McGlashan T H, Docherty J P, Siris S
Psychiatry. 1976 Nov;39(4):325-38. doi: 10.1080/00332747.1976.11023903.
The types of recovery from an acute schizophrenic break are manifold: one patient "returns" to reality and walks away as if untouched; another despairs for months about "losing control" of himself; still another finds his reentrance into the world less attractive than his psychotic exit. Each "copes" with his psychosis uniquely, both during and after the acute regression. Nevertheless, from observing and treating several acutely psychotic and recovered schizophrenics on a National Institute of Mental Health clinical research unit, we have noted that individual recovery styles tend to cluster around one of two distinct types--integrative or sealing-over. Broadly defined, the sealing-over patient prefers not to think about his psychotic experience during recovery, the integrator, by contrast, is interested in the psychotic experience and desires to place it into some coherent perspective. Specific behavioral definitions and dynamic considerations of these concepts have been presented elsewhere (McGlashan et al., 1975; Levy et al., 1975). As recovery "styles," we are talking about dichotomies, such as expansion versus constriction and flexibility versus rigidity of controls over consciousness, which in turn determine the range of feelings, thoughts, and actions that a person permits himself and is reasonably comfortable with. This paper illustrates and further delineates these recovery styles with specific cases of two young women who each experienced a first psychotic break and were treated on our clinical research unit. Though but two of many acute schizophrenics admitted to our unit, these patients demonstrated clinical courses most representative of each recovery style and provided rich material for a greater understanding of the dynamics of integration and sealing-over.
一位患者“回归”现实，毫发无损地离开；另一位患者则因对自己“失去控制”而绝望数月；还有一位患者发现重返现实世界不如他精神错乱时那么有吸引力。每位患者在急性病情恶化期间及之后，都以独特的方式“应对”自己的精神病症状。然而，通过在美国国立精神卫生研究所的一个临床研究部门观察和治疗几位急性精神病发作且已康复的精神分裂症患者，我们注意到个体的恢复方式往往集中在两种不同类型中的一种——整合型或封闭型。广义而言，封闭型患者在康复过程中不愿去想自己的精神病经历，相比之下，整合型患者则对精神病经历感兴趣，并希望将其置于某种连贯的视角中。这些概念的具体行为定义和动态考量已在其他地方阐述过（麦克格拉申等人，1975年；利维等人，1975年）。作为恢复“方式”，我们讨论的是二分法，例如扩展与收缩以及对意识控制的灵活性与僵化程度，这些反过来又决定了一个人允许自己拥有并能合理接受的情感、思想和行为范围。本文通过两位年轻女性的具体案例来说明并进一步阐述这些恢复方式，她们都经历了首次精神病发作，并在我们的临床研究部门接受治疗。尽管她们只是我们科室收治的众多急性精神分裂症患者中的两位，但这些患者展示了最能代表每种恢复方式的临床病程，为更深入理解整合与封闭的动态过程提供了丰富的素材。
