McGlashan Thomas H, Levy Steven T
Psychiatry. 2019 Spring;82(1):1-12. doi: 10.1080/00332747.2019.1594437.
INTEGRATING and sealing-over are terms that are frequently used to describe a patient's general style of coping with stress, especially the stress of an acute psychotic break. Work to date (McGlashan et al., 1975, 1976, in press; Levy et al., 1975) has defined these terms both clinically and dynamically within the context of a patient's relationship to his own psychosis. Integration and sealingover as concepts have also proved useful in understanding and describing interpersonal and group behavior on an inpatient psychiatric unit. A patient's ultimate style of recovery from an acute psychotic episode results from many forces-internal and environmental. The tendency to either review and assimilate (integrate) or deny and repudiate (seal-over) the often painful affects and ideas prominent during psychosis mobilizes various forces within the patient's social environment. The way in which the therapeutic milieu and patient interact with one another reflects and, in part, determines the manner and degree to which each party comes to master the patient's psychotic experience. This report explores this interaction as observed in an inpatient therapeutic community established to treat acutely schizophrenic patients.
整合与封闭是经常用于描述患者应对压力，尤其是急性精神病发作压力的总体方式的术语。迄今为止的研究（麦克格拉斯汉等人，1975年、1976年、即将发表；利维等人，1975年）已在患者与自身精神病的关系背景下，从临床和动态角度对这些术语进行了定义。整合和封闭作为概念，在理解和描述住院精神科病房中的人际和群体行为方面也已证明是有用的。患者从急性精神病发作中最终恢复的方式取决于许多因素——内部因素和环境因素。在精神病发作期间突出的常常令人痛苦的情感和想法，患者倾向于审视并吸收（整合）还是否认并摒弃（封闭），这调动了患者社会环境中的各种力量。治疗环境与患者相互作用的方式反映并在一定程度上决定了双方掌握患者精神病体验的方式和程度。本报告探讨了在为治疗急性精神分裂症患者而设立的住院治疗社区中观察到的这种相互作用。
