Collin Johanne
University of Montreal, Canada
Health (London). 2015 May;19(3):245-62. doi: 10.1177/1363459314545695. Epub 2014 Aug 18.
Over the past decades, there has been a significant increase in prescriptions of psychotropic drugs for mental disorders. So far, most of the explanations of the phenomenon have focused on the process of medicalization, but little attention has been cast towards physicians' day-to-day clinical reasoning, and the way it affects therapeutic decision-making. This article addresses the complex relationship between aetiology, diagnosis and drug treatment by examining the style of reasoning underlying prescribing practices through an historical lens. A genealogy of contemporary prescribing practices is proposed, that draws significant comparisons between 19th-century medicine and modern psychiatry. Tensions between specific, standardized cures and specific, idiosyncratic patients have been historically at play in clinical reasoning - and still are today. This inquiry into the epistemological foundations of contemporary drug prescription reveals an underlying search for scientific legitimacy.
在过去几十年里，用于精神障碍的精神药物处方显著增加。到目前为止，对这一现象的大多数解释都集中在医学化过程上，但很少关注医生的日常临床推理及其对治疗决策的影响方式。本文通过历史视角审视处方实践背后的推理方式，探讨病因、诊断和药物治疗之间的复杂关系。本文提出了当代处方实践的谱系，对19世纪医学和现代精神病学进行了重要比较。在临床推理中，特定的标准化治疗方法与特定的特殊患者之间的紧张关系在历史上一直存在，如今依然如此。对当代药物处方的认识论基础的探究揭示了对科学合法性的潜在追求。
