COJ?ERTA/OEORGeMAlUR TEHNOREDACTARE/NICOLAETURCAN

REDACfOR/MlHAl GOTLU

CASTLES. OF SAND Sdence and ~seudos.deJlce

in_ psycliQpu~Uology.

~ COPYRIGHTTR.ITONLC .'CLUJ/ Tui.IF~U.: +40.164.431.655

B UCURB~Tl/1'e1Jflnx.: .,_40.21.242,.54.09 e:nnll: edilura@tritonic.m

ww.w. tritonic.ro __ "Vlrww .j~rnalism.ro

DeJcrleten CJI' R l}lblloLe-;;ii_Nu'l~nRle P 1toan6nlel DAYU>,DANI:EL . . . .. '<

"FIIstelede 11lsfp .. : ~Ubt.ii. f~psmtlo~Uiulii in p5Umpatologie I Daniel David;'::. Ducu~ti : Trilonic, 2003

ISUN 973~8497-1.1-J

'

Daniel-David

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CASTELE'-DE NISI~ ~tiinta ~i psettdo~tlin~a

i11 psihopatologie

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Mndu: "A:f~ri .JI devi110!" (Ooelhe: .Se/Jge SellltrlldJI)

:, Dedicatle:J.Jtcfll(ell.~e,tkdicalii acdorcolcti ~i pro:fusioni:;fi Jlenrm care ~liinJa eme opl)rtu~itatea 4!= a 1e mira critiC ~i activ fn(i de spectncolul

fumii~i ck. a k: lmcuri\din plitll~:pmpriiJccoAllibnfli Ia a east specfilcol, ~:nro! au supra vio[uit inca tncerclirii-lnle continue d~ a lc snbotn .

. Dedication: I dndioatc tbis book to those ~:oUeoguell nnd prof~imtalslbr wllflll\ scienl:e ~presentstbe opportunity lh crilically nnd' activ11ly wonder -in the facb of I!JC~ wm:ld Bpeclnclc and to fblly enjBy your own contributions. to Ibis specrnclc. contributitfna that have still resiliently Sfr-vived your peNisteni:.attempt to aqbotnge them.

. Mnlfutuiref Aparitia,acesteiJfJcilri afost_impulsio~nut dt! oameni cArora tin sate null!Umesclrimod deo!ebit;ParaMizlindll fd calebrli, Guy Montgome..y,~i"ilana,Bovbjerg tie Ja r,:lifo1mt Slnay;S~I\oc:ll of Medicine, SUA, an-btl tr02.it din 'SOmnul tJO!filatic Qi m-au lnvl\1111 ceeuce inse6mnil flUnlll, certeflu'ea.vi pmi;lica-vtiiqfificli;'lltUnCi dud CfeM'lm t1l ~Jill RCtSI i1iem fi ell nu mlmlli p~te ~Jirimlani.mi~. ~~rHilis .. d.: la Alben Hills llrstfrure. SUA. a faar onruJ,Citfcn141 iospinn fn1UOOdineft crilic;ii~i refleJtivd QSUpl"n Bllll I:CCD ecfiU:~tl:afC't!""ainviirbl sltnll:f~f pierd niciodrtlif iucre-derea fi sA tontinuu sl tollStfUiesc Criticlltdnci dnd muldl tumc f:Stc tll\pl)-lfiw mea ~i a dec&~ me:" AR.Ptl'UN.Bca lucrurllesli stea nll16\, dnr niciunde nu si:ri.e, t1 lncmrile N\J.'Iltl!llUIJ!sl\ sleanva prosb::um stnu,.deei:c:4}nlinull sll construitfti $i ~~ eritic~ tin,c insutl" .. ar sptme,ekS,~evcn ~~~n~ ile h1 SUNY ar Binghamton. SUA i laving Kirsch. de--Jn.Conneaticul Utlivo:rsity, SUA. an filM Jlfieti;nf ljlmodel~tde,atlbldiQe crlliiA fi constru.clivli ~Stlpm domeniului tlinic, CIU'C ln.:.au infliienJ&tinceelfce lim &ut oict MtdlttnlCSI: lroftlorcolagi ti prititeni care au citit rextul fi care m-au njutat Siiil n~roximez itt aoaastl thrmii . SuPl prea multi ca sAi enmnlb' a.ici; ~oi ftlentinnn door oote.tlii tie In Catedm de Psibologie a UniveuiMtfi DabCfi:..:aiityai din .Cluj Nntmc~r . cnre anm.ticlind nllfptmntolluciarea in cndml-col~:ctivtilui ile atfttfrii lltl ft~ut sugisfii (ll!omonrarii ulile. j\tola unde este enzul ii vni

ili~rttionl\ in mod SJ1cCin11~ incepu~ ~llCllroi ,capitol pe tlcei pl1lf~ion i~l i, s

...

colegi ~i prhder1i, care au recenZHf mnlcfiu.lul ~i r.nr~ ~i-au ;tQl~. n.~;lfel conlributia lafonualui actualii. Nu in ultimul rfiud, n~ul\Unlesc.srudeJ;tilorde In Progrrunul de ~aster iu "CoJISilh;rel'sihologicli ~i rsihotempie, de Ia Uuhernilallea Babc~-Bolyui,. Cluj-NapuCII, penlnlsuge:tliile referjlohre In :;lruclurii Btestui votum lli [a iitabunnU'itiren OSlJeclulu.i slilislic. Pruadoxal, trebuie sa mul\utuesc lit ocelot "ptofesionil}ti" ca.remi-nu dat. oportu11ilnten all itlli exersezsimtul critic prin:;ofi:~mele,:~olemlliliilile bannle lli lruimnele pe cure le-ou )Jtudus lli pe cure le-ou ridicat In nivelul uuor opere vi d1scur.mri ~liinliflce.

Ac:lmuwlc:tlgenumbi: The writing Qflbis hook was olirnulnled by peo-tJie whom l especially want to lllB!Jk. .Jllllllpb.,;'rJi~g u fnmous-saying, Guy Montgomery and PnnaBovbjerg, from Mount Siuni School of Medicine_

USA, nwakened me from the dogmatic sleep mtllnughlme \vhatscicnee, research ond Jlnlclice meuut iliu time Uhougllt lknew lhi! all lou well and uothing culllld 1mrprise me. Albert EUis, from Albertfillislnslilute. USA, wns the mntrwlm. ins[liretl me lo-ba criti~>nl nnd re0e1'ive witU everjUting l did nm.Fwho taughlrne never to .lose fttith iu myself and to wnlinue to .m1ild crilir.nlly when mnuy were agni.ttl!t me e.nd my work. Stuen Lynn, from SUNY nt Bingbnmlou,USA,atKIIrviugKihJcll, from Cotmci:licul Universi-ty, USA, had a major impac& on my work, being friemla nmlntodels of crilical ttud conslntctive ollltude in the clinicul dorunh1, Lo:~l but notlcast l woullo

. . ' tlmuk my colleagues Jrom BnbesBolyal University nnd lhe students en-rolled in the Master's Pltlgr.am in "Psycltolaglcal Counseling and Psyclm-

thetllpy~' Jmm Babe:t-Bo.Yni University, Ch[j..:Napocu forlheirsuggeslions .. conce!'niug the slruclureoflhis vo'lume and I be i111proven1e1il o[lhe 11lylistic

nstJecl. Pnmdox ically; ll\tusfulso llmnk tlrose "prores&itrnfils" who gave me . the opport\lnity to exercise my critical s!lllse 011 lheso}lbiarus, trite reatmrb und tmismsthey had pruduued uud raised lollmlevel of scir!nlificdisoours-cs nnd self-declared works of ort.

Prcz;euf:tt"l!IHutforului; Daniel Oavid esle p~iholog, leulllr univ. dr.ln Coledra de .Psihologie n Universiliijii Bnbev-Dolyaidhi Cluj-NnpOQl. A oblinut !icen!o in psihologie-{in 1996) Ia Uuiversilnlea Bnbe.~-Bolyai~i ductomtul in psihulogie { 1999) Ia aceen~i Universil!'le. A fi~ul studii .postilniYernilnre

(l999-2002} iu psihologieclinica Qi psiltopalologie Ia Moun I Sinai School of Medicine, New York, SUA, ~in JlafCUIS un progmm de fuonnre (1998-2001) in psih(llern}Jia t\lgllilivii ~i comporlnmrnlnla Ia Albert l!llis luslitute ~i Aca-demy of Cognitive 'll1empy, SUA. Esle pre~edinldeAsocinliei Rumiiuede Hipnn7.ii si P::iho1ern11ie Cngnitiv-Comporlnrnentnli'i.IJircdQr ol Centmlui

Rmn5n de Psiholempie Cognilivli lli Rt!lionai;.Emotivil \{i Comportamenlnlli. ~i Hditoral revistei"Romsninn Joumnl of Cognitive and HehuYiorat f'.syho-

lberapies''. Automleste memb1_11 in=SSillciJ1.Jii prufellionttle iJiten!nJiontde de Jrrolili desfil~oarti activiliili didnclice., de ccrceJnre, ~i ptacticil pflibolerupeu~ ticii ii 11 publiclll pfina in prezent 4 ciiJii vi p.esfe 3U de urficofc, din cnre majoritatea in revjste de presligiu diu strninillale.

Volume rt1evnnte: David, D. (1000). Pf"efucrarilillcolllieule cfe irrjoriuafle. Cclflftnlli-nar~cr l''iilrologicci in mas:r-mec/i.o, practica cliJlica flju,-iJicii. Edillrm Oncin: Clnj-Nappc!L .

David !}i co lab. (1998-200U). J::silrotempit ~rtrlpllt1fet"t1J1ie crJglfifll .... comportamentalii. Editulll Risopriot: CluJ-NdJlOJ:II.

Aboul tbenulhor. Onuiel J)nvid isliceru:ct.{psychpl~gisf, )?h.JJ., nnd Assislnnl Professor al-Bnbcs-BblyoiiJ Univemity, 0eporlr11ent"uU1syclru1o-gy, Cluj-Napoca. He ublllined his licenllc lnJJ&ycho1ogy {in J!J9G) nl ''Bnbes-Bolyoi" \]uiversity, CllJi:-~arKJ(:onnd lhePlt.Q. {in 1999) ~t lheantnc Univer-sity. Ha cmnpleled a postdoc1omlprogrum (l999-2U02) in clinit:al p.:ycliul-ogy and psychopnlhology.ntlvf,ouut Sinni Scbool of{IAeditlinc, t-Jcw York. .USA, and a !mining progrom {l998-2002fbi l;ognlti'l'eand bcbnvioml tbcr-llpies at lbeAlbertEilis lnstilute RtJd A,clldemy otCogniliveJ~u:ntpy, USA. He is Pre:lidenl of the Ron1nnian ABsociotlon vf ll}lpnosis and-Cognitive .Behavioral PsychothemlJY, Direclur of. Ill&! Rl)mn~tianCetJies:.fotCiJ~nilive nnd Ralionoi-Emotive oud Debavioml PsycboUtcrapy and:6tlitnr cpf'~llothonilui Journal ofCognilivc B.ntl-BeiiiJ,'Y;iorfll P~ycbodlentpieu~~. The uulbor i1:1 member in iutemnlioual prore!laioJtBiliiiSo~iali~us in lbe nreu pfiuf.erest: nud is invohed in lenchiitg, research nnd',psyclu,tbJ!O\peufie;)J~ctlce nctivitie!!. He has nlrendy published 4 boo~ nml over 3.0 urticles, most of these in f!restigious inlemati,on!lljoumals ..

Rell'.vnnl hooks: David, D. (2000). Prelflcriiri incollflielllc de iTtfontra(ie: Crmtqm-inme~ psi/Jologicii .f11 mass-media, prticticacllrilcif~l jllridlcf'i (UIICfltl-~ciortS lnfornrafiou proces.rlirg). Etlihtm Dacin: Clu}-Nu}JfJCII.

David i oolob. (1998;.2000}. P.dltof~mplefllriptmiiUcq,;e cogllitil'-comporlamenlalti (Cogni[ille-be,lmvioml p1ycli1Jtf1eropy a11d ltipuot!ler-

aJ~lj. Edilum RiSOJlfinl: Clt.Y-Nnpocn.

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Pref.'\Cc ......... ~ ................... , ...................................................................... 27 Povest u 1 V - 1 "- l R I 'I k' 2.9

. ea tvtare UI lliJIIarL 111 u.qt a m umpe stl ts m . 7 ........ ,.-....... ,. Comenlllrii despretiin{ii . :." ....... , ....... : .......................... , ... ~ ... : ................ Jj

Pna:tea I. Fundnmeutcn.l~pr>lh~pnlolnglel en llinjlL_ ....... ~ ....... ..;. .... _. si ci rol 11 n fi r ' 1 tpl_ u ... e .. mJtqtpreclzilrlc~nceptuo c .............. , ......... : ................. 51

l. r. Defiui(in Psibopntolo(:.ici ctt liintll ............................................. 51 1.2. Slln~lst~ ~i_bonlll ......... v--: ..... : ... , ............... , ....... : .. ; ....... 52 1.3. ~olltl11i a~ribu(iiiC: psiltgpp~ologului 'c'--------:------':.'" 5ll 1.4, Orienliri t(l(}retic~ in psjlmpatolo_gie. ('\,$!!tn1ii introduc.ere .... 59

Cqpiloluf 2. S~ruphttn amuis,!ndiu de l)J. Scmnl!l}isinlptomc.Tubloul clinic ai . . . pacieritului Psibopiltnlogie ....... : ........... ~~ .............. , .. , ....................... 9t

:t 1.1. ProblemcaJePaibopnlologjei cu modnliffitil~ de a fuCG din,.PQ&tt"c"i cvol 1' - f .

... . v, ~l'!rlr p 1n1c~ ......... ::---:. ... : ............................... 92 J.l.l.l.liumiiml ~xngern( de mare dp categor-ii diagnostice lji tendinfl! df! pnrqlo~t~.'Y a vlet\i ~ntidieM. . Mnlla!S Malefi~ntnJ .. , ...... -......... , .......... ,., ............................. 92 3.l;f:2. Udli211r~ ltllui ioiii.:;I!JMmlor.~ihologic depil~ir l}i problcmntlcsau Cm-ut en Hoi ...................... ,.-... : .............. 100 JJJ ~3. Oingnostic nosologic descriptiv versus diagnostic nosologic eliopntoget~elic. 0 int.Tem'"ire ill proiecr ............ 105

. - . . .--::.

--~---------~------------------~.:::t

,)C J(lh!JYi!ll(U! ?t hiri;tiH ... ;.u .. ................. - ~- ....... ~- .... --~- .. " ).1.2. L Numaml i'a>tlgenu tit: mare ul fonnelunll! tflllllllli:ll\

I nl - ., M' I . .. . nn Sllll Lttlllrtnl\i muumm m ................................................. .. 3.1.22. Bre,e in ~lidilfltea lilntificii atnltiiillenlclor. lO Ecce Mesmer .............. _ ........................ ! .................... , .......... i 3.1.2.3. Lobby ;i traditi~ 'impolrivn ~tiintei; .. C l - -d. . 116 117.11 shmtt e s1ne , ................................................... : ........ .

3.1J. Probleme ale Psibopatologiei cnl}'IOdalitil\ile 1 de: a fac~ cero:c[Jlre ............... : ..................................................... l .. l

3 .1.3 .1. Caztil:nlttlir.aliei llntideprMivc $Jill . . . . ; ti" t . l i? Victotia mnrla:ting-:ulurtanpatmYil'~ mel............................. --

3.1 J.2. Cazul efe.ctului plncebo smr . Cum sl i1cizi ell mliinilc -enrate ............................................. 125 l.l.J.3.:Cn:nil psiholiJillpiilor:in psii\QIIOID&tioll. Victorip dorintei asupra dntelar ~i Re-zcrvare penlnt locul doi ; ... , ........ - ............... , ..................... 14

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J.J. t Niv.clut ridic:alal capacilifilor intel~ualo :;. : . ulec )lSiftopatoiogitor --~~1-N-:, .. , .. , ..... L.l04 11U.1.;Spiiii\il critical.psibopn.tGtogilo.r: -; . ";~~.;:0;.;;.';~ .. : .. ~~~ iU4 4J.3. P.reSiu~Jea.cwrelordeasiguriri;dtJiiniJ:IRfr:: .. . ~i Jlnmdigmaniedicinei:!ialidatii\tlii.l\lific .. ,; ......... ,;;.. ...... ..,~w: 207 4.3.4. Globnlizarea vi inlerdisciplluarltrJI.elil.iiltJei ~ .............. ;. 214

Ca]JitobJl\5 l'mtanumtulpacielltuluiPsiliopalulogie.;.;,....,;;,.,.., .......... .,. 216 . to tntneltluLJ1eUtau pn:ible~ueleinmutlnlititlle de a face

dingt1~sticft e'alunrecliiuci,lneiiutarea&mntului:GnJal:;_, ........ :.ll6 5.2. Ttnlnn1enlul pe1~1nl probleJnele t~~lhlifiJild.tle~~ :. inlet v~jlie ~i lnllruneril; Sfftnla.Treillte ~~~::u..~.~~ ........ ~~; .. .:: .. ~: ....... ~. 117

s.J~T~lttan~~J.lW. p~p~ebl~Ji,et:!~~1toaub1i'i:l~ .... - ;,. de a f~ce Cercel!!re. Cele VBSe.POruncr :.,~ .. ~~ ............... -:-.... ": .... _.,lt9 5.-i. 'trntamentulpcnttu.prnbtenrclailrl\ludllliifttrfede a'f~ . ~ ethn:.ntla vl funoaJ;e/lndning. Bl;iciull~Qeftt .. , ................ , ....... ""' .. 22:2 1~, ",{.,,vi>';;.:-\ ', ,'',.~~~j" ~ ;"-~'~;,.;:, ',"~1~(.~/_..,.,,"'' '' ">',-

CllpiJ~lul6~ Jtsiltui(Jgiaclinic,iht Romll.l)iasn.\J fugadit~'(umuf~~t~J,el. . Un pnJ-,\net fundJ\nle1tat ~tiintific: ........ ~~ .. ; .. :~ ..... ~;.;.~::~.,.. ......... ~: .. ~; ...... :ZZ.'l

Capiltllul?,. Psihologiac;ttn~ vernwrtJsiltologi~ 1\Jllj~atii inJ~l1e dQmenii ~,.,_,, ""'" ' ' ' ' ' ''' ' ,, . -''. ,, ',: ' .

sau Cent~iireasa ............. ! ..... :.~ ............. - .. - ........................................ 213 . . .

Cupitolul U.lteanm-ci linale :;au Un nou inc6pUt .... ~ .................. :.--....... 2.S5 E11gllsla SuaOI!\nJ7 .; ....... ~ ..... ~ ...... -. .......... - .......................... .-..... :l5tl

llllillug.fl,ll e/1\efcaeces ................. ~,.. ... ~ ... --""''""'"'"'''"""'''!'~"'-l-i 1 li;ltC...'tC '"-~ .. - ... ,.~~..,"_..._ ..:.__to;~!;-~"'~~~ 2.83 Ane:tn' I. tlata lratwueutelor p&ibotcmlJ~WtiQe validate vtiittlifi~ fi instJttt:lh~nide utili.~.~~o~ ~ .. ~"""t"'"''":~r~:--.;...,,.,,, ..... ~7 .......... ; 2lU .Anexo~~Gy.Wponc.nte.,vnlic;fole!lliin(ific diu teln\ia psihoterillJeuticii ............. :_: ,.:~~~~-~---~: ........... - .... 314 At1e:tn 3. S~tul de insttmoellle psiltologict;.penlru ~tb;!Jfen :rti evnhlilrea COJJijlor/elevilor in vetlereu. orietdlh:ii teo fare nprobate 11riu Hotarl\rell Ouvernului Romli11iei nr. 2 l 8 din 1 Martie, 2602 ----~-JII'i

10

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.Ftueword )'~(a~ ... . < . .. . The story of heOrent. WiUud of Oz: nnd the slol}' t.Jf Runtt!e151Hl'lk.in

Comruent.o; aboutscic:nee .. ..,1,> :

J~art 1. JJus,h:s:o[psycbopalliololfr us.adetlcu' Chopter 1. Jlcfinit.lons nt~d coJ1qt!pL~Il1 cloJ;ifi~~li~l~. U. Deftnil!luwef'pfi.Yhupatij'Ji~8}F!it sci~?: : ... 1.2. HeahMutti'Utn~s.J;,

3:1.1.3. Descriptive no.:ologicnl 1Ui!gnosili versus etiopalhugeuelic no-solo~ical diagn~is. Stuck in lbe original prQjocl

3.1.2... Problems Psycbopnlbhlogy bas wilh different ways of conduct-ing imerventinn and lteatment

3.1.2. L 'l'he large number of trentmenl melbods or the Labyrinth of I be Minotaur r . . .

_3. \ .2.1. Breilches in lhi! scientific validity of the treatment Ecce Mes-mer

3.1.2.3. Lobby nnd trn4ition agai11&t scienc:c. The eliSe of self-~teem 3.1.3. Problems P!;ycbopnthp\ogy b11s will).dlfi'e{qnt ways ot conctuct-

lng ~enrch 3.1.3.1 .. The case of antidepressive m~icarion or 111e victory of mnr-

l::eting on science . ; . ' 1 3.1.3.2.. Tlie cuse of 1\le jiiloce\Jo effect pf How ll;l klll and kt:i!p your

luiutls clenn 3.1.3.1. Tho c~c of Iisycboti;CCOJ.li~. in psychosom.llics. The- victory

of. ~ishfullhinkif!g on dntn nnd Appli"Prion.fer the l(CCOnd plaec 3.1.3.4. T~e co.sc. oC lo.gical fotmc\llli!ln. in:-~icqtifio research or ll :wns

when ilcQuldnol be seen~ rodny you,sec h yet is missing . 3.1.4. Problems P:.--ychopmbology has with different wnys of conduet-

i ng. educ.triou find !mining 3.1.4.1. SlntCI\Irc or the lrpil}_illg prpgrams in psycholherni)Y or Tiu'i

Ordaining _ __,. 3.1.4.2. Tilo challenge of pQSitive. neycboiQgy 3.1.4.3. 'l,lll challenge or pnrnprofesaionnls 3.1 AA. TI1c challen~JH;~f~!~~l'-help_ t~tmeniA 3.1.4.5. Speaking ngainsc llle clinical experience

.. ...., ~ .. ' ... .

32. His{ory ~>f lhecliniCllll P~flrariqn of d..-:: pntient_Psychoptuhology 3:3. Pe.-sonaland .&ocinl history of lhe pntienl ~sychopalhology

3.4. Menl.{l! &.!fl.lD.li Qt' tllf: ptltienl Pli}'chop~tlmlqgy , 3.5. R~1ts of diagno&ia and cljnicnl evaluation qf the p11tie111 ~sy-

cbqpnlh!l1ogy ~ .

Ciu1p1Cf:4 ~OI!CCplUuli~nrion 0~ cli~i~aJ pcosenU:tiop Of the pl!.lienl Psycl,opalliofogy .. ... ... .. . ... ... . ... / . 4.1. Specif}'.!-etlop~lhogc~~bt-mer;)lpni~ms - ..

4.~. Non-specific eriopllilhogenelic mechllf!isms or &he psycbnpnlhol~ ogy of psychopalMiogists

4.3. Protective factorS nntl resiliepce

li

4.3.\. High Ulti!Uecl~nl 1\bi\ilies of psy~l10palho\ogint:s 4 3 'l Critical sense of psyc.hnpo.ltu:.loglsts , , .. , ~i.3~3~.The pressure of Henllh lnsunmce Companu:s and fht p.u.uhgm

of lhe evidence-based medicine . . .rt'l.4. G!obalittllioo m1d interilisciplmruy scet:c~ Chapter 5 Trentmenl of lhe pmient Psycbopnthology . J

. . . .:-...& 'n the WR11S fi[COilllU;l 5.1. Trentmenl for the problems encountet~ I 1 ing diag11osis and clinical evalUation. Tile scnrcb \'or l\l.e holy frnnld . 1

S.2. TI"eanneotfor lhe problems cn~u~ll~red in "the wnys 0 . COil nr.:-ing intervention nnd rmatment.: Holy Tnmty . . . _ .

5.3. Trentinent for the. problems encoolltered m lhe wuys: of conduct-ing research.11le six .::omninndments . . . . . . .

5.4. Treatment for the problems encmmte~ m llli: WI\'JS of cOO

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CUVANT CATRE Cfi1:TQR

Sesponeciidiferen{at)intreuu geniu ~iunhnbeci1 e!;tedi primuhre limite. PsibopatJJlogia .::a ~tiil\tii, s-nprezeutntlanive1 social prm promovurea obseslva a tm~i itu11ghd de .l>ceuit-in termenii reu~iteblr, ram {J pre:re.nt(lre.~lad\~l pn~lii n.lhui tel or.

gre~elilor ~i ner~tl~itelor ei~ Ace~ til htcrate.{ vqtum) va incercn sn of~re.incontrapon~ere.o al).ordare t:tlticaa psi,bopa\Ologi.ei. Lm::rnrea prezetltaUi.aici es~ nllfeh fii,ndatipicllpelltfu peisajul lite.qtturii ~tiit)\ifice romllu~ti. dat: J'llii regaS~f! ill.eli complel :, I ma exprimii cu clarita~ca om .~j .. ca profesionist! .M.id prer;is sp!Js: lucrarea de fatii este uninanJfest ~tiintifi.::.cu elemenle de pam.flet pentru o MitliiJJaRatjon(l/i.;.'l.itlpsibopatOlogie~i trebuie trata.tii ca atare. lguorj]l'ea a cestui nspectpba.~duce ln pierdereu rnesajului 'tiintifie. olluc::riiril ~i 1.a anit~ozitiiti fn\ide en $i autorul

el. Sper ca acestlucru s.ii nu se. inUbnple Iii ca lucrare1l. sii fie privltiica 0 premierii jnl.resanU1l ~i uu modelde'uttnatillliteraturn l;tiintifica. romaneasca.

Urml\nd logica hegelianli, arttebui ca teza (ln1ag\t)-en de. scenlt a psihopatologiei) !;ii aui:lte:z.u (ttce$t velum} sit ducn la sioteza (promo.varea uueipsiltopatologii valid~e :ttiintific). Vom vedea in psihopatologie, prin prisma acestei logici hegeiiene. dacli Hegel a putut lntr -adeYar sll gtiudea.scli. gdndurile lui 0-zeu de dinaintea Crea~ei, gftndire care 1-a dtts la. panioglsmuJ exprimatprbtformuln: totce e real est.e rntlouulfli totcee-rntional este real. Angajamenttil meu~tiintlfici epistetriologiceste unur al Rol;ionalismului Cdtic dublat de uu sceptioistn.de genul celui promovat de~coala Sceptica a lui-Py.tdton din Elis. Stml insa

IS F ~-

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~~~~sceptic mai atipic ~i mai conslructiv. Cred en tlirie ca eel mui lllll mod de a te ap'ropia de cea mai bnna . . . . :::::::{':"'" ~te niil~~ea crlrlc~i reflruri~~;.:';! !,~~~:

. . . .. ll~~c ust; l'jtnO:tlfice. Critica permanenta a acescora ~~;.:::,: !:!:.";'~ l~r _:mb semoul inn-ebiirli. sno>l cliilc ea;; P .. 1lcn.rc in a . . una.I~{eleger-e a fenomenului studial Din

5 .-eel ml\l mulp oameqi d c ~ inQeUi.tonre Iii anume ac~eA de n-~i a;a:au;ad tlU ~les ~ cale pernl.aJ!ept p1.0dalillit{ d .. .. . . 0 u~e ~ cautfind. c:ontraexemlllele.'Nu~sl.c nfm~o~fl~m~r.e a lor. tgnoriind "'"P ~usptle'J.nmctele de \tbde . tJ~u ~n-a cauta-exemple pentm ln o scofumiznro a-1-enlid\ 'ire .. re r uclln~acestdemersd~ce conViilqipr.intJ;:.:oigrto~a~::.-o sttlectte a datelo~ enre ne pc care~ sl.lsJinerir~ Aceastao .. i\e~~mplelo lnteza generalii f}tiinti defensivi ~ nroeriint:tf~ne lt.fac~lpemulri oameni de

mecanls&tmldeli t. . .' . e cnrern e de performan{li . . ens v prototJp C!laca vrei sli . .. d . . . . .

pcrfonnanl!esre sa-l~ ci\ri tt . . ;. .. scnpt e cntedila de rigiditare'':. o clisc:utfe .. 't~~ ~~~ ?llmmdu-le "stereotipuri ~i este !nterpretatiide as;l ~e ~e :to~re_la_~;oprlile l~r ?rod use en n~c pemonal. ceen ce reflec ~r~ .. ~s'.olmitl ca ag':e~n~ttnre snn cu.prodnsul acesi:\Jin. Acesli . m.tde~fi!iea~~ropnnlmlor .. E.u .. Cl~impactlimirar.limltii'dat~~~t:~~~~.du~ 1~ produse ~tiinpfice nutudine din perspectiv R . . . u ce ~1 ~l\1-e le-apmdus. 0

. includem sqgestiile via~le attna~smul~i Crit!c ne penn ire sit de.vede~remitate dintr oa a e c~ .ed_altJ coleg~ snll puncte noi rezultat d~pill}indliniirel~ ce~t?Cnu~n slintitoas~; produsul asrJel . .. Cmdo ~tiin{if.ic .. v~i anau:~:: .,a c~pt. _Prln ~rismaacestui

.. en 'it. iint~ tratfi .d . . . . . . . re~ nctllala a pszhopatologiei n -ocnpe.1m pnci t paihopntolog.. P. . . . . .. . . en cate sa prezil}[li la r~spunde la ~;..:;:::e~~i!~::!::i ~~~a::izoi~linice ... vo~

. sunptamelepacientului''; (t}Su . . . ~ . and. ~emnele ~tt lulbudil'ilor psihh::e corecre ... ;r.mod~litaple de dJ1lgnostic al lltlburarilorpsilliceefic, t~?e,. Clem~?; (2lS~nttrntamcntele . . . . . ,. . en e. ~1 asociatacesteLintrebihi, sunt .

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~~nereaza produse -~tiiufifice ~i stele - "profesioJ~ti" _ de lan~tru~oc,,J~~~ .P.,?,r1u~e. ~~n(ifie pentm_ o.tJiata iuterna~qnaHt ~i .. pr~f~I~R~~~y,~voca~e-~t anveL=gur_iiintematit)nala.Acesle stele de lact11aroc SU~t .adesea fie fom-te complexnte, crezand cii UU

(~Ot fi :omparab.ile cu colegii lor:diu strainatate, fie"d,hnpotriva l?ru:te unportm~~e, crezand di ~tiu tobJJ~,neayand cultulvalorii ~i linut!=!lor propntsau_.a.l respectului valorii celuilalt. Uuele stele expandate de.iannaroc publica ~de.'ie~ilucrnriin ca.re mereu 1i se pare di fac dlt~ orevoiuti~-!n dqmeuiu,.revotqfie p~ insa care . . n~t Q bfl~a ~ seamii-~imeni in afar,.., celorobliga{i prin po~tia lor s~ ~ fa.ca (ex. SlUdei-.p). M,-nau sa[Untt sii lTHtl.revalulii de iarruaroc

~.t_ ~n~1 e.~te do; ~tt,'yiid in: ~tiiuta Ull s.til. on;;&t, baz;at pe con~~711tiza~-en fu~utelor PPprii ca om ~iiJrofesionist, pe respectul

. valonlcelmtaltllt.peo atiludinecritica ~i conslruc;.tivaasUpru n ceea ce face111. Mi-a fustdat.sa vijd ncest stil;d~fensh',in nmlte ii_ll-er~cjluni cu :uul~i prof~ion~tl ro1uaoi1 stitc

:>,'unor(int~ts:e- Ji mo~~vn~i. p~s~nale. ~le r~c~~r1.9~~l~--~ ~}1m ~e pcidt~faee*i~eest~nctil'lSi~l!J1n~ ~~t,.s.~i1ll.dt~c.rni}l~,!!1etft~Pl~)gle

: ~ito~Dcll i\~lo senp'~le lltnJ~~fi(pJilbleme? f\H)n~tlwnl~~r~~,~ind c:a:fu.aibttfill~lltodq1~g1e~}!trlli\VIU1Sarencunoa~~ji,e~ cure o av~nYtn n'C~sf~oll"\tmt. ntrll a spune cJi este J;i pe{fecrlt Ei birie~~inv~canliiitae,g~~iflie.~lElmett'idolagie ~tiintifjce penrm . a critit:a o 'luCI11re 1lau ,n~:d~-qienil~ {irirh ,este ipocri#e (mafel su)1t a~sea ctiticaife; P,c:'~~~ept"i~Brlri valor()ase!). !O .1urirare

: z ~ :: tintii 'trelltt~ricntic~t~:~!;t!~obl~ttle'~llpl itpontnrc; ~e care le , ; .. nref.t(ltde pro6lemclagencti1elfttc rnete~o1ogiei ijtijntl~ce. n ltfct

j\lugemsaicrlticum I~ltbl fiecilre l~cn\re. De llse~nea, n in- clU.dc:~Uenefbtf.ttc'tJeIDerod01Mgifi4ttintlfibliaifi ,1nei lucri'iri

.. slt;:betll.entlnib."liiliftelen.tmfo11lfii:fliir1(ifice" ~st~1utli~lincorecr :l

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IeprezetltaLiv de l OO.de as.J:(el decone.>c.huu din caleva mii obtinute piiu motorul de. cilu~are ooo.CLE'". DJ\l aflat ca doar apw~,~~~at!;!,~!;;~.J!~~'!~IJ~lilj;.s~~e,.~a~p~"~~"~tiit(; " restl}lJ~i!i~~Etlt,~~i;).~.~fu.1,~~te,; p~~i'-"W~ll~1te .S:att tottfple.t: u~edo~e:,.:~1,.~1~~~ ~tfrl.g~~;~a,t~Un4~tY.oium,,o[erlud o .

ubordar~.frilic,~ (Uifel~~~~~.&if,.tJ.pc~i!GIJ;:YWeJJl~;eon.stJ;llc-. . live pen~ru progresuliJl.dcmu:miq.Jlplll~. v9itla posibilimtea

. , . : r. : ... . . " .. . . . f.> . . .. celor~aJr:nu s.tilit de ~S9.@~ ~;~C.U~~t tex~si:lti e:lprime plHlc~et~\de v~derf~.r&Wn~~~ \~ii~:.in,~i~ta, al:catcied,itor suut: ftg~~ntl1PurJ.la1.o.f..~Wti~~r.B~aviQ~~ P~fcho

~lerapie~/Rt;v~sta )i~~I!l. de Psibokehpii ~gititive.,f Con~.eo~1fUtet~tale (IlttR;f/~~~p~pb,otbentpy:llll) , . . . :

lVlollnlltnten 1\e.-~t).ot:dnr&.l\i9daliliat.eade alloniaa:~ a . I ' . . . . . .. . .. . : 'r;:- h". tel}\~ a~tei :lusr~i -va n 1Wl.ll1:11C01Ji~liltita.:~ai Pf~~~ ~pys.

. ''pacjeutt~r~;u:e ya:fi qnaUut pepa.rcurstiKn008teUtilif~ va fi tqqm,ai ps~Jiopatolegmii!IP fliOdalifi.\~i dt; :nb{j~~ ~~,~~~ta

. toctJliti. iilliLJeb::u,ipipgia .u;tilii:atltinlp~pa~ltigie'c~~~~~m de-a fo,ce pu:QD ptl.~Zieat:Q.d~varat ;' 'tiU1anZt1 clniici'O,:~. #~ -.

G~t\ cl\ ~itea.s~il nbord:u:e;iq.,~tiip!Iate con~tbuilr~; . 'i . .. . . .-0 .~ni Q.!lnli, caoiep~ a:litllitelilr d,oJI1al~i~lill prio reliefaJ:el;\:.~lerpf!nte,_lor de nernu.:l.itate {'tiinti}' fii ancl'rnUl1j~te (p~et,tdo~ti~ltt~)din fl:atiiul a.ceswia; ...... . . ... . .. . . . . .

0 re,ceptat-ershnukat1ii a\lllmstY.Yl~a.Str.il~~ihi w ~pul de pr.oft;SiQtti~ti,~i,pampf9fa~oniv~.a~t P!ibbp!l{qlo~i.

cnd\ul c~JpJiolu}ui respecri v. B ibliografia ~i anexele vor 1ncheia nc~asta lutrm'e.

-E\\ apr.eciez c.n fiind co.ntri\>utii originale ale ac~teHucdhi urni~toarelei - _

. '."f~t~~.fintTe put!ne!e abordari critice ale \)Sihopatologiei dm peasrutllltti!n\tudi romane~ti.

o Orilizea7,it o modalirare origin alii de \eliefare a t)roble-~nelor psihopatologiei. trntl\na Psihopatologia ca pe un pacient

. m ca~h~lunei an~li.ze ~;:lin ice de ca~ _ . ... . . lncea!~lt sa f~p~clar 0 disti~otie intra "descrlere" .lji

m~e.rpr.etare .. 'OescrJenle se ba':lt;aw-pe date dinliteratura de . specia\itute lar interpnstll'ile pe care le faoem aceston:hite- flidi

a av~a _pret,enpa file;, ~ .voT fi meaeu nrg\llllentare in cadr.ulunui diseurs teoretio .!!8ll:prnctic.

ln CP!Jlparatic cu lu~rli{i stmilary pi'Czent{ltc 'in Uteratura de 'PFialitate intema(ionaUi(ptttine [a numl\r). Iucrarea de-fn{a

ndu.~~ cflteva ~~~l!:~cte . ooi. ca urrnare .a 1:1tjnnlirli laola1tl1 1o . c~pttolela noestei c~r.ti t\ unor inforrnnpi prezentate in articole

dtsp~mte,_ ~rr_icol~ id~ntificat~,pijn analiia pwprie a bnze1or de dntemterotl(l?naleMEDlJNE ~i "?.SYCHINFO: p Evatua,pn efielenl-el prqgral'llelor de farmare in p!ilho-fernpte.;

a A~pecte ~feriUHtre la psihapncologia psihopatoiogilor. l?~lgur.,Jucrnreaonr~liilimire,limitepeea~lementionez

tn co~tmq,nrc:'llJteeas~a secpune ~e:cuvant ciitrecititar. pennu 1\ ofen aqest.pul.~portnmtaten de a ave a el tnsu~i o ntimdine ~ritica

a.~npm P.IJ:~~z~nl'e1lucrari. f : . ... .. ..J~ _anumire segnient~ ale teJtului lu{!nue~ cere mtllte

prereo~tZJ~e COJ1Qt;p~uqle ii de specialitate de la oititor. astfel cit nu es~e ~n te:tt~or.1n p~us. Nte:lentm'ea SllCcintli fii punctuaUi a

!t~o_r tdet, uneoti fiirii dotalii lj~ficiente l'efetitoare la_constn\ctele utJ)~~te . p.~ate .c~~~ citltomlui difi~ultati in a in{elege lnlele nspecte care IWfC~itJ..p_uno~tinte cu carncter mni general. Ynct!rc

sa co~pet\sexz. aeesrelimitari ~and meren, acolo undee~re_ eraul: ttimiteri pentru nmi m\llte detalii lo.literamra d~ spe_:mhtflte_~~ folrisind uneorl un limbaj rnii :Col'ocvinl. Fo1osuea m anum1Le.

. sectiuniale lucrl\rii a unut \imbRj et;llbcvial nu 1nseml"ma 1n~a nictdecum Tenun~reu ll.l rigoat-el~tiintifidi n cr~ntinu~ului ~

;.: Uneori textnl vn iintroduce anumite cuvilife noicme se rcferii ln wncepte importantc din liter:iturn de specialitate dar cafe 11\\ fi.U 1nc1\ un corespondenr geneta{ t\CCepmtin limht\ roroana. Desi voi evica s~ fac acest lucru, neola unde totU!li voi fi l1evoit sa i~rroduccuvinte noi. voi incercnsli le p1;e2inr elm !li patcis. Gu toate ncesten. cititorul s-n~rmtea nfln'in situntin sa nu ~nt~lef!gli seml)ificapt\ unor tenneni fii sn~fie nevoir !>il commlte litciraturii suplimcntnrli. ceea ce neeesidi timp ~i efort.

CGl~.n1ai multe date pe baza caroril tmi fundrunenrez. lucrrarellsunc din conrexntl cercetarii americane !ji vest ~europe~tc 'i~don1e,~in, astful eli ele .s-lwputea sa nu se potd'lleasdi ll'lodului

inJ~riL'l! npa,re psihopatologin 'in ~He c.ontexte specifice. Tinilnd tnsl1 cont ~e faptul di t\spectele generale ale d.omenjului sunt

aptoximnt~ tn principal de acf!ste doui1 contexte, cO'Otexte cu o fort~ ~tiio{ificl1 ~i ecouomid. deosebitli (vezi spr~ exemplu utilizaren pe scarii largl a DSM). credtotu$i ell generstlizt\t-el\ lor e&te celpupninfonnacivli fii pentru i!lte conle>:.re mui specifi~.:e. in; plus, voi prezentn 1ul capitol sepurnt 'jn care una din .

c#mpo11enrelo psihopatologiei. p_sil1ologi.a clinic~ este discumtn SJ?.ecific In conrcxt'fdmanesc. . -

; '* Anumite inteTpretiid ale datelor pre.zenrare aid, deJii atgumenmte. nr putea sa nu fie singurele existent~. L11s ilsrfel cititomlui posihilitatea de. a face propriile iuterpret~ri.

In iocbeiece doTeSC siimentione7. ca. peOh"\.\ a fi congruent C~l fllOda{iUl(ea inediti\ de nbordare a remci. ~i ljmbl\illl Utillzflt vafi in anumite segmenre mai dit'icile ale textului unul colocvhll si adesea la persoana intni s1ngnlnr. exprirnllnd i.n\erognti1k :;i indoielile pel'Silnnle n~a cum a par in fiuxul gfi11dirii, fl'lrilit face

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~ prelucrare formaHi a ]or. in conse~jnta. distincli~ .. dhtlre 0~.utext~~;~e~g.?~eririiu !li ''contexlulprezentliriiei'; esti-;ni~d putlllln_m~anta m aceasUi lucrare ~are adesea _ .. _., te- sct'1' .; ~ _-t- rb-'1' u~ _...., samr-un un aJ ( etnterfa~amtre unul ~tiinfific ~i unul del)tipul S t '{ ~:~nzarea ~~untet. p~r c~ acest lucru nu. va du.ce la o singulm:izare n

dtscur.suh.Jt c1 dimpotriva Ia impJJcarea in text atat a profesioni~tilordi t~ia parnprofesloui~tiLor ~ in p~~licului larg.

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-_P-REFACE ...

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lt is said that the dlireretlce bet:Wl!en a geniuiruWl'aniinbe-cHe is;tha~ lhe ftJmter haslhuitaitl6us. PsY.mls~es a.ndfailure8.This p~per offers .JJs ciounte~t!lgti tt ctlt1.~ col approach to J?!iY~bop.aU1oiogy .. '11tufi, it: is highly~\'tilusimJ and atypical for tlt~eJtisting Ron1tti1iau sci:CnGfit!liU:rat~te. J n other words, tlu! presentpaper l.s ~ st!iett'tific'JlJ;anjfesto, COll-taining elemt!bts of pany_:~~let foill Nlinbna ftatiohali~ 1n p~ycbopiJthoiogy. and mustbe c~rtsidered as suc!Ii. My sdenlilic a(ld epislemolQgical COllllttitmelitis'Critidtl RalibuaUsu1,' com-bined witha Skepl:icisin lik:ethe eue'promoted. bytlit! ~kepli.cal School ofPyrrhon ofElis;- yet, I am a riiorentyiUcat aud:ton-structive skeptic. I strongly believe lhatthe bestwa}' lo approxi-mate the optimal perspective on a certain phenomenon is by adopting R critical and ref1e:;dve a~tituue about your OWll scjelt,~ tific methods and rest.ilts;pennaneully criticizing, challenging and questioning U1em is the way toward lbe best uuderstatld~ng of the studied phenomenon. Unfortunately. most scieutists chose a deceitful path, Ibat ofprote.cting lherr resul.ls, perman~ntly look-ing for ways to confinn them, ignoringcounterex

or personal offense. whicll refle~ts the identification of their ego with il"s -results. These attitudes lend to scientific results of lhuited impact, lim irs set hy the producer's ego. An attitude fron) the p_erspective of Critical Jlationalism nllows m: to include vi-nble.suggestfons from cullttagtle~ a.n~t other points of view emerged from a-healthy self-criticism, maldng the results thus obtained go beyond f11e limiU. nf their producer.l will furtl1er nnnlyze th~ p~ent stlltfi:pfpsycllopatholPgy. throllgh this "Sci-

ent~fic-Cre4() ... trel}liPg\tl!~ a p_atient seeking the belp of a psycltopathologist. ':fhroughout tb"-pa~r..,.. "1he clinici}l nnaly~ sis:- ~pan lll)lll~J:l~the:signs am! sy.mpt.oms ot ~J_c patient", I wtU try. to.an$Wer t~c next,nuestion&: (1) fs .tbe diagnQsis .of

__ ment~l~isorde~ scif?UtificallY.Sopport~ and efficient'J;(2) Are rhe (re~tmentsfprmepral disqrders efficjp~t at~Jevidence=-basep'i. ll1ld lll~onnecti,;m totblSjCJll~tlon,arepsychopat!\Ologists hap-}ller a~r,l mentallYJlealth~(JJ::I:hnn tile rest afthc population?: (3) Js the r~SC(l.rch iu psychopnlhology rigorO\)S? and (4) Are (he trai_Ili1lg. prOgJ:f'lmS for psychopatnhlagists well-organized and

evid~9e~bt\sed? Theq, startiqg with a qo'!)structive criticism, I W1U preSC{\t W}lfffCVCf the Cl)SC suggestlo~ for conoection JlQQ

impro:vemel~L

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POVES'l'EAMARELUIVRknTOllDIN oz ~~A LlJI.R"QMPELSTIT.TSI\JN

Marele Vrlijitor din -91- a rem;it sa.i.nwte.sioneze pe toura lumea .. Vrl.ijitoarele din c~lelalte tinutnri se temeau de el ~i de fo,{a h.ii tcribila. Onmenii .din tinutu1 srio lji din Onl-!lul clc Smnrald nnde; lo~uia vrl\jitorisl, iJ JiESj}el;:tflO en teamli. Nll eru.lncru pe cnreVriijironl din Oz sa nu poaUtsl'i n faclt Ern eel mal mnre :;i mai putemic vdl.jitorl Inrl\ insl'i ca. in rimp ce printr-o prctinsti prezentii nevnzmli r~r demonsria for{a r~ribilli 'i'nrr-o incapere in care se nfl.a Llll,grup de. vizitn~od venit~.f!n il implore sa-i ajute, Toto. cfiinele unei felite numite Doro~hy, smu\ge perd.:a'-m c11re ncqperea tm col~ dintt-o 1ndipere. Acolo, mirati. vizirnrurii nu vihntun on~ulet. Tmbiitr8nit, mi_c-lii sperint:

... E!u sunt morele Jil fngro:thon1! Oz", n.spuli omllk\ul t.:U o vu.:e tremualinda, &}lenind io(:li sli impresloneze. Vib:fl.nd insii cl\ 11 f0111 d~cup.:.

. til, a contlnu11l: "VIi rog, sii m1-mi fnceti i'iiu. P11c. orice spune~i voL."

Marele Vdijitor db1 Oz ern de faptun om nbif;nuiL TCJ::Hit vrajirQtiile lui erau iltl7.ii ~i ~:rn-curi. El era de fnpt un fosr arrist de eire care distra onmenii zbu.l'lind- cu llll balon. LEI o .asrfel de

,et~rezenmtie. un vfinl putemic l~n dus fntr-o a!ll:i lome .. Oameni i din acea 1ume v~2andu-lzburtind in balmt, 1-au crezur vrajiror. L~i i..,a plilcut :rcest]ucru. 11~a ca ~i-a intri\l tn 1ol. J-a pu~ pe loctliforii acelui iinut sa~i conslrlliasca mrpallll de unde-li iln-zi~na -en mid rr~curi ~i ~mecherii". Spre exemplu~ Om~ul de Smnmld pn era chiar ve .. de. O:tmenii nvedeau a~n deoarece

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Vrlijitotul iu~a-e.ra de neitumit! ju,cen de-a treiazi, ~;~enals~r IJ:inlJ~. ~e J~pa~te~jt'u,~~>~~~~u,te,tiUJne~tei; iip~~~~r~~ ~~i~~~ frt.C~\l~Pqtlt!~P t:t~~.~~ . .;t;lb.utu:u.0Mt11~t~ilttlnH:are-. cnul:.fl:' ' . . . . . .. ' . .. ,,

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" ... den.r prince l c.ume ftotn you

noue cau guess, none can .dnin .. ..,.

that Rumpeletill:;kin is ny name.~

. vui ve.ni .!lli iau ci:-i '' tm:u . tnliine .....

ciici nilncni .Jt.u ponte ghici. nimenl 110 poRt~ fli cli RunttJe:b;lills1d.n ml 11c spune..:

Lq_aqzul~cestei VeLi inipiiriiteasa s-a~U(l]PJUtd~bucu.de. Cand vriljitorul a venit n treill zi i~upft.dltettsn 1-a :~pus.uumefe: Rumpebtiltskin.ln ncelmometlt vdijitotulr$i-a pierdu;ttualii forht mitleficfi. i influenpt asupra.reginel. Pe fapt~ era atiU. de fudo~ Ciruy t!.samle~a ujtat . .Ea a p1iORDS prO!ilOVafea iJniii demers in care serviciiJ'e oferile populatiei &5. fie fundamentale ~Liin{lflc; .a promis sit punli ,tiintn inaintea iotereselor! Ignorate, acestepronusiunl se hatorciJ~lpoyivu ei Povestea fratilor Orimm m:atl insii. eli. uoeoli, num.lnd>dlul e"'-pUcit, problemele creoLe de ncesla se pot reml)!a. mut uw~ Aceasta voi tncerca sn fac ~i ett in cazul psibopfJ.lt}lo~Jei pe parcursullucrilii. .

A:;;adar! lucJne& va fi :;.i.nJilara:uuei c;i.Ulilorii inlumea 0~ pentru a-l iotillni pe MareleV:riijitor., a b:age perdeaua 'Ji n.numi raul. Voi incerca astfe1.sa elimlu iluzill.e. Cllfe exisUi in jurul

psiftopato{ogi.ei ca ~tiinti. sa VUd ce Se O.SCWlde.-dupt{ perdea~ .din colo de imaginea de ~tiinta rigutoasa 'i putemidi pe care

~i-n construit-o Ia ~tivel ~mcial Sper d\ uumin" diul diu ;;~cest domeniu, acesla Sa ii piardi illflUellta JUaleflca, Wlf.l CUJll ~i~a pierdut-o ~i Rumpelstiltsldn. Sperde as.eme1teu di, la fel cu fustul

31 ~ ..

~ar~ Vrltj!tor- ~iu Oz. psiiwpatolagia v~ fi mnitumita en tmngmen ~~ !eala. care va reielihfin analiza prezentei luci,". . . cnre este ma. plilcuta. in opioia mea, decat imaginea ei de s:e~~~

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COMENT A.Rll DESPRE STllNTA I I

0 ubordare criGdhmupni psihopntolcrgiei ca ~tiintn neces.ira clarifica1ea preulabilli n coristnlctulul de Jiliintfi. Flidl n imru detalintin llSpecte defilosofie a .$riint~i ~ide episten1ologie (pentn.l dera!Jivczi Greenwood,. t 989; 1'oulmin, l953), -voi prc2.j!nf.ll '111

. conlinoare aspectelc cele mai rel'evante f\;>Upra demcrsr.lui !itilntific. A~aUar., ce. 'insean"lnii o n'bordare ~tiint.ifidi tnrr-uo donieniu? tn primul rlind rrebuie spus c1i $liintaNU l'nlietmmii cunOlStere adunntii tn sisremJ. cur/i aaesea se nfirm~ "in uncle Jucraride $pecialitme. Daci\ am concepe asti'el .!]tiint;1. ~~ l'i sinucidcre pentru noi. ca onmeni de !j;tiinta. intr~t> n*fel de per!qlecLiva,.nu ampnteaJatefarli et'iri'cilorcare at1rmn di un fenomennueste~tih)tific deonrece nu avem inacest mo.menL curiotirtte necesar.e predicpei Iii controlului lui .~i in coosecinfi'i, fenomenul_trehuie a};1ordat p1in strafegii a1temttrive !}tiintci.

~;Qinta este un proceso' tste o mbda1irate metoddlog1cll de aburdar~ a.nnulfenomen 1;are duce In cunoasrere ru.1uoad\ 1n siJtenl. A~adar. chinl' dabl\ nu nvem initial cuno;tin tele oeecsmi: ui1ei nbo~ditd !}tiiJlt:Hiice asupra unui :feriofllen. nceftSra nu

insearrm~ ~a fenatnemilrespecov nu poare ft1ce ol-,iectul desmdiu oJ,~tiintei.Dacn. inptineipju. el pdate fi abon..lntprin mijloace specifice ;'itiinrr;i atunci este un f~nomen filiintific; o ~stfel de abordnrc }lOl\te avei\'foc ulterior. dnci1 fenomenul este i nreresnm.

tu ~liiotn. seJace () djstinctie c~rli mrre asump{ii. teor!i ~ii modele senck i Kenrre,199ll).

Asru1lpfiilc. Asumptf e suntlde'i funclamenrale care sum acceptate ca fiind adevan1te de~i ele nu se pot resta direcr em,

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plric:imiles~rea }t_?r eitefoarte dificilii, d~i p~s.il)lla in prJ!Icipiu .Elei (e~. ,.~~.~!1JJ~tHfa decermlnisumlu~. a~\~l11pJi~ .. fcni~c;perU: " . psillictdut:_ifina!l ~a sistemd~prelttc11're~.t~tuiili~~e1 etc.), (Qrm~a~a.preulabilul filortofic alod~ilrei mclQqede Gl!ttetare

~m~\ti fip~ J?n(J.~mer,. ;1'973)'~. ~al~a~~lor e.~~1~4e~~_pragtnaJiF D!lt:IJ,nsumptille aa consecmte PP71lt!Ye .(~X::. ~Juti Ia. generaren de leorii, modele 4i tehnolo~ii.e.Q#ietire):o.tuncisuut buuej~l.valoFqa~~; d~t!li nu'O:eteonsec~n~~.ItP~i~~-~ . ~~~~e~ stmt fitt;lt~al[l{lf~~i ;probnbil en intin.lp ~ntqhilll~a. itiintifi~a va r~R#JrJ~;-~e; . r~ ... . ~.': . : . .,.c. . :' ...

! l;eQ.riik. Teor.ill.e.Jitiii~[ifl~e s~q~tfa,~I~~d:iJ5l.det.iv-e din . a~unm~ii~.earepotft~~te-~IYP~p:rr~WJ.~.~e;aQ~tYalt:~aiealor de.,aq~v.aq. a~~d~i"t' ~e&~l'~ .fl)e~d~,~#te~ 'R!!flle ~acli este ~tdev&fatitsa\i fntsit' ~is~~~~ #faf~,~~; ~!~.~lWt.ta~ceewce este .Jttt -~le1 sau.diceea ce nit, ~te; ~~~~. cQns.tif.U:ie,u.,teede:"fr4sii; o

: : ".. :,.:. ,;._r.:::t:::~::-->,'"-{;;;,;~(,.-" ''~.-' ';- .. - --_- '' .teode ~ste. ,ade"arata cl~iits~.l!l;!e;~~ ."~~e;g=a:este+~j ca nu Ste c~eaee uu es.t~fi~atsrow~~p"s.:o.Lt;aFie'~ate mfe\iaralli citld;c~ero~e'~U:ti~~~-'?~~~$:Qlkdatcle deoas~[1r~e ti este fttlsii ,c6.od IlU C:~~Ul 0 ~SeJJ:l~R~a C:Oll;SpOUtf6fi~reoriile. suntsistelUe orglm1iatc:.d~ cons~e~j tiiud nsU"eclfd~te din

I ... -- ;: .. -':\. :;'~_Z,->t:'i,' .. - /- - " ~ . _. _ '''< -.. ,.-,-o,;-~/_;~ Pr(Jf1Ciu~i: Fu.nc.tiif.eupei_teqfii,.~t.tn.~;(l)'functiad8edp~~~ {se descr.ie\ un f~n~ltJ,~q); .(2) fl\l1e,tia ~;c.p!ieat.fvti''(*'~~ll~~~, uu fenomepJ;'_(3),'~~Y~~.~~!:t~l;;{s~~faep~~i~ti~~~fij\~unui feitorn~n) 'l(4)f~~~~df;~!J~I:e.tmt~{seergatu~~tof!lhtatea iof-onnafillot.ttsllprnit.nn!(eno~en,lrltF-&srmeru~~~erf@. .L1{oa,elet~~,~l?Ji~~~ .. QJil~iteerii..'ft~ofificel~~ll.~az bine cJelhuitu~~a~1ao~~~~fie ~tJtg~ lllO:~fe~\:i.W,tifice. iu pmc11fn $tiintific~ ~ illtthllpm.~d-en moiieil.tJ. sa fie ~es- . coperit ptimut iar ~Eqf:,a s~d~volte rg:t~.urie pdugene~pirea uodelul_. Ji l~ufuli tJ;J.~te ~~~~i sit:uatit Oncum. ..dl~fta rliinaue ~--t:: -:: \ ,- _ ~-- - . _.,. - .-- -- ._.:;,,,:,-,:-

(euinpte, 18~~o).:P~~~xoJL~t ipc~~o~~1118f~ estcf ijco~{a ... . . . ~ :.l,l~1.>:'~i\-)~ri,. )Jll0Jl&;Diliti'f'e1 sisLentatizat --~~.a .de:tW.I)lbt~ 1~Ptt~

' l

. f~l(.lte s.tiin{iflce, -pe date empirice. Termenul d~ .empiric ate in \ lunba romiina AcademiaRon:lllna,l9g6) o sen1otftcatiediferit.'i \ de eea folotitii in ~tiiMfi- 11 l1mba r_omana ~l se ref era a esea la rer__ce~~\ n~s~sre.rontice.. ha2nre pe experienta dfl viata. in timtl ce m titn(:llit filosofia ~tiin{ei t~rmctnul se referii adesca ln dnre ~erv,n{ie"sistematica en lese prin metode 1;guronse ~i care ad?Sea as~~rJi genem1itnte11 conclu-djlorformnlnte 1.,e bu7J\ lor, sensul ~tthnttfical tcrmenului de :empiric este eel pe cure ilvoi .utiliza 'i'ti ncenstli lucuwe. -~adnr. suport empiric 1nseilmna in

~r.:eltstli lucra~ .. intem~in~ ~t:iintific. PozitivismoUogic apl1mtin JUL"Ll~ ~~eulut de la y1ena {aarereu_nea autori _precum Camap,

Schl1q.k) fa~e partedm~-:un grop .de ~ol!>li reunite-sub numele de fi~.o.sofie.-an~litica (M"ar_ga,l9S8)~ ~~~te:~coli ntilizeaz3 anidizn. I

(ad~~n 1o~co-matemstic:tt)pentt.~ clarifica teoriiJe coustn.1ih~ de ~tun{.lt us!lpra :fenomeoid.or~are fac obieclllllor. Po1.itivismlll

~~~tc reprezintii cehirai clar Iii tigt1ros aaiimstatradi{ie, As a cum Sagmund ~reud prin sisremul ~rent de el- psillanaliza -a avut

. _. ~olu~ dtHl mflucn~n dez.~oltar~le ulterio~i:e in psihoternpie { cnre n~esen s-~u ~&~olrarpr~qtr-o atjrudlne Pro sau Con{!"a Sigmund F~ud), po:tilJ-VJSapullogrc ainfluen{Rt noiJeqezvoltlhi infilosofia :;tunteig~~ ~ttuctura lor lagici'i tor~spuoz.ind stmcturli { ~:bt~~~ In p07.lttv:smul ~lasic se cons idem ciifi.mc~a explicmiva \ .

eorot ~r nu sere~edi lao expl.icatie geneativa. c;acinu pntem ~unoa~~e ~a~ra. adevilrata a 1ucrurilor prin care acescea Jnflu~~t~mti'i. ~lte lucruri: Noi incepem eunoa~teren de fa

propoutnl~ de.obsenmlie care :ja sunt altceva declit realil&tea \

in si~e.(desigur, de upro~timea:zi\.r.el\lltnrea, dU.lltt\ fiBcare l'll pnde sau dlnd nu av01n .lncn tehnologlnJneee~ur~ imre&tigiicii,.propfi2.i(iilo.r de obSaJ:\lDli~.{ex. mulre pre(h.ct\1 nstrOllomice m.1 a.u -putut fi vet"ificate inninre de desnopenr~a relescopului). in aeost GR:Z.. concluzin ~tiil'lt\licli est~ una probilbl H\ dar care ponte i11 pdncipiu.sii se trnnsfonn& 'in leguare l)e m:I~nri\ ce.uulcgem date:re.feriroare-lb.:toarn }ilr~poo.i{ii \e cl(} obtterviltl~ h1 care se ruduce teoria stn.t .pe ma.s.\"trl\ dez.vcltari\()r ~hno\ogu:e care ex\ind sin\\Ufi\e prQptii (eK. re}eSGOpU1;01lSCl"OSI!0~1~~\elC.). Deasemenea. confe:n:m fil~sofiei anlllitice; t:onre -propoz1tnle care constituie lemia trcbuiesii respacte.silitaxn. logidi., strut:rum logidi i\ ae~s1orn nrupximfind structurn t1\nnii tf~;\\e. Spn~ cxr:mpln.

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~ PfOlfOZitia va~ti~l David. este lllUlla~ pdut. n.uu esl~ f~.lsl .ea est~jfiir~J~~!!,~;~~arece nu tesp~cta siltt~~aJ{niicli .. (etiritrirm ;:~_:: siJ_'_t.1'ei logicei Daniel David nu ~re prog~~~tiq:.~~.iiii,~1uiir

. .'pr~lJ. ~tplus fata de al~-rc~ ~~_tr~~lie,i~~!l~~~{~i~~~111uJ logtc\(l .. uss~l .196~} ~~ a ~ezy9lt~f pces~~l;J,,~it~Jj~lein. J953~].pezJttvUJmuHogiccete.cat(Jf1Le~or.s~1fcU,J.efalru,itetu . elnbej:areaune.i ~rli'Y~rifica&ilt: sit1fil?~ l;ttutl~U9ry-eri,&ablte= rus~4tt~r -o pm~eziJi.~~~mqltRf"~r_~J~P:~P~~!~.~~btJic:.~!iP.oatl fi red~set~ l1,!()POZl~l~p~Q.~s,~~~~~' ~~~~ir;~~plu8 dacii?~nun mf ~enfic~u-~au~b:uc~l:Jl;~~ ~~f! ... ~~llllfhpg_al,l,ul.p~~'acelu de a p1ne,ac~~t~~~~!J"u6~lntt--o'Pf9-PO~j\i~cl~~en\ata aetipul: X e:>te~~~Elf. A.pqJ1~c~st1l~Pf,OJ;l~~e!~me~estt:f!(td\1sa la prop(J?tlV:J-_cle ~~~eJ:;Y,,V~ .lili~ \9.~~;~"tl1fie ded~~i:lm (J ) * este u~.?:~f',~tJ.fC e&.t~ ~e:IJl\jJd~;{;:\)

sa fie.adevaraHi (na n~ropiem de adevun1l reoriei de~i prol)nbil ciiel nu va Liatias niciodata}; Al'}adar, celmai bun lncrn pe care putemsiH f(lcean daci'itlorim sa COliStruim feorii ~tii(ltifi~e -est.e sa delliiYiilt1,predictii (r.iscante}cdinacestea ~i sii vedem dacii ac!!slct pmdictri suntsan.nu suntconfirtnarc.de dmele din realihlre. in ilCeSt context, l:rebuie sa.discoram 0 .alta variaotii de mtionalisJn lli nnome raf.ionnlf.smril d(scurslv (Perelman, c:oarece poaiti-Vi$nlllln .fo&t .descris;1naJ sus, inninfe de a prezenra i.f.lei1e CIJipitisllJUlui prllgmnric sii:t1c~mcateva comenrani de~pre prag-mlilis~l. f'l!ag1lraUsmuh-aformtnfnjt;~ntf Clubului Meta:fizirc d~ Htf!at)1bridge Mass~tclntsett!i 0 B7l) care teunea P''()fesol'i ca

C. S. Peirct;;W, Jaq.ies ~i altij.)'-lullleje de pragmatism n fost mai in~fti folnsJl dcPeime c.-nre )-a deli vat din distincp.a l.:anrianH din~"rariuneapra~ridi" care esr.a 1-ariuMa mor.ala, ~i ".fntiunea {Jt'I\Wttadcii'' Ct!re esto tnthme.a ntilitarti. Ideile.fun_liamtmtale ale pr,agmarisniului.sunf.(Mm-ga. 1988; Peirce. l93$. apud. Buchler, lSNO): . .

Vin{a 11\Ste ~emeiul cunoa~terii.;. . Cu~roa~terea -este activit-are;

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~ .. . . d- ~ati csre conferil tie. reu~it;.\ ilC\iunii p~! ,_ .. Adcvarul unct JU uc. . ca~ o orie~n~nzii~ - -~ltin1~ i~tantll re:znlmrnl on or infe~~n~e

. Realitateaesteln . 1. 't"tadeonmenide:Hunta; . . - I il comumlntl!! ne 11llt .. . iporenceoperar~ L ~ - nuchi area mtiunii 1n-pmgmatlsm.

coiilunitarea.nelumrarn esLe_m . : ailistiL~criei dinrre discur:ml . . Pragm,~u;i.smul reduce nnlpo~?. dl Avllluai"e aici nrin reu:;il n

. . r . a:mbe e a-un ... ~ ~ tcq~:eti: IJi ce pmct1~.. . irismul pp~gmatic nrara c~. nctiuou pe care o orre?t~a~.:.~r:me an vnlori d~ ndevl\r pn~ .chiar dnca.nm ~cceu-mdqea c~ e(ide&.a pozitivjst!l. el!i nu port~ r-aportnre Ju dntele d& observatte . gm"t.Ic~

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Ui1 zp~;,.d~prole.cfle formalli din ipolez;e auxili.;re. . . n.a.s~g~~~~fuile infinna predicpilc fii.cute p'e ba21aniicleului ..

tare, mf.trebllie:~a. negam ad0vfu:ul acestuinucleu ci~putew. modifita ipolezele aux,iliare Jiiprill aceastn sii dobfitldiut\.Ui plus de cunoa!jlere; un astfel de program de cerceta{"e riinlli~1e un program de cercetare pmgres~v. Newton spre ex.e1pplu1 pornind de I a te.mia _elahorati\ de el.a inceu:.atsa. pret.ldi orbita lui Ura-nus. Predio~ia nu n .ftJst insa confinuatii. Farii a considcra ca leo ria sa este f~li. Newton a modi.ficat o ipotem aux.iliara ~i anume di t:irobabil existl1 o alti. plaueta itJca.neidettlificata n1 f , - - d\rei efect nu a fostluattn ealcul in predictille generate pe baza LeoHei sru.e ~r de ~ceea predic~iilt; 'nu au fost coufinnate: iufr-adr'flir, h1cluderea acestei fpoteze; all)ljliru:e a dus ladescoperlrea plane lei Nepl::tut. ,P~ca ihsii modificl.ll"flaipolerelor imxiliare nu aduce uuplus de cttnom;tereci ajutii.doar ln salvarenuucleului

tar~ al unei tt~orii; atunci l\cele progtame de cercetare suut r.egre.~ive ~i probabil influenta lor in cercetal:ea ~tUntifidl se va reduce. 0 alta couldbu(ie a eiupirismului prngruatic este ideeu di o teorie nu este leslnta iuflecare propozitie.n ei lua~ti iudi-v idual, ci ea este testat~ ca w1 tot. unitar. D~~i in cerceLfu:i specifice facem predic\ii. poruit1d. de la iununite corup~neute (pmpozitii) ale te6riei, c:le sunt itlflue-lltaLede tecn;ie ca wi tot. ~i iu couseciu.tli, concluzin. ast1pra lor sc ras.frt\ngc;: adesea:rumprn iutregnlui sistem teoa:etic.

A doun bad~.t~e asupt~aqtiiufei este uun ci't-s.:-dptl~ii. E~ ne araHi. nu cum ar trebui sa functioneze llliinta"ci CUll..\ ~dese.a .func~Oneaza COUCl~t iuviata tle z1 ~\1 zi, fiira Sa i~fproguna CU necesitale ofer.irea de:standarde pcnt.ru ceea ~etnseantua ~tiintn. Dadi in prima tradipe s~.recuno~leai'n dife.dte ~de ( de1~inwnd de ~coala).un conslluclivism ep.i?temo~ogic ( cuno~fintele ooaslre 1m sui1t slamlarde absolute ci npro.Uutiiri. ~iq:mstruc\ii ale feno-

tnenu~ui) ~i de cele tnai multe od. se nega un constmq~i vism ontologie (darvezi pragmaUsmul), in aceaslii trnditiei descdptivl\

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adeseori un constructivism epistem.ologic poate sa fie 1nsotillji de WI COllStlUCtiVislll ontologie-S~n~aga eiistell\n'UUei roolita~i

lndep~ndent~ de subiect, realitatea ilt~a.~l fi.ind c:onsttuita de acestR-,.Spre e;tetnplu, .Goocl~ta.lt ( 1978) ~rata cup1~etnetsul unui studhi,poateJl astfel oontrol~pncat~,ebtine~dalele pe care le a~teptiint oonform teoJ:iei. Suportul eL,1plrie n.u e.~le obiectiv ~i imuabil..Ci este eli11su~l9 coustrocU~teoreticii:. Adesea

... vederi1 in datele de qbservaUe!' ceen ce ue sputJtttceria. Astfel, este clasic cazul orunenilQrdp. ~dlnta di.usecoltr.! xvu-xym. adep\ii teodei preforu1nrii, cru'e privittd-,ltt uucroscop celi.\lele sexuale nmsculine au vtizut -conform teoriei preali'!.bile - ca aces len. coutin fiintetniniatnrir..Rtet Astfel;.ln celule seJtuale ale n(luasruilor au -vl.U:~t caiitl1ninintudi, iu cele;.ulecftitillor au v6.7.ut c!llui 1n roiuiaturti. iar in cele rue oamenil.or, desigur; t\u vhul fon.t1e umaueminintudwtel (peutrudetnHi vez;i~rsch, I-999); in ncest coptext Goodman (1918-) vorb~te despre "[nbric:area faptelm;"" S-ar puleti replica autofl!l.ui cit d~ioalel~ empirice n ... u st.u.ll.imuabi. 'le. elesuntcelnuu rigums ... c.riter'. u .. .. P .. "'. cn ... r.e. 1.' tl.\'~tn ' . . pana in nccst montent peutru ~tiin~~. deoar~ ele .pot Ii e:ut-minate critic prin rep1lcare ~i ncordul iute.fevaluatQri (ex. t.eoria prefor_maril a fost infirmatitot emplrlG). Desigltr, oatitucline cdtica reflexiva asupra llmitelor acest\Ji~r~ti'l\ ~111'pidc ~ste insa de dorlt. Voi prezenta douli orientat'i ill c::ndrulhe5lei trnditii.

d~criptive, care nu avutun impact mnltnnre in filosOfill. Gtjjn~ei. (1) Cndrul par-ndigmntlc: ln 1962 Thomas Kuhn a

pubticut corte..'\ numiUi cstructurareyoluUUot ~tli.nti(\ee" in C'a1"e afinna diistoria unttldomertiu al ~tiintel parcur. g~de obicei !ja.

.(s)Tiizh:~e ~'~~~i~~.~ittttjtn i~r~ ~~~~u~Ni .u,oQa pmJ\di,gma; ~~~~, ~-~~t?!iri' 'ti~~,,a,,,,rli!Hr.~.}~'elp 'do~tli Pilradigme ~i re"rnmat-cet-en lll ~a~a i:f~~fih1Pi,not~nitt!fi. 1.. . . . . .

. . . A:cl!~tlf~est;ner~a~tF\~~i ~~v~illti~i ~~Hn(iljce a exercirac o putimieti'abilti~'~sit~t-~ruiii1en,tl,o~~.~e ~l"iiQ.ta. cat'le~lui 11\o-mtt~ll~ffiin'Icl~cttifiii~t~~11.na~in ~~e filai pitate carti .de-fiJ9Sofia "tiin(ei,tn'lb~ilJStiJct~espb'ciali'ra~t .. .. . .

, .;s,Jr(~). :Ji!-~~iltktji~.:,PiiiiiafmaliiL A~eairii eta pit a-~.voltl(iei fiti!Ptifi~~~~erenta\lttWtl4l'fiiipn1furil1~t~ns.Cte: . . . r~rd~te1e,cib(i~1t1t:e. .sunt'irrtifhiplatollr-f:. ~learonrc fii ,~~1n~dicliale;, ,i ~ . .. . .. :

:; .~'i ;.:.:~;:;~ e:~etitamo>s~. ba'2'ea~H ~e obseiva{ie {ades.~a }riesis~ , ., l'i?rtll)flf?i~)~n~ipe31l:qterit1lenc;:~;:' ', . . . . . , .... .

,;!; ::jYD.1>'~.ttJ~~~a~;AA;:ti}nlielor_ ~mllinl simplnl riu cdoiplexul . ~":~'' a~~.Jlf1Jl~,~;~lml!i:dirn:tltlod lm~asot~bre~tn peritPf!qtiva ))) ~~~~ta:f1\Qf!l'lll~1ui;,tn-ngat; : .

...,~;; ~'~~s,~:~9~~i~6lltlfr~PU~~O:SL1riUn cqmpeti(i~ urrelecu'altl}le, ,,,, .. ,.: 8~~~fVfi~~f!Q~i~twf\nd.Olposedl\'ade~,~n'l~1 ci\ este mai

.. ~t.~~~dF.pljt:~~~P~W,iJ;:~;~;~ ': . t/ttl::'!tf'!l/,t;lliJifl~~;qiA'.:A;~east:QSCJirBcfi!Fi~.prin:

. , :;; . ,i;:-'"~~~Pe11;~!1,1m~~~~!~:ftiillti1l~.BBninificative; ,, "'' ';.t:~~~ . ,,,~:o'!i.,.,.;.,- mf~~dei pr~pa ra(\i-grni\ti.fe Sllll ztlo

JtW~ttJrnrilortt1ineffipa p&}J~Illdigmnticn. . .. - .. ... i'

-- .,

---- ~4---. ..

- ob{i IIUteempiric. 0 perloada de Qriz.ii,pur\tine atunc.i ca;~:vec.bea P11~[(~~"~~~~=t~~~~ntl\lii

..... ---

1953). Considerlind 1~r&meiere . - . ntlcleuhare nl validitlif" f' . fi a pnn snportul empiric ca fiind snbiecriv s1 tJ.- ~"' .. ta- .:tn~IJ un[t 1ce se reduce l'onder.ednctamlni . ... ll. .r 1-mpunerea n fen omen. Astfel. . .. nei pitr-Spectwe asupra unu i peripecti~n tearer:~~en~~l se _mnra ~snprasnporiului empiric. eel c .. llre.prop.un.e. ~-"'cJa~sun .d tdt 'MS.ratn re.petat!}i independenr de

""'"' an mo . elul pdn. l"d -Acestsupar~-em . . va ' are mterevalllatori-OperntionalizaTc:;;~::~\7-~"' :;J_'rimrr prin verificnb;Utat~: poppe .. rhlJJ.a $au a de--Lvo1tli !l~on. dl ttate.(in~.elea.sll in vmiantfi l> . '' n or a use de dtferit r:agnlansmului(ra-tion~lisn'lulilisc . . . . e vanante nle lJ.ei acest deme-rs ~0 ' . . un;av ~empan:smul prngmmic)] . nodeul- tate nl dem:mar:. ba~ucye supqrtul em~iric est~ psihos .. oc. h.lli .. n.Ie.n .. rao .. n....,l.!.su udt ~tuopfic. desig.llr eli .factorii

.. . . . . . . '" ""' an mo e)e des . . . . . mult sm\ mai''Pritm acesrnucle . . cnpnve-oonmmmeilZfi mni

estetnsli acelnde.a .. ... . . . . . u. tara. R.ol~;~l omului de ~tiinlli d ' .. mnKmliU pondcren stn d d e areduce poodelea fuct .... . . . .. .. . . ." ar. ulni empirre-~i

. modelele desc1iptive .. 0 '10~' contamrnantt. prezentati tn AJte abortlt'd normative !flni pnstmodernisteextrem~ 1- r~cen~e._cum suntdezvoltnrile 199l)~i cnrepeliblnliun ,.asllpr~ !J,limteJ (De_rrida~ 1 976; Rorty

e2 excesJv con r sus tin ~i un "exre s ructlV1Slll episremolo~c

.- SlV COOSI:nlC[iViS f . b" snportului empiric.rolul dee r . d . ~ onto ogtc, negfind o.ferit tncll. smndarde ulrem~::i~:l~ ecstv pen~..!jtiint~.:nu au lntuatiaincarefiecare{ind a : are sit ne I!Jllfe sa depli~im

. lui, en. m=vnllrc li tmei im~~i~nu ~mp) are adevamllui ~i ~riintn t~rmehulde~excesiv" I uruce.-in fenomen! Am tolosit rotnlil a construo~"iet P:!.~~ru. nf_::tflitn~oa se.incearcii relati viznrea

. '" .,.-.mtt ace An vari t 1 neoll~Zltiv.iste (po~irivls"nlul . . 80 e e pozitivisre, 11GStpoz1tiviste(rationnl;....., l . l~dg!c, o~erallonalism) si

.. ) ...,. ... u ora be Sl mcurstv e . 1 . . mnttc presentate-aiai' d~ . mpmsmu pt-ag-

e . . ,. c::;t se aceepdl un

etsremologic -~i uneQri chiar 1 . :on_strnctivism sugereazl:i cii exis~:c . I nul o~tologJC moderar se

.. ua m~t~ standarde m 1 fjtnntifice comune nwjorit~ 1 _t~tme a e coustrUC(iei atn oamemlor. Accste stnntlarde 41!

I commie-- l.!::itedul en1pir\C - ne njlli"U sa evitfii.ll silm,~ii\ in C;\re fiecare avemadevarnl nostm tii asiglli"a minima rut\l.)nn\ili\le -minin'ianlionnlia-in ctiscurS $l comUI'\\Gare.Alle ubOl'dli~i noi-mative postanodnrne motluate~i important!~ it1 fitosotia $fiintei (d~i'nu nu penet.l'llf practica ~tiintHl.ci\ atf\t de purernic ca nbm"Liarilc desctise de-noi itici}precmn feoomenologh1 {llusser\. 1947) flihennel\eutica filosofica (Gadamer. 1975). ~are. t\\1 recui1osc :;t\pOrlulrti empiiicr:olulrnaj-or in standardul ~r.ih1{ific,

1 pa:;rreaz.ii (Otn~i criterii miniiue c-omune construcl)ei l;fiintitice. Acdte Ol'ie:ntiid postmodeme n'loderate au incercnt sa ofcre ~liintd stanrl;nrde no..-mative. nlternntive celu1 etnpiric, Asrfel, fenjillcnQlogia {Hllsserl. i947) a aiffmtcli scopul ~tiht{ei nu e!lli! cttnon$tereafaQru lui empiric ci itfenon1enul tli.l\ctul de co o:>ri in tli c:we ne pen~1lte nccesulla faptul e1_npiric~ prin acest tmgajamenr. fenpmenologill anuleazlidisiincpa dintte subiectul cuno~d\tor

. 5iobiecllll ctinoscut.Jnroi\ionismul (Bergson, \934).!li 1\bon:tnrik: henne.nc\ltic~ (bilrhe~. 19~7~ insistl nl!,Pe faptutenil"lir~~.? situ pe fenm'nen. ci p~tdiirealinterpret.!lrea fupmlui eo1piric: la ui yel subiectiv. Sa exen1plifi_cam cele ~l?nse aicj~ 0 1tn~\lizi\ illungi mii de undli n culgrii ~9!?U este o abo!:~1l.\ce emlliricn/enotitntivii. 0 nonU-rli n.modului in cnr~ el{pttli.\entien lnnivel r-ubiet:tiY culoa.-ea ROS,"Q :or.uin. o trliit:nflll rerp~t~rn noi, trnire/h)terprl!ti\fe. care nu sereducejn nivc;lll\;\\l~~imH (le.unda :- ~ste l'l ubo~dare jmui\ioni$t'a *i hepneneubd\ Ct1~ pu ge~-ati11 ~ti inti\ ll'letntlologii.l cnlimtivll.? A poi. pllntlnd-~n parnntezruobiecml. culonran R.O~lJ in, ,,cest cnz, pu~enHljGnge In fen omen, "!'di9a l' uctul d~ con~lihl[ii (~X.. esenla. prpcll:;ohJj pllrcept(v}.cn~. ptin fnptul en c.xi:>ri\ ~i es.tJi: cnrscterizat prinintentiGmalitnte(se rcfe.ri\ h\ obic:ct). c,;ri! prerechizit;a !fi fllndnmentu1 annli~oJ?.r;antit~[jve $i ~illililllVC ule colorii RO~U[nct}aljta e~te abordaren f~nomenologicn (Hu~e~l. 1947) !lin h~~l1Cllti!:ii filost'>-fice (Gqdamer, 1975')}. In 4nncluzie. d~m~rsul ~tiintific in cndrul pozitivismului. I1eopo'1.\tivisn1ului (pozitivisnml logic; operutionuli~m} ~i

' '

-

postpaz.i~vistuului (tntiunalismul crilic fi discrusiv; empirlsm\!1 II pragtim4c) ru:e -~JJil~!~lil tare suportul ~~~~p_jtk. Suporf.\lletil:._ pitie poa~_rf91!tf1i.~~i?wutiversemetor.le~eriercRbli~~SiU4lU1!-': experim~~tnfn~T~.tuffitii'elit1ic cetJtrolatimt ccl~ nt@;~~oasu: ' - t _

meto~e9iiiiei.pey.ntit ~i genetali$rel!Jr~iUJibttelor~-Desigor di"' ~e:l\istit~iJ\tdte; Jnetode perttru 8:'DU$ti!!:ll'PCt!,DOa~tii pe baz3'';

prlliclpiq~~I!Ji;-~l11P;:iriG'.t;7~t'l~nl. de-ca~,t-~l:i~atta!-s~tet\latiei'f . .aunliV~:tt~e,! s,iruat(i-pt'oblenta sau.ex_pelieutactinicii~~otgut:e 1~

uoi. C\}~t~t.i_Jl(,,- sff~ ~eq~p,~u~ t)c~te:~lllltl~~iltt~ S'~~t ~s~ _ coulextwd.,>el~:uu ppt~rr:'ge11e~~B;~#~~~~llasnrp;;tn'_core ~:' cou,tiett~~~;:ace&~tu.-eru:m;~~opl!ijna~tli~~~~sand'' furmtr:l~1ii1eorrcl.uziilepe~bQZ&~91tat8tor:-QbViflt1ltel:n'a~te--melode .~ek~ -sntd,in~ -lile'c~) facetil1'$t~1ntit tit inaatin1 in a~.

- "=. ~~ \' , ,, . : ,~ . .-- . , ;' '_/- --"----c,- _"!~ ._': '< --/~ -- _, .. ulili~iitltzY~tfel>fle;met~tJ~>~!~-r:sttllfiti'dec:9zJ'~B:t1t ., it getlemli~~Y'l"el~ul~~leob~utitef~t.~~tte~~.Jl . ,.,:,.:~:

Pentr~tgeJJernliza:tea-~ultatd:I!Jf&vettl'n.evore des :rtce coJ.tb:qlatet }\lllflar~;Jn itetastii1luct'a',:ei -~91et'sl!iiii,~ijf . ;~~If;.

tleu1e~;c'S . ill>~e.nteiat. ett\pidc~:rseudl'JI}lJlijrlt~ ;inseanli'ili'iitrna~' suppn.~;tluJ~~htpit'ic {~. dateleempiiiceivali:taeazitcel~atliiliiite:': saucutt~~.W~~epre.zentate~aJJiud~atle~'11tratt[qStinca~': les.tale ~lllf!l:l"jc} sau ullilizarea l11i' Ql:fnml~ex-~ get1~riltliarea \;.:. concluzi.U9J:\Peb~a.unordateemph:ice. eltiaut:ipnii{met~:>_ care tJu pen,tit.genentli:t.area) .. Cu>toatelii11itaelui'~'cutoatcit presi unilela ear.e este supus defacta.it outamitmn\i, aee&f't~itrrt; .. ~lupiifG$.-~~~~~i;tb~~~J!ctn~evolli~;~e~tritteJ~~bt~~~ ;!i~1. ~ Jtnbi.Ulit~t1~111l'!e,l:l:,ll,.t.tt;(itl,tl1ll,:.constit.umdl~Wffdmtclell\l'.tpte'.Ul-::. :;tiiutei ci}In~~~a.il;l~l~~f.i;UitiiZ;k:~~:Qledefi:Usin\Jl~dem_t\_:: (c;t. .. fenotlleP{Qlg~ja\ ~~]~le!llt':Utia,;.i&ui~i'lnismul) nwareu~jt :, : sii se iu1pulta ~,~Q:~l~ati~il ~-efliter~ul~mpitie-iu '~iiJJ~fdara .gene~11L abo~~J cqw.pt~ffl'~lato celo.r,emplrice,.cutn~tll.et~ . dolog.ia ~ti~ti;v;~;J!Iell~ unpliattii fJ,l;psillolegie'V6Zi M:Hrtin Jif -.Sugan~ul11.2QRO),.iarpostmodemisntulsextrm:t'(DtSrtida,1916:}' ou a. adus inca u~inh~. competiti~rtdedit nl~te,'lettuti de sea.di inleresnnte.

50

~.~ . :. . . . . . . .. . ..

I)''

~~~~~~W:,iJ~"" 1, 1. uimii"='~ .~sl"-~l'Qt.9t~~.-.~~f~~~ui~t;l.ti7,._

A . r .. , ... .,. "> -- :

l i l '

.S 1 .-.;.

\

\ \

.. ':..

, "!.'""", "), ", ,c" . :. . . ' . . "i ;" ~ii/ii '$}~.G- ~i~ll!W~~s~mnhf,O; . ma,..,li) J,"~~; follio~~\'ilP"' fi itl@!iliF!~:~-~ln>";llm ~-~~ all J>'l#~,.i!!fiu,:;i>!.p"llit'lllllll!"bli>C;sim\'lrll_i'< p~@~*-'ndp~;~fll ~~~i"'\'""de~Aaiil~ien!ul (ox,l""'llici elosiftol'Ji>~ ".lSgiii'~~ ugenli .:~nd~g~~j~ t.~ rAndul.;\DT& ':A'ge'nt1ieic!igonil'IO 'sli'Ji~ '!1zid (ex. ;:mf!(!AJ'li\tt~:te,:Ulici, electrid; ptlfi 6n~rgie'rt\dilintatitc"J:i dt in1ici (:l{e.l 1!Jili*;' .v~ .

. ... -- . :-...... : .. .

55 :":,

.Tnlr~'1!~n~~t~ .. ~ol~~~;~icaleputale~eti~el~tihP;~t~genetiea)., smn Uri dO>~~~~ :lmt~llft"""ll rue~~f~~~ '!l!il deooreco: ~Je ~~~zli.~llislllle~J,;etip~gi~ ~i~rol!(?);)!; ...... ' ! ' . ,.,.,,,.,.,,,:iil~!;.: ...... ,. : ... ~: :mecllf:a~~~~!Jltlnmfite lfdc 'l1lrot'tfi1j}o't.l HiiP* i111plieit~s-ernne ~i

o: iu .. ,.; . ..

..

'

combinat. Adesea este o p.wvocare pent.fu psiholog a face p'silwterapjg_~~ ~c~tii. cntegorie ~e boluavi, deo.are~ ~ce~lia, nvaucl sirilptcin1ntologic-somaticli. nu intel~g gJar ~i.t:lt! flCceplci tt~or rolul factorilor psihologici in genemre:a d.; nce:;tlucnl aram .. lipsa tll1:~i .. s!-ll~ur1 psihologice ~i prezeota uLtui model"bi~~~~u.:. col oitodox ~i puternic nu doar la nivelulsim{ului coJnuu ci ~i la uiveluJ. uuui segmentlarg de profesioru~ti din domcni\Jl sanatli(ii.

1.3. Rvlul ~i atdbufiile psibuvntologului ~

. Psihopatologul are mai mulle nltibu\ii (penb.-u detalii verl. David, 2003}:

(1) Diagnostic psilzologic ri tWaiUBJ'e clinicli. (2) lnterven(ie ~i tra.tomeJJt. Dadi psiltopntologul este

psiholog, fonua de lratnm.ent ulil.iz;aU\ include consHierea psihologidi. ~i int-er-veutia psilio~ernpeuLidi .. Ea s.e referli la ~ontroltil factQ,rilor p~ibologici impiica~i 1n boat~ ~i in optitiuzrirea subiec(:iloru~nani s~inato~t))ad psib.opntologul este psihirt!J.U. atunci tratamentul esletn prindputmedJcamentos, d~i mulfi psihi~td au qi co-mpetenta .in psiluJLerapje. .

(J) Cercetme. Sg,r!!fera la .invesligarea roluluifadorilor psihologicj lli. fizici impliC~\i lit sanatatf? ~iboata.

(4) Edu(;JJ{ie'-{i fonmu:elcrainiJ1g. Psiholog'!ll olinichin este ucellicentiatlnp~ihologJe .. ca.re.s~a speciaHzat *i l\lcread in domeui.ul clinic (ex. Spitale, lal:Ioraloare de SRnatate rojntala, orgmu;-;atii ~oa1guvemamenta.le). Psibiatml este licenpat in tnediciun ~i a parcurs 011 progrnlll de rezidentiat iu. psibiatrie. Arubii profesiollifiti pot pg_rcurgeoption~ programe defo~mare

. in psihulerapie care le:oferfi. compctentade praclicant ~i fonnator/ supervizor (pot cduca~i forma nlti pmfcsioni~ti) ln psihole.rapie.

53

.- ._ ...

! I

I \ i ! I

~

i

1.4. OJ:ientar-i tem:eli~ io. p.sih~patologie. 0 scut

imQlicat.i ip b0ala ~itle~volrareai{)I?limharea-personnlli. Cele r~~~ste 200 de !icoli depsillon~rapie snnt grupat.e tn trei traditii mujore c-tl~1g;n ~i Garfield. 1994). Elevor fi de&crise succinl in l'tk .. c ~trmeazi\ (pentn~ deral!i \'ezi D9-v'id, 2003; Sarason ~i ,"\,ll"LISOO. 19.99). .. : , > . . -

TDJ .JlJ,ordp1feflt1iiutrn_ic-psihtrmlili~;i)pelln-u. yeralii vezi. Dav~2003). Gao pafn~hgtn1i.ce a fost~l~l)otara pomiod in apecial.c.lela ebsew9tii ~i intuitii eli nice, psihanaliza a abordnt

prepdnc1erentiml*lcl:\llJnoon~liel')p,ll'JiMPP~Jl~tulb,,rliri1orpsituce fiip.sihosomatic~. Asumptiile fundnmenlal~;_a1e acestei perspec-

riv~tsunr: 1 . P.sil:\icu}uman ~rc o-structurli {ljvelarn fiin:d nlcatuitdin

L h-elcQmpQnenrs (n)ld-tlls~u lne(Ul~tientU carp funet1onenza dupH .i:n;incipitJl;pllle&jifil.cart} contjne:instinjfteJe-namsrre sexnule Iii ~gre~ivepte~~l!Jllli q,naul~i!l1edeiuforqltttii refulnie, asQ~_inte

nc~~ror in:;tincte; (b)$go-t'l_ (Eu .. ul) sau can~rientul .care fu~ct)ona~z~ t19-Dli .prineipiull.1U\Utiitii. prindpiu en,~ dett~rmi~i\ refulnrei\ u1.mcon1ftit\t1t .t\ il~faT\llali!lor anxipg~~le cu tocardlrurli

sexual~csau..ngres~vij.. Fl.l.n~pon!lrOD;~~o--ului ~lite constrfiosn *i de_

' :. -

Figura 2. T~;.i.unghiul terapeutic

(2) Ahordanicuurwn.ist-fP.:W(~nfialis1ii (peuttu detnlii.vezi David, 2003). Abordare{l Ul'llnRiat ... e;tistentiali5UI. pornete de ln premisa ca palo.logia psih.icn ll~ _psilloson!aticlS. a.cpru:e. caur.01ru-e a faptului Gii expeci.eu~le. ne_gatiYe rle -viata b.locbeaza'~Ioqele''/ factori i pozitive/pozitJ,viGare sl:au la bnza!Jersonrllitatii uoastre. DJHIIe ace:51l factori fac parte n~v~ia 9,e.aulorealizare, apreciere, securilnt~. afiliece.. seusetc, ~colidifeqtc:fdin ace~stu.nbord~.tre. audat tloudereJnai mare unora din nc~tifactQri (ex.. nevoia de se.ns-lugotenipie; uevoin.d~.autorealizare~let

; .....

c~li\b . Ul9V; $adeck ~l:colab . 2~~2; Sm1tson ~iS1~nlso~~ l999 J. Confurcni"lc:estlli ;Pi~t1~l. f.a~to"Ei~~psihol{lgici ~i cei. biolo:[~ici au

acela~i statllLontolop.k:ca:ifi fuetOli' efi~ldgi i~ 'pai_olilgie. Ei nctronen:dt inten:Iepenllcnt in de:li\n~area ntlloillt.W clinic ~i in consecintn tratamelltele tt&bui~' t~ne c~nlplexi~~; incluzfind . pr,qt;~du(i,me~icme ~i t:lsiflolag}ce_ ;1mlbal.e.procedoli AV.~nd

aeeln~i stntut. ontologie~ ne,i progresisre~:~eeato reqdirit~ i;lt~~ . ~9fi~et!Jl~i!P~n~~ d~0c1frt1dadi: n\lmai 'elir~' })sih&tbgidi ~i medicalli ~;i 4speetelc teol:"ericc ale disciplinei. prat!tica'cu~enrl\

11~expd d~!!ll~lt ~~d~n~'ma~.es,~01Jtcru,.:pllQmQvi\ndlln modi!l ';;~il1il).. ... '' ~ija~~l~1~ .. ii.t. 12en~b~- .:Sit.~~ia esre.simiJarat. en . ,:=.tii!~~,.ll~fQ~':~~-;;.:~~g~

. , . ,Dlr ~~d~iteei*n~ 1,iL'i\t.\'impnl'{rt p\iterea ~l'n 11u1d. egul . Zeus a rltmns stftpiin !~ ' .'

~'.'~C~!i~8it1Li s~gcTBJ~A~Nuk~;~~nm ml:,.~Az i'''

; ~"""-~ : . .:':~'':.\~: ,,.::_~.~~-: :-".-.->'- -- .- - _-

; : ~-l~,~!.a~g~Qst~J~ . ~l ev~lnarepin~cil . I>b>~~9~~;~l;(~:~~a~~~~l;o~-oa~c~tal~ d~~di~ri~~~~de }1~~;~J'}-j1~!~;, ~N3~i~:;9"1~q;~!lter~) ef>tl!'' din pitnc[ d~ \t~dera

~~IT'r}e~~?.,f?,&,f!.t!~~ll~~~~~~n:~aa~~e: Psihodi!fgrlosrictll~:tc?fem .. l~.C,LIIle~r~fCI.l rJl.pa;ps\~PllJgiini>$J~jeetnJuiumill\l~i\,.18sea . J~}~:{~fe~il~t~ .. }i d~~fFr~~ np~~lt~(i :esiho~ingnusrict\)itJ]hic

... ~~F~~~~~~l?: .;7 ~ ./,~PfQ~Jor;;~sih9l9gi~i cu reJ,~;vantn ~~n~ .. ~~!ol~~e~Jrac~.~J~e:.um;ie~vot;;p,rezenta.doBrmot:Jelutprotottp ~-,_~_-----~"'. < :~( l/-.":;,, )~'(. /"''' ,_.;;_, . -. . - ' '. -. _' . -"':"- -

. ,.it' ps~~odiq~osti~nlLlf r;:linie -psi4Q(jiagnQ!!tic't:lini~ rio~otll~c .._ Cgr~ no~~~: :rail: li.cidli\l,~:~~se ief~~;ittai,meatruat:eir!einsificnrea , ~11ilil\1e1orp~~i~J)~ij\~' tnrr7o i\nu~nitl categatie det81lbnt"i\fe

~" . ,~-' J t ' :-;. --> -,''.' 1 -- -- ' , i. --. ' - . .., - - ' . '""""'

.- .. :.

----------------....... ~~.

psif11ca. (penti'U dumlii vczi Kaplnn i colc.tb . 1997; Sj~dock $i col~6.: 2002). M~ntlonam-ihsi faptulcii in fm1clie de Oflenrareu teoretid din psihe:patalogie existfl. ~r alte mo!dele_ de psihodiagnostic clinlc~ 'Spreexemplur, tn-esfhodiagnosriul clinic fm)clion;tl nu sc urml\t~retncndra'ten problemelor pnoientuhl~

. rntr-u categorie nosolot.rica,. ci ithmtificmea tJnor fndon . psibologic:i. cognitivi-eoJrtpottiUnenta.l:i' (ex. srimull; frttariri

po~tive etc.) cave sli explioe;problemele 13aaientului (p13t~l'ru tlemlii veziDavid, 2003; Satuson fti Sarason. 1999). Mt."'dll) in

. cal'C sc s-enli7.e.~?:li

in ac~stli faza se inregistreaza num.ttle-~i prenunieie p~cienLuluit . ,Yfu~~(t~ ~~~~?~:. ~1apo~alitatea ~i-~omicilil!li u~e.Jlill~~tede~~~

pncJel!lf::sa~;~~H~Etillaton -ln~ cazul ~.t.nm: tulbur~p.~guav~, Sf.J.U a. COll,HX e:npiiaza ~i motivlll trinutedl. Spre e~~\plu3ii CJlljUl

... uttllf~ 1 .~~Ua.fizici. am iu~eput intervlul c:u discutii'~re prruuU~~ua~. proiecfulep.e J;ll.t~J,f; ~~-~bu~~~~lA\'S:t;rl\ill~atc prilntteeDat::iilerapetitui do:ve~~ ~l~q~tinte lllido~;netiiW. de itite~1~t.'pacienthl;':J,l.qc~nsia~~l:l~'f t'~llbibui :ta dezvol~area

poxili~l'i~mai rapi;dqJ:-~!,tj,eJ ~~Pt;u~ce. Nu insean:U~ti. ca treb~':~~~t'' e?cicl~-'b.~~~!~nat:l?orcli o ev~iafuaUi preg.~.~g,n~enoadt -:-f!JC?atu~:m~~~tn cu cu~evoru d1slll-s-ar}pl,i~~a-.. sn fl~ ~U:llTB~Ulnl a,~~~~;:);~~ raportlrelatie C~lllCi eficie~J~~-:'Apoi, tJ.rep!at1 se. v~reazll ,ff~re. obit;ctul ten1piei, "1~~!!~~~\~~~ ~1if#l4~~~b_t~t~~tf~~~,~~~cteristici~eri~~ la

p~~~t:!:~~~Jt~;. pac1~11t 'Bun, bat aC;J:tm~'lfne intonrcem pU.liu.l~ pi0tikrile1ei1o~l:l~~lfiiai;:aims&~:- ~ us u ,ce, .. {su arlt a .. i _ .. 'ft~t' ftebcmfi~ _ . puL Deci,ce pro~leme.

(neca~ti)'~uni:,~ ce _te,:~up,li,:l.;t. ;,;J.ieazii)~!':,,i!~;~putinuare, intervi4l trebuiesii,vl~

!rl~~iiti~ia~~1I'"' ~~:~:. . '" .; v~zau.ttirm\~d.oualdutcivitituiurnJsiio.ilive!dim:e. dete,UataA.~'lJllJl.~~,ent\dl'i-!Ji-oot~Y.ler;Jpslbiee~,,lt~estigatea prin interViU trebuie Sa fie dublata de o.;~-1-"M~tiga:~~o)!)jeeti.va prin teste--psibolo~ ncoio~unde ncest:l~c1Jlt .. ~~i!~~Un exel\lplu schematizat d~.~~,g~ care ttebpi". ln cursut itttervilitui ~ites~~J:>s~h'!l~Jilce ~~ __ .. :l!l~ pes, est-e prezentatltl "~~ 2(p~ptlttf{U _ -IJ.t i~sqw; . Spitz.er l$i colab:.,J~~~~t;,.~~~q i.faze, dlagllos~c.u1 nosologic p~l:~Jmiu~se~G~'1'\0z _ .. , . I

. Fn7..8 m. in f~'\att;et~~~~~l~~!dltJi\rli clluice, Becpo~Le tt-eee ta 0 inve~t!~ii~ i~~~ 't!~i~ ~lzeazli su~rin~rea stru~;tmii ~i,dina.Jilicifinflli:. (!ientului. l.care 9feri 1Dro :~,nteletf:outiJ~(core

p d'reli~a 1 cme catege;~;ia; neJ~et~gt _ .. 'fl~'P1l~u nn~ . . u pacientuluipe fQ;\il Aiciseate.i!t~ ~aluarea psibol~idi detalinta a stiini'w~t~ .u :1~:~~J0 . _ 'i a Inodul~Jiin c~tc se

ndapteazijl~BiiDJ;l@~;~~~~~~~'?~~'-i.E!i.~,~!P;?~~glLefo.: ~;unptolnati,~. a si\t.uatiels~li~ iate'a'~~ietttu.~.ui. o

din~ljcii~i~~~~~!~*; ,.R:~,;,., ;,~,II~!\i:~t~~er-pen>t>,J]~!~pllbCJ:IJ~~~.m~f,,.~. ,~;:,., . rnrs _ . e,afun9,tulor :;;i.i~~~mi~eu,~,,f1:1)1~~~elQJ7~er~ns,vel3i de ~OJ~i1..1g pr~um i g c9nfllc(~l{)r. ~!;W1:1311li~~1or;,a}:';~~~tp.\ll~::~ .. ~~pll ~~sine, a iQtel1gi:!0~ei, a Q,~ifitltti}ol:';; 18: :~~!ilt~D\el, a uetemltnafl\ilor

, .~~i@.;i:_situ~t~iJ.orc~reQ~"~Yii\a.;~jp~blemelorde ecqlugie s-ocial,a.,:;j familiaUi. a cunt-(;)llu:lui 'ii autocontro'~uluj

compo~,~~nlultti ~i emotiiloretc. . :t.a sfat~itul diaguostid\rll ~i evaluiitH. cliuice nvem .nUit o CQt~gQ~UQSO}Ogicade diagnostic Cat ~i J_latticularizm.~n BC'e."Jtein pri!i ~{lfPri'Q.derea (1) diuamicii indi viduale a tnl~ur~U~l~~!lll

,'., .. . . ,' . .... .. ' -~-:.:~ ': .;, . . .

61

_____ ..... -.- i -~~---=--..z_...:_.,~~-

'p'ati~ntt~hit ~f,,ll{~),P;~Qilttll:ui11.cnre c,~te~ori~ .9~t?PlMiS~ "se ,,~xp~-i01a ~I.j?~9~J~IJi~ .C(\n~ret~: pe :via tliJ~e ... I'Itrtl fiecar'c:q1aciimt .,~

gem::ra simptoq_~~t()logia. Spre. exemplu, dadi modifl~aril~ benigne-ate 'fitih:tihii cai:diac ca urmare. a unui efurt fizi~ sunt adeseailit~r[:mitate ca.senme nle unui imineutstop cardiac sau ale uuei boll severe, treptatunii diotre uoi putem dezvol~'ailic de panlca satl nevrezii ~ardiadi. C~racteristicile esentfale ale unei concep_tq~d cliltice eficiente 3utit:

~ ~a h.e acceptaffi de pacient; sa ne ajute SU CQUCeplualizam teoretic problemel"'

padentului. lrnnsfonnliud incomprebcnsibilul iu compreb.eqsibil .. . (a tat pentru pacient cat ~i pentru psihopl\tolog). Acestlucru J!Sle

similur cu principiu1 lui Itumpe!stiltskin, descris de nQi in introducerea acestui volum. Aiadar-, dadl reu~im s~ nuiuj_m simploniatoiogia pnch.mtulu.i, sa 0 iitcadrlim leoretic, ea de~ine nmi comprehensibila ~l illi pierdeo .Pa~te din 'Tor{ a maleficli";

a~ sa sugereze exis~nt:a unor t~hnici_de interveti\ie eflciente in reducerea simptor.hatologlei. '

_ Deci. a!la cum se observii, com:eplualizarea climcanu este important sa fie adevarata pentru a1i utiUi. Pacitimtul are nevole de o conceptualizru-e cru~.sa-i explice shnptomele lli sa-i sugei-ere o scheLt15~ de tratameut, nu de un adeYar ~tiin\iOc; in ac~le condi\ii. ctmceptualizmea clinicl!. esle un mit. in mitologie, nt~tul esle definit ca o. naratiuue ttadiponala emRilati'l. de o societpte

. prinuti"a imagi~1fuldu-~i explicarea concrcHi a feno.menelot ~j evenimeulelor enigmalice cu e.nracter fie spatial, fielemporal. car.e s-at\ intamplatln existenta psiho-fizjca a umului.in natura runbianlll ~i in un.iversut vizibil on nevnzpt; aceste evenhnerite stmt in legatudl cu destiu~I.condiP..ei cosmice umane, dar omul le atdbuie obar~ii supranalurale dalftnd din vremea creatiei prin10rdiale ~i, ca atare,le considera sacte \'i relevate strfuuo~Hor arhetipali ai omenirii, de fiinte.supranalur.al~rn clipele de gra\ie ale inceputurilor (Kern bach, 1978). Adaptaud aceastii defini~ie in psihopnto'logie, mitut cliuiclternpeulic este o conceptuali:c;ru:e 'din.icadespre care uu ~tim dacli este adevaralli sau nu. Caud:

70 \

( e,'{. se face o lista cu pf()blome concrete de vi at~). in functie de. pacient ~i de obiecLivele.letapeutuluL(cftt! in[onuaUe considerii l:erapeutulL-eJevanta pe:ntru tmlnntent)~ ~tapa de diag.; nostic ~i evaluaoo clinicii S,~ poate intiltde iutre J-2 ~edin\s. l- St1maridlnd, eta~a de diBgnoslic 1i evalu~re cUnid\

11resupun~ urudiloiiL-eleomnpooe.ulepriuci~e: - ' -- Identificarea senmeloc :Ji simptomelot;

Istoricul tulbuti\rli; f. ~toria pe1-sonala, sociaUl:Ji medicaUi il4;:t12itilui; .statutuimental; . .- Formulnrea diagulsticului uo.sologi.;. (DSM) :ti

concluzi'upr evaluarii clii1ice.

. 2.2. Cenceptuallzarea. clinlcli .

~~unlizntea (explicnrea, iuterpretarea) fiicutii tnb~oului clinic al pacientului este fu.ndrunw1tala lu reducertn sitnptomatol~ei (pentrti detalli vczi Fronk. .1973). Pe lfinga Q

ronceptualizare genera Hi, fec:ali~aUi pe cnlegE>.cia nosologici in -~are se incndtea"Lli. tnbloul clinle .\ pneienf\luui,;pe parcursuJ trntamenltl.lube fac conceptualiziirispeelli~peutt~ piObltnnele de viata.specifice pritt care se exvrhnii diagnostlcuhl.osologic. Dl!!ii conc~pt:Ualizarile generate fii, specifice se.lae in fune\ie !le angajamen.tul teoretic:'al psihopatologttl\li (peJ1tm delalii vczj David, 2003; Sarason. ~i Snrason; 19.!'19), s~ pat evidentia nmunite trlisaturi cbmune ale acestora dincolo d:e acest ruJ.gnjmnent .

Astfel, o lipsa a une) cenceptualizari .cli11i

. . d~ p~!lf~i s~~ 1\~W:;(ezi\ cardiac~ Oarnc~tlsllcile esentiale ale ~ :~: 'tln~i ;Ct1IICJ1Pill!l~i!aai\e:li~tice ~frciente surii: ' .. ... .. . . .... ,!\ ' ~.~~:fl~~~~fitatiideitJif~1enf; . ... . .... . .

. .lln:: .. ~-. s~ :mh'aj~(e~sa ~lln~~l)~ali~iin-l.~~fl~t9~1 ftroblemele ;, . :P~Pt~!lt~l~~. ~~~'-!'~~~ in~ll1pre~~nsibHiil~1it;~~~l111ensibil

. ... (?tntpen~ .. ~ci~cAt~pcdtrupsthqpatalog). A~El~cm estc s1milnr cu princi~iul ll),l RumpelSoltsldn, descris de noi fn

i~troduccrea acestt~i vo1um.l .A:~ildlli,; cH\~ii' 1-uu~rn. sa numi.m Slmpto~~~wa.;g~io)\:ll)lt~1 Sit 0 mcnddhnteOr~tic. en: devine mu~ 'Cti'ii\prebensibtla ~j~i pierde 0. paife din .. 'IOrfa .;,ali:l'icli'' "s~ suo:&-- erl ~~ ... t . . ~t l A .... :.

1 , }.:.> y\ 1. .,,r;, , , ~~o;;csoi" ~ . s~,a?~()F. Mlll"Sl ue-tnt,6r-yenfl~ eficterare ln redl~rea.stmptomarologU!I.; ,; .;.

peci. ru;a cum se observli, conceptualizarea cli11icii nu este nopo11ant~~:f}~ att,eYitT;;lta )?r;q~cfr,!l:ff:tlili\'Pacientul are nevoic de o coneepllia1futtecal:eslt-ie'xplice simptomele :;i sii-i sngerete '0 s~~ll ~~ ,:tf~tn'!~l~~',J"IU;::~~LUI) .,s~!!~E. it~ii'fl(ii.fic;in aceste

: ; ,,qOI)~~~.'l!a'.~~~ti~~}~~~lj~1~' ~ft;.9"fl~itl,ffiimitOlogie.' milld . . . . e.st'Q:defmr4l 'L:tt o n.a~(li;1ntH1:ndip onalli enll!na:l!l de o saeietnte .. : .~ .. p~tivl n\la~nfi.~?u;~~e~pticaroa 'C~nc,re~~a~enoJmmelal! ~1 ;f} .. ~;,!i.~'?Y;!.mente]~J:E~m~~~t;~~~.c~t~~ter ij~spatj~;jti&tem}lornl.

~'~.1 ~, .'t. , in'tftifitll~~'f:'tn;~~t~~ ~~~~l~f~ei .. .;: >e> ,';, '. 10 ' ' 1 i

~. ~ 73

~. io ~ ..,Jot a a .. ~ '

.;

. l

. f ~

- ' - . .. .. : .... o. .. ..- . :. ~.:,, .... ;.~!:'~:i;.:'c.~., sunmlului sau coupuutului,iuformajiooal)] a continutului mental ~i a pr?ceslit:~or informationale. Procesarile inriJrmatiouale JUC()?~liy.r~J~ se refeta.la faplul eii uu }JUtem exprima,J,Jngvistic eontt~~-~J.t!:pl~tal qi procesfuila info.rm::rf.iona!e . Prelucrarlle infoituatioiJ ale detennina calitatea trliitilortioliSiie eJJtotibnale/su-biective in condi(llle tmei Bctiviiri fi,riologicereduae si.lu medii. Dadi ac,tivarea fizlologidi estefoarte mare, atunci iudiferent de lipulcognjtiilor, trrurileemotionale.suntndeseaneg~tive.

(4) lVii'Ciulsubiectiv se refera la ceea ce simte ~ublectul uman.El este ope.lfl\ionalizat prin descdexile pe care subiectul le face propriel atii.ri psibice ~i emotiCn\ole: poiitiva; negativ~ .sau n?tttdl. A~adur; acesta ~I.e opera~ionalizaL prin etichetele

verba~e ale 8liirii euto(idnnle(ex; "mn silnt auxios/deuuul.igitl n.1~innl'~ etc.)..

Compone.ntele. principale al conceptuali~ii cliniee i11te grutive ~i Utodullo.rda Otgpni~ara suutptetentnte~Jfigura 3.

. A!in CU!ll_apl~ gura 3, od~tfi .~nerati\ J>.i'in mecanisme etiop~togen~tice specifice [agenrl . f;\~i~logici (tiechtn~atorl, fnvorizanti. detem~lnanfi~ pn~clispozanV. de menpn(e) ~i tnodifidiri patogenetiee (teac{:ii ale organisnni.lui 111 agentii

hlfDlJ!t-aiaro:tsunplolr~at.,logtnl tle clilte J.uu:itud

I Shnptul~alologH! l-~~ # l'rrsctUt~lue eit\lp.atugeJUiii.cti

~.Peclficc

.lleefiilo ))lodf~ul .oclat

Fig,ura 3. Mecarus_me itnl,)licate U.1. conr;eptualizarea dn~ica

74

.f

I

-. .

0:: ._ . .:' :.-.-. .

etiolog,\ci)), simptomatolGg[a este m.eu\inuta ql;amplillcaHi prin intervent]a unor faclol'i uespocjfici, extren~-de cofDpl~i ~i greu de ~ontrolal: Pentru detalli privindmecbnisn~ele.etiopatQg~netice

specifice implicate in div~rsetulburilripa1bice pot~ censultnle Jucdirile de spccial..itate (Sarason ~i Sarasou,. 1999).it~ceenoo pri v~te mecanismele eli.opat(Jgenetice uespecillce (i1Jtex:p~;etaren s1mptoroatologiej de catre pacieut ~ireat:tiil~ ntediului ~ocial), e\e pot men\ine sau ainplifica siiupLomntqlogia udntif,g~oerall\ prtu me.cm:usme etiopnt?.gene.ti~specilice, A~tfel1 dad\ sul:.lieclul 1~i- iutcJpeteaz#: siuwtoii-&ttologia liltr .. un mod n~gativ ~j

dezastrt.t9~ (v.ez.i fig. ;,l), nct:".Q5ta duce prin..in~rmediul sttesulu.l ~i tUL"tieta~i generate de aceastii iJllelpretnre la RtU{JJificurea

simptomatolog~ei.. Spre eJte.uiplu, d~diuu padeo~ i~j inLerpreteazii situptomeleca.fiind incontrolablle, de_uerezolvnl, ca expresil ale.unei. boli a.Scunse i inc.l!rabil~. c.~ deneinteles, .en sf5.r~illu lui ca pecsorulll~O~-~ii.(~sle~leQ~O~deci 'l sJfu~itul carierei, famlliei etc., aceasta gener~clQlres ~f.a,mti~tl1te prin meca.trlsntul discrepru1tei c.oguitive.(~.; ..... tlll_t!oresc sl\ flu considerat. nebun. dar nile. ell sun(; yreau sa .inteleg. ce se 'iutampla ilnt nu poi:'' elc.). Stresui ~i anx.iem.te~astfel ge11erate pot mnplifica siroptOinatologia care >in tmele cnzuri, dacitnu nr n Jost prelucrata de subiect in. J)tod eJtl:tgei-at negativ, nu ar fi (ost prea inteosii snu reul.atcatii., -dispiir.Dt1d pda~ Cl:!_tteceren timpull1i (ex,: modificiiri in ritniul ~ard.iac ca unnare a UJ1~lefor\ ~ de.osebH: ln cursuLzilei). Un\alrJ.oilea factor etiopnto~enetlc ne&pecific ex trent' de im~ort~nt, care. itt~l~u~nt~aza

. simptomatologia prin ptecanisrnuldJucrepanteJ deacn~ mat su~. este.reprez.entat d~ reac(iile mediu,ui-s?daJla.sitn,pt~m~l?logte s11u La perfotnlan\ele schute ale pacientulm, detenruuar.e de

1,rez.en\a ta\:lloutui clinic~ Spre exemplu, ca. unnare a uuor simptome {ex .. nmnezie.le.

diSC1'4pan{tti eo~n.ilive (ex:.: ''vreau,s~ fiu.cu ei dar nu pot. nu mi nccep"ra"' ""yn:;all .sii reu~esc in ceea ce fac dar nu fac fatii s~roi~ilor ~tc.). stre~>u l~ anxietat~a asti(;l genemtean1plifi~a SlmJ?f0fll_Qqlogia. ~cala~Unct'Ll se fntfimpH).tn cazulln care .

perfon~anfele ser,;!duo ca. L1rmare a simprmnelor. Spre~xemph};. i"~ Cll7.Ul,onorsimptonu~ nevroticr:;~_cnpacirurea deconrentrare.

~ pacieotulniseJ+;dlice d1:asnc. Yn conecinta. p~rfom1an{ele.t;ale (ex.:.~~ se~iciu) .se~nc.:an1treni\ndcdtir.i Jii otiserva1ii dh1 pa:rtea ~9rl.,l.~ (f1lt. ~~!l~'ltutea ~efuloi):.Ace:jte.nai conflicte nrqulifich

de!a'Pt~tt~ll9t~~lumpt.oPlatoJogta,dejl:l existentli. putf\nd ndauga cluarelell}O\lte noi..,

. . .

2}~ Planl)lde tr~tamcnt S,t descder-ea intet;rentiei - .

.. . . _yra_ta.?len~ul. ~tili~~hlerp~ (}ev.sn{n. Altfel3.Spus. ne interesifazamodul in

cm.re'tmfilgoriileno~ologicese manifesa in probleme de v1atli llenl:{u fiec;.ue pacient, ~riuf fiind faptul.cli a~ela~i dingnostic nosologic se paart mnnifasrn diferit la pacir:mti dirc.riti.

76

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~ ' f

d.cop.tlrile. Scopmile. stah\\ite tt'ebuie sa_fie._cl~re *ipre-cise, eve.nrual orgnnizate perermen scurt, mednf ~' lung ..... ..

a PJ1wul de lril/MlJ~IJf,#~llrile Htilizllte. Ele sunr: stran~ legate tie ooneepma]jzatea c1 inicn. ~~sunt ~l10prii_ f~ecfiret moda.liH\t\ terppeuliCI!', ile~i ~desea nsistam in- pracncn lann eckcristnmet.odolagic. -

.. Qbstnco!e sconlate. E1e n'Gbui~&c.clnrificate de la'inceput ~~ planul de tratament trebui~ astfel cobceput 1Wclit si:i lUI fie afectnt de no13te JllbsmcmJe, . RezrJ}tiJteob{illl.l(C. Se tnregistlell'loii tezultatele obr;inute $i se urmare~te e:voltltia pacientnluiiaitimpulrernpi~i. . . .. .

. Yn caz.ul unui trflU\Illent n1edicamenros pentru tnlburftn p&illic;e._ see~e,n~I~.sunr ns~ana~oar.tt{I{ap1Rn ~i colah., !997: Saclopk :Si Qolah,. 2,00"?). exceptfind"J:-se uneori &tabilirea une1 listed p~llleme cleoarcc~ n-atamentul.roedical\1eotases[e foca-liu'\tR;e. categpr\anasll)logi-cit. Trel:mie m(!ntionatinsal'~ptnl di nilesea tratilmennllmedit:alllentos l:Ste insoti. de terapie suporctva unde:se disiilMli n~~cte \)Siholt>giae ~i prC!bleme. .:~pacific~ nsociato trntamenrului medicnn1entas. Pentru multe. rulburi.\ri lmtmrienml psihelogic ~i.JI!;nlm&dict\l'I.Umtcs se. com bini\. Aceustii combiniltle rrehnieinsii fticudi pebazn tmor studii cares~ ate~ae ciicibntn combifmtiai deam

2.4. C~mcluzii ~i 11J.iuarirea e'\olufiel ~:otcientului ' . ::.._~.:...-

-~:

. AC.~~st~:~~ectlt1ne a aJmlizei de t~z include ton~I~ziile asuprn cawlul ~i evolutiei ac::estuia;Jn filllpul tratatne[ltului ~i prez~ntnrea planului d_e ur~uir~re_a ~volu~ei pa~ieutullii;dupa mch~Ierea lra~entu~u1, .1~ difenle peno~dede timp dupa lerapie~ penllu .a .pc:evem recadedle (penttu d~talii vezi David 2003 S.. -.in ru; doil~a .rfutd . evaluarea este uecesard. activilii~lor ndmuustrntive ~:hn cadrul in care tBrapeulul i~i desfli~oara actlvitatea (ex. statistica_interventiilor, a reu~itelor ~i er;c~;:urllor intr-a nnumitapedoadiitle timp in cad1ul unui spital).

- In W. treilea rfind, datele cul~e pot fncc obiectul unor nnalize ~liintifice ~?i E!. pllbli~::nril. Pentru. detalii vezi expetiltlenlul cu uu singur subiect (Catania 11i Brigham, 19?8; David, 1999).

2.5. Un exemlllu de slmliu,dc c:tz...Cazul Dana

2.5.1. I-storiclcl cazulu.i Daoa.ore 28 de ani, este medic, are un copil, locuj~te c.u

sotul sa~ ~;in ulLiro'ii treiani a lucrnt c.a rezident intr-o sec\ie de ntedicinii inlema. . A. Acuzele priJlcipa.Ie

Dana a ptimit trnf.amentul psiholo6io lleotru atacuri de panicli ~i anxietate genet:allZJf.ta ptezeti\.

-

' ::

. : ~~ ....

flU!i'-aU pen.uis Sa JOCUiasca iUfr-UI\ cfun.in Sludenle~ ~i i-au im,,liriaL u.u apmtameutpeatru a puten sa 1nvete in.Jlui,~Le . .In

. titupulpli9:tH~~! .. an defacu~tate ~in~e~t.~~:~~~Q~U;~p~temiC .. sinlptQfiT~bffB.ti?Q81itri'geneiB.liza~~iinet~.s4ll.P.t~we.~j~~resie :!~b,~~ini':~~ ~e':1i~tnt~!fing~~.n,;~~t#~~!rit..~-~~~P:~~.,~.a se . ~~l~~.~.t~z~ ,desence (inslttt~ ~t~e m:et~i?~:(~~~~.se~~r~tii. d6 P.~~~!l~et?~~~e.st_e un~l dnt~~~otiy~~~ l'Fll9J1f,C~~~~~~pms : ttfl:Pp.~~ttil. dt~~uqstic rde'aU)Ct~~t! ?e .~~~~;~~p~ ,ltt.~~l ;de-:n

.. E'~h>#~~ ?~~1d7 ~a~W.~~{1993~'!.~~!~~~~ ':l~zG'~W~l~~~.J;l~:tnedic .g~n~l}s.~t.Ja ttapsihmbru.~.1""3.U P.~~!"!~~9,~1\\,fl.\~,li!t;~Olln). BHRA\t ~~~)p~~rlli,~el1l~icqJ.;Ps).!li~~U . ~ i J;J'!'r ' I~ton.c medfedl. ~ _ ;: ., .. _ : _ ... i: "r: ..

; . ,O;a,rl~.uuavea:~ciun fel depto,W.~Jl!e ~f]i~~,,~,sl ii iuf1tt1311_l~fmt~tiQuarea:psibica;prt)I.U~Jl\~!r:R~.lM:e:~U{en:tel$8u p,to~,~ ~~ Ja,ll:;c\tnel4t. '' ~ ... . \ ~~ \l:.$f.~sd.tre,,IIJ.l . . .. , . . .

\ ~qci~utaelia bine'orientatii to_~!PP-~patbt~. 4.ojd!spo~(ie anxi(Jnsa,,\

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83

~Ufr~rt-dirrpart~a SO{Ullli e! ~i de:faptol caSe simtMeoplc$ilfi de ~nrcmlle as~mare ~fa(!ton declan~atari). Dana se n~reptase la surortemotlonal dtll pnrteusotnluisau:; in schimb ea simtea ca ~n~ii ~nsatorie a avutfiimai mnlra obliga{ii decfitinainre,-.~sf~l mcatacesreill\O st'a~itprin f\ o coi?I~~i. Aces[ moment coincide en decl.an:;.llren primului:atac ds.panidt

IJ.. .. . ~laltuiJ.eil cogJJifiilol' fl eomporlamenlelnr ar:tuale .~ SJlllT_Popro!Jle.IJ]lJticii dpic.iiipentru Dum~ a fost ~ea JegaU1

del1l'lmnl san ata~;: ~epani~iL In tim.p ce isi pn~gliteit exainenul !e ~~to~atin ~:U?e.nt fil. i-RVllti un:gtind n~1tcimat de genul~ ."N u

Ol.ICU!il s~ ma pre-g~He.ac.cum trebuier !o 1.mnotoara.le zile . d~O~l\l'eCC. 'lll\- mli. ajutli ~imeni Cll-~t.elelnlte sarcini .fii llll pOl sit

Qb~m mm mult~ml' pcntrua-:I"Ili p.regati ex.ameimr'. bin punct L~~-v~d~re -~~l~{l~nat. "S"-.a simtit foart:eanxioasa~ s-a opdt din crt.!i. S-ll_ndtcat dln foroliu. A"pt>i a simtit c.1. nu inailpnare respira ilt~ durert p~ecordia1e,palpit.'l(:ii ~i tremor incontrolabll. tn ncei moment t::ent-rnliiSi:!Tefel~ la rcspons(lbilitate lji control; ''Dad\ ceUal\i nu mn .ajutn~ .auu~ci nt\ mn pot cancentra s.i nu por sl:i detin controlul ~\ sllreuJif!S tn sitt.ta\i'll~:huportante din viata men ... AMi\StR cognipe est~:l.ncontlntlnre. ~J/f\hliltli! ~Jl~t'SO(U1Cle apropinte niie trebriitl"Sli mlli1jute s~.contr61ftg;situatia, l)entru ca slims pot COI'lCerttra Iii sa:imi at.ing flhlfiotivele i mp.ortnnte. Dncil nn ma ajnta, este gronznic l!i nu pdtS\'\porta aqtl cevn". Ceil de-n {J-eia cJ-edin[:'f centmJ;ise rcfera la d:mfort ~i control ~i pare a l'i

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implica~a tn apari\ia-emotiilor seundare (adica. panicli d~pre paoi.di)~ o~ca suntueajutorntii ~i nu miipat control a, atu.i1ci ~L eu ~l ce~alti ~01~ avea ~e ~fe~;~~~.J\treat;l3:. 9{)gt;~itie ~%~pq_i . e~.~t~{ll,~~~~kt::-~b];U;~~.-til~UI~:fi~J4.Lrm~, pt~e~~~~~~~11ie ::tu~sup .I~ .... :l ::,,~~ _ .. __ .. . ~ .:::~~-~::.t '

.1J . 1 .. :fMl{~-~i!Pf~i~~.e~~JJ~tfi~~. t(U"i-4lf!:pa~ietztJtJ,J{ .

._'--P~~~-~t: -~- P~[S{)Bll.~J~~b"k~l!lifrc~.q~~~~~~.~~i~~tia . ll:lbe.-sten~~dJCJJn\ 5il este foar.tediseiplitu!L{L Ea d~t;~e~t.p_ua ce est~ JP~l ~till pe~t:J:u.: ~- ~i f~.ij~~t:JJ~-~-GO:l\S~ilil~llici un .

efor~ 11}}.~~-ef?F~~ J~~~f~!~~n~ ~.QijtP:!,e~~t blem,k.tE!lWaaltrait cy ~~!~t~fr~~e!"~~li9P. ~np~P;P~~p~;~i~ltt~i:~ti

'?am,.: mecitt,m:.stuele de coptnJJ. uttltznlt;rap- ;fo:st::,-r,-.- ;.;:_:;._y;,',-,;. ~ per:.weffi"f~ t~ap.l~J.cqgnittV6 .

A~. . lJst.tL 1fe.j1Fgbl~n.es. . . ... _ . . . .. . _ ..... 11 -~'~ .~t.~F~il~~.P~~~.Iileililaitd.; ~!21) s~atlnt~'!~!~~!~gt~- .. jo~aW:itl'eg~p..~q qri~.~~~t~n~t*~u.eyniW;!t~!fi.~~~esJe .. :;ubiURi~);.{~~~Plii.C,~~W\"'li ayJ8td~3J.!poQipe ~~~esta

l-~r.\1~~pf~g.~~~

,,'~fita rel~tia dint.L~ ~L1