精神障害の場合 : 日本の精神医療とリベラリズム(精神科医の立場から,シンポジウム 日本の医療とリベラリズム-患者の位置づけから共通基準の形成まで-)

抄録

Psychiatric practice in modern Japan has a history of about 100 years. In the early stages, legal regulations placed more emphasis on the protection of society in general rather than the protection of the patients with mental disease. However, in the Mental Health and Welfare Law as currently enforced, it is stressed that the human rights of each patient must be esteemed as much as possible and the core of the policy is on the liberalization of the therapeutic environment. Hence the history of legislation for psychiatric practice in Japan may be interpreted as a process with liberalistic tendencies gradually influencing this legislation. On the other hand, when we look at the physician-patient relationship in psychiatric practice in severe cases, in particular, in the cases of schizophrenia, volition and individual thinking are often disabled in both content and application. In these cases, where mental disorders reach such a stage that human judgment is impaired, informed consent cannot be obtained, and medical treatment by the "autonomy model" is practically impossible to perform. In this case, we might say that from the beginning psychiatric practice has gone beyond the frame of liberalism. The patients are often confined in a certain morbid thinking and cognitive system, and they can speak only from inside a certain framework, and the disease is based on "lack of freedom in thinking". The purpose of psychiatric practice is to help the patients be free from such morbid world and to help them speak freely and openly. In this sense, the treatment for the patients may be defined as an attempt to acquire liberalism. Therefore, perhaps as in other countries, psychiatric practice in Japan may be defined as a process toward the restoration or establishment of liberalism both in the historical sense and in each individual physician-patient relationship.