Cook J A, Wright E R
Thresholds National Research and Training Center, Chicago, IL 60614, USA.
J Health Soc Behav. 1995;Spec No:95-114.
Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future.
在过去的40年里，精神卫生保健系统已经从一个专注于机构化护理的体系彻底转变为一个以社区环境中的治疗为核心的体系。虽然医学社会学在精神病住院治疗和非机构化过程的研究中发挥了重要作用，但对基于社区的精神卫生保健的社会学层面进行系统探索才刚刚开始。本文回顾了过去学科所做的贡献，并探讨了精神疾病研究领域中一些重要的实证和理论方向，这些方向可能会从更广泛的社会学分析中受益。核心论点是，向基于社区的精神卫生系统的转变增加了对社会学视角的需求，特别是医学社会学家拥有理论和分析视角，对于更全面地理解当前影响重度精神障碍患者生活的状况至关重要。借鉴医学社会学的近期研究成果，我们阐述了在重度精神疾病的治疗、社会变革和公共政策方面争议核心的一些重要主题领域。我们最后讨论了这类社会学研究的障碍，并就医学社会学家未来可能如何为重度精神障碍研究做出贡献提出了建议。
