Kasai Kiyoto
Seishin Shinkeigaku Zasshi. 2015;117(8):636-45.
The discipline of psychiatry promotes well-being and recovery based on a comprehensive understanding of the patient from the perspectives of the brain, real-world, and life-course. Pursuant to efforts toward addressing social issues at a regional and national level, it is assumed that the psychiatrist can assist individuals based on an understanding of these three perspectives. This tripartite relationship goes beyond the history of extreme reductionism in neuroscience and the aftermath resulting from the anti-psychiatry movement to provide a foundation for the development of psychiatry and a theoretical groundwork for such basic psychiatric issues as what role pharmacotherapy plays in psychiatric treatment, just why the lives of people living in the community are thought to be important to an individual's well-being, and just what constitutes recovery. Humans have come to possess highly developed brain and mental functions as a result of the adaptation to the social environment that takes place as part of the evolutionary process. While mental functions are thus dictated in large part by evolution of the brain, they also consist of important features that are not attributable to reductionist models of the brain. That is, human mental functioning forms a foundation for metacognition and sophisticated language functions, and through interactions with others and society, one's mental functioning allows for further brain transformation and development (self-regulation of mental functions). Humans develop their own brain and mental functions through mutual exchanges with others, and their dealings with other people and society form their individual modes of living in the real-world. The human brain and mental functions have evolved in such a way as to provide for a better mode of living. Accordingly, for the individual, the makeup of his or her mode of living in the real-world is the source of the well-being that serves to support that individual's values. The scientific background that the human recovery process for those suffering from mental disease involves the combined support of work, school, marriage, and childrearing stems from this fact. Humans develop their own mental capital over their life-courses and utilize it in an effort to realize their well-beings. Humans utilize mental function self-regulation based on the emotional and interpersonal functions developed during childhood in order to formulate an image of themselves (the ego) as well as the type of person they want to become (values/needs). This is indeed the true essence of adolescence. The values that drive an individual's behavior by their very nature exist in the outside world and are shared by others as well as society. These are internalized as individual characteristics through the self-regulation process of adolescence. Regardless of life stage or type of mental illness, individual reflection, verbalization, and reorganization of adolescent ego and values formation are essential to the recovery process. Humans are born with both bodies and brains, and throughout the courses of their lives, they formulate and develop values. Based on an understanding of the tripartite relationship between the brain, real-world, and life courses, it can be argued that the supporting of individual values is the scientific basis for the so-called "patient-centered care" and "needs-based support" that serve as a psychiatrist's essential capabilities. Along with the patient's recovery, which is based on this values-based psychiatry, professional growth is the privilege enjoyed by those in the psychiatric field. Beginning with a foundation based on assisted recovery at the individual level, the psychiatrist can produce mental health changes at the regional level. The psychiatrist consequently possesses the national-level vision necessary to implement a community design model that combines mental health and preventive medicine.
精神病学学科基于从大脑、现实世界和生命历程的角度对患者的全面理解,促进幸福感和康复。为努力在区域和国家层面解决社会问题,假定精神科医生能够基于对这三个角度的理解来帮助个体。这种三方关系超越了神经科学中极端还原论的历史以及反精神病学运动的后果,为精神病学的发展提供了基础,并为诸如药物治疗在精神科治疗中所起的作用、为何社区中人们的生活被认为对个体的幸福感很重要以及康复究竟由什么构成等基本精神科问题提供了理论基础。人类由于在进化过程中对社会环境的适应而拥有了高度发达的大脑和心理功能。虽然心理功能在很大程度上由大脑的进化所决定,但它们也包含一些无法归因于大脑还原论模型的重要特征。也就是说,人类的心理功能为元认知和复杂的语言功能奠定了基础,并且通过与他人及社会的互动,个体的心理功能能够实现进一步的大脑转变和发展(心理功能的自我调节)。人类通过与他人的相互交流来发展自身的大脑和心理功能,他们与他人及社会的交往形成了他们在现实世界中的个体生活方式。人类的大脑和心理功能以一种能够提供更好生活方式的方式进化。因此,对于个体而言,其在现实世界中的生活方式构成是支撑该个体价值观的幸福感的来源。精神疾病患者的康复过程涉及工作、学校、婚姻和育儿的综合支持这一科学背景即源于此事实。人类在其生命历程中发展自身的心理资本,并利用它来努力实现自身的幸福感。人类基于童年时期发展起来的情感和人际功能进行心理功能自我调节,以便形成自我形象(自我)以及他们想要成为的人的类型(价值观/需求)。这确实是青春期的真正本质。驱动个体行为的价值观本质上存在于外部世界,并由他人以及社会所共享。这些价值观通过青春期的自我调节过程内化为个体特征。无论处于生命阶段或精神疾病类型如何,个体对青春期自我和价值观形成的反思、表达和重新组织对于康复过程至关重要。人类生来就有身体和大脑,并且在其生命过程中形成并发展价值观。基于对大脑、现实世界和生命历程之间三方关系的理解,可以认为支持个体价值观是作为精神科医生基本能力的所谓“以患者为中心的护理”和“基于需求的支持”的科学基础。随着基于这种以价值观为基础的精神病学的患者康复,职业成长是精神科领域从业者所享有的特权。从个体层面基于辅助康复的基础开始,精神科医生能够在区域层面产生心理健康变化。精神科医生因此具备实施将心理健康与预防医学相结合的社区设计模型所需的国家层面视野。