治疗决策十题

治疗决策是临床决策中的重要组成部分。为了提高治疗决策水平,临床医生可以从以下几个基本环节入手深究决策依据、明确治疗目标、坚持疗效优化、强调安全第一、注意条件约束、注重时效原则、突出救治重点、减损方案危害、分析失悔程度和了解敏感阈值。     

从认知逻辑视角看西方伦理学的发展

本文希望从认知伦理学的视角出发探讨伦理学的发展,以及人类对道德问题认知的过程与人类一般认知的逻辑之间的一致性。人类认知的逻辑是由概念到判断再到推论的过程,伦理学史由德性伦理学到规范伦理学再到话语伦理学、元伦理学和新德性伦理学的过程,实际上就是人类在道德认知上从概念伦理学到判断伦理学再到推论伦理学最后回归到概念伦理学的过程。     

论生态学的马克思主义的人道主义

生态学的马克思主义基于对人类命运的关照,立足人道主义,反对以单纯保护生态为目的的生态中心主义和企图转嫁生态矛盾的生态帝国主义;认为资本主义的生产、分配和消费方式是引发生态危机的根源;要想摆脱已经上升为人和自然之主要矛盾的生态危机,不仅需要建立“无增长的”经济模式,倡导“劳动闲暇一元论”和日常生活的“简朴主义”,根除虚假需求,克服异化消费,使生产过程分散化、民主化和管理科学化,变控制自然为解放自然,提倡技术为全人类服务,使生态学充满人道主义,而且需要根除资本主义生产的利润动机,杜绝独裁主义的政治和生产逻辑,反对技术法西斯主义,最终废除资本主义制度,建立非极权的、更易于生存的、以实现生态与社会和谐发展为目标的“稳态社会主义”。     

启新、拓新与创新——论生态伦理学对伦理学的贡献

构建和谐社会,必须弘扬生态伦理,繁荣生态伦理学。生态伦理学对伦理学的贡献功不可没,主要体现为：开辟了伦理学研究的新领域,确立了处理人与自然关系的新原则,培育了人对自然的新态度,对传统思想展开了新的系统批判,明确了人类在自然生活中扮演的新角色,对伦理学基本观念进行了新阐释,制定了人类行为新规范。     

Zur Dynamik der Interaktion in der Supervision

The manifold functions of a supervisor in following the course of complex processes together with the trainee, are: ? to keep the goals of the supervision in view, ? to establish a teaching alliance and to support the wish and ambitions of the candidate to learn, ? to build a platform for the complex interactions with the trainee with regard to the dynamics of the training situation and keeping in mind the institutional influences, ? to lay down the setting for the work, ? to explore and to reflect how transference and counter-transference influence the interaction between patient and analyst as well as between trainee and supervisor, ? to examine these interactions together focussing continuously on the interaction between candidate and patient, and to encourage the candidate to do the same on his own, ? to continuously formulate hypotheses about the core conflict, the transference phenomena and resistance of the patient, ? to explore and reflect on the cooperative work.     

Klein's Archaic Oedipus Complex and Its Possible Relationship to the Myth of the Labyrinth: Notes on the Origin of Courage

The ancient Greek myth linking the images of the labyrinth and the Minotaur provides an allegory for Melanie Klein's conception of the archaic Oedipus complex as well as a vivid illustration of Winnicott's notions of object usage and the 'subjective object'. The labyrinth is suggestive of mother's body as the first area for an infant's exploration and putative sadistic conquest. The Minotaur, in turn, suggests the infant's unconscious phantasies about the content of mother's body, namely such projective identifications onto that body as the paternal penis and the 'internal babies'. Further, the heroic dynamic personified by Theseus in the myth of the labyrinth metaphorically signifies what is here proposed as a developmental line that involves the courage to do a number of things, including to become, to create, to seek, to explore, to do, to challenge, to undertake risks, to accept, to rescue, to initiate, to think, to know and to realize. The Minotaur can thus be thought to serve as a universal subjective signifier for an 'Object of Challenge', which, if not successfully dealt with by the ego-development of the infant, transforms that default into the 'Object of Nemesis'. Ultimately, this myth of mastery speaks to the psychoanalytic process itself as well as casting light on the transformative aspects of sexual intercourse as a personal healing ritual.     

Discussion of Dominique Scarfone’s Paper, “On ‘That Is Not Psychoanalysis’: Ethics as the Main Tool for Psychoanalytic Knowledge and Discussion”: Terminable and Interminable Discussion

When we ask ourselves if psychoanalysis is a science and what type of science it is, we raise many questions related to the notion of faithfulness. For instance, we might ask what it means to be faithful to a text, to the essence of an author’s writings, or to his or her creative power. If being a psychoanalyst means, at the very least, being able to translate the other’s thoughts, one of the difficulties of this task lies in what we call the complexity of translation. Analysts translate, interpret, interfere with the thoughts of the other in order to open up new paths, to offer themselves as a projection screen, or to try to create a link between two subjects so as to make room for the present, which is sometimes erased by history. To elucidate some of these issues, Scarfone (this issue) focuses on a discussion on the ethics of the analyst and of psychoanalysis     

Joy in the Midst of Suffering: Clowning as Care of the Spirit in Palliative Care

SUMMARY

We find joy in the midst of suffering at Daw House, a palliative care unit. Stories, ranging from moments of gentle tenderness to wild hilarity, speak of profound joy and of the courage of those who participate. We articulate some of the why and how of caring clowning. Clown Doctors aim to affirm people as people with richly storied lives, to give permission for both laughter and tears, and to bring consolation to the spirit. The art of clowning means that we seek to elevate people, to sensitively tailor music, touch, and colour to the interests of those we encounter, to invite a sense of wonder and spontaneity and to work to transform situations through the imagination.     

Attachment style and subjective motivations for sex

The relation of attachment style to subjective motivations for sex was investigated in an Internet survey of 1999 respondents. The relations of attachment anxiety and avoidance to overall sexual motivation and to the specific motives for emotional closeness, reassurance, self-esteem enhancement, stress reduction, partner manipulation, protection from partner's negative affect and behavior, power exertion, physical pleasure, nurturing one's partner, and procreation were explored. As predicted, attachment anxiety was positively related to overall sexual motivation and to all specific motives for sex, with the exception of physical pleasure. Avoidance was negatively related to emotional closeness and reassurance as goals of sex and positively related to manipulative use of sex but minimally related to most other motives. Sexual passion was positively related to attachment anxiety and negatively related to avoidance, and anxiety was related to the maintenance of passion over time, whereas avoidance was related to loss of passion over time.     

Individualism-Collectivism and Personality

This paper provides a review of the main findings concerning the relationship between the cultural syndromes of individualism and collectivism and personality. People in collectivist cultures, compared to people in individualist cultures, are likely to define themselves as aspects of groups, to give priority to in-group goals, to focus on context more than the content in making attributions and in communicating, to pay less attention to internal than to external processes as determinants of social behavior, to define most relationships with ingroup members as communal, to make more situational attributions, and tend to be self-effacing.     

The compulsion to confess and the compulsion to judge in the analytic situation

In this paper the author shows that human beings have two quasi‐instinctual primitive tendencies – namely, the compulsion to confess and the compulsion to judge (to condemn or to absolve). These compulsions are originally unconscious and become conscious during the course of the analytic process. The compulsion to judge is a natural consequence of the compulsion to confess. These two tendencies are intensified by the analytic situation. The patient has a compulsion to confess to the analyst and to himself, and likewise the analyst has a compulsion to confess to himself and to the patient. The patient therefore has a compulsion to judge himself as good or bad and to judge the analyst as good or bad while, on the other hand, the analyst has a compulsion to judge himself as good or bad and to judge the patient as good or bad. The task of analysis is to make both patient and analyst conscious of their compulsions to confess and to judge (to condemn or to absolve). The compulsion to judge in the analyst, particularly if unconscious, may give rise to mistakes in diagnosis, technique, treatment, and the assessment of analysability. The requirement of analytic neutrality in the analyst constantly conflicts with his compulsion to judge. If we are profoundly involved in our patient's dramatic conflict, we are bound to pass a judgement (condemnation or absolution); however, when we judge, we are not neutral and therefore become incapable of intellectual consciousness of the patient's conflict. Conversely, if we do not judge, we are neutral, but are then relatively uninvolved in the patient's conflict and are hence virtually unable to achieve emotional consciousness. The author attempts to show that neutrality cannot and must not be a preconstituted attitude in the analyst, but can and must be a point of arrival following a profound, intensely felt existential experience based on an attitude of non‐condemnation and non‐absolution.     

我国乙型肝炎病毒携带者健康权现状分析

乙型肝炎病毒携带者健康权包括医疗保障权、劳动权、受教育权以及包括婚姻、家庭、社会交往在内的其他生活平等权。本文分析了我国乙肝携带者健康权现状,对我国近年来的乙肝维权工作进行回顾,并从减轻医疗费用负担、规范医疗市场、完善法律法规、推动非政府组织的发展等方面对维护和保障乙肝携带者健康权提出建议。     

What If? The Farther Shores of Neuroethics

Neuroscience is clearly making enormous progress toward understanding how human brains work. The implications of this progress for ethics, law, society, and culture are much less clear. Some have argued that neuroscience will lead to vast changes, superseding much of law and ethics. The likely limits to the explanatory power of neuroscience argue against that position, as do the limits to the social relevance of what neuroscience will be able to explain. At the same time neuroscience is likely to change societies through increasing their abilities to predict future behavior, to infer subjective mental states by observing physical brain states (??read minds??), to provide evidence in some cases relevant to criminal responsibility, to provide new ways to intervene to ??treat antisocial brains,?? and to enhance healthy brains. Neuroscience should make important cultural changes in our special, and specially negative, views of ??mental?? versus ??physical?? illness by showing that mental illness is a dysfunction of a physical organ. It will not likely change our beliefs, implicit or explicit, in free will, or spark a new conflict between science and religion akin to the creationism controversy.     

推进新时代中国社区心理学新形态建设

建设中国特色的社区心理学是时代的呼唤和要求。在党的二十大精神指引下,新时代中国社区心理学需要坚持中国化时代化的马克思主义为指导以推进理论建设;以新时代社区心理建设为场域,助力社会主义核心价值观培育;构建新时代中国社区心理学服务路径,助推人民共同富裕。总体而言,中国特色社区心理学的理论建设与实践探索需要关注新时代社区发展中涌现出的新问题,提出解决中国社区发展问题的中国办法和中国方案,努力推进中国社区心理学新形态的建设。     

Psychological and behavioral implications of connectedness to communities with opposing values and beliefs

Without a doubt, people can feel simultaneously connected to multiple communities (e.g., Deaux, 1993; Roccas & Brewer, 2002). But, to what degree can people feel simultaneously connected to communities with opposing beliefs and values? And, more importantly, what are the psychological implications of being dually connected to these communities? Capitalizing on a sample of individuals positioned to potentially feel connected to two very distinct communities, we examined jail inmates' (N = 256) sense of connectedness to the criminal community and to the community at large. Results indicated that (a) connectedness to the community at large is orthogonal to connectedness to the criminal community, supporting the supposition that it is possible to be dually connected to opposing communities; and (b) connectedness to the community at large moderated the relationship between criminal connectedness and indicators of psychological distress, suggesting that connectedness to the criminal community is especially problematic when it occurs in tandem with connectedness to the community at large. These findings are consistent with predictions from the self-expansion model.     

“Bodyheartminding” (Xin 心): Reconceiving the Inner Self and the Outer World in the Language of Holographic Focus and Field

In this essay, inspired by the somatic turn in philosophy initiated by Richard Shusterman, I want to invoke the language of classical Confucian philosophy to think through the best efforts of William James and John Dewey to escape the mind-body and nature-nurture dualisms—that is, to offer an alternative vocabulary that might lend further clarity to the revolutionary insights of James and Dewey by appealing to the processual categories of Chinese cosmology. What I will try to do first is to refocus the pragmatist’s explanation of the relationship between mind and body through the lens of a process Confucian cosmology. And then, to make the case for James and Dewey, I will return to the radical, imagistic language they invoke to try and make the argument that this processual, holistic understanding of “vital bodyminding” is in fact what they were trying to say all along.     

Reasons-responsiveness and degrees of responsibility

Ordinarily, we take moral responsibility to come in degrees. Despite this commonplace, theories of moral responsibility have focused on the minimum threshold conditions under which agents are morally responsible. But this cannot account for our practices of holding agents to be more or less responsible. In this paper we remedy this omission. More specifically, we extend an account of reasons-responsiveness due to John Martin Fischer and Mark Ravizza according to which an agent is morally responsible only if she is appropriately receptive to and reactive to reasons for action. Building on this, we claim that the degree to which an agent is responsible will depend on the degree to which she is able to recognize and react to reasons. To analyze this, we appeal to relations of comparative similarity between possible worlds, arguing that the degree to which an agent is reasons-reactive depends on the nearest possible world in which given sufficient reason to do otherwise, she does so. Similarly, we argue that the degree to which an agent is reasons-receptive will depend on the intelligibility of her patterned recognition of reasons. By extending an account of reasons-responsiveness in these ways, we are able to rationalize our practice of judging people to be more or less responsible.     

Comment réagir face à une situation de harcèlement à l’école ? Une synthèse de la littérature

Bullying affects a significant number of students and can have serious negative consequences in terms of physical and mental health. It is, therefore, necessary for education staff to know how to respond effectively to stop it. However, this does not always seem to be the case at present. The purpose of this article is to describe six commonly used reactive approach (direct sanctions, restorative practices, reinforcement of the victim, mediation, the support group method, and the shared concerns method), as well as to synthesize the scientific knowledge regarding the effectiveness of each of these approaches. It emerges that no approach appears to be particularly effective in all cases and that it is therefore necessary for professionals to be trained to be able to choose the appropriate approach according to the situation.     

Response of the rat brain beta-endorphin system to novelty: importance of the fornix connection

In control rats, a step-down inhibitory avoidance training trial using a 0.8 mA footshock, or simple exposure to the training apparatus without footshock, was followed by a decrease of beta-endorphin-like immunoreactivity measured in the hypothalamus and ventral thalamus. The effect of inhibitory avoidance training was also measured in rats submitted to a brain sham operation, to bilateral transection of the dorsal fornix, to anterior or to posterior hypothalamic deafferentation, to adrenal medullectomy, to an adrenal sham operation, to 16 daily ip injections of 0.2 mg/kg dexamethasone, or to 16 daily ip injections of 1 ml/kg saline. The diencephalic beta-endorphin-like immunoreactivity response to training was abolished by fornix transection and was unaffected by all other treatments. This suggests that the response is not mediated by anterior or posterior neural afferents to the hypothalamus, or by a hypersecretion of epinephrine by the adrenal medullae, or of ACTH by the pituitary gland. The response, instead, appears to require the integrity of the pathway that sends projections from the septo-hippocampal system to the hypothalamus. Previous evidence had suggested that the diencephalic beta-endorphin-like immunoreactivity response to training is a result of novelty, and the septo-hippocampal system has been postulated to play a role in the registration of novelty.     

Public prejudice as collaborative accomplishment: towards a dialogic social psychology of racism

Existing social psychological perspectives tend to overlook the fact that public expressions of racial, ethnic or national prejudice normally constitute collaborative accomplishments, the product of joint action between a number of individuals. Awareness of the inherently dialogical character of prejudiced talk affords appreciation of the ways in which expressions of ethnic or racial antipathy need not simply be used to display a speaker's private attitudes or to defend a group position, but may also be oriented to the local context of talk in action. Recognizably prejudiced talk may be used to claim the floor, to bully, to amuse, to shock, to display intimacy and solidarity, to mark a variety of personal and social identities or to key the informal, backstage, character of a social encounter. The fact that prejudiced talk can be intricately woven through the delicate choreography of everyday sociability may greatly complicate any attempts to challenge it. Copyright © 2006 John Wiley & Sons, Ltd.