Weinryb R, Bárány F
Scand J Gastroenterol Suppl. 1987;130:47-54. doi: 10.3109/00365528709090998.
The first part of this paper deals with the psychological background to the most common difficulties in the relation between doctors and patients, particularly when the two parties disagree about the diagnostic and therapeutic approach to a psychosomatic affection. The following causes for discord are discussed: Alexithymia--a mental deficiency that obstructs the insight into the connection between emotional and physical reactions to all types of life experiences; Anal object relationships--a disturbance of the psychosexual development in early childhood, involving in particular the risk of a destructive struggle for power between the patient and the doctor; Regression--the return to a more infantile stage of behaviour in a person who had once passed that stage, involving the risk of mistrust and hatred from the patient towards a doctor whom he conceives as coldhearted and repudiating; Gain of illness--unconscious psychic defence mechanisms that are often misunderstood and may lead the unwise and unsuspecting doctor to fateful errors of treatment and management. The second part describes the tactics for a fruitful cooperation between doctor and patient in regard to the investigation and management of gastrointestinal complaints, possibly originating from psychosomatic reactions to stress and other psychological and social strains. Before the diagnosis is made, it is essential to pursue in parallel two lines of investigation--the somatic and the psychosocial--to avoid one line impeding advances along the other. When a thorough somatic examination has made it clear that the patient's complaints are not caused by an organic disease and the patient's search for a psychosomatic connection has not yet been successful, the so-called redirectional work remains.(ABSTRACT TRUNCATED AT 250 WORDS)
本文第一部分探讨了医患关系中最常见困难的心理背景，尤其是当双方对心身疾病的诊断和治疗方法存在分歧时。文中讨论了以下导致分歧的原因：述情障碍——一种心理缺陷，妨碍人们洞察对各类生活经历的情绪和身体反应之间的联系；肛欲期客体关系——幼儿期心理性发展的一种障碍，尤其涉及患者与医生之间发生破坏性权力斗争的风险；退行——一个曾经度过某个阶段的人回到更幼稚的行为阶段，这涉及患者对他认为冷酷无情、拒绝自己的医生产生不信任和仇恨的风险；疾病获益——无意识的心理防御机制，常常被误解，可能导致不明智且毫无戒心的医生犯下致命的治疗和管理错误。第二部分描述了医患在调查和处理胃肠道不适（可能源于对压力及其他心理和社会压力的心身反应）方面进行有效合作的策略。在做出诊断之前，必须同时进行两条调查线——躯体方面和心理社会方面——以避免一条线阻碍另一条线的进展。当全面的躯体检查明确表明患者的不适并非由器质性疾病引起，而患者寻找心身联系的努力尚未成功时，就需要进行所谓的重新定向工作。（摘要截选于250词）
