Variations on the concept of traumatism: Traumatism,traumatic, trauma1

In this paper, the author outlines Freud's fundamental hypotheses concerning the concept of traumatism, then goes on to differentiate three notions (French being a particularly apposite language for such a venture): ‘traumatism’, ‘traumatic’ (in a substantive sense) and ‘trauma’. These three terms correspond to the three turning points in Freud's theory with respect to the concept of traumatism (1895‐97, 1920, 1938). The author evokes also the developments that are due to Ferenczi, particularly in his later writings (1928‐33), where he defi ned and discussed the question of ‘trauma’ in contemporary clinical practice; the author goes on to explore the different variations on this theme as regards mental functioning. He then defi nes, from a metapsychological point of view, the differences between ‘traumatisms’ that have been ‘worked over by secondary processes’, organised and governed by the pleasure‐unpleasure principle (‘traumatism’) and ‘early’ or ‘primary traumatisms’, which interfere with the process of binding the instinctual drives (‘trauma’); states of mind infl uenced by a traumatic imprint (‘traumatic’) are looked upon as belonging to both categories of the above mentioned traumatisms. The author illustrates his hypotheses with a clinical example.     

自我:从生物性到精神性

本文一方面从“生物性”与“精神性”两个人性层次透视自我,将自我视为一个由“生物自我”与“精神自我”组成的、以“生物自我”为基础“精神自我”为目标的对立统一体;另一方面又从“内容”与“功能”两个意识维度解析自我,将自我看成既是一个意义的存在又是一架认识的“机器”。自我便是一个由上述两个层次与维度有机组成的心理系统,这里的“有机”的涵义主要体现在,不仅生物自我与精神自我是相辅相成的辩证结构,而且这两个层次又都各自表现为内容与功能相互联系的认识主体。     

Invited Special Review: Psychological Approaches for Managing Chronic Pain

Psychologists have had an important impact on the conceptualization, assessment, and treatment of chronic pain. Their contributions have been in the areas of emotional distress, behavioral limitations, cognitive mediating events, and psychosocial disruption of chronic pain. These foci have enabled them to clarify the multidimensional nature of chronic pain and to support the biopsychosocial framework as a conceptual guide for research and clinical purposes. Clinically, along with members of an interdisciplinary team, psychologists have a key role in the assessment and treatment of patients with chronic pain. Interdisciplinary collaboration allows the team to recognize important interactions between biomedical and psychosocial dimensions and to appreciate a broader conceptualization of patients' problems. The literature documents strong empirical support for operant-behavioral and cognitive-behavioral therapies for the treatment of chronic pain. On the other hand, although widely accepted from a clinical perspective, the use of motivational interviewing and motivational enhancement therapies is more recent and less well documented for use with patients with chronic pain.     

Normal Personality Correlates of Chronic Pain Subgroups

A heterogeneous sample of chronic pain patients was first classified into one of three previously identified subgroups (i.e., dysfunctional, interpersonally distressed, adaptive) using the Multidimensional Pain Inventory (R. D. Kerns, D. C. Turk, & T. E. Rudy, 1985). Multiple differences at the domain and facet levels of the Revised NEO PI-R Personality Inventory (P. T. Costa, Jr. & R. R. McCrae, 1992) were found among the three subgroups of patients. In particular, the interpersonally distressed patients showed a greater degree of Neuroticism and were more introverted. Further analyses revealed that this group had tendencies toward feeling more vulnerable, being less trustful, and experiencing less positive emotions than the other groups. The dysfunctional group of patients was notable in terms of their low activity level and lower Openness (to new experience). Adaptive copers reported being emotionally stable, having a moderate degree of Extraversion, and being open to a wider variety of experiences. These differences may act as mediating influences in differing patient responsiveness to pain management programs.     

Intrinsicalism and Conditionalism about Final Value

The paper distinguishes between two rival views about the nature of final value (i.e. the value something has for its own sake) — intrinsicalism and conditionalism. The former view (which is the one adopted by G.E. Moore and several later writers) holds that the final value of any F supervenes solely on features intrinsic to F, while the latter view allows that the final value of F may supervene on features non-intrinsic to F. Conditionalism thus allows the final value of F to vary according to the context in which F appears. Given the plausible assumption that there is an intimate tie between final values and appropriate attitudinal responses, it appears that conditionalism is the better approach for mainly the following three reasons: First, intrinsicalism is too indiscriminate, which makes it subject to what I call ‘location problems’ of final value. I illustrate this problem by discussing alleged examples of Moorean organic unities. Second, intrinsicalism evokes symptoms of ‘evaluative schizophrenia’. Third, considerations of theoretical economy tell in favour of conditionalism. Thereafter I respond to some recent challenges to conditionalism. An appendix surveys some meritorious implications that conditionalism offers for various substantial versions of such structurally different views about value as monism, pluralism, and particularism.     

The use of dreams in the clinical context: convergencies and divergencies: an interdisciplinary proposal

This paper aims to define some unexpected convergences and foreseeable divergences regarding the conceptualization of dreams and their use as a research tool, specifically in clinical practice with non-neurotic patients. It includes a concise review of different lines of thought on the vicissitudes of dreams throughout the history of psychoanalysis: from their initial conception up to their use to examine transference and relational aspects in the context of a psychoanalytic process. The idea of the merely evacuative function of dreams from patients in certain diagnostic categories is discussed and compared with that of their potential communicative value. Lastly, the essay sets forth an interdisciplinary semiotic-pragmatic approach to the function of dreams and their clinical and technical use in the context of the intersubjective dynamic field. Based on the hypothesis that dreams related in the session are communicative signs, this proposal argues their significance as a symbolic matrix that generates processes of psychic semiosis. To do so, it combines certain lines of psychoanalytic thought with ideas coming from C. S. Peirce's analytic semiotics. Clinical material is included to illustrate this viewpoint.     

How beliefs influence the relative magnitude of pleasure and pain

Loss aversion is an economic assumption about utility—people value giving up a good more than they value getting it. It also has hedonic meaning—the pain of a loss is greater in magnitude than the pleasure of a comparable gain. But value and pleasure are not necessarily identical. We test the hedonic interpretation of loss aversion in experimental markets. With hedonic forecasts, sellers imagine the pain of losing their endowment, and buyers imagine the pleasure of being endowed. With hedonic experiences, sellers rate the pleasure of having the endowment, and buyers rate the pain of being without it. Contrary to loss aversion, predicted pleasure is greater in magnitude than predicted pain, and experienced pleasure surpasses experienced pain. We show that the relative magnitude of pleasure and pain depends on beliefs about the likelihood of outcomes, as well as utilities. Surprise makes gains more pleasurable and losses more painful. With surprising gains and expected losses, pleasure can surpass pain. But when gains and losses are equally likely (or losses are surprising and gains are expected), the opposite pattern can occur. Finally, within‐group and between‐group prices are significantly correlated with hedonic experiences. Sellers who feel better with their endowments assign higher selling prices, and buyers who feel worse about the absence of endowment assign higher buying prices. Despite the fact that hedonic experiences deviate from loss aversion, these emotions predict the endowment effect. Copyright © 2009 John Wiley & Sons, Ltd.     

子宫内膜异位症引起的盆腔疼痛的诊断和治疗

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,且发病率呈逐年上升趋势,盆腔疼痛是它常见的症状之一,其发病机制尚未明确,易复发,成为妇科研究的热点和难点。随着对EMT引起盆腔疼痛的发病机理的不断认识,其诊治也相应得到完善和发展。本文从哲学的角度以认识和实践等观点对EMT引起盆腔疼痛的诊断和治疗进展进行综述,以助于临床诊治。     

急腹症疼痛管理新观念——早期止痛

从早期止痛的意义,早期止痛的依据以及传统止痛观念的成因等三个方面论述急腹症早期止痛的必要性和合理性,并探讨早期止痛的策略。提醒医务人员要更新观念,对急腹症患者应尽早实施止痛干预。     

疼痛条件下时间目标对时距估计的影响

本研究采用冷压任务引发疼痛,以健康大学生为被试,试图探讨在疼痛条件下时间目标对时距估计的影响。结果发现：疼痛条件下的时距估计值小于非疼痛条件下时距估计值,疼痛条件下具体时间目标的时距估计值显著大于无目标时距估计值。临床上给患者提供具体的时间目标或许有助于他们应对疼痛。