Richard Zaner’s “Troubled” Voice In <Emphasis Type="Italic">Troubled Voices</Emphasis>: Poseur,Posing, <Emphasis Type="Italic">Possibilizing</Emphasis>?

This essay considers Richard Zaner’s storytelling in Troubled Voices as a form of possibilizing which uses the stories to exemplify important moral themes such as contingency and freedom. Distinguishing between activities of moral discovery through the telling of a story and “posing” in the sense of writing to tell the “moral” of the story, I suggest that something crucial goes on for Zaner in his own tellings. Several of the more insistent implications Zaner reveals about the moral relationships encountered in the activity of clinical ethics consultation are examined in that light, especially regarding this question: is it more beneficial, or harmful, to articulate elements of core meanings and values that are entailed in individual viewpoints, which, prior to an ethics consultant’s participation, may have remained unspoken and possibly unacknowledged?     

Narrative imagination and taking the perspective of others

Narrative imagination, as MarthaNussbaum (1996) discusses it, is ``the abilityto be an intelligent reader of another person'sstory', an ability tied to being a democraticand cultivated world citizen, one whounderstands the lives of others. Narrativeimagination does not only need knowledge andlogical reasoning but also love and compassion.This article argues that in order to be agenuine tool for democracy, narrativeimagination and consciously taking theperspective of others has to be based on anunderstanding of humans as basicallypluralistic, as homines aperti. Criticalexamination and reflection should be broughtcloser to the lives we live and confront ourhabits and implicit values in order tocultivate us as humans so that we are genuinelyaffected and touched.     

奥斯勒的生命书写及其叙事意义

叙事具有强大的人文和人际功能,它能促使主体之间更有效地实现认知上的共识。居丧者的哀伤历程和罹患疾病的患者接受自己生病身份的过程是一个需要通过见证、续写或改写故事来重构人生意义的过程。从奥斯勒创设天堂来信帮助作为居丧者和患者的妻子格蕾丝克服心身疾痛这个故事,发现叙事素养能够帮助临床语境下的多方主体之间构建“同声相应,同气相求”的生命共同体关系。从叙事医学的角度而言,医学是一门综合性的艺术。在“医学是不确定的科学与可能性的艺术”的基础上,医学实践可以理解为需要科学技术知识和叙事人文素养合力的“应用型科学和关系性艺术”。     

Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

叙事医学在医学教育与临床实践中的五个关键词

叙事医学是新时代医学人文的落地工具,以医护患三大主体的叙事素养提升以及多维度生命和谐健康关系构建为中心议题。围绕叙事医学强调的叙事素养、关系构建、身份认同、主体间性和视域融合五个关键词,全方位阐释这一医学教育和实践新模式。叙事素养是实现和谐关系构建、医护职业和患者身份认同、主体思维模式和视域差异融合的综合体现,由关注力、再现力、互纳力和反思力四个方面能力构成。叙事素养以叙事性文本细读训练为内化手段,以叙事性反思写作为检验工具。     

生命健康视野下的叙事闭锁

从弗里曼的叙事闭锁理论出发,将“叙事闭锁”重新定义为“将自己禁锢在停滞的故事空间里,无法吸纳推动叙事进程向前发展的生命状态”,并将其进一步分为职业型、创伤型、疑虑型和老年型四种类型。叙事闭锁不仅在老年人群中高发,在其他年龄阶段人群中也不少见,以至于人生故事提前进入结束状态或者处于无法更新的停滞状态。对叙事闭锁者开展叙事介入可以帮助他们提升叙事素养,重启再次体验和阐释人生的按钮,赋予他们由内而外突破闭锁的能量。当人处于一种叙事稳定性和叙事开放性的平衡状态之中时,主体经历的就是一种健康和谐的生命进程。     

Narratives of escape: A hermeneutic study of resiliency

This study examines the structure of narratives told by well-functioning adults who were at-risk as children. Participants told stories of their childhood based on pictures they selected from the TAT test (Thematic Apperception Test). Analysis of their narratives resulted in a set of hermeneutic rules which may be useful in interpreting the structure of narratives and in understanding the relationship between internalized images, reality construction, and resiliency. Two types of images were identified: negative images of stress and darkness and more positive images of escape and hope. Implications for helping clients develop images of strength and competence are discussed.The authors wish to thank an anonymous reviewer for his or her very helpful suggestions.     

老年医学科叙事医学实践及思考

介绍老年医学科叙事医学理论学习和实践案例。应用关注、再现、反思、归属等叙事医学实践,关注老年患者主体性,发现疾病背后的故事,弥合医患视域差异,帮助老年患者及家属正视死亡教育。间接反思提升老年医学科医患沟通品质。直接反思助力医务人员发现工作中的短板,完善工作范式,提升工作品质。老年医学科叙事医学实践帮助医务人员从老年患者生命病痛的角度出发、理解和善待生命,帮助医护人员化解医患沟通困境,优化医患关系生态,全方位维护老年患者的生理、心理、情感、精神健康。     

中国叙事医学实践的反思

首先,以叙事学、人类学、叙事医学三个学科领域的界定与分析来厘清叙事概念。其次,在此基础上指出叙事医学发展进程中存在的问题,包括医学教育与临床实践适应性不同、平行病历工具的运用不宜脱离临床情境、对反思性写作进行反思、对叙事走进医学的质疑与反思等。最后,提出中国叙事医学高质量发展的可能路径：叙事病历研究构成临床实践落地的重要起点、构建中国主体的叙事医学教育框架、跨学科多向度的综合实践意义重大等。

     

The Constructive Use of Power and the Philosophy of the Self in the Training of Family Therapists

Abstract

This article presents findings from an exploratory qualitative study, which used individual interviews and a focus group to investigate how women in Black-White interracial heterosexual partner relationships retrospectively described their racial identity development and the influence of gender identity development on this process. Social consrructionist, feminist, and racial identity development theories guided the grounded theory methodology. Participants described both constraining and empowering racial identities. Salient constraining racial identities were being a “sell-out” or “traitor,” being a “rule-breaker,” having a masked reference group orientation, needing to prove reference group orientation, and having minority family status. Empowering racial identities included refusing to take sides, being “not racial,” being neutral, identifying by respect rather than by race, having a multiple reference group orientation, being strong, and being an educator and mediator.

Gender identity themes of strength and resiliency emerged as significant influences in racial identity development. Suggested questions for use within a narrative therapy context provide a clinical application of findings from the study.     

疾病叙事阅读：医学叙事能力培养

在叙事医学和医学人文的情感转向这两大理念基础上,提出将医学叙事文本按照创作方式分为虚构疾病叙事和非虚构疾病叙事两大类型,按照作者身份分为文学疾病叙事、自我病情书写和医生病理书写（平行病历故事）等,并提出将元病历叙事作为医学院校叙事医学能力培养的重要阅读材料,在此基础上,增加阅读与某种具体疾病相关的叙事作品,如神经叙事,癌症叙事等。同时探讨如何将叙事学基本知识融入疾病叙事阅读中,切实引导医学生提高医学叙事能力,达到医患视域融合和医患沟通效果最佳化。     

Imagination and Memory

A growing body of literature shows that imagining contrary-to-truth experiences can change memory. Recent experiments are reviewed to show that when people think about or imagine a false event, entire false memories can be implanted. Imagination inflation can occur even when there is no overt social pressure, and when hypothetical events are imagined only briefly. Overall, studies of imagination inflation show that imagining a counter-factual event can make subjects more confident that it actually occurred. We discuss possible mechanisms for imagination inflation and find that, with evidence supporting the involvement of both source confusion and familiarity in creating inflation, the primary mechanism is still to be determined. We briefly review evidence on individual differences in susceptibility to inflation. Finally, the widespread use of imagination-based techniques in self-help and clinical contexts suggests that there may be practical implications when imagination is used as a therapeutic tool.     

叙事医学赋能医院管理与高质量发展

叙事医院管理强调在医院管理中融入叙事管理理念,是一种与循证管理互补的新兴管理模式。以广东省医院协会的叙事医学专业委员会平台和南方医科大学指导的叙事中心作为实践起点,在构建中国叙事医学体系的基础上,创新性地提出叙事医院管理框架下的医院叙事生态、管理者叙事商数、职业叙事闭锁、组织核心叙事、叙事调解等核心关键词,旨在激发国内医院管理者聚焦叙事理念,推动医院实现各维度的价值共生。

     

叙事传输的说服机制

叙事传输是人们沉浸在故事情景中的独特心理过程,也是故事信息特有的说服机制.叙事传输会使决策者产生与现实世界脱离的感觉,体验到强烈的情绪,然后对故事产生认同,改变态度.本文在界定叙事加工、叙事传输等理论概念基础上,重点比较叙事传输与分析加工的差异,认为两者在信息内容组织、作用途径、判断逻辑、认知努力及问题距离上都有区别.进一步研究叙事传输与分析加工、自我控制、情景决策等理论领域的关系具有重要价值.     

错误记忆中的新领域--想象膨胀

文章就近年来错误记忆研究中的新领域——“想象膨胀”进行介绍。“想象膨胀”是一种源自生活的错误记忆现象,它是指通过想象能提高一个人确信某一未发生事件发生过的程度。本文对想象膨胀研究范式、现状、相关理论及其研究意义进行一一介绍,为进一步的研究提供参考。     

Against the Additive View of Imagination

According to the additive view of sensory imagination, mental imagery often involves two elements. There is an image-like element, which gives the experiences qualitative phenomenal character akin to that of perception. There is also a non-image element, consisting of something like suppositions about the image's object. This accounts for extra-sensory features of imagined objects and situations: for example, it determines whether an image of a grey horse is an image of Desert Orchid, or of some other grey horse. The view promises to give a simple and intuitive explanation of some puzzling features of imagination, and, further, to illuminate imagination's relation to modal knowledge. I contend that the additive view does not fulfil these two promises. The explanation of how images come to be determinate is redundant: the content constituting the indeterminate mental images on which the view relies is sufficient to deliver determinate images too, so the extra resources offered by the view are not required. When applied to modal epistemology, the view either delivers implausible results or offers no distinctive insight. Since the view is sold on its explanatory merits, and since these are dubious, the additive view should be rejected.