Mental Health Activists Hold Diverse and Varied Perspectives on Psychiatry
一項針對美國和英國心理健康活動家和倡導者的調查發現了從支持精神病學到反對精神病學的一系列觀點。
A survey of US and UK mental health activists and advocates finds a spectrum of views, from pro- to anti-psychiatry.
彌迦英格爾，MA-2022 年 8 月 18 日
By Micah Ingle, MA -August 18, 2022

發表在《精神病學服務》雜誌上的一篇文章著眼於心理健康活動家和倡導者 (MHAA) 世界的各種觀點。
An article published in the journal Psychiatric Services looks at the variety of perspectives in the world of mental health activists and advocates (MHAAs).

作者在 547 名接受調查的人中發現了六類人，他們都有精神病學系統的親身經歷，並自我認定為倡導者或活動家。這些類別的範圍從相當保守到對精神病學服務極為挑剔，中間有幾個類別代表了在諸如非自願住院、吸毒、ECT 等問題上較為溫和的個人子集。
The authors discovered six classes of people out of the 547 surveyed, all of whom had personal experience with the psychiatric system and self-identified as either advocates or activists. These classes ranged from being fairly conservative to being extremely critical of psychiatric services, with several classes in-between representing a more moderate subset of individuals on questions such as involuntary hospitalization, drug use, ECT, and more.

該研究由Awais Aftab、Shira Collings和Nev Jones進行。他們寫：
The research was conducted by Awais Aftab, Shira Collings, and Nev Jones. They write:

“具有使用心理健康服務的個人經驗的心理健康活動家和倡導者 (MHAA) 在精神病護理的歷史演變中發揮了至關重要的作用，他們一直處於改革的最前沿。MHAA 還充當臨床醫生、患者和服務用戶、立法者和公眾之間的聯繫紐帶。
“Mental health activists and advocates (MHAAs) with personal experience of using mental health services have played a vital role in the historical evolution of psychiatric care, and they have been at the forefront of reform. MHAAs have also served as connectors among clinicians, patients and service users, legislators, and the general public.

患者和服務使用者、公眾和臨床醫生的態度已成為眾多研究的主題；然而，明顯缺乏類似的研究來描述那些自我認同為積極分子並積極參與倡導工作的個人的態度。”
The attitudes of patients and service users, the general public, and clinicians have been the subject of numerous studies; however, there is a glaring lack of similar research characterizing the attitudes of individuals who self-identify as activists and who are actively engaged in advocacy efforts.”

近年來，抗精神病學領域、瘋狂行動主義的努力、服務用戶倡導和其他相關舉措受到越來越多的關注，甚至紐約時報也發表了一篇關於聽力的文章，衛報也發表了關於瘋狂研究的文章。
The field of anti-psychiatry, efforts in mad activism, service user advocacy, and other related initiatives have received increased attention in recent years, with even the New York Times publishing an article on hearing voices and the Guardian publishing on mad studies.

通過這樣的網站，讀者可以接觸到許多不同的觀點，這些觀點挑戰了病因、診斷、治療等方面的主流精神病學和心理學模型。
Through websites like this one, readers can engage with numerous different perspectives which challenge the mainstream psychiatric and psychological models for etiology, diagnosis, treatment, and more.

大多數研究都集中在“患者和服務使用者、公眾和臨床醫生的態度”上，而不是本文所稱的心理健康活動家和倡導者 (MHAA)。作者試圖通過調查這些活動家和倡導者的觀點來彌補研究的不足。最終，他們想質疑二元、“黑白”、支持精神病學或反精神病學運動的概念，代表了倡導者和活動家之間觀點的多樣性。
Most research has focused on “the attitudes of patients and service users, the general public, and clinicians” rather than what this paper calls mental health activists and advocates (MHAAs). The authors sought to remedy that lack of research by surveying the perspectives of these activists and advocates. Ultimately, they want to interrogate the notion of a binary, “black and white,” pro-psychiatry or anti-psychiatry set of movements, representing the diversity of perspectives among advocates and activists.

最初的調查是由“服務用戶主導的研究團隊”開發的。該調查包括現有材料，例如 NAMI 的 2017 年政策優先聲明和全國心理健康恢復聯盟 2017 年的聲明。此外，根據服務用戶對該領域的經驗/知識，包括調查項目。努力納入批判性觀點和更主流的觀點。最後，通過一組具有生活經驗的活動家對調查進行了完善。
An initial survey was developed by a “service user–led research team.” This survey included existing materials, such as NAMI’s 2017 policy priority statement and the National Coalition on Mental Health Recovery’s 2017 statement. Additionally, items on the survey were included based on the service users’ experience with/knowledge of the field. An effort was made to include both critical perspectives and more mainstream ones. Finally, the survey was refined through a focus group of activists with lived experience.

研究參與者僅限於以下個人：1）有“精神差異或精神殘疾”的個人經歷，以及 2）“自我認定為倡導者或活動家”。制定了兩份傳單，一份針對更“保守”的改革派團體，另一份針對更重要的團體和組織。每種語言都使用了不同的語言，例如前者使用“心理健康宣傳”，而後者使用“神經多樣性、瘋狂、用戶”之類的東西。
Study participants were limited to individuals who 1) had personal experience with “mental difference or psychiatric disability” and who 2) “self-identified as either advocates or activists.” Two flyers were developed, one that targeted more “conservative” reformist groups and one that targeted more critical groups and organizations. Different language was used for each, such as “mental health advocacy” for the former and things like “neurodiversity, mad, user” for the latter.

四個“分組變量”被用作統計分析的核心：
Four “grouping variables” were used as central to the statistical analysis:

• “對於被診斷為患有嚴重精神疾病和有暴力襲擊史的個人，需要更多地獲得輔助門診治療 [AOT] 和社區治療令 [CTO]。”
  “Greater access to assisted outpatient treatment [AOT] and community treatment orders [CTOs] is needed for individuals diagnosed as having a serious mental illness and a history of violent assaults.”
• “所有的精神病診斷都是有問題的，需要接受挑戰。”
  “All psychiatric diagnoses are problematic and need to be challenged.”
• “需要廢除非自願住院承諾。”
  “Involuntary inpatient commitment needs to be abolished.”
• “精神科藥物是有害的。”
  “Psychiatric drugs are harmful.”

作者認為，這些擔憂將針對倡導活動空間中更溫和和關鍵的部分中的一些中心極化。
The authors believed these concerns would target some central polarizations within more moderate and critical divisions of the advocate-activist space.

547 個人完成了基於李克特 7 點量表的調查。88% 的參與者確定為白人，66% 為女性，90% 的參與者在某個時候進行過正式的精神病診斷——最常見的是抑鬱症。58% 曾住院，34% 非自願住院。68% 的參與者來自美國，11% 來自英國。
Five hundred forty-seven individuals completed the survey based on a 7-point Likert scale. 88% of the participants identified as white, 66% as female, and 90% as having a formal psychiatric diagnosis at some point—most often depression. 58% had been hospitalized, 34% involuntarily. 68% of participants were from the United States, while 11% were from the United Kingdom.

通過潛在類別分析的靜態方法，作者發現了一系列觀點，他們將這些觀點分為六個不同的類別。例如，1 類最強烈同意關於輔助門診治療和社區治療令的陳述，而在其他問題上得分較低。
Through the statical method of Latent Class Analysis, the authors found a range of perspectives which they grouped into six different classes. Class 1, for example, agreed most strongly with the statement about assisted outpatient treatment and community treatment orders while scoring low on the other issues.

“除了一個班級之外，所有班級都支持為有暴力史的個人擴大 AOT 和 CTO。第 2 類和第 4 類表現出特別混合的特徵。第 2 類在更多地接觸 AOT 和 CTO 的問題上是中立的；對於拒絕精神病診斷，同意廢除非自願治療以及將精神藥物定性為有害的中立態度，存在分歧。第 4 類贊成更多地獲得 AOT 和 CTO，反對廢除非自願住院承諾，並強烈同意拒絕精神病診斷，並在較小程度上同意將精神藥物定性為有害。”
“All but one of the classes endorsed the expansion of AOT and CTOs for individuals with a history of violence. Classes 2 and 4 showed a particularly mixed profile. Class 2 was neutral on the question of greater access to AOT and CTOs; there was disagreement with the rejection of psychiatric diagnoses, agreement with the abolition of involuntary treatment, and neutrality on characterizing psychotropics as harmful. Class 4 favored greater access to AOT and CTOs, against the abolition of involuntary inpatient commitment, and agreed strongly with the rejection of psychiatric diagnoses and, to a lesser extent, with characterizing psychotropics as harmful.”

在光譜的另一端，第 6 類與第一個問題幾乎沒有一致意見，但對其他項目有強烈的意見。中產階級代表的觀點比 1 級和 6 級更為溫和。然而，所有類別都同意“獲得傳統心理健康的替代方案、住宿需求以及有生活經驗的人擔任領導職務”的必要性。
On the opposite end of the spectrum, class 6 saw little agreement with the first issue but had strong opinions on the other items. The middle classes represented more moderate views than classes 1 and 6. However, all categories agreed with the need for “access to alternatives to traditional mental health, need for accommodations, and persons with lived experience being in positions of leadership.”

不出所料，個人對精神病學系統的體驗與觀點的激進性質之間存在差異——歷史經歷與當前觀點有很強的關係。例如，第 6 級的電痙攣治療 (ECT) 病史率最高，為 39%，而目前的精神科治療率最低，為 20%。6 級接受門診治療和諮詢的比率也最低，為 33%，而 2 級最高，為 61%。非自願住院史在各個班級之間有所不同，但在 2、5 和 6 級中最高。
Unsurprisingly, differences between personal experience with the psychiatric system and the radical nature of perspectives were noted—historical experiences had a strong relationship with current views. Class 6, for example, had the highest rate of history with Electroconvulsive Therapy (ECT) at 39% and the lowest rate of current psychiatric management at 20%. Class 6 also had the lowest rate of receiving outpatient therapy and counseling at 33%, while class 2 had the highest at 61%. History of involuntary hospitalization varied between the classes but was highest in classes 2, 5, and 6.

例如，儘管在第 1 類和第 6 類之間仍然存在強烈的極性，但類之間的差異表明，極端極化比媒體和其他社會群體有時假設的要少：
The variability between the classes, although you still have strong polarity between classes 1 and 6, for example, suggests less extreme polarization than is sometimes assumed in the media and other social groups:

“調查結果顯示出相當大的異質性，這表明二元表徵未能公正地反映 MHAA 所表達的觀點範圍。”
“Survey responses reveal considerable heterogeneity, suggesting that a binary characterization fails to do justice to the range of views expressed by MHAAs.”

作者指出了該研究的幾個局限性。他們懷疑批評觀點的代表過多，因為這些人最有可能對調查做出回應。考慮到被調查的個人在個人歷史和當前觀點方面可能具有獨特性，他們還對從這些發現中進行概括的能力提出了疑問。
The authors noted several limitations to the study. They suspected an overrepresentation of critical perspectives because those individuals were most likely to respond to the survey. They also had questions about the ability to generalize from these findings, given the possible unique nature of the individuals surveyed in terms of personal history and current perspectives.

作者得出結論：
The authors conclude:

“然而，真誠地與具有批判性觀點的人交往是民主多元化的基礎。先驗地排斥具有某些觀點的個人的衝動強化了現有的權力結構並阻礙了改革。
“Engaging with people with critical perspectives in good faith, however, is foundational to democratic pluralism. Impulses to exclude individuals with certain views a priori reinforce existing power structures and hinder reform.

正如我們的調查所表明的那樣，那些對主流精神病學最懷有敵意的人往往是那些有更具侵入性或非自願治療歷史的人。只有認真對待從這些經歷中產生的觀點，我們才能解決精神科護理中令人不快的問題。”
As our survey suggests, those with views most hostile to mainstream psychiatry are often those with histories of more invasive or involuntary treatment. We can tackle unpleasant dimensions of psychiatric care only if we take perspectives born from such experiences seriously.”

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Aftab, A.、Collings, S. 和 Jones, N. (2022)。超越心理健康倡導的二元敘述：具有生活經驗的心理健康活動家和倡導者的潛在概況。精神科服務，1-7。（關聯）
Aftab, A., Collings, S., & Jones, N. (2022). Beyond binary narratives of mental health advocacy: Latent profiles of mental health activists and advocates with lived experience. Psychiatric Services, 1-7. (Link)

彌迦英格爾，MAMIA 研究新聞團隊：Micah Ingle 是西喬治亞大學的心理學博士生：意識與社會。他發表了關於以人為中心的治療方法，而不是個體化的醫學模型，以及高度同理心的人的特徵。他目前的興趣包括社會政治/經濟結構與心理健康的交叉點、心理學中的個人主義、性別、解放心理學以及受榮格思想啟發的神話觀點。

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