Mohl P C, Burstein A G
Gen Hosp Psychiatry. 1982 Jul;4(2):113-9. doi: 10.1016/0163-8343(82)90040-8.
Explanations of emotional and behavioral response to illness seen by consultation--liaison psychiatrists include crisis theory, stress theory, classical Freudian theory, grief, and alexithymia. Recent developments in self psychology are also useful. Kohut identifies empathy as central to the establishment and maintenance of a sense of personal integrity, self-esteem, tolerance, and administration of others; deficits may cause feelings of shame, humiliation, rage, emptiness, and hypochondriasis. Persons who experience insufficient empathy during development are particularly vulnerable to these findings at the slightest hint of decreased concern, support, or empathy from parent surrogates. They attempt to compensate with a grandiose self-image, or by attachment to an idealized other. Prior formulations have considered illness a real or threatened object loss, with the lost object assuming symbolic significance in the individual's emotional or behavioural experience. However, illness may also be understood as a threat to the integrity of the self. This helps explain the range of emotional reactions observed and the disturbances in the doctor-patient relationship. Intervention is directed toward reconstitution of the self. Cases are presented to illustrate the application of this theory to formulation and treatment.
会诊联络精神科医生所观察到的对疾病的情绪和行为反应的解释包括危机理论、应激理论、经典弗洛伊德理论、悲伤和述情障碍。自体心理学的最新进展也很有用。科胡特认为共情是建立和维持个人完整性、自尊、宽容以及对他人管理感的核心；共情缺陷可能会导致羞耻感、羞辱感、愤怒、空虚和疑病症。在成长过程中经历共情不足的人，在来自替代父母的关心、支持或共情稍有减少的迹象时，就特别容易出现这些情况。他们试图用夸大的自我形象或通过依恋理想化的他人来进行补偿。以前的理论认为疾病是一种真实的或受到威胁的客体丧失，丧失的客体在个体的情感或行为体验中具有象征意义。然而，疾病也可以被理解为对自体完整性的一种威胁。这有助于解释所观察到的各种情绪反应以及医患关系中的障碍。干预旨在重建自体。本文通过病例展示该理论在诊断和治疗中的应用。
