Fabrega Horacio
Department of Psychiatry, University of Pittsburgh School of Medicine, WPIC, 3811 Ohara Street, Pittsburgh, PA 15213, USA.
Perspect Biol Med. 2006 Autumn;49(4):586-601. doi: 10.1353/pbm.2006.0054.
In non-Western and premodern societies, approaches to sickness involved moral considerations laden with existential and spiritual implications. Healers and physicians had access to this aspect of their patient's lives, were expected to use it constructively, and often did so. The contemporary biomedical theory of disease no longer assigns to illness such metaphysical connotations. While general physicians are permitted - perhaps even advised - to avoid involvement in morally laden dialogues tied to illness and the self, such dilemmas are more prominent and qualitatively different in psychiatry, as psychiatric conditions often entail changes in self-conception, psychological disaffection, unacceptable behavior, and untoward personal reactions to social circumstances. Manifestations of psychiatric conditions can overwhelm an individual's control in areas of cognition, emotion, autonomy, social responsibility, behavior, and body functions - exactly those matters that "modern" individualistic minds are supposed to master. Consequently, psychiatric conditions challenge basic presuppositions of the modern, secular credo about personhood, disease, and behavior. They comprise a species of human problems ontologically distinct from the conditions handled by other medical disciplines.
在非西方和前现代社会，应对疾病的方法涉及充满生存和精神内涵的道德考量。治疗师和医生能够了解患者生活的这一方面，人们期望他们建设性地利用这一点，而且他们通常也确实这样做了。当代生物医学疾病理论不再赋予疾病这种形而上学的内涵。虽然普通医生被允许——甚至可能被建议——避免参与与疾病和自我相关的充满道德意味的对话，但这类困境在精神病学中更为突出且性质不同，因为精神疾病往往会导致自我认知的改变、心理疏离、不可接受的行为以及对社会环境的不良个人反应。精神疾病的表现可能会在认知、情感、自主性、社会责任、行为和身体功能等领域超出个人的控制范围——而这些正是“现代”个人主义思维理应掌控的方面。因此，精神疾病挑战了现代世俗关于人格、疾病和行为信条的基本预设。它们构成了一类在本体论上与其他医学学科所处理的病症截然不同的人类问题。
