„ Den Alkoholiker“ gibt es nicht

Zusammenfassung:  Im Gegensatz zur lange vorherrschenden Konzentration auf die Behandlung des Entzugs und der Abh?ngigkeit, haben sich durch neuere Befunde Tendenzen entwickelt, die Therapie Alkoholabh?ngiger wieder st?rker auf die tats?chlichen individuellen Hintergründe auszurichten. Besonders hilfreich für eine verbesserte therapeutische Transparenz erwiesen sich die aktuellen Erkenntnisse neuro-biologischer Befunde. Damit erkl?ren sich viele bisher r?tselhafte Hintergründe einer Abh?ngigkeitsbildung und suchtbedingte Stereotype, speziell „Craving“ (massives Alkoholverlangen) und die krisenhaften Turbulenzen und Rückfallstendenzen auch nach l?ngerer Abstinenz. Die süchtige Umprogrammierung des mesolimbischen Belohnungssystems macht auch die rasche Reaktivierung des Abh?ngigkeits-prozesses bei neuerlichem Alkoholkonsum besser verst?ndlich. Da allerdings zu akzeptieren ist, dass die neurobiologischen Ver?nderungen keinesfalls die Ursache, sondern erst die Konsequenz einer süchtigen Umprogrammierung darstellen, muss sich die therapeutische Aufmerksamkeit wieder vermehrt auf die individuellen Hintergründe einer Suchtentwicklung fokussieren: Spezielles Interesse gilt hier schon seit l?ngerem den pathologischen Mustern der überanpassung und Selbstentwertung, die sich als Folge einer Dekompensation des Selbstwertregulationssystems entwickeln. Zahlreiche Befunde weisen darauf hin, dass gerade der Versuch, Selbstwertprobleme, permanente Verunsicherung und soziale ?ngste mit Alkohol zu „behandeln“, ein deutlich erh?htes Abh?ngigkeitsrisiko bewirkt. Daraus ergibt sich die Aufgabe einer zus?tzlichen therapeutischen Ver?nderung derartiger Hintergrundfaktoren, da andernfalls eine Alkoholrückf?lligkeit auf dem Boden dieser Muster programmiert w?re. Die somit gegebene Vielfalt individueller Entwicklungsfaktoren und Verlaufsbilder best?tigt auch eindrucksvoll die inzwischen weitgehend akzeptierte Not-wendigkeit einer syndrombezogenen und verlaufsorientierten Individualisierung der Langzeittherapie und damit eine Abkehr von kategorial orientierten, kollektiven Behandlungskonzepten.

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Summary:  In contrast to the long prevailing concentration towards the treatment of withdrawal symptoms and addiction, latest experiences and medical findings support tendencies towards individually designed treatment concepts, taking into consideration individual root causes. Recent consolidated findings in neurobiology have proved valuable for an improved therapeutic understanding since puzzling processes in the development of addiction, as well as the context and dynamic of addictive stereotypes, the phenomenon of craving and critical turbulences can now be explained. Furthermore, it is now better understood, why the mesolimbic gratification system reprogrammed with addictive features can provoke relapse and the recurrance of addictive behaviour immediately after reuptake of alcohol consumption. Since those neurobiological findings mentioned above have to be considered a consequence of addictive processes, the instances leading to the primary onset of addictive behaviour have to be brought into the therapeutical focus. Here, special emphasis has been placed on pathological behavioural patterns such as over-conformity and self-devaluation which might develop after decompensation of the self-concept regulation system. On-site findings in diverse fields of addiction research point towards an increased risk of self medication efforts as compensation efforts of self-worth problems, personal instability or social anxiety. As a result, any therapeutic intervention would intend to alter such background factors since they might be seen as elevated risk potential for relapse. The highly visible diversity of possible alternatives regarding developmental factors and aetiopathology impressively supports the widely accepted necessity for individually designed syndrome, as well as process-oriented, treatment concepts, thus abandoning categorically oriented universal approaches.

     

Working with “Difficult” Patients: An Interview with Jorge García Badaracco

Jorge García Badaracco's pioneering work is well-known in his native Argentina, but not so much elsewhere. Since he was appointed as Director of a service in the Borda Buenos Aires Neuro-Psychiatric Hospital in 1959, García Badaracco started to make use of all available resources to overcome the many problems that the analysis of "difficult patients" (often psychotic) entails. In later years, he developed his ground-breaking "multifamily groups", that is, therapeutic groups that included patients, their relatives, nurses, members of the staff, and that offered the possibility to work simultaneously, in one single therapeutic intervention, on the individual, familiar, and social dimension of the mind. In this interview with García Badaracco, Francesca Viola Borgogno introduces the reader to this distinguished figure, as well as to some of his most original theoretical and clinical concepts, such as "the maddening object", "the pathological and pathogenic interdependence", "the healthy virtuality", and so on.     

Depressive symptoms in Friedreich ataxiaSíntomas depresivos en la ataxia de Friedreich

Background/Objective: Almost no attention has been paid to depression in Friedreich ataxia (FRDA), a highly disabling cerebellar degenerative disease. Our aim was to study the presence and the profile of depressive symptoms in FRDA and their relationship with demographic-disease variables and cognitive processing speed. Method: The study groups consisted of 57 patients with a diagnosis of FRDA. The Beck Depression Inventory-II was used to assess symptoms of depression. Speed of information processing was measured with a Choice Reaction time task. Results: The mean BDI score for patients was significantly higher than the mean score in the general population. Twenty one percent of participants scored in the moderate/severe range. A Cognitive-Affective score and a Somatic-Motivational score was calculated for each patient. Patients’ scores in both dimensions were significantly higher than the scores in the general population. Demographic and disease variables were not related with symptoms of depression, except for severity of ataxia. Depressive symptoms predict cognitive reaction times. The greater proportion of variance was explained by the Cognitive-Affective dimension. Conclusions: Our data show that both somatic-motivational and cognitive affective symptoms of depression are frequent in individuals with FRDA. In addition, depressive symptoms may influence cognition, especially, the cognitive and affective symptoms.     

Discussion of Jorgelina Corbatta’s “Sexuality,Normality, and Social Terror: XXY by Lucía Puenzo”

Gender is confusing. Sexuality is confusing. Gender and sexuality are confusing and confounding for children, adolescents, and adults. Jorgelina Corbatta (this issue) gives us a glimpse as to how we might think about the complexity and confusion of gender and sexuality by sharing her analysis of the film XXY (Puenzo, 2007). We are grateful to her, both for her fine discussion of these issues and for sharing a poetic work of art that brings so many complicated topics to light.     

“兴”之“景”与“意境”之“境”

从诗歌艺术形象构成的角度看,“兴”与“意境”都是标志艺术本体的审美范畴,都由“情”“景”二元构成。不过“兴”之景只是借以引起其情的“物”,而“意境”之“景”则是“处身其境”的“境”,即主体处身于其中借情感体验过程中酝酿、萌生特定情感和独特感受的生活环境,而且“情”与物”、“意”与“境”生成关系的方式亦不相同。     

“四大”、“五蕴”为何“皆空”

常听人说,“酒色财气”“四大皆空”,以为这就是佛教的主张。稍懂佛教或有一点佛学常识的人,都知道佛教所说的“四大皆空”的“四大”指的是:地、水、火、风,那么,四大又为何“皆空”?空的是什么? 一般较少接触佛教的人都认为“空”很难理解,认为既然有我们的生存环境,一切事物或现象的存在也都是实实在在的,怎么能说是“空”呢?如果一切都归之于空,那     

“地真”“女真”与“真人”

清华简《汤在啻门》中的"地祇"称"地真",容易使人联想到《楚帛书》的"女填"。"女填"应读为"女真",是"女娲"的另一种称法。"地真"和"女真"得名与"真人"有关。真人本指修真得道的人,引申表示圣人、至人或帝王。"地真"和"女真"这种称法是"真"在使用过程中意义泛化的结果,具有明显的道家色彩,对于判别文献的性质有一定参考作用。     

“喂奶”与“喂饭”

前不久,我接到一位姊妹的电话,告诉我,她和另一位姊妹在信仰上遇到了极大的困惑,希望我腾出半天时间,与她们进行一次推心置腹的长谈.几天后的一个礼拜六,我和妻子在约定的地方见到了这两位姊妹.一见面,她们就打开话匣,向我们倾诉.我们之间非常熟悉,所以她们没有任何顾忌,把想说的话都说了出来.     

“撒种”与“收割”

<正>《诗篇》126篇是一篇非常优美感人的诗歌,全诗如下:"当耶和华将那些被掳的带回锡安的时候,我们好像作梦的人。我们满口喜笑、满舌欢呼的时候,外邦中就有人说:‘耶和华为他们行了大事!'耶和华果然为我们行了大事,我们就欢喜。耶和华啊,求你使我们被掳的人归回,好像南地的河水复流。流泪撒种的,必欢呼收割。那带种流泪出去的,必要欢欢乐乐地带禾捆回     

“信心”与“良心”

我一直对“教牧书信”情有独钟，因为我能从中看到牧者应有的操守与修养，从而严于律己，力求成为上帝及肢体心目中的好牧人。因此，每隔一段时间，我就会认真品读“教牧书信”，以便藉此反省过去，正视未来。近日再读“教牧书信”时，我被《提摩太前书》中的一段话深深地打动，不由掩卷沉思，再三品味。     

“胸有成竹”与“胸无成竹”

“与可画竹时,胸中有成竹。”(宋·晁补之《鸡肋集·杨克一学文与可画竹求诗》)文与可,北宋人,以画竹著称。“郑板桥画竹,胸无成竹。”(《郑板桥集·题画》)郑板桥,清初名画家,善于画竹、兰、石。这里提出了     

“银子”与“银字”

清代某地,银袋与钱袋是两个概念．前者是装着银子的袋子,后者是装着铜钱的袋子。同样体积的袋子,银展的价值是钱袋的好多倍。一次,一个住宿的客人拿出一个袋子要店老板寄存。他大声说：“这是钱袋,明天取。”到了深夜,店老板偷偷打开袋子,一看,里面全是白花花的根子．原来,这是客人耍的小跑闻：他见店里人多眼杂,生怕既存后有人贪财,便故意把根系仅u以自袋．店老太dhk巴记研上写的是钱袋”,而给客人的收据上也是“钱袋”,便起了黑心,同老板娘一起用打出自以限子忐勇U任出。第二天,客人见银子变成了铜钱,傻了。官司打到县行…     

“爱心”与“见识”

第六期《天风》在“媒体扫描”一栏中有一篇题为《忧心：乐于助人成‘另类’》的文章,读后很受启发。尤其是编者写的一段“随感”,觉得很有见地。的确是这样,我们不能让这个社会失去诚心和爱而变得越来越冷漠,我们需要付出真善美,去融化假丑恶。既然那些人知道在教堂里能够获得更多一点的爱心,那就让我们这些基督徒凭着自己的力量去证明这一点吧!     

“道理”与“道路”

耶稣说：“我就是道路、真理、生命,若不藉着我,没有人能到父那里去。”（约14：6） 这里的经文特别提到“道路”、“真理”和“生命”,这是基督徒灵陛的三要素。     

“天机”与“人为”

正有一次,家里的地毯用旧了,我卷起来捆好准备丢掉换新的,没想到站在身后的小儿子乐朋,竟大哭起来,叫道:地毯太可怜了,它又不是垃圾,怎么可以丢掉?我被这出奇的同情心怔住,原来七岁的孩子将生活中的物品看成相互依存的朋友;孩子广泛的同情心十分敏锐,其中就含着虚灵的天机。经过后天智能活动的梳理,成人才逐渐失去朴实真切的世界。由此我想起一个天真的小女孩,得意地将母亲以土布手工     

“传统”与“现代”

近年来,很多教会对于崇拜中不同的敬拜方式的讨论,大都纠结于“传统”和“现代”之争。或者说,是对在崇拜中“传统音乐”和“现代音乐”的使用之争。     

“亚”不读“哑”

在第11届亚运会筹备和召开期间,亚运会成了人们最热门的话题。北京更是“满城争说亚运会”,听广播,看电视,开会讨论,谈话唱歌,甚至幼儿园的小朋友作游戏,小胡同里的老太太唠家常,都离不了亚运会。但是,对这个盛会的称呼,北京人却并不一致。有的说Yǎyǜnhuì,有的说Yàyǜnhǜl,即有的人把““亚”读成上声(第三声)与“哑、雅”同音,有的人把“亚”读成去声(第四声),与“哑、雅”不同音。这是什么原因?哪个是标准音呢?