Chung M C, Nolan P
Department of Psychiatry, Queen Elizabeth Psychiatric Hospital, University of Birmingham, England.
J Adv Nurs. 1994 Feb;19(2):226-32. doi: 10.1111/j.1365-2648.1994.tb01075.x.
The development of positivism, which had a considerable influence on the evolution of psychiatric thought and practice during the second half of the nineteenth century, is outlined. It was within this intellectual framework that figures such as Kraepelin, Bleuler and Schneider developed psychiatric nosologies and diagnostic criteria for certain mental illnesses. While there was little scientific evidence to support the claim that medical treatments had any beneficial effects on pyschiatric disorders, nevertheless psychiatric institutions were established in the mid-nineteenth century based on the medical model. Nurses were expected to observe, collect and report data on mental patients which were then presented to doctors for analysis. The intellectual climate of the asylums was such that nurses were not encouraged to question the scientific principles upon which the therapeutic regime was based, nor were they encouraged to seek a rationale for their daily observations and data collection. The specialized training for asylum nurses which was introduced towards the end of the nineteenth century did not give nurses their own professional identity, but rather reinforced the supremacy of medical knowledge in the care of the mentally ill. Trained nurses enhanced medical credibility, but did not progress care of the mentally ill because their training did not imply or encourage questioning of the positivistic basis of psychiatric treatment.
本文概述了实证主义的发展，它在19世纪下半叶对精神病学思想和实践的演变产生了相当大的影响。正是在这种知识框架内，诸如克雷佩林、布鲁勒和施奈德等人物制定了某些精神疾病的精神病学分类法和诊断标准。虽然几乎没有科学证据支持医学治疗对精神疾病有任何有益影响的说法，但尽管如此，基于医学模式的精神病院还是在19世纪中叶建立起来了。护士被期望观察、收集并报告精神病人的数据，然后将这些数据提交给医生进行分析。精神病院的知识氛围使得护士不被鼓励质疑治疗方案所基于的科学原则，也不被鼓励为他们的日常观察和数据收集寻找理论依据。19世纪末引入的针对精神病院护士的专业培训并没有赋予护士自己的专业身份，而是强化了医学知识在照顾精神病人方面的至高无上地位。受过训练的护士提高了医学的可信度，但并没有推动对精神病人的护理，因为她们的培训并没有暗示或鼓励质疑精神病治疗的实证主义基础。
