Sakakibara Eisuke
Department of Neuropsychiatry, the University of Tokyo Hospital, Tokyo, Japan.
Theor Med Bioeth. 2023 Oct;44(5):477-502. doi: 10.1007/s11017-023-09627-1. Epub 2023 May 24.
The notion of epistemic injustice was first applied to cases of discrimination against women and people of color but has since come to refer to wider issues related to social justice. This paper applies the concept of epistemic injustice to problems in the therapeutic relationship between psychiatrists and psychiatric patients. To this end, it is necessary to acknowledge psychiatrists as professionals with expertise in treating mental disorders, which impair the patient's rationality, sometimes leading to false beliefs, such as delusions. This paper classifies the characteristic features of the therapeutic relationship in psychiatry into three stages: those of a professional-client relationship, those of a doctor-patient relationship, and those of a psychiatrist-psychiatric patient relationship. Epistemic injustice is prevalent in psychiatric care owing to prejudice against patients with mental disorders. However, it is also predisposed by the roles that psychiatrists play in relation to psychiatric patients. This paper suggests some ameliorative measures based on the analysis.
认知不公正的概念最初应用于对女性和有色人种的歧视案例，但此后已扩展到与社会正义相关的更广泛问题。本文将认知不公正的概念应用于精神科医生与精神科患者治疗关系中的问题。为此，有必要承认精神科医生是治疗精神障碍的专业人员，精神障碍会损害患者的理性，有时会导致错误信念，如妄想。本文将精神病学治疗关系的特征分为三个阶段：专业客户关系阶段、医患关系阶段和精神科医生与精神科患者关系阶段。由于对精神障碍患者的偏见，认知不公正在精神科护理中普遍存在。然而，精神科医生在与精神科患者关系中所扮演的角色也会引发认知不公正。本文在分析的基础上提出了一些改善措施。
