对精神创伤和创伤后应激障碍的主体模式的看法

Denys Starkov
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摘要

文章从主体性概念--心理创伤的主体性模型--的角度,阐述了如何看待心理创伤和相关疾病,尤其是创伤后应激障碍(PTSD)。心理创伤被定义为主体性严重贬值的自我领域。本文简要回顾了主体性的概念,并强调了三个主要方面:综合、活动和认知。主体性的综合功能(方面)负责形成自我、世界和人际关系的整体形象--一个人对世界和自我的感知越全面,包括以整体自传时间的形式进行的人生叙事,他的主体性水平就越高。认知功能相当于将感官层面的信息转移到抽象层面,并通过设置和解决问题来创建、构建和重组世界的心智模式。综合和认知功能可以比作心智化(mentalization)这一概念。活动功能是指个人认为自己是其生活的自由主宰者,有能力以个人的行为方式行事,在这种行为方式中,他独立选择目标和实现目标的方式,和/或道德自决行为,在这种行为方式中,他坚持自己是一个人。活动功能可以与代理这一概念相提并论。研究表明,主体性综合功能的临界贬值可以描述创伤后人格分裂现象,主体性活动功能的贬值--创伤后应激障碍和创伤后消极自我概念中的一组回避症状,认知功能的贬值--无法整合创伤压力体验及其以分离的感官形式存在。作者提出了创伤后分裂、心智贬值和通过形成习得性无助情结形成消极自我概念的模型实例。主体性概念之所以便于描述精神创伤,一方面是因为它具有整体性和人文性。另一方面,它允许对主体性的个别功能进行研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PERSPECTIVES ON THE SUBJECT MODEL OF MENTAL TRAUMA AND POST-TRAUMATIC STRESS DISORDER
The article presents the perspectives of considering psychological trauma and related disorders, in particular post-traumatic stress disorder (PTSD), through the concept of subjectness - the subjectness model of psychological trauma. Psychic trauma is defined as an area of the self with a critical devaluation of subjectness. The concepts of subjectness are briefly reviewed, and three main aspects are highlighted: synthesizing, activity, and cognitive. The synthesizing function (aspect) of subjectivity is responsible for the formation of a holistic image of oneself, the world, and relationships - the more holistically an individual perceives the world and oneself, including one's life narrative in the form of a holistic autobiographical time, the higher the level of one's subjectivity. The cognitive function corresponds to the transfer of the sensory level of information to the abstract level and the creation, construction, and restructuring of mental models of the world by setting and solving problems. The synthesizing and cognitive function can be compared to such a concept as mentalization. The activity function corresponds to the individual's sense of himself as a free author of his life and ability to act in sense of a personal form of behavior in which he independently chooses goals and ways of achieving them, and/or an act of moral self-determination in which he asserts himself as a person. The activity function can be compared to such a concept as agency. It is shown that the critical devaluation of the synthesizing function of subjectness can describe the phenomenon of post-traumatic split personality, the devaluation of the activity function of subjectivity – a group of avoidance symptoms in PTSD and post-traumatic negative self-concept, the devaluation of the cognitive function – the inability to integrate the experience of traumatic stress and its existence in a dissociated sensory form. Examples of the author's models of post-traumatic splitting, devaluation of mentalization and formation of a negative self-concept through the formation of a complex of learned helplessness are presented. The concept of subjectness can be convenient for describing mental trauma because, on the one hand, it is holistic and humanistic. On the other hand, it allows working with individual functions of subjectness.
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