“反精神医学”的谱系： 精神卫生公共性的历史及其启示

基于对上世纪后半叶以来“反精神医学”历史的考察，本文试图提出反精神医学运动如何影响精神卫生公共性建设的问题。文章结合当时欧美社会民权运动的背景，从“反精神医学”诸种思潮中梳理出其指涉公共性的各个面向，探讨其历史经验与启示。在传统精神医学陷入危机之时，反精神医学的精神卫生观转向以精神病患为主体，其中对“全控机构”的批判和标签论颠覆了传统精神医学的神话，成为“去机构化”意识形态的合力;同时，草根组织的援助改变了被收容者的社会处置方式;巴扎利阿的精神医疗改革则进一步解放了被收容者，其提出的废除精神病院、通过立法保障患者权益的案例，进一步彰显出精神卫生的公共性何以可能的历史经验。在此基础上，文章对精神卫生的公共性所指涉的目标和价值取向、精神卫生改革中的公众参与以及争取合法保障精神卫生相关权益的经验进行了讨论。

A Genealogical Study of the Publicness in Mental Health: A History of Anti Psychiatry and Its Implications

The author of the present thesis attempts to explore the implications of the Anti psychiatry Movement and its practice since 1950, as regards the publicness and its realization of mental health in the modern society, and elaborate the historical motivation for the aforementioned publicness. Through the evaluation of the social and political background of the Minority Groups’struggle for Civil Rights in the 1950s, a review has been initiated of the publicness of mental health in the context of Anti Psychiatry Movement, which as against the traditional psychiatric crisis, treats patients of mental disorder as subjects in the psychiatric sphere. In other words, when the traditional psychiatry leads to nowhere, the criticism of“total institution”and the Labeling Theory has become the driving force of Deinstitutionalization. The Groupe Information Asiles (GIA) as the voluntary grassroots organization has revolutionized the social care in respect of mental disorder. In Italy, Basaglia’s mental health reform has rehabilitated and released the inmates from the institutions, and thus has ensured their rights of citizenship through the Basaglia Law as well as the disestablishment of psychiatric hospitals. It follows that the historical facts in review would facilitate the construal of the publicness of mental health, including the openness of the mental health service provided with the promotion of public participation as well as the establishment of legal perimeters for mental health, among which, however, the most urgent task is to ensure the inmates as subjects through the maintenance of civic spirit and values. The author concludes with a reinterpretation of the objectives and value orientation of the publicness of mental health, the public participation into the reform of mental health system, and the historical process of the progressive in human rights and legislative reform.