走进病人的真实世界:一场临床思维的革命——读“临床判断:基于病人的真实世界”有感

真实世界理论对医学、生命、疾病的认识,不只限于细胞、分子等微观层次,而是回到人的整体和病人的真实世界。病人的真实世界包括疾病所引起病人主观上的不良感受和客观病态改变,不断探索病人全部的真实世界是生物心理社会模式的体现;大型仪器和检查是病人局部的真实世界,关注病人感受可以便捷、高效扩展医生的横向思维,实现临床医学科学与非科学的统一。有效的医患沟通是进入病人真实世界的唯一途径,能够更多获得病人信息,提高诊疗水平,是医学人文与医疗技术的有机融合;通过不断探索病人的真实世界,可以为病人的叙事奠定基础。     

体验病人痛苦:医学力量的源泉

通过对两个叙事医学案例的详细分析试图表明,叙事医学兼具理论与实践的双重特性,它所企图构建的“医患共同体”不仅可以通过促进医患沟通而使患者在当下获得更有尊严、更高质量的医疗服务,在更深意义上,它可以帮助医者“看见真实之人:从恻隐之心到相互成就”、“看见平等之人:从视域融合到人格认同”。通过体验病人的痛苦从而超越技术主义与“知识-权力”的认知局限,弥合医患分裂,提升甚至成就医者自身,推动实现医学的至高价值。     

抑郁症主要叙事疗法的解析

叙事疗法在治疗抑郁症的过程中,以把人和问题分开的外化思维和“问题从哪里来”的解构思维为基础,从个体监控、家庭监控和社会文化层面的监控三个视角,去追溯困扰抑郁症来访者问题的源头。从而可以有距离地看待“抑郁症”这个问题,提高患者对抑郁症的掌控感和力量感。叙事疗法从患者生命中的闪光点着手,通过寻找抑郁症患者生命中的独特结果,重塑、改写和丰厚抑郁症患者想要的生命故事,从而重建患者的自我身份认同,开启崭新的生命历程,带着新的自我身份认同,从而应对生命中的问题和困难。     

奥斯勒的生命书写及其叙事意义

叙事具有强大的人文和人际功能,它能促使主体之间更有效地实现认知上的共识。居丧者的哀伤历程和罹患疾病的患者接受自己生病身份的过程是一个需要通过见证、续写或改写故事来重构人生意义的过程。从奥斯勒创设天堂来信帮助作为居丧者和患者的妻子格蕾丝克服心身疾痛这个故事,发现叙事素养能够帮助临床语境下的多方主体之间构建“同声相应,同气相求”的生命共同体关系。从叙事医学的角度而言,医学是一门综合性的艺术。在“医学是不确定的科学与可能性的艺术”的基础上,医学实践可以理解为需要科学技术知识和叙事人文素养合力的“应用型科学和关系性艺术”。     

基于叙事医学的人文医学实践教学体系建构——以《温暖的医学》课程为例

叙事医学强调叙事能力的养成从而为医学人文的落地和人文医学的实践提供路径。《温暖的医学》基于叙事医学理论,设计了覆盖“生•老•病•死”全生命周期的两层进阶式实践教学体系,将叙事医学能力培养和临床实践有机结合,在实际医疗场景中锻炼医学生运用叙事医学理念和工具,围绕“生物−心理−社会”三个层面开展观察和反思,并做出回应和行动。实践教学提升了医学生对医学本质的理解,促进了医疗关系中主体间性的建立及全人医学诊疗思维的形成。该课程的设计和建构在医学人文课程教学的系统化、规范化、标准化方面也开展了有益的探索。

     

叙事取向团体辅导对大学生自我认同的干预研究

自我认同的发展与大学生心理健康水平及其今后的社会适应关系密切。本研究用叙事取向团体辅导对大学生自我认同进行干预。结果发现,叙事治疗强调的好奇、尊重、珍惜的态度,为成员创设了安全、温暖、支持的团体氛围;外化和解构使成员与问题拉开距离,探讨问题的影响力;寻找并丰厚特殊意义事件,让成员看到自身的正向力量和资源;局外见证人团队,进一步巩固成员身上的正向力量。结论：叙事取向团体辅导是促进大学生自我认同发展的有效途径。     

TALKING THE WALK AND WALKING THE TALK: Stanley Hauerwas's Contribution to Theological Ethics

Stanley Hauerwas's contribution to the study of Christian ethics is analyzed in the course of offering an overview of his work, including (1) his early reflections on “vision,”“narrative,” and moral agency; (2) his continuing focus on Christian virtues and practices in contrast to the ethos of moral and political liberalism; and (3) his specific attention to the meaning of peaceableness and the rejection of violence. The essay concludes by considering Hauerwas's legacy as a postliberal theologian, a critical participant in American Protestant ethics, and a conversation partner with Roman Catholics.     

Writing life narratives through art practice

This article shares some of my doctoral experiences in a practice-based PhD research in arts developed at the Chelsea College of Arts, University of the Arts London. It locates art practice within the academic research realm and contributes to researchers working on autobiographical studies and practice-based research methods. By offering an overview on my research topic focusing on the relationship between language and place in the life of Brazilian women living in London, I reflect on the relevance of “not-knowing” as a fruitful space for researching autobiographical and situated life narratives through art practice. The article concludes that qualitative methods are relevant for building passages from the individual to the collective sphere of an art practice developed within geographical displacement and in the context of academic research.     

Liberating narratives and the play of unforbidden pleasures: In brief dynamic therapy

Drawing upon the work of Adam Phillips and Ronald Britton the author highlights the intimidating and fear-inducing nature of the super-ego and the role of the therapist in supporting the judgements of the ego and liberating it from the domination of the super-ego. He goes on to explore the proposition that moral principles do not need to be oppressive in nature and that they can emanate from objects that are more akin to sexual or aesthetic objects. These themes are linked to Woodmansey’s conceptualistion of the punitive and humiliating super-ego, and the origin of the super-ego as an internalisation of an external conflict is outlined. The role of identifying a Cyclical Maladaptive Pattern as a focus and its contribution in identifying the super-ego and how it manifests in the client’s narrative are explored, as well as the crucial contribution of a playful stance on the part of therapist in subverting and undermining the intimidating strictures of the super-ego.