軍精神科病棟에서의 不祥事 및 事故 分析

姜錫憲,李三民,李忠憲,金相煜 최신의학사 1970 最新醫學 Vol.13 No.4

The authors have analyzed 144 cases of trivial untoward affairs and accidents displayed by psychiatric patients who had been admitted in Chin-hae Naval Hospital from January, 1968 to December, 1969. To begin with, several characteristic aspects of military psychiatric ward and present status of the psychiatric ward of Chin-hae Naval Hospital were reviewed. The analyses are presented as to several categories, i, e, the kinds of accidents, the time and the places occured, the objects involved and repetitions of accidents in one patient, as well as some relations between diagnostic categories and the kinds of accidents. The pursuits of probable motivations of accidents were also included. The results are as follows: 1. As to the kinds of accidents, physical assaults ane antagonistic behaviors (61.8%) were most frequent. 2. There were no significant differences in frequencies of occurence of accidents between during jffice hours and the rest of a day, but the tendencies to occurence of more serious accidents after office hours, weekends and holidays are noted. 3. The most popular phenomena, the authors observed, were that patients rarely attack the therapeutic team and they displaced to more "reasonable objects" such as inferiors in ranks and civilian outsiders. 4. There were no specific relations between diagnostic categories and kinds of accidents except suicidal attempt and escape. It is evident, however, that neurotics are apt to make less frequent untoward affairs and accidents compared with schizophrenics and psychopaths. 5. As to the probable motivations involved, conflicts among patients of different ranks, intentional display of self-mutiliatory acts for the purpose of postponing hospitalization, struggles for leader and, realistic as well as phantastic involvement of nurse-officer would be most distinguished. 6. In the present study, because of the lack of statistical validation and comparision with control group, the authors hesitate to conclude the general pattern.

꿈 分析을 통한 精神治療 修練

申明淑,姜錫憲 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

정신치료의 修練을 目的으로 著者들을 포함한 7명의 수련의가 Supervisor의 주제하에 1981년 3월부터 11월까지 8개월간 慶北醫大 神經精神醫學 敎實에서 週1回 90分間 19回의 꿈 分析時間을 시도하였다. 19回의 錄音된 꿈 분석 資料를 정리하고 參加者들의 反應을 設問紙로 조사하고 集團討論을 거쳐 다음의 결과를 要約한다. 參加者 전원은 꿈 분석시간이 정서적으로 유익한 同察精神治療의 經驗으로 느꼈다. 참여자들의 轉移現象은 權威者를 둘러싼 兩價感情이 주류를 이루었고 이는 꿈 분석을 주도한 Supervisor의 現實的 役割이 크게 작용함을 알았다. Supervisor는 자신의 逆轉移感精을 과다한 꿈 解釋으로 방어할려는 경향이 있음을 자각하게 되었다. 꿈 분석시간에 참가한 수련의 전원은 정신치료의 基本槪念 습득에 도움이 되었다고 反應하였고 특히 꿈 해석의 技法을 배우는데 유익하였다고 보고하였다. 19회의 꿈 분석시간에 보고된 전체꿈 수는 122개였으며 이들 꿈을 몇가지의 주제별로 분류해보면 依存·獨立의 葛騰(26%), 敵愾心과 功擊心의 表現(21%), 無力 또는 無能感(15%), 兩價感情(8%), 排斥感(5%), 憂혈(3%) 등이었다. 꿈 내용에 있어서 수련기관이 그 배경으로 등장하는 경우가 전체 꿈의 32%나 되었으며 따라서 수련의의 정신과 수련에 따른 갈등의 一面을 表現, 解消되거나 現實的 調整이 가능한 예가 많았다. 이상에서 볼때 集團 꿈 分析時間이 정신치료 수련에 유용하게 利用될 수 있다고 본다.정신치료의 修練을 目的으로 著者들을 포함한 7명의 수련의가 Supervisor의 주제하에 1981년 3월부터 11월까지 8개월간 慶北醫大 神經精神醫學 敎實에서 週1回 90分間 19回의 꿈 分析時間을 시도하였다. 19回의 錄音된 꿈 분석 資料를 정리하고 參加者들의 反應을 設問紙로 조사하고 集團討論을 거쳐 다음의 결과를 要約한다. 參加者 전원은 꿈 분석시간이 정서적으로 유익한 同察精神治療의 經驗으로 느꼈다. 참여자들의 轉移現象은 權威者를 둘러싼 兩價感情이 주류를 이루었고 이는 꿈 분석을 주도한 Supervisor의 現實的 役割이 크게 작용함을 알았다. Supervisor는 자신의 逆轉移感精을 과다한 꿈 解釋으로 방어할려는 경향이 있음을 자각하게 되었다. 꿈 분석시간에 참가한 수련의 전원은 정신치료의 基本槪念 습득에 도움이 되었다고 反應하였고 특히 꿈 해석의 技法을 배우는데 유익하였다고 보고하였다. 19회의 꿈 분석시간에 보고된 전체꿈 수는 122개였으며 이들 꿈을 몇가지의 주제별로 분류해보면 依存·獨立의 葛騰(26%), 敵愾心과 功擊心의 表現(21%), 無力 또는 無能感(15%), 兩價感情(8%), 排斥感(5%), 憂鬱(3%) 등이었다. 꿈 내용에 있어서 수련기관이 그 배경으로 등장하는 경우가 전체 꿈의 32%나 되었으며 따라서 수련의의 정신과 수련에 따른 갈등의 一面을 表現, 解消되거나 現實的 調整이 가능한 예가 많았다. 이상에서 볼때 集團 꿈 分析時間이 정신치료 수련에 유용하게 利用될 수 있다고 본다. Seven psychiatric residents have experienced 19 successive series of group dream sessions as a method of psychotherapy training. The dream sessions were conducted by the senior author (psychotherapy supervisor) in the department of neuropsychiatry, Kyung-Pook University Hospital, and the sessions lasted for 8 months' duration from March to November, 1981. Each dream session ran for 90 minutes on the weekly one time basis. Dream sessions primarily consisted of reporting manifest dreams of all participants, of freely associating to the dream images, and of discussing the materials. The supervisor tried to interpret the dream material psychotherapeutically. All dream sessions were tape-recorded. The presupposed purpose of group dream sessions was to experience the psychotherapeutic situation and to understand basic concepts of dynamic psychotherapy as well as to have insight into their own emotional problems. To evaluate the effects of dream sessions, the authors reviewed all the recordings of the dream sessions after 10 months after the termination of the sessions. In addition, the authors had individual interviews and one group discussion with all participants to evaluate the after effects. A questionnaire composed of 32 items was applied to the participants of analyzing the data of the experience. The results could be summarized as follows; All participants of the group dream session agreed that the experience was a kind of insight group psychotherapy with highly emotional atmosphere; each session had been rather terse and characterized by lack of verbal exchange, but was followed by extra group talking when the supervisor was absent. Main subjects of and emotional conflicts among the participants. The nature of the transference of the participants was colored by the authority problem toward the supervisor; the reason for this could be partly explained by the fact that the supervisor also serves as a real figure (director of the psychiatric department). The supervisor himself gained insight into his own countertransference of domineering tendency, which manifested in the form of excessive and sometimes rather critical interpretations. The total number of manifest dreams reported during 19 sessions was 122, which counted 1 dream for each member in a session. As to the contents of the manifest dreams, the author could identify several categories of central themes; dependence-independence conflicts(26%), expression of hostility and aggressive impulse(21%), helplessness(15%), overt ambivalence(8%), feeling of rejection(5%), depression(3%), and others. It is interesting that the pictorial background in the manifest dreams frequently showed the training hospital; around one third of all dreams. Accordingly, the members could express various emotional conflicts of the psychiatric training and the conflicts could by worked through. Finally, the reaction to the dream session was particulary impressive in that their previous concepts about psychotherapy became vividly clear from their own experience of dream sessions; in terms of the basic concepts of the unconsious, transference, resistence and others. The authors felt that the group dream sessions could be a useful tool for learning and teaching dynamic psychotherapy.

精神治療에서의 解釋

姜錫憲 대한신경정신의학회 1991 신경정신의학 Vol.30 No.1

The purpose of this paper is twofold. One is that the author briefly reviewed the concept of interpretation in psychoanalysis and psychotherapy through the literature of Western psychotherapy ; the concepts of interpretation relating to its historical change, the function,the contents and the practice of making interpretation. He noted the recent trends of emphasizing the analyst,s function as an interpreter not only to simply paraphrasing the patients’ s verbal reports, but also indicating what is not being reported at the appropriate moments. The other is that the author, from his personal experience of psychotherapy training in Korea, described the significance of “Taoistic Perspective of Interpretation” in the traditional Tao and traditional form of psychotherapy. Since the begining of 1970,he has been actively involved in the activities of the Korean Academy of Psychotherapists which has been led by prof. D. Rhee, and of which the aims were to assimilate Western psychoanalysis and psychotherapy on the basis of traditional Eastern Tao and to integrate both Eastern and Western disciplines. Through the repeated exposure to the psychotherapy practice of and teachings of Prof. D. Rhee, the author found that his demonstrations and illustrations of psychotherapy were good examples of integration of Eastern Tao and Western psychotherapy. The Prof. D. Rhee’ s therapeutic climate was unusually warm and natural. Active participation on the part of the therapist, vivid interaction with the patient and the highest quality of empathy were very characteristic of his therapies. The interpretations of his therapy are very different from the Western style of psychotherapy. His interpretations were not primarily focused on the emotional abreaction(sexual and aggressive), but were frequently focused on the ultimate resolution of the conflicts producing the lifelong effects on the patient’ s mind. Finally, the author depicted the importance of Taoistic perspectives of interpretations in various aspects. The Taoistic interventions include not only verbal interpretations given by the therapist but also all the activities of the psychotherapist and even the mere presence of the therapist, because the Tao emphasizes therapy with “Wu-Wei” ( 無爲) “Jen” (仁) or “No Mind” ( 無心) ,the highest form of psychotherapy.

憂鬱神經症에 관한 臨床的 考察 : 發病誘因을 中心으로

姜錫憲 慶北大學校 醫科大學 1977 慶北醫大雜誌 Vol.18 No.1

退院한 精神分裂症患者의 便紙

姜秉祚,姜錫憲 大韓神經精神醫學會 1972 신경정신의학 Vol.11 No.2

Letters from 12 discharged schizophrnics are analyzed in its form content, and psychodynamics. Fourty letters from one of schizophrenic girl to her therapist has been studied intensively as a model case. Results: 1) Some features of schizophrenic letters are well corresponded with characteristic modes of primary process. 2) The whole process of letter writing was interpreted as on-going psychotherapeutic one based on intense, positive parental transference, The nature of this transference was analyzed and discussed in comparison with general features of transference in schizophrenia. 3) The authors also discussed several aspects of therapeutic significance of letter-writing itself, and stressed its usefulness as a tool of therapy in schizophrenic patients.

Ganser 病候群의 臨床的 觀察

姜錫憲 慶北大學校 醫科大學 1978 慶北醫大誌 Vol.19 No.1

The author reported three cases of Ganser's syndrome; two males in their twenties and forties, and on female, sixties. All three cases had been hospitalized in Kyungpook university hostpital during last three years, and complete psychiatric study with application of clinical psychologic testing in one case was made. The clinical course of three cases was brief and rather episodic in its nature revobering after only around 15 days of treatment respectively with no lasting residue. Typical symptoms of Vorbeireden (approximate answer) and amnesia with loss of personal identity were observed in all three case, while symptoms of ludicrousness in two cases only. Other symptoms included clouding of conicousness, hallucination and depressive mood, etc. As to the precipitating factors, overwhelming emotional upset superimposed by legal problems in t재 male cases, and guilt provoking sexual arousal in the female patient in her sixties could be identified. Finally, the author discussed the hysterical nature of this syndrome with the literature review.

한養子의 自己同一性 混亂

姜錫憲 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.1

The author experienced a therapeutic relationship with a patient of severe identity confusion in an adoptee of 17 year-old high school boy. His major psychopathology revealed a severe depersonalization, regressive behavior as well as grandiose ideations. In his fugue state during acute psychotic break, he wandered around seeking for his 'true parents' and uttered himself several 'incomprehensible remarks', which were characterized by severe time diffusion, and historical as well as geographical dislocation. He had been separated and uprooted from his biological mother in his earliest year of age, and was adopted to his present family with his natural father and foster mother as an eldest grand-son of his family tree. Due to deceptive and secretive family atmosphere with rejecting mother and distant father, he had been deserted since childhood. In his understanding of the identity of the patient, the auther tried to delineate the identity fragments of his father and foster mother. Finally, the author attempted to interpret the contents of the patient's depersonalization phenomena in terms of individual, family dynamics and societal changes.

小兒精神科病室의 環境療法 : the milieu therapy

姜錫憲 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

The purpose of this paper is to describe an approach of a short term child psychiatry unit. The paper gives a brief literature riview of milieu therapy, therapeutic community, and children's psychiatric hospitals. Secondly a historical review of the philosophy and structure of the Child Psychiatry Unit at the Mount Sinai Medical Center, New York City, and thirdly, a description of some of the principles which form the basis for the practices on this ward. In conclusion, the author stressed the difference between the milieu therapy of the Child Psychiatry Unit of the Mount sinal Medical Center and that modelled along a developmental/educational paradigm. The therapeutic techniques of the ward varies including ego supportive and ego interpretive methods. The therapeutic activities program of the ward provides for each child to develop his cognitive and social skills. The nursing staff supports the child, helps his social skills and provides for new models of identification. In addition, the method of ego interpretation is a valuable tool that even in a short term treatment provides for ego development and progression by enabling the child to gain some insight and control over some of his instinctual urges.

精神治療 經過에 따른 꿈 變形

朴寧雨,姜錫憲 大韓神經精神醫學會 1990 신경정신의학 Vol.29 No.3

The purpose of this study was to identify the dream transformation in accordance with the progression of psychotherapy and to suggest the possibility of manifest dream as an indicator of its clinical progress. Materials of study were 524 dreams in the protocols of 55 cases having good clinical progress and dream reports among 130 psychotherapy cases which had presented at the Korean Academy of Paychotherapists for 10 years from Feb. 1987 to Mar. 1988. The functional scoring system that had been disgned and studied by Corriere et al. was adopted as the method of dream analysis. The psychotherapy course was divided into 10 segments ; first 9 segments on equal interval of 5 between lst and 45th sessions, last 1 se-gment of 46th session and above. The means and standard deviations of the ratings by the rater on the ordinal variables in process scales were calculated for each segment of psychotherapy sessions. The percen-tage of dreams that fall into each classification on the categorecal variables in content sca-les was also calculated in all segments of psychotherapy session. Averge feeling intensity scores gradually rose across all segments of psychotherapy ses-sions with some fluctuations on initial two segments and the latter four segments. Dreamer activity scores, dream clarity scores, and dreamer expression scores also rose gradually with some fluctuations. The proportion of symbolic dreams decreased gradually. as psychotherapy progressed whereas that of dreams close to reality increased. The proportions of dream setting that has clear reference to dreamer's personal present life, dream characters that the dreamer personally knows, and the origin of feeling which are evidently about people or events in dreamer's present situations increased relatively gradually in accordance with the progres-sion of psychotherapy. The proportion of dream' setting that had clear definite refere-nce to dreamer's past life decreased across all segments of psychotherapy sessions. The proportion of younger age dreams showed minimal changes through the course of psycho-therapy. The findings support the hypothesis that dream transformation occurs as psychotherapy progresses and suggest the possibility of manifest dream as an indicator for its clinical pro-gress.

내가 지내온 길

강석헌 圓光大學校 醫科大學 神經精神科學敎室 1991 圓光精神醫學 Vol.7 No.1

원래 이런 계획을 안하고 왔는데 박남진 교수가 아침에 뭐라도 이야기를 해달래서 미리 생각한 것은 없고 그냥 내가 지내온 것...자유연상 생각나는 대로 해볼까 생각합니다. 저 자신의 이야기는 과거에 미국에 78년, 79년도 2년 있는 동안에 한국에서 내가 정신치료 받은 경험을 정신과 의사들에게 이야기 한 적이 있고, 돌아와서 80년도 초에 서울대학교 정신과에서 해달라고 하는데 내 자신의 꿈 가지고 이야기 한 일과, 2번 있습니다.