Menolascino F J, Gilson S F, Levitas A S
Community Ment Health J. 1986 Winter;22(4):314-27. doi: 10.1007/BF00754386.
Developmental disability, particularly mental retardation, both affects a person's cognitive functioning and places that person on an alternative track of development which, when combined with social, political and economic pressures, places the developmentally disabled person at increased risk for mental illness. The presenting symptoms of mental illness will be modified by the mentally retarded person's cognitive impairment, personality development, and massively different life experience, as will the nature of his interactions with helping agencies. Evaluation, diagnosis and treatment must evolve from an alliance with the mentally retarded persons, not with caretaking agencies, and must be modified to take into account the retarded person's powerlessness. The therapist must be prepared to act as both advocate and bridge-builder for the patient, with the patient's increasing participation. The therapist must be prepared to steer between the Scylla of ignorance about the diagnosis and treatment of mental illness in the mentally retarded and the Charybdis of financial disincentives for human service agencies to collaborate in their care. The advantages of inter-agency cooperation in the treatment of dually-diagnosed individuals is described and illustrated.
发育障碍，尤其是智力迟钝，既会影响一个人的认知功能，又会使这个人走上一条不同的发展轨迹。当这种情况与社会、政治和经济压力相结合时，发育障碍者患精神疾病的风险就会增加。精神疾病的表现症状会因智力迟钝者的认知障碍、人格发展以及截然不同的生活经历而有所改变，其与救助机构互动的性质也会如此。评估、诊断和治疗必须基于与智力迟钝者建立的联盟，而非与照料机构的联盟，并且必须加以调整以考虑到智力迟钝者的无力状况。治疗师必须准备好既为患者充当倡导者，又为患者搭建沟通桥梁，同时让患者更多地参与进来。治疗师必须准备好在对智力迟钝者精神疾病诊断和治疗的无知这一“锡拉岩礁”与人类服务机构在照料方面缺乏合作经济动力这一“卡律布狄斯漩涡”之间找准方向。文中描述并举例说明了跨机构合作在治疗双重诊断个体方面的优势。
