Psychiatry and the mental patient : an uneasy relationship

Abstract

XX a. viduryje prasidėjęs deinstitucionalizacijos bei bendruomeninio pobūdžio psichikos sveikatos priežiūros paslaugų plėtros procesas pareikalavo naujo- įgalinančio- požiūrio į psichikos liga sergantį žmogų ir jo galimybes savarankiškai gyventi bendruomenėje. Šis požiūris reiškia, kad psichikos liga sergančio asmens nuomonė ir poreikiai yra laikomi legitimiais priimant su psichikos sveikatos priežiūra, savo liga bei gyvenimu susijusius sprendimus. Tačiau nepaisant pastarąjį dešimtmetį Lietuvos psichikos sveikatos priežiūros sistemoje vykstančių pokyčių deinstitucionalizacijos link, psichikos liga sergantis pacientas išlieka pasyviu sveikatos priežiūros paslaugų gavėju, kurio poreikius apibrėžia sveikatos specialistai, institucijos ar artimieji, bet ne pats pacientas.[...]

The second half of the 20th century has witnessed major changes in the way mental health care in the Western countries has been organized and provided for people suffering from mental illness. Deinstitutionalization and community care became common terms used to define a policy that aims to shift the locus of psychiatric care from large mental hospitals and custodial institutions into community. Deinstitutionalization of psychiatric care requires an empowering approach towards the mentally ill individuals and their capabilities to lead a self-dependent life in the community. Such an approach implies accepting the mentally ill health-care service users as credible individuals capable of taking responsibility for their actions and life. The aim of this article is to examine psychiatric conception of mental illness, treatment and the psychiatric encounter. The presentation largely draws upon analysis of Lithuanian psychiatric texts, although some foreign psychiatric literature is also used. The article starts with an introduction of a changing situation of the mental patient and proceeds to the analysis of the psychiatric discourse. The author argues that by conceptualizing mental illness as pathology located within the functioning of the individual body that affects the ability of a sick individual to apprehend the reality and to retain critical insight towards one’s health problem, psychiatric discourse may reproduce paternalistic approach towards the mentally ill individuals even in the deinstitutionalized settings. Such an approach may have certain implications for the individuals’ ability to lead an independent life in the community