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抑郁症—自我攻击的困境-给力心理
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抑郁症—自我攻击的困境

抑郁症—自我攻击的困境
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发表时间:2015-02-04 13:02:09 104 0 2

除了外伤、细菌感染之类的疾病以外,几乎所有的内源性疾病,都或多或少跟遗传有关系。很多精神疾病,包括抑郁症,也跟遗传有一定关系。但是,我们目前还不清楚,遗传到底在多大程度上决定了抑郁症的发生。相对于家族式的抑郁症聚集现象,另一个相反的事实是,更多的家族中往往只有一个抑郁症的患者。这就说明,遗传不是抑郁症唯一的、决定性的病因。
有三个原因使我们不必要让患者把他们的抑郁症归结为遗传的问题。第一,因为这相当于说,你的种不好。这是对一个人的巨大否定,在实际效果上会加深病人的抑郁倾向。第二,过度强调遗传学的因素,会为人种优劣论者提供口实,这些狂人们试图从基因角度改变人,而且他们真的曾经这样做过:纳粹德国一些精神科医生,就跟希特勒政府合作,杀死了数以万计的住院精神病人。第三,到目前为止,我们无法对遗传进行干预,而且,即使以后我们有办法从遗传学角度干预抑郁症的产生,从人本主义和医学伦理学上来说,我们也反对这样做,因为这是对人的尊严和价值的否定。
来自环境刺激因素,比如人际关系中的冲突、失恋、考试的失败、亲人的去世等等,只是导致抑郁症的诱发因素,而不是抑郁症的真正的病因。面对同样的心理创伤性事件,有些人可以在短暂哀伤后重新变得积极健康,而另一些人却很长时间都处于抑郁之中,这就证明外因只是抑郁产生的非本质因素。
产生抑郁症的真正的内因、或者说本质因素是一个人的人格特点。从深层心理学上说,在抑郁症患者的人格结构中,有一个严厉的惩罚者,这个惩罚者会时时监控他或者她的言行,一旦出现哪怕一点点过错或者失误,这个惩罚者就会以极其严厉的方式实施制裁和谴责。抑郁症患者的自责自罪、自我价值感地下、活力降低,都来自这样的自我攻击。
举个例子。一女孩去见网友,结果被网友强奸了。然后她有两种做法。一种是,搜集证据,然后将他告上法庭,使网友受到几年监禁的惩罚。这样的例子是真正发生过,而且事实证明,这样做了的女孩没有患抑郁症。但有如此遭遇的女孩更经常地反应却不是这样的,很多女孩会找自己的过错,会对前途丧失信心:我真傻,我不应该去见陌生人的,我从此不再是一个贞洁的女孩了,从此以后没有男孩会喜欢我了,等等。这都是在使用一种不成熟的心理保护机制,即把攻击性转向自身。而实施攻击的,就是她内心那个严厉的惩罚者。
关于抑郁症的产生,还有一个更加深刻的说法。这个说法是,抑郁来自于自己跟别人的边界不清楚。在上面例子中,女孩之所以惩罚自己,是因为她和强奸她的网友“边界不清”,她内心深处认为,自己和网友是同一个人,所以网友犯了法,就是自己犯了法,就应该被惩罚,这个惩罚就是患抑郁症。
再举一个例子,可以加深对这样的说法的理解。这个世界上,最为“边界不清”的关系,就是恋爱中的男人和女人的关系,他们不论在身体上还是在精神上都是融为一体的,你中有我、我中有你。所以爱情最容易导致抑郁。为什么大多数爱情诗句和歌曲都弥漫着抑郁的情绪,就是这个原因。
甚至还可以从这种说法延伸一个标准,用来判断一个人是否爱上了另一个人。假如另一个人不在你身边,你在想他或者她的时候仅仅是感到温暖和快乐,那表示你不过只是喜欢那个人而已,我们对普通朋友的思念经常就是这样的。而当你思念他或者她的时候,除了感到温暖快乐以外,还有着浓浓的抑郁情绪的时候,那就强烈地说明,你已经不可救药地爱上他或者她了。
从医学上说,抑郁症本身不易一种严重的精神疾病,它属于轻型精神病的一种。大约相当于身体疾病中的感冒而不是癌症。神经衰弱是十几年前的一个“时髦”疾病,1/3的脑力劳动者曾经患过这样的疾病。现在的国际诊断标准中已经取消神经衰弱的诊断,曾经被诊断为神经衰弱的80%的病人,现在看来应该是患了抑郁症,其他20%则属于焦虑症、强迫症之类。
抑郁症的危害主要来自两个方面。首先是可能危害生命,意即有自杀的危险。第二,患上抑郁症会极大地影响到自己和家人的生活质量,使人生不再是美好的旅程,而变成了痛苦的炼狱。
从治疗上来说,抑郁症并不是一种难治的疾病。很多治疗都可以起到不错的疗效。药物治疗是一种简单有效的方法,疗效肯定,见效快,而且不需要长期服药,正规治疗一般4个月就够了。心理治疗是一种标本兼治的措施,研究显示,其疗效跟药物治疗差不多,缺点是见效较慢而且费用太高。
抑郁症这个名字是一个不科学的诊断,因为它只是描述了疾病的外在表现,而没有说明它的病因。一切什么“症”的诊断都是现象学的,所以都是不科学的。举个例子:一个发烧病人住院,24小时内被诊断发热是没问题的,但如果24小时以后还是诊断为发热,那就不对了。因为发烧可以有很多原因,感冒、癌症、艾滋病都可以导致发热,其差别之大显而易见。抑郁症和发热就都是同一种类型的诊断。
所以被诊断为抑郁症的人,不要把抑郁症的诊断太当回事,不要让这顶疾病的帽子把自己压得更加抑郁。现在在中国,很多所谓专家轻易就给人一个疾病的诊断,即使按照诊断标准他们的诊断是正确的,也不可以这样做。这些精神科诊断应该是供同行之间交流用的,而不应该是用来吓唬患者的。一个受过良好训练的医生是不会随便给病人一个诊断的。我个人的习惯是,宁可冒着被认为基本诊断都弄不清楚的风险,决不给人下诊断。我会对我的患者说:你现在情绪有点问题,我们需要采取一点措施,或者吃点药,或者做做心理治疗,就会好起来的。这并不是安慰,而是事实。

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