University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland.
Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, 4055 Basel, Switzerland.
Int J Environ Res Public Health. 2022 Dec 3;19(23):16194. doi: 10.3390/ijerph192316194.
In acute psychiatry, where people with severe mental disorders are frequently treated, there can be contradictions between concepts of illness among, e.g., patients and healthcare professionals, and also between medical and legal aspects. These contradictions do not manifest themselves openly but are immanent in the social practices of the treatment teams as contradictions between the social level and the individual level. They can lead to alienation, which may be reflected in poorer quality of treatment, such as the more frequent use of coercive measures or poorer adherence to therapy in patients. In the normal daily routine of a clinic, these contradictions are mostly hidden by hierarchical structures or by unbalanced concepts of psychiatric illness, or external critique is used to try to solve these contradictions. However, another way of dealing with these contradictions could be to analyze the potential and causes for alienation through systematic analysis and transformation of the whole system of a psychiatric ward to reduce the level of contradiction within it. The aim of this work is to use the concept of meaning elaborated by Luhmann to identify and recognize alienation potentials as concretely as possible and thus make them accessible to immanent critique. Meaning in Luhmann's use of the term serves to reduce complexity in a social context and always opens up consequential possibilities for action. Consequential limited possibilities at the level of action in a rigid social system (which psychiatric wards can be) can-at an individual level-lead to people subordinating themselves to the rigid system to an excessive degree and thus alienating themselves from the system. Thus, a rigid system with a narrowing of consequential possibilities excludes meaningful consequential possibilities. This leads to alienating contradictions and to possibilities of world appropriation being missed. The aim of the current analysis is not to make a general critique of psychiatry but to improve the theoretical basis to better understand the problem of alienation in acute psychiatry as a symptom of system-immanent contradictions and thus open up the possibility of transforming systems, e.g., psychiatric acute care units, by means of immanent critique.
在急性精神病学中，经常治疗患有严重精神障碍的人，患者和医疗保健专业人员之间，以及医学和法律方面之间可能存在疾病概念上的矛盾。这些矛盾不是公开表现出来的，而是内在地存在于治疗团队的社会实践中，表现为社会层面和个人层面之间的矛盾。它们可能导致异化，这可能反映在治疗质量较差上，例如更频繁地使用强制措施或患者对治疗的依从性较差。在诊所的正常日常工作中，这些矛盾大多被等级结构或不平衡的精神病概念所掩盖，或者外部批评被用来试图解决这些矛盾。然而，处理这些矛盾的另一种方法可能是通过系统分析和转化整个精神病病房系统来减少其内部矛盾水平，从而分析异化的潜力和原因。这项工作的目的是使用卢曼阐述的意义概念尽可能具体地识别和认识异化潜力，从而使它们能够受到内在批判。在卢曼的使用中，意义在社会背景下用于减少复杂性，并且总是为行动开辟后果性的可能性。在僵化的社会系统（精神病病房可能就是这样的系统）的行动层面上，后果性的有限可能性可能会导致人们过度地服从僵化的系统，从而使自己与系统疏远。因此，一个具有缩小后果性可能性的僵化系统会排除有意义的后果性可能性。这导致异化的矛盾和错过世界占有可能性。当前分析的目的不是对精神病学进行一般性批判，而是为了改善理论基础，以便更好地理解急性精神病学中的异化问题作为系统内在矛盾的症状，从而通过内在批判为系统转变（例如，精神病急性护理病房）开辟可能性。
