Lee Ho Young
Dasarang Center Hospital.
Seishin Shinkeigaku Zasshi. 2010;112(2):116-23.
Psychiatry is more value-laden than any other field of medicine because it is concerned of human experience and behavior. It is natural that psychiatry should recognize the role of values, alongside facts, in all areas of clinical practice-diagnosis, treatment and rehabilitation. There is a considerable concern on the development and the current form of evidence-based psychiatry whether this being sufficient in decision making in complex environment of mental health services of today. Psychiatric diagnosis derived from observed symptoms silence the interpersonal dialogues. The clinical encounter is narrowly focused on the forms instead of contents, meanings and background of human mental distress. We need a complementary value model, value-based approach, which runs parallel to evidence-based psychiatry. Value-based approach, like evidence-based, is a resource for effective decision-making in psychiatric practice. It starts from equal respect for all values, individual patients, their families and communities, and the recognition of the fact that various value terms already exist in DSM or ICD diagnostic systems. To respect values, psychiatry must step down to be equal with service users. Current development of mental health services are based on the principles of patient centered decision-making and multidisciplinary teamwork. This should provide basis for value-based as well as fact-based psychiatric practice.
精神病学比其他任何医学领域都更具价值取向，因为它关注人类的经历和行为。精神病学在临床实践的所有领域——诊断、治疗和康复中，认可价值观与事实并存的作用是很自然的。对于循证精神病学的发展及其当前形式，人们相当关注它在当今复杂的精神卫生服务环境中进行决策时是否足够充分。源自观察到的症状的精神病学诊断使人际对话陷入沉默。临床问诊狭隘地聚焦于形式而非人类精神痛苦的内容、意义和背景。我们需要一种与循证精神病学并行的补充性价值模型、基于价值的方法。基于价值的方法与循证方法一样，是精神病学实践中有效决策的一种资源。它始于对所有价值观、个体患者、其家庭和社区的平等尊重，并认识到《精神疾病诊断与统计手册》（DSM）或《国际疾病分类》（ICD）诊断系统中已经存在各种价值术语这一事实。为了尊重价值观，精神病学必须放下身段与服务使用者平等相待。当前精神卫生服务的发展基于以患者为中心的决策和多学科团队合作原则。这应为基于价值以及基于事实的精神病学实践提供基础。
