U11  Scientific Experiment and Research

科学实验与研究

Mental Illness and Diagnosis

Reading Comprehension

       (包括“答案与题解”)

       Notes

       课文参考译文

       练习

         ●Cloze

●Reading Passages(包括“疑难长句翻译与注解”)

         ●Translation

●Writing(包括“审题指导”)

Mental Illness and Diagnosis

Like medical doctors, mental health professionals often use diagnosis as a way of categorizing patients and their problems. The use of diagnoses can, at times, help guide treating professionals as to the nature of the problems a patient faces, the origins of those problems, and potential treatment options. Diagnosis can also sometimes be used to straightjacket patients into ill-defined and ill-fitting categories that lend a scientific appearance to socially constructed biases. For example, a diagnosis of major depressive disorder is often used by psychiatrists and managed care companies as an argument that a person has a “biologically-based mental illness” and thus must receive a biological treatment, such as antidepressant drugs or, more rarely, electroconvulsive ［“shock”］ treatment. The assignment of the diagnosis mandates a treatment prescription despite considerable controversy among researchers and practitioners as to the relative effectiveness of drug treatment versus psychotherapy.

Some conditions bear enough of the characteristics usually associated with illness to be reasonably referred to as mental illnesses. But the jury is still out as to the extent organic factors play in schizophrenia. While there is increasing evidence of organic factors—including genetic factors and illness in the pregnant mother —playing a role in this condition, no organic factors at this point are known to be either necessary or sufficient. Similarly, there exists evidence suggesting that schizophrenia is a condition qualitatively distinct from other modes of living. On the other hand, there exists evidence questioning this view of schizophrenia as a clearly distinct illness. There is evidence that schizophrenia is the extreme end of a larger spectrum of “conditions.” And environmental factors clearly play a role in the prospects for the development of the condition and in its course.

If one concludes that schizophrenia is, indeed, largely a biological condition, then it would be reasonable to describe it as an illness. But what if one decides that environmental factors play a large role?

Once we get beyond the clearly organic conditions, the category of mental illness becomes metaphorical. There is nothing wrong with this. People make sense of the world largely through metaphors. The illness metaphor can be illuminating, but it can also be blinding. The question is whether applying it to the emotional problems and issues people face reveals hidden aspects, or covers over important characteristics. Thus, mental illnesses are like other physical illnesses in that they often appear to be involuntary and they can interfere with normal functioning and/or cause distress.

However, many uses of the mental illness construct ignore its metaphorical quality. Thus, it is sometimes presumed without question that anything diagnosed as a mental illness should be treated, despite the fact that the majority of those identified in epidemiological studies as having such a condition do not seek treatment. Others go so far as to form an equation whereby mental illness equals illness, illness means physical condition, and physical condition requires physical treatment. This logic underlies much of the overuse of medications and the downplaying of psychotherapy for problems in living that characterizes the last few decades.

Each of the three links in this equation is fallacious, of course. As I discussed above, mental illness may resemble other illnesses in certain ways, but in most cases definitely is not the same thing. Certainly, if one extends the concept of illness to include mental conditions with no obvious organic cause then illness does not mean physical condition and there is no necessary reason that it should be treated, much less treated by physical interventions.

1. The passage is mainly about              .

 ［A］ the way mental illness is diagnosed and treated

 ［B］ the value of psychotherapy in treating mental patients

 ［C］ the improvements made in treating mental illness

 ［D］ the danger in characterizing mental conditions as illness

2. The author uses the example of schizophrenia to make the point that              .

 ［A］ mental illness is a kind of physical illness that needs treatment

 ［B］ there is no conclusive evidence that mental conditions have a physical basis

 ［C］ environmental factors rather than organic ones cause mental illness

 ［D］ schizophrenia is most likely to be inherited from the maternal parent

3. In what way is the illness metaphor blinding concerning “mental illness”?

 ［A］ Mental illness is often mistaken as a physical condition to be corrected. 

 ［B］ Applying the metaphor to emotional problems yields no ready treatment.

 ［C］ The metaphor gives the impression that mental illness does not need treatment.

 ［D］ The metaphor often confuses medical professionals about the severity of the illness.

4. One of the consequences resulting from “the equation” is the             .

 ［A］ overuse of psychotherapy in treating mental illness

 ［B］ ineffective medication for both mental and physical illnesses

 ［C］ frequent use of medical treatment for mental illness 

 ［D］ ignorance of the sufferings of the mental patients

5. The word “fallacious” in the last paragraph most probably means              .

 ［A］ misleading      ［B］  critical      ［C］  obscure      ［D］ unnecessary

答案与题解

1.［D］   意为：把心理健康状况描述为“病”的危险。

  本文的主旨表达在第一段第三句，第四、五句举例说明这样做的危害。第二段以精神分裂症为例，说明了许多精神“疾病”是否由器质性因素造成的，这还没有确定的结论。最后一段的三个句子总结性地批评了把心理“疾病”盲目地看作“病”来加以治疗的做法。

［A］意为：诊断和医治精神疾病的方法。

［B］意为：心理疗法在医治精神病人上的价值。

［C］意为：精神疾病治疗上所取得的进展。

2.［B］   意为：没有确凿的证据证明精神疾病有其生理基础。

参阅第二段，尤其该段第一、二句。这两句话表达了本段的主题：生理因素在多大程度上与精神分裂症有关，这还是不确定的（the jury is still out）。该段以下各句都是对这个主题的进一步论述。

［A］意为：精神疾病是一种需要治疗的生理疾病。

［C］意为：环境因素而不是官能上的原因引起精神疾病。

［D］意为：精神分裂症最有可能是遗传自母亲。

3.［A］   意为：精神疾病经常被误认为是一种需要医治的生理疾病。

   参阅第四段第四、五句，以及第五段第一、二句。

  ［B］意为：把这个比喻应用于情绪方面的问题并不能帮人找到现成的治疗方法。

  ［C］意为：这个比喻给人的印象是：精神疾病不需要医治。

  ［D］意为：这个比喻经常使医疗专业人员弄不清病的严重性。

4.［C］   意为：经常使用医疗方法来治疗精神疾病。

  重点参阅第五段最后一句，这句话批评了给精神疾病做太多医学治疗、而忽视心理疗法的做法。

  ［A］意为：在治疗精神疾病时过度使用心理疗法。

  ［B］意为：对精神和生理疾病都无效的治疗。

  ［D］意为：忽视精神病人所遭受的痛苦。

5.［A］   意为：易于误导的。

  fallacious此处的含义是：tending to mislead, or deceptive。

  ［B］意为：至关重要的；批评的。

  ［C］意为：模糊的。

  ［D］意为：没必要的。

Notes

1. Diagnosis can also sometimes be used to straightjacket patients into ill-defined and ill-fitting categories that lend a scientific appearance of socially constructed biases. 诊断有时也被用来把病人狭隘地归入一些类别，而这些归类可能是定义模糊而不恰当的，但却使一些社会上形成的偏见披上了科学的外衣。此句中straightjacket原指束缚疯子或犯人双臂用的约束衣，是约束的意思。ill-defined即“定义不确定的”，ill-fitting即“不恰当的”。

2. managed care companies:管理医疗公司（在西方国家是指包括医院、保险公司和工人所在的企业，三方共同协商决定工人医疗支出的费用）。

3. electroconvulsive ［shock］ treatment:电休克法治疗。

4. condition:病况。

5. But the jury is still out as to the extent organic factors play in schizophrenia.有机因素在精神分裂症中究竟起多大作用尚没有定论。The jury is still out这个句子的意思是指尚未作出决定。

6. mental illness construct：精神病归类。construct做“概念、模式”讲。

课文参考译文

精神病和诊断

像内科医生一样，治疗精神病的医生常常把诊断作为给患者和他们的问题分类的一种方法。至于一个患者所面临的问题的性质、那些问题的起因和潜在的治疗方案，在这些方面，有时候，诊断能帮助引导治病的医生。诊断有时也被用来把病人狭隘地归入一些类别，而这些归类可能是定义模糊而不恰当的，但却使一些社会形成的偏见披上了科学的外衣。例如，对重要的抑郁性紊乱的诊断往往被精神病专家和——管理医疗公司用来作为一种论据，即一个人患有“生理上的精神疾病”，必须接受生理治疗，如使用抗抑郁的药物，或者，更罕见的，用电休克法治疗。使用诊断就是要拿出治疗处方，尽管在研究人员和医生之间就相关的药物治疗与心理疗法哪个有效的问题有相当大的争论。

有些病况具有足够的特征，通常与有理由被称为精神病的疾病有联系。但是专家委员会仍不能确定的是，器质性因素在精神分裂症中究竟起到多大的作用。虽然器质性因素（包括基因因素和怀孕母亲的疾病）在这种病况中起作用的证据越来越多，但是，据了解在这一点上，器质性因素要么是不必要的，要么是不充分的。类似的病况是，有证据表明，精神分裂症是一种病况，从性质上说，不同于其他生存方式。另一方面，对于这种把精神分裂症看作是明显疾病的看法提出质疑的证据是存在的。有证据表明，精神分裂症是“更多病况”中的一个极端。环境因素显然在出现这种病况的前景中和过程中发挥了作用。

             如果一个人得出结论，认为精神分裂症确实主要是一种生理病况，那么就有理由把它描述为一种疾病。但是，如果一个人决定说环境因素起了大作用，又会怎样呢？

一旦我们超出了明显的器质性精神障碍症，精神病的类别就变成一种比喻性的了。这一点根本没有错。人们主要是通过比喻了解世界的。有关疾病的比喻可能使人的眼睛明亮了，但是它也可能使人变得眼花缭乱了。问题在于把这种比喻应用到人们遇到的感情问题和其他问题是揭露隐藏的方面，还是掩盖重要的特点。因此，精神病就像其他的身体疾病一样，这些病常常显得是不由自主的，而且能干扰正常的功能或引起苦恼。

但是，对精神病进行的许多归类都忽略了它的比喻特性。因此，有时候毫无疑问地假定被诊断为精神病的任何疾病都应当治疗，尽管在流行病调查中被确认为属于这种病况的大多数人都不想治疗。其他人则形成一个等式，据此精神病就是病，即病就意味着身体有病， 有病就要治。这种逻辑导致用药过量的很多情况，并低估了在生活中为解决问题而进行的心理治疗。 这样的情况是过去几十年的特点。      

这个等式中的三种联系中的每一种联系都是荒谬的。如我在上面所讨论的，精神病可能在某些方面与其他疾病相似，但是在大多数情况下，肯定是不一样的。当然，如果一个人把疾病的概念扩大，把没有明显的有机原因精神病况也包括进去，那么，疾病并不意味着身体有病，而且也没有必要的理由认为它应当治疗，更不用说采用身体干预的方式去治疗了。

练习