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多重现实与混合客体:精神分裂症妄想的一种创造性方法

Multiple Realities and Hybrid Objects: A Creative Approach of Schizophrenic Delusion.

作者信息

Cermolacce Michel, Despax Katherine, Richieri Raphaëlle, Naudin Jean

机构信息

Department of Psychiatry, Hôpital Sainte-Marguerite, Aix-Marseilles University, Marseilles, France.

Laboratory of Cognitive Neurosciences (LNC, Centre National de la Recherche Scientifique 7291), Aix-Marseilles University, Marseilles, France.

出版信息

Front Psychol. 2018 Feb 13;9:107. doi: 10.3389/fpsyg.2018.00107. eCollection 2018.

DOI:10.3389/fpsyg.2018.00107
PMID:29487553
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5816900/
Abstract

Delusion is usually considered in DSM 5 as a false belief based on incorrect inference about external reality, but the issue of delusion raises crucial concerns, especially that of a possible (or absent) continuity between delusional and normal experiences, and the understanding of delusional experience. In the present study, we first aim to consider delusion from a perspectivist angle, according to the Multiple Reality Theory (MRT). In this model inherited from Alfred Schütz and recently addressed by Gallagher, we are not confronting one reality only, but several (such as the reality of everyday life, of imaginary life, of work, of delusion, etc.). In other terms, the MRT states that our own experience is not drawing its meaning from one reality identified as outer reality but rather from a multiplicity of realities, each with their own logic and style. Two clinical cases illustrate how the Multiple Realities Theory (MRT) may help address the reality of delusion. Everyday reality and the reality of delusion may be articulated under a few conditions, such as compossibility [i.e., Double Book-Keeping (DBK), in Bleulerian terms] or flexibility. There are indeed possible bridges between them. Possible links with neuroscience or psychoanalysis are evoked. As the subject is confronting different realities, so do the objects among and toward which a subject is evolving. We call such objects Hybrid Objects (HO) due to their multiple belonging. They can operate as shifters, i.e., as some functional operators letting one switch from one reality to another. In the final section, we will emphasize how delusion flexibility, as a dynamic interaction between Multiple Realities, may offer psychotherapeutic possibilities within some reality shared with others, entailing relocation of the present subjects in regained access to some flexibility via Multiple Realities and perspectivism.

摘要

在《精神疾病诊断与统计手册》第5版中,妄想通常被视为基于对外部现实的错误推断而产生的错误信念,但妄想问题引发了关键的关注,尤其是妄想性体验与正常体验之间可能存在(或不存在)的连续性问题,以及对妄想性体验的理解。在本研究中,我们首先旨在根据多重现实理论(MRT),从视角主义的角度来考量妄想。在这个继承自阿尔弗雷德·舒茨且最近由加拉格尔探讨的模型中,我们面对的并非只有一个现实,而是多个现实(例如日常生活的现实、想象生活的现实、工作的现实、妄想的现实等)。换言之,多重现实理论指出,我们自身的体验并非从被认定为外部现实的单一现实中获取意义,而是从多个现实中获取意义,每个现实都有其自身的逻辑和风格。两个临床案例说明了多重现实理论(MRT)如何有助于处理妄想的现实。日常现实和妄想的现实在一些条件下可能会相互关联,比如相容性(即按照布洛伊勒的说法,双重记录法)或灵活性。它们之间确实存在可能的桥梁。文中还提及了与神经科学或精神分析的可能联系。由于主体面对不同的现实,主体在其中发展并与之相关的对象也是如此。由于这些对象具有多重归属,我们将其称为混合对象(HO)。它们可以充当转换者,即作为一些功能性算子,让人们从一个现实切换到另一个现实。在最后一部分,我们将强调妄想的灵活性作为多重现实之间的动态互动,如何在与他人共享的某些现实中提供心理治疗的可能性,这需要通过多重现实和视角主义让当前主体重新获得一定的灵活性,从而实现重新定位。