led to serious confusion.

Author Affiliations
From the Department of Psychiatry, School of Medicine, Tufts University, Tufts New England Medical Center Hospital, Boston (Dr Adler), and the Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn (Drs Levinson and Astrachan).

Footnotes
Accepted for publication Feb 16, 1978.

Read in part before the 130th annual meeting of the American Psychiatric Association, Toronto, May 1977.

Reprint requests to New England Medical Center Hospital, Box 1007, 260 Tremont St, Boston, MA 02116 (Dr Adler).

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