預防精神醫學：飲酒問題為例

Preventive Psychiatary: An Example of Alcoholism

自1940年代以來，台灣精神醫學流行病學研究已有輝煌之研究成果，因此預防精神醫學之考慮在台灣精神醫學界就是一個自然發展之結果。40年來，台灣地區心理衛生界一直強調預防工作之重要性，但卻沒有任何預防工作，歷經實證性之檢定。這些年來，台灣精神醫學界一直沒有由公共衛生之立場，發展一套可行之精神疾病預防措施。由社會政治觀點而言，有許多理由足資說明這種遺憾之狀況。然而以科學的特定學門而言，精神醫學本身對精神疾病之定義與其病因有嚴重之理論模式混淆問題。這也是預防精神醫學無法發展的主因之一。本論文將以精神疾病之演進模式為理論基礎，進行精神疾病預防工作之觀念性探討，並建立預防精神醫學實務工作之四個基本步驟：(1)確認所要預防的是那一種精神疾病，(2)精神病理演進過程之釐淸，(3)擬定遏阻病理發展之預防工作，(4)預防工作之評估。本文並以飮酒問題為例，呈現預防精神醫學之實務性工作，以便能付之實驗。本文將引導心理衛生學界警覺於精神疾病病因概念之混淆，並進而有利於推動心理衛生學界不同理論模式與不同專業人員之整合，期待不久將能成功的發展精神疾病之預防工作。

Epidemiological Psychiatry has been well developed in Taiwanese Psychiatry since the 1940's. As a result of epidemiological studies, the preventive view of psychiatry would be a natural concern. In the past 40 years in Taiwan area, the preventive idea of mental health work has become a prominent voice which, unfortunately, has not gone through an empirical experiment. The Taiwanese psychiatry still has no operationallized preventive psyciatric work from the public health point of view. Reasons of this under-developed state are numerous from the socio-political point of view. However, as a scientific discipline, psychiatry itself has a major problem in conceptual model in dealing with the concept of disorder and its etiology. This problem makes the progress in preventive work impossible. The etiological analyses of psychiatric disorders based on evolutionary model of psychiatric disorder will be presented in this paper. Four basic steps of preventive workare suggested: (1)defining the specific disease category to be prevented, (2)calarifying the evolutionary process of psychopathology of the index disorder, (3)establishing the preventive procedures for intervening the progressive psychopathologyical process, (4)evaluating the preventive measures step by step. The alcoholism will be used as an example to illustrate this conceptual analysis and practical work of preventive psychiatry. A set of preventive measuresis established and ready for experimental exercise . Hopefully, this paper will lead the academic mental health circle to be aware of the pitfals of the confused theoretical models of psychiatric disorder and to integrate different theoretical disciples for successful preventive psychiatric service in the nearfuture.