A Two-Year-Old Goes to Hospital两岁小孩去医院
作者: 陈明 翻译 / 9179次阅读 时间: 2016年9月08日
标签: Bowlby BOWLBY bowlby 依恋

 A Two-Year-Old Goes to Hospital两岁小孩去医院心理学空间 R4M)m8f"F#eq
A Film Shown By JOHN BOWLBY, M.D., and JAMES ROBERTSON心理学空间c2GG3b6\7C|k
Tavistock Clinic心理学空间CXS`\x)rT
[November 28, 1952]
UXdAbx?0Proceedings of the Royal Society of Medicine Vol. 46 Section of Paediatrics心理学空间wHd(N0Ie~c

&s5]l4~[3](v0UY0Dr. John Bowlby:The theme of this film is a very commonplace one-simply the story of a child of 2 years who spends eight days in hospital for a minor operation and who frets a good deal of this time. It may be asked why bother to make and show a film of something so commonplace?

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T6r(w@8m6`@0Dr. John Bowlby:这部电影的主题是一个很平常的简单故事,两岁的小孩一个在医院接受小手术,在这8天的大多数时间里都烦躁不安。人们可能要问,为什么拍摄并展示一部如此普通的电影?心理学空间yQN7i,S,?m*N%Tz

r9p3vW'm2T0The reason is that we believe that fretting should no longer be looked upon as an unavoidable inconvenience but as something of serious importance and worthy of scientific study. There is now evidence that prolonged periods of maternal deprivation in very young children can, in some cases, give rise to extremely serious psychiatric disturbances. There has been a succession of papers and monographs on this subject during the last fifteen years and two years ago WHO published a review of this evidence (Bowlby, 1951). Furthermore, it is becoming fairly well known that the majority of children under 4 years old who have spent only a brief period in hospital, or otherwise away from their mothers, show emotional upsets of shorter or longer duration.心理学空间V4tf2N%Jx


原因是,我们认为,仍旧将烦躁不安视为是一个不可避免的麻烦,这是不应该,而应将其视为一件严肃的事情,值得科学的研究。现在有证据表明,在某些情况下,长期剥夺非常年幼孩子的 母爱,会引起非常严重的精神障碍。关于这个问题,在过去的十五年间,以及两年前WHO出版的关于这一证据的回顾之中,已经有了一系列的论文和专著。此外,众所周知,大多数4岁以下的儿童在医院度过一个短暂的时光、或以其他的方式远离他们母亲, 会或长或短的表现出情绪的不安。心理学空间-C2VvX*|/w6u6w^

W Dlv#G+t1AQ0B0Since the existence of the problem is no longer in doubt, the Research Team investigating it at the Tavistock Clinic is concentrating its attention on the psychological processes which lead to these adverse effects. We are giving special attention to the emotional responses of very young children during the first days and weeks following separation from their mothers. After a number of semisystematic studies we decided eighteen months ago to attempt as full a coverage as possible of one child throughout her stay in hospital. It was during this pilot study that this film was made.

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由于这个问题的存在是不容质疑的,塔维斯托克诊所的这个研究团队的调查所关注的是导致这些不良反应的心理过程。在一年半之前,我们决定尽可能的涵盖一个孩子在她院期间的整个过程。正 是在此期间拍摄了这部电影。心理学空间 Z3@[ZeE_-j

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It is because we believe it permits of an objective examination of what actually happens when a young child has this experience that we think it may be of value in furthering our understanding of fretting and the emotional disturbances to which it can lead. We believe that it is only on the basis of this knowledge that improved methods of care can be developed.心理学空间Ak@7SIx1k

haE4vmn*P s0这是因为我们相信当一个小孩子有这样的经历的时候,是允许客观检查到底真的发生了什么,对于孩子的这一经历,我们认为,在促进我们理解导致其烦躁和情感不安的事情而言,这可能是有价值的。我们相信,基于这一知识基础,这是唯一可以扩展改进护理的方法。心理学空间0L'V%xR+K)}/j6w

REFERENCE 参考文献心理学空间'kq;g;[F

BOWLBY, E. J. M. (1951) Maternal Care and Mental Health. WHO Mono. Ser. No. 2. Geneva.


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*l1b,]1JA+g-R d hUL0Mr. James Robertson:There are special difficulties in the way of getting objective data on the meaning of separation to children under 4. They can tell little in words, so that understanding has to be sought largely through interpreting their behaviour. As fieldworker I discovered that there were often limits to the agreement to be had in discussion with nurses and paediatricians not only about the meaning of behaviour in certain young patients but also about the actual facts of that behaviour.

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$J&`i#`4M2R7k0Mr. James Robertson:对于获取4岁以下儿童分离意义的客观的资料而言,是非常困难的。他们只能说很少的词,因此,在很大程度上,必须通过他们行为的解释来理解之。作为实地考察工作者,我发现在与护士的讨论的一致性经常是有限的,而且儿科医生对于某些小患者的行为的意义,以及这些行为的真实事实也是有限制的。


BUv;FI3`*O UmB0There was a gap in observation and interpretation which could not be bridged. It seemed that emotional factors in the pediatricians, nurses, and myself were suspect. I was thought at times to be diminished in my objectivity by becoming over-identified with the children; I in turn considered that a contrary phenomenon tended to occur in hospital staffs, namely that defences had built up in them against the painful recognition of the extent to which young patients are unhappy-not only in the initial phase of overt fretting but in later, stages of being "settled in".

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3d9zB o7Oc?0在观察和解释之间有一个不能弥合的差距。似乎儿科医生、护士以及我自己都怀疑这些情感因素。我认为,有时过度的认同于孩子们,会减少了我的客观性。相反,我认为一个相反的现象往往发生在医院的员工之中,也就是说,他们已经树立了防御,以便在某种程度上抵御对于小患者不开心的认识——不仅在最初的明显烦躁阶段,而且 也出现在随后被“安置好”的阶段。心理学空间lvg F9^pnM

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In the film I have tried to provide a record which will be accepted as objective, and which has the merit that the behaviour can be viewed as often as desired in discussion between interested groups. Thus I hope our mutual interest in discovering what is true will be advanced. Objectivity was sought by several devices. A schedule of filming was agreed beforehand with the ward staff; it consists of documentary record of main events such as admission, anesthetic, parents' visits-and a daily "time sample" covering the same period and at intervals determined by a clock which is seen in the film.

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The child was selected at random by a hospital clerk from the list of those awaiting operation for umbilical hemia. Filming was done by myself with a hand camera in natural lighting. There was no other apparatus to disturb the ward and the child was not segregated. The only departure from routine was that a nurse was detailed to play with the child during the daily time sample.心理学空间-}/fp%I&FRql

R(@ o lpKs0在这部影片中,我试图提供一个客观的、可以被接受的记录,其好处是,这个记录中的行为可以每次在兴趣小组讨论中的需求中被看见。因此,我希望在发现什么是真实的时候,我们的彼此的兴趣会看的更远。 影片的客观性是通过几台设备来探索的。预先商定的拍摄计划事先获得了病房成员的同意;它包括主要事件的记录,如准入院,麻醉,家长的探访,并且涵盖了每天相同时间的“时间抽样”,而且,在电影中可以看到的一个确定的时钟间隔。心理学空间F|+mVL6|i@m,@

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Laura is 2 years 5 months old, a first child and so far an only one. She is intelligent, mature, and has unusual control over the expression of feeling. She rarely cries. She is about to go into hospital for eight days to have a minor operation for umbilical hernia.

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Although her parents had tried to prepare her for going into hospital, when she meets the admitting nurse she is cheerful and friendly and clearly does not realize that her mother will leave her. Going through the ward she seems less confident, and when she is undressed to be bathed she screams for her 'Mummy. Within ten minutes, however, her unusual control over feeling asserts itself and she is apparently calm.


虽然她的父母曾试图准备让她住院,当她遇到助理护士时,她即高兴又友善,显然没有意识到她的母亲会离开她。经过病房的时候,她似乎不太自信,在她脱了衣服去洗澡的时候,她大声尖叫 ,喊着妈妈。然而,在十分钟内,她异乎寻常的自我控制着自己的感受,并且显然是平静的。心理学空间3tLf]+TGO

'u RKn"_Av\0She is put in a cot and breaks down again when nurse takes her temperature "Don't like it. I want my Mummy". A few minutes later her mother comes to say good-bye, and leaves for her consolation a piece of blanket she has had since infancy and which she calls her "baby". Throughout her stay this "blanket baby" and her Teddy make a link with home and are clung to when she is sad or frightened.心理学空间sy ~(N#mWx^


她被放在床上,同时,当护士来测量她的体温时再次崩溃“不喜欢这个,我要我的妈妈。”几分钟后,她母亲来和她说再见,同时,为她留下了一块她从婴儿期就开称其为“宝宝”的安慰毯子。 在她和这块毯子以及泰迪熊相处的期间,和家庭有了一个联系,而且,当她悲伤或害怕的时候,她会紧紧抱着它们。心理学空间r ~B5}~5A v$o M

N!a&MXc0O(c!@0When alone she appears calm, but if a kindly person stops to talk with her her feelings appear. Sister comes to greet the new patient and Laura's face crumples "I want my Mummy". This occurred throughout her stay: and the camera shows that what may easily be taken for calmness is often a facade which contact with a friendly person breaks down.

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p0ir&U7|;]7M@)Si0当她独自一人之时,她显得很平静。但如果一个好心的人停下来和她说话,她的情绪出现了。妹妹来迎接新的病人,劳拉板着脸“我要妈妈”。这发生在她呆着的时候,而且镜头显示 ,容易被拍摄的平静画面往往是一个假象,这与同友善的人接触时的崩溃形成了对比。


When the surgeon comes she clutches her Teddy and blanket "baby" for comfort, and despite his tact she is apprehensive and resistive. Occasionally during the day she asks quietly for her Mummy, but without insistence.

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*f ^t Lc0当外科医生过来的时候,她抓住他的泰迪熊和“宝宝”毯子以求安慰,而且,不顾于他的圆滑,她显得担心和抵抗。在白天,她偶尔安静的要她妈妈,但没有坚持。心理学空间2Y'h%L^)Ud"Cw

H)r7Z)d8S8@E:p0On the second day she looks strained and sad, and has difficulty in responding to the nurse who comes to play with her. Then her feelings appear and she cries a little for her Mummy. But though she cries little throughout her stay she takes great interest in the children who cry-as if they cry for her who is too controlled to cry. The rectal anesthetic is kindly administered, but the strange experience frightens her. Thirty minutes after recovery from the anesthetic her parents visit. She is very distressed-"I want to go homes'-tries to get to her mother but has to be restrained because of the stitches, and rolls about on her pillow crying. As her parents leave she is subdued and seems perplexed. She waves slightly in response to their cheerful going.心理学空间mE3Tu Hr

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第二天,她看起来紧张而又悲伤,而且对于和她来玩的护士有反应上的困难。然后她的情绪出现了,她为了她的妈妈哭了一会儿。然而,然而,尽管她在护士逗留中哭得很少,但她对那些哭泣的孩子们非常感兴趣,就好象 ,她们为了过度控制哭泣的她而哭泣。她无伤痛的做了直肠麻醉,但是奇怪的感受吓到了她。从麻醉中恢复三十分钟后,她的父母来了。她非常的痛苦——“我要回家”——试图抓住他的妈妈,但是因为身上有针,不得不控制住, 同时卷在她的枕头里哭着。当她的父母离开她时,她节制、并显得不知所措。她轻轻的挥手以回应他们愉快的离开。


cq/l"O2h#|t2k N0On the third day she is seen quietly clutching her Teddy and blanket baby, not crying or demanding attention and likely to seem "settled" to busy ward staff. But when a nurse comes to play with her she is at first withdrawn, then in contact with the friendly person her feelings break through again and she cries bitterly for her Mummy. When the nurse leaves her control gradually reasserts itself. This cycle of withdrawal, breakdown, and resumed control is repeated shortly afterwards when the nurse again plays with her. In the afternoon her mother visits, but although Laura has been sitting up all morning and has wanted her mother she makes no attempt to get to her. Mother would like to take her in her arms but is deterred from doing so by what she believes to be hospital regulations. Ten minutes later a nurse sits her up, but it is fifteen minutes before Laura thaws out towards her mother. Then she becomes increasingly animated and friendly, and is transformed by a radiant smile seen for the first time in three days. When her mother says she has to leave Laura is immediately anxious, and as her mother leaves she turns her head away. She does not cry, but shows her feeling clearly by the change in her face and the restless movement of her hands. Although it is the middle of the afternoon she asks to be tucked down with all her personal possessions tucked around her and forbids the nurse to remove the chair on which her mother had been sitting.心理学空间e0o0@M%k{*N+Fw

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第三天,她安静地抓着泰迪和毯子宝宝,不哭也不要求关注,而且似乎被繁忙的病房工作人员“安置好了”。但是,当一个护士来和她玩,她起初是退缩,然后在与友善的人接触之时,她的情绪再次爆发,并为为她妈妈而哭泣。当护士离开,她的控制逐渐恢复了。当护士再次和她玩耍,立刻又重复了退缩、崩溃并回复控制的循环。妈妈想把她抱在怀里,却不敢这样做,她认为医院规章制度是不允许这样的。十分钟后,一名护士扶她起来坐着,但是十五分钟前,劳拉从她妈妈哪儿复苏了。然后,她变得越来越活泼和 友善,并且,在这第三天里,第一次变得看到了灿烂的微笑。当她妈妈说她必须离开,劳拉马上就焦虑不安,而且,她妈妈离开时,她把头转了过去。她没有哭,不过,她的脸上的变化 以及双手焦躁不安的举动清楚地表明了她的感觉。虽然这是下午,她却要求被把她的所有东西藏起来堆在她的身边,并禁止护士移动她母亲曾经坐着的椅子。

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On the fourth dav the record is brief and featureless. She is not visited.心理学空间DLje8hE:A Xb

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On the fifth day her mother visits in the afternoon, and again there is a period of withdrawal before she warms up to her mother. She asks to go on mother's lap, but when mother says she cannot she does not ask again. When her mother has to go Laura is pained, cries a little, then quietly recovers and sits with pursed lips.

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.xW I5V } Fy$~"bQ O3\E0On the sixth day a new child is admitted who cries a lot, Laura, very controlled herself, watches him with a tense face. (When she got up she went to him and said "You're crying because you want your Mummy. Don't cry. She'll come to-morrow.")心理学空间#d'vrv}|'vQ`7[


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#B,U ?l-a)j#L%u0On the sevenith day both parents visit and Laura is up for the occasion. Although she knows chairs are being set out for them she shows no excitement, and when her mother comes she makes no attempt to go to her. She remains subdued. When Daddy comes from the office ten minutes later he gets a warmer welcome. Daddy leaves first and his going is apparently almost ignored. She asked to go with him but does not insist. When her mother leaves, Laura apparently ignores her going.


3P[*b-w| b UDgN2Y0第七天爸爸妈妈都来看她,而且劳拉期待这一场景。虽然她知道椅子是为他们而设置的,她没有表现出兴奋,当她的母亲来时,她没有尝试去接近她。她仍然很节制。当爸爸十分钟后从办公室里过来的时候,他受到了热烈的欢迎。爸爸先离开,显然,他的离去几乎被忽略了。她要求和他一起去,但没有坚持。当她妈妈离开的时候,劳拉显然是假装没有看见她离去。心理学空间o"F0KY4oX-a X CE0Q


On the eighth morning she is shaken by sobs. Her mother had told her the previous evening that she would be going home to-day and her control has given way. When her mother comes Laura remains cautious, however, and not until her outdoor shoes are produced does she accept that she is going home. She insists on taking all her possessions home with her, even a tattered old book she refused to leave behind. When she dropped that book on the way out and a nurse picked it up, she screamed in temper and snatched it away-the fiercest feeling shown during her whole stay. On the way out she is seen walking apart from her mother.心理学空间}6m;Acv nHU


在第八天的早晨,她因为抽泣而颤抖。在前一天晚上,她妈妈告诉她,她将会在今天回家,同时她的自控已经不见了。然而,当她母亲来的时候,劳拉仍然保持谨慎,直到摆好了她的户外鞋,她才相信她准备回家了。她坚持要把她所有的东西都带回家,甚至一本破旧的书都不愿意留下。当她在离开的时候,这本书 掉了下来,当护士捡起来的时候,她发脾气的尖叫并且抢了回去——这是她在医院里的最强烈的情绪。有人看见她和妈妈在出去的路上是分开走的。心理学空间oj,E `:^:vM H'ig

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Dr. D. W. Winnicott(President of the Section) welcomed the film as a highly successful first effort. Here, as he saw it, was a normal child. She came into hospital and gradually became affected as a normal child must. She was fortunately spared that phase of false recovery to which the child reaches if the break from the home lasts too long, and which may make the child cling to the nurse in fear when at last the mother or father comes to take the child home.


Dr. D. W. Winnicott(期刊儿科学主席) 欢迎这部非常成功的出世电影之作。在此,正如其所见,是一个正常的孩子。她住进了医院,并且就像一个正常孩子所不可避免的,逐渐变得做作。在此期间,她幸免于错误的康复,如果这个孩子所触及的与家人分离的这个阶段太过长久的话,这可能会让这个孩子在父亲或母亲最终带孩子回家时,在担惊受怕中依附于护士。心理学空间xx2e\8j_;R


The main comment Dr. Winnicott wished to make was that from long experience he could say that this film was definitely about a real problem. The effect of separation of small children from their mothers was so often serious, even producing irreversible changes, that every time when a child is to be taken into hospital there ought to be a careful weighing up of the value on the physical side against the danger on the psychiatric side. This principle is not vitiated by the undoubted fact that in certain circumstances certain children (not young ones) derive benefit and even enrichment from a stay in hospital-perhaps because of the relief that this affords on account of a parent's anxiety state or depression mood.

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L F5[8RnLj$p0温尼科特医生希望做的主要评论是,从长期的经验而言,他可以说,毫无疑问,这部电影是一个真切的问题。小婴孩和她母亲分离的影响是如此寻常的严重,甚至产生了不可逆的变化,当一个孩子每次被带进医院的时候,和身体方面的危险一样,应该对精神方面的危险也应该仔细权衡。这个原则不会被以下毋庸置疑的事实所损害,在某些情况下,某些的儿童(而不是小孩子)会从中受益,甚至在住院期间会更充实,因为这提供了关于家长焦虑状态或抑郁情绪的慰藉。

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It is interesting that the child who feels ill seems to be less harassed by being taken into hospital than the child who feels well, but who is considered to need something done. A verbal explanation given to a young child, whatever is said, is of no value as compared with the child's own feeling that help is needed. On feeling better, however, the child begins to have an urgent need to go home.心理学空间n'[[U:e7M


有趣的是,被送进医院感觉不适的孩子似乎比感觉良好的孩子显得不那么疲惫焦虑,但是他们被认为是需要一些帮助的。对于一个年幼的孩子的口头解释,无论是说什么,都是没有价值的,因为与孩子自己的感觉相比,帮助是必要的。然而, 那,感觉更好的,却是孩子开始迫切的需要回家。

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