Beeker Timo, Mills China, Bhugra Dinesh, Te Meerman Sanne, Thoma Samuel, Heinze Martin, von Peter Sebastian
Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.
School of Health Sciences, City, University of London, London, United Kingdom.
Front Psychiatry. 2021 Jun 4;12:645556. doi: 10.3389/fpsyt.2021.645556. eCollection 2021.
Worldwide, there have been consistently high or even rising incidences of diagnosed mental disorders and increasing mental healthcare service utilization over the last decades, causing a growing burden for healthcare systems and societies. While more individuals than ever are being diagnosed and treated as mentally ill, psychiatric knowledge, and practices affect the lives of a rising number of people, gain importance in society as a whole and shape more and more areas of life. This process can be described as the progressing psychiatrization of society. This article is a conceptual paper, focusing on theoretical considerations and theory development. As a starting point for further research, we suggest a basic model of psychiatrization, taking into account its main sub-processes as well as its major top-down and bottom-up drivers. Psychiatrization is highly complex, diverse, and global. It involves various protagonists and its effects are potentially harmful to individuals, to societies and to public healthcare. To better understand, prevent or manage its negative aspects, there is a need for transdisciplinary research, that empirically assesses causes, mechanisms, and effects of psychiatrization. Although psychiatrization has highly ambivalent effects, its relevance mainly derives from its risks: While individuals with minor disturbances of well-being might be subjected to overdiagnosis and overtreatment, psychiatrization could also result in undermining mental healthcare provision for the most severely ill by promoting the adaption of services to the needs and desires of the rather mild cases. On a societal level, psychiatrization might boost medical interventions which incite individual coping with social problems, instead of encouraging long-term political solutions.
在全球范围内,在过去几十年中,确诊精神障碍的发病率一直居高不下甚至呈上升趋势,精神卫生保健服务的利用率也在不断提高,给医疗系统和社会带来了日益沉重的负担。虽然被诊断为患有精神疾病并接受治疗的人比以往任何时候都多,但精神病学知识和实践影响着越来越多的人的生活,在整个社会中变得越来越重要,并塑造着越来越多的生活领域。这个过程可以被描述为社会的精神病化进程。本文是一篇概念性论文,侧重于理论思考和理论发展。作为进一步研究的起点,我们提出了一个精神病化的基本模型,考虑到其主要子过程以及主要的自上而下和自下而上的驱动因素。精神病化是高度复杂、多样且全球性的。它涉及各种行为主体,其影响可能对个人、社会和公共卫生保健都有潜在危害。为了更好地理解、预防或管理其负面影响,需要进行跨学科研究,以实证方式评估精神病化的原因、机制和影响。尽管精神病化具有高度矛盾的影响,但其相关性主要源于其风险:一方面,幸福感稍有扰动的个体可能会受到过度诊断和过度治疗;另一方面,精神病化也可能通过推动服务适应病情较轻患者的需求和愿望,而削弱为最严重患者提供的精神卫生保健。在社会层面,精神病化可能会推动医疗干预,促使个体应对社会问题,而不是鼓励采取长期的政治解决方案。