Kirmayer Laurence J
Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University.
Transcult Psychiatry. 2003 Jun;40(2):248-77. doi: 10.1177/1363461503402007.
The clinical encounter is structured hierarchically: explicit technical action is embedded in levels of organization that reflect the personality and biography of the clinician, which in turn, are embedded in a larger matrix of cultural values or ethos. Systems of medicine can be compared at each of these levels. Shamanism and other elementary systems of medicine are built on an ethos that identifies healers' calling, authority and effectiveness with their own initiatory illness experiences. The Asklepian religious cults of ancient Greece also drew from the image of the wounded-healer. This essay argues that ethos of the wounded-healer remains relevant to contemporary medicine, psychiatry and psychotherapy. Developmental changes in the relationship of the healer to his wounds during psychiatric training are illustrated by a series of dreams. The ethos of the wounded-healer has implications for the training of clinicians, as well as for the ethics and pragmatics of clinical work.
明确的技术行为嵌套于反映临床医生个性与经历的组织层面之中，而这些层面又进一步嵌套于更大的文化价值观或精神特质矩阵之中。医学体系可在这些层面中的每一个层面进行比较。萨满教及其他基础医学体系建立在一种精神特质之上，这种精神特质将治疗者的使命、权威和疗效与他们自身的初始疾病经历联系起来。古希腊的阿斯克勒庇俄斯宗教崇拜也借鉴了受伤治疗者的形象。本文认为，受伤治疗者的精神特质在当代医学、精神病学和心理治疗中仍然具有相关性。一系列梦境阐释了在精神科培训期间治疗者与自身创伤关系的发展变化。受伤治疗者的精神特质对临床医生的培训以及临床工作的伦理和实际应用都具有启示意义。
