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Thursday 8 December 2011

Prevention - better than cure?

I think the place to start would be to define exactly what we mean by prevention

prevention [prɪˈvɛnʃən]
1. the act of preventing
2. a hindrance, obstacle, or impediment

pre·vent  (pr-vnt)
v. pre·vent·edpre·vent·ingpre·vents
1. To keep from happening: took steps to prevent the strike.
2. To keep (someone) from doing something; impede: prevented us from winning.
3. Archaic To anticipate or counter in advance.
4. Archaic To come before; precede.

Which definition would you use for prevention?  If we are talking about archaic definitions (anticipation), would this mean that with the use of, say, bio markers, mental illness could be anticipated and then prevented? And what exactly are we trying to prevent?  The end stages of a disorder (psychosis, starvation) or prevent that actual "faulty wiring"?  Comments please.


  1. I think that the neuro-diversity community, which largely comprises those individuals with high-functioning autism, would balk at the idea of preventing a 'wiring' difference.

    If we are talking about a mental illness such AN, then some of the neurocognitive traits that seem to underpin this illness include superior attention to detail and superior focus. These characteristics can lead to talent and are also observed in people with autism. But if channelled down the wrong path and accompanied by starvation, then the outcome is somewhat disasterous.

    Many people with mental illness have great talents; e.g. think of the creativity of some people with Bipolar and the retrospective observations that Einstein and Turing most likely had Asperger's syndrome. If the wiring characteristic is removed from the gene pool then the world is losing some valuable folk.

    Just saying :D

  2. Extralongtail

    I was mainly talking about prevention of eating disorders but, as a by product, it occurred to me that this could be rolled out to other mental illnesses. Now I am all in favour of sparing people the mental and physical pain and damage that can occur, when suffering from a brain disorder. However, I, like you, would hate to see a society of sameness.

    I would definitely cast my vote for the prevention of the end stages of a disorder being "prevented", rather than "cured" - a long and painful process in the case of eating disorders. However, I worry that prevention could mean something more sinister in our rush to "normalise" society.

  3. Well, in terms of EDs, we still don't know the precise mechanisms; EDs as a group are widely heterogeneous in their presentation - and they may be co-morbid with other psychiatric disorders. So really we don't know precisely what we're preventing.

    Ken Nunn, Ian Frampton and Bryan Lask have developed the insula hypothesis, which suggests that a 'wiring disorder' may be present from birth. But it is still unclear to what extent the differences in blood flow observed via fMRI in people with AN vs. controls are related to starvation per se, or a neurodevelopmental condition that is comparable in many ways to autism.

    I don't know if there's adequate experimental evidence as yet to describe AN, BN etc. as discrete diorders caused by specific characteristics of brain neurophysiology. This doesn't seem to be the case in autism either. And even if it were possible to precisely define the neurophysiological profile of (say) AN in childhood; this doesn't mean that everyone who possesses that profile will automatically go on to develop the condition.

    Therefore, I think that at present we are stuck with early intervention when symptoms start to appear.

  4. Great question Charlotte and wonderful answer extralongtail. That answer is the scientific version of what was going through my head trying to sort out how to respond.

    If indeed the insula hypothesis is correct or some version of that idea then what I believe we are preventing (hoping to prevent) would be the manifestation of the painful and completely debilitating effects. By that I mean that if we are somehow able to see the early signs and prevent full blown AN, BN or BED while still welcoming the amazing personality characteristics to blossom then that would be prevention in my mind.
    Becky Henry
    Hope Network

  5. I just wish I could have received some of those amazing personality characteristics to go with the stupid eating disorder. I appear to have inherited all the bad parts :P I'm not especially wonderful academically or artistically and I'm the overwhelmed sort of obsessive rather than the get-things-done sort, so I just keep ending up dropping out of life. I see nothing positive about my possibly illness-related traits at all.

    My contribution to the discussion at hand will be stolen from Susan Ringwood: whilst I would love to see ED prevention/treatment get to the point at which we have bio-markers to signpost at-risk children, it really would be a small step sideways from there to eugenics. It might - well, probably will - be that the many genes involved in the development of EDs have multiple functions, making switching them on/off (if we could do that) impossible without harming a person or irrevocably changing their personality (not that I would really mind that happening to me at the moment!). But equally, "prevention" efforts of the moment are at best misguided and at worst harmful, and we can't carry on this way indefinitely.

    I complain a lot and do nothing to solve the problem :P I shall shush and go to bed. I'll be in a better mood at the weekend!

  6. Prevention of the end stages/unfortunate possible outcome can only be considered once we are aware of certain trait/bio markers. Awareness, for me, that my little boy has even more of a negative focus, notices small detals and is more of a people-pleaser than his an sister certainly has me on high alert. Whether I can do anything to prevent an ed? I hope so.

  7. Oy. The idea of biomarkers - or even just trait identification - as leading to eugenics is heartbreaking to me. I see it so differently. That concern strikes me as kind of fingers-in-ears don't tell me stuff I don't want to know. Identifying those at risk for asthma and diabetes leads to better quality of life - we live in an age where early identification of risk leads to earlier intervention and treatment.

    The way I see it with eating disorders is that those at risk have something like an allergy - one that we are better off knowing about as early as possible.

  8. This is true Laura - I wasn't saying I necessarily agreed with that particular argument, I just found it interesting because I'd never considered any possible negative side to the idea of discovering bio-markers. It was a worrying thought for a minute or two. I think it'd be great if it were possible to discover at risk children very early on - I guess then the issue would be how best to address that risk. I'm struggling to imagine how I could have avoided developing an eating disorder. CRT and coping strategies for stress being given as soon as I started showing signs of anxiety disorders? But I was four then, and I'm not sure how that sort of thing would work with a very small person. Hmm.