PROPHYLACTIC COMMUNITY

With the change in emphasis in the last decade to "Community Psychiatry", various hypotheses, ideas and theories have been postulated as to the cause of mental disease. Objectively, with the aid of statistics, one can say that there is an increase in mental disease, and therefore the cooperation of the total Community is required to prevent further propagation of the disease.

To make this brief resume of a wide subject acceptable, I want to clarify the terminological implications of a few words that are used at random in our daily communication with sick people, e.g. patients with an alcohol problem. Words like Hospital, Treatment, Therapy, Prophylaxis and Cure, have important significance to the patient. To expect maximum results it is imperative that one understands what one is doing, and what one's goals are. Simply these five terms mean: Care, Response, Type, Type of response that prevents disease, and total alleviation of the presenting problem.

When Dr. Bell started in this field about twenty five years ago, he cared, and due to limited Community interest, research programs, funds, and specialized staff, it was difficult for him to obtain the proper response with the limited "types" of therapeutic techniques at his disposal. Hence, over the years, he has built up a team of experts in many areas, so that there is and will be many types of responses to combat alcoholism and addiction, i.e. Prophylaxis. Many researchers have postulated various ideas that can be used to cultivate a "Sterile Community" i.e. free of all major mental disease. When the alcoholic or drug addict breaks away from the parent community, the tendency is to form islands or satellites around the main body. These fragmented individuals develop a life style of their own, and become a threat to the parent body. The question at this stage is "What holds people together in the parent body?"

Obviously, many changes are being made in the Community to prevent disease, with the need for survival being paramount. We should then be looking at what the Community has to offer. Can the alcoholic or drug addict in the fragmented Community accept this? What facilities are there in the Community to prevent further development of mental disease? Are these types (therapies) of responses amenable to all? Unfortunately, one can go on asking all sorts of questions which only indicate group interest and concern to initiate a prophylactic community.

I sincerely do hope that you all will appreciate the gravity of our work, and trust that we can count on your cooperation at all times in the fight against this huge problem, i.e. Alcoholism and Drug Addiction.

"To admit is to succeed - to deny is to fail".

NEIL R. MAHARAJ, M.D.

DON SAYS: Dr. Maharaj was on staff at the Donwood Institute while I was in residence in 1969 when this was written. I believe it points out the sheer brilliance of Doctor Bell, and the wonderful legacy he left we alcoholics and drug addicts.