Benevolent gambling: a critique of primary prevention programs in mental health

It has been said that medicine is the only profession which seeks to "put itself out of business"--that is, which has as its highest goal the prevention of those conditions for which the treatment is its stock in trade. There can be no serious argument with this preventive ideal: the conditions on which health practitioners focus their professional attention are, with the sole exceptions of pregnancy and childbirth, theoretically unnecessary and--apart from the issue of "secondary gain"--distinctly disadvantageous to those who develop them. This statement is as true of conditions which bring people to the offices of mental health practitioners as it is of conditions which bring them to physicians. It is my purpose in this paper to examine the concept of prevention as it applies to mental and emotional disorders and to assess the current state of allegedly preventive professional activities.