Freedman D X
Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine 90024-1759.
Am J Psychiatry. 1992 Jul;149(7):858-66. doi: 10.1176/ajp.149.7.858.
Psychiatry's appropriate agenda and severe distractions in sustaining it are presently a concern and have historically been so as we struggle with the issues of linking body, mind, and human purpose. Biology requires behaving, variability, and the development of regulations to implement "purpose" in coping with the milieu. Psychiatry begins and ends with our patients--with their diseases and dysfunctions, their biographies and aspirations--which, as a clinical medical science, we must systematically study. Doing that, we will borrow from and pose problems for all the life sciences. New knowledge about how cells and biological systems acquire, code, and exchange information challenges all of medicine. In assessing our advances and future, we consider the history of biological issues in psychiatry and the "sins" of biologism or reductionism. We will see that research questions and strategies in the current study of disease and therapeutics have not fundamentally shifted from Freud and Meyer to modern molecular neurobiology. The tension between the socially conditioned purposive self and impersonal biological processes is an inescapable intrinsic tension for psychiatry of which we must be cognizant as we continue the search.
当前，精神病学的恰当议程以及在维持该议程过程中面临的严重干扰令人担忧，而且从历史上看一直如此，因为我们在努力解决身心与人类目标相联系的问题。生物学需要行为、变异性以及制定规则以在应对环境中实现“目标”。精神病学始于并终于我们的患者——他们的疾病与功能障碍、人生经历与抱负——作为一门临床医学科学，我们必须对其进行系统研究。这样做时，我们将借鉴所有生命科学并向它们提出问题。关于细胞和生物系统如何获取、编码和交换信息的新知识对整个医学构成了挑战。在评估我们的进展和未来时，我们会考虑精神病学中生物学问题的历史以及生物主义或还原论的“罪过”。我们将看到，当前疾病与治疗研究中的问题和策略从弗洛伊德和迈耶时代到现代分子神经生物学时代并没有发生根本性的转变。社会条件塑造的有目的自我与客观生物过程之间的紧张关系是精神病学中一种不可避免的内在紧张关系，在我们继续探索的过程中必须认识到这一点。
