Psykiatriske sygdomsmodeller

Publisher Website
Google Scholar
Abstract
Formålet med nÆrvÆrende arbejde er dels at undersøge, på hvilken måde man kan sige, at sygdomme eksisterer, specielt for så vidt angår psykiatriske sygdomme, dels at redegøre for tre begrebsrammer inden for hvilke psykiske lidelser kan søges beskrevet. Formålet er altså dels ontologisk, dels erkendebesteoretisk, men også metodologiske aspekter vil blive berørt. Fire psykiatriske sygdomsmodeller skitseres: en klassisk medicinsk samt en medicinsk-epidemiologisk sygdomsmodel, der begge betegnes som naturvidenskabelige sygdomsmodeller, en psykodynamisk og en sociologisk sygdomsmodel. Det fremhÆves, at daglig praktisk klinisk sygdomsopfattelse rummer tankegang både fra den klassisk medicinske og den medicinsk-epidemiologiske sygdomsmodel. Det fremhÆves endvidere, at sygdomsklassifikation bliver meget forskellig alt efter om man klassificerer med baggrund i den ene eller den anden model. Ærindet med arbejdet er ikke at diskutere modellernes sandhedsvÆrdi eller at søge at prioritere deres betydning for videnskabsprocessen, men alene at pege på, at udsagn om sygdom, det vzre sig praktisk kliniske som klinisk videnskabelige, implicerer en videnskabsteoretisk holdning, der imidlertid som oftest vil vÆre ubevidst eller ukendt for både den, der fremsÆtter udsagnet og for tilhørerne. Mange kliniske og videnskabelige diskussioner ville vinde i klarhed ved, at man gjorde sig disse videnskabsteoretiske implikationer klart. Models of psychiatric disease Four different models of psychiatric disease are presented: the classic medical model, the medical-epidemiological model, the psychodynamic model, and the sociological model. Each model has its own conceptual basis and its own scientific frame-of-reference. Two models of disease are characterized as scientific, i.e. the classic medical model and the medical-epidemiological model on the basis that mental illness according to these models could be viewed as ‘something’ that is explainable by simple causation. It is emphasized that daily clinical thinking includes concepts belonging to both scientific models with some untoward nosological consequences. Disease classification according to the classic medical model implies the idea of diseases as separate, multiple disease entities, whereas disease classification according to the medical-epidemiological model implies that mental health and mental illness are viewed as falling along a gradient to be separated only by statistical means. Whereas mental illness according to the scientific models is something qualitatively and quantitatively different from mental health, it is rather unique according to the psychodynamic model. Illness as a phenomenon cannot be separated from the sick individual or described in itself. It is therefore meaningless to talk about ‘illness’ —only meaningfull to talk about sick people. Mental symptoms should be viewed not as a reflection of a specific disease. They have their roots in intrapsychic conflicts and should rather be seen as phenomena that could be understood by their psychological meaning or their psychological purpose. Disease classification makes no sense. The sociological models focus on the dynamic interaction between the individual and its social environment. They reject the disease concept as such. Mental «illness» is understood — not causated — as a reflection of fundamental social disharmonies. Mental illness is believed to be a fiction. The deviant behaviour that is so called is just a behaviour that people so label. It is of course not possible to establish which model is more true than the other. The aim of this paper is therefore rather to point out that most clinical discussions would gain in clearness in case their mostly unspoken scientific frame-of-references were explicitly stated.

This publication has 0 references indexed in Scilit: