Bergamin Jessy, Luigjes Judy, Kiverstein Julian, Bockting Claudi L, Denys Damiaan
Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands.
Front Psychiatry. 2022 May 31;13:801415. doi: 10.3389/fpsyt.2022.801415. eCollection 2022.
Mental illness undermines a patient's personal autonomy: the capacities of a person that enables them to live a meaningful life of their own making. So far there has been very little attention given to personal autonomy within psychiatry. This is unfortunate as personal autonomy is disturbed in different ways in psychiatric disorders, and understanding how autonomy is affected by mental illness is crucial for differential diagnosis and treatment, and also for understanding personal recovery. We will argue that disturbance of personal autonomy is related to patient's diminished quality of life and suffering that motivates seeking treatment. We hypothesize that (1) personal autonomy is generally reduced by mental illness but (2) the effects on autonomy are expressed differently according to the underlying psychopathology, and also vary according to the (3) context, and perspective of the individual patient. We provide a discussion of how autonomy can be affected in five prototypical mental disorders; Major Depressive Disorder, Substance-use Disorders, Obsessive Compulsive Disorder, Anorexia Nervosa and Schizophrenia. We take these disorders to be illustrative of how diminished autonomy is a central but overlooked dimension of mental illness. We will use our discussion of these disorders as the basis for identifying key dimensions of autonomy that could be relevant to innovate treatment of psychiatric disorders.
精神疾病会损害患者的个人自主性，即一个人能够过上自主创造的有意义生活的能力。到目前为止，精神病学领域对个人自主性的关注非常少。这很不幸，因为在精神疾病中，个人自主性会以不同方式受到干扰，而了解自主性如何受到精神疾病的影响对于鉴别诊断和治疗至关重要，对于理解个人康复也很关键。我们将论证，个人自主性的干扰与患者生活质量下降和促使其寻求治疗的痛苦有关。我们假设：（1）精神疾病通常会降低个人自主性，但（2）根据潜在的精神病理学，对自主性的影响表现不同，并且还会因（3）背景和个体患者的视角而有所不同。我们讨论了自主性在五种典型精神障碍中可能受到的影响，即重度抑郁症、物质使用障碍、强迫症、神经性厌食症和精神分裂症。我们认为这些障碍说明了自主性降低是精神疾病的一个核心但被忽视的维度。我们将以对这些障碍的讨论为基础，确定自主性的关键维度，这些维度可能与创新精神疾病治疗相关。
