‘Bound in a nutshell’: Thoughts on complexity,reductionism, and ‘infinite space’1

Pluralism is the hallmark of 21st century psychoanalytic discourse. Nevertheless, an unpleasant byproduct of pluralism is a tendency in some quarters to retreat into orthodoxy, stemming from a perceived need to shore up theoretical boundaries in the service of differentiating one theory from another. The delineation of borders places us at a risk of losing sight of the fact that genuine psychoanalytic thinking is fundamentally non‐reductionistic. Moreover, the core psychoanalytic notion of overdetermination, which Freud never abandoned throughout his career, has recently been neglected as authors argue in their communications that one point of view is better than another. Both analysts and their patients secretly are drawn to simple formulations that eschew complexity. The need to remain open to the ‘infinite space’ of meaning, motive, and causation should be a hallmark of clinical psychoanalytic practice. The author considers the implications for technique, and provides case material to illustrate some of the challenges inherent in approaching psychoanalytic work as a complex phenomenon.     

自闭症的性别差异及其与认知神经功能障碍的关系

儿童自闭症的发病率男性高于女性,已在世界各国的研究者中形成共识。自闭症患者在行为障碍,言语障碍和智力特征上的性别差异较为显著。这种性别差异的原因,显示自闭症的发症有其基因变异,以及神经生物学遗传因素所存在。神经生物学的障碍与自闭症儿童的认知神经功能障碍具有密切的对应关系。理解自闭症发生机制中的性别差异问题,对于探究自闭症的病因学,以及在今后诊断工具的开发和自闭症儿童的治疗、教育过程中,具有较高的临床应用价值。     

精诚合一:医学哲学事业的永恒主题

医学哲学事业的价值在于发现并弘扬医学的基本精神。“精诚合一”是医学亘古不变的基本精神。当代医学哲学研究的任务是揭示医学的“精诚合一”特征及其深刻内涵,注重“精”与“诚”的有机结合,批判现实医疗活动和理论研究在“精”、“诚”问题上的片面,弘扬医学的基本精神。     

Avicenna's Conception of the Efficient Cause

The concept of efficient causation originates with Aristotle, who states that the types of cause include ‘the primary source of the change or rest’. For Medieval Aristotelians, the scope of efficient causality includes creative acts. The Islamic philosopher Avicenna is an important contributor to this conceptual change. In his Metaphysics, Avicenna defines the efficient cause or agent as that which gives being to something distinct from itself. As previous studies of Avicenna's ‘metaphysical’ conception of the efficient cause attest, it takes God as a model agent. This essay considers whether Avicenna's ‘metaphysical’ conception of the efficient cause applies to natural agents. It ultimately argues that Avicenna offers a unified view of the efficient cause, which includes both divine and natural agents. On this view, an efficient cause gives being to another and is simultaneous with its effect. While Avicenna's defence of this view is an important chapter in the history of the concept of the efficient cause, it is also of interest in its own right. By appeal to a version of the principle of sufficient reason, it challenges a widespread view that causes are temporally prior to their effects.     

网络空间医患话语权失衡现象的成因分析

选取了两个标志性医疗传媒事件“八毛门事件”和“徐文被砍事件”为研究样本,以传播学的视角,透视网络空间医患话语权失衡现状,并从医疗报道的话语特征、医患双方的身份特征、网络话语的传播特征等方面剖析了成因,对构建以尊重差异,沟通各种意见表达为目标的医患对话空间具有现实指导意义.     

Functional ear (a)symmetry in brainstem neural activity relevant to encoding of voice pitch: a precursor for hemispheric specialization?

Pitch processing is lateralized to the right hemisphere; linguistic pitch is further mediated by left cortical areas. This experiment investigates whether ear asymmetries vary in brainstem representation of pitch depending on linguistic status. Brainstem frequency-following responses (FFRs) were elicited by monaural stimulation of the left and right ear of 15 native speakers of Mandarin Chinese using two synthetic speech stimuli that differ in linguistic status of tone. One represented a native lexical tone (Tone 2: T2); the other, T2′, a nonnative variant in which the pitch contour was a mirror image of T2 with the same starting and ending frequencies. Two 40-ms portions of f₀ contours were selected in order to compare two regions (R1, early; R2 late) differing in pitch acceleration rate and perceptual saliency. In R2, linguistic status effects revealed that T2 exhibited a larger degree of FFR rightward ear asymmetry as reflected in f₀ amplitude relative to T2′. Relative to midline (ear asymmetry = 0), the only ear asymmetry reaching significance was that favoring left ear stimulation elicited by T2′. By left- and right-ear stimulation separately, FFRs elicited by T2 were larger than T2′ in the right ear only. Within T2′, FFRs elicited by the earlier region were larger than the later in both ears. Within T2, no significant differences in FFRS were observed between regions in either ear. Collectively, these findings support the idea that origins of cortical processing preferences for perceptually-salient portions of pitch are rooted in early, preattentive stages of processing in the brainstem.     

血液透析患者在线血流量与Kt／V及尿素清除率因果关系分析

通过测定维持性透析患者血管通路血流量、Kt/V及尿素清除率(URR),利用自然辨证法中因果关系的复杂性探讨血流量与透析充分性之间的因果关系。选择维持性血液透析患者80例。设定血液透析开始后在线血流量,根据血流量不同分为三组,I组血流量300ml/min,Ⅱ组血流量250ml/min,Ⅲ组血流量200ml/min,计算各组Kt/V值与尿素减少率,观察血流量与Kt/V及尿素减少率之间的相关关系。三组之间Kt/V、URR比较P<0.001,差异均具有显著性;血流量与Kt/V、URR之间呈正相关(r1=0.448,P<0.001;r2=0.413,P<0.001;)随着血流量从300ml/min降到200ml/min,Kt/V、URR分别从1.33±0.33、(68.19±8.86)%降到0.99±0.31、(58.59±13.19)%。血液透析患者的血流量与Kt/V、URR密切相关,两者之间存在因果关系,较高的在线血流量是保证透析充分性的一项重要指标。     

评价和控制药物不良反应的认识与思考

用科学的世界观和方法论指导药物不良反应的评价和控制。从药物不良反应的发生机制、临床表现、因果关系的判定原则出发,与马克思主义哲学的基本观点相结合,提出了几点认识和思考。药物治疗作用与副作用既对立又统一;药物治疗效应向毒性反应的转变是量变到质变的过程;药物过敏反应的发生是内因外因相互作用的结果;药物与不良反应联系强度的判定必须符合前因后果性;药物与不良反应联系强度的判定必须排除混杂因素的干扰,找到内在的、本质的联系。     

术后认知功能障碍病因探索的反思

术后认知功能障碍(POCD)是手术后的一个并发症,随着接受手术治疗的患者越来越多,这一并发症引起了医学家们的广泛关注。但到目前为止,其发病的原因和机制尚不清楚。通过查找总结国内外学者对术后认知功能障碍病因的研究过程,我们发现其中无不渗透着哲学的思想。