Ogasawara Masayuki, Tagami Shinji, Inoue Yoichi, Takeda Masatoshi
Department of Psychiatry, Osaka University Graduate School of Medicine.
Seishin Shinkeigaku Zasshi. 2009;111(10):1203-11.
We report the case of a female in her 40s diagnosed with depression. She was raised by an eccentric father, suspected of having pervasive developmental disorder, and a dominant mother. After graduating from high school, she worked as a clerk in a company for twenty years or so; however, a change in her work environment made her fall into a depressive state. Her worsening depression caused her impulsive resignation and disappearance for about four months. She spent the duration of her disappearance traveling the country, with no dissociative episodes. After returning, she received treatment for depression as an inpatient for about four months. During the first month of hospitalization, she mainly complained of a depressive mood and anxiety over the prognosis of her disorder, while she made scarcely any progress in introspection. In the second month, she gradually advanced with introspective work, but, as her introspection progressed, her depressive mood became aggravated. The therapist avoided intervention to modify her cognition, and told her the following: "it is better not to persist in managing your depressive mood itself because curing depression does not mean resolving the superficial depressive mood, but to achieve a condition not directly influenced by mood." Then, at the beginning of the third month, she became aware of "the presence of God" and, at the same time, her depressive mood greatly improved. She extended her sympathy to her mother with her unfortunate life history, and expected her mother to change as she herself had experienced, but, disappointed by her mother, she experienced anxiety attacks and came to realize her own internal rage against significant persons in her life including her mother. After "the Great being" experience, she, who had formerly attended Christian church for a short time, started to read the Bible, but she still hesitated about committing herself to "religious following." One day during the last month of hospitalization, as she prayed to God for healing when she read a part in the Bible about a woman suffering from a hemorrhage for twelve years who touched the hem of Jesus' garment and was healed immediately (Matthew 9:20-22 and Luke 8:43-48), the patient suddenly experienced "the salvation of God" and realized what trust really meant. Through the experience, her clinical problems became totally cured, and the therapy concluded with her discharge from hospital. Several months later, she sent the therapist a letter including the following message: "I am grateful to the Lord for salvation from anxiety and irritation, but to the therapist for helping me realize it." This clinical course can be understood based on the patient's clinical problems (e.g., despair, anxiety, and depression), arising from the breakdown of her efforts to maintain stability by founding her psychological base on her feelings of omnipotence, avoiding facing her internal negative psychological factors (e.g., rage), and these were automatically resolved when her psychological base was switched to the transcendent level through "the Great being" experience and "the salvation of God." Such a sudden, marked improvement resembles what Miller and C'de Baca reported as "quantum change," of which the characteristics are vividness, surprise, benevolence, and permanence. The therapist paid attention to maintain a constant psychological distance from the patient, not persisting in modifying her cognition, with the transcendent level being the basis for the entire therapy. This stance of the therapist itself was considered to prompt her transcendence and bring about her eventual cure. This clinical course seemed to be highly suggestive of a psychotherapeutic mechanism, indicating the close relationship between the transcendent level and basic trust.
我们报告了一例40多岁被诊断为抑郁症的女性病例。她由一位疑似患有广泛性发育障碍的古怪父亲和一位强势的母亲抚养长大。高中毕业后,她在一家公司做了大约20年的职员;然而,工作环境的变化使她陷入了抑郁状态。她日益加重的抑郁症导致她冲动辞职并失踪了大约四个月。她在失踪期间游历全国,没有出现解离发作。回来后,她作为住院病人接受了大约四个月的抑郁症治疗。住院的第一个月,她主要抱怨情绪抑郁以及对病情预后的焦虑,同时她在自我反省方面几乎没有任何进展。第二个月,她逐渐在自我反省方面取得进展,但随着自我反省的推进,她的抑郁情绪却加重了。治疗师避免干预她的认知,并告诉她:“最好不要执着于控制你自己的抑郁情绪,因为治愈抑郁症并不意味着解决表面的抑郁情绪,而是要达到一种不受情绪直接影响的状态。”然后,在第三个月开始时,她意识到了“上帝的存在”,与此同时,她的抑郁情绪大为改善。她对有着不幸人生经历的母亲产生了同情,并期望母亲能像她自己经历过的那样改变,但因母亲让她失望,她经历了焦虑发作,并开始意识到自己对包括母亲在内的生活中重要人物内心的愤怒。在“伟大存在”的体验之后,她曾短暂参加过基督教教堂活动,开始阅读《圣经》,但她在投身“宗教信仰”方面仍犹豫不决。住院最后一个月的一天,当她读到《圣经》中关于一位患血漏十二年的妇人摸了耶稣的衣裳繸子就立刻痊愈的部分(《马太福音》9:20 - 22和《路加福音》8:43 - 48),并向上帝祈求治愈时,患者突然体验到了“上帝的救赎”,并明白了信任的真正含义。通过这次经历,她的临床问题完全治愈,治疗以她出院告终。几个月后,她给治疗师寄了一封信,内容如下:“我感谢主让我从焦虑和烦躁中得到救赎,但也感谢治疗师帮助我认识到这一点。”基于患者的临床问题(如绝望、焦虑和抑郁),可以理解这个临床过程,这些问题源于她通过基于全能感来维持心理稳定的努力失败,回避面对内心的负面心理因素(如愤怒),而当她的心理基础通过“伟大存在”体验和“上帝的救赎”转向超验层面时,这些问题自动得到了解决。这种突然的、显著的改善类似于米勒和德巴卡所报道的“量子变化”,其特点是生动性、惊奇性(惊异性)、有益性(良性)和持久性(稳定性)。治疗师注重与患者保持恒定的心理距离,不执着于改变她的认知,以超验层面作为整个治疗的基础。治疗师的这种立场本身被认为促使了她的超越并最终实现了治愈。这个临床过程似乎强烈暗示了一种心理治疗机制,表明超验层面与基本信任之间的密切关系。