섭식장애와 목회적 돌봄 - 자기의 결핍(deficits in the self)의 관점에서 -
Eating Disorder and A Pastoral Care For It -From the Perspective of Deficits in the Self-
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본 논문은 심리장애로서의 섭식장애의 증상들과 심리적 원인을 Heinz Kohut의 정신 역동적 관점에서 분석해 보고 그 치료와 목회적 돌봄에 대하여 고찰한다. 코헛은 섭식장애를 자기애성 행동장애의 하나로 분류하였다. 특별히 코헛은 중독을 보는 것과 같은 관점으로부터 중독적 행동의 범주 안에서 섭식장애를 논하고 있는데, 이러한 중독적 행동은 자기의 구조적 결핍에서 기인한다고 보고 있다. 즉 자기애성 행동장애로서의 섭식장애는 자기대상으로 기능하는 부모의 심각한 공감적 실패로 인해 자기의 자기애적 발달과정을 통한 자기 구조의 내면화 과정에 어떤 결핍이 생겼을 경우 결과하는 것이다. 따라서 섭식장애 증상들은 자기의 구조적 결핍을 채워보려는 필사적인 노력을 나타내고 있는 것이라 할 수 있다. 자기심리학의 이론의 틀 안에서 자기애성 행동장애로서의 섭식장애를 치유하고 돌볼 수 있는 가장 근본적인 방법은 바로 자기의 구조적 결핍을 메울 수 있도록 돕는 것이며, 그것은 섭식장애자들이 가지는 거울 자기대상욕구와 이상화 자기대상욕구 혹은 쌍둥이 자기대상욕구에 공감적으로 응답하여 자신들의 자존감을 회복하고 스스로 긴장을 잘 조절할 수 있는 능력을 회복하도록 돕는 것이다. 이는 바로 그들의 건강한 자기구조가 새롭게 다시 구축되도록 돕는 것이 된다. 따라서 섭식장애에 대한 기독교 공동체의 돌봄의 역시 섭식장애의 외적 증상들 자체에 대한 변화 보다는 자기구조를 튼튼히 다시 세울 수 있는 심리내적 기능과 힘이 생기는 것에 초점을 두는 것이 중요하다.
Abstract
The present paper examines the symptoms and causes of Eating Disorder as one major form of self pathology and explores its treatment and ways for a pastoral care for it from a self-psychological perspective. Heinz Kohut takes "addictive behavior" as a major symptom of narcissistic behavior disorders and puts the eating disorder into the category of narcissistic behavior disorders relating to the addictions. Eating Disorder as one of the narcissistic behavior disorders results from the deficits of self structure in the narcissistic development of the self, which occur due to serious empathetic failure of the selfobjects. Parents' empathic failure prevents the internalization of certain soothing and tension-regulating structures, and the resulting structural deficits in the self becomes the childhood anlage of eating disorder. It is the primordial foundation for their attempt to fill in the structural deficits within the symptoms of anorexia and bulimia. Kohut's self psychology provides an excellent framework for understanding deficit phenomena and the explication and treatment of these defects that self psychology facilitates. The role of the therapist is to provide an opportunity for growth and healing of the self by offering her/himself as a selfobject. It is not so much to change the anorexic and bulimic person, but to accept and understand who the person is and how s/he came to be that way. This can also be selfobject functions, which are critical to a pastoral care for the development of the total self.
참고문헌 (32)
- 김청송, "정신장애 사례연구: DSM-IV를 중심으로" (2002), 학지사
- 홍이화, "자기애성 성격장애와 그 목회상담적 함축 - 자기심리학(self psychology)의 관점을 중심으로 -", 신학과 실천, 23(23), pp.341~370 (2010), 한국실천신학회
- Siegel, "거식증과 폭식증 극복하기: 식사장애" (2003), 학지사
- Vath, Raymond E., "거식증과 대식증" (2002), 두란노
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" (2000), American Psychiatric Association
- Bruch, Hilde, "The Changing Picture of an Illness: Anorexia Nervosa. In Attachment and the Therapeutic Process", pp.205~222 (1987), International Universities Press
- Bruch,Hilde, "Anorexia Nervosa:Therapy and Theory" (1982), American Psychiatric Association
- Bruch, Hilde, "Psychotherapy in Anorexia Nervosa", International Journal of Eating Disorders, 1, pp.3~14 (1982)
- Bruch,Hilde, "The Golden Cage:The Enigma of Anorexia Nervosa" (1978), Harvard University Press
- Bruch, Hilde, "Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within" (1973), Basic Books
- Chernin, Kim, "The Hungry Self: Women, Eating, and Identity" (1985), Harper & Row
- Chernin,Kim, "The Obsession:Reflections of the Tyranny of Slenderness" (1982), Harper & Row
- Chodorow,Nancy J, "The Reproduction of Mothering:Psychoanalysis and the Sociology of Gender" (1978), University of California Press
- Gabbard, Glen O, "Psychodynamic Psychiatry in Clinical Practice" (2005), American Psychiatric Publishing
- Gehrie, Mark J, "Eating Disorders and Adaptation in Crisis: A Hypothesis, In Review of Psychiatry", pp.369~383 (1990), American Psychiatric Press
- Geist, Richard A, "Self Psychological Reflections on the Origins of Eating Disorders", Journal of American Academy of Psychoanalysis, 17, pp.5~27 (1989)
- Geist, Richard A, "Therapeutic Dilemmas in the Treatment of Anorexia Nervosa: A Self Psychological Perspective", Contemporary Psychotherapy Review, 2, pp.115~142 (1984)
- Goodsitt, Alan, "Self Psychology and the Treatment of Anorexia Nervosa, In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia", pp.55~82 (1985), The Guilford Press
- Goodsitt, Alan, "Self-Regulatory Disturbances in Eating Disorders", International Journal of Eating Disorders, 2, pp.51~60 (1983)
- Gull, W. W, "The Address in Medicine: Delivered before the Annual Meeting of the British Medical Association at Oxford", Lancet, 2, pp.171~176 (1868)
- Kohut, Heinz, "Addictive Need for an Admiring Other in Regulation of Self-Esteem, In The Kohut Seminars on Self Psychology and Psychotherapy with Adolescents and Young Adults", pp.113~132 (1987), W. W. Norton & Company
- Kohut, Heinz, "How Does Analysis Cure?" (1984), The University of Chicago Press
- Kohut, Heinz, "Preface to Der falsche Weg zum Selbst, Studien zur Drogenkarriere by Jürgen vom Scheidt(1976), In The Search for the Self. vol. 2", pp.845~850 (1976), International Universities Press
- Kohut,Heinz, "The Restoration of the Self" (1977), International Universities Press
- Kohut,Heinz, "The Analysis of the Self" (1971), International Universities Press
- Kohut, Heinz, "The Disorders of the Self and Their Treatment: An Outline(1978), In The Search of for the Self. vol. 3", pp.359~385 (1990), International Universities Press
- Miller,Jean Baker, "Toward a New Psychology of Women" (1976), Beacon Press
- Minuchin, S, "Psychosomatic Families: Anorexia Nervosa in Context" (1978), Harvard University Press
- Morton,Richard, "Phthisiologia:Or A Treatise of Consumptions", Smith and Walford
- Orbach, Susie, "Accepting the Symptom: A Feminist Psychoanalytic Treatment of Anorexia Nervosa, In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia", pp.83~104 (1985), The Guilford Press
- Orbach,Susie, "Fat Is a Feminist Issue" (1978), Paddington
- Sands, Susan H, "Eating Disorders and Female Development: A Self-Psychological Perspective, In Dimensions of Self Experience. Progress in Self Psychology, vol. 5", pp.75~103 (1989), The Analytic Press