Kobayashi Ryuji
Faculty of Social Work, Tokai University School of Health Sciences.
Seishin Shinkeigaku Zasshi. 2003;105(8):1045-62.
The "loss of self-evidence" has been noted by many, particularly in our country, as a fundamental dysfunction in schizophrenia. Recent recognition of this "loss of self-evidence" in personality disorders such as borderline cases, and developmental disorders such as autism and Asperger's syndrome is focusing renewed interest on this perspective. It is possible that investigation into this "loss of self-evidence" noted in the pervasive developmental disorders may provide clues into the process of its development and acquisition. This paper takes up the issue of "loss of self-evidence" illustrated through the treatment process of 2 patients (female, adulthood autism, adolescent Asperger's syndrome) the author has treated. The psychopathology of the "loss of self-evidence" seen in the pervasive developmental disorders is discussed through these cases in terms of development from the standpoint of clinical intervention for relationship disturbance. The conclusions are as follows. First, the grave psychopathology pertaining to "self-evidence" in the adult autism and adolescent Asperger's syndrome cases is discussed, wherein difficulty in controlling one's action by one's own will giving rise to serious estrangement between experience and consciousness is noted as the pathology held in common by the two. Next, through examination of the normal acquisition process of words and language, it is shown that the essence of the language disorder seen in pervasive developmental disorders lies in the acquisition of meanings of objects being based upon the absence of common experience between subject and caregiver. As such, words representing meaning and content as we see them are imprinted on such individuals, never harmonizing with their own experiential world, giving rise to serious estrangement between their experience and consciousness. Third, sharing what the child is focusing upon in the outer world and how he/she is relating to it in their experiential world, and approaching them with words appropriate to their interpretation, is pointed out as being of critical importance in the self-evidence. In support of this, it is asserted that the establishment of affective communication characterized by mutual resonance of body and affect, and the development of communication upon this basis will, for the first time, enable transmission of culture to such individuals in favorable form, emphasizing the exceptional importance of attachment formation (amae) as being the key to this process.
许多人，尤其是在我国，已经注意到“自我证据的丧失”是精神分裂症的一种基本功能障碍。最近在诸如边缘性人格障碍以及诸如自闭症和阿斯伯格综合征等发育障碍中对这种“自我证据的丧失”的认识，正使人们对这一观点重新产生兴趣。对广泛性发育障碍中所指出的这种“自我证据的丧失”进行调查，有可能为其发展和获得过程提供线索。本文通过作者治疗的2例患者（成年女性自闭症、青少年阿斯伯格综合征）的治疗过程，探讨了“自我证据的丧失”问题。从关系障碍的临床干预角度，通过这些病例讨论了广泛性发育障碍中所见的“自我证据的丧失”的精神病理学。结论如下。首先，讨论了成年自闭症和青少年阿斯伯格综合征病例中与“自我证据”相关的严重精神病理学，其中指出，难以凭自己的意志控制自己的行为，导致经验与意识之间严重脱节，这是两者共有的病理特征。其次，通过对单词和语言正常获得过程的研究表明，广泛性发育障碍中所见语言障碍的本质在于，客体意义的获得是基于主体与照顾者之间缺乏共同经验。因此，我们所看到的代表意义和内容的词汇被印刻在这些个体身上，但从未与他们自己的经验世界相协调，导致他们的经验与意识之间严重脱节。第三，指出在自我证据方面，分享儿童在外部世界所关注的事物以及他/她在其经验世界中与该事物的关系，并使用适合其理解的语言与之交流至关重要。为此，有人断言，以身体和情感的相互共鸣为特征的情感交流的建立，以及在此基础上的交流发展，将首次使文化能够以有利的形式传递给这些个体，强调依恋形成（依赖）作为这一过程的关键具有特殊重要性。
