The Sense of Agency and the Search for a Narrative in Acute Psychosis

The search for a narrative in acute psychosis exists but the result of this search can be insufficient because the stories available do not sufficiently capture the pre-narrative quality of personal experience, and hence the sense of agency may be diminished. The context of reflexivity is lost when a subjugating story blocks an individual off from making a choice from among a multiplicity of stories. Psychosis can also be an escape in order to maintain a sense of agency. When the patient has trouble in creating meaning through narrative action, the aim of therapy and treatment is to open a channel through which the pre-narrative quality of life can become narrated, to create a multiplicity of stories, and so offer the possibility of choice in the construction of a narrative identity.     

The Experience of Time in Acute Psychosis and Schizophrenia

From the narrative point of view the plot of a story configures time. In psychosis, when experiences remain unnarrated, experience being-in-time is also missing. Once experiences are given narrative form, they can be left behind as a part of individual's personal history, thus enabling present experiences to be narrated. Unnarrated experiences do not accumulate. Narrative history contains, however, enough redundancy to invite you to restory your past in a new way if you need to. Hence, from the narrative point of view, early, family- and network-centered intervention is of special value in cases of acute psychosis.     

Psychoanalysis and Psychosis: Trends and Developments

This paper presents the basic principles of insight-oriented therapy for schizophrenia, emphasizing the effectiveness of this approach: each treatment effort is a unique adventure, fueled by hopefulness in both participants. Next, it reviews the history of such treatment efforts and current tensions in the field. It presents information on the International Society for the Psychological treatments of the Schizophrenias and other psychoses (I.S.P.S.) and its current mission, to promote quality care for patients suffering from schizophrenia, to promote and facilitate research into this work, and to provide organizational support and ongoing educational programs for clinicians involved in these efforts.     

Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles

In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, patients who were offered CBT but dropped out of treatment early had outcomes that were no worse than patients who stayed in. The explanation for this curious finding might be that the drop-outs and the stay-ins had different but equally valid recovery styles. Two case studies from the trial are presented to illustrate these recovery styles: sealing-over and integrating. Discussion focuses on the idea that, rather than try to alter patients' recovery styles, a more appropriate aim might be to match treatment to the patients' styles.     

The Embodied and Contingent Self in Later Life: A Narrative Understanding

This article examines a narrative understanding of identity and discusses its relevance within the sociocultural contingencies of the postmodern age. Providing an historical overview of understandings of the self, Meador traces the lineage of the self from Augustine through contemporary theories of identity. He focuses on the narrative concept of identity, acknowledging the existence of multiple narratives—those that individuals tell about themselves and those told by others. Finally, he explores the transformative potential available within this context for those in their later years.     

Schizophrenia and the experience of intersubjectivity as threat

Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised dialogical capacities may be a contributing factor to social dysfunction in schizophrenia.     

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。     

Expressed Emotion In The Narrative Context of Family Photographs

This study aims to elucidate cognitive and contextual aspects of the EE (Expressed Emotion) concept. The EE levels of both parents of two first admission psychotic patients were rated from the Five Minute Speech Sample (FMSS), and the emotional responses were further analyzed in narratives of family photographs. The attribution model was found to provide an explanatory framework for understanding relatives' expressed emotions (EE) toward a family member suffering from psychotic disturbances. Four case reports indicated that family photographs induced parents to create narratives in which emotions, attributions, and strategies for coping with stressful aspects of the illness came forward as intertwined phenomena. The method can offer more comprehensive data for intervention strategies aiming to alter the prevailing atmosphere and interaction patterns within the high EE family.     

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。

     

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。

     

围生期叙事照护与生育关怀叙事生态研究

围生期死亡并未引起医护人员和社会的重视与关注,往往导致失胎或失婴家庭成员陷入严重的创伤叙事闭锁。以生命健康叙事理念为框架,从创伤叙事闭锁之后的两种不同哀伤应对方式,即工具性舒缓和叙事性调节作为出发点,阐述由围生期胎儿死亡造成的哀伤剥夺给失胎和失婴家庭成员带来的巨大痛苦,进而倡导全社会积极创设关于失胎和失婴主题的良好叙事生态,旨在通过妇产科医护人员的叙事照护,引导“天使父母”分享自己的故事,再现痛苦历程,并藉由叙事赋能,得到关注、找到归属、重构身份,走出创伤叙事闭锁,开始全新的生命旅程。

     

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.     

拉康精神病理论的历史性溯源研究

在精神分析理论对精神病的研究中,法国精神分析家拉康通过精神病临床的实践与思考,突破与拓展弗洛伊德后期提出的精神病理论。他的整个精神病理论研究分为四个阶段,从最初强调想象界发现精神病主体的形成机制到全盛时期强调象征界提出精神病发病机制,然后转到在实在界谈论精神病的稳定性,最终在三界中通过“圣状”纽结精神病的人格结构。拉康的精神病理论促使大众从精神分析角度去理解精神病的临床精神结构,充分体现了精神分析理论的独特性和创新性,拓展了精神分析的治疗范围,也影响了其后继者提出常精神病的概念。

     

论短期叙事医学课程对于医学生叙事能力的影响——以海南医学院为例

通过在海南医学院开展一项试点性的短期叙事医学课程,探究此类叙事医学课程对于医学生叙事能力的影响以及课程本身的有效性。探究结果显示,该课程项目对于医学生叙事能力无显著影响。通过统计学、心理学、教育学等多个角度,对结果进行了讨论和分析,归纳出课程本身存在的样本量、课程时间、量表等多种局限性;同时,也对课程的教学设计进行了反思,并提出了相应的建议,希望为未来叙事医学课程设计和研究提供参考经验。     

Narrative and persistence

Many philosophers say that the nature of personal identity has to do with narratives: the stories we tell about ourselves. While different narrativists address different questions of personal identity, some propose narrativist accounts of personal identity over time. The paper argues that such accounts have troubling consequences about the beginning and end of our lives, lead to inconsistencies, and involve backwards causation. The problems can be solved, but only by modifying the accounts in ways that deprive them of their appeal.     

叙事医学在中国：现状与未来

叙事医学的精髓在于愿意去倾听患者的叙事,并为之采取各样的行动,产生对医患都有益的结果。鉴于此,叙事医学近几年来在我国得以迅速发展,以叙事医学为方法的实践、为内容的教学和研究都有一定的发展,但其数量、质量和深度都有待进一步提高。当务之急是要研究各种情境中实践叙事医学的临床路径;探讨在现象学、叙事诠释学和社会建构论指导下医患互动中的关联性,在医学教育中加强细读训练,探索利用叙事进行临床教学的方法,多管齐下,以实现叙事医学在我国的扎根落地。     

从史瑞伯个案看精神病理论的多路径探究

从弗洛伊德对史瑞伯个案的精神分析研究入手,探讨其后期通过研究精神病所发展的父亲情结及力比多概念,这两个关键概念影响后继者走向不同的研究路径。拉康在想象和象征的维度下重读史瑞伯个案,结构化精神病的病理性人格结构,得出精神病是除权弃绝父亲的名字的结果。德勒兹与伽塔俐从欲望的角度解读史瑞伯个案,继承弗洛伊德对力比多的强调,重视无意识的实在性,反对精神分析过度强调俄狄浦斯情结影响了欲望的流动,主张精神病在实在中自由漫步达到治愈的新见解。

     

叙事隐喻的作用机制及其在绘本中的应用

叙事隐喻不仅仅是一种修辞手法或语言中暗含的言外之意,更是一种理解、看待问题的哲学方式,构成了叙事疗法的要素核心。通过文献梳理与分析,对叙事隐喻作用机制进行探讨,揭示了其在第三叙事视角转换、长时记忆、具身认知体验三个方面的特异性作用。并结合绘本阅读,阐明以绘本为载体的叙事隐喻在青少年与成人心理治疗中的表现形式、共通性作用机制和不同的临床实践运用,期望为“绘本阅读+叙事疗法”的联合治疗提供可能性和有效性参考。

     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

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。