When tragedies occur in life that could have been prevented with a just a little bit of forethought, the realization of a missed opportunity simply adds to the tragic nature of the event. The examples are endless: The bridge that collapsed that sent drivers plunging to their deaths which had been declared a disaster waiting to happen years earlier by bridge engineers; The guns that should have been locked up that were found by young children who accidentally shot themselves or someone else; The drugs people put in their body that were made in somebody’s basement that caused severe and irreparable neurological harm; and, on and on. We can’t even get people to put on their seat belts, sunscreen and condoms! Why don’t people think ahead? What is it about human nature that makes thinking a couple of steps further along a line of thought or action so difficult for so many? It’s a curious thing to me that mental health professionals are themselves divided over the value of forethought. So much of therapy is about encouraging people to look backwards and understand rather than looking forward and preventing. Yet, so much of human misery would be prevented if people could master the skill of foresight. Not everything can be prevented, of course, but many things can.
When I ask clinicians to separate into two piles the files of people they’ve treated in the last year according to whether the problems that drove them into therapy could have been prevented or not, almost invariably clinicians report that the pile of files of people with problems that could have been prevented is much bigger than the pile of files of people with problems that could not have been prevented. If forethought is so critical to prevention, then why isn’t it emphasized in school as a life skill or in therapy as a vital skill to develop? Do therapists even know how to teach the skill of foresight? Too many haven’t even given it serious thought because it simply conflicts with their therapeutic philosophy that suggests insight into the past will lead to foresight. This isn’t even close to true. Foresight is a separate, though related, skill set.
I hope the new report from the National Research Council and Institute of Medicine will help start the dialogue about prevention to move in a more serious direction. This report spotlights the role of prevention in saving lives and improving the quality of peoples’ lives. Prevention strategies could improve the well-being of millions of children and adolescents and, in simple economic terms, save the U.S. an estimated $247 billion a year. The report draws heavily on psychological research and was sponsored by several major government research and treatment groups, including the National Institute of Mental Health and the National Institute on Drug Abuse. The report is called, Preventing Mental, Emotional, and Behavioral Disorders Among young People: Progress and Possibilities, published by National Academies Press and is available (though relatively expensive to buy) at www.nap.edu. There are pdf version of sections available for review on the website.
The report offers solid evidence of the fact that prevention works. Numerous studies described in the report make it quite clear that we have effective means right now, and more approaches are being tested for their effectiveness, to help young people acquire the skills they need to meet the challenges of life with resources and strength. Structured programs that teach social skills, problem-solving skills, and effective behavioral strategies have been shown to significantly reduce depression and anxiety. I’m absolutely convinced that it is a sizeable blind spot in most clinicians’ practices that they focus exclusively on “mop up” of peoples’ problems rather than on the prevention of problems in the first place.
As you may know from my last blog entry, my new book, Depression is Contagious: How the Most Common Mood disorder is Spreading Around the World and How to Stop It, came out last month. All through the book I encourage readers to learn specific skills that can improve life for them as well as prevent future difficulties that can too easily spiral downward in to depression. The book contains lots of vignettes and structured exercises to make the skills learnable and usable. I hope it will be a valuable source for practical ways to stay at least a couple steps ahead of what Winston Churchill used to call the “black dog nipping at my heels” when referring to his depression. You can watch an interview about it on my website: http://www.yapko.com/simpo2/content/pages/depression%20is%20contagious.aspx.
Will it help if you think of foresight as hindsight in advance?
