Mead Shery, Hilton David
Fielding Institute, USA.
Psychiatr Rehabil J. 2003 Summer;27(1):87-94. doi: 10.2975/27.2003.87.94.
Psychiatric interventions for crisis care lie at the center of the conflict between involuntary commitment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been convinced by the media that people with psychiatric disabilities are to be feared. More and more this has led to social control but is erroneously still called treatment. This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with people in psychiatric crises. Rather than objectifying and naming the crisis experience in relation to illness, people can begin to explore the subjective experience of the person in crisis while offering their own subjective reality to the relationship. Out of this shared dynamic in which a greater sense of trust is built, the crisis can be an opportunity to create new meaning, and offer people mutually respectful relationships in which extreme emotional distress no longer has to be pathologized. The authors, who have had personal experience with psychiatric crises, have provided this kind of successful crisis counseling and planning and have designed and implemented peer support alternatives to psychiatric hospitalizations that support this model.
精神科危机护理干预处于心理健康服务中强制住院与康复/健康体系之间冲突的核心位置。尽管危机对于有相关经历的人来说可能意味着完全不同的事情,但公众已被媒体说服,认为患有精神疾病的人是可怕的。这越来越多地导致了社会控制,但错误地仍被称为治疗。这对患者毫无帮助,实际上还进一步困扰了那些已经在努力理解自身经历的人。本文提出了在理解和帮助处于精神科危机中的人方面的根本性转变。与其将危机经历客观化并与疾病联系起来命名,人们可以开始探索处于危机中的人的主观体验,同时将自己的主观现实带入这种关系中。在这种建立起更强信任的共享动态过程中,危机可以成为创造新意义的契机,并为人们提供相互尊重的关系,在这种关系中,极端的情绪困扰不再需要被病态化。作者们有过精神科危机的亲身经历,提供过这种成功的危机咨询与规划,并设计和实施了替代精神病院住院治疗的同伴支持方案,以支持这种模式。