Goetzmann Lutz
Psychosocial Medicine, University Hospital Zurich, CH-8091 Zurich, Switzerland.
Am J Psychoanal. 2004 Sep;64(3):279-89. doi: 10.1023/B:TAJP.0000041262.36839.fd.
There are indications in psychosomatic transplant literature that the "transitional space" (in the D.W. Winnicott's sense) plays an important part in the psychic integration of an transplanted organ or its donor. The present case study is based on a semi-standard textbook interview carried out in the course of a qualitative research program with 20 male and female patients following a lung transplant. Two transcribed passages in the text, which relate to the transplanted organ and its donor, were interpreted from the point of view of Winnicott's "transitional phenomenon" model. The case study made it clear that, even years after a lung transplant, the patient experiences the organ and donor as transitional objects. The donor, as perceived by the patient, is a living, omnipotent person who is really present and to whom the recipient attributes ideal (personality) qualities. The transplanted lung, however, insofar as a psychosomatic integration of the organ has only partially succeeded, remains in the possession of both the donor and the recipient. The donor, as a typical transitional object, performs a creative function in helping the patient to cope with everyday life. The employment of the donor or the transplanted organ as "transitional object" may be seen, above all, as a positive assimilation strategy. On the other hand, transitional phenomena may also draw attention to desintegrative processes in surmounting an organ transplant. These clinical questions are discussed at the end of the paper.
身心移植文献中有迹象表明,(在D.W. 温尼科特意义上的)“过渡空间”在移植器官或其供体的心理整合中发挥着重要作用。本案例研究基于一项定性研究项目过程中对20名肺移植术后男性和女性患者进行的半标准化教科书式访谈。文本中两段与移植器官及其供体相关的转录段落,从温尼科特的“过渡现象”模型角度进行了解读。案例研究表明,即使在肺移植多年后,患者仍将器官和供体体验为过渡性客体。患者所感知的供体是一个真实存在、无所不能的活人,接受者将理想的(人格)品质归因于他。然而,就器官的身心整合仅部分成功而言,移植的肺仍同时为供体和接受者所拥有。供体作为典型的过渡性客体,在帮助患者应对日常生活方面发挥着创造性作用。将供体或移植器官用作“过渡性客体”首先可被视为一种积极的同化策略。另一方面,过渡现象也可能在克服器官移植过程中凸显解体过程。本文结尾讨论了这些临床问题。