雄伯译
WHY DIAGNOSIS? 为什么诊断?
Throughout his works, Lacan insisted on the differences between various mental organizations, on the analyst’s need to recognize these differences, and on the mandatory adoption of a differential treatment approach in the light of the psychic economy the analyst has acknowledged in the patient. The ‘Lacanian analyst’ has to bear in mind some basic nosological categories and is held to diagnose patients at the earliest stage of the clinical process, because her position within the treatment should differ according to the psychic structure of the patient. Hence, the initial assessment of the patient is not merely a matter of registration, due to the fact that it has major clinical consequences.
精神病组织之间的差异,当它们探讨分析家体认这些差异的需要,与探讨义务地採用差异的治疗方法,从分析家在病人身上洞见的心灵活动的观点。“拉康派的分析家”必须将一些基本的疾病分类牢记在心,并且被认为应该诊断病人,在临床过程的最早期的阶段,因为分析家在治疗中的立场应该有所不同,依照病人的心灵的结构。因此,对于病人的最初的评估不仅是铭记的事情,由于这个事实:它具有重大的临床的结果。
在拉康的著作里,他坚持这些差异,在各色各样的Like so many other aspects of Lacan’s clinical theory, the importance of a correct diagnosis prior to the beginning of psychoanalytic treatment is rooted in Freud’s papers on technique. In ‘On Beginning the Treatment’ (Freud 1913c), Freud argued in favour of a trial period (Probezeit, Erprobung, Sondierung) of one or two weeks before the start of the treatment, for which he adduced the necessary, yet laborious diagnostic procedure as one of the main reasons.
像拉康的临床理论的许多其他的层面,在精神分析的治疗的开始之前,正确的诊断的重要性,是以弗洛伊德探讨精神分析技术的论文作为依据。在“论治疗的开始”(弗洛伊德1913c),弗洛伊主张,他赞同在治疗开始之前,要有一段大约一到两个星期的尝试期。他举出这个必要,但是费力的诊断的程序,作为这个尝试期的其中一个主要的理由。
Until the end of his career, Freud remained convinced that the standard method of psychoanalysis was of no use to people suffering from paraphrenia—or some other form of psychosis—which prompted him to demand that the analyst recognize this contraindication during the trial period (ibid.: 124).1 Failure to do so, or making a diagnostic mistake, would be disastrous as some patients (neurotics wrongly diagnosed as paraphrenics) would be unjustly excluded from treatment, whereas others (paraphrenics erroneously qualified as neurotics) would be unjustly admitted.
神经症者被错误诊断成为精神分裂症者),将会不公平地被排除在治疗之外。另一方面,其他的病人(精神分裂症者被错误地被认为是神经症者的特质),将会不公平地被接纳看诊。
一直到他从事业退休,弗洛伊德始终相信,精神分析的这个标准方法对于患精神分裂症的人们是没有用途,或是对某个其他种类的精神病。这引起他做这个要求:精神分析家应该在尝试期,就体认这个禁忌徵侯。假如精神分析家没有体认出来,或是犯了诊断的错误,那将会是个灾难。因为病人(Compared to Freud’s dual opposition of neurosis and psychosis, Lacan’s nosological framework is slightly more sophisticated and its categories more mutually exclusive. Whereas Freud also designated the psychoses as narcissistic neuroses (and the neuroses proper as transference neuroses) (Freud 1916–17a[1915–17]:420), Lacan defined neurosis and psychosis as fundamentally different psychic structures with separate causalities.