浅谈临终医疗的双重效应原则

双重效应原则常用于临终患者的治疗中,应用药物为患者解除痛苦,但可能导致患者严重不良反应甚至死亡,这在伦理上是可以接受的。但目前仍存在着较大争议,特别是如何认定医师的主观意图。     

生存质量与心律失常非药物治疗

生存质量的概念在９０年代广泛应用于临床,作为评价某一药物或某一治疗方法的手段之一。在心律失常的非药物治疗领域,正是引入了生存质量这一概念才使起搏器从单纯维持生命进展到双腔和／或频率应答。才改进生存质量,亦使快速性心律失常从手术治疗走向消融治疗。对高水平生存质量的追求是医患双方共同的目的。     

The double bind in psychoanalysis

The concept of the double bind has mainly flourished in the family system therapies. By contrast, it has been overlooked by psychoanalytic therapists. The present paper suggests that the double bind, while not regarded with the same importance as the intrapsychic or interpersonal factors, is certainly real. A concept of the analytic double bind is presented. The analytic double bind is not one of paradoxical, mixed messages and conflicting levels of communication. Instead, it arises from a conflict of incompatible levels of intimacy — specifically, the conflict between technique and intimacy. An attempt is made to delineate the central double bind both from the viewpoint of the analyst and from the viewpoint of the patient.     

Two Cheers for “Closeness”: Terror, Targeting and Double Effect

Philosophers from Hart to Lewis, Johnston and Bennett have expressed various degrees of reservation concerning the doctrine of double effect. A common concern is that, with regard to many activities that double effect is traditionally thought to prohibit, what might at first look to be a directly intended bad effect is really, on closer examination, a directly intended neutral effect that is closely connected to a foreseen bad effect. This essay examines the extent to which the commonsense concept of intention supports a reasonably consistent and coherent application of double effect. Two important conclusions are these: (1) a number of traditionally proscribed activities involve a kind of “targeting” of innocents that can be taken to exhibit a direct intention to harm them; (2) a direct intention to harm need not involve a desire to harm in any ordinary sense of the latter expression. Thanks to Thomas Flint, Paul Benacerraf, Mark Johnston, Gilbert Harman, Tom Cavanaugh, Jorge Garcia, Robert Audi and an anonymous referee for useful discussion and written comments.     

The Role of Relational Processing in Memory for Actions: A Negative Enactment Effect in Free Recall

The enactment effect occurs if people remember items that they enacted or enacted symbolically during study better than items that they were simply asked to remember. Enactment is generally believed to lead to thorough processing of individual items. There has been some controversy as to whether the superior processing of information concerning the relations between action phrases (i.e. whole-list relational information) may additionally contribute to the enactment effect. The extant empirical data on this issue seem contradictory. In the account brough forward here, it is hypothesized that whole-list relational information is processed better during enactment than during verbal learning only if it taps the same aspect of a concept as the verb-object relational information within each action phrase. It is processed worse if these two types of information tap different aspects of a concept. This explanation represents an extension of the three-factor account of positive and negative generation effects to the field of memory for actions. To provide evidence for this account, positive and, notably, negative enactment effects in object recall and in organization scores are demonstrated in three experiments with a total of 246 participants.     

The merits and problems with the concept of projective identification

This paper reviewed the merits of and problems with the concept of projective identification. On the negative side, lack of universal meaning of the term was cited. Personal countertransference receives little regard, while an isomorphic reading of patient feelings may be used to gratify omnipotent symbiotic analyst and patient fantasies. On the positive side, the concept offers a framework that can lead to deeper understanding of difficult therapeutic situations. It helps the analyst process and contain distressing feelings and eschews interpretation that can be destructive to the analytic process. Proper use of projective identification should engage the patient's ego rather than foster passivity and merger wishes. Case material was presented which illustrated problems with and merits of the concept. Personal countertransference, especially therapeutic omnipotence, was shown to receive insufficient attention. The important role of complementarity in projective identification was illustrated in the treatment of depression, a disorder which can offer difficult treatment resistances. In conclusion, the concept should not be used as a justification for analyst omnipotence and avoidance of countertransference responsibility. The concept, however, can lead to a deepening of the analytic situation if it is used with caution and respect for the patient's separateness.     

The Immigrant Analyst: A Journey From Double Consciousness Toward Hybridity

In this paper I utilize the concept of “double consciousness” as a framework for theorizing the subjectivity of the immigrant analyst. I invite the reader to journey with me as I deconstruct my experiences as an immigrant analyst in North America in order to depict how “double consciousness” shapes subjectivity. I show that I developed a binary, bifurcated analyst self, despite my wish to become a multicultural analyst who could “stand in the spaces.” This subtly clouded my clinical judgment causing me to side with the immigrant boyfriend of an American patient and to ignore significant differences between myself and a French patient because he too was an immigrant. When I named and processed my “double consciousness” I experienced resignification, my subjectivity was reconfigured, I was able to experience a panoply of selves, a hybrid “me-ness,” and I could recognize and address “double consciousness” in my immigrant patients.     

Conformity Bias: A Fact or an Experimental Artifact?

Upon exploring social psychology’s treatment of the term social influence, a skew towards conformity is noted. This skew points to the tendency of amplifying the effect of conformity and minimizing any other form of social influence and has been termed ‘conformity bias’. This review explores the concept of conformity and tries to examine what conformity entails and how it has been understood (and often misunderstood). It is observed that conformity is not a unitary concept and has various facets to it. Besides identifying key disciplinary features such as methodology and ideology that may be possible causes of this skew, implications of this bias are discussed. Failure to identify and move beyond conformity bias may lead to failure in recognizing real social issues. Therefore, it becomes imperative that researchers be wary of this bias and take steps to consciously overcome it.     

The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

Discrimination of visually perceived intervals of time

The discrimination of short intervals of time, demarcated by a foveally presented spatially distinct double pulse of light, was studied under several conditions of pulse intensity, angular diameter, and duration. We defined temporal acuity as a measure of discrimination capacity in terms of d′ values. It is shown that the acuity mechanism uses largely integrated information—in the spatial and temporal domain, up to at least 56′ and 32 msec, respectively. Acuity increases slightly with increasing integrated pulse energy, but seems quite independent of the presence of an adapting field of appreciable brightness. Studies on the effect of the foveal site aimed at by the pulses of light have shown that temporal projections lead to significantly poorer acuity values than nasal projections. Monoptic and dichoptic stimulation, however, are fully equivalent.     

Normativity unbound: Liminality in palliative care ethics

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill.     

Development of the concepts of energy conservation and entropy

Development of the concepts of energy conservation and entropy was studied in children between 5 and 15 years of age. Energy conservation, as illustrated by the operation of double and colliding pendulums, was not well understood until about 15 years of age. Understanding of entropy was dependent on the particular apparatus used. When illustrated by the gradual mixing of rolling marbles of different colors, entropy was understood by 9- to 15-year-olds. But when illustrated by the eventual equalization of water levels in two interconnected containers, entropy was not well understood until about 15 years of age. Errors on a problem used to illustrate the conservation concept could often be characterized by the misapplication of the entropy concept and vice versa.     

Lifespan extension and the doctrine of double effect

Recent developments in biogerontology—the study of the biology of ageing—suggest that it may eventually be possible to intervene in the human ageing process. This, in turn, offers the prospect of significantly postponing the onset of age-related diseases. The biogerontological project, however, has met with strong resistance, especially by deontologists. They consider the act of intervening in the ageing process impermissible on the grounds that it would (most probably) bring about an extended maximum lifespan—a state of affairs that they deem intrinsically bad. In a bid to convince their deontological opponents of the permissibility of this act, proponents of biogerontology invoke an argument which is grounded in the doctrine of double effect. Surprisingly, their argument, which we refer to as the ‘double effect argument’, has gone unnoticed. This article exposes and critically evaluates this ‘double effect argument’. To this end, we first review a series of excerpts from the ethical debate on biogerontology in order to substantiate the presence of double effect reasoning. Next, we attempt to determine the role that the ‘double effect argument’ is meant to fulfil within this debate. Finally, we assess whether the act of intervening in ageing actually can be justified using double effect reasoning.     

2001 SEYMOUR B. SARASON AWARD ADDRESS: The Spirit of Community Psychology

Community psychology as a field may have lost some of its original spirit; a spirit dominant at the founding of the field. Spirit is a difficult concept to discuss since it is a concept beyond usual discourse in psychology as a denotative, measurable and verifiable concept. Taking the lead from William James, Spirit, however elusive, is most essential to a sense of self. I offer three suggestions to enhance and to make our individual and collective spirit more vital: (1) Continuing education in the history of community psychology; (2) Creating time to share stories about our work; (3) Creating safe settings to enlarge our spirit. These ideas are offered as pragmatic suggestions to enable us to create more coherence between our personal and professional selves.     

妇产科临床决策中的辩证思维

妇产科临床实践中处处可以体现辩证唯物主义哲学原理的作用,以辩证的思维去认识妇产科疾病,树立整体观念、认清病情发展的主要矛盾、建立个体化治疗的概念、认识疾病的本质、建立疾病预防的观念、密切关注病情的发展变化,有利于正确的,临床决策。     

Trauma and the Wise Baby

This paper expands upon Ferenczi's concept of the wise baby and explores the dynamics of ignorance and compensatory ideals of wisdom as reactions to trauma and as manifestations of "double conscience," shame dynamics and Oedipal shame. Focusing on feelings of ignorance, of knowing and not knowing and their relation to trauma, the author elaborates on the dynamics of fantasies of wisdom, adumbrating implications for psychoanalytic technique.     

OVERT AND COVERT RECOGNITION OF FACES IN CHILDREN AND ADULTS

Abstract— There has been considerable recent interest in covert face-recognition effects. In Experiment 1, we adapted a paradigm, previously shown to produce covert recognition effects, to test 5-year-old children. Classmates' photographs served as the familiar faces. Children showed effects of familiarity on face matching similar to the effect normal adults and prosopagnosics had previously shown for famous faces In Experiment 2, we investigated whether brief familiarization with the photographs used in Experiment 1 would suffice to produce the effects, in children and adults. It did not, even though the exposure did lead to above-chance overt recognition. Taken together with previous studies, the data suggest that covert recognition may be doubly dissociable from overt recognition. Finding a double dissociation would place constraints on models of face recognition.     

Jung's concept of the archetype: An existential phenomenological reflection

Abstract

The concept of the archetype became the central focus of Jung's analytic psychology. This paper will present some phenomenological reflections on this concept. It will first reason that the archetype is not a phenomenologically acceptable concept by drawing upon the absolutely unconscious nature of the archetypes, their independence from the individual's intentionaliry, and their separateness from Dasein. The paper will then argue that what Jung refers to as “archetypal” images, ideas, and experiences do have phenomenological value. As data pursuant to a phenomenological analysis, they may lead to a better understanding of those psychological experiences that may be common to all of humanity.     

The Return of Dissociation as Absence within Absence

My aim is to translate Ferenczi’s central concepts of the intrapsychic impact and imprint of early developmental trauma into both revived and contemporary conceptualizations. The concept of dissociation was renounced by Freud, yet it is returning as a cornerstone of recent trauma theories. Ferenczi used the concept of “repression,” but used it in the sense of an intrapsychic imprint of early external trauma that fragments consciousness, that is, as dissociation. Furthermore, early trauma is double: an absence of protection that threatens existence of the self, combined with an absence of attachment and of recognition of this threat and terror; thus it is an absence-within-absence. This contemporary conceptualization entails a widening of the intrapsychic realm to include an intersubjective one, and regards dissociation as a unique and complex intrapsychic absence, which is a negative of the external absence-within-absence in the early environment.     

亲子依恋、自我概念与大学生自我伤害的关系

以广州市四所高校562名大学生为被试,检验了亲子依恋、自我概念与自我伤害之间关系的三种模型,以讨论其内部关系。结果表明：1）父子依恋和自我概念、母子依恋和自我概念均对自我伤害行为具有保护作用,支持了累加效应模型;2）父子依恋和母子依恋均通过自我概念的部分中介作用对自我伤害产生间接影响,支持了中介效应模型;3）父子依恋和母子依恋对自我伤害的保护作用在低自我概念组中明显,支持了保护因子-保护因子排除假说。