真的有精神病嗎?一個跨文化、跨領域精神 醫療研究取徑的定位與反省

Author Info
蔡友月
Yu-Yueh Tsai

中文摘要

  精神醫學所診斷的精神疾病是一種「病」嗎?它是來自生物學上的醫學證據,還是後天環境產生的問題?1960年代開始,對於精神疾病究竟是什麼,精神醫學與反精神醫學形成激烈論戰,兩個陣營近乎各說各話,毫無交集。對照1960年代之後、半世紀以來雙方的這種爭論狀態,1977年至今一個涵蓋社會學、人類學、精神醫學等跨領域學者研究群所推展的精神醫療研究新取徑,他們努力進行跨文化、跨領域的合作溝通與知識建構,相當值得重視。本論文分四部分,前兩部分「無心靈精神醫學的發展」、「對疾病本質存而不論的反精神醫學取徑」,分析精神醫學與反精神醫學兩個對立陣營各自的發展。第三部分針對Arthur Kleinman及其同仁為首的跨文化、跨領域精神醫學的研究取徑,從本體的預設、方法論、知識與實踐的貢獻,定位這個取徑的集體研究成果。第四部分從理論化程度、知識實用性格與專業權力批判、全球政治經濟轉型與精神疾病等三方面的問題,分析這個取徑的限制與負面效果。最後綜結本文提出前瞻性的思考與提問,本文指出面對全球化的時代,必須從「跨文化精神醫學」(cross-cultural psychiatry)進展到「超越文化精神醫學」(trans-cultural psychiatry)。
 
Is There Really Mental Illness? Positioning A Cross-Cultural and Interdisciplinary Approach in Psychiatry
 
Abstract
 
  Is mental illness defined by psychiatry really “disease?” Is its existence biomedically validated or derived from environmental factors? Since the 1960s, this has been the subject of heated debate between those who are for and those who are against psychiatry. Against a background of the continuing debate, my article reviews a significant approach in the study of mental illness advocated by a group of sociologists, anthropologists, psychiatrists, and suchlike. Their efforts to promote cross-cultural and interdisciplinary research cooperation and communication merit appreciation. The article consists of four parts. The first two parts on the development of mindless psychiatry and the anti-psychiatry approach that brackets off the essence of disease examine the evolution of the divided camps of pro- and anti-psychiatry. The third part positions the collective contribution of the cross-cultural and interdisciplinary research approach led by Arthur Kleinman and his colleagues in terms of its ontology, methodology, knowledge building, and social engagement. Focusing on their research findings, theorizing achievement, and pragmatic orientation and pointing out the importance of critiquing the professional power of modern medicine, changing global political economy, and transforming phenomena of mental illness, the forth part analyzes the limitations of this approach. I conclude with a recommendation for a way forward involving a movement from a cross-cultural psychiatry to a trans-cultural psychiatry that is vital in the era of globalization.
Citation: 
《科技、醫療與社會》,第15期,頁11-64,2012年10月出版