Survivors of Torture: Realities, Responsible Care, and Rehabilitation

This paper provides an overview of special issues and challenges for the psychiatrist providing care to a survivor of government sponsored torture. Case examples illustrate cultural concerns, issues of confidentiality, transference, dual loyalties, and provider responsibilities. The author hopes to stimulate interest in others to learn more about working with this challenging and rewarding group of patients.     

Why Do People Stay in Hateful Relationships? The Concept of Malignant Vindictiveness

Why do couples remain in hateful relationships? This article defines theoretically rigorous ways of viewing partners who stay together despite severe strife. A case presentation shows how a relationship of two people, each with his or her character structure and idealized image, creates interpersonal conflict because of opposing demands each makes on self and other. Such conflict requires radical defensive measures including alienation, idealization, and externalization that increase tensions. A vicious circle of malignant vindictiveness cements the relationship. Increasing implacability in the relationship is understood through Horneyan categories of interlocking idealized images, hurt pride reactions, and the externalizing process.

     

Learning to stand tall: Idiopathic scoliosis,behavioral electronics,and technologically-assisted patient participation in treatment,c. 1969–1992

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.     

“上医治未病”之内涵解析

“上医治未病”一词在古代中国历史文化中饱含着截然不同的文化内涵。“上医”,在古代中国文化中分别代表儒家、道家、医家三种不同学派,而“未病”也相应代表着“德性”“身体”和“疾病”三种概念。近年来,“治未病”一词重新出现并成为现代中医（包括民族医学）重要概念,逐渐成为专用病名加以推广,成立所谓“治未病”科,并纳入到中医（包括民族医学）医院专病科室建设的重要指标体系当中,是一种极为不妥的做法。通过古籍文献研究,就“上医治未病”正本清源,以求全面、准确领悟“上医”和“治未病”的正统理念。

     

心力衰竭治疗方法及理念转变之争议分析

关于心力衰竭（简称心衰）的病因病机和治疗中国自古以来就有所认识,而随着西医的传入与发展,基础和循证医学使人们更加深入地了解心衰的发病机制,并推动了心衰治疗方法及理念的更新。心衰已由最初的“水钠潴留”的病理生理机制过渡到“血液动力学异常”模式,再到“神经内分泌免疫调节”模式。近年来,人们对心衰综合征有了进一步的了解,同时随着医疗模式的转变及人文医学、哲学、心理学和全科医学的发展,心衰的诊断、治疗和预防理念产生了巨大的改变。

     

病患行为、地方性知识与治疗体系——以西部宁夏山区洼村为例

基于西部宁夏山区一个传统村落的鲜活案例,从患者对疾病认知治疗的感受和经历开始,包括患者自己对疾病的认知、求医的行为、求医方式选择、治疗物（医学药品和非医学药品）的文化属性,到医生与患者之间的互动关系,医疗场域的村医地方性知识实践,进行逐一剖析,揭示村民的整个求医过程中的疾病治疗逻辑。力图从医疗场域的患者动态治疗变化中,寻求文化传统在疾病治疗、健康维护中的参与行为和价值体现,并折射出洼村村民对待病患选择的生活逻辑和态度。

     

意识障碍患者撤销生命维持治疗的伦理困境

意识障碍领域中广泛存在着分类定义不清晰、诊断误诊率高、治疗缺乏有效性和康复不佳的临床问题。在意识障碍患者限制治疗的过程中,患者的最佳利益始终是一个未被讨论透彻的问题,西方医疗决策模式仍然存在一些缺陷且与我国存在显著差异。结合我国当下意识障碍患者医疗管理现状及医疗决策特点,提出可能的解决途径,如意识障碍患者多模态评估、分类管理、共同决策、预立照护计划。以期为意识障碍临床实践提供动力,并推进撤销意识障碍患者生命维持治疗的认识。