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感知、体验与身体认同。

Perception, experience and body identity.

作者信息

López-Ibor Juan J, Ortiz Tomás, López-Ibor María I

机构信息

Instituto de Psiquiatría y Salud Mental Hospital Clínico San Carlos Psychiatry, Department Facultad de Medicina, Universidad Complutense Centro para la Investigación Biomédica en Red en Salud Mental, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain Fundación Juan José López-Ibor, Madrid.

出版信息

Actas Esp Psiquiatr. 2011 Dec;39 Suppl 3:3-118. Epub 2011 Dec 1.

Abstract

Physician has to know the patient in the disease and not only the disease in the patient, from the dual perspective of the body as object and the body as subject. This also affects the patient who has to cope with the reality of having a body that bursts into the subject's consciousness as a vital threat, as source of discomfort and inability and being a body (Marcel). The human body in its dual aspect has been and is a great unknown, if not a great outrage in spite of the fact that we are our body and our body is each of us. We sometimes do not feel as we are and thus a confrontation arises, sometimes more normal, others more morbid. This forces the physician to face complex ethics considerations and the scientist to accept a personal identity disorder. Dualism considers that there are two substances in us, one that distinguishes us from other beings and from the rest of the individuals of the human species, the soul, the psychic life, mind or consciousness, and another more insubstancial one, the body. The aim of the first substance is to dominate the body, to survive it after death when it is, already a corpse is meant to become putrefied, is buried, incinerated or thrown to the depth of the sea. This dualism aims to explain the origin of the evil and the attitude to defeat it and it does so efficiently. This anthropology has very ancient roots (the Upvanishads, in the orphic texts, in Plato), it is the core of Gnostic thought and the foundation of the modern science since Descartes. Some monist perspectives are a masked dualism or a mereologic fallacy, according to which, the brain is conscious, when that what is conscious is the subject, although the subject, with the brain could not be conscious. Therefore, a new perspective is proposed, chiasmatic or janicular monism, that considers the adaptive value of focusing on the reality from two perspectives, as physical universe and the world of interpersonal relationships. In the agnosias and in the phantom limb there is a confrontation between the body object and the body subject that has made it possible to investigate how the perception of the own body is and how the brain generates the schema and the body image. The study of the body experience, from the phenomenology and the anthropological psychiatry perspective, has made it possible to go greater in-depth into the knowledge of the alterations of the experience of the own body in different mental diseases, especially in those in which a confrontation between the body and the personal identity arises makes it necessary to consider the process of individual identification and a category of personal identity disorders that would include body dysmorphic disorder, erythrophobia, anorexia nervosa, body integrity identity as well as the gender-type disorders (transsexualism, nonfetishistic transvestism, gender identity disorder during childhood). Key words: Dualism, Monism, Agnosia, Phantom limb, Cenesthesia, Body schema, Body image, Body experience, Personal identity disorders, Body dysmorphic disorder, Anorexia nervosa, Personal integrity identity disorder.

摘要

医生必须从身体作为客体和身体作为主体的双重角度,了解患病的患者,而不仅仅是了解患者所患的疾病。这也会影响患者,患者必须应对这样一个现实:身体作为一种重大威胁、不适和无能的来源,以及作为一个实体闯入主体的意识之中(马塞尔)。尽管我们就是我们的身体,我们的身体就是我们每个人,但人体的双重特性一直是且仍然是一个巨大的未知领域,甚至可以说是一种巨大的冒犯。我们有时感觉不到自己的真实状态,于是就会产生一种冲突,有时这种冲突比较正常,有时则更病态。这迫使医生面对复杂的伦理考量,也迫使科学家接受个人身份障碍。二元论认为我们体内有两种实体,一种将我们与其他生物以及人类物种的其他个体区分开来,即灵魂、心理生活、心智或意识,另一种则较为虚幻,即身体。第一种实体的目的是支配身体,在死后当身体已经成为一具会腐烂、被埋葬、焚烧或扔到海底的尸体时仍能存续。这种二元论旨在解释邪恶的起源以及战胜邪恶的态度,并且它做到了这一点。这种人类学有着非常古老的根源(奥义书、俄耳甫斯教文本、柏拉图),它是诺斯替思想的核心,也是自笛卡尔以来现代科学的基础。一些一元论观点是一种伪装的二元论或一种整体论谬误,根据这种观点,大脑是有意识的,而实际上有意识的是主体,尽管主体没有大脑就不可能有意识。因此,有人提出了一种新的观点,即交叉或关节一元论,它考虑了从两个角度关注现实的适应性价值,即作为物理宇宙和人际关系世界。在失认症和幻肢现象中,身体客体与身体主体之间存在冲突,这使得人们有可能去研究对自身身体的感知是怎样的,以及大脑如何生成身体图式和身体意象。从现象学和人类学精神病学的角度对身体体验进行研究,使得人们能够更深入地了解不同精神疾病中自身身体体验的改变,尤其是那些身体与个人身份之间出现冲突,从而有必要考虑个体认同过程以及一类个人身份障碍的疾病,这类疾病包括身体变形障碍、恐红症、神经性厌食症、身体完整性认同障碍以及性别类型障碍(易性癖、非恋物癖异装癖、儿童期性别认同障碍)。关键词:二元论、一元论、失认症、幻肢、共同感觉、身体图式、身体意象、身体体验、个人身份障碍、身体变形障碍、神经性厌食症、身体完整性认同障碍

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