정신의학 분야에서의 예방적 개입

Preventive Intervention in Psychiatric Area

This paper argues for the adoption of a theoretical framework within which to conceptualize the design and evaluation of preventive interventions. The benefits to be gained by basing the field’s activities within a conceptual model are reviewed in terms of their empirical and political implications. As evidence of the field’s readiness for such a step, three existing theoretical options are examined-Bloom s life-events model, Tricketts ecological model, and Rappaport s empowerment model. These models are compared with the transactional developmental model proposed by Sameroff as a viable framework for prevention programs and research. The fields rate of future progress is viewed as dependent on the organization of its activities within a paradigamatic structure. The most valuable contribution which any of the models presented herein offers to the field is a framework within its activities can be organized and its findings examined for the incremental value to the existing knowledge base. Whichever model is selected, it is important that it be used paradigmatically to establish criteria for determining which forms of deviance to target for defining the adequacy of its generative footing, and for establishing the basis for strategy’s success. It too has reached that point in its evolution that its findings will not be received by the scientific and political communities without overacrching frame for their interpretation. Fortunately, the field has multiple viable conceptual directions in which to pursue its long term objectives. More fortunately, it appears that those directions will merge at some point in the future. A number of barriers exist that make it difficult to enlarge upon primary prevention activities in the field of emotional disorders in Korea. First no national policy exists with regard to the enhancement of mental health. A second barrier relates to the difficulty in extending our knowledge regarding effective approaches to primary prevention. A third barrier lies in our failure to act on our growing realization that monoetiological theories do not really explain the development of most forms of psychiatric disorder and that the concept of health is itself multidimensional. A final barrier that should be noted lies within the mental health establishment itself reflected in the characteristics of contemporary practice and its underlying societal values