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论现代精神病学中的精神痛苦与自杀风险。

On mental pain and suicide risk in modern psychiatry.

作者信息

Pompili Maurizio

机构信息

Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

出版信息

Ann Gen Psychiatry. 2024 Jan 16;23(1):6. doi: 10.1186/s12991-024-00490-5.

Abstract

Facing suicide risk is probably the most difficult task for clinicians when dealing with patients in crisis. It requires professional, intellectual, and emotional efforts. Suicide risk assessment can sometimes be distressing for clinicians, and such a state may favour the avoidance of an in-depth exploration of suicidal thoughts and behaviour. Patients often feel subjected to interpersonal assessments with little opportunity to explore their perspectives. The "One size fits all" approach tends to create distance and paradoxically contributes to an increase in the risk of suicide. Traditional clinical factors may be of limited value if a shared understanding of the patient's suicide risk is missed. To understand the suicidal mind, it is necessary to take the point of view of the subject in crisis. In this essay, the "operational model of mental pain as a main ingredient of suicide" provided by Edwin Shneidman' is overviewed with the aim of a better empathic understanding of patients' sufferance. With a phenomenological approach, the suicidal crisis appears as a complex, pervasive state rather than as a symptom of a mental disorder, as the new paradigm also suggests. In this regard, the "mentalistic" aspects of suicide propose a broader insight into the suicidal scenario far beyond the diagnosis of psychiatric disorders. In this article, the perspective of individuals who deem their mental pain to be intolerable is described to make sense of their ambivalence between the wish to die and the wish to live that can prevail if relief is provided.

摘要

面对自杀风险可能是临床医生在处理处于危机中的患者时最艰巨的任务。这需要专业、智力和情感上的努力。自杀风险评估有时会让临床医生感到痛苦,而这种状态可能会促使他们避免深入探究自杀想法和行为。患者常常觉得自己在接受人际评估,却很少有机会阐述自己的观点。“一刀切”的方法往往会制造距离感,反而会增加自杀风险。如果错过对患者自杀风险的共同理解,传统临床因素的价值可能有限。为了理解自杀者的心理,有必要从处于危机中的个体的角度出发。在本文中,将概述埃德温·施奈德曼提出的“以精神痛苦作为自杀主要因素的操作模型”,以期更好地感同身受地理解患者的痛苦。正如新范式所表明的,从现象学角度看,自杀危机表现为一种复杂、普遍的状态,而非精神障碍的症状。在这方面,自杀的“心理层面”为深入了解自杀情境提供了更广阔的视角,远远超出了精神疾病的诊断范畴。本文描述了那些认为自己的精神痛苦无法忍受的个体的观点,以理解他们在想死和想活之间的矛盾心理,而如果能得到缓解,想活的愿望可能会占上风。

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