Clínica Universitária de Psiquiatria e Psicologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
J Eval Clin Pract. 2022 Oct;28(5):801-806. doi: 10.1111/jep.13679. Epub 2022 Apr 21.
Both in medicine and in psychiatry, it's essential to find a general definition for medical and mental disorders. For this we have to analyze the concepts behind these definitions. In this article, we intend to review the proximity between the concepts of mental and medical disorders regarding the presence of values, and to propose a way to deal with the different kinds of values that might be present.
The method used in this paper was a conceptual review/analysis.
Regarding the concept of medical disorder, it has resorted to different sub-concepts such as dysfunction and harm (distress disability). The concept of dysfunction, apparently being less value-laden, has been prioritized in relation to the harm component although several authors have already proved that implicitly and explicitly this concept is value laden. In medical-surgical disorder it is very unlikely to find any diagnostic information that includes moral values. In this type of disorder, the values in question are universally non-moral: pain, disability, distress (or risk for these) and risk of death. On the other hand, in several mental disorders, moral values have often been included in their diagnostic criteria.
It is concluded that values are present in the main concepts that have been used to define medical or mental disorder. What is essential is to understand what is descriptive and what is value and to try to avoid moral values in this context.
在医学和精神病学中，找到医学和精神障碍的一般定义是至关重要的。为此，我们必须分析这些定义背后的概念。在本文中，我们旨在回顾精神和医学障碍概念之间的接近程度，以及与价值观的存在有关，并提出一种处理可能存在的不同类型价值观的方法。
本文采用的方法是概念回顾/分析。
关于医学障碍的概念，它借鉴了不同的子概念，如功能障碍和伤害（痛苦、残疾）。功能障碍的概念，显然较少受到价值的影响，因此在与伤害成分的关系中被优先考虑，尽管几位作者已经证明这个概念在隐含和显式方面都受到价值的影响。在医疗手术障碍中，几乎不可能找到任何包含道德价值观的诊断信息。在这种类型的障碍中，所涉及的价值观是普遍非道德的：疼痛、残疾、痛苦（或这些的风险）和死亡风险。另一方面，在几种精神障碍中，道德价值观经常被纳入其诊断标准。
可以得出结论，价值观存在于用于定义医学或精神障碍的主要概念中。至关重要的是要理解什么是描述性的，什么是价值观，并试图在这种情况下避免道德价值观。
