论医学的理性精神

面对守望生命的神圣事业 ,人们开始发出“返回故园”的深切呼喊[1] 。自然 ,精神家园是我们的终极关怀所在 ,是我们最深切最真挚的向往。然而 ,当医学现代化的历史使命感和西方所谓“后现代化”思潮交织而来的时候 ,我们是踏上返乡之路 ,还是走向不归之途 ?这需要我们理智地沉思 ,沉思当前医学应具有的理性精神。1　对医学理性的阐释作为人类所特有的一种能力 ,理性同人类历史一样古老。同时 ,理性又不是一种超历史的先天能力 ,人们的理性只能表现在他们的实际活动和思考之中。所以 ,理性又必然带有历史的、文化的、社会的和个体特点的烙印…     

金基德:沉默的精神分析师

近年来,亚洲一批年轻新锐导演在诸多电影节中脱颖而出,频频获奖,引起了国际广泛关注。他们的迅速崛起在电影界被称为新现实主义浪潮中的后殖民一代。他们都有游学欧洲或接受西方现代主义思潮的背景,在实践中体现较强的先锋性与实验性,有意识地对抗好莱坞路线,在全球化语境下强烈关注本国的民生民态。其中尤其为人瞩目的是韩国导演金基德,在他所执导的14部影片中有7部获得国际大奖,3部入围各大电影节参选作品。近年来我国电影界也越来越关注这位当代大师。用拉康欲望主体哲学理论,从符号学与图像学的角度,对金基德主要作品进行精神分析,很多影片里,金基德都有意无意地构建了拉康式关于凝视三角公式的能指关系。他的电影是一堆介乎似醒非醒间的形象组合,是现实界[3]和象征界暧昧不明的混杂。     

临床医生的两难处境：兼论重新确立医学伦理地位的重要性

在经济建设获得迅速发展的同时,医疗服务领域却有越来越多的问题在困扰着人们：医疗保障事业如何适应人民日益增长的需要,又适应市场经济的环境？如何在保证病人享受最适用的（不是最昂贵的）医疗服务的同时,又要背负起部分乃至全部养活自己的巨大的经济压力？评价医疗服务的金指标是什么？如何既要完成层层下达的“创收”指标,又要维护救死扶伤、实行人道主义的医学伦理的崇高地位和满足人们对医务人员的较高的期望值？这些问题的存在使尚有责任感的临床医生常常处于两难境地。本文试图就这一范围的问题进行初步的探讨。１　两难处境下…     

论医学人文精神的重塑

重塑医学人文精神是一个无法回避而又必须作出回答的紧迫问题。把现代医学技术放到人文哲学的大视野中去体认,从人学本体论意义上现代医学技术的价值理性,进一步澄清人们对医学技术无限崇拜的工具理性的错误认识;阐述了现代医学人文精神的内涵,认为以人为本,确立科学理性对医学技术的指导地位,适时约束医学技术行为应该成为现代医学人文精神的核心理念;提出了重塑现代医学人文精神的基本原则,即：坚持医学技术进步与人的全面发展相一致的原则,坚持医学技术进步与医学工作者道德健全相一致的原则,坚持医学进步与卫生事业持续、协调、健康发展相一致的原则。     

家的无意识结构与主体化功能——精神分析视角下的家情结

不同于存在主义将人构想为被抛入世的孤独存在者,精神分析从一开始便将人置于家中进行考察,认为人在根本上便是有家、在家且恋家之人。从精神分析的视角出发,家首先是作为家族世代传递的无意识结构,具有赋予每个主体以其独特身份与位置的重要功能,是人由个体转化为主体的首要场域。作为主体的人往往不仅生于且终于、困于也成于作为一种情结的家中,而且正是对这种家情结的升华,造就了诸如国家这样的政治共同体,使得国在文化无意识层面有可能成为家之命运、结构与功能的延续、拓展与深化。     

科学的划界与医学：—一论在医学中坚持科学精神

这里所论的科学划界标准是就自然科学而言的，区分科学与非科学最重要的标准是它的可检验性和可重复性。科学的这个划界标准今天并未过时，医学和一般自然科学相比有其特点，但其为实验科学的医学也应坚持这个标准。     

从经验到实证:对无意识现象探究过程的分析

从中国古代的思想家到西方哲学的巨匠,从心理学经典的精神分析学派到现代心理学研究成果,人类对无意识的认识正在一步步走向深入。通过对不同时期、不同思想、不同领域人类对无意识现象及其规律的探究和认识的分析,逐渐形成了这样一条清晰的思路：在方法论层面上对无意识的探讨经历了从经验到实证这样一个过程。     

医学人文精神和医学科学精神的融通

医学人文精神和医学科学精神都是人类医学必不可少的内在组成部分,要达到两者的融通与共建,其前提便是在对医学人文和医学科学的全面理解中塑造当代医学精神,促进医学人文精神与医学科学精神的健康互动与协调发展。     

科技伦理教育:医学研究生科学精神与人文精神融汇的契机

科学精神是指人们在科学活动中形成的,体现于科学知识、科学思想、科学方法中的一种观念、意识和态度。理性精神、实证精神、求真精神、批判精神构成了科学精神的核心内涵。与科学精神形成对比,人文精神是在人文认识活动中形成的一系列价值观念和态度。其核心是主张以人为本,强调人的价值和尊严,重视对人类的无限关怀。“人文精神是医学科学的旗帜,……面对现代社会医学与人文的冲突及由此带来的种种矛盾和问题,必须高扬人文精神的旗帜,重新找回医学与人文亲和的‘蜜月’,建立两者之间和谐融合、共生互动的关系,让医学科学朝着人类希望的方向发展。”培养兼具科学精神与人文精神的医学研究生是21世纪医学人才培养的重要目标之一。     

从儒家的“鬼神观”和“天命观”看科学和理性精神

笔者认为鬼神迷信思想也是一个民族的传统文化的重要组成部分。鬼神迷信观念的存在也有着文化深层结构上的原因。通过对儒家的“鬼神观”和“天命观”的探讨．笔者认为儒学的这样一种“天人合一思维模式下的二人互相制约”的思维模式．决定了儒家文化在根本上对鬼神迷信思想有着实际的支撑。因此．要想从根本上破除迷信思想的存在,宣传无神论的思想,就需要中国传统文化的现代化的转变,吸收科学和理性精神进行重新的解构与建构。     

男科临床工作中的人文关怀

随着现代医学模式的转化和男科学诊治技术的发展,在男科临床工作中应该注重树立人文关怀理念和强化人性化服务意识.实施人文关怀的方法包括:重视心理应激,应用心理疗法;关注患者生活,有效预防疾病;营造人文环境,提供人性化服务;遵循最优化原则,做到适度医疗;关心老年人健康,关注社会特殊群体.在男科临床工作中应提高人文关怀的自觉性.     

Analysts' observing-participation with theory

The author summarizes some of the literature's critiques of psychoanalytic theory, which have noted its constrictive quality and failure to take into account the vicissitudes of treatment within each analytic dyad. Such postmodern reactions have given rise to a countertheoretical trend toward psychoanalytic pluralism, leading the author to suggest that a single, standard psychoanalytic technique no longer exists. The interpersonal tradition, which tends to prioritize praxis over theory, is discussed in the light of its emphasis on an intersubjective model of participant-observation, and two clinical vignettes are presented to illustrate the author's way of utilizing this model.     

Narcissism,Mania and Analysts' Envy

Character traits like narcissism, mania and grandiosity are routinely discussed in the psychoanalytic literature as aspects of psychopathology only. However, many individuals who have both achieved and contributed to society in the most profound ways often have such characteristics. Psychoanalysts, sometimes envious of patients who possess considerable wealth and/or power, may be inclined to overly pathologize such qualities, denying their own desires for the perks of power and material success. Mad Men is discussed largely in this context.     

Consultant or Comrade: Comments About Analysts' Working Relationships in Schools

The articles in this issue of the Journal of Applied Psychoanalytic Studies pose a dilemma for educators. On the one hand, each article describes an important psychosocial intervention implemented in schools. On the other hand, these interventions, at least as described in the articles, are either imposed on the work of teachers and students or isolated from that work. Either circumstance ultimately limits the impact of the intervention. I claim that analysts and teachers are natural allies despite lack of evidence for alliance in these articles. To extend that alliance beyond conversations about individual children, analysts must understand that teachers' views of learning and development are different from those that influence the organization and management of schools.     

Rule-Consequentialism's Dilemma

This paper examines recent attempts to defend Rule-Consequentialism against a traditional objection. That objection takes the form of a dilemma, that either Rule-Consequentialism collapses into Act-Consequentialism or it is incoherent. Attempts to avoid this dilemma based on the idea that using RC has better results than using AC are rejected on the grounds that they conflate the ideas of a criterion of rightness and a decision procedure. Other strategies, Brad Hooker's prominent amongst them, involving the thought that RC need contain no overarching concern to maximize the good are acknowledged to avoid the original dilemma, but lead to further problems of motivating and justifying RC in the absence of such a concern. The paper argues that Hooker's attempt to deal with these problems by using a 'Reflective Equilibrium plus method is unsuccessful.     

A Systems Dilemma

The current shift of interest, reflected in public policy, from the production of goods to the provision of services, has caused a major re-examination of the nature of the services the individual can expect from his society. This re-examination is producing a number of insights, some of them shocking. In particular, we are learning that many of the systems we have created to deliver services are, in the name of “progress” and “civilization,” contributing to the conditions of human distress they were designed to alleviate. Much has been written lately about how service systems of one kind or another subvert their announced goals—how a welfare system perpetuates poverty, or how the medical profession creates iatrogenic illness. There has not been very much written, however, about how several systems inadvertently combine in their day to day operations in such a way as to frustrate each others' activities, and how, in so doing, they destroy in varying degrees the lives of people, or render it difficult for them to improve their lives. We have all been much too tightly locked in our own niches by training, experience, and various types of private interest to see this kind of interlock. It comes into sharp perspective only when one studies the problems of a single person in terms of his total life space, his “ecology.” This paper represents an effort to describe one such situation in a family as viewed from a community health services program designed to approach human crises as ecological phenomena, and to explore and respond to them within this framework. We have found that the best way to organize our view of the environmental field people move in is according to the diverse systems which make it up, so we have labeled our theoretical base “ecological systems theory.” ( 1 ) What is of particular interest to the behavioral scientist in the situation described is that neither individual nor family diagnosis, nor the contributions of the larger systems (in this case a housing system and a system of medical care) will, if viewed separately, explain the state of the man in question. Only when the contributions of all of these systems are made clear, and their interrelationships explored, do the origins of the phenomena described begin to emerge.     

The Obligation Dilemma

I motivate a dilemma to show that nothing can be obligatory for anyone regardless of whether determinism or indeterminism (the falsity of determinism) is true. The deterministic horn, to which prime attention is directed, exploits the thesis that obligation requires freedom to do otherwise. Since determinism precludes such freedom, it precludes obligation too. The indeterministic horn allows for freedom to do otherwise but assumes the burden of addressing whether indeterministically caused choices or actions are too much of a matter of luck to be obligatory for anyone. I critically discuss a response to the deterministic horn that invokes the distinction between alternatives compatible with determinism (weak alternatives) and those incompatible with determinism (strong alternatives).