Reflections
on SPR and Prevention Science: The Phoenix Principle
By Gene Oetting
It
was dusk in the Colorado foothills and, after the
trail ride, the horses were back in the stable.
We were sitting, cold beer in hand, on the cleared
picnic tables; listening to the cowboy poet tell
tales of the old west while warming his hands at
the campfire. Behind him, heat lightning was flickering
far on the horizon, reflected in the lake.
On
this final night of the first meeting of the Society
for Prevention Research, about three dozen of us
were gathered at Lory State Park, above Ft. Collins,
Colorado. It was a dream-like evening, but our finest
fantasies for the future could not have matched
what we have become today, a vital, thriving society
of hundreds of scientists from a wide range of disciplines,
all committed to preventing harm of one form or
another.
And
the campfire is symbolic. Fire is beautiful and
warming and stimulating, but dangerous and damaging
as well. A large part of that park just burned in
a major forest fire. It destroyed much of the beauty,
leaving behind the raw black spikes of scorched
tree trunks and blackened earth.
But
the forest will recover, and eventually the beauty
will come back. We can already see the green shoots
of new growth struggling through the ash. Like the
phoenix, the forest will return, fresh and new,
from the ashes of its own destruction.
Why
do I think that this is a useful symbol for our
Society? Because, as prevention scientists, we always
need to be prepared for failure and ready to replant
and regrow. Prevention, by its very nature, must
be a phoenix. Whatever we are trying to do, no matter
how successful we are, there is almost undoubtedly
going to be failure down the road. We must be aware
that this will occur and be ready to start over
again.
Why
is failure likely? First, our attempt to alter whatever
it is we are trying to change may not succeed. Unless
they are trivial, and none of us is devoted to the
trivial, the problems that we are trying to solve
are deeply ingrained in society and the environment;
they are difficult and resistant to change. No matter
how brilliant, our endeavors simply may not work.
We go down in flames and have to try again.
On
the other hand, we might succeed. We may actually
change behavior, change social structures, develop
a vaccine, or alter the poisonous environment and
reduce the damage and the harm being done. What
happens then?
With
rare exceptions, like smallpox and the guinea worm,
where the causative agent can, perhaps, be eliminated,
a prevention program has to be maintained to be
effective. So even if we develop a superb prevention,
essentially eliminating the problem, some idiot
is likely to proclaim that it causes autism, or
is against God’s will, or is a CIA plot, or
for some other inane reason should not be used.
And prevention can always be challenged. One reason
is that, while you can point to the people you cured,
you can’t point to the ones that were kept
from harm, so it is harder to put a face on prevention.
Even a great program may be eliminated and, while
not exactly having to start over, the phoenix principle
applies, and we have to rise again and be ready
to find ways to reinstate what we have gained.
But
this level of success is exceptionally rare. Most
of us are trying to deal with ingrained societal
problems or damaging behaviors that have multiple
causes and multiple and complicated outcomes. Our
best efforts, much of the time, are likely to reduce
harm by a few percentage points. Those few points
are critical; they can mean lives saved, improved
well-being, and better health for hundreds or even
thousands of people.
Despite
that success, our prevention programs are likely
to die. Politics change, priorities shift or money
gets tight, and prevention is cut. This happened
to us in one of our first projects. Forty years
ago, we proved that vocational rehabilitation kept
mental patients out of the hospital longer and was
hugely cost effective. But the treatment professionals
were in charge and, with the first budget cuts,
rehab was eliminated. Follow the logic: Rehab kept
people out of the hospital. That reduced the patient
load. Fewer patients justified cutting the budget.
So rehab was eliminated. All we could do was dust
off the ashes of defeat and start over.
There
are ways of staving off defeat. If you institutionalize
a program, it is much more likely to continue. Prevention
becomes part of the system, accepted as a normal
expense or effort. But that creates its own dangers.
Programs that become part of the system are likely
to deteriorate in effectiveness over time. And,
since the environment is always changing, if the
program remains the same, it is likely to eventually
become irrelevant or inappropriate or less effective.
Further,
since institutionalization usually means that people
believe it is the “right” thing to do,
these programs are rarely evaluated. Getting it
tested and, if necessary, changed, may be a harder
task than simply starting a new program.
Back to the phoenix principle: In prevention, whatever
we create will eventually, fail and we must be ready
to rise again from the ashes. Well, at least that
keeps things interesting; it means that we will
always have a new challenge. But more than that,
the whole function of the Society for Prevention
Research is inherent in the legend of the phoenix.
Failure is just part of the ongoing process. We
need to recognize that, be ready for it, and constantly
plant the seeds or lay the eggs that produce a new
generation of prevention programs.
And, unlike the forest and the phoenix, which simply
regenerate themselves as they once were, we are
scientists. Each time we try, we produce new knowledge,
new theories, new concepts, and we spread and disseminate
those ideas. We are not merely rising from the ashes,
we are creating a science of prevention, the theories
and methods of inquiry that ultimately must lead
to progress. In the long run, we will always win.
That is the meaning and the purpose of the Society
for Prevention Research.
The first meeting of the Society was hosted at Colorado
State University by Gene Oetting, Fred Beauvais
and Ruth Edwards. Gene is now a Professor Emeritus,
meaning that he gets a free parking sticker and
letters asking for donations. He still works with
the faculty of the Tri-ethnic Center for Prevention
Research, struggling to get funding for prevention
research aimed at the problems of disadvantaged
populations.
Eugene
(Gene) Oetting , PhD, is Professor Emeritus at Colorado
State University and a founding member of the Society
for Prevention Research.
The
opinions or views expressed in this article are
those of the author and do not necessarily reflect
the opinions and recommendations of the Society
for Prevention Research and its Board of Directors.
