Many South African psychiatrists, and particularly those working in psychiatric hospitals with Black and Coloured patients, have the firm clinical impression that in many of these patients acute psychotic illness is associated with the abuse of cannabis. Most of the previous work in this field had been done by clinicians of Eastern countries where the use of cannabis has been endemic for thousands of years. However, those workers were handicapped because they lacked both the sophisticated techniques for standardized psychiatric evaluation and the availability of an assay to confirm cannabis use. It was decided to investigate acute psychoses in Cape Coloured males admitted to Valkenberg Hospital with the following aims: i. To identify a cohort of acutely psychotic patients who had recently been using cannabis and to compare them with a matched control group who were free of any drugs. The recently available EMITR immunochemical analytical technique was used for the detection of urinary cannabinoids. To exclude the contribution of other psychotropic agents to the aetiology of the psychoses, gas chromatography was performed to detect ethanol and thin-layer chromatography to screen for other psychotropic agents. ii. To assess the comprehensive mental state of patients on admission and then again after a 7-10 day period the Present State Examination (PSE), a well validated and standardized diagnostic instrument, was used. iii. To determine serum creatinine phosphokinase (CPK) and serum lactate dehydrogenase (LDH) levels (indicators of muscle damage) in view of the published reports of elevated levels in psychotic patients.

中文摘要 當前精神醫療過程中，存在若干矛盾的現象，尤其是生物－生理的以及社會文化的病因解釋與治療手法被交互運用。由於治療方法都是從診斷而來，因此精神治療意義的闡明指向診斷依據的釐清。本研究的目的在於探討當前的臨床精神醫療團隊拿什麼標準對於瘋狂的現象進行觀察，這個觀察的客觀標準的基礎又是什麼。研究方法使用田野觀察和質性訪談。資料分析則採用現象學的方法。 主要研究發現指出，正規臨床精神醫療的診斷標準，其實是社會文化生活中的常識。雖然常識作為衡量瘋狂是否存在的標準是客觀的，但也是不精確的。面對這個難題，臨床精神醫療的診斷採用了一種特殊的技術，亦即在一個已經設定好的時間中進行觀察，並且為這段時間設定好治療的目標。於是瘋狂的差異性就有了被規定出來的邊界，被觀察到的瘋狂將只是在一段治療時間中所觀察到的瘋狂，而且治療的目標也被設定為在這段時間中達成穩定的狀態的維持，以及讓精神病患養成一個不斷連結或憶起這段治療時間所學會的種種「儀式」的習慣。 因此，當今的精神醫療採用生物─心理─社會的社區精神醫療的模式，入院治療只是一種回歸社會的技術。現今的精神科醫療團隊，以治療計劃來為病人擬定「回歸社會」或「復原」的目標，進而提昇病人適應社會的功能，醫療在其中所扮演的角色就是控制瘋狂的差異相，讓它保持「穩定」。 然而，臨床精神醫療的深層結構其實是較不為人意識到的時間結構。透過這個可以被理性所限定與規劃的時鐘時間，形成一套將非理性時間納入理性時間的規範，這種時間的規範才是臨床精神醫療的時間結構的核心現象。時間因此成了一種技術，透過這種技術就能將瘋狂圈圍起來，在這個被限定的範圍內，瘋狂終於得以被認識，進而被有效地控制。 關鍵詞：臨床精神醫療、技術結構、時間結構、慢性病房、復原 / Abstract This study aims to explore the criterion of observation in modern psychiatric team’s madness observing, and to explore what is the basis of the criterion of observation. The research methods involved field observation and qualitative interviews. The data analyses were phenomenological methods. The major findings suggested that the clinical psychiatric team use a special technology in diagnosis which they observe madness phenomena in a schedule, and they set the target of curing for the time of observation and treatment. The target of curing is being setted to maintain a stable situation of symptom.To achieve the goal of recovery, modern psychiatry would place emphasis on one’s ability of adapting to norms of the society. In the beginning of recovering, medication would be used to keep patients' condition in a stable situation. Secondly, the whole team of treatment needs a comprehensive plan to guide themselves. In a way of "location", "orientation" and "connection", doctors and nurses ask patients to pass through a "threshold", and turn the process of treatment into the process of passing through. To find out a "breakthrough point " will be the first important thing in recovering, it is the roadmap of teaching a patient to form new habits by making an appointments, punishing and keeping a watchful eye on her or him. Once the patient has really proved herself or himself the ability of adapting to the society , it is the time for her or him to leave the hospital and go home. The results of the study may help psychiatric team members to rethink the strategies of treatment and to the possible benefits of understanding the modern culture which belongs to us. Key words: Clinical Psychiatry, Technical Structure, temporal structure

As a point of departure in this inherently interdisciplinary endeavour, the concept "Holistic Multidisciplinary Management" ("HMM") is introduced a.s a macrocosmic adaption of principles of project management. In line with HMM, a number of submissions regarding terminology and definitions in the interdisciplinary context of medicine (and particularly clinical psychiatry) and law, are made, and the foundations of medical malpractice are examined. Building on the various foundations laid, specific types of conduct that can constitute clinical-psychiatric malpractice, are addressed. A common theme that emerges in the various contexts covered, is that the psychiatrist must negotiate various proverbial tightropes, involving inter alia tensions between restraint and freedom, excessive and insufficient medication, becoming too involved and not being involved enough with clients, as well as client confidentiality and the duty to warn third parties. It is concluded that law and medicine. must work harmoniously together to establish appropriate balance. This can be achieved only if mutual understanding and integrated functioning are promoted and translated into practice. / Law / LL.M.

As a point of departure in this inherently interdisciplinary endeavour, the concept "Holistic Multidisciplinary Management" ("HMM") is introduced a.s a macrocosmic adaption of principles of project management. In line with HMM, a number of submissions regarding terminology and definitions in the interdisciplinary context of medicine (and particularly clinical psychiatry) and law, are made, and the foundations of medical malpractice are examined. Building on the various foundations laid, specific types of conduct that can constitute clinical-psychiatric malpractice, are addressed. A common theme that emerges in the various contexts covered, is that the psychiatrist must negotiate various proverbial tightropes, involving inter alia tensions between restraint and freedom, excessive and insufficient medication, becoming too involved and not being involved enough with clients, as well as client confidentiality and the duty to warn third parties. It is concluded that law and medicine. must work harmoniously together to establish appropriate balance. This can be achieved only if mutual understanding and integrated functioning are promoted and translated into practice. / Law / LL.M.