Abstract Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” (as the aim of understanding) and of “identity-making” (as a therapeutic aim) can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism.

中文翻译：

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精神病学的身份与疯狂行动主义的挑战：重新思考临床遭遇

摘要 现代医学专业（包括精神病学）的核心是实体抽象的概念：医生治疗被认为是人们“拥有”的“事物”的病症或障碍。疯狂激进主义拒绝了这一观点，因此挑战了精神病学作为医学专业的身份。本文阐述了疯狂激进主义的挑战，并发展了应用于医学的实体抽象。为了使精神病学在适应疯狂激进主义的挑战的同时保持其医学专业的身份，它必须对临床遭遇发展一个额外的概念。为了阐述这个概念，本文提出了两个基本的框架问题：临床遭遇应该针对什么样的情况理解？整个遭遇的治疗目的是什么？它提出“次要洞察力”（作为理解的目标）和“身份形成”（作为治疗目标）的概念可以允许临床遭遇以适应疯狂激进主义挑战的方式进行。