醫學與心理治療84

VII
MEDICINE AND PSYCHOTHERAPY
醫學與心理治療84

Carl Jung
卡爾 榮格

192
Speaking before an audience of doctors, I always experience certain difficulty in bridging the differences that exist between medicine on the one hand and psychotherapy on the other in their conception of pathology. These differences are the
source of numerous misunderstandings, and it is therefore of the greatest concern to rne, in this short talk, to express one or two thoughts which may serve to clarify the special relationship that psychotherapy bears to medicine.

面對醫生作為我的聽從,我總是經驗到某些的困難,要區別這個差異,一方面存于於醫藥,另一方面,存在于心理治療,有關它們的病理的觀念。這些差異的無數誤解的來源,因此在這次簡短的演講,我最大的關注是要表達一兩種思想,可以充當澄清心理治療與醫藥的特別關係。

192b
Where distinctions exist, well-meaning attempts to stress the common ground are notoriously lacking in point. But it is extremely important, in his own interests, that the psychotherapist should not in any circumstances lose the position he originally held in medicine, and this precisely because the peculiar nature of his experience
forces upon him a certain mode of thought, and certain interests, which no longer have or perhaps I should say, do not yet have a rightful domicile in the medicine of today. Both these factors tend to lead the psychotherapist into fields of study
apparently remote from medicine, and the practical importance of these fields is generally difficult to explain to the non-psychotherapist.

在差異存在的地方,強調彼此有共同點立場的這種善意企圖,顯而易見是沒有意義的。但是極端重要的是,為了本身的利益,精神分析師無論如何不應該失去,他在醫藥方面所持有的立場。這確實是因為他的精神分析經驗的特性,強迫給予他某種的思想模式,某些的利益。而這些利益,在今天的醫藥,已經沒有,說得確實些,是不再有合適的存身之所。這兩種因素傾向于引導心理治療師進入研究的領域,顯見是跟醫藥相距甚遠。這些領域在心理治療實踐的重要性,通常很難跟非心理治療師去解釋。

Lacking in point—欠缺意義
Notoriously– Known widely and usually unfavorably 惡名昭彰
Domicile–Housing that someone is living in 存身之所

192c
From accounts of case histories and miraculously successful cures the non-psychotherapist learns little, and that little is frequently false. I have yet to come across a respectable specimen of neurosis of which one could give anything like an
adequate description in a short lecture, to say nothing of all the therapeutic intricacies that are far from clear even to the shrewdest professional.

從個案歷史及奇跡般成功的治療的描述,非精神治療師獲知的資訊甚少。而且,就連那甚少的資訊都還往往是虛假。我還沒有遇到一個可確信的神經症個案病例,我能夠在一次的演講中充份地描述完整。更不用說,所有那些心理治療的複雜性,即使是對於一個高明的心理治療專業,根本都還是朦朧不清。

193

With your permission I will now examine the three stages of medical procedure anamnesis, diagnosis, and therapy from the psychotherapeutic point of view. The pathological material I am here presupposing is pure psychoneurosis.

請容許我現在檢視醫療程式的三個階段。從心理治療的觀點來說,就是:病例成立,診斷,及治療。我在這裏假定的病理資料,是純粹心理神經症患者。

194
We begin with the anamnesis, as is customary in medicine in general and psychiatry in particular that is to say, we try to piece together the historical facts of the case as flawlessly as possible. The psychotherapist, however, does not rest content with these facts. He is aware not only of the unreliability of all evidence, but, over and above that, of the special sources of error in statements made on one’s own behalf the statements of the patient who, wittingly or unwittingly, gives prominence to facts that are plausible enough in themselves but may be equally misleading as regards the pathogenesis.

我們先從病例成立開始。依照一般醫學及特別精神病學的慣例,換句話說,我們設法將個案的歷史事實,盡可能完整地串聯起來。可是,心理治療師並沒有滿足於這些事實。他不但知道,所有的證據都有不可靠的地方,而且,在代表自己所陳述的所有的錯誤的特別來源裏,病人的陳述,無論精彩或是平淡,都會凸顯這些事實本身能夠自圓其說,但是關於病因診斷而言,卻是同樣的誤導。

On one’s own behalf—as the representative 代表
Over and above—in addition to something 除外

194b
The patient’s whole environment may be drawn into this system of explanation in a positive or negative sense, as though it were in unconscious collusion with him. At all events one must be prepared not to hear the very things that are most important. The psychotherapist will therefore take pains to ask questions about matters that seem to have nothing to do with the actual illness.

病人的整個環境可能會被吸引到這個解釋系統裏,以一個積極或是消極的意義。好像這個解釋不知不解地跟他共謀。無論如何,我們必須準備不要聽到非常重要的這些事情。心理治療師因此要很費心去問一些問題。這些問題表面上是跟實際的疾病沒有什麼關聯。

194c
For this he needs not only his professional knowledge; he has also to rely on intuitions and sudden ideas, and the more widely he casts his net of questions the more likely he is to succeed in catching the complex nature of the case. If ever there were an illness that cannot be localized, because it springs from the whole of a man, that illness is a psychoneurosis. The psychiatrist can at least console himself with diseases of the brain; not so the psychotherapist, even if he privately believes in such a maxim, for the case before him demands the thorough psychological treatment of a disturbance that has nothing to do with cerebral symptoms.

因為這樣,他不但需要他的專業知識,他也必須依靠直覺及突然的靈感。他將他的問題之網撒得越寬廣,他就越有可能成功地捕捉到個案的複雜特性。假如有某個疾病無法被明確定位,因為它從人的整體呈現出來,那個疾病就是心理神經症。精神病醫師至少能夠安慰自己,說這是腦的疾病。心理治療師則是不能夠這樣說,即使他私底下相信這句箴言。因為在他面前的這個個案要求:他應該徹底地從心理方面治療這樣的疾病。而這個疾病則是跟腦的病徵沒有絲毫關係。

194d

On the contrary, the more the psychotherapist allows himself to be impressed by hereditary factors and the possibility of psychotic complications, the more crippled
he will be in his therapeutic action. For better or worse he is obliged to overlook such cogent factors as heredity, the presence of schizophrenic symptoms, and the like, particularly when these dangerous things are put forward with special emphasis,
His assessment of anamnestic data may therefore turn out to be very different from a purely medical one.

相反的,心理治療師越是讓他自己對於遺傳的因素,及心理併發症的可能性產生印象,他在採取治療的作為越是會遭受挫折。無論結果好壞,他不得不將諸如遺傳,精神分裂症狀的存在,等等確實的因素,擱置一邊,特別是當危險的事情,特別強調地被提出。他對於病例資料的評估,結果會因此與純粹是醫療隊病例,迥不相牟。

195

It is generally assumed in medical circles that the examination of the patient should lead to the diagnosis of his illness, so far as this is possible at all, and that with the establishment of the diagnosis an important decision has been arrived at as regards prognosis and therapy. Psychotherapy forms a startling exception to this rule: the diagnosis is a highly irrelevant affair since, apart from affixing a more or less lucky label to a neurotic condition, nothing is gained by it, least of all as regards prognosis and therapy. In flagrant contrast to the rest of medicine, where a definite diagnosis is often, as it were, logically followed by a specific therapy and a more or less certain prognosis, the diagnosis of any particular psychoneurosis means, at most, that some form of psychotherapy is indicated.

在醫學領域,通常的認為是:對於病人的檢查,應該盡可能地促成對於他的疾病的診斷。而且隨著診斷的建立,關於預診及治療,要形成一個重要的決定。心理治療學形成一個非常令人驚訝的例外,對於這個常規。預診是一個非常不相關的事情,除了替神經症的病情貼上一個相當幸運的標籤外,沒有其他利益,關於預診及治療,尤其沒有。在其他的醫療,明確的預診之後,邏輯上就是緊隨著明確的治療,以及相當確定的診斷,可以這樣說。跟它們明顯相比起來,任何特別的心理神經症的預診,充其量意味著:某種形式的治療被指示。

As to the prognosis, this is in the highest degree independent of the diagnosis.
Nor should we gloss over the fact that the classification of the neuroses is very unsatisfactory, and that for this reason alone a specific diagnosis seldom means anything real. In general, it is enough to diagnose a “psychoneurosis” as distinct from
some organic disturbance— the word means no more than that.

關於預診,這是最高層次的獨立的預診。我們也不應該掩飾這個事實:神經症的分類是非常不令人滿意的。光是因為那個理由,一個明確的預診很少意味著任何真實的東西。一般說來,只要診斷一個「心理神經症」,當作是跟某些的有機器官的疾病不同,那就足夠了。「心理神經症」的意思僅就是那樣。

Gloss over—to speak kindly of or refuse to mention ( something bad) so as to hide or excuse its wrongness 迴避錯誤 ,掩過飾非

I have in the course of years accustomed myself wholly to disregard the diagnosing of specific neuroses, and I have sometimes found myself in a quandary when some word-addict urged me to hand him a specific diagnosis。The Greco-Latin compounds
needed for this still seem to have a not inconsiderable market value and are occasionally indispensable for that reason.

在過去幾年來,我已經習慣于完全將明確的神經症的預診,擱置一邊。我有時候發現我自己處於這個尷尬立場,當某位元偏愛文字解說者要求我給予他一個明確的預診。我依舊需要希臘文及拉丁文的組合字來解說,它們似乎還頗具有市場價值。因為這樣,有時候還非要不可。

雄伯譯
32hsing@pchome.com.tw
https://springhero.wordpress.com

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