Radden Jennifer H
Philosophy Department, University of Massachusetts Boston, Morrissey Boulevard, Boston, Massachusetts 02125, USA.
Philos Ethics Humanit Med. 2012 Jan 13;7:6. doi: 10.1186/1747-5341-7-6.
Those in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.
First person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved--for consumers, practitioners, and the general public--in the reconstruction of these new meanings and realities.
To honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved.
心理健康相关消费者运动的参与者明确表达了他们对人道治疗和基本公民权利的要求,终结污名和歧视,以及参与自身康复过程的机会。但是,关于承认政治、“承认权利”和认知正义的理论表明,他们也与心理健康和疾病概念所关联的广泛文化意义息息相关。
对精神科诊断和心理保健的第一人称叙述(此处显示为对生物医学精神病学强大“主导叙事”的“反叙事”),为如何将精神障碍经历重新构建和重新定义提供了线索,这是承认和尊重承认权利及认知正义努力的一部分。然而,文化语义学的任务是整个文化的任务,而不仅仅是消费者的任务。这些新意义必须经过协商。如果它们不是协商的结果,群体构建的定义可能会带来一种限制,这种限制与它旨在取代的错误认知定义一样具有约束性。当涉及到关于精神障碍的文化意义时,有争议的现实使得这成为一项具有挑战性的任务。这里考察了精神疾病回忆录中关于与精神病相关的两个有争议现实的例子:症状的无意义性,以及对疾病洞察力的作用。它们展示了在重构这些新意义和现实方面,消费者、从业者和公众所面临挑战的巨大程度。
为了尊重承认权利和认知正义,必须认识到精神科诊断和治疗的效果及反应的异质性,以及所涉及的重构文化语义学挑战的程度。