Stein Dan J, Illes Judy
MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Groote Schuur Hospital, University of Cape Town , Cape Town , South Africa.
National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia , Vancouver, BC , Canada.
Front Psychiatry. 2015 Nov 23;6:166. doi: 10.3389/fpsyt.2015.00166. eCollection 2015.
The global burden of disorders has shifted from infectious disease to non-communicable diseases, including neuropsychiatric disorders. Whereas infectious disease can sometimes be combated by targeting single causal mechanisms, such as prevention of contact-spread illness by handwashing, in the case of mental disorders multiple causal mechanisms are typically relevant. The emergent field of global mental health has emphasized the magnitude of the treatment gap, particularly in the low- and middle-income world and has paid particular attention to upstream causal factors, for example, poverty, inequality, and gender discrimination in the pathogenesis of mental disorders. However, this field has also been criticized for relying erroneously on Western paradigms of mental illness, which may not be relevant or appropriate to the low- and middle-income context. Here, it is important to steer a path between scientism and skepticism. Scientism regards mental disorders as essential categories, and takes a covering law approach to causality; skepticism regards mental disorders as merely social constructions and emphasizes the role of political power in causal relations. We propose an integrative model that emphasizes the contribution of a broad range of causal mechanisms operating at biological and societal levels to mental disorders and the consequent importance of broad spectrum and multipronged approaches to intervention.
全球疾病负担已从传染病转向非传染性疾病，包括神经精神疾病。传染病有时可以通过针对单一因果机制来防治，比如通过洗手预防接触传播疾病，但在精神疾病方面，多个因果机制通常都与之相关。全球心理健康这一新兴领域强调了治疗差距的规模，尤其是在低收入和中等收入国家，并且特别关注上游因果因素，例如精神疾病发病机制中的贫困、不平等和性别歧视。然而，该领域也因错误地依赖西方精神疾病范式而受到批评，这些范式可能与低收入和中等收入背景无关或不适用。在此，在科学主义和怀疑主义之间找到一条道路很重要。科学主义将精神疾病视为基本类别，并采用覆盖律方法来解释因果关系；怀疑主义则认为精神疾病仅仅是社会建构，并强调政治权力在因果关系中的作用。我们提出了一个综合模型，该模型强调在生物和社会层面起作用的广泛因果机制对精神疾病的影响，以及由此产生的广泛和多管齐下干预方法的重要性。
