Takabayashi Akinobu
Med Hist. 2017 Apr;61(2):246-269. doi: 10.1017/mdh.2017.4.
In recent decades, historians of English psychiatry have shifted their major concerns away from asylums and psychiatrists in the nineteenth century. This is also seen in the studies of twentieth-century psychiatry where historians have debated the rise of psychology, eugenics and community care. This shift in interest, however, does not indicate that English psychiatrists became passive and unimportant actors in the last century. In fact, they promoted Lunacy Law reform for a less asylum-dependent mode of psychiatry, with a strong emphasis on professional development. This paper illustrates the historical dynamics around the professional development of English psychiatry by employing Andrew Abbott's concept of professional development. Abbott redefines professional development as arising from both abstraction of professional knowledge and competition regarding professional jurisdiction. A profession, he suggests, develops through continuous re-formation of its occupational structure, mode of practice and political language in competing with other professional and non-professional forces. In early twentieth-century England, psychiatrists promoted professional development by framing political discourse, conducting a daily trade and promoting new legislation to defend their professional jurisdiction. This professional development story began with the Lunacy Act of 1890, which caused a professional crisis in psychiatry and led to inter-professional competition with non-psychiatric medical service providers. To this end, psychiatrists devised a new political rhetoric, 'early treatment of mental disorder', in their professional interests and succeeded in enacting the Mental Treatment Act of 1930, which re-instated psychiatrists as masters of English psychiatry.
近几十年来,英国精神病学历史学家已将主要关注点从19世纪的精神病院和精神科医生身上转移开。这在20世纪精神病学研究中也有体现,历史学家们在其中探讨了心理学、优生学和社区护理的兴起。然而,这种兴趣的转变并不意味着英国精神科医生在上个世纪就成了消极且不重要的角色。事实上,他们推动了《疯人法》改革,以实现一种减少对精神病院依赖的精神病治疗模式,并大力强调专业发展。本文通过运用安德鲁·阿伯特的专业发展概念,阐述了英国精神病学专业发展背后的历史动态。阿伯特将专业发展重新定义为源于专业知识的抽象化以及关于专业管辖权的竞争。他认为,一个专业通过在与其他专业和非专业力量的竞争中不断重塑其职业结构、实践模式和政治话语来发展。在20世纪早期的英国,精神科医生通过构建政治话语、开展日常业务以及推动新立法来捍卫其专业管辖权,从而促进专业发展。这个专业发展故事始于1890年的《疯人法》,该法案引发了精神病学领域的专业危机,并导致了与非精神科医疗服务提供者的跨专业竞争。为此,精神科医生出于自身专业利益设计了一种新的政治说辞——“精神障碍的早期治疗”,并成功促成了1930年《精神治疗法》的颁布,该法案使精神科医生重新成为英国精神病学的主导者。