Wright D
Department of Psychiatry, Maine Medical Center, Portland 04101, USA.
Int J Health Serv. 1998;28(2):373-84. doi: 10.2190/E24M-QWRM-VEM9-6JC5.
Therapists in psychiatric hospitals often overuse a model borrowed from natural science, with the patient becoming an object to be examined, assessed, and altered, and underuse an interpretive psychotherapeutic approach, or misuse it to control patients. And while expressing an interest in the meaning of what patients say, they exclude most of the traditional sources of meaning, in ethics, religion, literature, art, and political thought. The author argues that therapists do these things for two ideological reasons: to maintain their position in the authoritarian structure of the hospital and to maintain the hospital as an agent of class domination. Along with other groups, therapists bring instrumental rationality, such as that of natural science, to bear on political, cultural, and personal questions for which this type of rationality is often destructive. In the long run, political participation and social integration decrease, culture traditions provide less meaning, and personality formation is disrupted. Thus the end result of the overuse of instrumental rationality is not only domination by one class of others, but a decrease in the stability of the society as a whole. Hospital therapists participate in these trends, but they could do otherwise, by working to create a more democratic form of therapy.
精神病医院的治疗师常常过度使用从自然科学借鉴而来的模式，将患者变成一个有待检查、评估和改变的对象，而对解释性心理治疗方法使用不足，或者将其滥用于控制患者。虽然他们表示对患者话语的意义感兴趣，但却排除了伦理、宗教、文学、艺术和政治思想等大多数传统意义来源。作者认为，治疗师这样做有两个意识形态方面的原因：在医院的专制结构中维持自己的地位，以及将医院维持为阶级统治的工具。与其他群体一样，治疗师将工具理性（如自然科学的工具理性）应用于政治、文化和个人问题，而这种理性往往会对这些问题造成破坏。从长远来看，政治参与和社会融合减少，文化传统提供的意义减少，人格形成受到干扰。因此，过度使用工具理性的最终结果不仅是一个阶级对其他阶级的统治，而且是整个社会稳定性的下降。医院治疗师参与了这些趋势，但他们也可以通过努力创造一种更民主的治疗形式来做出不同的选择。
