The countertransference impact of autistic defence in an otherwise neurotic patient

This paper investigates the question of why, in the psychoanalytic psychotherapy of a patient with encapsulated autistic pathology, the steady maintenance of a therapeutically neutral stance can be especially difficult. Transference and countertransference vicissitudes are examined. The author notices that the patient's intolerance of ‘opposites’ (cf. Tustin, 1986), combined with extreme antipathy to having that intolerance noticed, can elicit corresponding, and potentially destabilizing, countertransference reactions. These reactions comprise an unstable tension between co‐existing pressures towards fusion with, or expulsion of, the patient, their co‐existence under further pressure to remain unnoticed. Until perceived, this state of affairs risks collusion with the pressure either to merge with or to expel the patient, and compromises the capacity to notice the detail of the transference process and even to notice co‐existent positive and negative transference images. Detailed clinical illustration is given, including a session where it was difficult to notice the patient's experience of a couple as a combined object. The author finds these observations of bipolar countertransference tensions illuminated by Green's concepts of positive and negative narcissism and of the disobjectalizing function, and specifically accounted for by Ribas's theory of autism as radical drive defusion.     

临床工作者面对肿瘤患者照护需求的压力分析

在以实务为基础的研究上进行灵性多元观点的内容分析。对临床工作者进行焦点访谈,研究显示面对患者的死亡与未知的恐惧、患者的身心灵整合与情绪变化、家属的心理支持与情绪处理等,都会无意间增加临床工作者的压力困境。而当前存在的主要问题包括临床工作者认为灵性需求应该具备有意义的信念;临床工作者面对正负向情绪,透过修复自我的价值观与经验复制的分享,来协助家属适应与度过哀伤期;临床工作者并非仅是让患者得以善终,还必须着重改善照护质量。

     

论西方主流伦理理论的前提错误——兼论道德无力症与冷漠症对医疗的影响

从“畏死的恐惧”出发重塑扎根生命的道德基础,即道德行为和“生-生”式的道德关系是人的本真需要,道德权威性的根据是人类生命共同体这一“内在永恒大我”和人的本真存在方式的需要。这拯救了道德相对主义,也使个体作为潜在的人类生命共同体而能以“与永恒相关的生命意义”推开恐惧。进而,道德行为是出于内在自由而达于实在的自由的。道德主体应具备的道德实践能力包括独立能力、通达能力和勇气。生存性境况中的原子式个体不具备道德实践能力,生命境况中的“超个体的个体”才有此能力。由此,人类道德无力症和道德冷漠症的根源是西方主流伦理理论的前提错误,即以原子式个体充任道德主体。它是医疗纠纷和暴力频发的原因。     

Fear of death mediates ostracism distress and the moderating role of attachment internal working models

Ostracism is known to cause psychological distress; however, it remains unclear why ostracism evokes this response. Two experiments tested empirically whether fear of death mediates ostracism effects and whether attachment internal working models moderate this role. A total of 288 participants played Cyberball with two other ostensible players. After the game the accessibility of their death-related thoughts was assessed by a word completion task, and the Needs Satisfaction Scale was used to measure their distress. Participants’ attachment orientation was measured using the Experiences in Close Relationship scale. Death anxiety fully mediated ostracism distress. However, this effect was stronger in low-anxiety individuals. These studies contribute to the ostracism literature by providing further empirical support that death anxiety mediates ostracism distress, and to the attachment literature by documenting the moderation effect of attachment anxiety.     

对弗洛伊德“trieb”的误解及相关遗留问题的辨析

从弗洛伊德经典理论的角度出发,采用质性研究方法,主要基于弗洛伊德文本,对不同精神分析流派对弗洛伊德理论中驱力（trieb）概念的理解进行比较研究,探索出弗洛伊德经典理论被混淆的驱力与本能两个概念的区别、分析产生这一混淆的原因、分析了这一混淆会导致的对弗洛伊德理论的误解、讨论了对弗洛伊德理论中与驱力相关的一些重要概念的翻译问题,明确驱力概念在弗洛伊德理论中的重要地位。此外,梳理了驱力与相关的两个重要概念本能、力比多之间的关系。

     

“本己”抑或“他性”？——海德格尔与列维纳斯死亡观比较分析

海德格尔与列维纳斯都“直面”死亡问题,并对死亡的本性、自我与死亡的关系以及他人之死与自我的关系等问题做出充分回应。海德格尔认为死亡是始终“悬临”于此在生存之中的向终结存在的方式,死亡构成了此在最为本己的整体能在,并展现为主体“我-能”的意向性结构。列维纳斯却要打破生存论上的死亡“悬临”,消解主体的“我-能”,并将“向来属我”的死亡孤独转换为伦理学上“异质属他”的死亡责任,由此,死亡不再是此在为自身存在负责的方式而是为“他者”担负责任的伦理要求。

     

不给予或撤除生命维持干预与安乐死、消极安乐死的概念辨析

不给予或撤除生命维持干预是临床实践中常见且棘手的伦理学问题。该问题的讨论应建立在清晰的概念之上,但不给予或撤除生命维持干预常与安乐死、消极安乐死和尊严死等概念混淆,引发误解。重新定义安乐死和消极安乐死具有理论和现实的紧迫性。基于汤姆•比彻姆和阿诺德•戴维森提出的安乐死定义,提出消极安乐死的定义。基于该定义,认为不给予或撤除生命维持干预与消极安乐死为交叉关系。鉴于安乐死概念的争议及其富含的感情色彩,强调讨论生命维持干预的使用时应区分事实与价值,并建议慎用或弃用安乐死与消极安乐死。

     

解蔽死亡的必要性、可行性与教育实践主体

医学实践和殡葬活动以其自身的方式对死亡产生了遮蔽效应, 解蔽死亡的必要性、可行性和教育优势主体分析仍旧需要医学和殡葬的承负。以医学实践、殡葬活动为代表的死亡遮蔽导致了严重的人文疾患, 解蔽死亡成为医学变革和殡葬改革的必要, 也是再认生命意义的必要。生死哲学的理论成果是解蔽死亡的保障, 医学实践和殡葬活动本身的革新要求是解蔽死亡的动力, 当代社会条件保障了解蔽死亡的可行。解蔽死亡是教育实践活动的表现形式, 医务工作者和殡葬工作者是该教育实践的优势主体。     

我国公民逝世后器官捐献工作影响因素分析

探讨我国公民逝世后器官捐献工作的影响因素,为提高器官捐献率,推动器官捐献事业的发展,提供决策参考。通过文献查阅等方法,从政治、经济、社会和技术四个方面对影响公民逝世后器官捐献工作的因素进行深入分析。器官捐献与移植工作是一项系统工程,影响因素众多,为做好器官捐献与移植工作,需要政府、医疗机构和社会公众等多方面的努力和配合,从政治、经济、社会、技术等多个层面采取针对性的策略,以进一步提高器官捐献成功率。     

Sabina Spielrein: out from the shadow of Jung and Freud

Abstract: Since the 1982 publication of Aldo Carotenuto's book, A Secret Symmetry: Sabina Spielrein Between Jung and Freud, there has been renewed interest in the life and work of Sabina Spielrein. She was Jung's first psychoanalytic case at the Burghölzli Hospital in 1904, and was referred to several times in The Freud/Jung Letters. Spielrein recovered, enrolled in medical school, and went on to become a Freudian analyst. Her most famous paper, published in 1912, ‘Destruction as a cause of coming into being’, was referred to by Freud in 1920 in relation to his Death Instinct theory. In the few Freudian publications on this controversial theory since 1920, Spielrein's contribution is consistently omitted. Jung also neglected to refer to her ‘Destruction’ paper in his early 1912 version of ‘Symbols of transformation’, even though he had edited her paper and had promised to acknowledge her contribution. He did refer extensively to Spielrein's first paper, her medical thesis, ‘On the psychological content of a case of schizophrenia’, published in 1911, as yet unpublished in English. In her paper Spielrein sought to understand the psychotic delusions of Frau M, a patient at the Burghölzli, much in the style of Jung's ‘Psychology of dementia praecox’ (1907). The purpose of this paper is to explore to what extent Spielrein's Frau M paper, and its companion ‘Destruction’ paper, make an original contribution to both Jung and Freud's emerging theories on the possible creative versus destructive outcomes of neurotic or psychotic introversion, culminating in Jung's concept of the ‘collective unconscious’ (1916) and Freud's concept of a ‘Death instinct’ (1920).