Diamond D B
Brigham and Women's Hospital, Boston, MA 02115, USA.
Psychiatry. 1997 Spring;60(1):67-88. doi: 10.1080/00332747.1997.11024788.
Despite its fruitfulness, the concept of the ego has fallen into disuse in contemporary psychiatry. It is the aim of this paper to explore the phenomenon of the decline of the concept of the ego by looking at the psychoanalytic theory of schizophrenia in which the ego is central and the genetic/neurochemical theory in which the ego is absent. Kuhn's (1970) explication of the competition of explanatory paradigms is utilized to frame this investigation and some of the factors involved in the displacement of the ego-oriented theory with the genetic/neurochemical theory are elucidated. Each theory is reviewed as to its theoretic and epistemological assumptions and its overall explanatory power. The psychoanalytic theory centers on the role of regression to an early state of ego development, and utilizes an intersubjective mode of data collection to describe developmental determinants of pathognomonic ego deficits. The genetic/neurochemical theory rests on the therapeutic outcome of neuroleptic treatment and family clustering of the illness. In failing to take into account data derived from intrapsychic, interpersonal, and cultural influences, the genetic/neurochemical theory is limited in its ability to provide a comprehensive understanding of the nature of schizophrenia. The ego-oriented theory gains significance at the border of these limitations. The concept of the ego is capable of integrating a wide range of biologic, developmental, and social influences that can account for the clinical phenomena of schizophrenia and should be restored to a central position in etiologic theories.
尽管自我概念成果丰硕，但在当代精神病学中已不再使用。本文旨在通过研究精神分裂症的精神分析理论（其中自我是核心）和遗传/神经化学理论（其中不存在自我）来探讨自我概念衰落的现象。库恩（1970）对解释范式竞争的阐释被用于构建这一研究，并阐明了用遗传/神经化学理论取代以自我为导向的理论所涉及的一些因素。对每种理论的理论和认识论假设及其整体解释力进行了审视。精神分析理论以回归到自我发展的早期状态的作用为中心，并利用主体间的数据收集模式来描述特征性自我缺陷的发展决定因素。遗传/神经化学理论基于抗精神病药物治疗的疗效和该疾病的家族聚集性。由于未能考虑到来自心理内部、人际和文化影响的数据，遗传/神经化学理论在全面理解精神分裂症本质方面的能力有限。以自我为导向的理论在这些局限性的边缘获得了重要性。自我概念能够整合广泛的生物学、发育和社会影响，这些影响可以解释精神分裂症的临床现象，应在病因学理论中恢复到核心地位。
