当代中国临床医学伦理准则建设论纲

我国当代临床医学伦理准则亟待出台，建设时机现已水到渠成，为积极参与这项重要的建设工程，本文提出了找准现实生长点为根本课题的基本建设思路，并以病人中心准则为核心探索性地设计出了准则体系。     

天命观对中国人格心理的构建与影响

中国文化传统强调天与命对人的控制,天命是人格神对人的主宰。这种思想深远的影响着中国人对人格的建构,形成了中国人典型的人格特征,并影响和渗透到现代人生活的各个方面,影响着现代社会中人对人与人、人与社会、人与自然关系的建构。     

Personality and values as predictors of medical specialty choice

Research rarely considers the combined influence of personality traits and values in predicting behavioral outcomes. We aimed to advance a germinal line of inquiry that addresses this gap by separately and simultaneously examining personality traits and physician work values to predict medical specialty choice. First-year medical students (125 women and 119 men) responded to measures of personality and physician work values. After graduation, participants' residency choices were identified. Results indicated that personality traits predict person- or technique-oriented medical specialty choice. Physician work values, whether used alone or in tandem with personality traits, however, did not significantly predict specialty choice. Implications for practice and research are discussed.     

On Nachträglichkeit: The modernity of an old concept1

Nachträglichkeit provides the memory, not the event, with traumatic signifi cance and signifi es a circular complementarity of both directions of time. Conceived by Freud as early as 1895 in the Project for a scientifi c psychology, the concept remains in his work without offi cial status but through its character of biphasic development and latency indispensable for understanding temporal connections and psychic causality. As an implicit principle it is linked with the postponement and biphasic onset of sexual life … and retains its sometimes hidden importance until the late Moses study. Temporarily virtually forgotten, it was recalled to memory by Lacan in 1953. Translations into French as après‐coup and into English as ‘deferred action’ emphasized the two vectors (retroactivity and after‐effect) separately which are united in the substantive form coined by Freud. Unnoticed, it played a part in many aspects of clinical practice, especially in Winnicott's Fear of breakdown and the subsequent (nachträglich) working through of unconscious infantile and transgenerational confl icts. The author uses a clinical illustration to elucidate the belated understanding of the striving for non‐existence in Winnicott's sense. Wolfgang Loch extended Freud's concept of Nachträglichkeit in a constructivist way, advocating an art of interpretation as an innovative enterprise through which connections are not only unmasked but also created, constituted by subsequent (nachträglich) reinterpretation of a subjective past. Very briefl y the author refers to the interdisciplinary reception of the concept of Nachträglichkeit, especially in cultural studies.     

Medicine as a career: Choices and consequences

Medicine has traditionally been regarded as a rewarding career both financially and socially. How true, however, is that tradition in today's world of rising costs and decreasing revenues? The educational debt of the physician-in-training is steadily increasing, and currently does not affect specialty choice. As the cost of medical education continues to rise, the applicant pool begins to shrink, thereby possibly affecting the quality of future physicians. Once the physician has completed training however, the majority enjoy a positive return on investment. Their incomes generally fail to remain ahead of inflation, and therefore, have remained within a narrow band of $40,000 in 1970 dollars. Finally, the demand for physician services cannot be attributed solely to either the consumer (patient) or to the supplier (physician). Rather, the demand for medical services appears to be a unique combination of the two. In conclusion, medicine still is an attractive career path, but the choices and consequences are becoming much more demanding.     

Is science socially constructed—And can it still inform public policy?

This paper addresses, and seeks to correct, some frequent misunderstandings concerning the claim that science is socially constructed. It describes several features of scientific inquiry that have been usefully illuminated by constructivist studies of science, including the mundane or tacit skills involved in research, the social relationships in scientific laboratories, the causes of scientific controversy, and the interconnection of science and culture. Social construction, the paper argues, should be seen not as an alternative to but an enhancement of scientists’ own professional understanding of how science is done. The richer, more finely textured accounts of scientific practice that the constructivist approach provides are potentially of great relevance to public policy. This paper is based on a Topical Lecture presented at AMSIE'96, the 162nd National Meeting of the American Association for the Advancement of Science. Baltimore, Maryland, 8–13 February 1996. The views expressed are those of the author and do not reflect the opinions of the AAAS or its Board of Directors. For permission to cite or quote any part of this paper please refer to the author for permission.     

The social construction of gender

The categories provided by the language of our culture give us a meaning-making framework that guides our perception of the world. This paper views the process of categorizing people from a constructivist perspective. It argues that many categories such as race, nationality, homosexuality, and gender are arbitrary social constructions created to fill some human purpose based on sociopolitical rather than biological or natural considerations. Similarity among people may arise from a history of being in the same category rather than being the basis for categorization. Whereas people are attached to categories that shape their identity and unite with other persons from similar categories to fight for their rights, they should also envisage the possibility of revising these arbitrary categories.     

Power on the margins: A new place for intellectuals to be

This paper is concerned with rethinking the nature of social life in terms of how it appears — not to us academics at the centre of it, as consisting in a system, or a plurality of systems -but how it might appear from a position more in on the margins, at those moments when ordinary people must relate themselves to each other, unsystematically and practically. To do this, we must also rethink the nature of language and thought as possessing within these moments, a formative or creative character — for it must have the ability to create practical connections between aspects of people's lives, as required, on the spot. This is to privilege the role of rhetoric in these regions over that of logic. This also leads to a rethinking of ideology and power: as being to do with, not ideas, but the practical shaping (or not) — in moments when in practical communication with others — of collective, sharable forms of life. Where it is in such moments, in which different people meet each other in socially constructing their lives together, that political struggles are their most intense, and where ideology can be detected at work.     

Empirical Support for the Critical Assumptions of Empowerment Theory

This exploratory case study provides empirical support for three critical assumptions of empowerment theory. Many empowerment theorists have argued that empowerment takes on multiple forms across people, is contextually embedded, and shifts over time (Rappaport, 1984; Zimmerman, 1990, 1995). To better understand the implications of these assumptions for empowerment theory and the research and intervention methods we employ, the empowerment experiences of 49 employees within a large human service delivery organization were explored. A method well suited to investigate empowerment's assumptions of multiplicity and dynamism—a constructivist approach to inquiry—was employed. Content analyses of interview and observational data revealed that the process of empowerment may be more complex than originally conceived. Not only did multiple meanings and desires for empowerment emerge across employees and between employees and leaders, but several shifting ecologies impacted the employees' lives, causing the employees' empowerment experiences to fluctuate. Empowerment emerged as a dynamic, highly individualistic, contextually layered process. Multiple forms, contexts, and dynamics that influenced employee empowerment are described. Implications of these findings for empowerment research and intervention are discussed.     

目标焦点监控下目标信息的建构与整合

探讨文本阅读过程目标焦点监控下读者对目标信息的建构与整合。采用移动窗口技术,要求被试阅读24篇含有主人公目标的记叙文,设计了子目标未实现、子目标曲折实现或子目标直接实现三种条件,对不同条件下目标启动句阅读时间进行分析。实验1对子目标曲折实现与子目标未实现两种条件下目标启动句阅读时间进行比较,结果表明,曲折实现条件下目标启动句阅读时间长于未实现条件下目标启动句的阅读时间,说明在没有共振的情况下,目标启动句也可以激活先前的目标信息引发目标整合。实验2比较在子目标曲折实现与子目标直接实现条件对目标启动句阅读时间,以探讨在目标焦点条件下是否对相关信息进行追随性建构,结果表明,曲折实现条件下目标启动句阅读时间与直接实现条件下目标启动句的阅读时间差异不显著,说明在目标焦点监控下可以发生阅读信息的追随性建构。本实验结果初步证明,阅读不同文本信息可能会引发不同的信息加工活动,建构主义理论与记忆基础文本加工理论都只是说明了文本阅读信息加工的一个侧面。