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Two Sides of Depression: Medical & Social 抑郁症的两面性:医学与社会
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02039
A. Horwitz, Jerome C. Wakefield
Abstract Two models have dominated portrayals of depression. The medical model views depression as a disease that has distinct symptoms with predictable courses and outcomes. It typically relies on brain-related explanations and responses, although many adherents also use social and psychological causes and treatments. A second model conceives of depression as the result of external stressors, loss events, and other problems of living that naturally subsides when these conditions improve. In this view, optimal responses lie in addressing the social conditions that underlie depressed states. In this essay, we examine how each edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) since DSM-III in 1980 has blurred the medical and social approaches and conceived of all sorts of depressive symptoms as needing medicinal responses. Although the distinction between the social and medical types is often difficult to make, it is an essential first step in developing accurate conceptions of the two sides of depression.
摘要 对抑郁症的描述主要有两种模式。医学模式认为抑郁症是一种疾病,具有明显的症状和可预测的病程和结果。它通常依赖于与大脑有关的解释和反应,尽管许多追随者也使用社会和心理原因和治疗方法。第二种模式认为,抑郁症是外部压力、损失事件和其他生活问题的结果,当这些情况得到改善时,抑郁症就会自然消退。根据这种观点,最佳的应对措施在于解决导致抑郁状态的社会条件。在这篇文章中,我们将探讨自1980年《精神疾病诊断与统计手册》(DSM)第三版以来,每一版的《精神疾病诊断与统计手册》是如何模糊了医学和社会方法,并将各种抑郁症状视为需要医学应对的。虽然社会型和医学型抑郁症的区分往往很难做到,但这是准确理解抑郁症两面性的第一步。
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引用次数: 0
Indigenous Historical Trauma: Alter-Native Explanations for Mental Health Inequities 土著历史创伤:心理健康不平等的原住民解释
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02035
Joseph P. Gone
Abstract The well-being of American Indian and other Indigenous communities has long been compromised by ruthless processes of European colonial dispossession and subjugation. As a result, contemporary Indigenous communities contend with sometimes overwhelming degrees of demoralization, distress, and disability. The concept of Indigenous historical trauma has arisen during the past thirty years as an alternative mental health discourse that critically contests prevailing categories of psychological disability, psychiatric distress, and mental disorders (including addiction, trauma, and suicide). Indigenous adoption and promotion of historical trauma affords an explanatory account for community mental health inequities that designates the historical legacies of colonization as central for understanding contemporary Indigenous suffering. In so doing, Indigenous advocates of historical trauma creatively recast these problems as postcolonial pathologies, and ardently call for overdue advances in reconciliation, redress, and repair with respect to Indigenous Peoples. Ideally, such advances will be evidenced by societal transformations, structural reforms, and social justice that can enhance and ensure Indigenous futurity and well-being.
摘要 美国印第安人和其他土著社区的福祉长期以来一直受到欧洲殖民者无情的剥夺和征服。因此,当代原住民社区有时面临着严重的士气低落、痛苦和残疾问题。在过去的三十年里,土著历史创伤的概念作为一种替代性心理健康论述应运而生,它对心理残疾、精神痛苦和精神障碍(包括成瘾、创伤和自杀)的普遍分类提出了批判性的质疑。原住民对历史创伤的采纳和推广为社区心理健康的不平等提供了一种解释性说明,将殖民化的历史遗留问题作为理解当代原住民痛苦的核心。在这样做的过程中,历史创伤的土著倡导者创造性地将这些问题重塑为后殖民主义病理,并热切呼吁在土著人民的和解、纠正和修复方面取得早该取得的进展。理想的情况是,这种进步将体现在社会转型、结构改革和社会正义上,从而加强和确保土著人的未来和福祉。
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引用次数: 0
The Biology of Mental Disorders: Progress at Last 精神障碍生物学:终于取得了进展
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02038
Steven E. Hyman
Abstract Mental disorders are common, complex, highly morbid conditions for which basic underlying mechanisms are poorly understood. Despite the utility of many existing treatments, there remains vast unmet need for more effective and safer therapeutics. Most current medicines for mental disorders are based on chemical modifications of serendipitously discovered mid-twentieth-century prototypes, and widely used diagnostic manuals remain phenomenological and conceptually confused. After decades of stasis, research on mental disorders has reached an inflection point. Unbiased large-scale genetics provides information that, if interpreted circumspectly and integrated with neurobiology, provides “finding tools” for causal biological mechanisms that can advance discovery of biomarkers, preventive interventions, and better treatments. However, uncritically applied predictive genomic technologies can produce fatalism and exacerbate stigma. Moreover, polygenic risk scores for cognitive ability and risk of mental illness are already being offered commercially for embryo selection with in vitro fertilization, a worrisome resurgence of eugenics hiding in liberal (noncoercive) guise.
摘要 精神障碍是一种常见、复杂、高发病率的疾病,人们对其基本机制知之甚少。尽管现有的许多治疗方法都很有效,但人们对更有效、更安全的治疗方法仍有大量需求未得到满足。目前大多数治疗精神障碍的药物都是基于对二十世纪中期偶然发现的原型进行化学修饰,而广泛使用的诊断手册在现象和概念上仍然混乱不堪。经过几十年的停滞不前,精神障碍研究已经到了一个拐点。无偏见的大规模遗传学提供的信息,如果经过审慎的解释并与神经生物学相结合,就能为因果生物学机制提供 "发现工具",从而推动生物标志物、预防性干预措施和更好的治疗方法的发现。然而,不加批判地应用预测性基因组技术可能会产生宿命论,并加剧耻辱感。此外,针对认知能力和精神疾病风险的多基因风险评分已被商业化用于体外受精的胚胎选择,这是以自由(非胁迫)为幌子的优生学的卷土重来,令人担忧。
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引用次数: 0
Introduction: How Mental Health Matters 导言:心理健康如何重要
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_e_02029
Anne E. Becker, Giuseppe Raviola, Arthur Kleinman
Abstract The underpinnings of today's mental health crisis include both social structural inequities and neurobiological vulnerabilities. The COVID-19 pandemic has compounded and escalated a long-standing problem, rendering the mental health crisis and its dangerous consequences visible and exigent. We now possess a clearer and more nuanced understanding of the broken mental health care system and its serious inadequacies, as well as its potential for effective caregiving. The professional forms of knowledge and practice are paralleled by an even more substantial system of care involving families, networks, communities, and, of course, those living with mental health conditions themselves. Even when delivered by community care workers, psychotherapy can be as effective as somatic treatments for some mental health conditions. Harm reduction and other public health approaches offer means of preventing or mitigating the disastrous human toll of the substance use disorder epidemic. Social technology offers new opportunities for enhancing mental health and well-being. With these informal systems alongside standardized health care systems, the future could realize a mental health care system with much greater potential to avert the worst harms and offer effective care to many more.
摘要 当今心理健康危机的根源包括社会结构的不平等和神经生物学的脆弱性。COVID-19 的流行加剧了这一长期存在的问题,使心理健康危机及其危险后果变得更加明显和紧迫。现在,我们对残缺不全的心理健康医疗系统及其严重的不足之处,以及其有效护理的潜力有了更清晰、更细致的认识。与专业的知识和实践形式相辅相成的,是一个涉及家庭、网络、社区,当然还有精神健 康患者本身的更为庞大的护理体系。即使是由社区护理人员提供的心理治疗,对于某些心理健康问题的治疗效果也不亚于躯体治疗。减少危害和其他公共卫生方法为预防或减轻药物使用障碍流行病对人类造成的灾难性伤害提供了手段。社会技术为增进心理健康和福祉提供了新的机遇。有了这些非正规系统和标准化的医疗保健系统,未来的心理健康医疗保健系统将有更大的潜力来避免最严重的伤害,并为更多的人提供有效的治疗。
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引用次数: 0
The Protest Psychosis & the Future of Equity & Diversity Efforts in American Psychiatry 抗议精神病与美国精神病学公平与多元化努力的未来
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02033
J. Metzl
Abstract This essay chronicles the history of medical associations between schizophrenia and Blackness that emerged during the tumultuous decades of the 1960s and 1970s, when American psychiatrists overdiagnosed schizophrenia in Black men in ways that undermined brain science of the era. I provide data to show how racially disparate diagnostic outcomes resulted not solely from the attitudes or biases of clinicians, but from a series of larger political and social determinants, most notably changing frameworks surrounding mental illness and political protest. I conclude by highlighting how training clinicians to examine their own cultural biases also needs to include training in how structures and institutions produce symptoms and diseases, and how we can only build better structures to support health if we can individually and then communally imagine them.
摘要 本文记录了精神分裂症与黑人之间的医学关联史,这种关联出现在 20 世纪 60 年代和 70 年代动荡的几十年间,当时美国精神科医生对黑人男子的精神分裂症诊断过度,破坏了那个时代的脑科学。我提供的数据表明,种族差异化的诊断结果并不仅仅是临床医生的态度或偏见造成的,而是由一系列更大的政治和社会决定因素造成的,其中最主要的是围绕精神疾病和政治抗议的框架的变化。最后,我强调了培训临床医生审视自身文化偏见的同时,还需要培训他们了解结构和机构是如何产生症状和疾病的,以及我们只有在个人和社区都能想象的情况下,才能建立更好的结构来支持健康。
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引用次数: 0
Can Mental Health Care Become More Human by Becoming More Digital? 心理健康护理能否通过数字化变得更加人性化?
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02040
Isaac R. Galatzer-Levy, Gabriel J. Aranovich, Thomas R. Insel
Abstract Over the past two decades, advances in digital technologies have begun to transform three aspects of mental health care. The use of sensors and artificial intelligence (AI) have provided new, objective measures of how we think, feel, and behave. The ease of connecting and communicating remotely has transformed the brick-and-mortar practice of mental health care into a telehealth service, increasing access and convenience for both patients and providers. And the advent of digital therapeutics, from virtual reality for treating phobias to conversational agents for delivering structured therapies, promises to alter how treatments will be delivered in the future. These digital transformations can help to solve many of the key challenges facing mental health care, including access, quality, and accountability. But digital technology introduces a new set of challenges around trust, privacy, and equity. Despite high levels of investment and promotion, there remain profound questions about efficacy and safety of digital mental health technologies. We share our experiences from the front lines creating digital innovations for mental health, with a focus on what a digital transformation of care could deliver for millions with a serious mental illness.
摘要 在过去的二十年里,数字技术的进步已经开始改变心理健康护理的三个方面。传感器和人工智能(AI)的使用为我们的思维、感觉和行为提供了新的、客观的衡量标准。远程连接和通信的便捷性将实体心理保健转变为远程保健服务,为患者和医疗服务提供者提供了更多的获取途径和便利。数字疗法的出现,从治疗恐惧症的虚拟现实到提供结构化疗法的对话代理,有望改变未来的治疗方式。这些数字化变革有助于解决心理健康医疗面临的许多关键挑战,包括获取、质量和责任。但数字技术在信任、隐私和公平方面也带来了一系列新的挑战。尽管投资和推广力度很大,但人们对数字心理健康技术的有效性和安全性仍然存在深刻的疑问。我们将与大家分享我们在第一线为心理健康进行数字创新的经验,重点关注数字医疗变革能为数百万严重精神疾病患者带来什么。
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引用次数: 0
Empowering the (Extra)Ordinary 增强(非)普通人的权能
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02041
Vikram Patel, Atif Rahman
Abstract Psychological treatments are among the most effective interventions for a wide range of mental health conditions but remain inaccessible to most people who could benefit from them, including in many high-income countries. We describe two case studies from South Asia that demonstrate innovatively designed psychological treatments addressing many of the barriers that limit their scalability. The treatments are brief, less complex, and delivered by frontline providers, such as peer counselors in community settings. These case studies, alongside a large and growing literature from around the world, provide the foundation for a paradigm shift in mental health care by rejecting the nihilistic notion that communities do not have enough resources to address mental health problems or that these problems are too complex to address. Central to this notion is the recognition that mental health problems can be addressed effectively with resources that every community possesses: people who care for others in their communities.
摘要 心理治疗是治疗各种心理健康问题最有效的干预措施之一,但大多数人仍无法从中受益,包括在许多高收入国家。我们介绍了两个来自南亚的案例研究,它们展示了创新设计的心理治疗方法,解决了许多限制其推广性的障碍。这些治疗方法简短、不太复杂,由一线服务提供者(如社区环境中的同伴咨询师)提供。这些案例研究,以及世界各地大量且不断增加的文献资料,为心理健康护理模式的转变奠定了基础,摒弃了 "社区没有足够的资源来解决心理健康问题,或者这些问题过于复杂而难以解决 "的虚无主义观念。这一观念的核心是认识到,心理健康问题可以通过每个社区都拥有的资源来有效解决,这些资源就是社区中关心他人的人们。
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引用次数: 0
Good Mental Health Care: What It Is, What It Is Not & What It Could Be 良好的心理保健:它是什么、它不是什么以及它可以是什么
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02042
Arthur Kleinman, C.M.Angela Gardner
Abstract What makes for good mental health care? What are the barriers to good care and, when they can be overcome, what accounts for successful treatment? What does successful treatment and care, in fact, mean? Can they mean different things to different people? If so, how can we think about them in a practical way that is useful to patients, families, and clinicians? On the one hand, from work infields as various as neuroscience, clinical psychology, and anthropology, we are learning (and rediscovering) more and more about how the human mind works and the many ways that psychological suffering can be preempted and treated. On the other hand, in many ways, the mental health care system is either dysfunctional or working against what we know to be best for psychological and social flourishing-the disappearance, for example, of true “care” from medical and mental health care systems. In this essay, set against the background of diverse perspectives provided by the foregoing essays in this volume, we attempt to frame and address some of these basic questions, giving priority to practical, down-to-earth, lay, and professional considerations.
摘要 什么是良好的心理保健?良好护理的障碍是什么?当这些障碍可以克服时,成功治疗的原因是什么?成功的治疗和护理实际上意味着什么?它们对不同的人有不同的含义吗?如果是这样,我们该如何以对病人、家属和临床医生有用的实际方式来思考它们?一方面,从神经科学、临床心理学和人类学等不同领域的工作中,我们正在越来越多地了解(和重新发现)人类的心理是如何运作的,以及心理痛苦可以通过多种方式得到预防和治疗。另一方面,在许多方面,心理健康护理系统要么功能失调,要么与我们所知道的心理和社会繁荣的最佳方式背道而驰--例如,真正的 "护理 "从医疗和心理健康护理系统中消失了。在这篇文章中,我们试图以本卷中的前几篇文章所提供的不同观点为背景,提出并解决其中的一些基本问题,优先考虑实际的、脚踏实地的、非专业的和专业的因素。
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引用次数: 0
Disorders of Mood: The Experience of Those Who Have Them 情绪失调:患者的经历
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02036
Kay Redfield Jamison
Abstract Mood disorders are common, painful, and closely tied to suicide and alcohol and substance use. They are also treatable. Mania and depression, a part of the human record for as long as it has been kept, were well-recognized and described by physicians of antiquity. Our knowledge of mood disorders has broadened and deepened in the many centuries since those early times, and crosses many scientific and clinical fields, including genetics, neuropharmacology, neuroimaging, psychopathology, and neuropsychology. We have as well a rich history of personal narratives of depression and bipolar disorder that gives a different but essential perspective; I present several of these accounts here.
摘要 情绪失调是一种常见、痛苦的疾病,与自杀、酗酒和滥用药物密切相关。它们也是可以治疗的。躁狂症和抑郁症是有史以来人类记录的一部分,古代的医生对其有很好的认识和描述。自古以来,我们对情绪失调症的了解不断扩大和加深,并跨越了许多科学和临床领域,包括遗传学、神经药理学、神经影像学、精神病理学和神经心理学。此外,我们还拥有关于抑郁症和躁郁症的丰富的个人叙事史,这些叙事提供了不同但重要的视角。
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引用次数: 0
Democracy Therapy: Lessons from ThriveNYC 民主疗法纽约市茁壮成长的经验教训
IF 1.7 3区 社会学 0 HUMANITIES, MULTIDISCIPLINARY Pub Date : 2023-11-01 DOI: 10.1162/daed_a_02034
Gary Belkin
Abstract Despite massive unmet needs, U.S. mental health care systems and policy continue to aim too low. Laments about brittle foundations-including inadequate funding, fragmentation, stigma, lack of parity, ineffectiveness, unavailability, overmedicalization, and coercion-all share the same source. The mental health system is not working because it has been chasing the wrong goal: to treat illness, rather than to enable people to do nurturing things together. A focus on community nurturing and caring changes everything. It yields better treatment approaches while also engaging with the mutually reinforcing and desperately needed work of social cohesion, emotional well-being, participatory action, and communal learning and connection. In fact, the nurtured emotional health of individuals is fundamental to humane and resilient societies and to democracy itself. And in the face of environmental collapse and the related unraveling of core institutions, the stakes have never been higher. This essay makes the case for a paradigm shift in care and explores a recent effort to implement it at scale: ThriveNYC. The successes and especially the failures of ThriveNYC point to the possibilities and challenges of this essential mission.
摘要 尽管有大量的需求没有得到满足,但美国的心理健康医疗系统和政策的目标仍然过低。对基础薄弱的抱怨--包括资金不足、各自为政、污名化、缺乏平等、无效、不可用、过度医疗化和胁迫--都有相同的根源。心理健康体系之所以失灵,是因为它一直在追逐一个错误的目标:治疗疾病,而不是让人们能够一起做有教养的事情。关注社区的培育和关爱可以改变一切。它既能产生更好的治疗方法,又能参与社会凝聚力、情感健康、参与行动、社区学习和联系等相辅相成且亟需的工作。事实上,个人情感健康的培养是人道社会和民主社会的基础。面对环境的崩溃和相关核心机构的解体,我们面临着前所未有的风险。本文提出了转变关爱模式的理由,并探讨了最近为大规模实施这一模式所做的努力:纽约市的茁壮成长。纽约市茁壮成长计划的成功,尤其是失败,表明了这一重要使命的可能性和挑战性。
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引用次数: 0
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