本文认为,现象学在精神病学中的传统双重角色的辩证综合(一种以科学为中心的,另一个以个人为中心)需要支持以恢复为导向的实践,这是当代以人为中心的精神卫生保健的核心。本文分为两个主要部分。第一节说明了现象学的两种作用在20世纪精神病学现象学历史的三个重要时期中发挥的不同方式:随着1913年卡尔·雅斯贝尔斯的《一般精神病理学》中现象学的引入;随着几年后结构现象学精神病理学的发展;以及战后人文主义时期。第二节关注现象学在当代心理健康中的作用。在当前时期已经转向现象学,我们争论,作为对学术精神病学与一线临床护理脱钩的回应。与现象学的两个角色相对应,这种解偶联有科学方面和临床方面。后者,我们建议,在新的“恢复”模型中得到了最充分的表达,\"定义,不是由专业人员作为培训专家的价值观,但是根据患者和护理人员作为经验专家的价值观,具体来说,在有关情况下,什么对有关个人的生活质量很重要。我们说明了恢复的重要性,如此定义,以及它对临床决策的证据基础和价值基础带来的挑战,带有简短的临床插图。我们认为这些挑战,现象学通过其双重角色的综合具有独特的应对能力。注意到,然而,这种合成的许多障碍,我们认为,在该领域的发展现状下,我们应该通过对现象学作用的辩证综合来进行。从这样的辩证法,最终可能会出现真正的角色合成。最后,我们说明了这些事态发展的更广泛意义,认为与20世纪的刻板印象相反,他们表明精神病学正在引领整个医疗保健的道路,开发21世纪以人为中心的临床护理资源。
This paper argues that a dialectical synthesis of phenomenology\'s traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology\'s two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers\' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of \"recovery,\" defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology\'s roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.