The sciences of early development, disorder prevention and health have, according to Robert Emde (2019), undergone huge advances in recent times. This has grown out of a greater awareness of suffering, the adverse effects of unattended early risk and has given energy to preventive interventions. Public health designations break prevention down into primary, secondary and tertiary categories. Primary prevention refers to interventions that are designed to prevent the onset of a disorder or disease before it occurs. Secondary prevention refers to interventions designed to deal with early identification of a disorder and its treatment (usually before symptoms arise). Tertiary prevention deals with interventions that treat the disorder and seek to minimise disability.
Emde (2019) highlights five principles of prevention. The first is that prevention deals with health as well as illness; health is also understood as more that the absence of illness. Health promotion, therefore, must be considered alongside the prevention of disorder. A second principle is that prevention deals with regulation which is a central process in health. Adaptive regulation occurs between ‘enough’ and ‘too much’. This ‘golden mean’ can be applied to all levels of a system from cells to psyche to community. A third principle is that all prevention occurs in the context of culture and circumstances and such contexts must be understood and taken into account. Fourthly, all prevention involves development. The goal, therefore, is to promote healthy development and prevent disruptions in development over time. The prevention sciences are applicable across the lifespan but a privileged position is given to early experience (as it impacts all later development). Lastly, Emde highlights the principle that disorders are complex. Developmental pathways are not linear and many pathways exist to disorders. Most disorders and developmental outcomes are caused by many genes rather than few and genetic influences interact with each other. Genetic expression is strongly influenced by regulatory interactions. The environment and these regulatory interactions change as development progresses and circumstances change.
Many interventions, therefore, applied early, may be effective (Emde, 2019). In addition to specific interventions like the treatment of parental depression or reduction in trauma exposure, non-specific interventions like stress reduction and social support are also likely to be important. The complex nature of development and disorder mean that early preventive interventions are not permanent immunisation against disorder. They need to be followed up with healthy environments that provide opportunity for healthy development later. A principle of prevention is that even if we do not know how to cure a problem, we can still prevent it (Kloos et al, 2021).
Emde, R. N. (2019). Early parenting and prevention of disorder: Psychoanalytic research at interdisciplinary frontiers. Routledge.
Kloos, B., Hill, J., Thomas, E., Case, A. D., Scott, V. C., & Wandersman, A. (2020). Community psychology: Linking individuals and communities. American Psychological Association.