Moran Stephen T
Cabrini Medical Center, Department of Psychiatry, New York, NY, USA.
J Med Humanit. 2006 Summer;27(2):79-91. doi: 10.1007/s10912-006-9007-8.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, emphasizes diagnosis and statistically significant commonalities in mental disorders. As stated in the Introduction, "[i]t must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder' " (DSM-IV, 1994, xxi). Further, "[t]he clinician using DSM-IV should ... consider that individuals sharing a diagnosis are likely to be heterogeneous, even in regard to the defining features of the diagnosis, and that boundary cases will be difficult to diagnose in any but a probabilistic fashion" (DSM-IV, 1994, xxii). This article proposes that it may be helpful for clinicians to study narratives of illness which emphasize this heterogeneity over statistically significant symptoms. This paper examines the recorded experiences of unusually articulate sufferers of the disorder classified as Major Depression. Although sharing a diagnosis, Hemingway, Fitzgerald, and Styron demonstrated different understandings of their illness and its symptoms and experienced different resolutions, which may have had something to do with the differing meanings they made of it. I have proposed a word, autopathography, to describe a type of literature in which the author's illness is the primary lens through which the narrative is filtered. This word is an augmentation of an existing word, pathography, which The Oxford English Dictionary, Second Edition, defines as "a) [t]he, or a, description of a disease," and "b) [t]he, or a, study of the life and character of an individual or community as influenced by a disease." The second definition is the one that I find relevant and which I feel may be helpful to clinicians in broadening their understanding of the patient's experience.
《精神疾病诊断与统计手册》第四版强调精神疾病的诊断及具有统计学意义的共性。如引言中所述，“必须承认，没有任何定义能充分明确‘精神疾病’概念的精确界限”（《精神疾病诊断与统计手册》第四版，1994，xxi）。此外，“使用《精神疾病诊断与统计手册》第四版的临床医生应……考虑到即使在诊断的定义特征方面，具有相同诊断的个体也可能是异质的，而且除了以概率方式外，临界病例将难以诊断”（《精神疾病诊断与统计手册》第四版，1994，xxii）。本文提出，临床医生研究强调这种异质性而非具有统计学意义症状的疾病叙事可能会有所帮助。本文考察了被归类为重度抑郁症的异常能言善辩的患者的记录经历。尽管海明威、菲茨杰拉德和斯泰伦都被诊断为重度抑郁症，但他们对自己的疾病及其症状表现出不同的理解，经历了不同的病程，这可能与他们赋予疾病的不同意义有关。我提出了一个词“自病志”，来描述一种文学类型，在这种文学中，作者的疾病是叙事过滤的主要视角。这个词是对现有词汇“病理志”的扩充，《牛津英语词典》第二版将“病理志”定义为“a）对一种疾病的描述”以及“b）对受一种疾病影响的个人或群体的生活和性格的研究”。我认为第二个定义是相关的，并且觉得它可能有助于临床医生拓宽对患者经历的理解。
