Nys Thomas R V, Nys Maurits G
Centre for Economics and Ethics, Catholic University Leuven, Naamsestraat 69, 3000, Leuven, Belgium.
Med Health Care Philos. 2006;9(1):107-15. doi: 10.1007/s11019-005-9655-x.
We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources--the plea for individual autonomy and the idea of Managed Care--and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mental illness. It ignores that the psychiatrist's profession is essentially characterized by fragility: fluctuating between scientific reduction and the irreducible complexity of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well.
我们认为，当代精神病学针对各种外部压力源采取了一种防御策略。我们将识别其中两个压力源——对个人自主性的诉求和管理式医疗的理念，并解释它们如何推动了对疾病的严格生物医学概念。然而，对客观性的要求并未考虑到精神疾病的复杂性。它忽视了精神病医生这一职业本质上具有的脆弱性：在科学简化与现实的不可简化的复杂性之间波动。因此，精神病医生需要的不是硬性规定，而是判断力。最后，我们建议哲学可以在精神病学中注入一些有益的不确定性，以恢复其脆弱的身份认同。我们的例子取自荷兰的情况，但我们相信它们也适用于其他国家。
