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。     

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”。     

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。     

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.     

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。     

个人目标相关性对非临床抑郁者未来想象的影响

通过两个实验考查了非临床抑郁者未来想象的异常是否受到个人目标相关性的调节。实验1采用未来想象任务, 实验2采用可能性评估范式, 两个实验一致发现, 抑郁倾向者想象未来积极事件的异常, 受到了与个人目标相关性的调节：相对于非抑郁倾向者, 抑郁倾向者对未来与个人目标相关的积极事件的预期减弱, 而对未来与个人目标无关的积极事件的预期则没有表现出异常; 同时还发现, 抑郁倾向者表现出了对未来消极预期的普遍增强, 不受与个人目标相关性的影响。     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

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.     

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     

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。     

吸烟利弊权衡对戒烟计划的预测作用：一个有调节的中介模型

考察吸烟利弊权衡对戒烟计划的预测,以及戒烟意愿的中介作用和未来取向的调节作用。对340名吸烟者进行问卷调查结果的统计分析发现：（1）吸烟利弊权衡显著正向预测戒烟计划;（2）戒烟意愿对吸烟利弊权衡和戒烟计划的关系起完全中介作用;（3）未来取向负向调节吸烟利弊权衡和戒烟计划的关系,但对吸烟利弊权衡和戒烟意愿关系的调节不显著。这些结果说明,吸烟者戒烟计划发展经历前决策和前行动阶段,且该过程受未来取向的调节。     

Discipleship Transforming the World: A Coptic Orthodox Perspective

Discipleship is the core of Christianity, based on the work of the Holy Spirit, in fulfilment of the Lord's command. True discipleship is capable of transforming the world, so that in the end all kingdoms and reign shall be to the Lord and his Christ. Therefore, discipleship is linked with evangelism, missionary, teaching, and social work. With the emerging hostile trends all over the world, faith is endangered. So it is important to remind ourselves of the aim of Christianity for humanity, for which so great a price was paid by our Lord (his precious blood) to bring the world into the knowledge of the truth. We have the privilege and honour to bear the precious name and to declare it to the whole world, even if we suffer for that. Even though this means that we have to bear his cross, to face the challenges, and to resist the powers of evil in the world. The church is aware of its mission, to reveal to the world Christ the lover of humanity, and for this end to serve them – to warn, teach, and guide them – through our behaviour, our acts, and our words. Copts are keen on serving their communities and everywhere they go, are always ready to teach others about the cause of our hope, that they also may enjoy the fruit and the deserts of the blood of Christ. This article honestly records the experience of the Coptic Orthodox Church regarding discipleship in practice throughout its history up to the present day.     

MOURNING THE LOSS BUILDS THE BOND: PRIMAL COMMUNICATION BETWEEN FOSTER,ADOPTIVE, OR STEPMOTHER AND CHILD

In this article, a particular source for the gifts and agonies of non-biological mothering bonds will be examined, namely the losses both mother and child bring to the new bond-building endeavor. As many women choose non-biological parenting because they are unable to have children of their own, the degree to which they grieve their loss is a factor in their capacity to fully attach with foster, step or adoptive children. On the other side of the connection, many agonies that mothers endure result from the use of projective identification by the child to communicate the devastating feelings due to losses experienced prior to engaging with this new caretaker. The child, too, needs to make peace with these losses, to have them acknowledged so that s/he can move on to new developmental pains and gains. On neither side of the interaction can the attachment process be taken for granted: both mother and child have to work at belonging to one another. Often the feelings which permeate the intersubjective space between mother and newly-claimed child seem like insurmountable obstacles because of their unconscious, primitive or preverbal nature.The mother may be called upon to contain and bear witness to the child's profound distress, which can undermine her confidence as a mother. Similarly the child may be subject to the mother's unconscious fantasies about the child she wished she'd had, and experience the futility of living up to such expectations.This piece is an attempt to delineate the pitfalls, due to not-yet-mourned losses, on the way to mutual recognition on the part of mother and child in non-biological bonds.     

‘Can you push a camel through the eye of a needle?’ Reflections on how the unconscious speaks to us and its clinical implications

There has been a recent surge of interest in a type of thinking seen in some patients most of the time, and all patients some of the time. In the past it was simply called regressive thinking, but attempts to be more specific have led it to be called by various names, like 'pre-symbolic', 'pre-conceptual' and 'pre-operational'. What these labels attempt to capture is that the patient's thinking, at these times, is without representations and closer to actions. As a clinical phenomena I prefer to use Loewald's term, 'action–language', that is, where words become attempts to bore, seduce, anger, etc. It is different from when words are used to communicate internal states via free association. A case is made for action–language being the primary method by which the unconscious speaks to us in psychoanalytic treatment. This paper explores some of the reasons for this type of thinking, along with the clinical methods to find the thinker where there appears to be none. Distinctions will be made as to the use of the process versus the content, on the goal of interventions as bringing insight versus the capacity for insightfulness, and the model of treatment as leading to transformations in thinking, rather than lifting of repressions. A clinical example is presented to demonstrate these perspectives.     

Bringing critical social psychology to the study of political polarization

The study of political polarization, in both its ideological and its affective expressions, has garnered significantly more interest over the last years. But despite recent research on the conceptualization, measurement, causes, and consequences of this socio-political phenomenon, and some tentative interventions to mitigate it, relevant new avenues remain surprisingly underdeveloped. Indeed, scholarship in the field of political polarization, mainly in the case of affective polarization, frequently uses cognitivist approaches to make sense of the growing antipathy between different social and political groups. However, the bulk of this work seems to overlook valuable insights into the psychology of intergroup conflict, stereotyping, prejudice reduction, and discourse studies. The aim of this paper is to underline the main gaps in the political polarization literature, to subsequently argue how knowledge linked to the tradition of critical social psychology can help in filling them. Ultimately, the article aims to contribute to the psychosocial study of political polarization and to the design, if necessary, of interventions to counter its detrimental consequences.     

Psychoanalysis as science: the inductivist's resistance revisited

The scientific status of psychoanalysis has been the focus of heated debates among philosophers of science and among psychoanalysts. The most recent challenge to psychoanalysis as a science comes from the quarters of the inductivist philosophy of science. Since inductivism is a self-defeating philosophy, it is not surprising that inductivists demand that psychoanalysts pay an unlimited price for their claim of scientific status for psychoanalysis. Most psychoanalysts, in their response to this impossible challenge, unwittingly claim to have paid the price. What is worse, the claim is made in a confused and emotionally charged manner. Hence, psychoanalysts are usually defensive and, thus, in error when repelling (in this way) the attack of the inductivist philosopher. It is not psychoanalysis inductivists attack, but their own commitment to their own logic which leads inexorably to the dissolution of their argument, of all science, and, indeed, of psychoanalysis as well. It seems much more reasonable to postpone any response to the challenges that confront psychoanalysis today and to invest effort in a reformulation of the problem of the scientific status of psychoanalysis. Different rational solutions to the problem may evolve if we take care to become well informed first about the limits of our theoretical frameworks and show readiness to change them, if and when needed. That is to say, we can start with a somewhat tentative, not to say skeptical, frame of mind concerning the very concept of scientific status. We may try to keep and to contain our skepticism to the degree required by the discourse at hand, carry on exploring in our practice, report our results, and discuss them respectfully. We should start by admitting that, quite possibly, our discourse will end inconclusively.     

Confucianism and the Idea of Citizenship

Does Confucianism have anything to contribute to the idea and practice of citizenship? Many critics would argue that it does not, on the grounds that it is inhospitable to values such as individuality, individual rights, equality and democracy. However, these grounds have to be severely qualified. Furthermore, there is no single conception of citizenship, even though the liberal conception stands out as, probably, the most influential one. Recently in the debate on citizenship, many commentators have been highly critical of the liberal conception, precisely for its uncompromising emphasis on individuality and individual rights, which tends to produce a political practice that fails to bring about equality and democratic values. Confucianism has much to contribute to the critique of the liberal conception of citizenship, as well as to the construction of a more viable conception, one that has a better chance to cope with the effects of globalisation.     

基督徒祷告过程中人神依恋关系的质性探索

采用质性研究方法探索基督徒祷告过程中人神依恋关系的形成与发展。研究者以“局外人”身份, 采用逐步暴露方式进入研究现场开展客位研究。运用强度抽样方式和综合式抽样策略, 抽取14名(男女各7名)正式受洗(受洗时间从2年到32年不等)的基督徒作为样本, 通过深度访谈收集资料; 运用扎根理论对收集到的资料依次进行初步分析、类属分析和理论建构; 运用参与者检验法、非参与者检验法对研究结果进行效度检验。研究得出以下结论：祷告是基督徒以“信靠”作为承诺, 向上帝袒露心迹, 提出心理诉求, 进而与上帝建立亲密关系的沟通方式和重要渠道, 它提供了人神依恋系统被激活的情境。“信靠”是基督徒通过祷告与上帝之间形成和发展人神依恋关系的前提条件和关键因素; 人神亲密度的增加又反过来促进人对于神的信靠程度。现实生活的困难为基督徒祷告提供了刺激源, 并推动人神依恋关系不断向前发展。基督徒的祷告经历了三个阶段, 由Ⅰ期向Ⅲ期水平渐次提升, 最终形成“以上帝为中心”的困难应对图式。在此过程中, 随着“上帝”的观念越来越深地植入基督徒的自我, 有关“上帝”的心理表征不断得到强化, 相反, 有关“自我”的心理表征渐次弱化, 最终进入某种“无我”的状态。     

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.