Keadaan sakit atau penyakit.

Kami berkeyakinan bahwa dalam keadaan sakit hanya dapat dipahami secara lebih bermanfaat dan lebih mendalam apabila kita dapat memahami keadaan itu sebagai hal keadaan sakit daripada manusia yang menghadapi kita sebagai pasien namun yang tetap kita akui pula hakekat jasmaniahnya.
The differentiation between ‘neurology’ and ‘alienism’, as it occurred after the 1850s, was based on the distinction between ‘local’ versus general called alienism and had to do with the definition of local and . As things are at the moment, there is nothing psychiatry also deals with the semantics of mental disorder and this by definition has nothing to do with the brain.

Seterusnya di:
https://dryuliskandar.wordpress.com/2009/10/11/psikiatri-kusumanto-yul-iskandar-38/

Empat Dasa Warsa Pendekatan Eklektik-Holistik di bidang Kedokteran Jiwa (Psikiatri) (1966-2006), dan Terapi Gangguan Skizofrenia.

R. Kusumanto Setyonegoro.,MD.,SpKJ., PhD
Guru besar (emeritus) psikiatri FKUI, Jkt
mantan Direktur Kesehatan Jiwa, Depkes RI
dan
Yul Iskandar,MD., SpKJ., PhD
Direktur Institute for Cognitive Research.

Catatan.
Tulisan adalah diambil dari Disertasi Kusumanto Setyonegoro (1966), dan pendapat Yul Iskandar terhadap tesis itu, naskah ini telah dipersiapkan selama lebih kurang 10 tahun, dan baru bisa selesai tahun 2006. Naskah ini sedianya akan diterbitkan menjadi buku atas persetujuan Prof. Kusumanto pada tahun 2006, dengan judul diatas. Abstrak tulisan ini pernah dibacakan dalam kongress Indonesian Society for Psychopharmacology, Biological Psychiatry and Sleep Medicines. Tulisan ini untuk sementara diterbitkan dalam bentuk seperti ini.Tulisan ini bisa diperbanyak tanpa izin asal menyebut sumbernya.

Proses psikologik

Dalam tiap-tiap keadaan sakit manusia, sangat jelas bahwa kita sebagai seorang dokter dan seorang pengobat, tidak dapat mengesampingkan bergitu saja proses psikologi yang terlibat dalam keseluruhan keadaan sakit itu.
Tendensi dalam ilmu kedokteran modern yang sekarang sering diberi julukan approach psikosomatik menjadi salah satu tanda indikasi yang terkuat tentang orientasi klinik dalam ilmu kedokteran . Kami berkeyakinan bahwa dalam keadaan sakit hanya dapat dipahami secara lebih bermanfaat dan lebih mendalam apabila kita dapat memahami keadaan itu sebagai hal keadaan sakit daripada manusia yang menghadapi kita sebagai pasien namun yang tetap kita akui pula hakekat jasmaniahnya.

Dengan perkataan lain : dalam keadaan manusia sakit maka proses psikik atau psikologi itu merupakan hal yang tidak terpisah-pisahkan dari pada seluruh proses hidup manusia itu, juga proses hidup yang disebutkan dengan nama “keadaan sakit” atau “penyakit”.

Proses kehidupan khusus secara totalitas

Keadaan sakit juga dapat ditinjau sebagai suatu keadaan proses hidup (life process) yang bersifat khusus, dan yang mengenai hidup itu secara keseluruhan atau totalitas.
Apakah proses hidup yang khusus itu hendak kita golongkan dalam suatu jenis proses hidup yang normal atau abnormalsangat erat hubungannya dengan segala sesuatu yang hendak kita namakan sebagai normal atau abnormal. Dalam keadaan yang sederhana dan tidak majemuk maka normalitas dan abnormalitas itu dapat ditentukan dalam ukuran, standart-standart atau norma-norma yang diperoleh dengan menjalankan teknik-teknik perhitungan melalui kumulasi fakta-fakta dan variabel-variabel.

Berdasarkan pengetahuan kita tentang statistk dan matematik, maka akan diperoleh angka-angkatentang norma-normaatau standard-standart itu. Demikian pula akan diperoleh hal-hal perhitungan – perhitunganmengenai apa-apa yang tergolong kemungkinan kemungkinan yang terduga.

Jadi apa yang dipastikan secara demikian ialah suatu normalitas yang kira-kira dapat disamakan dengan suatu keadaan yang mencocoki dan yang tidak menyimpang daripada ukuran-ukuran yang rata-rata (the average). Dengan demikian maka yang didapati ialah suatu norma atau nilai normal statistik.

Dalam tinjauan lebih lanjut, maka suatu keadaan sakit mungkin dianggap merupakan suatu keadaan abnormal, dan oleh karena itu harus diberantas. Hal yang demikian itu tidak benar. Yang dimaksudkan sebenarnya ialah memberantas penyakit, dan bukan keadaan sakit. Sebab justru keadaan sakit itulah yang pada asasnya mampu memberantas penyakit itu.

Oleh sebab itu, maka apa yang disebutkan “keadaan sakit” itu mungkin lebih tepat dianggap sebagai suatu proses hidup khusus yang wajar, jadi yang normal, dan yang dijelmakan oleh organisme dalam dirinya sendiri. Proses hidup khusus itu terjadi apabila keseimbangan organisme terancam oleh kegoncangan yang merugikan.

Itulah sebabnya, maka dalam tinjauana ilmu kedokteran fisik tidaklah pula tiap-tiap invasi bakteri atau koman lain yang normatif mungkin dapat tergolong infeksi, perlu diikuti oleh suatu proses hidup khusus yang dinamakan keadaan sakit melainkan seringkali tanpa terjadinya proses hidup khusus inipun invasi itu bisa berlalu saja.

Demikianlah, maka menurut hemat kami, keadaan sakit itu lebih wajar kita tinjau sebagai suatu proses hidup khusus dari pada organisme, sama halnya dengan proses-proses atau fungsi-fungsi hidup khusus lainnya, seperti membela diri, memuaskan diri (dalam arti kata mencukupkan diri dalam makan, minum dan pemuasan-pemuasan naluri lainnya), melengkapkan diri serta menyempurnakan diri.
Ini berarti bahwa semua proses dan fungsi organisma yang disebutkan itu tertuju kepada pertahanan dan penyempurnaan diri organisma itu. Ikhtiar-ikhtiar yang demikian itu boleh disebutkan positif dan kreatif, jadi bukan bersifat reduktif atau destruktif, hal mana menegaskan lagi bahwa suatu keadaan sakit sesungguhnyalah merupakan suatu proses hidup khusus yang normal sekali.

Manusia dalam tinjauan filsafat kedokteran

Paham “keadaan sakit” dan paham “penyakit” hingga sekarang (juga dalam tinjauan a dan b tersebut diatas) masih dipisahkan. Hal yang demikian itu nyata amat jelas dalam tinjauan umum dari pada ilmu kedokteran, dan merupakan suatu ikhtiar agar pekerjaan dan tugas dokter itu dapat dipermudah.
Dengan perkataan lain ihtiar yang demikian itu tidak dapat dilihat lepas dari pada hal-hal yang artifisialis dan yang demikian itu perlu untuk teknik kedokteran, juga dalam aplikasinya dalam praktek rutin sehari-hari.
Kusumanto Setyonegoro , Disertasi 1966

Interviewing a Colleague: Prof. Germán E. Berrios*
On psychopathology, nosology and neurobiology.
*Prof. G.E. Berrios
BA (Oxford); DPhilSci (Oxford); MD; Dr. Med. honoris causa [Heidelberg; San Marcos]; FRCPsych; FBPsS; FMedSci
Consultant Neuropsychiatrist, Head, Neuropsychiatry Services.
Reader in the Epistemology of Psychiatry, University of Cambridge.
Addenbrooke’s Hospital, Cambridge. United Kingdom
This section is aimed at discussing controversial and up-to- date topics in biological psychiatry or related disciplines by means of a short interview with an expert. Personalities of Psychiatry and related fields will share their opinions, concepts and critical points of view about our subject of interest: The Human Brain and the Human Mind. (5)
JOD
A related question: some authors argue that eventually neuropsychiatry/ behavioural neurology will replace psychiatry. What do you think?
GEB
For the reasons mentioned above, which define psychiatry as a discipline dealing both with the causes (neurobiological) and reasons (semantic) of mental illness, it could never be replaced by ‘behavioural neurology’ which does not deal with the meaning of mental illness. With the same abandon, it could be said that behavioural neurology or neurology itself could and should be replaced should and could neurology could be replaced by psychiatry. The boundaries between these disciplines are not controlled by logical criteria or arguments written in stone. They are determined by the social power of interested groups. During the 19th century, neurology, psychiatry and some medical specialisms grew out of a broader proto-discipline which dealt with the neuroses. The latter were a large category of ‘diseases’ which had been put together since the middle of the 18th century. The differentiation between ‘neurology’ and ‘alienism’, as it occurred after the 1850s, was based on the distinction between ‘local’ versus general called alienism and had to do with the definition of local and . As things are at the moment, there is nothing psychiatry also deals with the semantics of mental disorder and this by definition has nothing to do with the brain.

JOD
All along the history of psychiatry diverse symptoms and syndromes have disappeared and as you have said, some for good. Which ones should be “revived”?
GEB
I am not sure that we need to revive any. This view is based on the belief that diseases may be like orchids or dogs, i.e. natural kinds. Hence, if in the distant past someone almost identified a disease but then lost the plot, we could then help ourselves to that disease and rescue it for the 21st century. Mental disorders are embedded in their own historical period and they make little sense in isolation. For example acedia, an extraordinarily common problem affecting novices in the medieval convents is a case in point. It started after the Benedictine rule started and a century later abbots became very alarmed by the increasing prevalence of this condition. Novices would become (anachronistically speaking) anxious, agitated, depressed, suicidal, obsessional, etc, and would kill themselves. Guidelines were written to cope with this epidemics but the problem continued well into the 14th century. Well, should we diagnose acedia in a convent of today when a novice shows the same behaviours? Would then we prescribe prayers and the various monastic exercises that were prescribed at the time? Would we prescribe SSRIs? Might we then say that acedia was really depression? Or should we shay that SSRIs are also good for acedia?
JOD
The oeuvre of diverse “classical” psychiatric authors is barely known today. Which ones would you suggest are of greater importance for the researcher on neurobiology?
GEB
I really cannot answer this question. One reason is a practical one. I do know the 19th century psychiatry perhaps better than I do know that of my own day and hence there are too many I could mention, and I can tell you, Griesinger, Baillarger, Calmeil, Meynert, Wernicke, Alzheimer, Nissl or Kraepelin would NOT be necessarily in the list. The correlation between being a celebrity and originality of ideas is very low. Like today, many a pushy psychiatrist, using the spring board of the WPA or some other association may get his name in many lists and become ‘well known’. This does not mean that such person has had an original idea in his entire life! The same situation applies to the past. Some alienists are well known because they were chosen as protagonists by earlier historians of psychiatry; others because they administered themselves well and got their names in all the important forums. On the other hand, the original minds may not be in these lists at all. This because they often spoke their own mind, were not team players, and soon became ostracised by the establishment. Without a substantial academic position, with their writings often turned down by the Journals of the day, they ended up in obscurity. Their work, however, can be like a breath of fresh air and is enough justification to believe in the existence of an underground history of psychiatry. Official history only celebrates the social victors; but being a social victor is no guarantee of creativity.
There is a second more subtle reason for not being able to answer your question. It concerns the definition of neuropsychiatry in the 19th and 20th century. We tend to read 19th century writers with 21st century eyes. But when they wrote about the brain, and about the mind, and about nature they meant something very different from what we mean today. Most of these writers only look fresh and ‘current’ to anachronistic eyes. The fact of the matter is that many of those who defended ‘brain explanations’ during the 19th century would have been horrified of being interpreted as pioneers of the ‘wonderful’ neuropsychiatry of today.
History is also used as a cosmetic device by many writers of today. It looks ‘cultured’ to include a historical vignette in the first paragraph of a paper. Historical quotations (mis-interpreted and out of context) are also used to legitimate current beliefs.
(Yul Iskandar, dikutip dariThe worl Jounal of Biological Psychiatry, 2006)

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