无授权翻译:#mind hacks+20120805#精神病:雾锁烟迷的现实

原文http://mindhacks.com/2012/08/05/psychosis-and-the-fog-of-reality/

Last May The New Yorker had a beautiful but paywalled article on on psychosis and insight. Thankfully the full text has found its way online as a pdf.

Psychosis is the psychiatric term for delusions and hallucinations, with insight being the ability to recognise that what you believe or experience is not a fair representation of reality.

The concept of insight is more easily applied to hallucinations than delusions, after all you can hallucinate patterns on the walls but realise that the patterns are not really there, but you can’t really have a belief and not believe it.

With regard to delusions, it is tested by seeing how readily people can accept that there is a chance they might be wrong. In other words, it’s an estimate of certainty with absolute certainty in a false belief being considered abnormal.

In practice, and due to the difficulties on agreeing on or verifying reality, it often comes down to whether you agree with your psychiatrist (indeed, one definition of insight, includes accepting treating as a sign of good insight), sometimes leading to situations where people with genuine psychosis completely reject any form of treatment even where it would be of clear benefit.

Rachel Aviv’s article for The New Yorker is a brilliant exploration not only of the experience of slipping into psychosis but also the politics and practicalities of insight.

By the way, Aviv has written a series of excellent articles about mental health including one called ‘Which Way Madness Lies: Can psychosis be prevented?’ for Harper’s Magazine which is also online as a pdf.

pdf of article on insight in psychosis.
pdf of article on preventing psychosis.

翻译:

五月的时候《纽约客》杂志发表了一篇很赞的有关精神病(psychosis)和自知力(insight)的文章。现在这篇文章可以在这里看到pdf. (http://www.xavieramador.com/files/Aviv,%20The%20New%20Yorker.pdf)

精神病psychosis在精神病学中指幻觉和妄想,自知力insight则指分辨你所体验到的事物是否是真实存在的能力。

“自知力”更适用于描述幻觉而非妄想,因为你能体验幻觉并且分辨这些感觉是否真实存在;但你不能辨认一个‘信念‘是虚假的然后不去相信它。

如何测试一个念头是否属于’妄想‘,就要看人们是否接受这个想法有可能出错。换句话来说,测试一个人是否有妄想的症状,就是看他/她是否不正常地执着于一个错误的想法。

实践中,因为难以确认或分辨所谓“现实”,所以通常就变成了你是否同意你的精神科医生(事实上,对于正常“自知力”的定义包括接受治疗http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292655/),所以有时候一些天生就有精神病的人完全拒绝治疗,即使治疗会带来显而易见的好处。

Rachel Aviv(http://rachelaviv.com/)在《纽约客》的文章是一篇很好的探索精神病体验以及对于自知力在实践中的理解。

顺便一提,Aviv也写过一系列有关心理健康的文章,包括一篇为哈泼斯杂志(Harper’s Magazine)所写的名为“疯狂隐藏在哪里:精神病有可能预防吗?”的文章。这篇文章的pdf在这里 http://www.columbia.edu/cu/neuwrite/pubs/avivHarpers.pdf

精神病的自知力:http://www.xavieramador.com/files/Aviv,%20The%20New%20Yorker.pdf
预防精神病:http://www.columbia.edu/cu/neuwrite/pubs/avivHarpers.pdf

(链接附带的文章正在阅读,稍后附上梗概)

笔者乱插花:
重要名词解释:[bold]精神病和psychosis[/bold]:
中文中的精神病一词含有至少两个意思:

维基百科中的解释是这样的:
精神病(或称做精神疾病、心理疾病、情绪障碍、认知功能障碍),主要是一组以表现在行为、心理活动上的紊乱为主的神经系统疾病。目前研究所得到的结果认为主要是由于家庭、社会环境等外在原因,和患者自身的生理遗传因素、神经生化因素等内在原因相互作用所导致的心理活动、行为、及其神经系统功能紊乱为主要特征的病症。http://zh.wikipedia.org/wiki/%E7%B2%BE%E7%A5%9E%E7%97%85
[bold]这一解释与英文中mental disorder重合。[/bold]

英文中psychosis一词,虽然在中文中习惯性被译作’精神病‘,但在这种情况下,[bold]“经神病”一词是狭义的,仅指幻觉(幻视,幻听)和妄想。[/bold]

笔者认为,中文世界中,“精神病”一词的多种解释与精神障碍/精神疾病(mental disorder)患者受到误解和歧视直接相关。连带“精神科”“精神健康“”精神疾病“”精神卫生“等词汇也受到歧视。报章杂志也往往浑水摸鱼,制造出标题为”一亿精神病人“之类耸人听闻的文章(http://news.sina.com.cn/c/sd/2011-06-16/111722651745.shtml)。

因此,笔者呼吁,至少业者以及各位心理学爱好者,不要滥用”精神病“一词。以及,希望一些重要的,涉及日常使用和政策制定的心理学概念,在翻译的时候多多谨慎。

附录:此文也发于http://www.guokr.com/post/306389/

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