伊斯兰教临终关怀与癌性疼痛心理治疗的探讨

如何利用伊斯兰教的信仰关怀、情感关怀和死亡关怀“三关怀”,提高癌症患者临终关怀质量和癌性疼痛心理治疗效果,作者根据在宁夏回族地区癌症患者中开展临终关怀的五年实践体会,从临终关怀的宗旨和目的出发,探讨了伊斯兰教的临终关怀之信仰关怀、情感关怀和死亡关怀三种形式和内容,解释了癌性疼痛的原因、疼痛的主观和客观影响因素及心理治疗的常用方法和原则,总结了在宁夏回族地区开展临终关怀应用伊斯兰教的信仰关怀、情感关怀和死亡关怀”三关怀”与癌性疼痛心理治疗之间的关系。     

慢性疼痛与抑郁的心身医学整合观

生物医疗观对慢性疼痛患者的诊疗作用较差。慢性疼痛常因为心理应激、个性、行为和疾病状况而复杂化,增加了患者诊疗的难度。患者常因情感症状、生活压力,而失去信心,陷入无助地痛苦选择冲突中。应用一种系统的跨学科方法重建和保持医生的共情和患者的积极心理,采用疾病状态、生活经历、个性特征和行为模式的四种心身整合观点,综合评估抑郁和慢性疼痛患者。设计综合诊疗方案评定的痛苦作用,在方案制定的过程中认识到这四个观点彼此不同,相互补充,全面阐释影响患者痛苦的生物、心理和社会的多种原因。心身整合观点为设计合理的治疗方案提供了方法,提高了医生成功治疗慢性疼痛患者的可行性。     

Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

La gestion des émotions et ses déficits,chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping

The goal of this review is to synthesize the data of scientific literature on emotional management and its deficits in chronic pain. We used terms referenced in databases and MesH terms (of the United States National Library of Medicine) to perform a literature search in a powerful online search engine (EBSCOhost research databases). Four hundred and forty-nine papers, taken from international reviews and published of 1994 (because it is in the middle of the 1990s that this theme begins to be handle) to the end of January, 2015, are identified by a total 5 electronic databases with predefined keywords about emotions and chronic pain. Forty-six of which met the inclusion criteria, according to their title, their summary and their complete text. The findings suggest that some emotional management strategies and its deficits can maintain a vicious circle of negative emotional states with physiological and psychopathological consequences. Several studies show that alexithymia, emotional ambivalence and emotional suppression have a deleterious impact on pain, emotional distress (depression, anxiety) and disability. In spite of some contradictions concerning the nature of this effect (sensory or affective pain intensity or even duration of pain), it seems that alexithymia is a major variable implied in chronic pain. Inversely, experiential acceptance has a beneficial effect on psychological distress (depression, anxiety and stress). Emotional disclosure (of stressful or traumatic events) can decrease pain intensity but not disability and mental health. Likewise, emotional expression in daily life seems beneficial, but when the expression of the positive and negative feelings are distinguished, emotional expression of negative feelings increases pain, disability and distress. The whole of these findings emphasize the need to further research about emotional management in chronic non-cancer pain. It is necessary to identify and control the source of potential bias. Some hypotheses have been proposed to explain these findings. In the future, it would be interesting to use a multifactorial approach to investigate the interactions between various processes of emotional management in chronic pain patients.     

THE FATHER,THE FATHER FUNCTION,THE FATHER PRINCIPLE: SOME CONTEMPORARY PSYCHOANALYTIC DEVELOPMENTS

The author discusses Freud's thinking on the role of the father, as well as that of later French theoreticians. To illustrate his remarks, he draws on the poetry of Carlos Drummond de Andrade (1912–1987), a Brazilian poet whose work often dealt with themes of the father, the family, and his own paternal relationship. The author also discusses the psychic formation of the father principle and how this may be evident in the clinical analytic setting, even when the analyst's approach privileges field theory, intersubjectivity, or other concepts emphasizing the relationship between analyst and patient.     

“I HEAR MY VOICE,BUT WHO IS TALKING?”: UNDERSTANDING DEPERSONALIZATION

Depersonalization is the frightening experience of being a shut‐inside, ghostlike, “true” self that observes another part of the self interacting in the outside world. The “true” self hides safely within, while the “participating” self holds all affects and impulses. This split in the ego is created via internal projective identification in the face of overwhelming affect, unavailability of adequate identifications, and insufficient support for psychic cohesion. As the transference develops, the powerful entrapping cocoon of depersonalization can be projected onto the now‐entrapping analyst, where it can be addressed. A clinical vignette illustrates these points.     

Memory of pain and affect associated with migraine and non-migraine headaches

The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.     

The empathizing–systemizing (E–S) model of autism and psychoanalytic theories of truth,play and symbolization

Little psychoanalytic material or theory features today in psychological work on autism and autistic traits and vice versa. Baron-Cohen's (2003) empathizing–systemizing (E–S) model of the autism spectrum posits two main clusters of autistic features: those surrounding impaired empathy, and those surrounding heightened systemizing behaviours. (Baron-Cohen, 2009) speculates that the common root of these two clusters is the individual's concept of truth. Psychoanalysis has addressed the related issue of internal and external reality since (Freud, 1897) differentiated ‘psychic’ from ‘historical’ truths. This could be of interest to those espousing the E–S model from a cognitive paradigm, as a ‘truth’-oriented cognitive style in autism may develop interdependently with the individual's experience of internal and external realities. Psychoanalysis has developed further ideas of relevance to the E–S model surrounding play and symbolization, the latter being an often-overlooked aspect of Wing and Gould's (1979) triad of autistic features. Seen from a psychodynamic perspective, the E–S model might provide a means to increase therapists' awareness of milder autistic traits amongst service users and analysands. Equally, it could offer a tool to structure empirical research into psychodynamic therapy with autism spectrum conditions.     

Catch 22: the inflammatory nature of insight

I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22?, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.