Singh Ajai R
Editor, Mens Sana Monographs.
Mens Sana Monogr. 2014 Jan;12(1):92-103. doi: 10.4103/0973-1229.130316.
Holistic understanding is necessary to study intimate nuances of psychological/psychopathological processes; also, individual manifestations and individual approach are laudable goals in treatment and approach. But we cannot forget that major therapeutic advances result when we are able to delineate commonalities and stable symptom clusters that cut across geo-cultural boundaries and are amenable to study and intervention. Even though the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, major therapeutic advancements and aetiologic understandings result only from a scientific methodology that stresses and figures out the commonalities of psychopathological phenomena. It is a mistake to stress individuality so much that commonalities are obliterated. Although stress on the individual's needs has helped psychiatry at times become more humane, it has hurt the task enormously by making some very bright minds question the very scientific basis of psychiatry and its status as a medical discipline. Hence, even as it is necessary to promote holistic and individualistic caring, it is equally necessary to shrug ambivalence and crippling disagreements that can result if individualism in therapy is carried beyond limits. Psychiatry's tradition, and field, will always allow for diversity in its practice, even in its theorising. For, psychopathology has both a personal, deep inner dimension - due to biogenetic and personality factors - and social, manifest/unmanifest, outer dimension - due to the environment. And the practice, and theory, of both are likely to be different, although we do try to amalgamate them in our 'bio-psycho-social' model. Such differences are only manifestations of an intricate network of influences that make for the human condition in health and disease. Psychiatry is the one branch which realises this diversity the most, but equally important for it is to stress its unity: Of purpose - that of reducing individual and social psychopathology;Of goals - that of unravelling the aetiopathology of psychiatric disorders; finding precision in diagnostics and investigative tests; finding biomarkers; and finding precise therapies for precise disorders that control such disorders; and not just control, but finally cure them; finding methods of primary prevention; of moving from mental disorder to mental health; and, further, of progress to individual actualisation and personal and collective well-being with longevity;Of practice - a) in therapy: By synergising psychopharmacology/somatic therapies with psychotherapy/therapies, social therapies and pharmacogenetics; b) in diagnostics: By identifying the phenotype-genotype-endophenotype axis; and (c) by promoting such therapy and diagnostics as brings about control, and finally, cure/primary prevention of psychiatric disorders.The future course for psychiatry involves a goal oriented forward movement - while allowing for diversity in practice and theory, stressing on unity of purpose, goals, and practice.
要研究心理/精神病理过程的细微差别,整体理解是必要的;同样,个体表现和个体化方法在治疗和方法中也是值得追求的目标。但我们不能忘记,当我们能够勾勒出跨越地理文化界限、易于研究和干预的共性和稳定症状群时,才会取得重大治疗进展。尽管精神病学与所有医学一样,其目的和方法必须以人为本且充满关怀,但重大治疗进展和病因学认识仅源于一种强调并找出精神病理现象共性的科学方法。过于强调个体性以至于抹杀共性是错误的。尽管强调个体需求有时有助于精神病学变得更加人性化,但这也极大地损害了其任务,因为一些非常聪明的人开始质疑精神病学的科学基础及其作为一门医学学科的地位。因此,即使有必要促进整体和个体化关怀,同样有必要摆脱如果治疗中的个人主义超出限度可能导致的矛盾心理和严重分歧。精神病学的传统和领域在其实践中,甚至在其理论中,总是允许存在多样性。因为,精神病理学既有个人的、深层次的内在维度——由于生物遗传和人格因素,也有社会的维度,包括明显的和不明显的外在维度——由于环境。两者的实践和理论可能会有所不同,尽管我们确实试图在我们的“生物 - 心理 - 社会”模型中将它们融合起来。这些差异只是构成健康和疾病中人类状况的复杂影响网络的表现。精神病学是最能认识到这种多样性的一个分支,但对它同样重要的是强调其统一性:目的的统一——即减少个体和社会精神病理学;目标的统一——即揭示精神障碍的病因病理学;在诊断和调查测试中找到精确性;找到生物标志物;找到针对精确疾病的精确疗法以控制这些疾病,而且不仅是控制,最终要治愈它们;找到一级预防方法;从精神障碍转向精神健康;进而实现个体成长以及个人和集体的幸福与长寿;实践的统一——a) 在治疗方面:通过将心理药理学/躯体疗法与心理治疗/疗法、社会疗法和药物遗传学协同起来;b) 在诊断方面:通过确定表型 - 基因型 - 内表型轴;以及 (c) 通过推广能实现对精神障碍的控制,最终实现治愈/一级预防的治疗和诊断方法。精神病学的未来发展方向是朝着一个目标导向的前进运动——在允许实践和理论存在多样性的同时,强调目的、目标和实践的统一。