The Hippocampus as a Cognitive Map
The Hippocampus as a Cognitive Map
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DOI：
10.1176/ajp.136.10.1353
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发表时间：
1979-10
影响因子：
17.7
通讯作者：
Jr. James B. Ranck
中科院分区：
文献类型：
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作者：
Jr. James B. Ranck
那些已经相信这种治疗是有效的人热切地接受了对严重精神障碍患者的精神分析治疗的研究，而那些信念在其他地方的人却经常立即拒绝接受。Giovacchini博士对更严重的精神障碍的精神分析的广泛考虑是一位有30年经验的天才，深思熟虑，博览群书的精神病学家的产物。这是一本激励人心的书，为所有信仰的精神病学家提供了大量的东西。Giovacchini博士的治疗立场是基于精神心理学和自我心理学，并反映了受弗洛伊德，克莱因和温尼科特强烈影响的客体关系理论。乔瓦奇尼博士在一次冗长的讨论中批评了科胡特的观点，他认为，无所不在、浮夸和自大狂代表了婴儿对脆弱感的防御反应，而不是发展的独立方面。在第一章中，他确定了这些患者的基本理论问题，并指出了他同意和不同于其他探索类似领域的人的原因。这本书并不主要致力于理论;尽管如此，我希望作者花更多的时间来详细说明雅各布森，拉克尔和马勒等作者对他思想的影响。理论上的考虑是交织在整个案例介绍和讨论。这种方法导致了大量的重复，但它为读者提供了许多机会来重新考虑Giovacchini博士的观点，因为它适用于不同类型的患者。Giovacchini博士对严重不安的患者的治疗方法始于这样一个前提，即他们无法成功地适应被认为具有威胁性的环境。因为他们未能整合他们的自我和客体表征，他们通常不会有“症状”，这些症状是设计用于维持压抑的良好防御机制的结果。相反，这些患者反映出他们难以适应周围的世界”（第59页）。在他们的分析中，“自我及其子系统的变化在回归过程中比本能回归更突出”（第472页），存在问题往往比性问题更突出。通过解释，Giovacchini博士认为这是分析的本质，病人意识到并整合了自我的未感知方面（自我表征），从而进一步发展。“我相信，”作者说，“病人体内有一种内在的力量，它努力追求更高的自我整合状态，一旦仇恨，约束性的内在矛盾就会以某种方式被处理掉，这些力量寻求CX-
Studies of the psychoanalytic treatment of severely disturbed patients are eagerly received by those already convinced that such treatment is effective and too often dismissed out of hand by those whose convictions lie else-where. Dr. Giovacchini’s wide-ranging consideration of the psychoanalysis ofthe more severe mental disturbances is the product ofa gifted, thoughtful, well-read psychiatrist with 30 years of experience. This is a stimulating book that offers a great deal to psychiatrists of all persuasions. Dr. Giovacchini’s therapeutic stance is based on both de-velopmcntal and ego psychology and reflects a theory of ob-ject relations strongly influenced by Freud, Klein, and Winnicott. Taking issue with Kohut, whose views he critiques in a lengthy discussion, Dr. Giovacchini believes that omnipotence, grandiosity, and megalomania represent the infant’s defensive response to a sense of vulnerability rather than separate, independent aspects of development. In the opening chapter he identifies the basic theoretical issues that pertam to these patients and indicates his reasons for agreeing with and differing from others who have explored similar ground. This book is not primarily devoted to theory; still, I wish that the author had devoted more time to detailing the influence of such authors as Jacobson, Racker, and Mahler on his thinking. Theoretical considerations are interwoven throughout the case presentations and discussions. This approach results in much repetition, but it offers the reader many opportunities to reconsider Dr. Giovacchini’s point of view as it is applied to different types of patients. Dr. Giovacchini’s approach to seriously disturbed patients begins with the premise that they have been unable to adapt successfully to an environment perceived as threatening. Because they have failed to integrate their self-and object-representations they do not usually have ‘‘symptoms that are the outcome of well constructed defensive mechanisms designed to maintain repression. Instead these patients reflect their difficulties adapting to the world around them’‘(p. 59). During their analyses,‘‘changes in the ego and its sub-systems are more prominent during regression than is instinctual regression’‘(p. 472), and existential issues are often more ‘prominent than sexual issues. Through interpretation, which Dr. Giovacchini believes is the essence of analysis, the patient becomes aware of and integrates the unperceived aspects of the self (self-representation), thus furthering de-velopment.‘‘I believe,’‘the author states,“that there are innate forces within the patient which strive for states of higher ego integration and once hateful, constricting in-trojects are somehow disposed of these forces seek cx-