自闭症与儿童精错乱

Autism and Childhood Psychosis
自闭症与童年的精神错乱

Specific references to autism and the psychoses of childhood in Lacan’s written works and seminars are scarce. Yet his theses on the structure of psychosis (see foreclosure; psychosis), have enlightened the clinical approach to those conditions and generated a wealth of research, theoretical developments and debate among psychoanalysts of the Lacanian orientation who work with children.

明确的提到自闭症与童年的精神错乱,在拉康的文字著作及研讨班,是很少的。可是,他对于精神错乱的结构的论文曾经启蒙探究那些情况的临床方法,并且产生许多的研究,理论的发展与辩论,在研究儿童的拉康派的精神分析家。

The topic is, however, of relevance for the theory and practice of all Lacanian analysts, as the psychoanalytic field is one, and interest in particular clinical or conceptual problems should not be understood as being the domain of only ‘specialized’ forms of psychoanalysis. Whether autistic, psychotic or neurotic, it is as a subject that the child (or the adult, for that matter) enters the psychoanalytic experience.

可是,这个议题跟所有的拉康派的精神分析家的理论与实践都息息相关,如同精神分析的领域。对它的興趣,特别是临床或是观念的问题,不应该被了解,仅是当著述精神分析的「专业」形式的领域。无论是自闭症,精神错乱,或是神经症,儿童(就那个情况,是成人),进入精神分析的经验,是作为一个主体。

In Lacanian psychoanalysis, the child works in this experience as a subject in his/her own right and in the full sense of the term; this is so despite the fact that the psychotic or autistic subject is outside discourse (hors discours) and cannot therefore be considered to be a ‘subject of the unconscious’ constituted by the operations of alienation and separation. It is still the aim of the psychoanalytic experience that the psychotic or autistic subject establish a ‘workable’ link with discourse.

在拉康的精神分析,儿童在这个经验里,充当是主体,拥有他/她自己的权利,就那个术语的完整意义而言。这是如此,尽管这个事实: 精神错乱或是自闭症的主体,外在于辞说之外,并且因此无法被认为是一个「无意识的主体」,由异化与分离的各种运作所组成。这依旧是精神分析经验的目标,精神错乱或是自闭症的主体应该建立一个跟辞说「可运作的」的关联。

Within Lacan’s works, the main references that have inspired the psychoanalysts who work with psychotic and autistic children (leaving aside for the moment the distinction between the two terms) are:
• The doctoral thesis on paranoia (1932).
• The article on the family published in the Encyclopédie française (1938).
• The commentaries on the cases of Dick (treated by Melanie Klein; Klein 1930) and Robert (treated by Rosine Lefort; Lefort and Lefort 1988). Both are part of the 1953-54 seminar, or Seminar I.

在拉康的著作里,曾经启发精神分析家的主要的指称如下,他们研究精神错乱及自闭症儿童(暂时将这两个术语的区别搁置):
1、 对于偏执狂的博士论文 (1932)
2、 论家庭的文章,发表于法国百科全书(1938)
3、 有关个案的评论,对于笛克(梅兰妮、克莱恩所治疗:克莱恩,1930年)及罗伯特(由罗欣尼所治疗:雷弗特1988年)。两个个案都是1953-54的研讨班的部分,或是第一研讨班。

雄伯说
罗伯特的个案,就是双臂大黑天翻译一半的「狼孩」,请参照。

• The seminar on the psychoses of 1955-56.
• The now ‘classical’ 1959 paper on the treatment of psychosis included in the English-language selection of the Écrits (1977).
• The intervention at the conference on childhood psychosis organized by Maud Mannoni (1968).
• The note on the child addressed to Jenny Aubry (1969).
• The revision of the concept of the Name-of-the-Father and the function of the symptom developed in the seminars of 1974-75 (R.S.I.) and 1975-76 (Le Sinthome).
• The 1975 Geneva lecture on the symptom.

4、1955-1956 年的精神错乱的研讨班。
5、1959年的论精神错乱的治疗,现在已成经典,在精神分析论文集的英文版收入(1977年)
6、对于儿童精神错乱的会议的介入,这个会议由莫德、曼诺尼主办(1968年)
7、跟珍妮、奥布瑞演讲的儿童观察(1968年)
8、1974-75年的(R.S.I)及1975年-76(圣庄),以「父亲之名」的观念的订正,及发展的病征的功用。
9、 1975年,在日内瓦演讲病正。

Diagnosis
The first question that faces the practitioners in the field, both of practical and conceptual significance, is that of diagnosis which, from a Lacanian perspective is necessarily structural.
In his seminar on the psychoses, Lacan speaks of ‘the structure of the psychotic phenomenon’: the observable phenomena are moments of the structure, rather than epiphenomena.
From a clinical perspective, ‘observable’ phenomena are not perceived unless the clinician’s conceptual mapping is prepared to admit them; and this requires structural hypotheses.

诊断
在这个领域实践者面临的第一个问题,兼具实践与观念的重要性,那就是诊断的问题。从拉康派的观点,它必然是结构的问题。

在他论精神错乱的研讨班,拉康谈论精神错乱的现象的结构:可观察到现象是结构的时刻,而不是次要现象。

从临床观点,「可观察的」现象没有被感觉,除非临床医生的观念的描绘准备要承认它们,而这需要结构的假设。

In the Lacanian orientation, childhood and adult psychoses are identical from the viewpoint of their structure; this position contrasts with the view adopted by the authors of current psychiatric classifications. In making of psychosis a developmental disorder, what the psychiatric orientation represented by the D5M-IV causes is, in the first place, to consider the psychotic phenomenon as a deficit, rather than a production; and secondly, to define the deficits of the patient in terms of developmental norms external to the structure of the subject as such.

依拉康派的研究方向,儿童与成人的精神错乱是一致的,从他们的结构的观点。这个立场可跟目前的精神分裂疾病的分类的作者们所採用的观点互相对照。他们将精神错乱解释为成长发展的疾病,精神分裂疾病的研究方向,由D5M-IV列举的目标所代表。它首先要将精神错乱的现象,作为一种缺陷,而不是一种产物。其次,他们定义病人的缺陷,用成长发展的标准,外在于主体本身的结构。

Diagnosis is thus established on the basis of what the subject has not achieved developmentally and his/her deviation from norms which combine medical and educational criteria, adaptation to conventional social demands being the central point of reference. This is a questionable criterion for clinical phenomenology, since the emphasis is placed on what is absent and not on what is phenomenologically observable, which is a production.

诊断因此被建立,根据主体在成长发展没有达成的东西。他/她偏离这个标准,这些标准联接医学与教育的标准,对于传统的社会要求的适应,成为指称的重点。这是一个受到质疑的标准,对于临床的现象学。因为强调被放置在所欠缺的东西,而不是在现象上可观察的东西。这是一种产物。

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