Condensing “Anatomy of an Epidemic” into a High-Level Summary Document
Penni Kolpin -August 15, 2022
編者註：高級摘要文件“為什麼當前的精神衛生保健模式必須發展”可在此處獲得。
Editor’s Note: The high-level summary document, “Why the Current Mental Health Care Model Must Evolve,” is available here.
網址:https://www.madinamerica.com/wp-content/uploads/2022/08/Why_Current_Mental_Health_Model_Must_Evolve_2022.pdf
2020 年 9 月，我在社交媒體上分享了一些與心理健康相關的內容。 我提到，如果我們要在幫助精神痛苦的人方面取得任何真正的進展，我們需要查看一個人所處系統的健康狀況以及他們的個人歷史。 我從未見過的人實事求是地評論說，精神“疾病”是大腦和生物化學的問題。
In September, 2020, I shared something on social media related to mental health. I mentioned that we need to look at the health of the systems that a person is in and their personal history if we are to make any real advances in helping people who are in mental distress. Someone whom I never met commented matter-of-factly that mental “illnesses” are problems with the brain and biochemistry.
作為一個在 1998 年忍受了我長久以來所謂的“嚴重壓力崩潰”的人，我知道將心理困擾視為“疾病”或“紊亂”而造成的損害，而這僅僅是生化性質的。我在社交媒體上自由分享了我過去的經歷，以及我是如何受到心理健康系統的額外創傷的。我被誤診為雙相情感障礙，我一直都知道這是不正確的。
As someone who endured what I have long called a “severe stress breakdown” in 1998, I knew the damage from trivializing psychological distress as “illness” or “disorder” that is merely biochemical in nature. I have shared freely on social media about my past experiences and how I was additionally traumatized by the mental health system. I was misdiagnosed as having bipolar disorder, which I knew all along was incorrect.
這個診斷是在沒有任何努力了解我的個人創傷史的情況下做出的，也沒有任何努力去了解我當時習慣和依賴的不健康動態。最終，這種崩潰更像是一種覺醒——從那些不健康的動態中突破，最終突破到更美好的生活。
That diagnosis was made without any effort to understand my personal history of trauma, nor the unhealthy dynamics I was conditioned to and was crutching at the time. Ultimiately, that breakdown was much more of an awakening—a breakout from those unhealthy dynamics and ultimately a breakthrough to a much better life.
該評論的輕蔑性質使我感到不安。發表評論的人只是在說他們聽到或讀過或從不知道在哪裡教過的東西。那個人當然不明白這種“疾病”模式對許多處理過去創傷的人來說是多麼災難性的。通常，對所謂“疾病”的診斷是終生無法治癒的。慢性的。我們給那些打破的東西貼上標籤，而不是那些打破人們開放的系統和動態。
The dismissive nature of that comment upset me. The person who commented was just spouting what they had heard or read or had been taught from who-knows-where. That person certainly didn’t understand how disastrous that model of “illness” is to many people dealing with past trauma. Often that diagnosis of so-called “illness” is life-long with no cure. Chronic. We label that which breaks, rather than the systems and dynamics that break people open.
幾個月前，我買了羅伯特·惠特克 (Robert Whitaker) 的書《流行病解剖》 。我是在 5 月 18 日買的——那是我中間兄弟去世的周年紀念日。他於 1999 年去世，九年前他就從視線中消失了。在 1998 年崩潰的時候，我不知道他是生是死。他的離開給我帶來了很大的壓力，我無能為力。隨著時間的推移，我最終在該層之上堆積了越來越多的壓力。最終，一切都崩潰了。
I had bought Robert Whitaker’s book, Anatomy of an Epidemic, a few months earlier. I bought it on May 18—the anniversary of my middle brother’s death. He died in 1999, after dropping out of sight nine years earlier. At the time of the breakdown in 1998, I didn’t know if he was alive or dead. His leaving was a significant layer of stress that I couldn’t do much about. In time, I ended up heaping more and more stress on top of that layer. Eventually, everything collapsed.
當我買Anatomy時，我看了幾章，但沒有通讀整本書。由於我在 9 月的觸發反應，我終於把這本書從頭到尾看完了。我把它當成一本教科書，在頁邊空白處做了筆記，並在上面寫了一遍。
When I bought Anatomy, I looked through a couple of chapters, but didn’t read the whole book. Due to my triggered response in September, I finally read the book cover to cover. I treated it as a textbook and made notes in the margins and wrote all over it.
當我讀完這本書時，我感覺自己就像從消防水管中被炸飛一樣，被惠特克提供的全面研究和材料完全浸透了。這本書經過細緻而徹底的研究，並將大量材料編織在一起。問題是，雖然我可以在社交媒體上向我的朋友分享和推薦這本書，但我知道他們中很少有人會真正購買或閱讀它。對於我的大多數沒有像我一樣陷入心理健康系統的朋友來說，這些材料過於詳細和全面。我沒有一種簡單的方法可以將最重要的關鍵點、最“核心”的材料分享給更廣泛的受眾。
When I finished with the book, I felt like I had been blasted from a firehose, completely drenched with the comprehensive research and material Whitaker presents. The book is meticulously and thoroughly researched and weaves together a massive amount of material. The problem was that while I could share and recommend the book to my friends on social media, I knew that very few of them would actually purchase or read it. The material was too detailed and comprehensive for most of my friends who had not been ensnared in the mental health system as I was. I didn’t have an easy way to share the most important key points, the most “core” material, to a wider audience.
我查看了 Mad in America 網站並查看了教育部分的材料。我發現了一些有用的演示文稿、培訓和網絡研討會。然而，再一次，這些材料比普通公眾看到的更詳細。我需要更簡潔明了的東西。我想要一些“備忘單”，可以在更高層次上總結材料，並且可以在幾分鐘內通讀。
I looked at the Mad in America website and reviewed the material in the education section. I found several useful presentations, trainings, and webinars. Yet, again, the material was more detailed than what a member of the general public would view. I needed something more condensed and concise. I wanted some “cheat sheets” that summarized material at a higher level and could be read through in a few minutes.
在 Mad in America 網站上，我看到了當時擔任 Mad in America 教育指導的 Bob Nikkel 的姓名和電話號碼。我打電話給鮑勃，詢問網站上是否有更簡潔的材料。我告訴他，雖然我認為《流行病剖析》很棒，但我想知道是否有一份簡短的文件可以讓普通公眾更容易地分享給那些不太參與其中的人。心理健康系統。我告訴鮑勃，“不要誤會我的意思。材料很棒。有這麼多。克里夫的流行病解剖筆記在哪裡？我需要懸崖筆記。”
From the Mad in America website, I came across the name and phone number of Bob Nikkel, who served as the Education Direction for Mad in America at the time. I called Bob to ask if more concise material was available on the site. I told him that though I thought that Anatomy of an Epidemic was fantastic, I was wondering if there was a short document that could be shared and more easily consumed by a member of the general public, to people who weren’t very involved with the mental health system. I told Bob, “Don’t get me wrong. The material is great. There is just so much of it. Where are the Cliff’s Notes for Anatomy of an Epidemic? I need the Cliff’s Notes.”
當我描述更多我正在尋找的內容時，Bob 意識到擁有一份包含關鍵點的高級文檔可能很有用。幾頁的文件介紹了最關鍵的項目，這些項目可以總結為什麼像《流行病解剖》這樣的書如此重要。這樣的文件在某種意義上可以幫助人們涉水進入游泳池的淺水端，而不是把他們扔到游泳池的深水端，冒著被大量信息淹沒的風險。
As I described more of what I was looking for, Bob realized that having a high-level document of key points could be useful. A document of a few pages that presented the most key items that could summarize why a book like Anatomy of an Epidemic is so important. Such a document could help people wade into the shallow end of a swimming pool in a sense, rather than throwing them into the deep end of a pool and risking drowning them in so much information.
我還告訴鮑勃，我曾經是一名知識工程師。（是的，這是真的。）我為我曾經工作過的公司管理所謂的知識庫。知識庫，有時稱為“KB”，是數百個問答對的集合，也稱為知識文章。知識庫通常用於網站的客戶支持部分，以便客戶可以快速查看和搜索信息，以找到與其產品和公司提供的服務相關的答案。
I also told Bob that I used to work as a Knowledge Engineer. (Yes, that’s a real thing.) I managed what is called a knowledgebase for the company I used to work for. A knowledgebase, sometimes called a “KB,” is a collection of hundreds of question-and-answer pairs, also called knowledge articles. A knowledgebase is often used in the customer support section on a website so that customers can view and search through the information quickly to find answers related to their products and the services that a company provides.
知識庫通常以固定、靜態的常見問題 (FAQ) 列表開始，然後隨著時間的推移而增長。隨著越來越多的問題被添加到知識庫中，靜態列表通常不再有效，也不足以讓人們輕鬆查找信息。需要額外的工具來動態地在頂部顯示最常用的材料，而較少使用的材料則位於列表的末尾。
A knowledgebase typically starts with a fixed, static list of frequently asked questions (FAQs) and then grows over time. As more and more questions are added to the knowledgebase, the static list is often is no longer efficient, nor sufficient, for people to easily find information. Additional tools are needed to dynamically present the most used material at the top with less used material settling toward the end of the list.
隨著時間的推移，一些知識文章由於使用而演變為最重要的，並且經常被戰略性地放置在網站上，以便用戶可以最容易地找到該材料。此外，總結大量信息的文章通常被用作幫助人們導航到更詳細內容的一種方式。
In time, some knowledge articles evolve as being most important due to usage and are often strategically placed on a website so that users can find that material most easily. In addition, articles that summarize larger amounts of information are often used as a way to help people navigate into more detailed content.
Bob 建議我嘗試創建我正在尋找的高級文檔。他提出通過審查和提供意見和批評我的努力來提供幫助。
Bob suggested I take a stab at creating the high-level document that I was looking for. He offered to help by reviewing and providing input and critique to my effort.
最初，我開始整理我在流行病解剖學中標記的筆記。看完前六章，我整理了24頁筆記。好吧，粗魯，那是行不通的。那時，我對Anatomy中的參考註釋部分進行了快速計算。有 700 多個參考筆記！好心疼！我需要一種不同的方法。
Initially, I began compiling my notes that I had marked in Anatomy of an Epidemic. After reviewing the first six chapters, I had compiled 24 pages of notes. Well, crud, that wasn’t going to work. At that point, I did a quick calculation of the Reference Notes section from Anatomy. There were more than 700 reference notes! Good grief! I needed a different approach.
接下來，我查看了 Mad in America 網站的使命宣言，其中指出：
Next, I looked at the mission statement from the Mad in America website, which states:
Mad in America 的使命是成為重新思考美國（和國外）精神科護理的催化劑。我們認為，目前以藥物為基礎的護理模式已經使我們的社會失敗，科學研究以及被診斷患有精神疾病的人的生活經歷需要進行深刻的改變。
Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.
從該使命宣言中，下一個合乎邏輯的問題是“當前以藥物為基礎的護理模式如何讓我們的社會失敗，需要什麼樣的改變？” 我把使命宣言的措辭打斷了，它提到了五個領域：以藥物為基礎的範式、失敗的社會、科學研究、生活經驗和深刻的變化。這五個短語成為進一步發展的主要領域。由於我不是心理健康提供者，我很感謝 Bob 能夠驗證和澄清我生成的內容。
From that mission statement, the next logical question was “How has the current drug-based paradigm of care failed our society and what kind of change is needed?” I keyed off the phrasing of the mission statement that mentions five areas: drug-based paradigm, failed our society, scientific research, lived experience, and profound change. These five phrases became the primary areas to develop further. Since I am not a mental health provider, I was thankful that Bob could validate and clarify the content that I generated.
Bob 和我每隔幾週就會通過 Zoom 見面，審查和更新文檔。在幾個月的時間裡，我們有了一份六頁的文件。每個主要部分都有項目符號列表項，每個列表項都包含文本以進一步描述所提出的觀點。由於 Bob 在 2003 年至 2008 年期間擔任俄勒岡州的心理健康和成癮專員，他知道這份文件對於人們做出政策決定來說仍然太長。“它真的需要不超過兩頁，”他告訴我。
Bob and I met every few weeks via Zoom to review and update the document. Over the span of a few months, we had a six-page document. Each of the main sections had bulleted list items, and each list item included text to further describe the point made. Since Bob served as a commissioner for both mental health and addiction for the State of Oregon from 2003 to 2008, he knew that the document was still too long for people making policy decisions. “It really needs to be no more than two pages,” he told me.
啊。他是在開玩笑嗎？不，他是認真的。我一直試圖盡可能簡潔。我怎麼能撕掉三分之二的已經凝結的材料？
Ugh. Was he kidding me? No, he was serious. I had been trying to be as concise as possible. How on earth could I rip out two-thirds of the already-condensed material?
我從每個列表項中提取了支持文本。瞧！這導致了一份不到兩頁的文件。鮑勃和我編輯和修改了一些部分以平滑一些粗糙的邊緣。Bob 甚至將文件草稿發送給 Robert Whitaker，幸運的是，他也看到了這種總結的潛力。我添加了第三頁參考資料，它既驗證了我濃縮的內容，又提供了讀者可以選擇研究的資料。也就是說，如果他們願意，他們可以更深入地研究材料。當然，我參考了《流行病解剖》和《美國瘋狂》網站。
I pulled out the supporting text from each list item. Voila! That resulted in a document just under two pages. Bob and I edited and modified a few sections to smooth out some rough edges. Bob even sent a draft of the document to Robert Whitaker, and, thankfully, he also saw potential in this type of summarization. I added a third page of reference material which both validated the content that I had condensed, but also provided material that readers can research if they so choose. That is, they can wade deeper into the material if they want. Of course, I referenced both Anatomy of an Epidemic and the Mad in America website.
文件是否完善？當然不是。然而，總結為什么生物醫學模型如此頻繁地使人們失敗，以及為什麼許多被診斷為患有長期“疾病”或“疾病”的人如此強烈地拒絕該診斷，這是一個合理的努力。Bob Nikkel 與他在工作中認識的多個人分享了這份文件。每個部分都可以擴展為包含更詳細信息的單獨文章。
Is the document perfect? Of course not. Yet it is a reasonable effort to summarize why the biomedical model has failed people so frequently and why many people diagnosed as having a long-term “illness” or “disorder” reject that diagnosis so vehemently. Bob Nikkel has shared the document with multiple people he knows from his work. Each section could expand into separate articles with more detailed information.
我覺得有很多材料描述了當前診斷和治療模型的問題。該材料的組織和總結方式可能有利於該材料如何呈現給公眾。由於藥品在美國的營銷，很多人仍然相信和支持“無序”模式，或者認為精神困擾是“病”，應該這樣對待。許多人仍然認為，這種慢性疾病是由大腦中的化學物質失衡引起的。組織和總結系統如何失敗和傷害人們可能是對人們進行再教育的有用工具。
I feel that there is plenty of material describing the problems with the current diagnostic and treatment models. How that material is organized and summarized can potentially benefit how that material is presented to the general public. Due to the marketing of pharmaceuticals in the US, many people still believe in and support the “disorder” model or that mental distress are “illnesses” and should be treated as such. Many people still believe that such chronic illnesses are caused by chemical imbalances in the brain. Organizing and summarizing how the system has failed and harmed people could be useful tools to re-educate people.
請不要誤解我的意思。我認為人們的個人故事重要嗎？絕對地！我覺得對具體研究的介紹和批評很重要嗎？確實！我認為出版的書籍和採訪重要嗎？最肯定！
Please don’t misunderstand me. Do I think people’s individual stories are important? Absolutely! Do I feel the presentation and critique of specific studies is important? Definitely! Do I think the books published and interviews are important? Most certainly!
然而，這些都是更大、更全面的信息集合的一部分——簡而言之，就是一個知識庫。將最“關鍵”的信息彙編和總結成更全面的文章或文件，可以有效地教育公眾。編譯的信息可能包括關鍵統計數據、研究、引用、書籍、資源和更有效的模型，這些模型對於理解為什麼這麼多人認識到需要改變或在應用不適當的模型中受到傷害至關重要。
Yet those are all pieces of a much larger and comprehensive collection of information—in short, a knowledgebase. Compiling and summarizing the most “key” information into more comprehensive articles or documents can effectively educate members of the general public. Compiled information could include key statistics, studies, quotes, books, resources, and more effective models that are key in understanding why so many people recognize the need for change or have been harmed in the application of an inappropriate model.
擁有 500 英尺、2000 英尺和 5000 英尺甚至更高的材料通常很有用。在 500 英尺的高度很容易被拉入細節，而忽略了更大的景觀。全面的、“基本的”材料對於教育那些不那麼參與並且不理解為什麼這樣的改革運動存在並且很重要的人來說通常是有價值的。
Having material at the 500-foot level, the 2000-foot level, and at the 5,000-foot level or even higher is often useful. It is easy to get pulled into the details at the 500-foot level and lose sight of a much larger landscape. Comprehensive, “bare-bones” material is often valuable in educating people who are not as involved and don’t understand why such a movement for reform exists and is important.
替換舊模型的過程已經開始。我們正處於轉變模式的時期，這些模式與為正在經歷精神鬥爭和危機的人們提供幫助有關。勢頭肯定正在建立，以達到開發和推廣更好的援助模型和工具的臨界點。越多的人了解占主導地位的生物醫學模型所造成的問題和損害，就越有動力推動實現迫切需要的變革。整合和總結最關鍵的元素和內容有助於讓更多人了解為什麼這麼多人呼籲變革。
The process of replacing the old model is already happening. We are in a period of transforming the models related to providing assistance to people going through mental struggles and crises. Momentum is definitely building to get to a tipping point for developing and promoting better models and tools for assistance. The more people who understand the problems and damage that the dominant biomedical model has caused, the more momentum builds towards bringing about change that is so desperately needed. Consolidating and summarizing the most key elements and content can help educate more people as to why so many people are calling for change.
最後一點：根據我的經驗，我經常注意到潛在的聯繫和同步性。多年來，我與我的名字和金錢建立了聯繫。我立刻注意到我正在和一個姓尼克的人一起工作。彭尼和尼克爾。在美國貨幣體系中，這些是“變化”的最小組成部分。很好的連接。
Final note: Through my experiences, I often noticed underlying connections and synchronicity. For years, I have made connections with my name and money. I noticed right away that I was working with a man whose last name is Nikkel. Penni and Nikkel. In the US monetary system, those are the smallest components of “change.” Nice connection.
***
Mad in America 擁有不同作家群體的博客。這些帖子旨在作為一個公共論壇，廣泛地討論精神病學及其治療。所表達的意見是作者自己的。
文章來源:https://www.madinamerica.com/2022/08/236130/
彭尼科爾平 http://pennikolpin.com Penni Kolpin 擁有統計學理學碩士學位和日耳曼語文學碩士學位。她的職業生涯專注於質量保證、流程改進和客戶服務。1998 年，她經歷了嚴重的壓力崩潰，導致精神覺醒/精神緊急情況。和許多其他人一樣，她被心理健康系統誤診和遭受的創傷比崩潰/覺醒更嚴重。
為什麼當前的心理保健模式必須發展
Why the Current Mental Health Care Model Must Evolve
當前占主導地位的精神保健生物醫學模型過於關注精神科藥物來解決行為症狀。 該模型並非基於“疾病”的科學原因。 很多時候，促進康復的循證研究被忽視了。 值得慶幸的是，其他模型認識到創傷和社會因素的貢獻作用，這些因素側重於一個人從心理健康危機中恢復和治癒的能力。 我們必須採用綜合模型，以實現比目前以狹隘的生物醫學模型為重點的恢復率更高的模型。
The current, dominant biomedical model of mental health care places too much focus on psychiatric medications to address behavioral symptoms. This model is not based on scientific causes for “illnesses.” Too often, evidence-based research that promotes recovery is ignored. Thankfully, other models recognize the contributing roles of trauma and social factors which focus on a person’s ability to recover and heal from mental health crises. We must embrace comprehensive models that result in better recovery rates than what is currently achieved with the narrow focus of the biomedical model.
1.什麼是生物醫學模型？
生物醫學模式是美國精神科護理的主要模式。 主要斷言是，心理健康問題是由大腦中的化學物質失衡引起的疾病。
因此，治療的重點是使用被認為可以糾正這些不平衡的藥物治療來改變大腦中的化學物質。 但是，這種模型存在重大問題：
從未發現明確的疾病標誌物或生化失衡。
治療源於改變症狀，而不關注根本原因。
暫時性病症被定義為慢性“疾病”。
糖尿病的類比過於寬泛地強調了對長期疾病的關注。
診斷和統計手冊 (DSM) 基於與最少科學數據的協作。
DSM 側重於行為集群，而不考慮個人歷史或經歷。
- What is the biomedical model?
The biomedical model is the dominant model of psychiatric care in the United States. The main assertion has been that mental health issues are illnesses caused by chemical imbalances in the brain.
The focus of treatment, therefore, is to modify the chemistry in the brain using drug treatments which are believed to correct those imbalances. However, there are significant problems with this model:
No clear markers or biochemical imbalances for illness have ever been identified.
Treatments arose from modifying symptoms without focus on underlying causes.
Temporary conditions became defined as chronic “disorders.”
The diabetes analogy too broadly reinforces the focus on long-term disease.
The Diagnostic and Statistical Manual (DSM) is based on collaboration with minimal scientific data.
The DSM focuses on behavior clusters without consideration for personal history or experiences.
- 當前以藥物為基礎的生物醫學模式如何讓我們的社會失敗？
殘疾率上升：基於生物醫學模型的現代精神科護理時代始於 1954 年和 1988 年引入百憂解。 自 1954 年以來已顯著下降。但事實並非如此。
自 1987 年以來，在生物醫學模型下，殘疾率增加了一倍多。
2010 年，雙相情感障礙和抑鬱症等情感“障礙”的致殘率超過 140 萬。
18 歲以下兒童和青少年的殘疾率增加了 30 倍。公共和私人保險的財務成本都是不可持續的。
美國的精神科藥物成本從 1986 年的 30 億美元激增至 2014 年的 500 億美元。
一名 20 歲的殘疾人將在 40 年內獲得超過 100 萬美元的福利。沒有成功康復的長期“疾病”的社會影響是無法估量的。
化學失衡理論低估了心靈強大的治愈潛力。
尋求幫助的人常常被精神衛生系統人格解體，甚至受到創傷。
缺乏恢復會影響該人的家人、朋友、學校、社區和工作場所。
年僅兩歲的兒童可能會被診斷出患有雙相情感障礙等終身疾病。
- How has the current drug-based biomedical model failed our society?
Rise in Disability Rates: The modern psychiatric era of care based on the biomedical model began with the introduction of Thorazine in 1954 and Prozac in 1988. If these drug treatments were truly
effective, the number and rates of people disabled by these mental health conditions should have dropped significantly since 1954. Yet this isn’t the case.
Disability rates have more than doubled under the biomedical model since 1987.
Disability rates for affective “disorders” like bipolar and depression exceed 1.4 million in 2010.
Disability rates in children and adolescents under 18 have increased 30-fold. Financial costs are unsustainable for both public and private insurance.
The cost of psychiatric medications in the US ballooned from $3 billion in 1986 to $50 billion in 2014.
A 20-year-old who goes on disability will receive more than $1 million in benefits over 40 years. Societal Impact of long-term “illness” without successful recovery is immeasurable.
Chemical imbalance theory underestimates the mind’s powerful healing potential.
People who seek help are often depersonalized and even traumatized by the mental health system.
Lack of recovery cascades into that person’s family, friends, schools, community, and workplace.
Children as young as two can be diagnosed with lifelong conditions such as bipolar “disorder.
- 數據和研究質疑生物醫學方法的有效性。
世界衛生組織 (WHO) 的研究和隨訪表明，精神分裂症的結果已經
在較貧窮的發展中國家比在較富裕的西方國家更有利。
Martin Harrow 博士和 Thomas Jobe 博士的研究和隨訪表明，
停止長期抗精神病藥物治療時的嚴重情況
多項研究表明，精神分裂症的康復率在上個世紀沒有提高。
Irvin Kirsch 博士的研究表明，抗抑鬱藥存在短期和長期風險。
- Data and Research questions the effectiveness of biomedical approaches.
World Health Organization (WHO) studies and follow up indicate schizophrenia outcomes have been
more favorable in poorer, developing countries than in wealthier Western countries.
Dr. Martin Harrow and Dr. Thomas Jobe’s study and follow up indicate better long-term outcomes for
severe conditions when off long-term antipsychotic drug treatments
Multiple studies indicate schizophrenia recovery rates have not improved over the last century.
Dr. Irvin Kirsch’s research indicates antidepressants present risks both short and long term.
- 誰在呼籲改變？
由於過度限制的生物醫學模型未能充分滿足那些經歷精神危機的人的需求，越來越多的不滿意的人要求改變，包括：
在沒有長期使用藥物的情況下康復並茁壯成長的人。
失去親人並見證親人痛苦的家人和朋友。
心理健康提供者，包括精神科醫生、心理學家和諮詢師。
獨立資助的大學和醫學院的研究人員
- Who is calling for change?
Due to the overly restrictive biomedical model that has not adequately addressed the needs of those experiencing mental crises, a growing chorus of dissatisfied individuals are demanding change, including:
People who have recovered and thrive without long-term use of medications.
Family members and friends who have lost loved ones and witness the suffering of loved ones.
Mental health providers including psychiatrists, psychologists, and counselors.
Independently funded researchers in universities and medical schools
- 需要什麼樣的改變？
採用包括發展、社會、個人歷史、種族和壓力因素的模型。
消除病態化和污名化的標籤和語言。
將重點放在診斷和統計手冊 (DSM) 上。
減少對精神藥物的關注和依賴。
對客戶和家人進行更好的教育，讓他們知道康復是可能的。
對了解恢復因素和方法進行更多研究。
擴大同行支持和同行提供的危機資源的可用性和資金。
- What kinds of changes are needed?
Embrace models that include developmental, social, personal history, racial, and stress factors.
Eliminate pathologizing and stigmatizing labels and language.
Drop the focus on the Diagnostic and Statistical Manual (DSM).
Less focus and reliance on psychotropic drugs.
Better education to clients and family that recovery is possible.
More research into understanding recovery factors and methodologies.
Expand the availability and funding for peer supports and peer-delivered crisis resources.
總結一下：過分關注疾病和化學失衡理論的生物醫學模型的狹隘焦點忽略了其他主要促成因素，包括與人的福祉相關的創傷和社會因素。 我們必須超越生物醫學模型及其對大腦化學和疾病的關注，為經歷精神挑戰和危機的個人提供更廣泛的幫助。 我們必須學會傾聽那些已經成功甚至通過這些經歷取得勝利的人。 他們可以為改善護理模式做出重要貢獻。
To summarize: The narrow focus of the biomedical model which focuses too heavily on illness and chemical imbalance theory ignores other major contributing factors including trauma and social factors related to a person’s well-being. We must move beyond the biomedical model and its focus on brain chemistry and illness to provide a broader base of assistance to individuals who experience mental challenges and crises. We must learn to listen to people who have managed and even triumphed through such experiences. They can make important contributions to improve models of care.
關於作者： Penni Kolpin, M.S. 統計學和 M.A. Germanics 在 1998 年經歷了嚴重的壓力崩潰，被誤診，並進一步受到心理健康系統的創傷。 顧問 Robert Nikkel，M.S.W，是前俄勒岡州心理健康和成癮專員，積極推動公共政策變革，以促進創傷性心理危機的康復和康復。
About the Author: Penni Kolpin, M.S. Statistics and M.A. Germanics, endured a severe stress breakdown in 1998, was misdiagnosed, and further traumatized by the mental health system. Consultant, Robert Nikkel, M.S.W, is a former Oregon mental health and addictions commissioner and is active in promoting public policy changes to promote recovery and healing from traumatic psychological crises.
參考
羅伯特·惠特克 (Robert Whitaker) 的《流行病解剖》，百老匯圖書，2010 年，2015 年。由於研究表明精神分裂症的康復率低，惠特克先生試圖找到答案，解釋為什麼自1950 年代引入精神科藥物。
Cracked: The Unhappy Truth About Psychiatry by James Davies 博士，Pegasus Books，2013 年。心理治療師和社會人類學家 James Davies 博士闡述了人類痛苦的“醫學化”如何導致精神病藥物處方水平的顯著提高。
殘疾率和財務成本在流行病解剖中進行了討論。
世界衛生組織 (WHO) 的研究在流行病解剖中進行了總結。
Martin Harrow 博士在精神分裂症和雙相情感障礙的治療和康復率方面的研究在《流行病解剖》和《破解》中進行了總結。
Irving Kirsch 博士在抗抑鬱治療和有效性方面的研究在 Cracked 中進行了討論。
References
Anatomy of an Epidemic by Robert Whitaker, Broadway Books, 2010, 2015. Troubled by studies that indicated poor recovery rates for schizophrenia, Mr. Whitaker sought to find answers as to why rates of mental “illness” in the United States have skyrocketed since the ntroduction of psychiatric drugs in the 1950s.
Cracked: The Unhappy Truth About Psychiatry by Dr. James Davies, Pegasus Books, 2013. Psychotherapist and social anthropologist, Dr. James Davies addresses how the ‘medicalization’ of human suffering has led to dramatically increased levels of prescriptions for sychiatric drugs.
Disability rates and financial costs are discussed in Anatomy of an Epidemic.
The World Health Organization (WHO) studies are summarized in Anatomy of an Epidemic.
Dr. Martin Harrow’s research in treatments and recovery rates for schizophrenia and bipolar is summarized in Anatomy of an Epidemic and also in Cracked.
Dr. Irving Kirsch’s research in antidepressant treatments and effectiveness is discussed in Cracked.
資源
下面列出的計劃和倡議為改變精神科護理模式的努力提供了一些見解。這是資源的一小部分，並不全面。
電力威脅意義框架 (https://www.bps.org.uk/power-threat-meaning-framework)
五年多來，主要作者 Lucy Johnstone 博士和 Mary Boyle 教授領導了一個由具有生活經驗的人、從業者和研究人員組成的團隊，開發了一種替代基於精神病診斷的更傳統護理模式的方法。
放下混亂！
由 Jo Watson 和相關網站撰寫的 A Disorder for Everyone (http://adisorder4everyone.com) 挑戰了精神病診斷的文化和情緒困擾的醫學化。
THEN 中心：創傷、健康合作研究中心
公平與神經生物學 (http://thencenter.org)
旨在為不利的創傷經歷如何影響身心關係創建更好的模型，並讓每個人都能獲得類似的健康環境。
Open Dialogue 治療方法：（http://open-dialogue.net）Open Dialogue 團隊成立於芬蘭，通過共享幫助個人和家庭成員度過極端的情緒危機
對話通常會為個人帶來更大的共同體驗和治愈意義。
Mad in America: (http://madinamerica) 成為重新思考美國精神科護理的催化劑
國家和國外基於對當前藥物為主的科學研究和生活經驗
範例。
Resources
The programs and initiatives listed below provide some insight for efforts to bring about change to the psychiatric models of care. This is a small subset of resources and is not intended to be comprehensive.
The Power Threat Meaning Framework (https://www.bps.org.uk/power-threat-meaning-framework)
Over five years, lead authors, Dr. Lucy Johnstone and Professor Mary Boyle, led a team of people with lived experiences, practitioners, and researchers to develop an alternative approach to the more traditional care models based on psychiatric diagnosis.
Drop the Disorder!
by Jo Watson and associated website, A Disorder for Everyone (http://adisorder4everyone.com) challenges the culture of psychiatric diagnosis and the medicalization of emotional distress.
THEN Center: The Center for Collaborative Study of Trauma, Health
Equity and Neurobiology (http://thencenter.org)
seeks to create better models for how adverse traumatic experiences affect the mind-body relationship and allow everyone to have similar access to healthy environments.
Open Dialogue Therapeutic Approach: (http://open-dialogue.net) Founded in Finland, Open Dialogue teams help individuals and family members work through extreme emotional crises through shared
dialogue which often leads to greater shared meaning of the experience and healing for the individual.
Mad in America: (http://madinamerica) Serves as a catalyst for rethinking psychiatric care in the United
States and abroad based on scientific research and lived experiences over the current drug-based
paradigm.