DSM and the death of phenomenology in America: An example of unintended consequences
DSM and the death of phenomenology in America: An example of unintended consequences
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DOI：
10.1093/schbul/sbl054
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发表时间：
2007-01-01
影响因子：
6.6
通讯作者：
Andreasen, Nancy C.
中科院分区：
文献类型：
--
作者：
Andreasen, Nancy C.
在 19 世纪和 20 世纪初，美国精神病学与英国和欧洲有许多共同的知识传统和价值观。其中包括源自启蒙运动的有关个人尊严和仔细观察价值的原则。然而，在 20 世纪，美国精神病学开始出现分歧，最初是由于更加强调精神分析原理，特别是与英国相比。到了 20 世纪 60 年代和 1970 年代，美英研究和国际精神分裂症试点研究等研究表明，精神动力学的强调太过分了，导致诊断不精确，并且对精神病理学体征和症状的传统评估评估不充分。 《精神疾病诊断和统计手册》第三版（DSM-III）就是在这种背景下在保留了更传统的英国-欧洲方法的机构（例如爱荷华州华盛顿大学）代表的领导下制定的。 DSM-III 的目标是创建一个更可靠、更有效、更符合国际方法的综合系统，用于诊断和评估精神病患者。这个目标在很多方面都实现了，但不幸的是它也产生了许多意想不到的后果。尽管最初的创建者意识到 DSM 代表了“尽力而为”，而不是明确的“基本事实”，但 DSM 开始在培训计划和医疗保健提供系统方面获得完全的权力。自 1980 年 DSM-III 出版以来，针对个人问题和社会背景并通过良好的精神病理学常识丰富的仔细临床评估的教学一直在稳步下降。学生被教导要记住 DSM，而不是向过去伟大的精神病理学家学习复杂性。到了2005年，衰退变得如此严重，以至于可以被称为“美国现象学的死亡”。
During the 19th century and early 20th century, American psychiatry shared many intellectual traditions and values with Great Britain and Europe. These include principles derived from the Enlightenment concerning the dignity of the individual and the value of careful observation. During the 20th century, however, American psychiatry began to diverge, initially due to a much stronger emphasis on psychoanalytic principles, particularly in comparison with Great Britain. By the 1960s and 1970s, studies such as the US-UK study and the International Pilot Study of Schizophrenia demonstrated that the psychodynamic emphasis had gone too far, leading to diagnostic imprecision and inadequate evaluation of traditional evaluations of signs and symptoms of psychopathology. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was developed in this context, under the leadership of representatives from institutions that had retained the more traditional British-European approaches (eg, Washington University, Iowa). The goal of DSM-III was to create a comprehensive system for diagnosing and evaluating psychiatric patients that would be more reliable, more valid, and more consistent with international approaches. This goal was realized in many respects, but unfortunately it also had many unintended consequences. Although the original creators realized that DSM represented a "best effort" rather than a definitive "ground truth," DSM began to be given total authority in training programs and health care delivery systems. Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual person's problems and social context and that is enriched by a good general knowledge of psychopathology. Students are taught to memorize DSM rather than to learn complexities from the great psychopathologists of the past. By 2005, the decline has become so severe that it could be referred to as "the death of phenomenology in the United States."