Geller J L
University of Massachusetts Medical Center, USA.
Psychiatr Q. 1995 Fall;66(3):219-35. doi: 10.1007/BF02265672.
Coerced community treatment in its various forms is receiving increasing attention and generating considerable controversy. Few attempts, however, have been made to articulate a rationale for its use. The author presents material in support of the concept that schizophrenia can be viewed as a set of biopsychosocial deficits and that some of the deficits can be efficaciously addressed using coerced community treatment. The biological, psychological, and social deficits are each examined and then a biopsychosocial-coerced intervention hypothesis is generated. The underpinning of the use of coerced community treatment in this model is its ability to affect structure and motivation and thereby to alter the customary community living equation. The charge that one can just treat the deficits and then coercion becomes superfluous is answered. The concerns that the employment of coercion could become too widespread or be used in lieu of adequate community resources for mental health services are also considered. The conclusion is that coerced community treatment is a logical component of the treatment of schizophrenia in outpatient settings.
各种形式的强制社区治疗正受到越来越多的关注，并引发了相当大的争议。然而，很少有人尝试阐明其使用的理论依据。作者提出了一些材料来支持这样一种观点，即精神分裂症可被视为一系列生物心理社会缺陷，并且其中一些缺陷可以通过强制社区治疗得到有效解决。对生物、心理和社会缺陷分别进行了审视，然后提出了一个生物心理社会 - 强制干预假说。该模型中使用强制社区治疗的基础在于其影响结构和动机的能力，从而改变惯常的社区生活模式。有人认为只需治疗这些缺陷，强制手段就变得多余，对此观点进行了回应。同时也考虑了对强制手段的使用可能变得过于普遍或被用来替代充足的心理健康服务社区资源的担忧。结论是，强制社区治疗是门诊环境中精神分裂症治疗的一个合理组成部分。
