Bach-Busoni: "Ich ruf zu Dir"
http://www.youtube.com/watch?v=La2MIYSDduY&feature=related
Solaris 1972 Theme
http://www.youtube.com/watch?v=wlD-9uwHA40&feature=related
http://www.youtube.com/watch?v=FcglyhUre4w&feature=related
精神分析-3 転移・逆転移
転移
転移はフロイトの考え方の中でも最重要のものである。
人生最初期の重要な対人関係で体験した感情を、現在の対人関係にも感じてしまうことを転移という。
人生最初期の経験が、新しい対人関係や状況に対するときの患者の態度の原型を形成している。
過去からの「テンプレート」によって現在を形成しているのである。
現在ならば「テンプレート」で、昔ならば「鋳型」と喩えたところだろう。
さらに現代では脳科学の言葉で表現したほうが分かりやすいかもしれない。人生最初期の段階で最初の対人関係を経験しているうちに、白紙の脳に、新しい回路が刻まれる。その後、さまざまに修正されることはあるものの、最初に刻まれた脳回路は一番の古層に保存されているだろう。
どの人も、自分の持って生まれた傾向と人生の初期の体験から得られた教訓の2つを組み合わせながら、自分なりの行動様式をつくり上げる。特に性的行動をフロイトは問題にした。このプロセスは鋳型またはテンプレートのようなもので、人生を通じて繰り返される。
過去と現在の状況が新しい自分を作り、それがまた新しい環境を体験し、新しい自分を作るという運動が続く。このあたりは簡単な数式ですっきり書ける。
その最初には生得的な性格特性と人生最初の体験があるわけだ。
精神分析では、転移の分析が治療の基本になる。
治療者に対する患者の転移は重要である。治療者に対する転移を分析することにより、どのような力が働いているのか、記憶や期待といった「脳内の出来事」と「外部現実」とをどのように区別しているかを知ることができる。
記憶や期待のような「脳内の出来事」と「外部現実」をきちんと区別できることが、relity testing 現実検討能力である。現実吟味能力（現実検討能力）とは、『外部世界にある事象』と『内面世界にある表象（心的内容やイメージ）』を区別する自我の機能である。
転移は過去から持ち越した鋳型であって、過去に反復されている行動や思考によって知ることができる。
患者は自分は昔反抗的だったと語るわけではなく、権威者に対して批判的だったと語るわけでもない。その代わりに、診察室で医師に対して反抗的に批判的に振る舞うのである。
転移を調べるには、臨床場面で中心葛藤関係課題Core Conflictual Relationship Theme (CCRT)を利用する。この文章の後半で、さらに説明し、妥当性の検証もする。
逆転移は治療者が患者に対して、過去の「鋳型」「テンプレート」で感じ、考え、行動することである。
転移と対になるもので、それは治療者が自分で解決しなければならない問題である。
患者の感情や非言語的コミュニケーションに対して治療者がどう反応したかを見れば、逆転移のあり方が評価できる。
電子レンジのファン
最近の電子レンジを使い始めたら
加熱終了のお知らせ音がなってドアを開けると
ファンが回り続けている
電磁波は止まっているのか気になって
嫌な気持ちだ
加熱終了のお知らせ音がなってドアを開けると
ファンが回り続けている
電磁波は止まっているのか気になって
嫌な気持ちだ
前頭側頭葉変性症（FTLD）
前頭側頭葉変性症（FTLD）はその昔 Pick 病と呼ばれていた疾患群である。Alzheimer 病（AD）が疾患
的に均質で、その固有病変はび漫性に発現するため脳は全般的、対称的に萎縮する。これに対し、Pick
病では前頭葉と側頭葉またはそのいずれか一方が限局性に萎縮する。従ってしばしば、左右差があり、
症状群も多彩であった。今日この様な定義に合致する疾患は実に多数存在することが知られ FTLD として
一括される結果となった。そして FTLD に属する疾患群の一方は tauopathy を呈して AD 関連疾患（CBD,
PSP）に連なり、他方はTDP-43 proteinopathyを呈してMND/ALSに連なる事が明らかになってきた。中枢
神経系が原発性に侵される大きな２つの難病変性疾患群、FTLD と MND/ALS の本体がこの₂₁世紀初頭に
ようやく暴かれようとしている。本稿では FTLD-ALS の剖検例の提示を契機に、文献レヴユーと共に、
臨床病理学的観点より FTLD が包括する疾患群の新分類を提案した。この知識が将来 FTLD の診断と治療
の進歩の基礎を提供することになることを期待する。
HirosakiIryoFukushi_1(1)_1.pdf
All physicians encounter patients
All physicians encounter patients they find difficult to manage and treat. Such patients engender myriad feelings in us, including aversion, anger, fear, guilt, frustration, and anxiety. They may be noncompliant
with recommended treatment, challenging to their physicians' approaches to their care, or resistant to forming an effective alliance with their doctors. Physicians' negative responses to such patients can offer important clinical data that can help health care professionals take better eare of difficult-to-treat patients. Failing to consider and acknowledge negative responses to patients may lead physicians to deliver suboptimal health care and may have a negative impact upon their enjoyment of this profession.
What can surgeons do when they experience these powerfully negative feelings? Ideally, they frustration, and anxiety. They may be noncompli-
should use their feelings to help them take better ant with recommended treatment, challenging to care of the patient. However, sometimes physicians their physicians’ approaches to their care, or react out such feelings in maladaptive ways. Some sistant to forming an effective alliance with their potentially maladaptive initial responses to the doctors.
There are several reasons why physicians help health care professionals take better care of may act in a maladaptive fashion. The patient– difficult-to-treat patients. Failing to consider and physician relationship can be influenced by fac- acknowledge negative responses to patients may tors about which both the patient and physician lead physicians to deliver suboptimal health care are unaware. Empathy, when accompanied by patience and tolerance, can lead to insight into the patient’s negative behavior and enable the physician to develop a better partnership with the patient.2 Failing to exhibit empathy can occur in the presence of “counter-transference.”
Maladaptive responses to the difficult patient
Counter-transference and counter-reaction
Counter-transference refers to the develop- ment, in the physician, of positive or negative feelings toward the patient based on issues in the physician’s own life. For example, if a physi- cian is somewhat emotionally needy, he or she may become overly involved with a dependent patient, leading the physician to provide the patient with undue access to the physician (for example, giving out e-mail or cell phone num- bers). If the physician has an overly demanding parent, he or she may overreact with aggression and hostility toward a patient who shares the negative characteristics of that parent.
“Counter-reaction” needs to be differentiated from counter-transference, as this is usually a common or normal response to the patient’s emotions or behaviors. For example, when the patient becomes hostile toward the doctor, the doctor may wish to withdraw, or may feel anger in response. The physician has to try to figure out how to better respond to the patient’s feelings and responses, without personalizing them. This is easier said than done, as physicians, like their patients, are only human, and are subject to their own feelings and those of others toward them.
Characteristics of difficult patients
In his insightful article in the New England Journal of Medicine, titled “Taking Care of the Hateful Patient,” James E. Groves, MD, describes difficult patients as those who “kindle aversion, fear, despair or even downright malice in their doctors.”3 In trying to understand the nature of this situation, Dr. Groves classifies “hateful pa- tients” into the following categories: “dependent clingers,” “entitled demanders,” “help-rejecting complainers,” and “self-destructive deniers.”3 In placing the difficult patient into one of these categories, it is easier for a health care profes- sional to see their patient’s psychopathology more objectively. Once the surgeon conceptualizes the
patient’s pathology, coming up with a clinical ap- proach to deal with the patient’s difficult behavior fits more into the medical model of treating illness and symptoms.
Maladaptive responses to the difficult patient
• Ignoring phone calls
• Telling the patient to go to another doctor
• Being accusatory
• Getting angry
• Blaming the patient
• Telling the patient there is nothing wrong with him or her
• Telling the patient there is nothing more to be done for him or her
• Overmedicating the patient to silence him or her
• Dismissing the patient as a “malingerer”
• Handing the patient a “sign out against medical advice” form
The dependent clinger
The dependent clinger
Dependent clingers alternate between requesting reassurance and demanding many differ- ent forms of attention (such as analgesics, long explanations, or the physician’s time). These patients feel like bottomless pits of need, and a physician often finds that they are avoiding the patient’s calls and visits. The behavior of these “velcro patients” comes from a profound need to be taken care of.
One warning sign of the dependent clinger is the patient who idealizes the physician and professes their undying admiration for their doctor. This patient initially makes health care professionals feel special. However, it does not take long for the physician to become “the inexhaustible mother; the patient becomes the unplanned, unwanted, unlovable child.”3 These are the patients who take up too much time, call outside office hours, request objectively unnecessary office visits, and may “cry wolf” to your answering service, simply to get your attention.
The best management of such a patient is to set very firm limits regarding appointments and telephone calls. The physician needs to kindly, but clearly, remind the patient that he or she cannot be an inexhaustible resource to the patient, available at any time of day or night. Regular office visits should be scheduled when the patient can see the doctor and ask questions. These actions should give the patient the contact he or she needs without disrupting the office and the physician’s life.
The entitled demander
The entitled demander
The entitled demander is fundamentally similar to the dependent clinger in terms of his or her neediness; however, this patient’s demeanor is quite different. This patient can be demanding, devaluing, insistent, hostile, on the attack, and intimidating. The entitled demander may threaten to bring lawsuits against the physician, or con- tact the patient relations department when the surgeon does not respond to his or her demands. The primary state of this patient is one of entitlement. This state is actually a defense against feelings of loss of control and helplessness. However, when a physician is at the other end of the angry demands and entitled behavior, it is easy to understand how one could become enraged with this patient. An entitled demander makes the physician feel fearful of their threats, such as threat of a lawsuit or a threat to contact the patient relations department and file a complaint. A typical physician’s reaction to this patient is to let him or her know, in no uncertain terms, how undeserving they are of what they are demanding. When the physician reacts in this fashion, the patient becomes even more enraged, demanding, and threatening.
Dr. Groves speaks eloquently about how to handle such a patient, by addressing the patient as follows:
You say you’re entitled to repeated tests, damages for suffering and all that. And you are entitled— entitled to the very best medical care we can give you. But we can’t give you the good treatment you deserve unless you help. You deserve a chance to control this disease; you deserve all the allies you can get. You’ll get the help you deserve if you’ll stop misdirecting your anger to the very people who are trying to help you get what you deserve—good medical care.
Dr. Groves’ approach enables the physician to tactfully address the entitled and demanding behavior in a constructive manner, rather than to respond with rage and retaliation, which are natural responses to this kind of mistreatment. This approach allows the patient to gratify his or her underlying belief in their entitlement, and re- inforces their wish to receive the best medical care.
The help-rejecting complainer
The help-rejecting complainer
The help-rejecting complainer will try to thwart any help offered to them. After their refusal to follow the physician’s instructions, these patients tend to express their feelings of hopelessness by stating that no doctor can help them. Week after week, he or she returns to the doctor’s office to assert that the recommended treatment has failed once again. When the physician is exhausted, the patient declares that the treatment has been un- successful. The physician ends up feeling tortured by the patient.
Like the dependent clinger and the entitled demander, the help-rejecting complainer can be viewed as a bottomless pit of need. They seem to wish an undivorceable marriage with their physician, yet they do not seem to wish to get well.4 When one symptom resolves, another magically appears to replace it. These patients often suffer from undiagnosed and untreated depression.
This patient group makes physicians feel help- less, anxious, and uncertain about their clinical skills. It is usually not constructive to confront this patient about his or her self-defeating behav- ior. It is important to realize that the patient’s goal is to always be connected to the doctor. They are terrified that if they get better, that they will lose that relationship with the physician.
A good strategy for the physician is to share the help-rejecting complainer’s pessimism that they cannot be “cured.” The physician could suggest treatments that may provide partial relief (but not enough that the patient will be cured, thereby provoking fear in the patient of losing the physician). The physician has to guard against trying to “turf” the patient to another
physician, so he or she will be someone else’s headache, as tempting as it might be to do so; in any event, the patient would likely refuse to see another doctor. It is also important to note that consultation with a psychiatrist can be helpful in this situation, but not as a replacement for the primary physician; psychiatric care must be presented as an adjunctive treatment.
竜巻と精神病
2012年ゴールデンウィークの最後の日、
NHK夜7時のニュース、トップは茨城県の竜巻
温暖化、亜熱帯化、竜巻、土砂降りあるいはスコール、
気候風土が変化してくると
精神病の表れ方も変化してくるとよく言われる
しかしそうだとして、精神病でも特に治療が問題になることもなく
一生を過ごす人もいるのだろう
精神病またはより包括的に病気とはなんだろうかと
思う
栃木ではひょうが降って
屋根の瓦が割れて落ちた
木々がなぎ倒された
おおむね、メランコリーは少なくなり、
躁病と双極性障害が増えるだろうと言われている
ーーーーー
一方で情報機器の発達により、
対人関係の質が変化するだろうと言われている
自分本位が進行する
ディメンショナル・モデルとカテゴリー・モデル
ディメンショナル・モデルとカテゴリー・モデル
| カテゴリー・モデル | ||||
| 1.神経症傾向/消極的感情/感情不統制 | 不安ー服従 | 神経病質 | 受動的、依存的 | 依存性、回避性 クラスターC |
| 2.外向性/積極的感情 | 精神病質(psychopathic) | 不愉快な性質、内向/外向 | 社会病質 | 反社会性、境界性、自己愛性、演技性 クラスターB |
| 3.非社会性/敵対心 | 社会的引きこもり | 精神病質傾向(psychoticism) | スキゾイド | スキゾイド、スキゾタイパル、妄想性 クラスターA |
| 4.抑制的/強迫的/良心的 | 強迫的 | 勤勉 | 強迫的 | 強迫性 クラスターC |
内向外向は2.外向性/積極的感情とあるのでここ
2.はネガティブな表現を回避したのだと思う
かつてのマイク・タイソンも外向的で積極的な人だったんでしょう
感情不統制は反社会性、境界性などが問題になるもので、神経症傾向と一緒にしていいものか疑問もある。むしろ2.に入る感じはするけれども。
まあディメンショナル・モデルということで、カテゴリー・モデルとはちょっと違うほうが本来だし18あったものを4つにまとめたというので、実用上はこれでいいでしょう、というものと書いてあるので、そう考えると、1.は1.でそれなりに分かる感じはする。
細かくしても利益は少ないということなんでしょう
1.は診察室でグズグズ言う、自信がなくて依存的
2.は迷惑な奴
3.はひきこもりで妄想性なやつ
4.は1.ときちんと分けられるかどうか怪しい感じがする。強迫の裏には不安があるわけだから。
ーーーーー
“アイゼンクによる人格体系 (H. J. Eysenck, 1981;H. J. Eysenck & S. B. G. Eysenck, 1976; H. J. Eysenck & M. W.Eysenck, 1985) において, サイコティシズム （ 精神病質傾向、Psychoticism ） は、外向性（ Extraversion ）、神経症傾向 （ Neuroticism ） に直交する第三の人格次元を構成する。それは、「サイコパシー」 （ 即ち、反社会的行動 ） と共に、精神病 （ 主に統合失調症と双極性障害 ）への傾向性の連続体として概念化され、「精神病への前段階」として定義される (H. J. Eysenck & S. B. G. Eysenck, 1976, p.203) 。したがって、H. J. Eysenck & S. B. G. Eysenck (1976) によれば、一つのサイコティシズムの人格次元が、正常者をサイコパス （ サイコティシズムにおける中間 ）から、また、統合失調症患者、双極性障害者 （ サイコティシズムにおける極 ）から区別していると考えられている。”
●“③ 精神病質傾向 （Psychoticism）
辻（1998）によると，精神病質傾向は，敵対的，被害念慮がある，社会的規範意識や道徳性が低くい，日常的な常識を無視するといったように脱抑制的な傾向である。精神病質傾向が高いと精神病や精神病質が疑われる。この精神病質傾向は外向性と神経症傾向ほどしっかりと定義されておらず，概念にあいまいさを残すものである。例えば，外向性の中には衝動性という特性が含まれるが，精神病質傾向にも衝動性が含まれることもあり，概念間に重複が見られる。また，その生理学的な基盤も外向性，神経症傾向にくらべてはっきりしない。このように，精神病質 (引用者注) は，操作的定義が不十分なため批判も多く，あまり研究がすすんでいない次元である。”
●“サイコティシズム定義
彼のサイコティシズムの描写によれば、人は精神病患者に共通して見られる特性を示すことがよくあり、特定の環境におかれれば、より精神病になりやすくなる可能性があるという。そのような精神病的傾向性の例は、向こう見ず、常識に対する軽視、不適切な感情表現などであるが、これらはほんの一部である (Boeree, 1998)。Heath と Martin (1990)によって述べられたように、‘それは、「サイコパシー」（ 即ち、反社会的行動 ） と共に、精神病（ 主に統合失調症と双極性障害 ）への傾向性の連続体として概念化され、「精神病への前段階」 として定義される’ (p. 111)。サイコティシズム尺度はまた、その他の敵対心、強情さの尺度と、文化的規範の非受容、未熟さ、反権威主義的態度などの特性と著しく関連性があることが知られている。サイコパスや犯罪者の間でもサイコティシズムのスコアが比較的高いことが報告されている (Howarth, 1986)。これは、サイコティシズム尺度として描写されたアイゼンクのアイデアを強固なものにする。”
ーーーーー
“アイゼンクによる人格体系 (H. J. Eysenck, 1981;H. J. Eysenck & S. B. G. Eysenck, 1976; H. J. Eysenck & M. W.Eysenck, 1985) において, サイコティシズム （ 精神病質傾向、Psychoticism ） は、外向性（ Extraversion ）、神経症傾向 （ Neuroticism ） に直交する第三の人格次元を構成する。それは、「サイコパシー」 （ 即ち、反社会的行動 ） と共に、精神病 （ 主に統合失調症と双極性障害 ）への傾向性の連続体として概念化され、「精神病への前段階」として定義される (H. J. Eysenck & S. B. G. Eysenck, 1976, p.203) 。したがって、H. J. Eysenck & S. B. G. Eysenck (1976) によれば、一つのサイコティシズムの人格次元が、正常者をサイコパス （ サイコティシズムにおける中間 ）から、また、統合失調症患者、双極性障害者 （ サイコティシズムにおける極 ）から区別していると考えられている。”
●“③ 精神病質傾向 （Psychoticism）
辻（1998）によると，精神病質傾向は，敵対的，被害念慮がある，社会的規範意識や道徳性が低くい，日常的な常識を無視するといったように脱抑制的な傾向である。精神病質傾向が高いと精神病や精神病質が疑われる。この精神病質傾向は外向性と神経症傾向ほどしっかりと定義されておらず，概念にあいまいさを残すものである。例えば，外向性の中には衝動性という特性が含まれるが，精神病質傾向にも衝動性が含まれることもあり，概念間に重複が見られる。また，その生理学的な基盤も外向性，神経症傾向にくらべてはっきりしない。このように，精神病質 (引用者注) は，操作的定義が不十分なため批判も多く，あまり研究がすすんでいない次元である。”
●“サイコティシズム定義
彼のサイコティシズムの描写によれば、人は精神病患者に共通して見られる特性を示すことがよくあり、特定の環境におかれれば、より精神病になりやすくなる可能性があるという。そのような精神病的傾向性の例は、向こう見ず、常識に対する軽視、不適切な感情表現などであるが、これらはほんの一部である (Boeree, 1998)。Heath と Martin (1990)によって述べられたように、‘それは、「サイコパシー」（ 即ち、反社会的行動 ） と共に、精神病（ 主に統合失調症と双極性障害 ）への傾向性の連続体として概念化され、「精神病への前段階」 として定義される’ (p. 111)。サイコティシズム尺度はまた、その他の敵対心、強情さの尺度と、文化的規範の非受容、未熟さ、反権威主義的態度などの特性と著しく関連性があることが知られている。サイコパスや犯罪者の間でもサイコティシズムのスコアが比較的高いことが報告されている (Howarth, 1986)。これは、サイコティシズム尺度として描写されたアイゼンクのアイデアを強固なものにする。”
いくつかのパーソナリティ障害
パーソナリティ障害は孤発的であることは珍しい気がする
たいていはいくつか重複してパーソナリティ障害を抱えているように思う
統計の話ではなく印象として
それは多分、潮位と海の岩の関係で、人格水準が低下すれば、
いろいろな岩が出現してしまう
人格水準が良好に保たれれば、消えてしまうことも多いように感じる。
DEVELOPMENTAL STAGES
Overview of Development
Whoever touches the life of the child touches the most sensitive point of a whole which has roots in the most distant past and climbs toward the infinite future.
-----Maria Montessori
DEVELOPMENTAL STAGES
What development is not is consistent and unalterable. The normal range of development is broad, and one stage does not neatly finish before the next can begin. However, recalling these stages is much more useful than merely studying for Board examinations. It keeps in mind the need to think developmentally, to consider the areas of development in which a child is doing well, and the areas in which he or she needs intervention. Although seeing hundreds of children (both typical and impaired) is the best Way to begin to differentiate normal variations in temperament and fantasy from more concerning symptoms of psychiatric disorder, the tried and true developmental models, particularly that of Erikson, may be useful for the ongoing assessment of a child’s ability to meet and master the developmental at each age. Each time I assess a child or adolescent, 1 review in my own mind the developmental tasks for the age, and how the child is faring with respect to these. For children and adolescents, treatment is not merely focused on a specific diagnostic disorder, but on providing interventions that address areas of developmental concern, and helping the child gain the skills and support needed to get on a healthier developmental trajectory
A basic understanding of human development is fundamental to the psychiatric evaluation in general and most essential in the assessment of children and adolescents. An appreciation for the wide variability among children in terms of development will assist in identifying and targeting areas of developmental concern while minimizing the risk of overdiagnosis and overpathologizing. Normal reactions of one developmental period (such as stranger anxiety in a 1-year old) when it occurs in another stage (such as similar severe fears in a 5-year-old) may suggest a disorder.
KEY POINT
I would like to emphasize at the very beginning of the book what I consider to be a key aspect of all of child and adolescent psychiatry which is frequently given short shrift. A thorough evaluation and treatment plan for a child, adolescent, or family needs to highlight areas of strength and resilience, not merely pathology. In child and adolescent psychiatry, many of the children we see have suffered severe psychosocial adversity, family chaos, abuse or neglect, have unsafe behaviors, and meet DSM-IV criteria for multiple disorders. In this context, sorting out the risk factors and pathology may dominate the therapeutic encounter. However, it is the assessment and appreciation of strengths that may most meaningfully build a therapeutic alliance, may provide our most accurate prognostic indicators, and may be the most useful method of choosing appropriate treatment modalities. l have found in each child or adolescent l assess or treat a unique inner “spark"--that part of her or him that is the healthiest, has the most hope, and is most amenable to treatment. Finding that “spark" within the patient may provide insights far beyond those gleaned from diagnosing the disorder.
Child and adolescent psychiatrists are, typically, first adult psychiatrists. It is thus easy to assume that children are just “miniature adults.” A frequent error is in the supposition that our evaluations, diagnoses, and treatment plans can merely be “downsized” for the child or adolescent. In fact, the chronological unfolding of progressive capabilities and processes from infancy onward must be appreciated to understand and treat the patient as a whole. Treatments are different for individuals at different stages of development.
Theories of development have encompassed entire textbooks, so I will distill out the concepts that I believe are most essential in assessing children and adolescents who are referred for emotional or behavioral developmental theorists discussed will be Sigmund Freud (psychosexual stages), Erik Erikson (psychosocial stages), and Jean Piaget (cognitive stages). Additionally, some highlights of each of the developmental periods of childhood and adolescence will be mentioned, as well as risk factors for each stage. Table 1.1 compares the three developmental theorists.
PRENATAL DEVELOPMENT
Each person has 23 double helix strands-of the genetic code for all physical characteristics and organ capacities in the body. Traits such as temperament and activity level also have a genetic basis. Although some genes have strong penetrance and express themselves in virtually all environments (such as eye color), much of development is the product of complex gene-environment interactions. Family history of development may give an indication of the genetic makeup and potential vulnerabilities of the fetus. Understanding the nurturing environment assists in gaining an appreciation for the unfolding of the genetic potential in a given individual.
The second trimester of gestation is when neurological and brain development occurs most rapidly. Thus, insults during this time may result in obvious or more subtle functional deficits for the baby. The clinician should inquire about the prenatal period. Exposure to substances (alcohol, substances of abuse, or medications), trauma, or severe stress during pregnancy may be significant to-the developing fetus and be 21 source of vulnerability when the baby is born.
INFANCY (BIRTH TO 1 YEAR)
Sigmund Freud characterized in infancy as the Oral Stage of development, during which time the mouth and eating were of dominant importance. This stage is marked by extreme dependency, urgency of needs, low frustration tolerance, and no consideration of others. Erik Erikson, in his psychosocial stages of development, postulated the normative crisis of infancy as that of Basic Trust vs. Mistrust. The capacity for basic trust is achieved when the infant [eels safe and Well cared for by his or her caregivers. Infants gain a sense of security by having their physical needs cared for in a sensitive manner, according to john Bowlby. This caring and mutual bonding is the key to secure attachment.
Temperament is a person’s inborn characteristic behavioral style. During infancy and the preschool years, temperament has moderate to high stability. Chess and Thomas have defined the dimensions of temperament. A temperamentally difficult child tends to demonstrate disrupted rhythmicity (irregularity of sleep cycles, feeding, and arousal states), social withdrawal, poor adaptability to change, intense emotional reactions, and negative mood. Goodness of fit describes a match between the parental expectations of the child and the child’s temperament and innate capabilities. It is the mismatch that may predispose a child to (although not necessarily cause) behavioral or emotional problems. It is important to assess any mismatch between temperament and parental expectations, as early intervention may help reconcile the mismatch to improve developmental outcomes. All relationships entail interactions, and it is the reciprocal interactions between parent and child that determine the nature of the attachment process.
The infancy period is a time of rapid loss of cortical neurons, called pruning. An infant is born with a full complement of neurons, but they are not well interconnected. The pruning process allows for more specific interconnections to improve the efficiency of the nervous system—somewhat analogous to trying to get through a forest, which is slow and inefficient until a road is built by cutting down trees to make a well-organized path to the goal. Optimal stimulation (talking to the baby, looking at the baby, caring for the baby, and protecting the baby from extremes of neglect or chaos) can improve the efficiency of pruning, and thus assist in the developmental process. We now know that optimal stimulation during the early years of life is essential to optimal cortical efficiency. The brain is approximately one-third of its adult size at birth, and it grows rapidly, reaching 60% by approximately 1 year.
カスピ海ヨーグルトの表面張力
カスピ海ヨーグルトの表面張力
指で触ってもくっつかないほど表面張力が強い
という言い方も確かにできて
表面を指でタップしていると
最初は少しくっついても
だんだんくっつかなくなる
納豆もうまくやるとこんなふうになる
Surface tension is strong enough not to touch with a finger stick
これならお腹の中を掃除してくれそうです
よかった！
指で触ってもくっつかないほど表面張力が強い
という言い方も確かにできて
表面を指でタップしていると
最初は少しくっついても
だんだんくっつかなくなる
納豆もうまくやるとこんなふうになる
Surface tension is strong enough not to touch with a finger stick
これならお腹の中を掃除してくれそうです
よかった！
