Hunter D E, Hoffnung R J, Ferholt J B
Yale Child Study Center, Yale University School of Medicine, New Haven, CT.
Fam Process. 1988 Sep;27(3):327-38. doi: 10.1111/j.1545-5300.1988.00327.x.
The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a "medical model" or "biogenic" view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psychotherapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.
作者引用临床文献证明，认识到家庭而非个体才是对精神疾病进行概念化、诊断和治疗的合适场所，这一点至关重要。具体而言，就严重精神疾病，尤其是精神分裂症来说，家庭功能失调会促使疾病的出现，显著影响其病程，并强烈影响治疗效果的达成与维持。目前，一场运动正在展开，旨在大幅限制为精神分裂症患者及其家庭提供的治疗数量和种类。这一思想流派植根于对精神分裂症病因的“医学模式”或“生物起源”观点，将心理教育规定为首选的家庭治疗方法。本文探讨了一些关于治疗的误解，这些误解促使人们普遍不再采用针对精神分裂症患者及其家庭的精神分析取向家庭心理治疗，审视了单纯使用心理教育所固有的还原论（生物学和行为学），并探讨了这种还原论的临床危险性。最后，文章提出，面对还原论研究者虚假的一概而论的说法，家庭心理治疗师不应放弃对重症患者及其家庭内心生活的关注。
