Society
Society
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DOI：
10.4324/9781351314008-8
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发表时间：
2020-03
期刊：
影响因子：
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通讯作者：
H. Redner
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作者：
H. Redner
意识——或者在这本刺激而及时的书中更愿意称之为意识——梅斯——既是研究的焦点，也是治疗工作的目标。弗洛伊德认为意识是理所当然的，并认为他的计划是探索我们不知道的深处。贝克承认需要与意识一起工作，但认知的复杂性和病态不能等同于意识本身。精神分析和认知行为疗法通常都关注心灵的“内容”，而不是不同的意识状态本身。相比之下，东方心理学，尤其是佛教心理学，以意识为对象。各种类型的正念训练，从冥想和瑜伽练习到禅宗公案的沉思（明显的悖论，其“解决方案”会导致意识的突然跳跃），旨在产生平静、清晰的感知和立足于“当下”，从而将心灵从神经质的恐惧、痛苦和自我挫败的欲望中解放出来。少数先驱心理治疗师，特别是荣格和弗洛姆，承认这种替代心理治疗资源，但直到最近，正念作为一种治疗技术才进入心理治疗主流。 Kabat-Zinn 针对身体疾病患者的基于正念的减压疗法、Linehan 针对边缘性人格障碍的辩证行为疗法以及 Williams 和 Segals 针对复发性抑郁症的基于正念的认知疗法都是最著名的。梅斯的这本紧凑、通俗易懂且文笔优美的书以富有同情心但并非不批判的眼光审视了这一领域。他涵盖了正念的胚胎科学（目前还很少有相关的功能性磁共振成像（fMRI）研究），并着眼于精神分析和认知方面的尝试，以促进正念与其核心学科之间的和解。他展示了认知行为治疗师如何发现标准技术不足以改变边缘型人格障碍和慢性抑郁症患者长期存在的功能失调思维模式，以及增加正念训练如何能够显着降低复发率。关于佛教“无心”理想与精神分析学家比昂要求治疗师在没有“记忆和欲望”的情况下接近患者的禁令之间的相似之处，有一个引人入胜的讨论。梅斯引用的研究表明，针对专业人士的正念训练（包括针对医学生的卓越的莫纳什计划）如何能够改善患者的治疗结果。他认为正念的关键贡献是通过开放对痛苦（自己和他人的痛苦）的认识来增强同情心的能力。他将治疗性正念的概念解构为三个组成部分：“去链化”（减慢感知速度，从而打破功能失调的思想和行动的自动性）、“重新感知”（接受而不是避免有问题的感觉）和“去中心化”（将精神痛苦视为“只是想法”）。我只有两条批评意见。首先，本书一开始就对佛教心理学进行了令人不快的阐述，即使对于入门者来说，这也是艰巨的（诚然，梅斯不诚实地邀请读者跳过这一章）。其次，没有提到心智化，这是精神分析传统中的一个相关概念，构成了贝特曼针对边缘性人格障碍的循证计划的基础。考虑到这些警告，我强烈向任何有意识的——甚至是半意识的——心理健康专业人士推荐这本书。
of consciousness – or awareness as Mace, in this stimulating and timely book prefers to call it – as both a focus for research and a target for therapeutic work. Freud took consciousness for granted and saw his project as plumbing the depths of that which we are unaware of; Beck acknowledged the need to work with the conscious mind, but the complexities and pathologies of cognition cannot be equated with consciousness itself. Both psychoanalysis and cognitive–behavioural therapy typically focus on the mind’s ‘content’ rather than differing states of awareness themselves. By contrast, Eastern, especially Buddhist, psychology takes consciousness as its object. Various types of mindfulness-training, ranging from meditation and yoga practices to the contemplation of Zen koans (apparent paradoxes, whose ‘solution’ produces sudden leaps in consciousness) aim to produce calm, clarity of apperception and grounding in the ‘present moment’, thereby freeing the mind from neurotic fears, miseries and self-defeating desires. A minority of pioneering psychotherapists, notably Jung and Fromm, acknowledged this alternative psychotherapeutic resource, but only recently has mindfulness as a therapeutic technique entered the psychotherapeutic mainstream. Kabat-Zinn’s mindfulness-based stress reduction for the physically ill, Linehan’s dialectical behaviour therapy for borderline personality disorder and Williams and Segals’ mindfulness-based cognitive therapy for recurrent depression are the best known. Mace’s compact, accessible and well-written book surveys the field with a sympathetic but not uncritical eye. He covers the embryonic science of mindfulness (there are as yet few relevant functional magnetic resonance imaging (fMRI) studies) and looks at both psychoanalytic and cognitive attempts at rapprochement between mindfulness and their core discipline. He shows how cognitive–behavioural therapists have found standard technique insufficient to change the long-standing patterns of dysfunctional thought found in individuals with borderline personality disorder and chronic depression, and how adding mindfulness training can significantly reduce relapse rates. There is a fascinating discussion of the parallels between the Buddhist ideal of ‘no mind’ and the psychoanalyst Bion’s injunction to therapists to approach their patients without ‘memory and desire’. Mace cites studies showing how mindfulness training for professionals (including the remarkable Monash programme for medical students) can improve outcomes for their patients. He sees the key contribution of mindfulness as enhancing the capacity for compassion by opening awareness to suffering – one’s own and that of others. He deconstructs the concept of therapeutic mindfulness into three components: ‘de-chaining’ (slowing down perception, thus breaking the automatism of dysfunctional thoughts and actions), ‘re-sensing’ (acceptance rather than avoidance of problematic feelings) and ‘de-centering’ (seeing mental pain as ‘just thoughts’). I have but two critical comments. First, the book opens with an off-putting exposition of Buddhist psychology that is hardgoing even for the initiated (admittedly, Mace disingenuously invites the reader to skip this chapter). Second, there is no mention of mentalisation, a related concept from the psychoanalytic tradition that forms the basis of Bateman’s evidence-based programme for borderline personality disorder. With those caveats, I strongly recommend this book for any aware – or even semi-conscious – mental health professional.