O'Shaughnessy E
Int J Psychoanal. 1994 Dec;75 ( Pt 5-6):939-47.
As a preliminary to the question, 'What is a clinical fact?', the author asks the wider question, 'What is a fact?', answering that facts are double in aspect: they both say how the world is, and they also depend on our species, our language, theory, etc. A claim of fact in any empirical discipline--in the natural sciences or in human studies with their different methods--is a truth claim which is not infallible or unique to the fact, and also a claim that must offer itself for verification. Using the clinical record of three sessions, she then tries to answer the question, 'What is a clinical fact?', offering the starting formulation that clinical facts, under the unusual conditions of an analytic hour which give an analyst access to a patient's inner world, manifests themselves in the form of immediate psychological realities between patient and analyst. On the way, the author discusses the analyst's anxieties about making a claim of clinical fact; further striking features emerge about clinical facts in the three sessions, and some unsolved problems, i.e. the variety of analytic theories, subjectivity and objectivity, are noted. Even while they bear the perplexities of their problems, clinical facts are of great significance to the study of the mind. They extend the domain of psychology to the area of the mind's interiority, with its human experiences of subjective meaning, conscious, and especially unconscious.
作为“什么是临床事实?”这一问题的前奏,作者先提出了一个更宽泛的问题,即“什么是事实?”,并回答说事实具有双重性:它们既陈述了世界的样子,又依赖于我们的物种、语言、理论等。在任何经验学科中——无论是自然科学还是采用不同方法的人文研究——对事实的断言都是一种真理断言,它并非绝对可靠,也不是该事实所独有的,而且还是一种必须接受验证的断言。接着,她利用三次诊疗的临床记录,试图回答“什么是临床事实?”这一问题,并给出了初始表述:在分析时段这种特殊条件下,临床事实能让分析师接触到患者的内心世界,它以患者与分析师之间即时的心理现实的形式呈现出来。在此过程中,作者讨论了分析师对做出临床事实断言的焦虑;三次诊疗中的临床事实还呈现出一些更显著的特征,并指出了一些未解决的问题,即分析理论的多样性、主观性和客观性。尽管临床事实承载着这些问题带来的困惑,但它们对心智研究具有重要意义。它们将心理学的领域扩展到了心智内在性的范畴,涵盖了人类对主观意义、意识尤其是无意识的体验。