Pediatrics and psychiatry.
Pediatrics and psychiatry.
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儿科和精神病学。
DOI：
10.1111/j.2044-8341.1948.tb01173.x
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发表时间：
1948
期刊：
影响因子：
--
通讯作者：
D. Winnicott
中科院分区：
文献类型：
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作者：
D. Winnicott
由于我的工作性质，我选择“儿科及精神科”作为我的发言题目。我是一个转向精神病学的儿科医生，也是一个坚持儿科的精神病学家。在主席的发言中，发言者利用自己的独特经验是情有可原的，甚至是通常的做法。我的职位，因为我是两个领域的工作者，应该使我有资格传达一些对儿童医生和工作与精神病有关的医生感兴趣的东西。当然，一个人同时从事两个学科的工作，必然要牺牲对每一个学科的某种程度的专业知识。多少从弗洛伊德的开创性工作开始的研究已经确定了这样一个事实，即在对精神神经症的分析中，病人的童年期原来是隐藏着无法忍受的冲突的，这些冲突导致了压抑，导致了防御的建立，导致了个体情感发展的中断，并形成了症状。因此，研究自然就转向儿童的情感生活。人们很快发现，成年病人对他们童年冲突的重建--与他们本能的观念和经验有关的冲突--可以在儿童身上看到，在对儿童的分析治疗中也可以清楚地看到。不久之后，人们开始怀疑，成年人的精神病是否与婴儿的经历无关。人类情感发展的高度复杂的理论逐渐形成，因此，尽管我们有着可怕的同时又令人兴奋的无知，但我们现在有了有用的工作假设;也就是说，真正有效的工作假设。现在有足够的材料可以用来试图阐明精神病学家和儿童医生同样关注的关于婴儿的事情，我想成为试图说这些话的人之一。因此，我的论点是，这两个专业的研究工作者都能通过与另一个专业的研究工作者会面而获益匪浅。必须作出一个假设，也许它不会被接受。我认为精神失常是有心理基础的。我认为精神病学可以在脑组织健康良好的情况下进行研究。自然地，如果大脑有病，或者身体受到干扰，或者受到伤害，心理上的变化肯定是可以预料的。我自己觉得，从一个大脑紊乱的人的人格研究中，我能学到的东西更少，因为在大脑完整的个体中可以研究的东西太多了，而关于正常的情感发展及其变幻莫测的情况，还有太多的东西有待理解。我不愿意做我被建议做的事，也就是使用美国意义上的精神病学这个词，因为至少在这个国家，精神病院的医生决不总是接受精神病作为心理问题的理论。因此，我把我在医院的部门称为心理学部门。我希望大家不要认为我忽视了遗传、GPI、老年痴呆、损伤、脑炎、中毒性谵妄、脑瘤，甚至是在诱发癫痫发作后症状的改善。让我重申一下我的观点，即在婴儿的发育和精神状态之间，以及在婴儿的护理和对精神病患者的适当护理之间，建立一种临床联系是可能的。
I have chosen the subject ‘Pediatrics and Psychiatry’for my address because of the nature of my work. I am a pediatrician who has swung to psychiatry, and a psychiatrist who has clung to pediatrics. In an address from the Chair it is excusable, even usual, for the speaker to draw on experience that is peculiar to himself. My position, as I am a worker in two fields, ought to qualify me to communicate something that has interest for the children’s doctor and also for the doctor whose work is concerned with the insane. It is, of course, inevitable that one who works in two subjects must sacrifice some degree of expertness in each. The researches that more or less started with the pioneer work of Freud have established the fact that in the analysis of psycho-neurosis the patient’s childhood turns out to have harboured the intolerable conflicts which led to repression, and to the setting up of defences, and to the interruption in the emotional development of the individual, with formation of symptoms. Naturally, therefore, research became directed towards the emotional life of children. It was soon found that the reconstruction which adult patients gave of their childhood conflicts-conflicts associated with their instinctual ideas and experiences--could be seen in children, and seen clearly in the analytic treatment of children. It was not long before it began to be wondered whether the more psychotic illness of adults might not relate to the experiences of infants. Gradually a highly complex theory of the emotional development of the human being has been worked out, so that with all our terrible and at the same time exciting ignorance, we now have working hypotheses which are useful; that is to say, working hypotheses that really work. There is now sufficient material available for attempts to be made to formulate things about infants which concern equally the psychiatrist and the children’s physician, and I want to be oneofthosetryingtosaythesethings. My thesis then is that the research worker in each of the two specialities has much to gain by meeting the research worker in the other. One assumption must be made, and perhaps it will not be accepted. I assume a psychological basis for mental disorder. I assume that psychiatry can be studied in cases in which the health of the brain tissueis good. Naturallyifa brain is diseased or physically disturbed, or cut about, mental changes must be expected. I feel for myself that I could learn less from a study of the personality of a person with a disordered brain, since so much can be studied in the brain-intact individual-and so much remains to be understood about normal emotional development and its vagaries. I am disinclined to do as I have been advised to do, which is to use the word psychiatry in the American sense, since in this country, at least, the mental hospital doctor by no means always accepts the theory of psychiatric disease as a psychological matter. Therefore I call my department in a hospital a psychology department. I hope it will not be thought that I am ignoring heredity or GPI or senile dementia, injury, encephalitis, toxic delirium, or brain tumour, or even symptomatic improvement following the induction of fits. Let me restate my idea, that it is possible to establish a clinical link between infant development and the psychiatric states, and likewise between infant care and the proper care of the mentally sick.