灾后儿童心理创伤及危机干预

地震后,幸存下来的儿童可能比成人心理承受的压力更大,及时地对他们进行危机干预,帮助他们进行灾后心灵的重建是非常重要的。本文就儿童心理创伤反应、危机、危机干预、展开,针对儿童较成人的特殊性提出了对儿童进行危机干预的具体措施。     

The language of absence

This paper will focus on the concept of 'absence', which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis - the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author's contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.     

儿童创伤截肢

儿童意外伤害在国内外一直是受到普遍重视的问题,我国在这这方面的研究不多。严重肢体创伤的处理无论从专业理论还是在手术技巧上均要求很高,尤其对儿童肢体的毁损性创伤的治疗往往使临床医师常需在截肢与肢体挽救二者之间作出困难的选择。如何确定急诊截肢和保留肢体,国内外目前尚未有一个客观合理权威的标准。本文主要综述儿童截肢的标准和方法,以供参考。     

创伤性截肢的适应证与手术原则探讨

截肢是肢体严重损伤时的一个重要治疗方法,在决定截肢与肢体挽救时受到多方面因素的影响,但在相当程度取决于原发损伤的严重性。目前还没有一个明确的截肢适应证标准,需要一个客观的对肢体估价的方法以明确是否行截肢术,损毁肢体严重程度评分MESS（mangled extremity security score）有较大的临床指导意义。截肢虽是一种破坏性手术,也是一种重建与修复手术,同样遵守矫形外科手术的基本原则。当肢体损伤必须截肢时,要认真周密地设计、仔细地组织处理,在满足治疗的前提下,合理保存肢体长度,最大限度地保留患肢功能,获得较为理想的残肢,以使装配的假肢发挥最佳的功能。严格创伤截肢的标准,掌握截肢的手术原则,了解假肢的安装要求,与患者及家属的积极沟通,进行必要的会诊,是截肢手术医生必须要做到的。     

On the equivalence between elimination-by-aspects and generalised extreme value models of choice behaviour

Elimination-by-aspects and generalised extreme value offer competing paradigms for the representation of a common behaviour, that of individual discrete choice. Observing certain consistencies in their mathematical structure, several eminent authors have commented on the degree of equivalence between the two paradigms. Most contributions to this debate have, however, been less than definitive. More fundamentally, the contributions lack consensus. We advance the debate by establishing formal mathematical conditions under which three-alternative tree models from the two paradigms are exactly equivalent. We then extend our analysis to consider more general models, showing that equivalence can be established for general tree models, but not for cross-nested models.     

肢体严重毁损伤保留与否的循证思考

肢体严重毁损伤的修复是当今医学领域的一个研究热点。从循证医学角度对肢体严重毁损伤的保肢与截肢提出思考并加以阐述,同时结合当前我国医疗环境提出一些这方面的倡议。     

My Silent Story: Conflicted Memories,Silences and Intergenerational Traumas1

This article aims to present the interdisciplinary project “My Story from Silence”, conceived in 2022. The project represents a pioneering effort in assembling individuals from diverse communities, characterized by varying ethnic, national, and migratory backgrounds, along a historically dynamic border. Its primary objective was to provide a platform for these participants to articulate and share narratives previously shrouded in silence, offering insights into their historical pasts. Emphasizing reciprocal dialogue for the first time, the initiative fostered an environment where participants engaged in the dual act of narrating their own experiences and attentively listening to the narratives of others. These memories were explored in group workshops on both sides of the border. By combining elements of cultural anthropology fieldwork and analytical psychology, the workshops attempted to address hitherto unaddressed traumas and silent personal memories linked to major traumatic historical events such as fascism and Istrian exodus through the narratives of individuals. Three vignettes will illustrate the workshop dynamic and our Jungian understanding of it.     

War: Mentalization and Totalitarian State of Mind

For most residents of Europe, war is a new experience in which they find themselves both as witnesses and participants. In this paper the war in Ukraine serves as an illustration and case example. Like any unfamiliar experience, war elicits profound emotional responses which can be so overwhelming that an individual may be unable to fully process them and to create mental representations of the reality of war. When the psyche becomes entrapped in an unprocessed state, without the capacity to derive meaning from it, this results in the “fossilization” of the psyche akin to what McGinley and Segal describes as a totalitarian state of mind. Subjectivity and individual differences come under collective or personal attack, or both. This state of being prioritizes the needs of the collective psyche over the individual psyche. The image of Gorgon Medusa, who transformed living people into “fossilized” ones, is presented as a metaphor of total identification with the collective dimension. In contrast, the psyche can reveal a creative approach to resolving war-induced trauma. This is depicted in the concept of the Alchemical Stone and its creation, which symbolizes a harmonious connection between the external and internal realms, the subjective and objective experiences, and the real and the imaginal dimension.     

足踝部创伤后畸形的修复决策

足踝部创伤后遗畸形是临床上最常见也是最棘手的病症之一。作为人体活动的支撑和力学传导支柱,足踝创伤后畸变将造成连锁的踝关节、膝关节、髋关节和脊柱的退变,最后严重影响患者的生活质量。因此,需要运用哲学体系的思路和理念来指导此类病症的临床诊治,以求获得最佳的远期疗效。本文根据足踝部不同部位创伤后遗畸形的治疗作一综合性论述,为临床作基本的指导。