新聞新知~心理學與精神學的對立
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心理學Psychology和精神學Psychiatry有何差別？哪個比較好？
Friday, October 1, 2010
中文翻譯：
心理學家和精神學家也許會彼此仇視。這是有歷史淵源的，在佛洛伊德時期之前，心理學開始發展時，對於「文化層面」對人的影響賦予相當重要的涵義。另一方面，精神治療學從工業革命時代才開始發展，主要著重於化學藥物治療，而非心理的行為治療。精神學家在過去很長一段時間，都不太被人們重視。
多年來，許多研討會和文獻都極力想復合這兩個心靈治療分支(心理學和精神學)。但終究徒勞，10月1日星期五早上，精神學家展開復仇。美國精神學會(American Psychiatric Association)發表了新的憂鬱症診斷指引(guideline)，而其內容仍舊詆毀美國心理學會(American Psychological Association)認知和行為取向的治療方法。(兩個組織縮寫都是A.P.A.，沒錯，他們都不想讓步修改縮寫，顯然兩個國家級的心理治療領導者都像個小孩一樣。)
這個精神學診斷治療指引即將被用在美國20萬個精神科住院病人身上，以及2000萬個精神科門診病人身上。第一個建議步驟竟然直接是藥物，沒錯，只有藥物。指引沒有提到心理學的認知、行為治療方法。直到第三個步驟才有，而且排在電擊療法之後。真是…
新的診斷治療指引輕描淡寫道：根據過去數十年來無數的臨床資料顯示，當藥物治療與心理學(進一步了解病人怎麼想的？怎麼表現的？) 的治療方式相比較時，最好的精神藥物都能發揮作用，以改變病人的行為和思想。一顆安慰劑比嚴謹的精神學方法(只有藥物)或是嚴謹的心理學方法(只有談話治療)都要有效。但假若精神學和心理學結合起來，就能提供人們最大的幫助。
那為何心理學和精神學不和睦相處呢？
原因之ㄧ為資料的問題：10月1日所發表新的美國精神學診斷治療指引，合併了數個精神學的方法，以提高證據的可信度，因為這些被合併的精神學方法，至少有一或兩種隨機實驗是正確的。但認知行為治療法卻有相當多的證據是較模糊的，像是人際關係治療。全國診斷治療指引文中修正了數以百萬計的治療法，它在無效的治療定義中，加入認知行為的治療方法。美國精神學會稱之為「問題解決法」。
當我星期四晚上採訪美國精神學會一位官方成員時，他拒絕接受錄製發言。我與他談及組織所發表的陳述：這個新的診斷治療指引經過1萬多個研究的評論，所有訊息已全數透露給藥商，並會接受任何的建議來修正診斷治療指引。
其實我只有一個建議：A.P.A和A.P.A.應該開始在facebook上建立友誼關係，心理學和精神學不能相互對立。
英文原文：
Psychologists and psychiatrists tend to hate each other. The reasons are historical: beginning even before Freud, psychologists held enormous power over the cultural imagination. The whole idea of psychiatry — an explicitly chemical rather than behavioral treatment of the mind — didn't start until the industrial age, and for a long time afterward, psychiatrists were held in disregard.
Friday morning, psychiatrists take a bit of revenge. Even after years of symposia and papers designed to reconnect the two tendril branches of mental-health treatment, the American Psychiatric Association has released new guidelines for treatment of depression that still denigrate the cognitive and behavioral approaches of the American Psychological Association. (Both organizations are called A.P.A., and neither will relinquish the shortened form to the other. Yeah, it turns out the nation's mental-health leaders act like children.)
According to the new guidelines — which will govern treatment for the 200,000 in-patient psychiatric patients in the U.S., as well as the 20 million or so who get out-patient treatment — the No.-1 preferred approach is drugs. Just drugs. The guidelines don't mention psychological approaches like cognitive-behavioral therapy until No. 3, just after electroshock therapy. Ouch.
The new guidelines underplay an enormous body of data from the past decade showing that even the best psychiatric drugs work better than sugar pills only when the drugs are used in conjunction with psychological therapies that help patients change how they behave and how they form their thoughts. Neither a strictly psychiatric approach (just drugs) nor a strictly psychological approach (just talk therapy) works much better than a placebo pill on its own. But when used in combination, the psychiatric and psychological treatments help a majority of people get better.
So why can't A.P.A. and A.P.A. get along?
One reason is a problem of data. The new American *Psychiatric* guidelines released today conflate several psychotherapy approaches equally because at least one or two randomized trials has shown them to be effective. But cognitive-behavioral therapy has a huge base of evidence compared to rather obscure approaches such as interpersonal therapy. In the context of national guidelines that will shape the treatment of millions, it borders on quackery to include cognitive-behavioral therapy in the same sentence that the A.P.A. (American *Psychiatric*, ugh) calls “problem-solving therapy.”
When I spoke with an A.P.A. (American *Psychiatric*, ugh again) official Thursday night, he declined to speak on the record. He referred me to an official statement the organization released, which says it “reviewed more than 10,000 studies,” revealed all ties to pharmaceutical companies, and will consider any comments to revise the guidelines. I only have one comment: the A.P.A. and the A.P.A. should start with becoming Facebook friends. Psychology and psychiatry shouldn't be enemies.
Friday, October 1, 2010
中文翻譯：
Psychologists and psychiatrists tend to hate each other. The reasons are historical: beginning even before Freud, psychologists held enormous power over the cultural imagination. The whole idea of psychiatry — an explicitly chemical rather than behavioral treatment of the mind — didn't start until the industrial age, and for a long time afterward, psychiatrists were held in disregard.
Friday morning, psychiatrists take a bit of revenge. Even after years of symposia and papers designed to reconnect the two tendril branches of mental-health treatment, the American Psychiatric Association has released new guidelines for treatment of depression that still denigrate the cognitive and behavioral approaches of the American Psychological Association. (Both organizations are called A.P.A., and neither will relinquish the shortened form to the other. Yeah, it turns out the nation's mental-health leaders act like children.)
According to the new guidelines — which will govern treatment for the 200,000 in-patient psychiatric patients in the U.S., as well as the 20 million or so who get out-patient treatment — the No.-1 preferred approach is drugs. Just drugs. The guidelines don't mention psychological approaches like cognitive-behavioral therapy until No. 3, just after electroshock therapy. Ouch.
The new guidelines underplay an enormous body of data from the past decade showing that even the best psychiatric drugs work better than sugar pills only when the drugs are used in conjunction with psychological therapies that help patients change how they behave and how they form their thoughts. Neither a strictly psychiatric approach (just drugs) nor a strictly psychological approach (just talk therapy) works much better than a placebo pill on its own. But when used in combination, the psychiatric and psychological treatments help a majority of people get better.
So why can't A.P.A. and A.P.A. get along?
One reason is a problem of data. The new American *Psychiatric* guidelines released today conflate several psychotherapy approaches equally because at least one or two randomized trials has shown them to be effective. But cognitive-behavioral therapy has a huge base of evidence compared to rather obscure approaches such as interpersonal therapy. In the context of national guidelines that will shape the treatment of millions, it borders on quackery to include cognitive-behavioral therapy in the same sentence that the A.P.A. (American *Psychiatric*, ugh) calls “problem-solving therapy.”
When I spoke with an A.P.A. (American *Psychiatric*, ugh again) official Thursday night, he declined to speak on the record. He referred me to an official statement the organization released, which says it “reviewed more than 10,000 studies,” revealed all ties to pharmaceutical companies, and will consider any comments to revise the guidelines. I only have one comment: the A.P.A. and the A.P.A. should start with becoming Facebook friends. Psychology and psychiatry shouldn't be enemies.
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