【摘要】 本文首先强调了精神病理学涉及的两大基本哲学范畴———决定论与目的论。然后简述了界定临床疾病,特别是精神科疾病的临床要件,尤其是病程特点与缺陷的出现。进而论述当今精神科临床诊断中存在的问题,一是临床相的碎片化,以及不再强调具有诊断意义的症状需要有典型性这样的要求;二是诊断"快餐化",随访不够以及证据不充分就进行长期干预等的影响。"字纸篓"诊断的产生和量表式追问的弊病。最后,引申到不同学科可能达到的准确性和可预测性的讨论,回到决定论与目的论两个不同范畴下精神科实践的特点,科学性与艺术性兼备的特点,还提到生活质量,诊断效度与有用性的不同。更多还原

【Abstract】 At the very beginning,the author addressed the two domains underlining psychopathology: determinism and teleology.Then he reviewed the essential components when trying to define a psychiatric disease,especially the course of mental illness and the appearance of deficit syndrome.Next,problems of current psychiatric diagnosing were pointed out,which were the fragmentation of clinical pictures by counting just items,less importance of diagnosis-specific symptoms in current criteria and fast-food styled diagnosing,i.e.over dependence on probing in clinical interview.In addition,the background of early and continuing treatment for suspected psychosis and lack of follow-up in clinical practice increased the difficulties of diagnosing a mental disorder precisely.So as that,waste-basket diagnosis presented as a problem along with the history of modern psychiatry,from the time of neurasthenia,through that of anxiety and depression.Finally,the author discussed the accuracy and the predictability in different disciplines,the difference of validity and utility.All of these phenomena reflected the characteristics of psychiatric practice under both determinism and teleology,with both scientific and artistic features.更多还原