The Healthy Management of Reality - Stanford University

problems. Prevention advocates argue that it is vitally important to direct more ofour efforts at providing our communities with education and other services thatcould avert the portion of these problems that are preventable.Since 1977, as a professor at the University of California, San Francisco, Ihave worked at San Francisco General Hospital, one of our teaching hospitals, andthe city’s public hospital. For twenty-eight years, I have seen at close range themany ways that people with very few economic resources can live their lives.I have seen the admirable ways in which so many people deal successfullywith adversity, as well as the disastrous results of personal choices. In my workwith patients, I have become ever more intrigued about how the way we think andthe things we do affect our feelings, our daily lives, and our relations with others;in short, how our day-to-day actions mold our personal reality.I worked with hospitalized psychiatric patients for six years and saw at closehand the major disorders that I wanted to prevent. I learned that many of thesedisorders have strong biological components, and gained great respect for thepharmacological and other medical interventions that are so important to helpindividuals resume their lives. But even here, choices made (including continuingwith their treatment after leaving the hospital) seemed to affect the kind of life eachpatient and their loved ones would live. I then found that if I wanted to intervenebefore individuals developed psychiatric problems, I needed to work with primarycare medical patients.Depression is one of the most common problems seen in primary caremedical settings. It turns out that most people suffering from depression do notseek mental health services. They go to primary care physicians. So, in the early'80s, I developed the Depression Prevention Course, which focused on reducingdepressive symptoms in people who had not yet developed a clinical, that is, aHMOR.July2005.Muñoz.doc 6