Ichi ndi gawo la lipoti loperekedwa ndi Special Rapporteur pa ufulu wa aliyense kuti asangalale ndi mulingo wapamwamba kwambiri wa thanzi lakuthupi ndi m'maganizo ku UN Human Rights Council. (A/HRC/44/48)
Chidule cha lipoti lathunthu: Mu lipoti lomwe lilipo, lomwe laperekedwa motsatira chigamulo cha Human Rights Council 42/16, Mtolankhani Wapadera akulongosola zinthu zomwe zikufunika kuti zikhazikitse ndondomeko yapadziko lonse yokhudzana ndi ufulu wopititsa patsogolo ufulu wa umoyo wamaganizo. The Special Rapporteur amalandira kuzindikira kwapadziko lonse kuti palibe thanzi popanda thanzi la maganizo ndipo amayamikira njira zosiyanasiyana zapadziko lonse zopititsira patsogolo zinthu zonse za umoyo wamaganizo padziko lonse: kupititsa patsogolo, kupewa, kuchiza, kukonzanso ndi kubwezeretsa. Komabe, akugogomezeranso kuti ngakhale zinthu zikuyenda bwino, padakalibe kulephera kwapadziko lonse lapansi kuthana ndi kuphwanya ufulu wa anthu m'madongosolo azachipatala. Kusakhazikika kumeneku kumalimbikitsa tsankho, kutaya mphamvu, kuumirizidwa, kusalidwa komanso kupanda chilungamo. Kuti athetse vutoli, kupsinjika, chithandizo ndi chithandizo ziyenera kuwonedwa mozama komanso kupitilira kumvetsetsa kwachilengedwe kwaumoyo wamaganizidwe. Zokambirana zapadziko lonse lapansi, zachigawo komanso zamayiko ndizofunikira kuti tikambirane momwe mungamvetsetse ndikuyankhira pamikhalidwe yamisala. Zokambirana ndi zochitazo ziyenera kukhala zozikidwa paufulu, zokhazikika komanso zozikidwa pa moyo wa anthu omwe atsalira kutali ndi machitidwe owopsa a ndale, mabungwe ndi machitidwe. Rapporteur Wapadera amapereka malingaliro angapo kwa Mayiko, mabungwe omwe akuyimira akatswiri amisala komanso a World Health Organisation.
Kuchulukitsa kwamankhwala ndi kuwopseza ufulu wa anthu
A. Nkhani: kuchokera ku "zoyipa" mpaka "zamisala". Mphamvu zachipatala ndi ulamuliro wa anthu
27. Anthu ambiri ochokera m’magulu oponderezedwa mwachikhalidwe, monga anthu osauka, anthu amene amagwiritsira ntchito mankhwala osokoneza bongo komanso olumala m’maganizo, akodwa mumsampha wovuta. utatu woyera wa zilembo: (a) Anthu oipa/zigawenga, (b) odwala kapena amisala kapena odwala, kapena (c) Kuphatikizana kwa ziwirizi.. Zolembazo zasiya madera oterowo kukhala pachiwopsezo cholangidwa mopitilira muyeso, kulandira chithandizo ndi/kapena achire "chilungamo" kwa mikhalidwe kapena makhalidwe omwe anthu amawaona ngati osavomerezeka. Chotsatira chake ndi njira yopatula, ya tsankho komanso nthawi zambiri yosankhana mitundu kuchokera kusukulu, misewu ndi madera osatetezedwa kupita kundende, zipatala ndi zipatala zapadera, kapena m'madera omwe akulamulidwa ndi chithandizo, kumene ufulu waumunthu kuphwanya kungakhale zokhudza zonse, ponseponse ndipo nthawi zambiri zamitundumitundu. Nkhani yapadziko lonse lapansi yazaumoyo wamisala idali yodalira njira iyi "yamisala kapena yoyipa" ndi zina malamulo, machitidwe ndi malingaliro a okhudzidwa kwambiri kutengera lingaliro lakuti chisamaliro chaumoyo makamaka ndicho kupewa makhalidwe omwe angakhale owopsa kapena amafuna kuchitapo kanthu malinga ndi kufunikira kwachipatala (kwachipatala). Ochirikiza njira zozikidwa paufulu zophatikizidwa ndi mfundo zamakono zaumoyo wa anthu ndi umboni wasayansi amatsutsa "zamisala kapena zoyipa" dichotomy ngati yachikale, yatsankho komanso yosagwira ntchito.
28. Zoyeserera zambiri zapadziko lonse lapansi zochotsa anthu m'ndende ndikuchotsa milandu ndizolandirika, koma chidwi chiyenera kuperekedwa kwa otsogolera ndale ndi ndondomeko kusintha kwa zochitika za over-medicalization, zomwe zimabweretsa nkhawa zazikulu za ufulu waumunthu. Kaya atatsekeredwa kapena kukakamizidwa chifukwa chachitetezo cha anthu kapena chifukwa chachipatala, zomwe zinachitikira pamodzi zakusalidwa zimawulula nkhani yodziwika bwino yazovuta zazikulu, tsankho, chiwawa ndi kusowa chiyembekezo.
29. Izi zowononga mawonekedwe a medicalization imabweretsa zovuta pakulimbikitsa ndi kuteteza ufulu waumoyo. Chithandizo chamankhwala chimachitika pamene mitundu yosiyanasiyana ya machitidwe, malingaliro, mikhalidwe kapena mavuto azaumoyo ali "ofotokozedwa m'mawu azachipatala, ofotokozedwa pogwiritsa ntchito zilankhulo zachipatala, zomveka potengera dongosolo lachipatala, kapena kulandira chithandizo chamankhwala."[1]. Njira yachipatala nthawi zambiri imagwirizanitsidwa ndi kuwongolera chikhalidwe cha anthu chifukwa imathandizira kuyika malire pamakhalidwe abwino kapena ovomerezeka ndi zochitika. Chithandizo chamankhwala chingabise kuthekera kodziŵika komwe uli ndi zochitika mkati mwa chikhalidwe cha anthu, zomwe zimapangitsa kuti anthu asazindikire zovomerezeka za magwero a mavuto (zodziwika bwino za thanzi, kupwetekedwa pamodzi) ndikupangitsa kuti anthu azidana. Mwachizoloŵezi, pamene zochitika ndi mavuto zimawoneka ngati zachipatala m'malo mwa chikhalidwe cha anthu, ndale kapena kukhalapo, mayankho amakhala okhudzana ndi zochitika zapayekha zomwe cholinga chake ndi kubwezeretsa munthu pamlingo wogwirira ntchito mkati mwa chikhalidwe cha anthu m'malo molimbana ndi zowawa za kuzunzika ndi mavuto. kusintha kofunikira polimbana ndi kuvutika kumeneko pamlingo wa anthu. Komanso, chithandizo chamankhwala chimaika pachiwopsezo chovomerezeka machitidwe okakamiza omwe amaphwanya ufulu wa anthu ndipo atha kukulitsa tsankho kwa magulu omwe kale anali osalidwa m'miyoyo yawo yonse komanso mibadwomibadwo.
30. Pali a zokhudzana ndi chizolowezi chogwiritsa ntchito mankhwala ngati njira yodziwira ndikuchotsa ulemu ndi kudziyimira pawokha kwa munthu. mkati mwa madera osiyanasiyana a ndondomeko za chikhalidwe cha anthu, zomwe zambiri zimawonedwa ngati zosinthika zotchuka ku mitundu yakale ya chilango ndi kutsekeredwa m'ndende. Kuchiritsa kwamankhwala kumapatuka ku zovuta zomwe zikuchitika monga anthu pagulu, kutanthauza kuti pali yankho lokhazikika, lokhazikika (ndipo nthawi zambiri la abambo). Izi zikuwonetsa kusafuna kwa anthu padziko lonse lapansi kulimbana ndi kuzunzika kwa anthu moyenera ndikukhazikitsa kusalolera ku malingaliro oyipa omwe aliyense amakumana nawo m'moyo. Momwe "mankhwala" kapena "zofunikira zachipatala" zimagwiritsidwira ntchito kulungamitsa tsankho ndi kupanda chilungamo kwa anthu ndizovutitsa.
31. A njira yayikulu yazamankhwala yapangitsa kuti mayiko azilungamitsa ulamuliro wawo kuti alowererepo m'njira zolepheretsa ufulu wa anthu.. Mwachitsanzo, zomveka zachipatala siziyenera kugwiritsidwa ntchito ngati chitetezo kapena zifukwa za ndondomeko ndi machitidwe omwe amaphwanya ulemu ndi ufulu wa anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo. Ngakhale kuti zoyesayesa zochotsa mayankho okhudzana ndi kugwiritsa ntchito mankhwala osokoneza bongo kuchoka pazachigawenga kupita kwa azaumoyo ndizovomerezeka, ndikofunikira kuchenjeza za kuopsa kwamankhwala omwe akukulitsa kuphwanya ufulu kwa anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo. Mayankho azachipatala kuti athane ndi chizolowezi choledzeretsa (makamaka akapangidwa ngati matenda) amatha kuwonetsa machitidwe okakamiza, kutsekeredwa m'ndende, kusalidwa komanso kusowa kwa chilolezo chopezeka m'njira zachiwembu. Popanda chitetezo chaufulu wa anthu, machitidwewa amatha kupita patsogolo ndipo nthawi zambiri amatha kusokoneza anthu omwe amayang'anizana ndi tsankho, zachuma kapena tsankho.
unyolo thupi ndi maloko akusinthidwa ndi zoletsa mankhwala ndi yogwira anaziika.
Danius Puras, Mtolankhani Wapadera wa United Nations kumanja kwa aliyense ku
kusangalala ndi mulingo wapamwamba kwambiri wotheka wakuthupi ndi wamalingaliro
thanzi, 2020
32. Kulowererapo kokakamiza pamakonzedwe azachipatala kwakhala koyenera chifukwa cha "zowopsa" kapena "zofunika zachipatala". Zosankhazo zimakhazikitsidwa ndi munthu wina osati munthu amene akufunsidwayo. Chifukwa iwo ndi omvera, amafunikira kuunika kwakukulu kuchokera kumalingaliro aumunthu. Ngakhale kuti anthu padziko lonse lapansi akumenyera ufulu wa anthu omwe ali ndi nkhawa kwambiri, unyolo thupi ndi maloko akusinthidwa ndi zoletsa mankhwala ndi yogwira anaziika. Maonekedwe a Boma ndi kugulitsa zinthu kumangoyang'ana kwambiri pakuwongolera munthu ndi "zofunikira zachipatala", nthawi zambiri amapemphedwa ngati zifukwa zomveka zowongolera izi.
33. Ngakhale kulibe zolembera zamoyo zamtundu uliwonse wamaganizidwe[2], Psychiatry yalimbikitsa kumvetsetsa kwachilengedwe komanso kogwirizana ndi kupsinjika maganizo. Chifukwa chosamvetsetsa bwino za etiology, komanso chithandizo chamankhwala, pali njira yomwe ikukula yomwe imalimbikitsa kusintha kwamankhwala.[3]. Pali ma foni omwe akukula mkati mwa azamisala oti "kulingaliranso kofunikira pakupanga chidziwitso ndi maphunziro amisala" ndikugogomezeranso kufunikira kwa chisamaliro chaubale komanso kudalirana kwaumoyo wamaganizidwe ndi chikhalidwe cha anthu.[4]. Special Rapporteur amavomereza koma imayitanitsa akatswiri azamisala olinganizidwa ndi atsogoleri ake kuti akhazikitse mwamphamvu ufulu wachibadwidwe ngati mfundo zazikuluzikulu poika patsogolo chithandizo chamankhwala..
34. Poganizira zoyambitsa chithandizo, mfundo ya primum non nocere, kapena "choyamba musavulaze", ayenera kukhala wotsogolera. Tsoka ilo, zolemetsa zobwera chifukwa cha chithandizo chamankhwala nthawi zambiri zimanyalanyazidwa, zovulaza zomwe zimagwirizanitsidwa ndi mankhwala ambiri a psychotropic zachepetsedwa ndipo ubwino wawo ukukokomeza m'mabuku ofalitsidwa.[5]. Kuthekera kwa overdiagnosis ndi mankhwala owonjezera Choncho ayenera kuonedwa ngati mphamvu ya iatrogenic ya zoyesayesa zapadziko lonse lapansi zokulitsa mwayi wopeza chithandizo. Kuonjezera apo, ufulu wachibadwidwe wa anthu ndi zovuta zomwe zimachitika chifukwa cha chithandizo chamankhwala, monga kusamalidwa ndi anthu, kulandira chithandizo chokakamiza, kutayika kwa ana ndi kutaya ufulu wodzilamulira, kumafuna chisamaliro chachikulu. Medicalization imakhudza mbali iliyonse ya moyo wa anthu olumala m'maganizo; zimasokoneza luso lawo lovota, kugwira ntchito, kubwereka nyumba ndikukhala nzika zonse zomwe zimagwira nawo ntchito m'madera awo.
35. Tsopano zadziwika bwino lomwe kuti kutsekeredwa m'ndende kwa anthu ambiri ochokera m'magulu a anthu oponderezedwa ndi nkhani yofunika kwambiri yokhudza ufulu wa anthu. Kuti tipewe kuchiritsa kwamankhwala ambiri, ndikofunikira kuyika ndondomeko yaufulu wa anthu pamalingaliro amalingaliro, ndi mfundo zaumoyo wamaganizidwe. Kufunika kwa kuganiza mozama (mwachitsanzo, kuphunzira za mphamvu ndi zofooka za chitsanzo cha biomedical) ndi chidziwitso cha kufunikira kwa njira yokhudzana ndi ufulu waumunthu ndi zomwe zimayambitsa thanzi ziyenera kukhala gawo lalikulu la maphunziro a zachipatala.
Zothandizira
[1] (21) Onani Peter Conrad ndi Joseph W. Schneider, Deviance and Medicalization: kuchokera Kuipa kupita ku Matenda (Philadelphia, Pennsylvania, Temple University Press, 2010).
[2] (22) Onani James Phillips ndi ena, "Mafunso asanu ndi limodzi ofunikira kwambiri pakuzindikira matenda amisala: gawo lochulukirachulukira gawo 1: malingaliro ndi matanthauzidwe okhudzana ndi matenda amisala", Philosophy, Ethics and Humanities in Medicine, vol. 7, No. 3 (Januware 2012).
[3] (23) Onani Vincenzo Di Nicola. "'Munthu ndi munthu kudzera mwa anthu ena': manifesto ya chikhalidwe cha anthu m'zaka za zana la 21", World Social Psychiatry, vol. 1, No. 1 (2019).
[4] (24) Onani Caleb Gardner ndi Arthur Kleinman, “Medicine and the mind – zotsatira za psychiatry’s identity crisis”, The New England Journal of Medicine, vol. 381, No. 18 (October 2019).
[5] (25) Onani Joanna Le Noury ndi ena, "Kubwezeretsa Phunziro 329: mphamvu ndi zovulaza za paroxetine ndi imipramine pochiza kuvutika maganizo kwakukulu muunyamata", The BMJ, vol. 351 (September 2015).
